Friesgaard, Kristian Dahl; Nikolajsen, Lone; Giebner, Matthias
BACKGROUND: Management of pain in the pre-hospital setting is often inadequate. In 2011, ambulance personnel were authorized to administer intravenous fentanyl in the Central Denmark Region. The aim of this study was to evaluate the efficacy and safety of intravenous fentanyl administered...... by ambulance personnel. METHODS: Pre-hospital medical charts from 2348 adults treated with intravenous fentanyl by ambulance personnel during a 6-month period were reviewed. The primary outcome was the change in pain intensity on a numeric rating scale (NRS) from before fentanyl treatment to hospital arrival...... patients (1.3%) and hypotension observed in 71 patients (3.0%). CONCLUSION: Intravenous fentanyl caused clinically meaningful pain reduction in most patients and was safe in the hands of ambulance personnel. Many patients had moderate to severe pain at hospital arrival. As the protocol allowed higher doses...
van der Velden, Peter; Bosmans, Mark; van der Meulen, Erik
Abstract Aim To examine predictors of repeated confrontations with workplace violence among ambulance personnel, the proportion of exposure to potentially traumatic events that are aggression-related and to what extent personnel was able to prevent escalations. Although previous research assessed
van der Velden, Peter G.; Bosmans, Mark W.G.; van der Meulen, Erik
Abstract Aim To examine predictors of repeated confrontations with workplace violence among ambulance personnel, the proportion of exposure to potentially traumatic events that are aggression-related and to what extent personnel was able to prevent escalations. Although previous research assessed the prevalences among this group, little is known about predictors, to what extent PTE’s are WPV-related and their abilities to prevent escalations. Design A longitudinal study with a 6 months’ time ...
Hansen, Claus D.; Nielsen, Kent J
Background Work injuries related to lifting are the most prevalent among ambulance personnel (AP) despite the introduction of ‘assistive technologies’ (AT) that help reduce situations of manual lifting. One third of the AP report using AT only ‘sometimes’ and 10% report having lifted a patient...... alone. Aim This presentation investigates whether failure to use AT is linked to male ambulance workers’ gender identity? Is lifting patients alone a way of performing masculinity for AP’s? Method Data is taken from MARS, a panel study of AP workers in Denmark (n = 1606). Information from questionnaires...... measuring traditional male role norms (MRNI), safety attitudes and safety behavior will be linked to company register information on work injuries categorized as lifting accidents. Logistic regression is used to analyse associations between masculinity, lifting behavior, and lifting accidents. Results...
Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen
Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island.......Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island....
van der Velden, Peter G; Bosmans, Mark W G; van der Meulen, Erik
To examine predictors of repeated confrontations with workplace violence among ambulance personnel, the proportion of exposure to potentially traumatic events that are aggression-related and to what extent personnel was able to prevent escalations. Although previous research assessed the prevalences among this group, little is known about predictors, to what extent PTE's are WPV-related and their abilities to prevent escalations. A longitudinal study with a 6 months' time interval ( N = 103). At T1 demographics, workplace violence and potentially traumatic events in the past year, mental health, personality, handling of rules, coping and social organizational stressors were assessed. Confrontations with aggression were also examined at T2. Multivariate logistic regression analyses showed that only problems with superiors independently predicted repeated verbal aggression and that only the (absence of the) ability to compromise very easily predicted repeatedly being on guard and repeatedly confronted with any form of aggression. Due to very low prevalences, we could not examine predictors of repeated confrontations with physical aggression ( N = 5) and serious threat ( N = 7). A large majority reported that in most workplace violence cases they could prevent further escalations. About 2% reported a potentially traumatic event in the year before T1 that was WPV related and perceived as very stressful.
Sterud, Tom; Hem, Erlend; Lau, Bjørn; Ekeberg, Oivind
This is the first paper on suicidal ideation and attempts among ambulance personnel. This study aimed to investigate levels of suicidal ideation and suicide attempts among ambulance personnel, and to identify important correlates and the factors to which ambulance personnel attribute their serious suicidal ideation. A comprehensive nationwide questionnaire survey of 1,180 operational ambulance personnel was conducted. Measurements included: Paykel's Suicidal Feelings in the General Population questionnaire, the Hospital Anxiety and Depression scale, the Subjective Health Complaints Questionnaire, the Maslach Burnout Inventory, the Job Satisfaction Scale, the Basic Character Inventory, and the Rosenberg Self-Esteem Scale. Lifetime prevalence ranged from 28% for feelings that life was not worth living to 10.4% for seriously considered suicide and 3.1% for a suicide attempt. Serious suicidal ideation was independently associated with job-related emotional exhaustion (feelings of being overextended and depleted of resources) (OR 1.5, 95% CI 1.1-2.0) and bullying at work (OR 1.7, 95% CI 1.02-2.7), younger age, not married/cohabitant, depression symptoms, low self-esteem and the personality trait reality weakness. In general, suicidal thoughts were hardly attributable to working conditions, since only 1.8% of ambulance personnel attributed suicidal ideation to work problems alone. In conclusion, ambulance personnel reported a moderate level of suicidal ideation and suicide attempts. Although serious suicidal ideation was rarely attributed to working conditions in general, this study suggests that job-related factors like emotional exhaustion and bullying may be of importance.
Petrie, Katherine; Gayed, Aimée; Bryan, Bridget T; Deady, Mark; Madan, Ira; Savic, Anita; Wooldridge, Zoe; Counson, Isabelle; Calvo, Rafael A; Glozier, Nicholas; Harvey, Samuel B
Interventions to enhance mental health and well-being within high risk industries such as the emergency services have typically focused on individual-level factors, though there is increasing interest in the role of organisational-level interventions. The aim of this study was to examine the importance of different aspects of manager support in determining the mental health of ambulance personnel. A cross-sectional survey was completed by ambulance personnel across two Australian states (N = 1,622). Demographics, manager support and mental health measures were assessed. Hierarchical multiple linear regressions were conducted to determine the explanatory influence of the employee's perception of the priority management places upon mental health issues (manager psychosocial safety climate) and managers' observed behaviours (manager behaviour) on employee common mental disorder and well-being within ambulance personnel. Of the 1,622 participants, 123 (7.6%) were found to be suffering from a likely mental disorder. Manager psychosocial safety climate accounted for a significant amount of the variance in levels of employee common mental health disorder symptoms (13%, pManager behaviour had a lesser, but still statistically significant influence upon symptoms of common mental disorder (7% of variance, pmanagement places on mental health and managers' actual behaviour are related but distinct concepts, and each appears to impact employee mental health. While the overall variance explained by each factor was limited, the fact that each is potentially modifiable makes this finding important and highlights the significance of organisational and team-level interventions to promote employee well-being within emergency services and other high-risk occupations.
Full Text Available Interventions to enhance mental health and well-being within high risk industries such as the emergency services have typically focused on individual-level factors, though there is increasing interest in the role of organisational-level interventions. The aim of this study was to examine the importance of different aspects of manager support in determining the mental health of ambulance personnel. A cross-sectional survey was completed by ambulance personnel across two Australian states (N = 1,622. Demographics, manager support and mental health measures were assessed. Hierarchical multiple linear regressions were conducted to determine the explanatory influence of the employee's perception of the priority management places upon mental health issues (manager psychosocial safety climate and managers' observed behaviours (manager behaviour on employee common mental disorder and well-being within ambulance personnel. Of the 1,622 participants, 123 (7.6% were found to be suffering from a likely mental disorder. Manager psychosocial safety climate accounted for a significant amount of the variance in levels of employee common mental health disorder symptoms (13%, p<0.01 and well-being (13%, p<0.01. Manager behaviour had a lesser, but still statistically significant influence upon symptoms of common mental disorder (7% of variance, p<0.01 and well-being (10% of variance, p<0.05. The perceived importance management places on mental health and managers' actual behaviour are related but distinct concepts, and each appears to impact employee mental health. While the overall variance explained by each factor was limited, the fact that each is potentially modifiable makes this finding important and highlights the significance of organisational and team-level interventions to promote employee well-being within emergency services and other high-risk occupations.
Brinkrolf, Peter; Lukas, Roman; Harding, Ulf; Thies, Sebastian; Gerss, Joachim; Van Aken, Hugo; Lemke, Hans; Schniedermeier, Udo; Bohn, Andreas
High-quality chest compressions during cardiopulmonary resuscitation (CPR) play a significant role in surviving cardiac arrest. Chest-compression quality can be measured and corrected by real-time CPR feedback devices, which are not yet commonly used. This article looks at the acceptance of such systems in comparison of equipped and unequipped personnel. Two groups of emergency medical services' (EMS) personnel were interviewed using standardized questionnaires. The survey was conducted in the German cities Dortmund and Münster. Overall, 205 persons participated in the survey: 103 paramedics and emergency physicians from the Dortmund fire service and 102 personnel from the Münster service. The staff of the Dortmund service were not equipped with real-time feedback systems. The test group of equipped personnel of the ambulance service of Münster Fire brigade uses real-time feedback systems since 2007. What is the acceptance level of real-time feedback systems? Are there differences between equipped and unequipped personnel? The total sample is receptive towards real-time feedback systems. More than 80% deem the system useful. However, this study revealed concerns and prejudices by unequipped personnel. Negative ratings are significantly lower at the Münster site that is experienced with the use of the real-time feedback system in contrast to the Dortmund site where no such experience exists-the system's use in daily routine results in better evaluation than the expectations of unequipped personnel. Real-time feedback systems receive overall positive ratings. Prejudices and concerns seem to decrease with continued use of the system.
Utku, Semih; Özcanhan, Mehmet Hilal; Unluturk, Mehmet Suleyman
Patient delivery time is no longer considered as the only critical factor, in ambulatory services. Presently, five clinical performance indicators are used to decide patient satisfaction. Unfortunately, the emergency ambulance services in rapidly growing metropolitan areas do not meet current satisfaction expectations; because of human errors in the management of the objects onboard the ambulances. But, human involvement in the information management of emergency interventions can be reduced by electronic tracking of personnel, assets, consumables and drugs (PACD) carried in the ambulances. Electronic tracking needs the support of automation software, which should be integrated to the overall hospital information system. Our work presents a complete solution based on a centralized database supported by radio frequency identification (RFID) and bluetooth low energy (BLE) identification and tracking technologies. Each object in an ambulance is identified and tracked by the best suited technology. The automated identification and tracking reduces manual paper documentation and frees the personnel to better focus on medical activities. The presence and amounts of the PACD are automatically monitored, warning about their depletion, non-presence or maintenance dates. The computerized two way hospital-ambulance communication link provides information sharing and instantaneous feedback for better and faster diagnosis decisions. A fully implemented system is presented, with detailed hardware and software descriptions. The benefits and the clinical outcomes of the proposed system are discussed, which lead to improved personnel efficiency and more effective interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Hansen, Claus D.
Background: Reviews show that ambulance personnel (AP) have an increased risk of work-related health problems especially musculoskeletal disorders. Because of the unpredictable character of the AP’s work environment, standard measures of work environment exposures are imprecise. The aim...... of this presentation is to examine the associations between objectively measured work load taken from the company register, health and long-term sickness absence (LTSA) in 1-year follow up period. Methods: Data is taken from the first round of MARS – Men, accidents, risk and safety, a two wave panel study of AP...... workers in Denmark (n = 1606) collected in winter 2010/11. The response rate to the questionnaire was 62% in the baseline. The respondents were asked about health status, physical (DMQ) and psychosocial work environment factors (COPSOQ). Information from the company register about work load (e.g. mean...
Full Text Available Abstract Background Ambulance personnel play an essential role in the ‘Chain of Survival’. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island. Methods The Basic Life Support (BLS and Automated External Defibrillator (AED skills of the ambulance personnel were tested in a simulated cardiac arrest. Points were given according to a scoring sheet. One sample t test was used to analyze the deviation from optimal care according to the 2005 guidelines. After each assessment, individual feedback was given. Results On 3 consecutive days, we assessed the individual EMS teams responding to OHCA on the island. Overall, 70% of the maximal points were achieved. The hands-off ratio was 40%. Correct compression/ventilation ratio (30:2 was used by 80%. A mean compression depth of 40–50 mm was achieved by 55% and the mean compression depth was 42 mm (SD 7 mm. The mean compression rate was 123 per min (SD 15/min. The mean tidal volume was 746 ml (SD 221 ml. Only the mean tidal volume deviated significantly from the recommended (p = 0.01. During the rhythm analysis, 65% did not perform any visual or verbal safety check. Conclusion The EMS providers achieved 70% of the maximal points. Tidal volumes were larger than recommended when mask ventilation was applied. Chest compression depth was optimally performed by 55% of the staff. Defibrillation safety checks were not performed in 65% of EMS providers.
Little is known about the impact of Critical Incidents (CIs) on the lives of ambulance personnel. One-to-one interviews were conducted with 27 participants who had experienced CIs during the previous 12 months in order to: assess the nature and impact of CIs on health and well-being; examine attitudes toward support services; and explore barriers to service use. The results showed that incidents involving children, suicides, and grotesque mutilation were the most distressing. Participants reported a wide range of physical and mental health problems including sleep difficulties, angry outbursts, irrationality and feelings of alienation. Key themes included: low support service uptake due to fears relating to confidentiality and machismo; a perceived lack of concern and support from management; and a need for professional counselling and stress awareness training. Emergency Medical Controllers (EMCs) also reported a number of difficulties unique to their role. The findings suggest that exposure to CIs has a significant impact on health and well-being; this has important implications for recognizing and appropriately addressing the health and training needs of ambulance personnel, including the effective management of Critical Incident Stress.
Plat, M J; Frings-Dresen, M H W; Sluiter, J K
Some occupations have tasks and activities that require monitoring safety and health aspects of the job; examples of such occupations are emergency services personnel and military personnel. The two objectives of this systematic review were to describe (1) the existing job-specific workers' health surveillance (WHS) activities and (2) the effectiveness of job-specific WHS interventions with respect to work functioning, for selected jobs. The search strategy systematically searched the PubMed, PsycINFO and OSH-update databases. The search strategy consisted of several synonyms of the job titles of interest, combined with synonyms for workers' health surveillance. The methodological quality was checked. At least one study was found for each of the following occupations fire fighters, ambulance personnel, police personnel and military personnel. For the first objective, 24 studies described several job-specific WHS activities aimed at aspects of psychological, 'physical' (energetic, biomechanical and balance), sense-related, environmental exposure or cardiovascular requirements. The seven studies found for the second objective measured different outcomes related to work functioning. The methodological quality of the interventions varied, but with the exception of one study, all scored over 55% of the maximum score. Six studies showed effectiveness on at least some of the defined outcomes. The studies described several job-specific interventions: a trauma resilience training, healthy lifestyle promotion, physical readiness training, respiratory muscle training, endurance and resistance training, a physical exercise programme and comparing vaccines. Several examples of job-specific WHS activities were found for the four occupations. Compared to studies focusing on physical tasks, a few studies were found that focus on psychological tasks. Effectiveness studies for job-specific WHS interventions were scarce, although their results were promising. We recommend studying
National Academy of Sciences - National Research Council, Washington, DC. Div. of Medical Sciences.
Ambulance personnel must be able to (1) appraise the extent of first aid rendered by others, (2) carry out additional measures at the scene and en route, (3) operate vehicles safely, (4) maintain communication with traffic authorities, dispatchers, and emergency departments, and (5) keep records for medical and other authorities. Guidelines for…
Full Text Available Abstract Objectives To address the relative importance of general job-related stressors, ambulance specific stressors and individual characteristics in relation to job satisfaction and health complaints (emotional exhaustion, psychological distress and musculoskeletal pain among ambulance personnel. Materials and methods A nationwide prospective questionnaire survey of ambulance personnel in operational duty at two time points (n = 1180 at baseline, T1 and n = 298 at one-year follow up, T2. The questionnaires included the Maslach Burnout Inventory, The Job Satisfaction Scale, Hopkins Symptom Checklist (SCL-10, Job Stress Survey, the Norwegian Ambulance Stress Survey and the Basic Character Inventory. Results Overall, 42 out of the possible 56 correlations between job stressors at T1 and job satisfaction and health complaints at T2 were statistically significant. Lower job satisfaction at T2 was predicted by frequency of lack of leader support and severity of challenging job tasks. Emotional exhaustion at T2 was predicted by neuroticism, frequency of lack of support from leader, time pressure, and physical demands. Adjusted for T1 levels, emotional exhaustion was predicted by neuroticism (beta = 0.15, p Psychological distress at T2 was predicted by neuroticism and lack of co-worker support. Adjusted for T1 levels, psychological distress was predicted by neuroticism (beta = 0.12, p Musculoskeletal pain at T2 was predicted by, higher age, neuroticism, lack of co-worker support and severity of physical demands. Adjusted for T1 levels, musculoskeletal pain was predicted neuroticism, and severity of physical demands (beta = 0.12, p Conclusions Low job satisfaction at T2 was predicted by general work-related stressors, whereas health complaints at T2 were predicted by both general work-related stressors and ambulance specific stressors. The personality variable neuroticism predicted increased complaints across all health outcomes.
Brian J Maguire
Full Text Available Objectives and importance: Paramedics have high rates of occupational injury and fatality. The objective of this study is to describe their specific risks of violence-related injury. Study type: This retrospective cohort study is an examination of retrospective data provided by Safe Work Australia (SWA. Methods: An examination of the 300 cases of serious claims of injury related to assaults, violence, harassment and bullying that occurred among individuals identified as ambulance officers and paramedics in Australia from 2001 to 2014. Paramedic risks likely vary by exposures such as hours worked and call volume. To examine how those exposures may influence risk, the available data were used to estimate rates based on hours worked and call volume. Results: The data show that, for serious injuries among paramedics in Australia between 2001 and 2014, the total number of violence-related cases increased from 5 to 40 per year; the number of cases of injury secondary to assault tripled from 10 to 30; and the rate of cases by call volume doubled from 6 to 12. The cost of these injuries was approximately AUD$250 000 for the year 2013–14. The median time at work lost per individual case of ‘work-related harassment and/or workplace bullying’ was 9.6 weeks. Although females comprised 32% of the paramedic workforce, they were the victims in 42% of cases of exposure to violence and 40% of harassment cases. Conclusions: Although anecdotal reports indicate that some interventions have been attempted, violence against paramedics continues to be a growing problem in Australia. The data presented in this study allow for a better understanding of the problem and can support efforts by ambulance service administrators, physicians, paramedics and university researchers to work together to develop and publish evidence based, cost-effective solutions to reduce the risk of workplace violence. Effective solutions will likely be multifaceted and include training
Plat, M. J.; Frings-Dresen, M. H. W.; Sluiter, J. K.
Some occupations have tasks and activities that require monitoring safety and health aspects of the job; examples of such occupations are emergency services personnel and military personnel. The two objectives of this systematic review were to describe (1) the existing job-specific workers' health
Strong gamme or X-ray sources are utilized for non-destructive testing of i.e. bridges. The activities involve certain risks of accident that might lead to serious injuries caused by radiation. The National Institute of Radiation Protection has during the laste decade greatly yhe inspection rate in this area. It has today made controls of most enterprieses running ambulating radiography. (O.S.)
Aksoy, Fikret; Ergun, Alper
The ambulance service is very important in emergency medicine. The aim of this study was to investigate the new governing statuate of private ambulance service and to propose some new ideas. We examinated the new governing statuate of private ambulance service, rules of patient transporte between the hospitals and reports written by SSK Goztepe Educational Hospital ambulance drivers. We concluded that SSK Goztepe Educational Hospital ambulance drivers have a iot of problems especially at the rules of patient transport between the hospitals and there are some defiencies at the new governing statuate of private ambulance service. We concluded that it is necesssary to manage all the ambulance services in one center; all the private ambulance services have to have a specialist and all these must be determinated by the special rules. Key words: Regulation ofprivate ambulance, emergency head maintanence, ambulance services
Although musculoskeletal disorders (MSDs) and other health complaints are an occupational problem for ambulance personnel, there is a lack of knowledge regarding work-related factors associated with MSDs and other health complaints. The overall aim of this thesis was to investigate the relationships between occupational demands, individual characteristics and health-related outcomes among ambulance personnel. A random sample of 234 female and 953 male ambulance personnel participated in a nat...
Chiu, Po-Wei; Lin, Chih-Hao; Wu, Chen-Long; Fang, Pin-Hui; Lu, Chien-Hsin; Hsu, Hsiang-Chin; Chi, Chih-Hsien
Ambulance traffic accidents (ATAs) are the leading cause of occupation-related fatalities among emergency medical service (EMS) personnel. We aim to use the Taiwan national surveillance system to analyze the characteristics of ATAs and to assist EMS directors in developing policies governing ambulance operations. A retrospective, cross-sectional and largely descriptive study was conducted using Taiwan national traffic accidents surveillance data from January 1, 2011 to October 31, 2016. Among the 1,627,217 traffic accidents during the study period, 715 ATAs caused 8 deaths within 24 h and 1844 injured patients. On average, there was one ATA for every 8598 ambulance runs. Compared to overall traffic accidents, ATAs were 1.7 times more likely to result in death and 1.9 times more likely to have injured patients. Among the 715 ATAs, 8 (1.1%) ATAs were fatal and 707 (98.9%) were nonfatal. All 8 fatalities were associated with motorcycles. The urban areas were significantly higher than the rural areas in the annual number of ATAs (14.2 ± 7.3 [7.0-26.7] versus 3.1 ± 1.9 [0.5-8.4], p = 0.013), the number of ATA-associated fatalities per year (0.2 ± 0.2 [0.0-0.7] versus 0.1 ± 0.1 [0.0-0.2], p = 0.022), and the annual number of injured patients (who needed urgent hospital visits) in ATAs (19.4 ± 7.3 [10.5-30.9] versus 5.2 ± 3.8 [0.9-15.3], p traffic accident reporting system should be built to provide EMS policy guidance for ATA reduction and outcome improvements. Copyright © 2018. Published by Elsevier B.V.
Ploeg, E. van der
The risk of high-risk jobs: Psychological health consequences in forensic doctors and ambulance workers This thesis has shown that forensic physicians and ambulance personnel frequently suffer from psychological complaints as a result of dramatic events and sources of chronic work stress. A
1 Department of Emergency Medical Care, Faculty of Health Sciences, ... 2 Aeromedical Division, ER24 Emergency Medical Services, Johannesburg, South Africa ..... Facilitating stroke management using modern information technology.
Brown, Lawrence H; Chaiechi, Taha; Buettner, Petra G; Canyon, Deon V; Crawford, J Mac; Judd, Jenni
To evaluate the impact of changing energy prices on Australian ambulance systems. Generalised estimating equations were used to analyse contemporaneous and lagged relationships between changes in energy prices and ambulance system performance measures in all Australian State/Territory ambulance systems for the years 2000-2010. Measures included: expenditures per response; labour-to-total expenditure ratio; full-time equivalent employees (FTE) per 10,000 responses; average salary; median and 90th percentile response time; and injury compensation claims. Energy price data included State average diesel price, State average electricity price, and world crude oil price. Changes in diesel prices were inversely associated with changes in salaries, and positively associated with changes in ambulance response times; changes in oil prices were also inversely associated with changes in salaries, as well with staffing levels and expenditures per ambulance response. Changes in electricity prices were positively associated with changes in expenditures per response and changes in salaries; they were also positively associated with changes in injury compensation claims per 100 FTE. Changes in energy prices are associated with changes in Australian ambulance systems' resource, performance and safety characteristics in ways that could affect both patients and personnel. Further research is needed to explore the mechanisms of, and strategies for mitigating, these impacts. The impacts of energy prices on other aspects of the health system should also be investigated. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.
The National Association of EMS Physicians (NAEMSP), the American College of Emergency Physicians (ACEP), the Air Medical Physician Association (AMPA), the Association of Air Medical Services (AAMS), and the National Association of State EMS Officials (NASEMSO) believe that patient care and outcomes are optimized by using air medical transport services that are licensed air ambulance providers with robust physician medical director oversight and ongoing quality assessment and review. Only air ambulance medical transport services with these credentials should advertise/market themselves as air ambulance services.
U.S. Department of Health & Human Services — The Ambulance Reasonable Charge public use files for calendar years (CY) 2003 through 2005 are located in the Downloads section below. These public use files are...
Suhr, Ralf; Raeder, Kathrin; Kuntz, Simone; Strube-Lahmann, Sandra; Latendorf, Antje; Klingelhöfer-Noe, Jürgen; Lahmann, Nils
So far, there are few data available on the changes of ambulant home-care in Germany over the last decades. Therefore, the aim of this research was to provide structure data on nursing personnel, funding, size, regional differences, and training needs of ambulant home-care services in Germany. In addition, a possible association between structure parameters and quality outcomes for pressure ulcer and malnutrition was investigated. In 2015, a multicenter cross-sectional study was conducted in home-care services in Germany. Structure data from 99 randomly selected home-care services as well as data on pressure ulcers and malnutrition of 903 care-dependent clients were analyzed. The median (home-care services. From a cut-off of 20,000 inhabitants, a region was considered urban. The average prevalence for decubitus and malnutrition (BMIhome-care service, and possible associations with structure parameters were analyzed using a multiple linear regression model. The proportion of registered nurses in non-private (private) home-care services was 60.6% (52.3%). The proportion of employees with a 200- h basic qualification in nursing was higher in private (12.5 vs. 4.7%), small home-care services (14.0 vs. 5.8%) and in urban regions (11.5 vs 5.7%). In average, registered nurses working in small home-care services spent significantly more time per client than the ones working in large services (3.8 vs. 2.9 h/week). The highest need for further training was shown on the subjects of pain, medication and cognitive impairment. No statistically significant correlation could be found between the average decubitus prevalence and structure parameters. Only the association between malnutrition prevalence and the proportion of registered nurses was statistically significant. The present representative study provides structure data on nursing personnel, funding, size, regional differences, and training needs of ambulant home-care services in Germany that could be used as a baseline
Tippett, Vivienne C; Toloo, Ghasem Sam; Eeles, David; Ting, Joseph Y S; Aitken, Peter J; Fitzgerald, Gerard J
To determine the impact of the introduction of universal access to ambulance services via the implementation of the Community Ambulance Cover (CAC) program in Queensland in 2003-04. The study involved a 10-year (2000-01 to 2009-10) retrospective analysis of routinely collected data reported by the Queensland Ambulance Service (QAS) and by the Council of Ambulance Authorities. The data were analysed for the impact of policy changes that resulted in universal access to ambulance services in Queensland. QAS is a statewide, publically funded ambulance service. In Queensland, ambulance utilisation rate (AUR) per 1000 persons grew by 41% over the decade or 3.9% per annum (10-year mean=149.8, 95% CI: 137.3-162.3). The AUR mean after CAC was significantly higher for urgent incidents than for non-urgent ones. However projection modelling demonstrates that URs after the introduction of CAC were significantly lower than the projected utilisation for the same period. The introduction of universal access under the Community Ambulance Cover program in Queensland has not had any significant independent long-term impact on demand overall. There has been a reduction in the long-term growth rate, which may have been contributed to by an 'appropriate use' public awareness program.
Due to developments of the health market, economic aspects of the health system are more relevant. In this upcoming market the patient is regarded as customer and the doctor as provider of medical services. Studies on customer orientation in the ambulant medicine lag behind this dynamic. An aim of the study is to comprehend the attitudes of the doctors referring to the customer orientation. In a second step the findings are discussed according to statements of health-care paticipants. Developments in role comprehension of doctor and patient are focused to gain results in scientific and practical applications. Guideline-supported, partly narrative interviews with n=9 gynaecologists and n=11 general practitioners in Freiburg/Germany are recorded, transcribed and reviewed in a qualitative analysis. The statements of the doctors show patient satisfaction has an incremental meaning sspecially regarding the sequence of patient relationship and economic management of the doctor's workplace. The doctor's role comprehension meets with a refusal of the role of salesman and the patient as customer. The method of interviews is suitable to gather empirical impressions of the doctors. The control sample is adequate, however a bias due to inhomogeneous thematic affinitiy and local social-demographics might be possible. The customer orientation has become an important factor in doctor-patient relationtships. The relevance of the doctor-patient conversation and the risk of misuse of the patient confidence are mentioned by the doctors. The doctor as paternalistic care provider gives way to the customer-focused service provider. The doctor's necessity of autonomyssss and dependency on patient satisfaction have potential for conflict. Intensive mention of customer orientation in medicine in the media emphasises its importance. Rational handling with the possibilities of individual health markets is a prospective challange. Further research could be established in all aspects of
The ambulance is to replace another based on the off-road vehicle design which was originally acquired for the civil engineering phase of LEP construction. Just one figure, in 1999, the CERN ambulance was called out 195 times.
Werner, Kristoffer; Kander, Kristofer; Axelsson, Christer
To describe ambulance nurses' practical electrocardiogram (ECG) interpretation skills and to measure the correlation between these skills and factors that may impact on the level of knowledge. This study was conducted using a prospective quantitative survey with questionnaires and a knowledge test. A convenience sample collection was conducted among ambulance nurses in three different districts in western Sweden. The knowledge test consisted of nine different ECGs. The score of the ECG test were correlated against the questions in the questionnaire regarding both general ECG interpretation skill and ability to identify acute myocardial infarction using Mann-Whitney U test, Kruskal-Wallis test and Spearman's rank correlation. On average, the respondents had 54% correct answers on the test and identified 46% of the ECGs indicating acute myocardial infarction. The median total score was 9 of 16 (interquartile range 7-11) and 1 of 3 (IQR 1-2) in infarction points. No correlation between ECG interpretation skill and factors such as education and professional experience was found, except that coronary care unit experience was associated with better results on the ECG test. Ambulance nurses have deficiencies in their ECG interpretation skills. This also applies to conditions where the ambulance crew has great potential to improve the outcome of the patient's health, such as myocardial infarction and cardiac arrest. Neither education, extensive experience in ambulance service nor in nursing contributed to an improved result. The only factor of importance for higher ECG interpretation knowledge was prior experience of working in a coronary care unit. © The European Society of Cardiology 2014.
Küpper, Thomas E; Zimmer, Bernd; Conrad, Gerson; Jansing, Paul; Hardt, Aline
Although ambulance flights are routine work and thousands of employees work in repatriation organizations, there is no data on noise exposure which may be used for preventive advice. We investigated the noise exposure of crews working in ambulance flight organizations for international patient repatriation to get the data for specific guidelines concerning noise protection. Noise levels inside Learjet 35A, the aircraft type which is most often used for repatriation operations, were collected from locations where flight crews typically spend their time. A sound level meter class 1 meeting the DIN IEC 651 requirements was used for noise measurements, but several factors during the real flight situations caused a measurement error of ~3%. Therefore, the results fulfill the specifications for class 2. The data was collected during several real repatriation operations and was combined with the flight data (hours per day) regarding the personnel to evaluate the occupationally encountered equivalent noise level according to DIN 45645-2. The measured noise levels were safely just below the 85 dB(A) threshold and should not induce permanent threshold shifts, provided that additional high noise exposure by non-occupational or private activities was avoided. As the levels of the noise produced by the engines outside the cabin are significantly above the 85 dB(A) threshold, the doors of the aircraft must be kept closed while the engines are running, and any activity performed outside the aircraft - or with the doors opened while the engines are running - must be done with adequate noise protection. The new EU noise directive (2003/10/EG) states that protective equipment must be made available to the aircrew to protect their hearing, though its use is not mandatory.
Luna-Reyes, O B; Reyes, T M; So, F Y; Matti, B M; Lardizabal, A A
The energy expenditures (Ee) for locomotion by nondisabled and disabled Filipino children aged 7 to 13 were determined and compared using indirect calorimetry. Forty-one controls (20 boys and 21 girls) ambulated at a comfortable pace; 16 children (eight boys and eight girls) with lower extremity poliomyelitis of varying severity ambulated by (1) wheelchair propulsion, (2) bilateral axillary crutches, (3) unilateral lower extremity ankle-foot orthoses or knee-ankle-foot orthoses, and (4) unassisted. Disabled children, regardless of their mode of ambulation, had to expend significantly more energy to ambulate than normal children (p less than 0.05). Wheelchair propulsion cost 16% more energy than the normal gait; crutch ambulation cost 41% more than the control. Children using unilateral braces sacrificed speed to attain near-normal Ee. When they ambulated without orthoses, their Ee increased by 109% over the control. In ascending order, the least energy was expanded by normal ambulation followed by disabled ambulation with unilateral brace, disabled propelling a wheelchair, disabled ambulation with bilateral axillary crutches, and disabled ambulation without brace. Efficiency of locomotion was reflected in the values obtained for Ee in terms of kcal x 10(-3)/kg/m, as demonstrated by the lower Ee but slower ambulation of children with braces, as compared to the nondisabled children.
Yun, Jong Geun; Jeung, Kyung Woon; Lee, Byung Kook; Ryu, Hyun Ho; Lee, Hyoung Youn; Kim, Mu Jin; Heo, Tag; Min, Yong Il; You, Yeonho
The available data suggest that automated external defibrillators (AED) can be safely used in vibration-like moving conditions such as rigid inflatable boats and aircraft environments. However, little literature exists examining their performance in a moving ambulance. The present study was undertaken to determine whether an AED is able to analyse the heart rhythm correctly during ambulance transport. An ambulance was driven on paved (20-100 km/h) and unpaved (10 km/h) roads. The performance of two AED devices (CU ER 2, CU Medical Systems Inc., Korea, and Heartstart MRx, Phillips, USA) was determined in a moving ambulance using manikins. Vibration intensity was measured simultaneously with a digital vibrometer. AED performance was then evaluated again on manikins and on a swine model under simulated vibration intensities (0.5-5m/s(2)) measured by the vibrometer in the previous phase of the investigation. The vibration intensity increased with increasing speeds on paved roads (1.98+/-0.44 m/s(2) at 100 km/h). While driving on unpaved roads, it increased to 6.40+/-1.06 m/s(2). Both AED algorithms analysed the heart rhythm correctly under resting state. When tested on pigs, both algorithms showed substantially degraded performances, even at low vibration intensities of 0.5-1m/s(2), which corresponded to vibration intensities while driving on paved roads at 20-60 km/h. This study also showed that electrocardiograms generated on manikins were more resistant to motion artifacts than were the pig electrocardiograms. Ambulance personnel should consider the possibility of misinterpretation by an AED when this device is used while transporting a patient. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
This film stresses the need for personnel monitoring in work areas where there is a hazard of exposure to radiation. It illustrates the use of personnel monitoring devices (specially the film dosimeter), the assessment of exposure to radiation and the detailed recording of the results on personnel filing cards
This film stresses the need for personnel monitoring in work areas where there is a hazard of exposure to radiation. It illustrates the use of personnel monitoring devices (specially the film dosimeter), the assessment of exposure to radiation and the detailed recording of the results on personnel filing cards
In the name of cost-conscious care, air ambulance program directors and service contractors are seeing the dawn of integrated networks as a boon to their business. As integrated networks form, facilities will become increasingly specialized in the types of services they provide. Patients will need to be moved around the system, resulting in more frequent patient transport and more points of transfer. Many programs are considering aircraft replacement and additions, rather than leasing. Financial benefits could come on depreciation and the high resale value of aircraft. Unless reimbursement levels increase, more program mergers and affiliations may take place to spread and reduce cost. Air ambulance services will increasingly become part of a facility's strategic plan.
Narad, R A
This study was intended to identify economic regulatory programs used by California counties (including ambulance franchising and rate setting), to inventory their foci and application, and to identify differences around the state. By studying the variety of programs used in one state, this study establishes a framework for evaluation of state and local regulatory programs elsewhere. This study surveyed all California local EMS agencies (LEMSAs); these are California's equivalent of regional EMS organizations. The survey achieved a 100% response rate, and all data involve population parameters obviating the need for inferential statistics. Seventy-three percent of California counties use economic regulations. Large-population counties and those that operate their own LEMSAs are more likely to use economic regulations than are small counties and those that participate in multicounty EMS agencies. Despite a preference for competition in the authorizing statute, most franchises were granted without competition to existing providers. The majority of franchises in the state were granted to public services. Most ambulance rate setting occurs outside of a competitive process. Economic regulations that were intended to provide a structured marketplace are often being used to protect existing providers, particularly public services, from competition. The growing interest by fire departments in entering the market for emergency ambulance service, along with the existing bias toward them in granting of franchises, does not bode well for use of the competitive process. The growth of managed care may change or eliminate the need for economic regulations but, if they are to continue, more state oversight should be considered.
Ohio State Dept. of Education, Columbus. Trade and Industrial Education Service.
This textbook for emergency medical personnel should be useful to fire departments, private ambulance companies, industrial emergency and rescue units, police departments, and nurses. The 30 illustrated chapters cover topics such as: (1) Emergency Medical Service Vehicles, (2) Safe Driving Practices, (3) Anatomy and Physiology, (4) Closed Chest…
Wilmer, Ian; Chalk, Graham; Davies, Gareth Edward; Weaver, Anne Elizabeth; Lockey, David John
The identification of serious injury is critical to the tasking of air ambulances. London's Air Ambulance (LAA) is dispatched by a flight paramedic based on mechanism of injury (MOI), paramedical interrogation of caller (INT) or land ambulance crew request (REQ).This study aimed to demonstrate which of the dispatch methods was most effective (in accuracy and time) in identifying patients with serious injury. A retrospective review of 3 years of data (to December 2010) was undertaken. Appropriate dispatch was defined as the requirement for LAA to escort the patient to hospital or for resuscitation on-scene. Inaccurate dispatch was where LAA was cancelled or left the patient in the care of the land ambulance crew. The χ(2) test was used to calculate p values; with significance adjusted to account for multiple testing. There were 2203 helicopter activations analysed: MOI 18.9% (n=417), INT 62.4% (n=1375) and REQ 18.7% (n=411). Appropriate dispatch rates were MOI 58.7% (245/417), INT 69.7% (959/1375) and REQ 72.2% (297/411). INT and REQ were both significantly more accurate than MOI (pinterrogation of the caller by a flight paramedic is as accurate as ground ambulance crew requests, and both are significantly better than MOI in identifying serious injury. Overtriage remains an issue with all methods. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Iorga, Magdalena; Dascalu, Neonila; Soponaru, Camelia; Ioan, Beatrice
Healthcare professionals are frequently confronted with urgent situations and a high-risk human intervention. They are usually exposed to what is called burnout syndrome. To identify the effects of burnout syndrome on the professional conduct and attitudes of doctors and nurses who work in the Romanian public ambulance service. Secondary, the causal relationships between burnout and various socio-demographic variables were analyzed. The 20-item Toronto Alexithymia Scale (TAS- 20), Maslach Burnout Inventory and Job Satisfaction Questionnaire were administered to 122 ambulance doctors, nurses and drivers (62 females and 60 males). The degree of job satisfaction is the most important indicator of burnout syndrome. Significant differences were found between low and high alexithymic subjects. Women are more susceptible to experience higher levels of burnout than men. The level of burnout is influenced by the combined effect of job satisfaction and alexithymia. Burnout syndrome is a common problem among people working in the emergency medical system. The causes of job-related burnout have to be identified in order to apply an appropriate level of burnout intervention program and to increase the efficiency of coping strategies.
... activities, the applicable standard is the one which applies to the activity in which the employee spends the majority of work time during the work period. (b) Ambulance and rescue service employees of public agencies... 29 Labor 3 2010-07-01 2010-07-01 false Ambulance and rescue service employees. 553.215 Section 553...
Laan, Corine Maartje; Vanberkel, Peter T.; Boucherie, Richardus J.; Carter, Alix J.E.
Emergency department overcrowding is a widespread problem and often leads to ambulance offload delay. If no bed is available when a patient arrives, the patient has to wait with the ambulance crew. A recent Canadian innovation is the offload zone—an area where multiple patients can wait with a
Ambulance vehicles are required to respond rapidly to medical emergencies. A number of factors may affect response times, most importantly the location of emergency services stations, the number of ambulance vehicles available at each station, road conditions and traffic volumes. To support spatial planning and provide ...
..., which are defined in § 414.605 of this chapter: (1) Basic life support (BLS) (emergency and nonemergency). (2) Advanced life support, level 1 (ALS1) (emergency and nonemergency). (3) Advanced life support... Coverage of ambulance services. (a). Basic rules. Medicare Part B covers ambulance services if the...
Fair, George, Ed.; Stodden, Robert, Ed.
Three articles comprise a section on personnel preparation in vocational education. Articles deal with two inservice programs in career/vocational education for the handicapped and a project to train paraprofessionals to assist special educators in vocational education. (CL)
Hinton, C A; Cullen, K E
Thirteen normal male college students were studied during unassisted ambulation and nonweight-bearing ambulation with Ortho crutches and axillary crutches to determine energy expenditure. Subjects walked at self-selected velocities. Energy expenditure was determined by analyzing expired air collected by a calorimeter. Heart rate was monitored by telemetry. During the first 2.5 minutes of walking, heart rate and energy expenditure were significantly greater for ambulation with axillary crutches than with Ortho crutches. After 11.5 minutes of walking, no difference in energy cost was found between crutch types; however, heart rate increased significantly (p less than .01) during ambulation with axillary crutches. Differences in energy cost and heart rate were attributed to increased upper extremity work performed when using axillary crutches. We concluded that during nonweight-bearing ambulation for short periods of time or over a short distance, the Ortho crutch is less taxing in terms of energy cost and heart rate demands.
Ebben, R.H.; Vloet, L.C.M.; Grunsven, P.M. van; Breeman, W.; Goosselink, B.; Lichtveld, R.A.; Groot, J. de; Achterberg, T. van
OBJECTIVES: Adherence to prehospital guidelines and protocols is suboptimal. Insight into influencing factors is necessary to improve adherence. The aim of this study was to identify factors that influence ambulance nurses' adherence to a National Protocol Ambulance Care (NPAC). METHODS: A
Ferriero, Giorgio; Kristensen, Morten T; Invernizzi, Marco
INTRODUCTION: In the geriatric population, independent mobility is a key factor in determining readiness for discharge following acute hospitalization. The Cumulated Ambulation Score (CAS) is a potentially valuable score that allows day-to-day measurements of basic mobility. The CAS was developed...... and validated in older patients with hip fracture as an early postoperative predictor of short-term outcome, but it is also used to assess geriatric in-patients with acute medical illness. Despite the fast- accumulating literature on the CAS, to date no systematic review synthesizing its psychometric properties....... Of 49 studies identified, 17 examined the psychometric properties of the CAS. EVIDENCE SYNTHESIS: Most papers dealt with patients after hip fracture surgery, and only 4 studies assessed the CAS psychometric characteristics also in geriatric in-patients with acute medical illness. Two versions of CAS...
based analysis of ambulance response time was undertaken. The purpose was to .... He tested the travel time of the primary response vehicles and ..... Real CORP Proceedings / Tagungsband, ISBN: 978-3-9502139-7-3, pp, 22-25, viewed 18.
N. F. Plavunov
Full Text Available This article is devoted to 130th anniversary and publication of academic writings of Alexander Puchkov — Doctor of Med. Sci., Honored Doctor of Russian Soviet Federative Socialist Republic. He was permanent leader of Moscow Ambulance Station from 1923 to 1952. Data presented in Puchkov’s articles were used to compare performance of work of Moscow ambulance in it’s formative period and our days. This article shows specificities, characteristics and environment of Moscow ambulance in 1926 and 2016. For example, the number of brigades had increased by 67,9 times (from 15 in 1926 to 1018 in 2016. Average time of arrival to accident is 10-12 minutes is same for 1926 and 2016. The proportion of pediatric interventions (from birth to 15 years old had increased. Analysis of indicators allows to look at development of Moscow ambulance station from it’s formative period to our days. Fundamental principles laid down by A. Puchkov last in many cases in work of Moscow Ambulance in our days. Ambulance doctors continue to provide medical assistance promptly in the framework spelt out more than 90 years ago.
Full Text Available The aim of the present study was to develop and examine the quality of the Ambulance Driver Self-assessment Questionnaire (ADSQ and the Ambulance Driver Peer-assessment Questionnaire (ADPQ measuring aspects of, driving performance, driving style and driving competence. In addition the ADSQ measures self-reflection and safety-attitudes. The aim of the study was also to examine ambulance drivers' self- and peer-assessments as well as to examine the accuracy of self-assessments by comparing self-assessed and peer-assessed driving performance, driving style and competence. 76 ambulance drivers employed at two ambulance stations in northern Sweden completed ADSQ and ADPQ. Item analyses were conducted to examine the psychometric properties of the items, and based on the results some revisions were made to improve the questionnaires. The revised questionnaires were functioning rather well, although some subscale demonstrated low internal consistency. Subscale inter-correlations provided support for construct validity. Self- and peer-assessments indicated safe driving performance and good driver competence, which is positive from a traffic safety perspective. A comparison of mean self- and peer-assessment ratings, controlling for age, gender and driving experience showed no significant differences, except for the subscale overtaking. This indicates that ambulance drivers' self-assessments are realistic in most areas.
The arrival of a new vehicle is always an important moment in the life of a fire station. So when a new ambulance was delivered to the CERN Fire Brigade on Wednesday 16 September 2000, it was given a warm welcome, attended by staff of the different divisions involved in its purchase. It took a year from the first administrative moves to the day of acquisition. On the one hand there were the calls for tender needed for such a purchase and on the other the development of this custom-designed ambulance with its unique features. Three visits to the manufacturer had to be made, including two to the head office of the Miesen factory at Bonn to study and incorporate in the ambulance the special requirements called for by its future users. These requirements, born from the past experience of CERNs ambulance crews, concerned not only interior arrangements but also included a new side panel, opening up a stowage compartment where everything will be put that gets dirty during ambulance operations. This will minimize ...
Poetter-Lang, S.; Herold, C.J. [Medizinische Universitaet Wien, Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Wien (Austria)
The diagnosis of community-acquired pneumonia (CAP) is often not possible based only on the clinical symptoms and biochemical parameters. For every patient with the suspicion of CAP, a chest radiograph in two planes should be carried out. Additionally, a risk stratification for the decision between outpatient therapy or hospitalization is recommended. Based on the evaluation of the different radiological patterns as well as their extent and distribution, a rough allocation to so-called pathogen groups as well as a differentiation between viral and bacterial infections are possible; however, because different pathogens cause different patterns an accurate correlation is not feasible by relying purely on imaging. The radiological findings serve as proof or exclusion of pneumonia and can also be used to evaluate the extent of the disease (e.g. monolobular, multilobular, unilateral or bilateral). In cases of prolonged disease, suspicion of complications (e.g. pleural effusion or empyema, necrotizing pneumonia or abscess) or comorbid conditions (e.g. underlying pulmonary or mediastinal diseases) computed tomography is an important diagnostic tool in addition to chest radiography. Ultrasound is often used to diagnose pleural processes (e.g. parapneumonic effusion or pleural empyema). (orig.) [German] Anhand der klinischen Symptome und laborchemischen Befundkonstellation alleine ist es oft nicht moeglich, die Diagnose einer ambulant erworbenen Pneumonie (''community-acquired pneumonia'', CAP) zu stellen. Bei jedem Patienten mit Verdacht auf CAP sollte eine Roentgenthoraxaufnahme in 2 Ebenen angefertigt werden. Weiter muss eine Risikostratifizierung im Sinne der Entscheidung ambulante Therapie vs. Hospitalisierung erfolgen. Anhand der Analyse radiologischer Muster sowie deren Verteilung und Ausdehnung koennen eine grobe Zuordnung zu sogenannten Erregergruppen sowie eine Differenzierung zwischen viralen und bakteriellen Infektionen gelingen. Da
Schiszler, Bence; Karamánné Pakai, Annamária; Szabó, Zoltán; Raposa, László Bence; Pónusz, Róbert; Radnai, Balázs; Endrei, Dóra
Among Hungary's health sector workers the presence of a high level of stress is known, which can affect the individual. The aim of the authors was to uncover major risk factors causing work-related stress, as well as its extent, and positive and negative coping strategies among ground and aerial rescue workers. From June until October 2015, a national survey was conducted among Hungarian rescue workers. An own questionnaire and Rahe Stress and coping validated short questionnaire online form were used. A total of 141 persons took part in the survey. As compared to air-ambulance workers, ground rescue workers were exposed to higher work-related stress effects (pStress and Coping Index effective coping mechanisms were observed among air rescue workers (pstress reduction. Orv. Hetil., 2016, 157(45), 1802-1808.
Aléx, Jonas; Karlsson, Stig; Saveman, Britt-Inger
Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients' experiences of cold exposure and to identify related factors. During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients' finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation. In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from -22.3°C to 8.4°C. Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons.
Background Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients’ experiences of cold exposure and to identify related factors. Method During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients’ finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation. Results In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from −22.3°C to 8.4°C. Conclusion Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons. PMID:23742143
Full Text Available [i][/i][b]Introduction and objectives. [/b]The system of emergency medical services (EMS in Poland was established in 2006. The risk of occupational injuries to EMS personnel is very high, irrespective of the country where they operate, as they face many hazards in their everyday work. The aim of this study is to describe the type, incidence and consequences of occupational accidents among the personnel of the National Emergency Medical Services in Poland (NEMS – land and air ambulance crews in 2008–2012. [b]Material and methods:[/b] The study reviewed all occupational accidents among the EMS personnel reported to the National Labour Inspectorate in 2008–2012. [b]Results[/b]: In the period reported, the number of accidents decreased from 32 in 2008 to just 6 in 2012. Traffic accidents predominated and most of the victims were male paramedics under 30 years of age. The most common injuries included multiple organ injuries and injuries of the cervical spine, chest and trunk. [b]Conclusions:[/b] The growing professional experience of the EMS personnel has a beneficial effect on occupational injury rates as they tend to decrease with longer employment. Occupational accidents are definitely more common among ambulance crews than in the personnel of other organizational units of the National Emergency Medical Services.
Al-Harbi, Nada; El-Masri, Samir; Saddik, Basema
In this paper we propose an Emergency Department Information System that will be integrated with the ambulance system to improve the communication, enhance the quality of provided emergency services and facilitate information sharing. The proposed system utilizes new advanced technologies such as mobile web services that overcome the problems of interoperability between different systems, HL7 and GPS. The system is unique in that it allows ambulance officers to locate the nearest specialized hospital and allows access to the patient's electronic health record as well as providing the hospital with required information to prepare for the incoming patient.
Hansen, Claus D.; Rasmussen, Kurt; Kyed, Morten
with higher levels of poor mental health and poor sleep quality. To improve work environment, attention should be paid to musculoskeletal problems and the presence of positive organizational support mechanisms that can prevent negative effects from the high levels of emotional demands....
Seitzberg, A.; Lind, M.; Biering-Sørensen, Fin
OBJECTIVE: The objective of this study was to evaluate the prediction of ambulation in adults with myelomeningocele from muscle strength testing and ambulation in early life. MATERIALS AND METHODS: Fifty-two myelomeningocele (MMC) individuals at the age 18-37 years at follow-up were studied....... Information on muscle strength and ambulatory function in early life was retrieved from medical records. The motor levels determined by the muscle strength were used to predict ambulatory function later in life. At follow-up, a clinical examination was performed. RESULTS: Of 20 MMC individuals assessed...... life than predicted. Good strength in quadriceps muscles gave significant better prospect for adult walking. Of the 52 participants, 41 retained their ambulation status from 5-8 years of age. CONCLUSION: For MMC individuals with motor levels L3-L5, adult ambulatory function cannot be determined from...
Full Text Available Ambulance vehicles are required to respond rapidly to medical emergencies. A number of factors may affect response times, most importantly the location of emergency services stations, the number of ambulance vehicles available at each station, road...
KATHRYN JEAN EASTWOOD
Increasing demand for emergency ambulances places a substantial burden on ambulance services. Many cases are low-acuity, having no urgent clinical need for paramedic treatment. Ambulance Victoria implemented a secondary telephone triage services to divert low-acuity cases away from emergency ambulances to more appropriate care. This research found this ‘Referral Service’ has had a substantial impact upon emergency operations, referring over 70% of the cases it managed away from emergency am...
A total of 12,674 victims were transported to different tares of hospital and referrals ... The mean cost-efficiency (technical) of Machakos ambulance transport services was 90.6% (C.I 82.7% - 98.2%). ... EMAIL FULL TEXT EMAIL FULL TEXT
Wastell, D.; Newman, M.
The development of information systems (IS) is a problematic process that all too often ends in failure. This paper reports a comparative analysis of two projects involving the computerisation of ambulance control-room operations in London and Manchester. The outcomes were strikingly different. In
Ackermann, Ole; Barkhausen, Joerg
The radiology trainer for surgical ambulance includes informative X-ray imaging examples for the following issues: zygoma, nasal bone, spinal cord, clavicle, shoulder, upper arms, elbow, forearms, wrist, hand, phalanx, thorax, sternum, pelvis, abdomen, hips, femur, knee, lower leg, ankle, feet.
... 42 Public Health 3 2010-10-01 2010-10-01 false Publication of the ambulance fee schedule. 414.620... SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedule for Ambulance Services § 414.620 Publication of the ambulance fee schedule. Changes in payment rates resulting...
Krause, James S.
The author compares current employment status after spinal cord injury between participants who were independent in ambulation (required no assistance from others) and those who were dependent in ambulation (required assistance from at least one other person to ambulate). Those who were independent of assistance from others in ambulation were…
Nielsen, Kamilla; Johansson, Pär I; Dahl, Benny
BACKGROUND: Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision...... surgery. METHODS: The trial was registered at Clinicaltrials.gov ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation...... received RBC. CONCLUSIONS: A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing....
The practice-as-research project Homing Place proposes a transferable percipient-led methodology of performance and research activated by ambulant and conversive mechanisms as the culmination of this research. The thesis is comprised of a range of activity that represents a moment and way of writing practice. Three artworks that comprise part of the practical component of this thesis--- way from home, Take me to a place and Yodel Rodeo-- each involved participation and contribu...
Sherwin E. Phillips
Full Text Available Objectives. There are no published studies on the Barbados Emergency Ambulance Service and no assessment of the calls that end in nontransported individuals. We describe reasons for the nontransport of potential clients. Methods. We used the Emergency Medical Dispatch (Medical Priority Dispatch System instrument, augmented with five local call types, to collect information on types of calls. The calls were categorised under 7 headings. Correlations between call types and response time were calculated. Results. Most calls were from the category medical (54%. Nineteen (19% percent of calls were in the non-transported category. Calls from call type Cancelled accounted for most of these and this was related to response time, while Refused service was inversely related (. Conclusions. The Barbados Ambulance Service is mostly used by people with a known illness and for trauma cases. One-fifth of calls fall into a category where the ambulance is not used often due to cancellation which is related to response time. Other factors such as the use of alternative transport are also important. Further study to identify factors that contribute to the non-transported category of calls is necessary if improvements in service quality are to be made.
Togher, Fiona J; O'Cathain, Alicia; Phung, Viet-Hai; Turner, Janette; Siriwardena, Aloysius Niroshan
There is an increasing need to assess the performance of emergency ambulance services using measures other than the time taken for an ambulance to arrive on scene. In line with government policy, patients and carers can help to shape new measures of ambulance service performance. To investigate the aspects of emergency ambulance service care valued by users. Qualitative interview study. One of 11 ambulance services in England. Twenty-two users and eight of their spouses (n = 30). Users of the emergency ambulance service, experiencing different types of ambulance service response, valued similar aspects of their pre-hospital care. Users were often extremely anxious about their health, and the outcome they valued was reassurance provided by ambulance service staff that they were receiving appropriate advice, treatment and care. This sense of being reassured was enhanced by the professional behaviour of staff, which instilled confidence in their care; communication; a short wait for help; and continuity during transfers. A timely response was valued in terms of allaying anxiety quickly. The ability of the emergency ambulance service to allay the high levels of fear and anxiety felt by users is crucial to the delivery of a high quality service. Measures developed to assess and monitor the performance of emergency ambulance services should include the proportion of users reporting feeling reassured by the response they obtained. © 2014 John Wiley & Sons Ltd.
Gustavsson, Pär; Nilsson, Peter M
The fact that Sweden has been spared from war on its soil for almost 200 years, has not stopped Swedish citizens from participating in conflicts worldwide during this period. This has been described, especially from the soldiers perspective. The contribution of Swedish physicians has not been written about to the same extent. When Mussolini's Italy in October 1935 invaded the poor and underdeveloped country of Ethiopia (former Abyssinia) an ambulance was immediately organized by the Swedish Red Cross. To lead such an expedition, a great knowledge of Ethiopian culture och maybe most importantly, of the weather and geographical conditions, was undoubtedly demanded. Therefore, the Swedish Red Cross turned to two Ethiopian veterans. Doctor Fride Hylander, a missionary-son who had been working on a hospital project in the Ethiopian province of Harrar and his friend since school years, doctor Gunnar Agge, were assigned the leadership of the ambulance. Dr Agge had also participated in improving the Ethiopian health care both in Harrar and later as civilian and military doctor in the province of Ogaden, where he was medically responsible for the more than 9 000 men strong army that the Ethiopian emperor had stationed there after Italian provocations. Most of the other members of the ambulance were handpicked by these two leaders and many of them had, just like themselves, a stong religious belief. A money-raise was immediately initiated and in less than six weeks 700 000 Swedish crowns had been collected, more then twice the sum the ambulance was calculated to cost. In early november 1935 the ambulance was clear to go. Their primary objective was to travel through British Somaliland and establish a field-hospital in the province of Harrar. However, the Ethiopian emperor had other things in mind. He wanted to reorganize the ambulance and divide it in two and place it closer to the front line. The ambulance decided to go along with his wish. Both groups started eventually
van Schaaijk, A.; Boschman, J. S.; Frings-Dresen, M. H. W.; Sluiter, J. K.
Purpose To gain insight into which job-specific health requirements relate to work ability, the following two research questions were formulated: Which job-specific health requirements are associated with the appraisal of work ability in ambulance drivers and paramedics? How are appraisals of physical and mental work ability associated with the appraisal of overall work ability in ambulance drivers and paramedics? Method Workers Health Surveillance cross-sectional data of 506 ambulance worker...
Seow, E; Wong, H; Phe, A
Methods—All (13 697) ambulance arrivals in 1996 to the ED of Tan Tock Seng Hospital were studied and where relevant compared with the walk in and total arrivals of the same year. The following data were obtained from computer records: (a) patients' demographic data; (b) number of ambulance arrivals by hour; (c) the classification of the ambulance arrivals by emergency or non-emergency, trauma or non-trauma; (d) cause of injury for trauma cases; (e) discharge status.
Mochimasu, Kazumi Dokai; Miyatake, Nobuyuki; Tanaka, Naoko; Kinoshita, Hiroshi
The aim of this study was to investigate the linkage among ambulance transports, the number of death and air temperature in Takamatsu area, Japan. Monthly data of ambulance transports (total and acute disease) and the number of death from 2004 to 2012 were obtained from Fire Department Service in Takamatsu and Takamatsu city official website, Japan. Climate parameters for required period were also obtained from Japan Meteorological Agency. Population data in Takamatsu area were also used to adjust ambulance transports and the number of death. The linkage among ambulance transports, the number of death and climate parameters was evaluated by ecological analysis. Total ambulance transports (/a hundred thousand people/day) and ambulance transports due to acute disease (/a hundred thousand people/day) were 12.3 ± 0.9 and 6.8 ± 0.7, respectively. The number of death (/a hundred thousand people/day) was 2.5 ± 0.4. By quadratic curve, ambulance transports due to acute disease and the number of death were significantly correlated with the parameters of air temperature. However, the number of death was the highest in January and the lowest in August. Although higher air temperature was only associated with higher ambulance transports, lower air temperature was associated with both higher ambulance transports and the number death in Takamatsu area, Japan.
The current state-of-the-art in neutron personnel dosimetry is reviewed. Topics covered include dosimetry needs and alternatives, current dosimetry approaches, personnel monitoring devices, calibration strategies, and future developments
Huppert, David; Griffiths, Matthew
To review internationally recognized models of police interactions with people experiencing mental health crises that are sometimes complex and associated with adverse experience for the person in crisis, their family and emergency service personnel. To develop, implement and review a partnership model trial between mental health and emergency services that offers alternative response pathways with improved outcomes in care. Three unique models of police and mental health partnership in the USA were reviewed and used to develop the PACER (Police Ambulance Crisis Emergency Response) model. A three month trial of the model was implemented and evaluated. Significant improvements in response times, the interactions with and the outcomes for people in crisis were some of the benefits shown when compared with usual services. The pilot showed that a partnership involving mental health and police services in Melbourne, Australia could be replicated based on international models. Initial data supported improvements compared with usual care. Further data collection regarding usual care and this new model is required to confirm observed benefits. © The Royal Australian and New Zealand College of Psychiatrists 2015.
The activities and purposes of the Personnel Monitoring Dept. of the Institute of Radioprotection and Dosimetry of the Brazilian CNEN are presented. A summary of the personnel monitoring service is given, such as dosemeters supply, laboratorial inspections, and so on. The programs of working, publishing, courses and personnel interchange are also presented. (J.A.M.M.)
van der Veen, Egbert
Summary The personnel of an organization often has two conflicting goals. Individual employees like to have a good work-life balance, by having personal preferences taken into account, whereas there is also the common goal to work efficiently. By applying techniques and methods from Operations Research, a subfield of applied mathematics, we show that operational efficiency can be achieved while taking personnel preferences into account. In the design of optimization methods, we explicitly con...
Dibene, Juan Carlos; Maldonado, Yazmin; Vera, Carlos; de Oliveira, Mauricio; Trujillo, Leonardo; Schütze, Oliver
In this work we report on modeling the demand for Emergency Medical Services (EMS) in Tijuana, Baja California, Mexico, followed by the optimization of the location of the ambulances for the Red Cross of Tijuana (RCT), which is by far the largest provider of EMS services in the region. We used data from more than 10,000 emergency calls surveyed during the year 2013 to model and classify the demand for EMS in different scenarios that provide different perspectives on the demand throughout the city, considering such factors as the time of day, work and off-days. A modification of the Double Standard Model (DSM) is proposed and solved to determine a common robust solution to the ambulance location problem that simultaneously satisfies all specified constraints in all demand scenarios selecting from a set of almost 1000 possible base locations. The resulting optimization problems are solved using integer linear programming and the solutions are compared with the locations currently used by the Red Cross. Results show that demand coverage and response times can be substantially improved by relocating the current bases without the need for additional resources. Copyright © 2016 Elsevier Ltd. All rights reserved.
Wu, Ching-Han; Hwang, Kevin P
To improve ambulance response time, matching ambulance availability with the emergency demand is crucial. To maintain the standard of 90% of response times within 9 minutes, the authors introduce a discrete-event simulation method to estimate the threshold for expanding the ambulance fleet when demand increases and to find the optimal dispatching strategies when provisional events create temporary decreases in ambulance availability. The simulation model was developed with information from the literature. Although the development was theoretical, the model was validated on the emergency medical services (EMS) system of Tainan City. The data are divided: one part is for model development, and the other for validation. For increasing demand, the effect was modeled on response time when call arrival rates increased. For temporary availability decreases, the authors simulated all possible alternatives of ambulance deployment in accordance with the number of out-of-routine-duty ambulances and the durations of three types of mass gatherings: marathon races (06:00-10:00 hr), rock concerts (18:00-22:00 hr), and New Year's Eve parties (20:00-01:00 hr). Statistical analysis confirmed that the model reasonably represented the actual Tainan EMS system. The response-time standard could not be reached when the incremental ratio of call arrivals exceeded 56%, which is the threshold for the Tainan EMS system to expand its ambulance fleet. When provisional events created temporary availability decreases, the Tainan EMS system could spare at most two ambulances from the standard configuration, except between 20:00 and 01:00, when it could spare three. The model also demonstrated that the current Tainan EMS has two excess ambulances that could be dropped. The authors suggest dispatching strategies to minimize the response times in routine daily emergencies. Strategies of capacity management based on this model improved response times. The more ambulances that are out of routine duty
Takeda, Elisabete; do Carmo Cruz Robazzi, Maria Lúcia
We analyzed the occurrence of occupational accidents (OA) among ambulance drivers in Emergency Relief (ER), with a view to disclosing the types of events and their causes. A quantitative-qualitative study was carried out through the interview of 22 workers in a city in São Paulo, Brazil. The subjects were male, between 36 and 40 years old (40.9%), married (81.82%), with uncompleted primary education (40.9%), individual (90.9%) and family (54.55%) income between two and four Brazilian minimum wages, not performing any other paid occupation (45.45%). The majority of the OA were typical, due to an excess of exercises and vigorous and repeated movements (42.11%) and aggression through body strength and other means (26.33%). The OA occurs mainly because drivers carry out tasks that do not suit their professional formation.
van der Veen, Egbert
Summary The personnel of an organization often has two conflicting goals. Individual employees like to have a good work-life balance, by having personal preferences taken into account, whereas there is also the common goal to work efficiently. By applying techniques and methods from Operations
Kataoka, Hiroaki; Mochimasu, Kazumi Dokai; Katayama, Akihiko; Kanda, Kanae Oda; Sakano, Noriko; Tanaka, Keiko; Miyatake, Nobuyuki
The aim of this study was to investigate the linkage among climate parameters, total ambulance transports and the number of deaths in Asahikawa City in northern Japan. Monthly data on total ambulance transports and the number of deaths from January 2004 to December 2011 were obtained from Asahikawa City Fire Department and the Asahikawa City official website. Climate parameters for the required period were also obtained from the Japan Meteorological Agency, Japan. To adjust for the population, we also used monthly population data on Asahikawa City. The linkage among climate parameters, total ambulance transports and the number of deaths was evaluated by ecological analysis. The mean air temperature in the Asahikawa area was 7.3 ± 10.1 °C. Total ambulance transports (/a hundred thousand people/day) and the number of deaths (/a hundred thousand people/day) were 10.0 ± 0.6 and 2.6 ± 0.3, respectively. Using quadratic curves, total ambulance transports and the number of deaths were weakly correlated with some climate parameters. The number of deaths was weakly and positively correlated with total ambulance transports. A weak linkage among climate parameters, total ambulance transports and the number of deaths was noted in Asahikawa City, Japan. However, these associations were not as high as expected.
Lorello, David John; Peck, Michael; Albrecht, Marlene; Richey, Karen J; Pressman, Melissa A
It is common practice to keep those patients with lower extremity autografts immobile until post-operative day (POD) 5. There is however inherent risks associated with even short periods of immobility. As of now there are no randomized controlled trials looking at early ambulation of patients with lower extremity autografts in the burn community.The objective of this study was to show that patients who begin ambulation within 24 hours of lower extremity autografting will have no increased risk of graft failure than those patients who remain immobile until POD 5. Thirty-one subjects who received autografts to the lower extremity were randomized after surgery into either the early ambulation group (EAG;17 subjects) or the standard treatment group (STG;14 subjects). Those subjects randomized to the EAG began ambulating with physical therapy on POD 1. Subjects in the STG maintained bed rest until POD 5. There was no difference in the number of patients with graft loss in either the EAG or STG on POD 5, and during any of the follow-up visits. No subjects required regrafting. There was a significant difference in the mean minutes of ambulation, with the EAG ambulating longer than the STG (EAG 23.4 minutes [SD 12.03], STG 14.1 [SD 9.00], P=.0235) on POD 5. Burn patients with lower extremity autografts can safely ambulate on POD 1 without fear of graft failure compared with those patients that remain on bed rest for 5 days.
Bingley, Paul; Westergård-Nielsen, Niels Chr.
personnel structure variation. It is found that personnel policy is strongly related to economic performance. At the margin, more hires are associated with lower profit, and more separations with higher profit. For the average firm, one new job, all else equal, is associated with ?2680 (2000 prices) lower...
The safety and efficiency with which a station operates is a function of the competence and proficiency of all personnel. This includes the nonlicensed personnel who make up the bulk of the station staff. Thus the training of these members of the station complement is an important function in overall station performance. Standards, regulations, regulatory guides, and codes provide guidance to the training requirements for such personnel. Training needs and objectives must be established, a plan prepared and then all incorporated into a training program. A well planned and operated training program will stimulate effective communications between the different groups within the station and between the station and off site support groups
On 19 April the Fire Brigade unveiled its latest acquisition: a brand-new ambulance specially designed for CERN. One of the Fire Brigade's two ambulances has just been replaced by a state-of-the-art vehicle tailor-made to meet CERN's unique requirements. At 4.6 metres long it's much more spacious than its predecessors, providing plenty of room for patient, doctor and paramedic. The ambulance's design and manufacture are the result of a successful collaboration between the Fire Brigade and the technicians from Profile Vehicles, the Finnish company that won the contract following a call for tenders launched in June 2011. "It took us six months to finalise the specification for our new ambulance," explains Patrick Berlinghi, who is responsible for the Fire Brigade's logistics. "We wanted it to be spacious enough for us to be able to work comfortably and to have the latest safety and patient care equipment. We also reques...
Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad
) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48......: Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased....
Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad
) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48......: Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased....
This revision; (1) Contains changes required by the establishment of a consolidated and realigned management structure for civilian personnel, manpower, and related functions in the Office of the Assistant Secretary of the Army...
This edited transcript of a presentation on personnel neutron discusses the accuracy of present dosimetry practices, requirements, calibration, dosemeter types, quality factors, operational problems, and dosimetry for a criticality accident. 32 figs
Implementation of DOE N 5480.6 Radiological Control Manual Article 511(3) requirements, to minimize the assignment of personnel dosimeters, should be done only under a broader context ensuring that capabilities are in place to monitor and record personnel exposure both for compliance and for potential litigation. As noted in NCRP Report No. 114, personnel dosimetry programs are conducted to meet four major objectives: radiation safety program control and evaluation; regulatory compliance; epidemiological research; and litigation. A change to Article 511(3) is proposed that would require that minimizing the assignment of personnel dosimeters take place only following full evaluation of overall capabilities (e.g., access control, area dosimetry, etc.) to meet the NCRP objectives
Discussion: This multicentre randomised study will be the first to test whether a home-based multi-component physiotherapy intervention targeting specific precursors of community ambulation (PUSH is more likely to lead to community ambulation than a home-based non-specific multi-component physiotherapy intervention (PULSE in older adults after hip fracture. The study will also estimate the potential economic value of the interventions.
Acharya, Rija; Badhu, Angur; Shah, Tara; Shrestha, Sharmila
An effective ambulance is a vital requirement for providing an emergency medical service. Well-equipped ambulances with trained paramedics can save many lives during the golden hours of trauma care. The objective was to document the availability and utilization of basic life support equipment in the ambulances and to assess knowledge on first aid among the drivers. Descriptive design was used. Total of 109 ambulances linked to B.P. Koirala Institute of Health Sciences were enrolled using purposive sampling method. Self- constructed observation checklist and semi structured interview schedule was used for data collection. More than half of the respondents had less than five years of experience and were not trained in first aid. About two-third of the respondents had adequate knowledge on first aid. About 90% of the ambulance had oxygen cylinder and adult oxygen mask which was 'usually' used equipment. More than half of ambulance had equipment less than 23% as compared to that of national guidelines. There was significant association of knowledge with the experience (p = 0.004) and training (p = 0.001). Availability of equipment was associated with training received (p = 0.007),organization (p= 0.032)and district (p = 0.023) in which the ambulance is registered. The study concludes that maximum ambulance linked to BPKIHS, Nepal did not have even one fourth of the equipment for basic life support. Equipment usually used was oxygen cylinder and oxygen mask. Majority of driver had adequate knowledge on first aid and it was associated with training and experience.
Hollman, John H; Watkins, Molly K; Imhoff, Angela C; Braun, Carly E; Akervik, Kristen A; Ness, Debra K
Reduced inter-stride complexity during ambulation may represent a pathologic state. Evidence is emerging that treadmill training for rehabilitative purposes may constrain the locomotor system and alter gait dynamics in a way that mimics pathological states. The purpose of this study was to examine the dynamical system components of gait complexity, fractal dynamics and determinism during treadmill ambulation. Twenty healthy participants aged 23.8 (1.2) years walked at preferred walking speeds for 6min on a motorized treadmill and overground while wearing APDM 6 Opal inertial monitors. Stride times, stride lengths and peak sagittal plane trunk velocities were measured. Mean values and estimates of complexity, fractal dynamics and determinism were calculated for each parameter. Data were compared between overground and treadmill walking conditions. Mean values for each gait parameter were statistically equivalent between overground and treadmill ambulation (P>0.05). Through nonlinear analyses, however, we found that complexity in stride time signals (P<0.001), and long-range correlations in stride time and stride length signals (P=0.005 and P=0.024, respectively), were reduced on the treadmill. Treadmill ambulation induces more predictable inter-stride time dynamics and constrains fluctuations in stride times and stride lengths, which may alter feedback from destabilizing perturbations normally experienced by the locomotor control system during overground ambulation. Treadmill ambulation, therefore, may provide less opportunity for experiencing the adaptability necessary to successfully ambulate overground. Investigators and clinicians should be aware that treadmill ambulation will alter dynamic gait characteristics. Copyright © 2016 Elsevier Ltd. All rights reserved.
Corrigan, Rosemary; McBurney, Helen
Community ambulation is an important element of a rehabilitation training programme and its achievement is a goal shared by rehabilitation professionals and clients. The factors that influence a physiotherapist's or health professionals decision making around the preparation of a client for community ambulation and the factors that influence a client's decision to return to walking in their community are unclear. To review the available literature about the factors that have influenced the reasoning and decision making of rehabilitation therapists and clients around the topic of ambulation in the community. Three separate searches of the available literature were undertaken using Ovid, Cinahl, ProQuest, Medline and Ebscohost databases. Databases were searched from 1966 to October 2006.The first search explored the literature for factors that influence the clinical reasoning of rehabilitation therapists. The second search explored the literature for factors that influence client's decision to ambulate in the community. A third search was undertaken to explore the literature for the demands of community ambulation in rural communities. Very few studies were found that explored community ambulation in the context of clinical reasoning and decision making, the facilitators and barriers to a clients return to ambulation in their community or the demands of ambulation in a rural community. Consideration of the environment is key to the successful return to walking in the community of clients with mobility problems yet little literature has been found to guide physiotherapist's decision making about preparing a clients to return to walking in the community. An individual's participation in their society is also a result of the interaction between their personal characteristics and his or her environment. The influence of these characteristics may vary from one individual to another yet the factors that influence a person's decision to return to walking in their community
The book contains the 21 technical papers presented at the Technical Committee Meeting to Elaborate Procedures and Data for the Intercomparison of Personnel Dosimeters organizaed by the IAEA on 22-26 April 1985. A separate abstract was prepared for each of these papers. A list of areas in which additional research and development work is needed and recommendations for an IAEA-sponsored intercomparison program on personnel dosimetry is also included
Anisah, A; Chew, K S; Mohd Shaharuddin Shah, C H; Nik Hisamuddin, N A R
Little is known regarding public opinion of prehospital care in Malaysia. This study was conducted to find out the public's perception and expectations of the ambulance services in one of the university hospitals in Malaysia. A six-month prospective cross-sectional study to look at patients' perception of Hospital Universiti Sains Malaysia's (HUSM) ambulance service was conducted from February 2006 to July 2006. Upon arrival at the hospital, patients or their relatives (who used our hospital's ambulances) were interviewed with a set of questions regarding their perception of the ambulance services and were asked to rate the perception on a Likert Scale from 1 to 10. A convenient sampling method was applied. A total of 87 samples were obtained. Despite the many problems faced by the ambulance service in HUSM, the mean score for each of the questions on patient's perception ranged from 9.33 to 9.70 out of 10. The questions with the highest mean score, which were both 9.70 each, were related to staff attentiveness and staff gentleness. Patients' perceptions can be very subjective, but until further similar studies could be carried out in other parts of Malaysia, this set of data merely represents a numerical measure of public perception of the ambulance services from HUSM.
Marliyyah A. Mahmood
Full Text Available Ambulance services are in operation around the world and yet, until recently, ambulance data has only been used for operational purposes rather than for assessing public health. Ambulance call-out data offers new and valuable (near real-time information that can be used to assess the impact of environmental conditions, such as temperature, upon human health. A detailed analysis of London ambulance data at a selection of dates between 2003 and 2015 is presented and compared to London temperature data. In London, the speed of ambulance response begins to suffer when the mean daily air temperature drops below 2 °C or rises above 20 °C. This is explained largely by the increased number of calls past these threshold temperatures. The baseline relationships established in this work will inform the prediction of likely changes in ambulance demand (and illness types that may be caused by seasonal temperature changes and the increased frequency and intensity of extreme/severe weather events, exacerbated by climate change, in the future.
Luksamijarulkul, Pipat; Pipitsangjan, Sirikun
We sought to assess microbial air quality and bacterial surface contamination on medical instruments and the surrounding areas among 30 ambulance runs during service. We performed a cross-sectional study of 106 air samples collected from 30 ambulances before patient services and 212 air samples collected during patient services to assess the bacterial and fungal counts at the two time points. Additionally, 226 surface swab samples were collected from medical instrument surfaces and the surrounding areas before and after ambulance runs. Groups or genus of isolated bacteria and fungi were preliminarily identified by Gram's stain and lactophenol cotton blue. Data were analyzed using descriptive statistics, t-test, and Pearson's correlation coefficient with a p-value of less than 0.050 considered significant. The mean and standard deviation of bacterial and fungal counts at the start of ambulance runs were 318±485cfu/m(3) and 522±581cfu/m(3), respectively. Bacterial counts during patient services were 468±607cfu/m(3) and fungal counts were 656±612cfu/m(3). Mean bacterial and fungal counts during patient services were significantly higher than those at the start of ambulance runs, p=0.005 and p=0.030, respectively. For surface contamination, the overall bacterial counts before and after patient services were 0.8±0.7cfu/cm(2) and 1.3±1.1cfu/cm(2), respectively (pair samples and bacterial counts on medical instruments and allocated areas. This study revealed high microbial contamination (bacterial and fungal) in ambulance air during services and higher bacterial contamination on medical instrument surfaces and allocated areas after ambulance services compared to the start of ambulance runs. Additionally, bacterial and fungal counts in ambulance air showed a significantly positive correlation with the bacterial surface contamination on medical instruments and allocated areas. Further studies should be conducted to determine the optimal intervention to reduce
Coleman, Gill; Wiggins, Liz
Purpose The purpose of this paper is to argue for the widening of attention in healthcare improvement efforts, to include an awareness of the humanity of people who work in the sector and an appreciation of the part human connection plays in engagement around good quality work. Theoretical frameworks and research approaches which draw on action-based, interpretive and systemic thinking are proposed, as a complement to current practices. Design/methodology/approach The paper describes the early stages of an action research (AR) project, which used the appreciative inquiry "4D" framework to conduct participative inquiry in Hamad Medical Corporation's ambulance service in Qatar, in which staff became co-researchers. Findings The co-researchers were highly motivated to work with improvement goals as a result of their participation in the AR. They, and their managers, saw each other and the work in new ways and discovered that they had much to offer. Research limitations/implications This was a small-scale pilot project, from which findings must be considered tentative. The challenges of establishing good collaboration across language, culture and organisational divides are considerable. Practical implications Appreciative and action-oriented inquiry methods can serve not only to find things out, but also to highlight and give value to aspects of humanity in the workplace that are routinely left invisible in formal processes. This, in turn, can help with quality improvement. Originality/value This paper is a challenge to the orthodox way of viewing healthcare organisations, and improvement processes within them, as reliant on control rather than empowerment. An alternative is to actively include the agency, sense-making capacity and humanity of those involved.
Lam, Sean Shao Wei; Ng, Clarence Boon Liang; Nguyen, Francis Ngoc Hoang Long; Ng, Yih Yng; Ong, Marcus Eng Hock
Dynamic ambulance redeployment policies tend to introduce much more flexibilities in improving ambulance resource allocation by capitalizing on the definite geospatial-temporal variations in ambulance demand patterns over the time-of-the-day and day-of-the-week effects. A novel modelling framework based on the Approximate Dynamic Programming (ADP) approach leveraging on a Discrete Events Simulation (DES) model for dynamic ambulance redeployment in Singapore is proposed in this paper. The study was based on the Singapore's national Emergency Medical Services (EMS) system. Based on a dataset comprising 216,973 valid incidents over a continuous two-years study period from 1 January 2011-31 December 2012, a DES model for the EMS system was developed. An ADP model based on linear value function approximations was then evaluated using the DES model via the temporal difference (TD) learning family of algorithms. The objective of the ADP model is to derive approximate optimal dynamic redeployment policies based on the primary outcome of ambulance coverage. Considering an 8min response time threshold, an estimated 5% reduction in the proportion of calls that cannot be reached within the threshold (equivalent to approximately 8000 dispatches) was observed from the computational experiments. The study also revealed that the redeployment policies which are restricted within the same operational division could potentially result in a more promising response time performance. Furthermore, the best policy involved the combination of redeploying ambulances whenever they are released from service and that of relocating ambulances that are idle in bases. This study demonstrated the successful application of an approximate modelling framework based on ADP that leverages upon a detailed DES model of the Singapore's EMS system to generate approximate optimal dynamic redeployment plans. Various policies and scenarios relevant to the Singapore EMS system were evaluated. Copyright © 2017
Full Text Available Abstract Background Ambulance response time is a crucial factor in patient survival. The number of emergency cases (EMS cases requiring an ambulance is increasing due to changes in population demographics. This is decreasing ambulance response times to the emergency scene. This paper predicts EMS cases for 5-year intervals from 2020, to 2050 by correlating current EMS cases with demographic factors at the level of the census area and predicted population changes. It then applies a modified grouping genetic algorithm to compare current and future optimal locations and numbers of ambulances. Sets of potential locations were evaluated in terms of the (current and predicted EMS case distances to those locations. Results Future EMS demands were predicted to increase by 2030 using the model (R2 = 0.71. The optimal locations of ambulances based on future EMS cases were compared with current locations and with optimal locations modelled on current EMS case data. Optimising the location of ambulance stations locations reduced the average response times by 57 seconds. Current and predicted future EMS demand at modelled locations were calculated and compared. Conclusions The reallocation of ambulances to optimal locations improved response times and could contribute to higher survival rates from life-threatening medical events. Modelling EMS case 'demand' over census areas allows the data to be correlated to population characteristics and optimal 'supply' locations to be identified. Comparing current and future optimal scenarios allows more nuanced planning decisions to be made. This is a generic methodology that could be used to provide evidence in support of public health planning and decision making.
Full Text Available BACKGROUND Abdominal hysterectomy is one of the most frequently performed surgical procedures in women. The non-ambulatory postoperative period is a high risk period for the development of various complications like wound infection, venous stasis, lower respiratory infection, secondary haemorrhage, deep vein thrombosis, pulmonary embolism, paralytic ileus etc. Prolonged surgery, delayed ambulation and not feeding the patient within 48 hours of surgery are often associated with post-operative morbidity and mortality. This study aims to assess the effectiveness of Scheduled Ambulation on early post-operative outcome among patients undergone abdominal hysterectomy by introduction of Scheduled Ambulation from second day of surgery. MATERIALS AND METHODS Method used is quantitative and quasi experimental post-test control method. Scheduled ambulation technique and pattern were taught pre operatively to 35 patients consecutively selected from general and post-operative ward who formed the experimental group. They were given scheduled ambulation from second to fifth post-operative days and results analysed. Another 35 patients taken as control were given the routine post-operative care. Data Analysis- was performed using SPSS version 17.0. Between group comparisons, quantitative variables analysed by Chisquare test p value >0, 05 considered significant. RESULTS The indication of hysterectomy was fibroid uterus in 80% of the control group and 88, 6% of the experimental group. 51.4% of the hysterectomies were encountered in the age group 40-49 years. There was a statistically significant reduction in the severity of pain, fatigue, postural hypotension and risk for developing Deep vein thrombosis in the experimental group on practicing Scheduled Ambulation from second to fifth post-operative days. CONCLUSION Scheduled ambulation helped the abdominal hysterectomy patients to recover from fatigue, pain, postural hypotension and risk for Deep vein thrombosis
This lecture precises the method and means developed by EDF to ensure the training of maintenance personnel according to their initial educational background and their experience. The following points are treated: General organization of the training for maintenance personnel in PWR and GCR nuclear power stations and in Creys Malville fast breeder reactor; Basic nuclear training and pedagogical aids developed for this purpose; Specific training and training provided by contractors; complementary training taking into account the operation experience and feedback; Improvement of velocity, competence and safety during shut-down operations by adapted training. (orig.)
Vidal Gómez, José
The open field test is used to assess ambulation and anxiety; one way to assess anxiety is to compare ambulation in the center with ambulation in the periphery: the more anxious is the mouse, the less it moves in the center. The results of this report cast doubts on the generality of that rule, because they show that ambulation, both in the center and in the periphery, depends on the mouse strain and on the size of the open field; specifically, in a brightly lit open-field of moderate size (3...
Chari, Satyan R; McRae, Prue; Stewart, Matthew J; Webster, Joan; Fenn, Mary; Haines, Terry P
Objective The aim of the present study was to establish the point prevalence of 'suboptimal' features in footwear reported to have been used by older hospital patients when ambulating, and to explore underpinning factors for their choice of footwear. Method A cross-sectional investigation was undertaken on 95 of 149 eligible in-patients across 22 high fall-risk wards in a large metropolitan hospital in Brisbane, Australia. Results Over 70% of participants experienced an unplanned admission. Although most participants had access to some form of footwear in hospital (92%), nearly all reported ambulating in footwear with 'suboptimal' features (99%). Examples included slippers (27%), backless slippers (16%) or bare feet (27%). For patients who ambulated in bare feet, only one-third reported 'lack of access to footwear' as the primary cause, with others citing foot wounds, pain, oedema and personal choice as the main reason for bare foot ambulation. Conclusions Admitted patients frequently use footwear with 'suboptimal' features for ambulation in hospital. While some footwear options (for example well-fitting slippers) could be suited for limited in-hospital ambulation, others are clearly hazardous and might cause falls. Since footwear choices are influenced by multiple factors in this population, footwear education strategies alone may be insufficient to address the problem of hazardous footwear in at-risk patients. Footwear requirements may be more effectively addressed within a multidisciplinary team approach encompassing foot health, mobility and safety. What is known about the topic? Accidental falls while ambulating are an important health and safety concern for older people. Because certain footwear characteristics have been negatively linked to posture and balance, and specific footwear types linked to falls among seniors, the use of footwear with fewer suboptimal characteristics is generally recommended as a means of reducing the risk of falling. While footwear
Using telecommunications technology it would be possible to link a patient and paramedic to a Doctor in the Emergency Department (ED) at the point of first patient contact. A questionnaire-based study on telemedicine in the pre-hospital environment involving patients, paramedics, doctors and nurses in the ED, was performed to assess if they would want and accept telemedicine in pre-hospital emergency care. When asked 98.5% (55) of patients, 89% (11) of doctors, 76% (14) of nurses and 91% (42) of ambulance personnel saw the potential of an audio-visual link from the pre-hospital environment to the ED. The potential benefits were felt to be in diagnosis of time-dependent illnesses, time management, increased hospital preparedness for incoming patients and increased triage efficiency. Stakeholder enthusiasm for pre-hospital telemedicine must be met with the technological requirements to provide such a service. As noted by one patient a pre-hospital audio-visual link to the ED could be “potentially a life saving service”.
Technology of personnel photographic film dosimetry (PPD) based on the photographic effect of ionizing radiation is described briefly. Kinds of roentgen films used in PPD method are enumerated, compositions of a developer and fixing agents for these films are given [ru
Fijn van Draat, Laurens; Post, Gerhard F.; Veltman, Bart; Winkelhuijzen, Wessel
The area of personnel scheduling is very broad. Here we focus on the ‘shift assignment problem’. Our aim is to discuss how ORTEC HARMONY handles this planning problem. In particular we go into the structure of the optimization engine in ORTEC HARMONY, which uses techniques from genetic algorithms,
FOIA Electronic Reading Room Privacy Impact Assessment DTRA No Fear Act Reporting Nuclear Test Personnel Review NTPR Fact Sheets NTPR Radiation Dose Assessment Documents US Atmospheric Nuclear Test History Documents US Underground Nuclear Test History Reports NTPR Radiation Exposure Reports Enewetak
Erbay, Hasan; Alan, Sultan; Kadıoğlu, Selim
This paper will examine a sample case encountered by ambulance staff in the context of the basic principles of medical ethics. An accident takes place on an intercity highway. Ambulance staff pick up the injured driver and medical intervention is initiated. The driver suffers from a severe stomach ache, which is also affecting his back. Evaluating the patient, the ambulance doctor suspects that he might be experiencing internal bleeding. For this reason, venous access, in the doctor's opinion, should be achieved and the patient should be quickly started on an intravenous serum. The patient, however, who has so far kept his silence, objects to the administration of the serum. The day this is taking place is within the month of Ramadan and the patient is fasting. The patient states that he is fasting and that his fast will be broken and his religious practice disrupted in the event that the serum is administered. The ambulance doctor informs him that his condition is life-threatening and that the serum must be administered immediately. The patient now takes a more vehement stand. 'If I am to die, I want to die while I am fasting. Today is Friday and I have always wanted to die on such a holy day,' he says. The ambulance physician has little time to decide. How should the patient be treated? Which type of behaviour will create the least erosion of his values?
Shaikh, Shiraz; Baig, Lubna A; Polkowski, Maciej
The findings of the Health Care in Danger project in Karachi suggests that there is presence of behavioral negligence among vehicle operators on roads in regards to giving way to ambulances. A mass media campaign was conducted to raise people's awareness on the importance of giving way to ambulances. The main objective of this study was to determine the effectiveness of the campaign on increasing the proportion of vehicles that give way to ambulances. This was a quasi-experimental study that was based on before and after design. Three observation surveys were carried out in different areas of the city in Karachi, Pakistan before, during and after the campaign by trained observers who recorded their findings on a checklist. Each observation was carried out at three different times of the day for at least two days on each road. The relationship of the media campaign with regards to a vehicle giving space to an ambulance was calculated by means of odds ratios and 95% confidence intervals using multivariate logistic regression. Overall, 245 observations were included in the analysis. Traffic congestion and negligence/resistance, by vehicles operators who were in front of the ambulance, were the two main reasons why ambulances were not given way. Other reasons include: sudden stops by minibuses and in the process causing obstruction, ambulances not rushing through to alert vehicle operators to give way and traffic interruption by VIP movement. After adjustment for site, time of day, type of ambulance and number of cars in front of the ambulance, vehicles during (OR=2.13, 95% CI=1.22-3.71, p=0.007) and after the campaign (OR=1.73, 95% CI=1.02-2.95, p=0.042) were significantly more likely give space to ambulances. Mass media campaigns can play a significant role in changing the negligent behavior of people, especially when the campaign conveys a humanitarian message such as: giving way to ambulances can save lives.
Heightman, A J
You can see and hear more about my journey throughout Germany and England in a special, archived, free Webcast on jems.com. And in future articles, videos and Web presentations, you'll see and learn about the different EMS delivery models I saw, the men and women whom I met and rode with on calls, and, most importantly, their impressive attitude about patient care, customer service and safety. Progressive American and Canadian ambulance manufacturers now agree with safety experts and forward-thinking ambulance operators that the squad bench is dead. These manufacturers now offer innovative seats that are much safer and functional than those coffin-like obstructions that gobbled up so much space in our rigs for the past three decades. Design your next ambulance around the needs and safety of your crews and their patients, and spec a patient compartment that is laid out logiclaly and efficient.
Liman, Thomas G; Winter, Benjamin; Waldschmidt, Carolin; Zerbe, Norman; Hufnagl, Peter; Audebert, Heinrich J; Endres, Matthias
Pre- and intrahospital time delays are major concerns in acute stroke care. Telemedicine-equipped ambulances may improve time management and identify patients with stroke eligible for thrombolysis by an early prehospital stroke diagnosis. The aims of this study were (1) to develop a telestroke ambulance prototype; (2) to test the reliability of stroke severity assessment; and (3) to evaluate its feasibility in the prehospital emergency setting. Mobil, real-time audio-video streaming telemedicine devices were implemented into advanced life support ambulances. Feasibility of telestroke ambulances and reliability of the National Institutes of Health Stroke Scale assessment were tested using current wireless cellular communication technology (third generation) in a prehospital stroke scenario. Two stroke actors were trained in simulation of differing right and left middle cerebral artery stroke syndromes. National Institutes of Health Stroke Scale assessment was performed by a hospital-based stroke physician by telemedicine, by an emergency physician guided by telemedicine, and "a posteriori" on the basis of video documentation. In 18 of 30 scenarios, National Institutes of Health Stroke Scale assessment could not be performed due to absence or loss of audio-video signal. In the remaining 12 completed scenarios, interrater agreement of National Institutes of Health Stroke Scale examination between ambulance and hospital and ambulance and "a posteriori" video evaluation was moderate to good with weighted κ values of 0.69 (95% CI, 0.51-0.87) and 0.79 (95% CI, 0.59-0.98), respectively. Prehospital telestroke examination was not at an acceptable level for clinical use, at least on the basis of the used technology. Further technical development is needed before telestroke is applicable for prehospital stroke management during patient transport.
Sehnaz Akın Paker
Full Text Available Objectives: In our study we aimed to investigate the quality and quantity of medical management inside ambulances for 14 and over 14 years old patients transported to a level three emergency department (ED. Material and methods: Our study was conducted prospectively at a level three ED. 14 and over 14 years old patients who were transported to the ED by ambulance were included in the study consecutively. “Lack of vital rate” was described as missing of one or more of five vital rates during ambulance transportation. Both of two attending emergency physicians evaluated the medical procedures and management of patients at the ambulance simultaneously and this was recorded on the study forms. Results: Four hundred and fifty six patients were included in the study. Missing vital signs were identified for 90.1% (n = 322 of the patients that were transported by physicians and 92.4% (n = 73 of the patients that were transported by paramedics. For five patients with cardiac arrest two (33.3% had cardiopulmonary resuscitation (CPR, one (20% was intubated, one (20% received adrenaline. Out of 120 patients, needed spinal immobilization, 69 (57.5% had spinal board. Cervical collar usage was 65.1% (n = 69 We have revealed that 316 (69.3% patients did not receive at least one of the necessary medical intervention or treatment. Conclusion: During ambulance transportation, life-saving procedures like cardiopulmonary resuscitation, vital sign measurement, crucial treatment administration, endotracheal intubation, defibrillation, fracture immobilization were not performed adequately. Increasing the training on the deficient interventions and performing administrative inspections may improve quality of patient care. Keywords: Emergency department, Ambulance, Prehospital emergency care
Haferburg, M.; Rehn, H.
Personnel training in German nuclear power plants adheres to high standards complying with government regulations. The development of PC technology allows the introduction of new training methods, e.g. computer based training (CBT), as well as their integration into existing systems. In Germany, the operators of nuclear power plants have developed their own computer based standards with a screen design, a hardware platform and an assessment standard. 25% of the theoretical training of the shift personnel is covered by CBT. The CBT-Programmes offer multimedia features: videos, photographs, sound, graphs and switching diagrams of existing systems, practice oriented simulations and 3-D animations. Interaction is the most important attribute of an efficient self-learning-programme. A typical example of such an appropriate theme is the CBT-Lesson ''Pressure Surges in Pipes and Components of Power Plants''. (author)
Itshayek, Eyal; Candanedo, Carlos; Fraifeld, Shifra; Hasharoni, Amir; Kaplan, Leon; Schroeder, Josh E; Cohen, José E
Metastatic epidural spinal cord compression (MESCC) is a disabling consequence of disease progression. Surgery can restore/preserve physical function, improving access to treatments that increase duration of survival; however, advanced patient age may deter oncologists and surgeons from considering surgical management. Evaluate the duration of ambulation and survival in elderly patients following surgical decompression of MESCC. Retrospective file review of a prospective database, under IRB waiver of informed consent, of consecutive patients treated in an academic tertiary care medical center from 8/2008-3/2015. Patients ≥65 years presenting neurological and/or radiological signs of cord compression due to metastatic disease, who underwent surgical decompression. Duration of ambulation and survival. Patients underwent urgent multidisciplinary evaluation and surgery. Ambulation and survival were compared with age, pre- and postoperative neurological (American Spinal Injury Association [ASIA] Impairment Scale [AIS]) and performance status (Karnofsky Performance Status [KPS], and Tokuhashi Score using Kruskal-Wallis and Wilcoxon signed-rank tests, Pearson correlation coefficient, Cox regression model, log rank analysis, and Kaplan Meir analysis. 40 patients were included (21 male, 54%; mean age 74 years, range 65-87). Surgery was performed a mean 3.8 days after onset of motor symptoms. Mean duration of ambulation and survival were 474 (range 0-1662) and 525 days (range 11-1662), respectively; 53% of patients (21/40) survived and 43% (17/40) retained ambulation for ≥1 year. There was no significant relationship between survival and ambulation for patients aged 65-69, 70-79, or 80-89, although Kaplan Meier analysis suggested stratification. There was a significant relationship between duration of ambulation and pre- and postoperative AIS (p=0.0342, p=0.0358, respectively) and postoperative KPS (p=0.0221). Tokuhashi score was not significantly related to duration of
Raun, L H; Ensor, K B; Campos, L A; Persse, D
Asthma is a serious, sometimes fatal condition, in which attacks vary in severity, potentially requiring emergency medical services (EMS) ambulance treatment. A portion of asthma attacks requiring EMS ambulance treatment may be prevented with improved education and access to care. The aim of this study was to identify areas of the city with high rates of utilization of EMS ambulance for treatment, and the demographics, socio-economic status, and time of day associated with these rates, to better target future interventions to prevent emergencies and reduce cost. A cross-sectional study was conducted on individuals in Houston, TX (USA) requiring ambulance treatment for asthma attacks from 2004 to 2011. 12,155 EMS ambulance-treated asthma attack cases were linked to census tracts. High rate treatment areas were identified with geospatial mapping. Census tract demographic characteristics of these high rate areas were compared with the remainder of the city using logistic regression. The association between case level demographics and the time of day of asthma attack within the high rate area was also assessed with logistic regression. EMS ambulance-treated high rate areas were identified and found to have a utilization incidence rate over six times higher per 100,000 people than the remainder of the city. There is an increased risk of location in this high rate area with a census tract level increase of percent of population: earning less than $10,000 yearly income (RR 1.21, 1.16-1.26), which is black (RR 1.08, 1.07-1.10), which is female (RR 1.34, 1.20-1.49) and have obtained less than a high school degree (RR 1.02, 1.01-1.03). Within the high rate area, case level data indicates an increased risk of requiring an ambulance after normal doctor office hours for men compared with women (RR 1.13, 1.03-1.22), for black compared with Hispanic ethnicity (RR 1.31, 1.08-1.59), or for adults (less than 41 and greater than 60) compared with children. Interventions to prevent
These principles have been applied to our air ambulance system based from Lanseria International Airport. By combining preventative and control measures, there has been no breach in our infection control strategies, as evidenced by no growth noted on specific and random swabs even when more and more ”super bugs” are being identified in hospital. As an air ambulance service flying patients from various African countries, we have the responsibility to conduct our own ”Border Security” to keep our hospitals, patients, aircraft and crews clean and safe. In this presentation we will share our ”Border Security” principles and experiences with the audience.
Steg, Philippe Gabriel; van 't Hof, Arnoud; Clemmensen, Peter
In patients with ST-segment elevation myocardial infarction (STEMI) triaged to primary percutaneous coronary intervention (PCI), anticoagulation often is initiated in the ambulance during transfer to a PCI site. In this prehospital setting, bivalirudin has not been compared with standard-of-care ......In patients with ST-segment elevation myocardial infarction (STEMI) triaged to primary percutaneous coronary intervention (PCI), anticoagulation often is initiated in the ambulance during transfer to a PCI site. In this prehospital setting, bivalirudin has not been compared with standard...
following questions: In what fields are military personnel most likely to patent, and how do demographics, such as age, race, and gender , along with...technologies, which have transformed how the United States wages war. DARPA continues to develop new technologies and capabilities for the U.S. military today...build the European navies so it instead decided to utilize an innovative ship design to exploit a gap specific to the British Royal Navy. The six
If a company or institution hires personnel of a security service company to protect its premises, this kind of employment does not mean the company carries on temporary employment business. Within the purview of section 99, sub-section 1 of the BetrVG (Works Constitution Act), the security service personnel is not 'employed' in the proper sense even if the security tasks fulfilled by them are done at other times by regular employees of the company or institution. The court decision also decided that the Works Council need not give consent to employment of foreign security personnel. The court decision was taken for settlement of court proceedings commenced by Institute of Plasma Physics in Garching. In his comments, W. Hunold accedes to the court's decision and discusses the underlying reasons of this decision and of a previous ruling in the same matter by putting emphasis on the difference between a contract for services and a contract for work, and a contract for temporary employment. The author also discusses the basic features of an employment contract. (orig./HP) [de
Lattin, Kenneth R.
United Nuclear Industries, Inc. (UNI) has developed an automatic personnel contamination monitor (APCM), which uniquely combines the design features of both portal and hand and shoe monitors. In addition, this prototype system also has a number of new features, including: micro computer control and readout, nineteen large area gas flow detectors, real-time background compensation, self-checking for system failures, and card reader identification and control. UNI's experience in operating the Hanford N Reactor, located in Richland, Washington, has shown the necessity of automatically monitoring plant personnel for contamination after they have passed through the procedurally controlled radiation zones. This final check ensures that each radiation zone worker has been properly checked before leaving company controlled boundaries. Investigation of the commercially available portal and hand and shoe monitors indicated that they did not have the sensitivity or sophistication required for UNI's application, therefore, a development program was initiated, resulting in the subject monitor. Field testing shows good sensitivity to personnel contamination with the majority of alarms showing contaminants on clothing, face and head areas. In general, the APCM has sensitivity comparable to portal survey instrumentation. The inherit stand-in, walk-on feature of the APCM not only makes it easy to use, but makes it difficult to bypass. (author)
US Agency for International Development — The eOPF is a digital recreation of paper personnel folder that stores electronic personnel data spanning an individual's Federal career. eOPF allows employees to...
Wihlborg, Jonas; Edgren, Gudrun; Johansson, Anders; Sivberg, Bengt
The Swedish ambulance health care services are changing and developing, with the ambulance nurse playing a central role in the development of practice. The competence required by ambulance nurses in the profession remains undefined and provides a challenge. The need for a clear and updated description of ambulance nurses' competence, including the perspective of professional experiences, seems to be essential. The aim of this study was to elucidate ambulance nurses' professional experiences and to describe aspects affecting their competence. For data collection, the study used the Critical Incident Technique, interviewing 32 ambulance nurses. A qualitative content analysis was applied. This study elucidates essential parts of the development, usage and perceptions of the competence of ambulance nurses and how, in various ways, this is affected by professional experiences. The development of competence is strongly affected by the ability and possibility to reflect on practice on a professional and personal level, particularly in cooperation with colleagues. Experiences and communication skills are regarded as decisive in challenging clinical situations. The way ambulance nurses perceive their own competence is closely linked to patient outcome. The results of this study can be used in professional and curriculum development. Copyright © 2016 Elsevier Ltd. All rights reserved.
Dieperink, Willem; Weelink, E. E. M.; van der Horst, I. C. C.; de Vos, R.; Jaarsma, T.; Aarts, L. P. H. J.; Zijlstra, F.; Nijsten, M. W. N.
Background: Early initiation of continuous positive airway pressure (CPAP) applied by face mask benefits patients with acute cardiogenic pulmonary oedema (ACPE). The simple disposable Boussignac CPAP (BCPAP) has been used in ambulances by physicians. In the Netherlands, ambulances are manned by
Competence of personnel is one of the important problems for safety operation of nuclear power plant. This paper gives a description of some aspects, such as the administration of NPP, posts, competence of personnel, training, assessing the competence and personnel management
Gardner, Andrew W.; Parker, Donald E.; Krishnan, Sowmya; Chalmers, Laura J.
Purposes To compare daily ambulatory measures in children, adolescents, and young adults with and without metabolic syndrome, and to assess which metabolic syndrome components, demographic measures, and body composition measures are associated with daily ambulatory measures. Methods Two-hundred fifty subjects between the ages of 10 and 30 years were assessed on metabolic syndrome components, demographic and clinical measures, body fat percentage, and daily ambulatory strides, durations, and cadences during seven consecutive days. Forty-five of the 250 subjects had metabolic syndrome, as defined by the International Diabetes Federation. Results Subjects with metabolic syndrome ambulated at a slower daily average cadence than those without metabolic syndrome (13.6 ± 2.2 strides/min vs. 14.9 ± 3.2 strides/min; p=0.012), and they had slower cadences for continuous durations of 60 minutes (p=0.006), 30 minutes (p=0.005), 20 minutes (p=0.003), 5 minutes (p=0.002), and 1 minute (p=0.001). However, the total amount of time spent ambulating each day was not different (p=0.077). After adjustment for metabolic syndrome status, average cadence is linearly associated with body fat percentage (pmetabolic syndrome ambulate more slowly and take fewer strides throughout the day than those without metabolic syndrome, even though the total amount of time spent ambulating is not different. Furthermore, the detrimental influence of metabolic syndrome on ambulatory cadence is primarily a function of body fatness. PMID:22811038
... helicopter air ambulance operators implement a safety management system program that includes sound risk... partially address NTSB Safety Recommendation A-09-89 regarding the implementation of sound risk management... documents. Authority for This Rulemaking The FAA's authority to issue rules on aviation safety is found in...
Yperzeele, Laetitia; van Hooff, Robbert-Jan; De Smedt, Ann; Nagels, Guy; Hubloue, Ives; De Keyser, Jacques; Brouns, Raf
Background Heart rate variability (HRV) is a parameter of autonomic nervous system function. A decrease of HRV has been associated with disease severity, risk of complications and prognosis in several conditions. Objective We aim to investigate the feasibility and the reliability of in-ambulance HRV
Clemens, C. H. M.; Samsom, M.; van Berge Henegouwen, G. P.; Smout, A. J. P. M.
Our objective was to evaluate left colonic motility patterns recorded under physiological conditions during 24 hr in fully ambulant nonconstipated IBS patients compared to healthy controls. A 42-hr manometry of the left colon was performed in 11 nonconstipated IBS patients and 10 age- and
Bergmueller, A; Zavgorodnii, I; Zavgorodnia, N; Kapustnik, W; Boeckelmann, I
The work in Emergency Medical Ambulance Service is one of the professions, which is accompanied by high psychological and emotional stress. The aim was to determine the risk of professional burnout syndrome of Emergency Medical Ambulance Service staff and the relationship between burnout syndrome and personality. Ninety-seven doctors (57 women and 40 men, aged 37.0±12.21) of Emergency Medical Ambulance Service were interviewed using the MBI-GS questionnaire and the Freiburg personality questionnaire (FPI). Correlation and regression analysis were used. Nine (11.5%) of respondents had a risk of burnout syndrome and 28 (35.9%) had some symptoms. In the group, aged 45 years and older, the risk of burnout syndrome was not identified. The staff of Emergency Medical Ambulance Service is characterized by stable personality features. It is necessary to identify the prevalence of burnout syndrome and also to identity the causes for its prevention and development of measures on the increase of personal stress resilience.
Chae, Hee Dong; Choi, Seung-Bok
The vibration experienced in an ambulance can lead to secondary injury to a patient and discourage a paramedic from providing emergency care. In this study, with the goal of resolving this problem, a new vibration isolation bed stage associated with magnetorheological (MR) dampers is proposed to ensure ride quality as well as better care for the patient while he/she is being transported. The bed stage proposed in this work can isolate vibrations in the vertical, rolling and pitching directions to reflect the reality that occurs in the ambulance. Firstly, an appropriate-sized MR damper is designed based on the field-dependent rheological properties of MR fluid, and the damping force characteristics of a MR damper are evaluated as a function of the current. A mechanical model of the proposed vibration isolation bed stage is then established to derive the governing equations of motion. Subsequently, a sliding mode controller is formulated to control the vibrations caused from the imposed excitation signals; those signals are directly measured using a real ambulance subjected to bump-and-curve road conditions. Using the controller based on the dynamic motion of the bed stage, the vibration control performance is evaluated in both the vertical and pitch directions. It is demonstrated that the magnitude of the vibration in the patient compartment of the ambulance can be significantly reduced by applying an input current to the MR dampers installed for the new bed stage. (technical note)
Ten Duis, K.; Bosmans, J. C.; Voesten, H. G. J.; Geertzen, J. H. B.; Dijkstra, P. U.
The aim of this study was to analyze survival, wound healing and ambulation after knee disarticulation (KD). A historic cohort study using medical records and nursing home records was performed. Data included demographics, reason for amputation, concomitant diseases, survival, wound healing,
Tolboom, N.; Cats, E. A.; Helders, P. J. M.; Pruijs, J. E. H.; Engelbert, R. H. H.
We studied the effects of spondylodesis on spinal curvature, functional outcome, level of ambulation and perceived competence in 11 children with osteogenesis imperfecta (OI). Mean age at surgical intervention was 13.1 years (SD 2.5 years) and follow-up amounted to 3.4 years (SD 2.3 years). Spinal
Abdollahi, Ali Akbar; Mehranfard, Shahzad; Behnampour, Nasser; Kordnejad, Abdol Mohamad
After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization. In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol), early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS) of pain and Kristin Swain's check list was applied to evaluate the severity of bleeding and hematoma. None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference. Based on the findings of this study, changing patients' position can be safe and they can be ambulated early after angiography.
Ali Akbar Abdollahi
Full Text Available Introduction: After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization. Methods: In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol, early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS of pain and Kristin Swain’s check list was applied to evaluate the severity of bleeding and hematoma. Results: None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference.Conclusion: Based on the findings of this study, changing patients’ position can be safe and they can be ambulated early after angiography.
Deakin, Charles D; Thompson, Fizz; Gibson, Caroline; Green, Mark
Prompt ambulance attendance is aimed at improving patient care. With finite resources struggling to meet performance targets, unforeseen demand precludes the ability to tailor resources to cope with increased call volumes, and can have a marked detrimental effect on performance and hence patient care. The effects of the 2006 World Cup football matches on call volumes and profiles were analysed to understand how public events can influence demands on the ambulance service. All emergency calls to the Hampshire Ambulance Service NHS Trust (currently the Hampshire Division of South Central Ambulance Service, Winchester, UK) during the first weekend of the 2006 World Cup football matches were analysed by call volume and classification of call (call type). On the day of the first football match, call volume was over 50% higher than that on a typical Saturday, with distinct peaks before and after the inaugural match. Call profile analysis showed increases in alcohol-related emergencies, including collapse, unconsciousness, assault and road traffic accidents. The increase in assaults was particularly marked at the end of each match and increased again into the late evening. A detailed mapping of call volumes and profiles during the World Cup football shows a significant increase in overall emergency calls, mostly alcohol related. Mapping of limited resources to these patterns will allow improved responses to emergency calls.
Wang, Po T.; King, Christine E.; Chui, Luis A.; Do, An H.; Nenadic, Zoran
Objective. Spinal cord injury (SCI) often leaves affected individuals unable to ambulate. Electroencephalogram (EEG) based brain-computer interface (BCI) controlled lower extremity prostheses may restore intuitive and able-body-like ambulation after SCI. To test its feasibility, the authors developed and tested a novel EEG-based, data-driven BCI system for intuitive and self-paced control of the ambulation of an avatar within a virtual reality environment (VRE). Approach. Eight able-bodied subjects and one with SCI underwent the following 10-min training session: subjects alternated between idling and walking kinaesthetic motor imageries (KMI) while their EEG were recorded and analysed to generate subject-specific decoding models. Subjects then performed a goal-oriented online task, repeated over five sessions, in which they utilized the KMI to control the linear ambulation of an avatar and make ten sequential stops at designated points within the VRE. Main results. The average offline training performance across subjects was 77.2±11.0%, ranging from 64.3% (p = 0.001 76) to 94.5% (p = 6.26×10-23), with chance performance being 50%. The average online performance was 8.5±1.1 (out of 10) successful stops and 303±53 s completion time (perfect = 211 s). All subjects achieved performances significantly different than those of random walk (p prosthesis systems may be feasible.
Schoenmakers, M. A. G. C.; Gooskens, R. H. J. M.; Gulmans, V. A. M.; Hanlo, P. W.; Vandertop, W. P.; Uiterwaal, C. S. P. M.; Helders, P. J. M.
The aim of this study was to determine the long-term outcome of neurosurgical untethering on neurosegmental motor level and ambulation level in children with tethered spinal cord syndrome. Forty-four children were operated on (17 males, 27 females; mean age at operation 6 years 2 months, SD 5
A dosimeter and method for use by personnel working in an area of mixed ionizing radiation fields for measuring and/or determining the effective energy of x- and gamma radiation; beta, x-, and gamma radiation dose equivalent to the surface of the body; beta, x-, and gamma radiation dose equivalent at a depth in the body; the presence of slow neutron, fast neutron dose equivalent; and orientation of the person wearing the dosimeter to the source of radiation is disclosed. Optionally integrated into this device and method are improved means for determining neutron energy spectrum and absorbed dose from fission gamma and neutron radiation resulting from accidental criticality
In the field of personnel policy and management two main points must be considered and fitted together: the aspects of the applicant and the aspects of the utility. The applicant wishes a position which suits to his abilities, education, training, experience and self-evaluation. The enterprise has beside these qualification criteria to look to some additional points: reliability - not only in the profession of the applicant but also in his daily life. In this examination licensing authorities are involved too; responsibility in a very broad sense and the ability to make correct decisions sometimes under stress situations. (orig.)
Williams, Teresa A; Finn, Judith; Celenza, Antonio; Teng, Tiew-Hwa; Jacobs, Ian G
Acute pulmonary edema (APE) is a common cause of acute dyspnea. In the prehospital setting, it is often difficult to differentiate APE from other causes of shortness of breath (SOB). Radiography and echocardiography aid in the identification of APE but are often not available. There is little information on how accurately ambulance paramedics identify patients with APE. Objectives. This study aimed to 1) describe the prehospital clinical presentation and management of patients with a clinical diagnosis of APE and 2) compare the accuracy of coding of APE by paramedics against the emergency department (ED) medical discharge diagnosis. This study included a retrospective cohort of all patients who had episodes identified as APE by ambulance paramedics and were transported to a metropolitan hospital ED in 2011. Two databases were used: an ambulance database and the Emergency Department Information System. The ED medical discharge diagnosis (using International Statistical Classification of Diseases and Related Problems, 10th Revision, Australian Modification [ICD-10-AM] codes) was used as the comparator with paramedic-assigned problem codes for APE. The outcomes for the study were the positive predictive value, i.e., the proportion of patients identified as having APE in the ambulance database who also had an ED discharge diagnosis of APE, and the sensitivity of paramedic identification of APE, i.e., the proportion of patients with an ED discharge diagnosis of APE that were correctly identified as APE by the ambulance paramedics. Four hundred ninety-five patients were transported to an ED with APE identified by the paramedics as the primary problem code. Shortness of breath, crepitations, high systolic blood pressure, and chest pain were the most common presenting signs and symptoms. Pink frothy sputum was rare (3% of patient episodes of APE). One hundred eighty-six patients received an ED discharge diagnosis of APE, i.e., a positive predictive value of 41%. Of 631 ED
Casey, Megan L; Nguyen, Duong T; Idriss, Barrie; Bennett, Sarah; Dunn, Angela; Martin, Stephen
Prehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control. An ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance. A convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed. Many vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a
Ssebunya, Rogers; Matovu, Joseph K B
Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda. This was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool. Of the 391 women, 189 (48.3%) reported that they had ever utilized motorcycle ambulances. Of these, 94.7% were currently married or living together with a partner while 50.8% earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95% CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95% CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95% CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95% CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances
Trowbridge, Matthew J; Gurka, Matthew J; O'Connor, Robert E
Minimizing emergency medical service (EMS) response time is a central objective of prehospital care, yet the potential influence of built environment features such as urban sprawl on EMS system performance is often not considered. This study measures the association between urban sprawl and EMS response time to test the hypothesis that features of sprawling development increase the probability of delayed ambulance arrival. In 2008, EMS response times for 43,424 motor-vehicle crashes were obtained from the Fatal Analysis Reporting System, a national census of crashes involving > or =1 fatality. Sprawl at each crash location was measured using a continuous county-level index previously developed by Ewing et al. The association between sprawl and the probability of a delayed ambulance arrival (> or =8 minutes) was then measured using generalized linear mixed modeling to account for correlation among crashes from the same county. Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival (p=0.03). This probability increases quadratically as the severity of sprawl increases while controlling for nighttime crash occurrence, road conditions, and presence of construction. For example, in sprawling counties (e.g., Fayette County GA), the probability of a delayed ambulance arrival for daytime crashes in dry conditions without construction was 69% (95% CI=66%, 72%) compared with 31% (95% CI=28%, 35%) in counties with prominent smart-growth characteristics (e.g., Delaware County PA). Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival following motor-vehicle crashes in the U.S. The results of this study suggest that promotion of community design and development that follows smart-growth principles and regulates urban sprawl may improve EMS performance and reliability.
Scott, Erika E; Earle-Richardson, Giulia; Krupa, Nicole; Jenkins, Paul
Agriculture ranks as one of the most hazardous industries in the nation. Agricultural injury surveillance is critical to identifying and reducing major injury hazards. Currently, there is no comprehensive system of identifying and characterizing fatal and serious non-fatal agricultural injuries. Researchers sought to calculate a multiplier for estimating the number of agricultural injury cases based on the number of times the farm box indicator was checked on the ambulance report. Farm injuries from 2007 that used ambulance transport were ascertained for 10 New York counties using two methods: (1) ambulance reports including hand-entered free text; and (2) community surveillance. The resulting multiplier that was developed from contrasting these two methods was then applied to the statewide Emergency Medical Services database to estimate the total number of agricultural injuries for New York state. There were 25,735 unique ambulance runs due to injuries in the 10 counties in 2007. Among these, the farm box was checked a total of 90 times. Of these 90, 63 (70%) were determined to be agricultural. Among injury runs where the farm box was not checked, an additional 59 cases were identified from the free text. Among these 122 cases (63 + 59), four were duplicates. Twenty-four additional unique cases were identified from the community surveillance for a total of 142. This yielded a multiplier of 142/90 = 1.578 for estimating all agricultural injuries from the farm box indicator. Sensitivity and specificity of the ambulance report method were 53.4% and 99.9%, respectively. This method provides a cost-effective way to estimate the total number of agricultural injuries for the state. However, it would not eliminate the more labor intensive methods that are required to identify of the actual individual case records. Incorporating an independent source of case ascertainment (community surveillance) increased the multiplier by 17%. Copyright © 2011 Elsevier Inc. All rights
Selected staffs (in the area of NPPs) are examined by the State Examining Committee established by Nuclear Regulatory Authority of the Slovak Republic (NRA SR's) chairman. The committee consists of representatives of NRA SR , Bohunice NPPs, Mochovce NPP, Research Institute of Nuclear Energy and experts from the Faculty of Electrical Engineering and Information Technology of the Slovak Technical University. The review of selected personnel of NPP V-1, V-2 and Mochovce NPP which passed exams in 1996 is given. NRA SR paid attention to the upgrading training process of individual categories of staff for V-1, V-2 and Mochovce NPPs, simulator training and training with computerized simulation system according to the United criteria of nuclear installation personnel training that started in 1992. During the year, an inspection was performed focused on examination of technical equipment of the simulator of Mochovce NPP, professional eligibility and overall preparation of simulator training including simulator software. Throughout the year launching works continued at the simulator with the deadline of commissioning to trial use operation in the first half of 1997
With the increasing use of nuclear power and radiation sources, the selection of optimum systems for personnel monitoring is becoming a matter of worldwide concern. The present status of personnel dosimetry, sometimes characterized by unstable and inaccurate detectors and oversimplified interpretation of the results, leaves much to be desired. In particular, photographic film, although having certain advantages with regard to economics and information content, undergoes rapid changes in warm and humid climates. Careful sealing reduces, but does not prevent, these problems. The replacement of film by solid-state dosimeters, primarily thermoluminescence dosimeters, is in progress or being considered by an increasing number of institutions and requires a number of decisions concerning the choice of the optimum detector(s), badge design, and evaluation system; organizational matters, such as the desirability of automation and computerized bookkeeping; etc. The change also implies the potential use of such advanced concepts as different detectors and monitoring periods for the large number of low-risk persons and the small number of high-risk radiation workers. (auth)
In order to make the full benefits of neutron radiography available in the nondestructive test (NDT) field, it has been necessary to formalize its application. A group under the Penetrating Radiation Committee of the American Society for Nondestructive Testing (ASNT) was organized to prepare a recommended practice for neutron radiography. The recommended practices require the establishment of an appropriate certification program. The requirements on the employer to establish and maintain a qualification and certification program are outlined. To conduct a program of nondestructive testing using neutron radiography requires the usual three levels of qualified and certified personnel. The program is administered by a Level III person. Routine exposure, reviews, and reporting of test results are the responsibilities of Level I and Level II personnal. The amount of training and nature of the required practical examination are also specified. The recommended practices document assures users that NDT work in the field of neutron radiography is performed by qualified personnel. Although no training courses are available to provide experience in the depth required by the recommended practices document, SNT-TC-1A, short courses are provided at a number of locations to familarize user's representatives with the interpretation of neutron radiographs and capabilities and limitations of the technique
Li Wang; Xilin Hou; Lili Zhang
The existing personnel selection decisions in practice are based on the evaluation of job seeker's human capital, and it may be difficult to make personnel-job matching and make each party satisfy. Therefore, this paper puts forward a new personnel selection method by consideration of bilateral matching. Starting from the employment thoughts of ¡°satisfy¡±, the satisfaction evaluation indicator system of each party are constructed. The multi-objective optimization model is given according to ...
Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Buono, Serafino
These three single-case studies assessed the use of walker devices and microswitch technology for promoting ambulation behavior among persons with multiple disabilities. The walker devices were equipped with support and weight lifting features. The microswitch technology ensured that brief stimulation followed the participants' ambulation responses. The participants were two children (i.e., Study I and Study II) and one man (i.e., Study III) with poor ambulation performance. The ambulation efforts of the child in Study I involved regular steps, while those of the child in Study II involved pushing responses (i.e., he pushed himself forward with both feet while sitting on the walker's saddle). The man involved in Study III combined his poor ambulation performance with problem behavior, such as shouting or slapping his face. The results were positive for all three participants. The first two participants had a large increase in the number of steps/pushes performed during the ambulation events provided and in the percentages of those events that they completed independently. The third participant improved his ambulation performance as well as his general behavior (i.e., had a decline in problem behavior and an increase in indices of happiness). The wide-ranging implications of the results are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.
Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick
U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.
Asci, Ozlem; Hazar, Guleser; Sercan, Isa
The objective of this study is to determine the states of health care personnel, working at 112 emergency stations in the province of Artvin, to encounter with regarding forensic cases and determine their practices aimed at recognizing, protecting, and reporting the evidences that may affect the forensic process. This descriptive study was conducted with nurses and emergency medicine technicians working at 112 emergency stations in Artvin between January 2013 and February 2014. Of 141 health personnel that constituted sample of the study, 48.9% were nurses, 9.9% emergency medicine technicians, and 41.1% ambulance and emergency care technicians. The rate of feeling sufficient in coping with forensic cases and incidents was 20.6%. There was a lower rate of receiving education about the approach towards forensic cases (15.6%). In the study, the frequency of encountering with at least one forensic case was 88.7%. Traffic accidents (72.5%), suicides (41.5%) and assaults (41.5%) were among the most frequent reasons of forensic cases. The practices of nurses were more successful in woundings by firearms compared to other health personnel (p forensic cases. The personnel with higher educational level and nurses have more successful practices in forensic cases. Health personnel have approaches that may negatively affect the solution of forensic cases.
Ischaemic stroke clinical outcomes are improved by earlier treatment with intravenous thrombolysis. An existing pathway at the Mater University Hospital for assessment of suspected acute stroke in the Emergency Department was updated, aiming to shorten ‘door to needle time’. This study examines the final clinical diagnosis of Dublin Fire Brigade Ambulance Paramedic identified Face Arm Speech Test (FAST) positive patients presenting to the Emergency Department over a 7 month period. A retrospective analysis was carried out of 177 consecutive FAST positive patients presenting between March and November 2014. The final clinical diagnosis was acute stroke in 57.1% (n=101) of patients. Of these, 76 were ischaemic strokes of whom 56.5% (n=43) were thrombolysed. In the pre-hospital setting Ambulance Paramedics can identify, with reasonable accuracy, acute stroke using the FAST test. Over half of the ischaemic stroke patients presenting via this pathway can be treated with intravenous thrombolysis
Kuisma, Markku; Väyrynen, Taneli; Hiltunen, Tuomas; Porthan, Kari; Aaltonen, Janne
We examined the effect of the change from paper records to the electronic patient records (EPRs) on ambulance call duration. We retrieved call duration times 6 months before (group 1) and 6 months after (group 2) the introduction of EPR. Subgroup analysis of group 2 was fulfilled depending whether the calls were made during the first or last 3 months after EPR introduction. We analyzed 37 599 ambulance calls (17 950 were in group 1 and 19 649 were in group 2). The median call duration in group 1 was 48 minutes and in group 2 was 49 minutes (P = .008). In group 2, call duration was longer during the first 3 months after EPR introduction. In multiple linear regression analysis, urgency category (P introduction was noticed, reflecting adaptation process to a new way of working.
van Bergen, Leo
The paper looks at two First World War ambulance teams which distinctly differed from each other, both in the way they perceived the war and the places at the front where they worked. The first was working on the Serbian side and the second on the Austrian-Hungarian. The questions raised are: how was medical neutrality defined (was it defined at all)? Was neutrality maintained, and if so how? The writings of several protagonists are closely examined, and placed in context, to show that total neutrality was not adhered to by the physicians and nurses of these ambulances. Apparently neutrality in wartime is difficult, even for men and women coming from a neutral country with an occupation seen as essentially neutral.
Bøtker, Morten Thingemann
dyspnea in the ambulance requires identification of high-risk groups and early correct treatment. Bringing forward simplified versions of advanced diagnostic modalities known from the hospital as point-of-care diagnostics already in the ambulance may aid the discrimination of underlying conditions causing......, we included all patients dialing the emergency number (1-1-2) due to a medical emergency in three of five Danish regions. For identification of highrisk patients and evaluation of electrocardiogram-based triage, we compared short-term mortality between patients included in the first study based...... that are highly prioritized in emergency medical services – including chest pain and trauma. Whether this increased mortality can be ascribed to an older age and comorbidity among patients suffering dyspnea, or if modifiable risk factors are also present, is unsettled. Improving outcome for patients suffering...
de Boer, Edith M; Geerkens, Maud; Mooij, Michael C
The incidence of crural ulcers is high. They reduce quality of life considerably and create a burden on the healthcare budget. The key treatment is ambulant compression therapy (ACT). We describe two patients with crural ulcers whose ambulant compression treatment was suboptimal and did not result in healing. When the bandages were applied correctly healing was achieved. If correctly applied ACT should provide sufficient pressure to eliminate oedema, whilst taking local circumstances such as bony structures and arterial qualities into consideration. To provide pressure-to-measure regular practical training, skills and regular quality checks are needed. Knowledge of the properties of bandages and the proper use of materials for padding under the bandage enables good personalised ACT. In trained hands adequate compression and making use of simple bandages and dressings provides good care for patients suffering from crural ulcers in contrast to inadequate ACT using the same materials.
As required by 10 CFR Part 73, this training manual provides guidance to assist licensees in the development of security personnel training and qualifications programs. The information contained in the manual typifies the level and scope of training for personnel assigned to perform security related tasks and job duties associated with the protection of nuclear fuel cycle facilities and nuclear power reactors
Discusses the backgrounds and qualifications appropriate for a library personnel administrator, including (1) a master's degree in library science; (2) library work experience; (3) additional training in administration, personnel management, organizational development, and psychology; and (4) personal attributes such as good communication skills,…
Bouchard, Ronald A.
Personnel administration in higher education is the focus of this "hands-on, how-to-do-it" guide that provides fundamental materials for developing and maintaining a sound personnel program. Part One (Employment) examines government regulations, employee recruitment and selection, pre-employment inquiries and screening, post-employment process,…
Full Text Available Background: Transient neurological symptoms (TNS, was described in patients recovering from spinal anesthesia with lidocaine but its etiology remains unknown this study was evaluated the influence of ambulation time on the occurrence of TNSs after spinal anesthesia with lidocaine 5%. Materials and Methods: This randomized clinical trial was conducted on 60 patients with American Society of Anesthesiologists Grades I and II, who were candidates for lower abdominal surgery in supine or lithotomy positions. Patients were randomly divided into early ambulation group (Group A who were asked to start walking as soon as the anesthesia was diminished or to the late ambulation group (Group B who walked after at least 12 h bedridden. Participants were contacted 2 days after spinal anesthesia to assess any type of pain at surgical or anesthesia injection site, muscle weakness, fatigue, vertigo, nausea, vomiting, headache, and difficult urination or defecation. Results: Four subjects (13.3% in Group A and two patients (6.7% in Group B had pain at anesthesia injection site (P = 0.019. Fourteen patients in Group A (46.7% and six patients in Group B (20% had post-dural puncture headache (P = 0.014. Participants in Group B reported difficult urination more than Group A (P = 0.002. there were not statistically significant differences between two groups regarding frequency of fatigue, muscle weakness, vertigo, nausea, vomiting, difficult defecation, paresthesia, and the mean of visual analogue scale at the surgical site. Conclusion: Early ambulation after spinal anesthesia with lidocaine did not increase the risk of neurologic complication.
Delgado, M. Kit; Meng, Lesley J.; Mercer, Mary P.; Pines, Jesse M.; Owens, Douglas K.; Zaric, Gregory S.
Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion. Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional st...
Rosell Ortiz, Fernando; García Del Águila, Javier; Fernández Del Valle, Patricia; J Mellado-Vergel, Francisco; Vergara-Pérez, Santiago; R Ruiz-Montero, María; Martínez-Lara, Manuela; J Gómez-Jiménez, Francisco; Gonzáez-Lobato, Ismael; García-Escudero, Guillermo; Ruiz-Bailén, Manuel; Caballero-García, Auxiliadora; Vivar-Díaz, Itziar; Olavarría-Govantes, Luis
To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome. Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.
The measurement of neutron exposures to personnel is an issue that has received increased attention in the last few years. It is important to consider key aspects of the whole dosimetry system when developing dose estimates. This begins with selection of proper dosimeters and survey instruments, and extends through the calibration methods. One must match the spectral response and sensitivity of the dosimeter to the spectral characteristics of the neutron fields. Threshold detectors that are insensitive to large fractions of neutrons in the lower energy portion of reactor spectra should be avoided. Use of two or more detectors with responses that complement each other will improve measurement quality. It is important to understand the spectral response of survey instruments, so that spectra which result in significant overresponse do not lead to overestimation of dose. Calibration sources that do not match operational field spectra can contribute to highly erroneous results. In those situations, in-field calibration techniques should be employed. Although some detection developments have been made in recent years, a lot can be done with existing technology until fully satisfactory, long term solutions are obtained
Baechler, S.; Gardon, M.; Bochud, F.; Sans-Merce, M.; Verdun, F.R.; Trueb, Ph.
Physicians who frequently perform fluoroscopic examinations are exposed to high intensity radiation fields and should use protective equipment such as lead aprons, thyroid shields and lead glasses. Standard individual dosimeters are worn under the lead apron in order to measure a dose that is representative of effective dose. However, large parts of the body are not protected by the apron (e.g. arms, head). Given a protection factor for the apron of about 100, an important irradiation of a body part not under the apron could go undetected. A study was conducted to analyse this situation by measuring dose using two dosimeters, one over-apron and one under-apron, for radiologists performing frequent fluoroscopic examinations. Measurements made over six-month period show that, indeed, the use of a single under-apron dosimeter is inadequate for personnel monitoring. Large doses to the head and arms are going undetected by this technique. A method for weighting the doses measured by under- and over-apron dosimeters to obtain a value better representative of the effective dose will be proposed. (authors)
The first step of on-the-job training is practical observation phase in an operating Nuclear Plant, where the participants are assigned to shift work. The simulator training for operating personnel, for key personnel and, to some extent, also for maintenance personnel and specialists give the practical feeling for Nuclear Power Plant behaviour during normal and abnormal conditions. During the commissioning phase of the own Nuclear Power Plant, which is the most important practical training, the participants are integrated into the commissioning staff and assisted during their process of practical learning by special instructors. The preparation for the licensing exams is vitally important for shift personnel and special courses are provided after the first non-nuclear trial operation of the plant. Personnel training also includes performance of programmes and material for retraining, training of instructors and assistance in building up special training programmes and material as well as training centers. (orig./RW)
Managers of ambulance stations face many communicative challenges in their interaction with employees working in prehospital first-line services. The article presents an exploratory study of how paramedics experience these challenges in communication with station leaders. On the basis of a dialogue perspective in qualitative method, 24 paramedics were interviewed in one-to-one and focus group settings. Naturalistic and phenomenological approaches were used to analyze the interviews. All the paramedics said that they wished to be more involved in decision processes and that station managers should provide better explanations of information "from above." The paramedics understood that it was difficult for the managers to find time for extensive dialogue, but many thought that the managers should give more priority to communication. The paramedics' views correspond to theoretical assumptions in human resource management. According to this model, employees should be involved in decision processes on management levels, as long as it is realistically possible to do so. Furthermore, expressing emotional support and positive attitudes does not take much time, and the study suggests that many ambulance managers should focus more on interpersonal relations to employees. It has been extensively documented that management communication affects organizational performance. The study indicates that managers of ambulance stations should be more aware of how their leadership style affects professional commitment and motivation in the first-line services.
Full Text Available Selecting the best solution to deploy an ambulance in a strategic location is of the important variables that need to be accounted for improving the emergency medical services. The selection requires both quantitative and qualitative evaluation. Fuzzy set based approach is one of the well-known theories that help decision makers to handle fuzziness, uncertainty in decision making and vagueness of information. This paper proposes a new decision making method of Interval Type-2 Fuzzy Simple Additive Weighting (IT2 FSAW as to deal with uncertainty and vagueness. The new IT2 FSAW is applied to establish a preference in ambulance location. The decision making framework defines four criteria and five alternatives of ambulance location preference. Four experts attached to a Malaysian government hospital and a university medical center were interviewed to provide linguistic evaluation prior to analyzing with the new IT2 FSAW. Implementation of the proposed method in the case of ambulance location preference suggests that the ‘road network’ is the best alternative for ambulance location. The results indicate that the proposed method offers a consensus solution for handling the vague and qualitative criteria of ambulance location preference.
Hagihara, Akihito; Onozuka, Daisuke; Nagata, Takashi; Abe, Takeru; Hasegawa, Manabu; Nabeshima, Yoshihiro
Although dispatching ambulance crews from unaffected areas to a disaster zone is inevitable when a major disaster occurs, the effect on emergency care in the unaffected areas has not been studied. We evaluated whether dispatching ambulance crews from unaffected prefectures to those damaged by the Great East Japan Earthquake was associated with reduced resuscitation outcomes in out-of-hospital cardiac arrest (OHCA) cases in the unaffected areas. We used the Box-Jenkins transfer function model to assess the relationship between ambulance crew dispatches and return of spontaneous circulation (ROSC) before hospital arrival or 1-month survival after the cardiac event. In a model whose output was the rate of ROSC before hospital arrival, dispatching 1000 ambulance crews was associated with a 0.474% decrease in the rate of ROSC after the dispatch in the prefectures (p=0.023). In a model whose output was the rate of 1-month survival, dispatching 1000 ambulance crews was associated with a 0.502% decrease in the rate of 1-month survival after the dispatch in the prefectures (p=0.011). The dispatch of ambulances from unaffected prefectures to earthquake-stricken areas was associated with a subsequent decrease in the ROSC and 1-month survival rates in OHCA cases in the unaffected prefectures.
Ichiki, Toshihiro; Onozuka, Daisuke; Kamouchi, Masahiro; Hagihara, Akihito
The aim of this study is to determine whether short-term exposure to fine particulate matter (PM 2.5 ) is associated with emergency ambulance dispatches for cardiovascular diseases in Japan. The nationwide data on emergency dispatches of ambulance for cardiovascular diseases classified as I00-I99 by International Classification of Diseases-10th revision in 30 Japanese prefectures between April 1 and December 31, in 2010 were analyzed. Data on weather variability including PM 2.5 , temperature and relative humidity were acquired from ambient air pollution monitoring stations. Conditional Poisson regression models were used to estimate the prefecture-specific effects of PM 2.5 on morbidity, and adjust for confounding factors. A meta-analysis was then applied to pool estimates at the 30-prefecture level. A total of 160,566 emergency ambulance dispatches for cardiovascular diseases were reported during the study period. The risk of emergency ambulance dispatch for cardiovascular diseases significantly increased with an increase in the exposure to PM 2.5 in Fukuoka and Iwate Prefectures. However, we found no statistically significant associations between PM 2.5 and emergency ambulance dispatches in the pooled analysis (odds ratio 1.00, 95 % confidence interval 0.99-1.00). Heterogeneity was not observed between prefectures (Cochran Q test, p = 0.187, I 2 = 18.4 %). Exposure to PM 2.5 is not associated with overall emergency ambulance dispatches for cardiovascular diseases in Japan.
Adogwa, Owoicho; Elsamadicy, Aladine A; Fialkoff, Jared; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos
Ambispective cohort review. To examine the effects of early mobilization on patient outcomes, complications profile, and 30-day readmission rates. Prolonged immobilization after surgery can result in functional decline and an increased risk of hospital-associated complications. We conducted an ambispective study of 125 elderly patients (>65 years) undergoing elective spinal surgery for correction of adult degenerative scoliosis. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. "Days of immobility" was defined as the number of days until a patient moved out of bed beyond a chair. Patients in the top and bottom quartiles were dichotomized into "early ambulators" and "late ambulators", respectively. Early ambulators were ambulatory within 24 hours of surgery, whereas late ambulators were ambulatory at a minimum of 48 hours after surgery. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between early ambulators and late ambulators. Baseline characteristics were similar between both cohorts. Compared with patients with a longer duration of immobility (i.e., late ambulators), the prevalence of at least one perioperative complication was significantly lower in the early ambulators cohort (30% vs. 54%, P = 0.06). The length of inhospital stay was 34% shorter in the early ambulators cohort (5.33 days vs. 8.11 days, P = 0.01). Functional independence was superior in the early ambulators cohort, with the majority of patients discharged directly home after surgery compared with late ambulators (71.2% vs. 22.0%, P = 0.01). Early ambulation after surgery significantly reduces the incidence of perioperative complications, shortens duration of inhospital stay, and contributes to improved perioperative functional status in elderly patients. Even a delay of 24 hours to ambulation is
Kotani, Kazuya; Ueda, Kayo; Seposo, Xerxes; Yasukochi, Shusuke; Matsumoto, Hiroko; Ono, Masaji; Honda, Akiko; Takano, Hirohisa
The elderly population has been the primary target of intervention to prevent heat-related illnesses. According to the literature, the highest risks have been observed among the elderly in the temperature-mortality relationship. However, findings regarding the temperature-morbidity relationship are inconsistent. This study aimed to examine the association of temperature with ambulance dispatches due to acute illnesses, stratified by age group. Specifically, we explored the optimum temperature, at which the relative health risks were found to be the lowest, and quantified the health risk associated with higher temperatures among different age groups. We used the data for ambulance dispatches in Fukuoka, Japan, during May and September from 2005 to 2012. The data were grouped according to age in 20-year increments. We explored the pattern of the association of ambulance dispatches with temperature using a smoothing spline curve to identify the optimum temperature for each age group. Then, we applied a distributed lag nonlinear model to estimate the risks of the 85th-95th percentile temperature relative to the overall optimum temperature, for each age group. The relative risk of ambulance dispatches at the 85th and 95th percentile temperature for all ages was 1.08 [95% confidence interval (CI): 1.05, 1.12] and 1.12 (95% CI: 1.08, 1.16), respectively. In comparison, among age groups, the optimum temperature was observed as 25.0°C, 23.2°C, and 25.3°C for those aged 0-19, 60-79, and ≥80, respectively. The optimum temperature could not be determined for those aged 20-39 and 40-59. The relative risks of high temperature tended to be higher for those aged 20-39 and 40-59 than those for other age groups. We did not find any definite difference in the effect of high temperature on ambulance dispatches for different age groups. However, more measures should be taken for younger and middle-aged people to avoid heat-related illnesses.
Full Text Available Objectives: Assessment of microbial air quality and surface contamination in ambulances and administration offices as a control place without occupational exposure to biological agents; based on quantitative and qualitative analysis of bacteria, yeasts and filamentous fungi found in collected samples. Material and Methods: The sampling was done by wet cyclone technology using the Coriolis recon apparatus, imprint and swab methods, respectively. In total, 280 samples from 28 ambulances and 10 offices in Warszawa were tested. Data was analyzed using Shapiro-Wilk normality test, Kruskal-Wallis test with α = 0.05. P value ≤ 0.05 was considered as significant. Results: The levels of air contamination were from 0 to 2.3×101 colony-forming unit (CFU/m3 for bacteria and for yeast and filamentous fungi were from 0 to 1.8×101 CFU/m3. The assessment of office space air samples has shown the following numbers of microorganisms: bacteria from 3.0×101 to 4.2×101 CFU/m3 and yeast and filamentous fungi from 0 to 1.9×101 CFU/m3. For surface contamination the mean bacterial count in ambulances has been between 1.0×101 and 1.3×102 CFU/25 cm2 and in offices – between 1.1×101 and 8.5×101 CFU/25 cm2. Mean fungal count has reached the level from 2.8×100 to 4.2×101 CFU/25 cm2 in ambulances and 1.3×101 to 5.8×101 CFU/25 cm2 in offices. The qualitative analysis has revealed the presence of Acinetobacter spp. (surfaces, coagulase – negative Staphylococci (air and surfaces, Aspergillus and Penicillium genera (air and surfaces. Conclusions: The study has revealed a satisfactory microbiological quantity of analyzed air and surface samples in both study and control environments. However, the presence of potentially pathogenic microorganisms in the air and on surfaces in ambulances may endanger the medical emergency staff and patients with infection. Disinfection and cleaning techniques therefore should be constantly developed and implemented. Int J Occup
Bielawska-Drózd, Agata; Cieślik, Piotr; Wlizło-Skowronek, Bożena; Winnicka, Izabela; Kubiak, Leszek; Jaroszuk-Ściseł, Jolanta; Depczyńska, Daria; Bohacz, Justyna; Korniłłowicz-Kowalska, Teresa; Skopińska-Różewska, Ewa; Kocik, Janusz
Assessment of microbial air quality and surface contamination in ambulances and administration offices as a control place without occupational exposure to biological agents; based on quantitative and qualitative analysis of bacteria, yeasts and filamentous fungi found in collected samples. The sampling was done by wet cyclone technology using the Coriolis recon apparatus, imprint and swab methods, respectively. In total, 280 samples from 28 ambulances and 10 offices in Warszawa were tested. Data was analyzed using Shapiro-Wilk normality test, Kruskal-Wallis test with α = 0.05. P value ≤ 0.05 was considered as significant. The levels of air contamination were from 0 to 2.3×101 colony-forming unit (CFU)/m3 for bacteria and for yeast and filamentous fungi were from 0 to 1.8×101 CFU/m3. The assessment of office space air samples has shown the following numbers of microorganisms: bacteria from 3.0×101 to 4.2×101 CFU/m3 and yeast and filamentous fungi from 0 to 1.9×101 CFU/m3. For surface contamination the mean bacterial count in ambulances has been between 1.0×101 and 1.3×102 CFU/25 cm2 and in offices - between 1.1×101 and 8.5×101 CFU/25 cm2. Mean fungal count has reached the level from 2.8×100 to 4.2×101 CFU/25 cm2 in ambulances and 1.3×101 to 5.8×101 CFU/25 cm2 in offices. The qualitative analysis has revealed the presence of Acinetobacter spp. (surfaces), coagulase - negative Staphylococci (air and surfaces), Aspergillus and Penicillium genera (air and surfaces). The study has revealed a satisfactory microbiological quantity of analyzed air and surface samples in both study and control environments. However, the presence of potentially pathogenic microorganisms in the air and on surfaces in ambulances may endanger the medical emergency staff and patients with infection. Disinfection and cleaning techniques therefore should be constantly developed and implemented. Int J Occup Med Environ Health 2017;30(4):617-627. This work is available in Open Access
Cantwell, Kate; Morgans, Amee; Smith, Karen; Livingston, Michael; Dietze, Paul
This paper aims to examine whether an adaptation of the International Classification of Disease (ICD) coding system can be applied retrospectively to final paramedic assessment data in an ambulance dataset with a view to developing more fine-grained, clinically relevant case definitions than are available through point-of-call data. Over 1.2 million case records were extracted from the Ambulance Victoria data warehouse. Data fields included dispatch code, cause (CN) and final primary assessment (FPA). Each FPA was converted to an ICD-10-AM code using word matching or best fit. ICD-10-AM codes were then converted into Major Diagnostic Categories (MDC). CN was aligned with the ICD-10-AM codes for external cause of morbidity and mortality. The most accurate results were obtained when ICD-10-AM codes were assigned using information from both FPA and CN. Comparison of cases coded as unconscious at point-of-call with the associated paramedic assessment highlighted the extra clinical detail obtained when paramedic assessment data are used. Ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Coding of ambulance data using ICD-10-AM allows for comparison of not only ambulance service users but also with other population groups. WHAT IS KNOWN ABOUT THE TOPIC? There is no reliable and standard coding and categorising system for paramedic assessment data contained in ambulance service databases. WHAT DOES THIS PAPER ADD? This study demonstrates that ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Representation of ambulance case types using ICD-10-AM-coded information obtained after paramedic assessment is more fine grained and clinically relevant than point-of-call data, which uses caller information before ambulance attendance. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? This paper describes
Vajshnis, P.P.; Kumkov, L.P.; Omel'chuk, V.V.
Shortcomings of NPP personnel training are discussed. Development of full-scale training systems is necessary for qualitative training operative personnel. Primary problems that should be necessarily solved for ensuring effective training NPP personnel are considered
Office of Personnel Management — Security file-related information for the U.S. Office of Personnel Management (OPM)'s employee and contractor personnel. The data is OPM-specific, not government-wide.
Tharion, William J; Lieberman, Harris R; Montain, Scott J; Young, Andrew J; Baker-Fulco, Carol J
...) have been measured while training under various conditions. Group mean total energy expenditures for 424 male military personnel from various units engaged in diverse missions ranged from 13.0 to 29.8 MJ per day...
Koshcheev, V.S.; Gol'dshtejn, D.S.; Chetverikova, Z.S.
Specific features of NPP personnel individual protection are considered, mainly with respect to maintenance and repair works on various type reactors. The major concern is given to the selection and application reglamentations of the individual protection system (IPS), employment of sanitary locks, the organization of individual protection under the conditions of a heating microclimate. The ways are specified to the development and introduction of the most effective IPS and improvement of the entire NPP personnel individual protection system with respect to providing the necessary protection effect for maintaining high working capability of the personnel and minimizing the IPS impact on human organism functional systems. The accumulated experience in the personnel individual protection can be applied during construction and operation of NPP's in CMEA member-countries [ru
Romanova, I.N.; Seredin, Yu.V.
State of radiation safety for the personnel of geologic crews carrying out neutron logging of wells using Po-Be sources has been evaluated. Given are results of development of methods for the evaluation of individual radiation loads for personnel when working with Po-Be neutron sources useful for the application in practice by a geologic logging crew as well as a quantitative evaluation of profissional radiation loads during this kind of work. The following methods are recommended for personnel monitoring: 1) calculation of whole-body irradiation doses and hands from averaged values of radiation dose rate; 2) calculational tabulated determination of irradiation doses during recharging of shanks of well instruments. Personnel monitoring by means of instrumental methods is not necessary in the considered case [ru
Objective of this manual is to train security personnel to protect special nuclear materials and nuclear facilities against theft and sabotage as required by 10 CFR Part 73. This volume contains the introduction and rationale
Social Security Administration — The purpose of this agreement is for SSA to verify SSN information for the Office of Personnel Management. OPM will use the SSN verifications in its investigative...
Full Text Available Bed rest has been considered as the cornerstone of management of deep vein thrombosis (DVT for a long time, though it is not evidence-base, and there is growing evidence favoring early ambulation.Electronic databases including Medline, PubMed, Cochrane Library and three Chinese databases were searched with key words of "deep vein thrombosis", "pulmonary embolism", "venous thrombosis", "bed rest", "immobilization", "mobilization" and "ambulation". We considered randomized controlled trials, prospective or retrospective cohort studies that compared the outcomes of acute DVT patients managed with early ambulation versus bed rest, in addition to standard anticoagulation. Meta-analysis pertaining to the incidence of new pulmonary embolism (PE, progression of DVT, and DVT related deaths were conducted, as well as the extent of remission of pain and edema.13 studies were included with a total of 3269 patients. Compared to bed rest, early ambulation was not associated with a higher incidence of new PE, progression of DVT, or DVT related deaths (RD -0.03, 95% CI -0.05∼ -0.02; Z = 1.24, p = 0.22; random effect model, Tau2 = 0.01. Moreover, if the patients suffered moderate or severe pain initially, early ambulation was related to a better outcome, with respect to remission of acute pain in the affected limb (SMD 0.42, 95%CI 0.09∼0.74; Z = 2.52, p = 0.01; random effect model, Tau2 = 0.04. Meta-analysis of alleviation of edema cannot elicit a solid conclusion because of significant heterogeneity among the few studies.Compared to bed rest, early ambulation of acute DVT patients with anticoagulation was not associated with a higher incidence of new PE, progression of DVT, and DVT related deaths. Furthermore, for the patients suffered moderate or severe pain initially, a better outcome can be seen in early ambulation group, regarding to the remission of acute pain in the affected limb.
The status and trend of personnel external dose monitoring system are introduced briefly. Their characteristics, functions and TLD bedges of some commercially available automatic TLD system, including UD-710A (Matsushita, Japan), Harshaw-2271, 2276 (Harshaw, USA), Harshaw-8000 (Harshaw/Filtrol), Studsvik-1313 (Sweden) and Pitman-800 (UK) were depicted in detail. Finally, personnel dose management and record keeping system were presented and two examples were given
Necessity of personnel risks management is based on research results. The authors' approaches to the determination of personnel risks and to their management have been explored. The author's definition of the concept of "personnel risks" is proposed. A classification of personnel risks is developed depending on the stage of origin and the tasks of the personnel policy, as well as the methods of management personnel risks in the organization. The article presents a methodical approach to perso...
Full Text Available Background: Stroke subjects face reduced tolerance to activity and sedentary lifestyle due to various impairments, such as muscle weakness, pain, spasticity, and poor balance. Thus, loss of independent ambulation especially outdoors is generally observed in them. Methods: Chronic stroke patients (> 6 months with Functional Ambulation Category score > 2 and able to walk at least 10 meters of distance with and without assistance from a tertiary healthcare centre were selected and treated. Subjects were randomly divided into 2 groups control group (n=14 and experimental group (n=13. Each group received Motor Relearning Programme for 60 minutes, 6 times a week for 4 weeks. The experimental group received an additional shoe-raise of 1 cm on the unaffected side along with while ambulating during therapy as well as at home. Pre and post treatment the patients were assessed for spatio-temporal parameters using foot print analysis method and Rivermead Visual Gait Assessment (RVGA Score using RVGA scale. Results: There was significant improvement seen in almost all the spatio-temporal gait parameters and RVGA score in within group analysis. Whereas on between group the results from between group comparison suggests that subjects in MRP with shoe-raise group showed better results in spatio-temporal parameters of gait than subjects receiving MRPalone. But there was no additional benefit of shoe-raise seen on RGVA score and angle of toe-out parameter. Conclusion: Additional use of shoe-raise helps to improve spatio-temporal gait parameters. However, there was no additional change seen in RVGA score.
van Schaaijk, A; Boschman, J S; Frings-Dresen, M H W; Sluiter, J K
To gain insight into which job-specific health requirements relate to work ability, the following two research questions were formulated: Which job-specific health requirements are associated with the appraisal of work ability in ambulance drivers and paramedics? How are appraisals of physical and mental work ability associated with the appraisal of overall work ability in ambulance drivers and paramedics? Workers Health Surveillance cross-sectional data of 506 ambulance workers (236 drivers and 270 paramedics) were used. The tests for specific job requirements were divided into six categories. Work ability was appraised as overall, physical and mental/emotional. Multiple linear stepwise regression analyses were used to model the associations. Outcomes in 'raised alertness and judgment ability' (R 2 = 0.09), 'job-specific physical abilities' (R 2 = 0.10) and 'emotional peak load' (R 2 = 0.07) significantly explained appraised overall, physical and mental/emotional work ability. Physical and mental/emotional work ability together explained 48.3% of the variance of overall work ability. The explained variance by physical and mental/emotional work ability was almost 4% higher in drivers than in paramedics. Overall work ability was significantly explained by outcomes in 'raised alertness and judgment ability' and 'emotional peak load.' Physical work ability was significantly explained by 'job-specific physical abilities' and 'raised alertness and judgment ability' outcomes, while 'emotional peak load' and 'raised alertness and judgment ability' outcomes significantly explained mental/emotional work ability. Physical and mental/emotional work ability explains the same proportion of variance in overall work ability.
Asselin, Pierre K.; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M.
Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment. PMID:27340808
Woods, Rashida H; Shah, Manish; Doughty, Cara; Gilchrest, Anthony
The National Highway Traffic Safety Administration (NHTSA) released draft recommendations in 2010 on the safe transport of children in ground ambulances. The purpose of this study was to assess awareness of these guidelines among emergency medical service (EMS) agencies and to identify implementation barriers. We conducted a cross-sectional, anonymous online survey of 911-responding, ground transport EMS agencies in Texas. Demographics, modes of transport based on case scenarios, and barriers to implementation were assessed. Of 62 eligible EMS agencies that took the survey, 35.7% were aware of the NHTSA guidelines, 62.5% agreed they would improve safety, and 41.1% planned to implement them. Seventy-five percent of EMS agencies used the ideal or acceptable alternative to transport children requiring continuous monitoring, and 69.5% chose ideal or acceptable alternatives for children requiring spinal immobilization. The ideal or acceptable alternative was not chosen for children who were not injured or ill (93.2%), ill or injured but not requiring continuous monitoring (53.3%), and situations when multiple patients required transport (57.6%). The main requirements for implementation were provider education, ambulance interior modifications, new guidelines in the EMS agency, and purchase of new equipment. Few EMS agencies are aware of the NHTSA guidelines on safe transport of children in ground ambulances. Although most agencies appropriately transport children who require monitoring, interventions, or spinal immobilization, they use inappropriate means to transport children in situations with multiple patients, lack of injury or illness, or lack of need for monitoring.
Woods, Rashida H; Shah, Manish; Doughty, Cara; Gilchrest, Anthony
The National Highway Traffic Safety Administration (NHTSA) released draft recommendations in 2010 on the safe transport of children in ground ambulances. The purpose of this study was to assess awareness of these guidelines among emergency medical service (EMS) agencies and to identify implementation barriers. We conducted a cross-sectional, anonymous online survey of 911-responding, ground transport EMS agencies in Texas. Demographics, modes of transport based on case scenarios, and barriers to implementation were assessed. Of 62 eligible EMS agencies that took the survey, 35.7% were aware of the NHTSA guidelines, 62.5% agreed they would improve safety, and 41.1% planned to implement them. Seventy-five percent of EMS agencies used the ideal or acceptable alternative to transport children requiring continuous monitoring, and 69.5% chose ideal or acceptable alternatives for children requiring spinal immobilization. The ideal or acceptable alternative was not chosen for children who were not injured or ill (93.2%), ill or injured but not requiring continuous monitoring (53.3%), and situations when multiple patients required transport (57.6%). The main requirements for implementation were provider education, ambulance interior modifications, new guidelines in the EMS agency, and purchase of new equipment. Few EMS agencies are aware of the NHTSA guidelines on safe transport of children in ground ambulances. Although most agencies appropriately transport children who require monitoring, interventions, or spinal immobilization, they use inappropriate means to transport children in situations with multiple patients, lack of injury or illness, or lack of need for monitoring.
Vencloviene, Jone; Babarskiene, Ruta; Dobozinskas, Paulius; Siurkaite, Viktorija
The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature ( T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October-April) and warm (May-September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June-September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACS.
Foss, Nicolai Bang; Kristensen, Morten Tange; Kehlet, Henrik
fracture patients with an independent walking function admitted from their own home. Rehabilitation followed a well-defined multimodal rehabilitation regimen and discharge criteria. MAIN OUTCOME MEASURE: Admission tests with a new mobility score to assess prefracture functional mobility and a short mental......OBJECTIVE: To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients. DESIGN: Prospective, descriptive study. SETTING: An orthopaedic hip fracture unit in a university hospital. PATIENTS: Four hundred and twenty-six consecutive hip...... of short-term postoperative outcome after hip fracture surgery....
Albertsson, Pontus; Sundström, Anna
The aim of the study was to evaluate whether a new e-learning tool for insight training of ambulance drivers can have an effect on drivers' driving behaviors, perceived driving competence, competence to assess risks, self-reflection, and safety attitudes. A quasi-experimental study design, with participants nonrandomly assigned into a control and intervention group, was used. The intervention group participated in the insight-training course and the control group did not. Both groups completed a self- and peer assessment online questionnaire before and after the training. The main finding is that the ambulance drivers assessed themselves through the instruments after the training, with the e-learning tool Driver Access Recording Tool (DART), as safer drivers in the areas of speed adaptation, closing up, and overtaking. In the answers from the group-based evaluation, the ambulance drivers responded that they were more reflective/analytical, had increased their risk awareness, and had changed their driving behaviors. After insight training, the ambulance drivers in this study assessed themselves as safer drivers in several important areas, including speed adaptation, closing up, and overtaking. In future training of ambulance drivers there should be more focus on insight training instead of previous training focusing on maneuvering capabilities.
Wolf, G.; Obe, G.; Bergau, L.
During long-distance flights at high altitudes flight personnel are exposed to cosmic radiation. In order to determine whether there are biological effects of such low dose radiation exposure in aircrew, chromosomal aberrations were investigated in 59 female cabin attendants and a matched control group of 31 members of station personnel. The mean number of dicentric chromosomes amounts to 1.3 (95% CI 1.0-1.6) per 1,000 cells in cabin attendants and 1.4 (95% CI 1.0-1.9) per 1,000 cells in controls. In an additional control group of 56 female clerks from Berlin the mean frequency of dicentric chromosomes was 1.3 (95% CI 1.0-1.6). Neither in dicentric frequency and distribution nor in other aberrations was a significant difference between the groups of flight and station personnel found. The high frequency of multi-aberrant cells was remarkable in flight personnel as well as in station personnel. The reason for this phenomenon is unknown and needs further investigation. (author)
... Security Personnel System AGENCY: Department of Defense; Office of Personnel Management. ACTION: Final rule... concerning the National Security Personnel System (NSPS). Section 1113 of the National Defense Authorization... National Security Personnel System (NSPS) in regulations jointly prescribed by DOD and OPM (Office of...
Research reactor personnel operate the reactor and carry out the experiments. These two types of work entail different activities, and therefore different skills and competence, the number of relevant staff being basically a function of the size, complexity and versatility of the reactor. Training problems are often reactor-specific, but the present paper considers them from three different viewpoints: the training or retraining of new staff or of personnel already employed at an existing facility, and training of personnel responsible for the start-up and operation of a new reactor, according to whether local infrastructure and experience already exist or whether they have to be built up from scratch. On-the-spot experience seems to be an essential basis for sound training, but requires teaching abilities and aids often difficult to bring together, and the availability of instructors that does not always fit in smoothly with current operational and experimental tasks. (author)
Full Text Available Aim: The purpose of this study was to determine the reasons for referral to the hospital and 112 emergency ambulance service uses patterns of the inmates and convicts in an E type prison. Material and Method: In this descriptive study, it was evaluated the prison records associated with referral to the hospital and 112 emergency ambulance service uses for one year in 2010- 2011. Of the statistical analysis, descriptive statistics, chi-square test and Fisher%u2019s Exact Test were used. Results: All inmates and convicts were man, the median of age was 30,0 (min 18- max 68 years and substance use was 34,5%. The number of prisoners were referred to the hospital 815, total referrals were 1491; (referrals ranged from one to six and most common in January; and according to frequency, reasons of the referral were eyes problems, musculoskeletal disorders and psychological problems. Emergency medical service was used for in medical causes (78,3%, accident, trauma and injuries (16,4%, suicide (5,3%. Discussion: Findings from the study show that prisoners are more likely to have suffered physical and mental health problems that compared to the rest of society and have significantly high substance use rates.
Brand, T; Slob, A K
The validity of the hypothesis put forward earlier, that testicular secretions during puberty have an organizing effect on open field ambulation was examined. Male rats were castrated or sham-operated at days 21, 43 or 70. At the age of 17 weeks the males were tested in an automated, octagonal open field (3 consecutive days, 3 min/day) for locomotor activity. Male rats castrated at day 21 or day 43 ambulated more than sham-castrated controls. Males castrated at day 70 did not differ from sham-castrated controls. It thus appears that pubertal testicular secretion(s) organize adult open field locomotor activity in male rats. From 18 weeks of age partner preference behavior was tested in the same open field apparatus with one adjacent cage containing an ovariectomized female and an opposite one containing an ovariectomized female brought into heat. The females in the adjacent cages were separated from the experimental males in the octagonal cage by wire mesh. Peripubertally castrated males did not show a clear-cut partner preference, whereas the intact males preferred the vicinity of the estrous female. There were no differences among the males castrated either before, during or after puberty. Testosterone treatment (crystalline T in silastic capsules) caused peripubertally castrated males to prefer the estrous female. Thus, adult partner preference behavior does not seem to be organized by peripubertal testicular androgens.
Gerber, L H; Binder, H; Weintrob, J; Grange, D K; Shapiro, J; Fromherz, W; Berry, R; Conway, A; Nason, S; Marini, J
Management of children and infants with osteogenesis imperfecta (OI) poses difficult decisions for pediatricians, orthopedists, and physiatrists. These children are frequently frail with disabling bone and joint deformities and fractures. In an eight-year cumulative management of 12 children with OI, a comprehensive program included strengthening exercises to the pelvic girdle and lower extremity muscles, in addition to pool exercises and molded seating to support upright posture. Long leg braces were fitted when the children were able to sit unsupported. All 12 were fitted with braces; nine were functional ambulators, and three were home ambulators. Six children required femoral plating or rodding, two of whom subsequently had the metal removed. Lower extremity fractures averaged one and one-half per year prior to bracing for nine children who had fractures. There was 0.83 fracture per year for the ten children who had fractures after bracing. The degree of femoral bowing increased in four, decreased in four, and remained unchanged in four, while the degree of tibial bowing increased in two, decreased in nine, and remained unchanged in one during the observation period. A comprehensive rehabilitation program and long leg bracing with surgical operations on the femur result in a high level of functional activity for children with OI with an acceptable level of risk for fracture.
Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David
Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.
Liu, Ruicong; Zeng, Jie; Jiang, Xianyan; Chen, Jianyu; Gao, Xufang; Zhang, Li; Li, Tiantian
High levels of fine particulate matter (PM 2.5 ) are known to cause adverse effects to human health. The goal of this study was to estimate the acute health effects of short-term exposure to ambient PM 2.5 by analyzing cause-specific emergency ambulance dispatches as the endpoint in Chengdu, a city in Sichuan Province in southwest China. The ambient PM 2.5 concentration of Chengdu reached 63 μg/m 3 in 2015. Data related to the causes of specific emergency ambulance dispatches, air pollution, and meteorological conditions were collected from 2013 to 2015 (1095 days). A generalized additive model (GAM) was constructed to control the confounding conditions and to estimate the effects of PM 2.5 on human health conditions. Emergency ambulance dispatches for all causes with (RR for lag0 = 1.0010, 95%CI: 1.0002, 1.0019) or without injuries (RR for lag0 = 1.0012, 95%CI: 1.0002, 1.0022), respiratory diseases (RR for lag0 = 1.0051, 95%CI: 1.0012, 1.0089), and cardiovascular diseases (RR for lag0 = 1.0041, 95%CI: 1.0009, 1.0074) were associated with ambient PM 2.5 concentrations in Chengdu. In addition, the effects of PM 2.5 were not confounded by ozone. - Highlights: • Short-term exposure to PM 2.5 was associated to emergency ambulance dispatches. • PM 2.5 strongly affected ambulance dispatches for respiratory and cardiovascular diseases. • High PM 2.5 levels induced acute health effects in Chengdu and other east China cities. - PM 2.5 strongly affected emergency ambulance dispatches for respiratory and cardiovascular diseases in Chengdu, a southwestern city in China.
@@ 1.Introduction Many new businesses are opened in the whole world every day.Unfortunately,only a minor part of them has success and continues its activity.There is a variety of reasons which determine the hankruptcy of companies.Most of them are included in running a business,and more and more people come to realize the significance of management,especially personnel management,as personnel represents the relationship between people in the company,which is a key point for the development of enterprise.
Personnel departments often have particular responsibility for equal opportunities within their organizations. This paper explores equal opportunities within personnel departments themselves, in relation to the careers of ethnic minority personnel practitioners. Through primary research, it identifies a range of criteria which can affect personnel careers, of which ethnic origin is often one. However, although being categorized as of ethnic minority origin often hinders personnel careers, the...
Rerucha, F.; Odehnal, J.
Basic scheme of the training system for NPP personnel of CEZ-EDU personnel training system is described in detail. This includes: specific training both basic and periodic, and professional training meaning specialized and continuous training. The following schemes are shown: licence acquisition and authorisation for PWR-440 Control Room Personnel; upgrade training for job positions of Control Room personnel; maintaining and refresh training; module training for certificate acquisition of servicing shift and operating personnel
Calışkan, Cüneyt; Algan, Aysun; Koçak, Hüseyin; Biçer, Burcu Küçük; Sengelen, Meltem; Cakir, Banu
Emergency and core ambulance personnel work under all environmental conditions, including severe weather condtions. We evaluated emergency medical personnel in Çanakkale, Turkey, for their degree of preparedness. A descriptive study was conducted in Çanakkale, Turkey, within 112 emergency service units and their 17 district stations. Surveys were developed to measure the level of preparedness for serious winter conditions that individual workers made for themselves, their homes, and their cars. Of the 167 survey participants, the mean age was 29.8 ± 7.9 years; 52.7% were women; more than half (54.75%) were emergency medical technicians; and 53.3% were married. Only 10.4% of those who heated their homes with natural gas had carbon monoxide detectors. Scores relating to household and individual preparation for severe winter conditions increased by participants' age (P tires (P winter conditions (P = .016). Many of the surveyed emergency health personel demonstrated insufficient preparations for serious winter conditions. To increase the safety and efficiency of emergency medical personnel, educational training programs should be rountinely conducted. (Disaster Med Public Health Preparedness. 2014;0:1-4).
Ward, C L; Lombard, C J; Gwebushe, N
Objectives To assess critical incident exposure among prehospital emergency services personnel in the developing world context of South Africa; and to assess associated mental health consequences. Methods We recruited a representative sample from emergency services in the Western Cape Province, South Africa, to participate in this cross sectional epidemiological study. Questionnaires covered critical incident exposure, general psychopathology, risky alcohol use, symptoms of post‐traumatic stress disorder (PTSD), and psychological and physical aggression between co‐workers. Open ended questions addressed additional stressors. Results Critical incident exposure and rates of general psychopathology were higher than in studies in the developed world. Exposure to critical incidents was associated with general psychopathology, symptoms of PTSD, and with aggression between co‐workers, but not with alcohol use. Ambulance, fire, and sea rescue services had lower general psychopathology scores than traffic police. The sea rescue service also scored lower than traffic police on PTSD and psychological aggression. The defence force had higher rates of exposure to physical assault, and in ambulance services, younger staff were more vulnerable to assault. Women had higher rates of general psychopathology and of exposure to psychological aggression. Other stressors identified included death notification, working conditions, and organisational problems. Conclusions Service organisations should be alert to the possibility that their personnel are experiencing work ‐related mental health and behavioural problems, and should provide appropriate support. Attention should also be given to organisational issues that may add to the stress of incidents. Workplace programmes should support vulnerable groups, and address death notification and appropriate expression of anger. PMID:16498167
Espinoza, Alexis Valenzuela; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Tellez, Helio Fernandez; Dupont, Alain; Putman, Koen; Brouns, Raf
Background: In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study
Dwyer, R; Gabbe, B; Tran, T D; Smith, K; Lowthian, J A
to examine demand for emergency ambulances by older people. retrospective cohort study using secondary analysis of routinely collected clinical and administrative data from Ambulance Victoria, and population data from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. Victoria, Australia. people aged 65 years and over, living in Residential Aged Care Facilities (RACF) and the community, attended by emergency ambulance paramedics, 2009-13. rates of emergency ambulance attendance. older people living in RACF experienced high rates of emergency ambulance attendance, up to four times those for age- and sex-matched people living in the community. Rates remained constant during the study period equating to a consistent, 1.45% average annual increase in absolute demand. Rates peak among the 80-84-year group where the number of attendances equates to greater than one for every RACF-dwelling person each year. Increased demand was associated with winter months, increasing age and being male. these data provide strong evidence of high rates of emergency ambulance use by people aged 65 years and over living in RACF. These results demonstrate a clear relationship between increased rate of ambulance use among this vulnerable group of older Australians and residence, sex, age and season. Overall, absolute demand continues to increase each year adding to strain on health resources. Additional research is needed to elucidate individual characteristics, illness and health system contributors to ambulance use to inform strategies to appropriately reduce demand.
Full Text Available Objective: To investigate the effects of overground bionic ambulation with variable assistance on cardiorespiratory and metabolic responses in persons with motor-incomplete spinal cord injury. Design: Case series. Subjects: Four participants with chronic, motor-incomplete spinal cord injury. Methods: Subjects completed a maximal graded exercise test on an arm-ergometer and 3 6-min bouts of overground bionic ambulation using different modes of assistance, i.e. Maximal, Adaptive, Fixed. Cardiorespiratory (oxygen consumption and metabolic (caloric expenditure and substrate utilization measures were taken using a mobile metabolic cart at each overground bionic ambulation assistance. Results: Cardiorespiratory responses ranged from low (24% VO2peak for the least impaired and fittest individual to supramaximal (124% VO2peak for the participant with the largest impairments and the lowest level of fitness. Different overground bionic ambulation assistive modes elicited small (3–8% VO2peak differences in cardiorespiratory responses for 3 participants. One participant had a large (28% VO2peak difference in cardiorespiratory responses to different modes of overground bionic ambulation. Metabolic responses mostly tracked closely with cardiorespiratory responses. Total energy expenditure ranged from 1.39 to 7.17 kcal/min. Fat oxidation ranged from 0.00 to 0.17 g/min across participants and different overground bionic ambulation modes. Conclusion: Overground bionic ambulation with variable assistance can substantially increase cardiorespiratory and metabolic responses; however, these responses vary widely across participants and overground bionic ambulation modes.
Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger
Background The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care. Methods A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Results Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, pthermal comfort and may prevent the negative consequences of cold stress.
Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger
The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care. A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, pthermal comfort and may prevent the negative consequences of cold stress.
Guerra, Aline B.; Lorenzini, Fabiane; Carlos, Janaina; Bernasiuk, Maria E.B.; Rizzatti, Mara R.; Fuentefria, Jose L.B.
Surveillance of several health institutions who use ionizing radiation sources, as well as data from the state of Rio Grande do Sul (Brazil) are studied concerning the use of personnel dosimeters. The results show that several institutions do not provide them and those which provide do not know how to use them
Barker, Gale; And Others
This module on rights and responsibilities is intended to introduce the hospitality manager or supervisor to sound personnel management practices that comply with the law. The material is presented in a self-instructional format in seven sections. At the beginning of each section is a statement of the objectives that will be achieved as a result…
Piesch, E.; Johns, T.F.
The practical considerations which have to be taken into account in the design of personnel monitors intended to measure doses resulting from exposure to beta rays are discussed. These include the measurement of doses in situations involving either fairly uniform or non-uniform irradiation and of doses to the male gonads. (UK)
Full Text Available An important factor for the success management of IT projects is the human resource. People involved in the project management process have to be evaluated. In order to do that, same criteria has to be specified. This paper describes some aspects regarding the personnel evaluation.
Sjölin, Helena; Lindström, Veronica; Hult, Håkan; Ringsted, Charlotte; Kurland, Lisa
In Sweden, ambulances must be staffed by at least one registered nurse. Twelve universities offer education in ambulance nursing. There is no national curriculum for detailed course content and there is a lack of knowledge about the educational content that deals with the ambulance nurse practical professional work. The aim of this study was to describe the content in course curricula for ambulance nurses. A descriptive qualitative research design with summative content analysis was used. Data were generated from 49 courses in nursing and medical science. The result shows that the course content can be described as medical, nursing and contextual knowledge with a certain imbalance with largest focus on medical knowledge. There is least focus on nursing, the registered nurses' main profession. This study clarifies how the content in the education for ambulance nurses in Sweden looks today but there are reasons to discuss the content distribution. Copyright © 2014 Elsevier Ltd. All rights reserved.
Jyoti V. Dube
Full Text Available Background: Caesarean section has been a part of human culture since ancient times. It has been used effectively throughout the 20th century and among the major abdominal surgeries, it is the most common, oldest worldwide surgery performed in obstetrics. Despite the life saving advantages, there are several adverse consequences of caesarean delivery for a woman and to her household. The rate and risk of these complications increases due to the increasing incidence mainly in countries like India. The role of nurse midwife is to act in the best interest of patient and newborn and make the patient independent in carrying out the activities of daily living as soon as possible. This can lead to a faster recovery and shorter hospital stay. Also it can indirectly help in reducing the complications associated with prolonged bed rest and can improve the maternal newborn bonding. Aim and Objectives: The present study was done to evaluate the effect of planned early ambulation on selected biophysiological health parameters of post caesarean patients. Material and Methods: The study included total 500 study subjects, 250 in experimental and 250 in control group. Quasi experimental approach with multiple time series design was adopted for the study. The experimental group was given an early planned recommended ambulation technique starting from the day of surgery. This consisted of deep breathing exercise, cough exercise, leg exercise and early mobilization. Over and above, the routine general health care was given by the doctors and nurses. The control group received only by routine general care by doctors and nurses and mobilization on third post operative day as per strategy adopted by the hospital. The deep breathing exercises, coughing exercises and leg exercises were not given routinely and hence were not given to the control group. Post caesarean biophysiological parameters chart was used to assess the selected parameters for first five post operative
Raaber, Nikolaj; Duvald, Iben; Riddervold, Ingunn; Christensen, Erika F; Kirkegaard, Hans
Emergency departments (ED) recognize crowding and handover from prehospital to in-hospital settings to be major challenges. Prehospital Geographical Information Systems (GIS) may be a promising tool to address such issues. In this study, the use of prehospital GIS data was implemented in an ED in order to investigate its effect on 1) wait time and unprepared activations of Trauma Teams (TT) and Medical Emergency Teams (MET) and 2) nurses' perceptions regarding patient reception, workflow and resource utilization. From May 1st 2014 to October 31th 2014, GIS data was displayed in the ED. Data included real-time estimated time of arrival, distance to ED, dispatch criteria, patient data and ambulance contact information. Data was used by coordinating nurses for time activation of TT and MET involved in the initial treatment of severely-injured or critically-ill patients. In addition, it was used as a logistics tool for handling all other patients transported by ambulance to the ED. The study followed a mixed-methods design, consisting of a quantitative study (before and after intervention) and a qualitative study (survey and interviews). Participants included all patients received by TT or MET and coordinating nurses in the ED. 1.) Quantitative: 599 patients were included. The median wait time for TT and MET was 5 min both before and after the GIS intervention, showing no difference (p = 0.18). A significant reduction in the subgroup of waits >10 min was found (p GIS data as a tool to optimize resource utilization and quality of all patients' reception, critically or non-critically ill. No substantial disadvantages were reported. The contradiction of measured median wait time and nurses perceived improved timing of team activation may result from having both RT- ETA and supplemental patient information not only for seriously-injured or critically-ill patients received by the TT and MET, but for all patients transported by ambulance. The reduction in waits > 10
Sommers, Juultje; Wieferink, Denise C.; Dongelmans, Dave A.; Nollet, Frans; Engelbert, Raoul H. H.; van der Schaaf, Marike
Purpose: Early mobilisation is advocated to improve recovery of intensive care unit (ICU) survivors. However, severe weakness in combination with tubes, lines and machinery are practical barriers for the implementation of ambulation with critically ill patients. The aim of this study was to explore
Yperzeele, Laetitia; Van Hooff, Robbert-Jan; De Smedt, Ann; Espinoza, Alexis Valenzuela; Van Dyck, Rita; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; Lauwaert, Door; De Keyser, Jacques; Brouns, Raf
Background: Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third
Jorge Luis Alvarado‐Socarras
Conclusions: Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation to obtain good clinical outcomes according type of ambulance.
Husa-Russell, Johanna; Ukelo, Thomas; List, Renate; Lorenzetti, Silvio; Wolf, Peter
Before making interpretations on the effects of interventions or on the features of pathological gait patterns during stair ambulation, the day-to-day consistency of the investigated variables must be established. In this article, the day-to-day consistency was determined for kinematic variables during barefoot stair ambulation. Ten healthy athletes performed two gait analysis sessions, at least one week apart, utilizing a marker set of 47 skin markers, and a functional joint center/axes determination. Being found on limits of agreement and mean differences between the repeated stair ambulation sessions, totally 43 ranges of motions were examined at the hip, knee, ankle, and midfoot joints. The day-to-day consistency was generally in the magnitude of three degrees, irrespective of test condition, investigated joint, or regarded cardinal body plane. The reported values of the day-to-day consistency provide guidelines to distinguish between pathological and healthy gait patterns, and thresholds to determine minimal effects of interventions during stair ambulation. Copyright © 2011 Elsevier B.V. All rights reserved.
Encheff, Jenna L; Armstrong, Charles; Masterson, Michelle; Fox, Christine; Gribble, Phillip
This study investigated the effects of a 10-week hippotherapy program on trunk, pelvis, and hip joint positioning during the stance phase of gait. Eleven children (6 boys and 5 girls; 7.9 ± 2.7 years) with neurological disorders and impaired ambulation participated. Joint range of motion data were collected via 3-dimensional computerized gait analysis before and after the program. Paired t tests were performed on kinematic data for each joint. Significant improvements (P ≤ .008) and large effect sizes (ESs) for sagittal plane hip positions at initial contact and toe-off were found. No differences in pelvic or trunk positioning were determined, although sagittal plane pelvic positioning displayed a trend toward improvement with large ESs. Several trunk variables displayed moderate ESs with a trend toward more upright positioning. Improvements in pelvic and hip joint positioning and more normalized vertical trunk position may indicate increased postural control during gait after 10 sessions of hippotherapy.
Jenstrup, M T; Jæger, P; Lund, J
Total knee arthroplasty (TKA) is associated with intense post-operative pain. Besides providing optimal analgesia, reduction in side effects and enhanced mobilization are important in this elderly population. The adductor-canal-blockade is theoretically an almost pure sensory blockade. We hypothe...... hypothesized that the adductor-canal-blockade may reduce morphine consumption (primary endpoint), improve pain relief, enhance early ambulation ability, and reduce side effects (secondary endpoints) after TKA compared with placebo.......Total knee arthroplasty (TKA) is associated with intense post-operative pain. Besides providing optimal analgesia, reduction in side effects and enhanced mobilization are important in this elderly population. The adductor-canal-blockade is theoretically an almost pure sensory blockade. We...
Todkill, Dan; Loveridge, Paul; Elliot, Alex J; Morbey, Roger A; Edeghere, Obaghe; Rayment-Bishop, Tracy; Rayment-Bishop, Chris; Thornes, John E; Smith, Gillian
Introduction The Public Health England (PHE; United Kingdom) Real-Time Syndromic Surveillance Team (ReSST) currently operates four national syndromic surveillance systems, including an emergency department system. A system based on ambulance data might provide an additional measure of the "severe" end of the clinical disease spectrum. This report describes the findings and lessons learned from the development and preliminary assessment of a pilot syndromic surveillance system using ambulance data from the West Midlands (WM) region in England. Hypothesis/Problem Is an Ambulance Data Syndromic Surveillance System (ADSSS) feasible and of utility in enhancing the existing suite of PHE syndromic surveillance systems? An ADSSS was designed, implemented, and a pilot conducted from September 1, 2015 through March 1, 2016. Surveillance cases were defined as calls to the West Midlands Ambulance Service (WMAS) regarding patients who were assigned any of 11 specified chief presenting complaints (CPCs) during the pilot period. The WMAS collected anonymized data on cases and transferred the dataset daily to ReSST, which contained anonymized information on patients' demographics, partial postcode of patients' location, and CPC. The 11 CPCs covered a broad range of syndromes. The dataset was analyzed descriptively each week to determine trends and key epidemiological characteristics of patients, and an automated statistical algorithm was employed daily to detect higher than expected number of calls. A preliminary assessment was undertaken to assess the feasibility, utility (including quality of key indicators), and timeliness of the system for syndromic surveillance purposes. Lessons learned and challenges were identified and recorded during the design and implementation of the system. The pilot ADSSS collected 207,331 records of individual ambulance calls (daily mean=1,133; range=923-1,350). The ADSSS was found to be timely in detecting seasonal changes in patterns of respiratory
M Kit Delgado
Full Text Available Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED crowding are unclear. We performed a systematic review of published simulation studies to identify: 1 the tradeoff between ambulance diversion and ED wait times; 2 the predicted impact of patient flow interventions on reducing diversion; and 3 the optimal regional strategy for reducing diversion.Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields.Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion.Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals. [West J Emerg Med. 2013;14(5:489-498.
Lin, Chih-Hao; Kao, Chung-Yao; Huang, Chong-Ye
Ambulance diversion (AD) is considered one of the possible solutions to relieve emergency department (ED) overcrowding. Study of the effectiveness of various AD strategies is prerequisite for policy-making. Our aim is to develop a tool that quantitatively evaluates the effectiveness of various AD strategies. A simulation model and a computer simulation program were developed. Three sets of simulations were executed to evaluate AD initiating criteria, patient-blocking rules, and AD intervals, respectively. The crowdedness index, the patient waiting time for service, and the percentage of adverse patients were assessed to determine the effect of various AD policies. Simulation results suggest that, in a certain setting, the best timing for implementing AD is when the crowdedness index reaches the critical value, 1.0 - an indicator that ED is operating at its maximal capacity. The strategy to divert all patients transported by ambulance is more effective than to divert either high-acuity patients only or low-acuity patients only. Given a total allowable AD duration, implementing AD multiple times with short intervals generally has better effect than having a single AD with maximal allowable duration. An input-throughput-output simulation model is proposed for simulating ED operation. Effectiveness of several AD strategies on relieving ED overcrowding was assessed via computer simulations based on this model. By appropriate parameter settings, the model can represent medical resource providers of different scales. It is also feasible to expand the simulations to evaluate the effect of AD strategies on a community basis. The results may offer insights for making effective AD policies. Copyright © 2012. Published by Elsevier B.V.
Full Text Available We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009–2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs, in which the conditions for the emergency calls were made coded I.10–I.15. The Kaunas Weather Station provided daily records of air temperature (T, wind speed (WS, relative humidity, and barometric pressure (BP. We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS > 600 km/s increased the daily number of elevated arterial blood pressure (EABP by 12% (RR = 1.12; 95% confidence interval (CI 1.04–1.21; and WS ≥ 3.5 knots during days of T < 1.5 °C and T ≥ 12.5 °C by 8% (RR = 1.08; CI 1.04–1.12. An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T ≥ 17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population’s sensitivity to different weather conditions.
Røislien, Jo; van den Berg, Pieter L; Lindner, Thomas; Zakariassen, Erik; Uleberg, Oddvar; Aardal, Karen; van Essen, J Theresia
Helicopter emergency medical services are important in many health care systems. Norway has a nationwide physician manned air ambulance service servicing a country with large geographical variations in population density and incident frequencies. The aim of the study was to compare optimal air ambulance base locations using both population and incident data. We used municipality population and incident data for Norway from 2015. The 428 municipalities had a median (5-95 percentile) of 4675 (940-36,264) inhabitants and 10 (2-38) incidents. Optimal helicopter base locations were estimated using the Maximal Covering Location Problem (MCLP) optimization model, exploring the number and location of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, in green field scenarios and conditioned on the existing base structure. The existing bases covered 96.90% of the population and 91.86% of the incidents for time threshold 45 min. Correlation between municipality population and incident frequencies was -0.0027, and optimal base locations varied markedly between the two data types, particularly when lowering the target time. The optimal solution using population density data put focus on the greater Oslo area, where one third of Norwegians live, while using incident data put focus on low population high incident areas, such as northern Norway and winter sport resorts. Using population density data as a proxy for incident frequency is not recommended, as the two data types lead to different optimal base locations. Lowering the target time increases the sensitivity to choice of data.
Goemans, Nathalie; Lowes, Linda P.; Alfano, Lindsay N.; Berry, Katherine; Shao, James; Kaye, Edward M.; Mercuri, Eugenio; Hamid, Hoda Abdel; Byrne, Barry J.; Connolly, Anne M.; Dracker, Robert A.; Matthew Frank, L.; Heydemann, Peter T.; O'Brien, Kevin C.; Sparks, Susan E.; Specht, Linda A.; Rodino‐Klapac, Louise; Sahenk, Zarife; Al‐Zaidy, Samiah; Cripe, Linda H.; Lewis, Sarah; M, Pane; E, Mazzone; S, Messina; GL, Vita; Bertini, D Amico A; Casimiro, Berardinelli A; Y, Torrente; F, Magri; GP, Comi; G, Baranello; T, Mongini; A, Pini; R, Battini; E, Pegoraro; C, Bruno; L, Politano; S, Previtali
Objective To continue evaluation of the long‐term efficacy and safety of eteplirsen, a phosphorodiamidate morpholino oligomer designed to skip DMD exon 51 in patients with Duchenne muscular dystrophy (DMD). Three‐year progression of eteplirsen‐treated patients was compared to matched historical controls (HC). Methods Ambulatory DMD patients who were ≥7 years old and amenable to exon 51 skipping were randomized to eteplirsen (30/50mg/kg) or placebo for 24 weeks. Thereafter, all received eteplirsen on an open‐label basis. The primary functional assessment in this study was the 6‐Minute Walk Test (6MWT). Respiratory muscle function was assessed by pulmonary function testing (PFT). Longitudinal natural history data were used for comparative analysis of 6MWT performance at baseline and months 12, 24, and 36. Patients were matched to the eteplirsen group based on age, corticosteroid use, and genotype. Results At 36 months, eteplirsen‐treated patients (n = 12) demonstrated a statistically significant advantage of 151m (p < 0.01) on 6MWT and experienced a lower incidence of loss of ambulation in comparison to matched HC (n = 13) amenable to exon 51 skipping. PFT results remained relatively stable in eteplirsen‐treated patients. Eteplirsen was well tolerated. Analysis of HC confirmed the previously observed change in disease trajectory at age 7 years, and more severe progression was observed in patients with mutations amenable to exon skipping than in those not amenable. The subset of patients amenable to exon 51 skipping showed a more severe disease course than those amenable to any exon skipping. Interpretation Over 3 years of follow‐up, eteplirsen‐treated patients showed a slower rate of decline in ambulation assessed by 6MWT compared to untreated matched HC. Ann Neurol 2016;79:257–271 PMID:26573217
James Robert Langabeer
Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.
In this paper are presented essential themes in the subject of personnel economics. In the first part analysis has been conducted on the impact of peer pressure on workplace behaviour. Then again models for compensation structures within firms, and their influence on the utility of work by employees. In the final section of the paper the productivity spillover effect has been analyzed, and the causes of existence of spillovers and their impact on workers’ productivity
Kraus, W.; Herrmann, D.; Kiesewetter, W.
The physical properties of radiation detectors for personnel dosimetry are described and compared. The suitability of different types of dosimeters for operational and central monitoring of normal occupational exposure, for accident and catastrophe dosimetry and for background and space-flight dosimetry is discussed. The difficulties in interpreting the dosimeter reading with respect to the dose in individual body organs are discussed briefly. 430 literature citations (up to Spring 1966) are given
Ninin, P.; Valentini, F.; Ladzinski, T.
Large particle physics installations such as the CERN Large Hadron Collider require specific Personnel Safety Systems (PSS) to protect the personnel against the radiological and industrial hazards. In order to fulfill the French regulation in matter of nuclear installations, the principles of IEC 61508 and IEC 61513 standard are used as a methodology framework to evaluate the criticality of the installation, to design and to implement the PSS.The LHC PSS deals with the implementation of all physical barriers, access controls and interlock devices around the 27 km of underground tunnel, service zones and experimental caverns of the LHC. The system shall guarantee the absence of personnel in the LHC controlled areas during the machine operations and, on the other hand, ensure the automatic accelerator shutdown in case of any safety condition violation, such as an intrusion during beam circulation. The LHC PSS has been conceived as two separate and independent systems: the LHC Access Control System (LACS) and the LHC Access Safety System (LASS). The LACS, using off the shelf technologies, realizes all physical barriers and regulates all accesses to the underground areas by identifying users and checking their authorizations.The LASS has been designed according to the principles of the IEC 61508 and 61513 standards, starting from a risk analysis conducted on the LHC facility equipped with a standard access control system. It consists in a set of safety functions realized by a dedicated fail-safe and redundant hardware guaranteed to be of SIL3 class. The integration of various technologies combining electronics, sensors, video and operational procedures adopted to establish an efficient personnel safety system for the CERN LHC accelerator is presented in this paper. (authors)
This paper explains how selected personnel can now obtain a Bachelor of Science degree in Physics with a Nuclear Power Operations option. The program went into effect the Fall of 1984. Another program was worked out in 1982 whereby students attending the Nuclear Operators Training Program could obtain an Associates of Science degree in Mechanical Engineering Technology at the end of two years of study. This paper presents tables and charts which describe these programs and outline the career path for operators
Barlem,Edison Luiz Devos; Lunardi,Valéria Lerch; Lunardi,Guilherme Lerch; Tomaschewski-Barlem,Jamila Geri; Silveira,Rosemary Silva da; Dalmolin,Graziele de Lima
OBJECTIVE: to analyze the frequency and intensity of moral distress experienced by nursing personnel in southern Brazil, covering elements of their professional practice. METHOD: a survey was undertaken in two hospitals in Rio Grande do Sul, Brazil, with 247 nurses. Data was collected by means of the adapted Moral Distress Scale. RESULTS: the perception of situations that lead to moral distress is enhanced in nurses and in nursing staff working in institutions with greater openness to dialogu...
Polanco-González, Carlos; Castañón-González, Jorge Alberto; Villanueva-Martínez, Sebastián; Samaniego-Mendoza, José Lino; Buhse, Thomas
In most places all over the world–including our country–services in emergency rooms are oversaturated. This situation frequently forces the continuously arriving ambulances to be redirected to other medical units, delaying the admission of patients moved and thus adversely affecting their physical condition. To introduce an improvement to the Índicede Saturación Modificado computational system, which monitors the degree of saturation of a network of emergency medical services, to include a network of ambulances, enabling in the system: (i) the effective allocation of ambulances to the site of the accident, or severe clinical event, and (ii) the remote booking of beds in the nearest and least saturated emergency room available. The evaluation and connectivity of the computational improvement to the Índicede Saturación Modificado system was carried out with a computational test verifying these two aspects, using only differences in postal codes, for time measuring. The verification of its sustainability online showed the new Índice de Saturación Modificado y Ambulancias system (ISMA) has a robust structure capable of being adapted to mobile phones, laptops or tablets, and can efficiently administrate: (i) the quantification of excessive demand in the emergency room services of a hospital network, (ii) the allocation of ambulances attending the site of the event or contingency, and (iii) the allocation of ambulances and patients, in the best distance-time conditions, from the site of the accident or clinical event to the nearest and least saturated emergency room service. This administrative management tool is efficient and simple to use, and it optimally relates independent service networks.
Shenoy, K.S.; Patel, P.H.
The manifold increase in production, and ease of availability of radioisotopes in India have been responsible for a tremendous increase in use of radioisotopes in industrial radiography during past fifteen years. Among various applications of radioisotopes the industrial radiography involves a large potential risk of occupational radiation exposures. The dose records of past fifteen years in respect of all radiation workers maintained by the Personnel Monitoring Group of Division of Radiological Protection of the Bhabha Atomic Research Centre, Bombay, have been analysed. Analysis of excessive exposure (exceeding 400 mrem/fortnight) reveals that this figure is increasing at an alarming rate among the radiation workers of this category. In spite of various regulatory controls the dose per person per week has remained higher as compared to the same in other categories. This combined with the increase in number of radiation workers every year would soon contribute significantly to the per capita dose for radiation workers. Use of adequately shielded fool-proof remote control equipment and training of all personnel in safe handling of radiation sources seem to be the only solution to arrest the rate of increase in personnel exposures of this category. (auth.)
US Agency for International Development — The NFC system is an USDA system used for processing transactions for payroll/personnel systems. Personnel processing is done through EPIC/HCUP, which is web-based....
Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio
The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between -20 and 4 (mean -4.4). The mean changes were -3.79 in the glucocorticoid group, -5.52 in those who stopped at loss of ambulation and -4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
... 10 Energy 1 2010-01-01 2010-01-01 false Personnel monitoring. 36.55 Section 36.55 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR IRRADIATORS Operation of Irradiators § 36.55 Personnel monitoring. (a) Irradiator operators shall wear a personnel dosimeter that is...
... 49 Transportation 3 2010-10-01 2010-10-01 false Personnel health. 193.2711 Section 193.2711 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY...: FEDERAL SAFETY STANDARDS Personnel Qualifications and Training § 193.2711 Personnel health. Each operator...
Ozdemir, Tuncay Yavuz
Nowadays everything develops and changes very quickly and sustainability of organizational goals will be possible only when personnel can keep up with these changes. From administrative aspect it is important to enhance personnel's potential and prompt them to achieve organizational goals. Personnel development is a process which influences and…
LOCOG Medical managed thousands of patient contacts across all the Games venues without our intervention. A polyclinic in the athlete's village had extensive diagnostic options, including X-ray and magnetic resonance imaging for athletes and the Olympic family. These helped limit the number of patients who needed transport to the ED. Although the delivery was seamless, there were "behind the scenes" moments in the final stages of planning that made us think. We received additional requests for ambulance cover at training venues that hadn't been planned for on short notice. In addition, the torch relay attracted bigger crowds than initially planned for. Some of the planning assumptions and agreements changed on short notice for various reasons. This meant we had to adjust our plans while also solving human resource issues that you would expect to see among a workforce of around 500 across a six-week period. As part of the National Health Service (NHS) ambulance service Games cohort, more than 500 staff were deployed across 18 venues and 30 days of sport in London. In doing so, they delivered in excess of 165,000 hours of standby and care, responded to nearly 1,500 Games-related incidents and conveyed 800 patients to emergency departments across the capital. After such an influx, it wasn't easy to return to business as usual. Officials with previous host cities had advised us that there would be a feeling of "what next" once the Games concluded. When I first heard this, I thought the opposite would be the case. I expected feeling relieved of overwhelming emotion as well as from the exhaustion of the long days. I do have to say that although this was the case, it's also true that there is a "post Games" come down. We had just been part of a fantastic summer of sport with a brilliant medal tally from Team Great Britain and Paralympics Great Britain that, of course, helped the euphoria. But we did feel real sense of uncertainty about what to do next. We had spent five
Fleischman, Ross J.; Lundquist, Mark; Jui, Jonathan; Newgard, Craig D.; Warden, Craig
Objective To derive and validate a model that accurately predicts ambulance arrival time that could be implemented as a Google Maps web application. Methods This was a retrospective study of all scene transports in Multnomah County, Oregon, from January 1 through December 31, 2008. Scene and destination hospital addresses were converted to coordinates. ArcGIS Network Analyst was used to estimate transport times based on street network speed limits. We then created a linear regression model to improve the accuracy of these street network estimates using weather, patient characteristics, use of lights and sirens, daylight, and rush-hour intervals. The model was derived from a 50% sample and validated on the remainder. Significance of the covariates was determined by p times recorded by computer-aided dispatch. We then built a Google Maps-based web application to demonstrate application in real-world EMS operations. Results There were 48,308 included transports. Street network estimates of transport time were accurate within 5 minutes of actual transport time less than 16% of the time. Actual transport times were longer during daylight and rush-hour intervals and shorter with use of lights and sirens. Age under 18 years, gender, wet weather, and trauma system entry were not significant predictors of transport time. Our model predicted arrival time within 5 minutes 73% of the time. For lights and sirens transports, accuracy was within 5 minutes 77% of the time. Accuracy was identical in the validation dataset. Lights and sirens saved an average of 3.1 minutes for transports under 8.8 minutes, and 5.3 minutes for longer transports. Conclusions An estimate of transport time based only on a street network significantly underestimated transport times. A simple model incorporating few variables can predict ambulance time of arrival to the emergency department with good accuracy. This model could be linked to global positioning system data and an automated Google Maps web
Lund, Cathrine; Bjornaas, Mari A; Sandvik, Leiv; Ekeberg, Oivind; Jacobsen, Dag; Hovda, Knut E
The long-term mortality after prehospital treatment for acute poisoning has not been studied previously. Thus, we aimed to estimate the five-year mortality and examine the causes of death and predictors of death for all acutely poisoned patients treated in ambulances, the emergency outpatient clinic, and hospitals in Oslo during 2003-2004. A prospective cohort study included all adults (≥16 years; n=2045, median age=35 years, male=58%) who were discharged after treatment for acute poisoning in ambulances, the emergency outpatient clinic, and the four hospitals in Oslo during one year. The patients were observed until the end of 2008. Standardized mortality rates (SMRs) were calculated and multivariate Cox regression analysis was applied. The study comprised 2045 patients; 686 treated in ambulances, 646 treated in the outpatient clinic, and 713 treated in hospitals. After five years, 285 (14%) patients had died (four within one week). The SMRs after ambulance, outpatient, and hospital treatment were 12 (CI 9-14), 10 (CI 8-12), and 6 (CI 5-7), respectively. The overall SMR was 9 (CI 8-10), while the SMR after opioid poisoning was 27 (CI 21-32). The most frequent cause of death was accidents (38%). In the regression analysis, opioids as the main toxic agents (HR 2.3, CI 1.6-3.0), older age (HR 1.6, CI 1.5-1.7), and male sex (HR 1.4, CI 1.1-1.9) predicted death, whereas the treatment level did not predict death. The patients had high mortality compared with the general population. Those treated in hospital had the lowest mortality. Opioids were the major predictor of death.
Azimi, S.; Delavar, M. R.; Rajabifard, A.
In response to natural disasters, efficient planning for optimum allocation of the medical assistance to wounded as fast as possible and wayfinding of first responders immediately to minimize the risk of natural disasters are of prime importance. This paper aims to propose a multi-agent based modeling for optimum allocation of space to emergency centers according to the population, street network and number of ambulances in emergency centers by constraint network Voronoi diagrams, wayfinding of ambulances from emergency centers to the wounded locations and return based on the minimum ambulances travel time and path length implemented by NSGA and the use of smart city facilities to accelerate the rescue operation. Simulated annealing algorithm has been used for minimizing the difference between demands and supplies of the constrained network Voronoi diagrams. In the proposed multi-agent system, after delivering the location of the wounded and their symptoms, the constraint network Voronoi diagram for each emergency center is determined. This process was performed simultaneously for the multi-injuries in different Voronoi diagrams. In the proposed multi-agent system, the priority of the injuries for receiving medical assistance and facilities of the smart city for reporting the blocked streets was considered. Tehran Municipality District 5 was considered as the study area and during 3 minutes intervals, the volunteers reported the blocked street. The difference between the supply and the demand divided to the supply in each Voronoi diagram decreased to 0.1601. In the proposed multi-agent system, the response time of the ambulances is decreased about 36.7%.
Phung, Viet‐Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne
Abstract Rationale, aims and objectives Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). Methods We used a self‐administered online questionnaire survey sent to front‐line clinicians in all 12 English ambulance services. We conducted a cross‐sectional analysis of quantitative data and qualitative analysis of free‐text responses. Results There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Conclusions Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre‐hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large‐scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. PMID:26303398
Mazzone, Elena; Martinelli, Diego; Berardinelli, Angela; Messina, Sonia; D'Amico, Adele; Vasco, Gessica; Main, Marion; Doglio, Luca; Politano, Luisa; Cavallaro, Filippo; Frosini, Silvia; Bello, Luca; Carlesi, Adelina; Bonetti, Anna Maria; Zucchini, Elisabetta; De Sanctis, Roberto; Scutifero, Marianna; Bianco, Flaviana; Rossi, Francesca; Motta, Maria Chiara; Sacco, Annalisa; Donati, Maria Alice; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Pane, Marika; Pasquini, Elisabetta; Bruno, Claudio; Vita, Giuseppe; de Waure, Chiara; Bertini, Enrico; Mercuri, Eugenio
The North Star Ambulatory Assessment is a functional scale specifically designed for ambulant boys affected by Duchenne muscular dystrophy (DMD). Recently the 6-minute walk test has also been used as an outcome measure in trials in DMD. The aim of our study was to assess a large cohort of ambulant boys affected by DMD using both North Star Assessment and 6-minute walk test. More specifically, we wished to establish the spectrum of findings for each measure and their correlation. This is a prospective multicentric study involving 10 centers. The cohort included 112 ambulant DMD boys of age ranging between 4.10 and 17 years (mean 8.18±2.3 DS). Ninety-one of the 112 were on steroids: 37/91 on intermittent and 54/91 on daily regimen. The scores on the North Star assessment ranged from 6/34 to 34/34. The distance on the 6-minute walk test ranged from 127 to 560.6 m. The time to walk 10 m was between 3 and 15 s. The time to rise from the floor ranged from 1 to 27.5 s. Some patients were unable to rise from the floor. As expected the results changed with age and were overall better in children treated with daily steroids. The North Star assessment had a moderate to good correlation with 6-minute walk test and with timed rising from floor but less with 10 m timed walk/run test. The 6-minute walk test in contrast had better correlation with 10 m timed walk/run test than with timed rising from floor. These findings suggest that a combination of these outcome measures can be effectively used in ambulant DMD boys and will provide information on different aspects of motor function, that may not be captured using a single measure. Copyright © 2010. Published by Elsevier B.V.
Full Text Available Background: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care. Methods: A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30 was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30 no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS, subjective comments on cold experiences, and finger, ear and air temperatures. Results: Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001 but decreased in the control group (p=0.014. A significant higher proportion (57% of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001. At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions: The use of active heat from underneath increases the patients’ thermal comfort and may prevent the negative consequences of cold stress.
Espinoza, Alexis Valenzuela; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Tellez, Helio Fernandez; Dupont, Alain; Putman, Koen; Brouns, Raf
Abstract: Background: In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB) to facilitate a wider spread of the knowledge regarding this technique. Methods: Successful execution of the project involved the develop...
Espinoza, Alexis Valenzuela; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Tellez, Helio Fernandez; Dupont, Alain; Putman, Koen; Brouns, Raf
Background: In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB) to facilitate a wider spread of the knowledge regarding this technique. Methods: Successful execution of the project involved the development and v...
Lombardo, Lisa M; Kobetic, Rudolf; Pinault, Gilles; Foglyano, Kevin M; Bailey, Stephanie N; Selkirk, Stephen; Triolo, Ronald J
Test the effect of a multi-joint control with implanted electrical stimulation on walking after spinal cord injury (SCI). Single subject research design with repeated measures. Hospital-based biomechanics laboratory and user assessment of community use. Female with C6 AIS C SCI 30 years post injury. Lower extremity muscle activation with an implanted pulse generator and gait training. Walking speed, maximum distance, oxygen consumption, upper extremity (UE) forces, kinematics and self-assessment of technology. Short distance walking speed at one-year follow up with or without stimulation was not significantly different from baseline. However, average walking speed was significantly faster (0.22 m/s) with stimulation over longer distances than volitional walking (0.12 m/s). In addition, there was a 413% increase in walking distance from 95 m volitionally to 488 m with stimulation while oxygen consumption and maximum upper extremity forces decreased by 22 and 16%, respectively. Stimulation also produced significant (P ≤ 0.001) improvements in peak hip and knee flexion, ankle angle at foot off and at mid-swing. An implanted neuroprosthesis enabled a subject with incomplete SCI to walk longer distances with improved hip and knee flexion and ankle dorsiflexion resulting in decreased oxygen consumption and UE support. Further research is required to determine the robustness, generalizability and functional implications of implanted neuroprostheses for community ambulation after incomplete SCI.
Vencloviene, Jone; Babarskiene, Ruta M; Dobozinskas, Paulius; Sakalyte, Gintare; Lopatiene, Kristina; Mikelionis, Nerijus
We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009-2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10-I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS>600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR=1.12; 95% confidence interval (CI) 1.04-1.21); and WS≥3.5 knots during days of Tweather conditions. These results may help in the understanding of the population's sensitivity to different weather conditions.
Wong, Ho Ting; Lin, Teng-Kang; Lin, Jen-Jia
This study aims to assess rural-urban differences in the predictors of emergency ambulance service (EAS) demand and misuse in New Taipei City. Identifying the predictors of EAS demand will help the EAS service managing authority in formulating focused policies to maintain service quality. Over 160,000 electronic EAS usage records were used with a negative binomial regression model to assess rural-urban differences in the predictors of EAS demand and misuse. The factors of 1) ln-transformed population density, 2) percentage of residents who completed up to junior high school education, 3) accessibility of hospitals without an emergency room, and 4) accessibility of EAS were found to be predictors of EAS demand in rural areas, whereas only the factor of percentage of people aged above 65 was found to predict EAS demand in urban areas. For EAS misuse, only the factor of percentage of low-income households was found to be a predictor in rural areas, whereas no predictor was found in the urban areas. Results showed that the factors predicting EAS demand and misuse in rural areas were more complicated compared to urban areas and, therefore, formulating EAS policies for rural areas based on the results of urban studies may not be appropriate. Copyright © 2018. Published by Elsevier B.V.
Morgan, P; Murphy, A; Opheim, A; McGinley, J
The relationship between spatiotemporal gait parameters, balance performance and falls history was investigated in ambulant adults with cerebral palsy (CP). Participants completed a single assessment of gait using an instrumented walkway at preferred and fast speeds, balance testing (Balance Evaluation Systems Test; BESTest), and reported falls history. Seventeen ambulatory adults with CP, mean age 37 years, participated. Gait speed was typically slow at both preferred and fast speeds (mean 0.97 and 1.21m/s, respectively), with short stride length and high cadence relative to speed. There was a significant, large positive relationship between preferred gait speed and BESTest total score (ρ=0.573; pfalls taking shorter strides. Faster gait speed was associated with better performance on tests of anticipatory and postural response components of the BESTest, suggesting potential therapeutic training targets to address either gait speed or balance performance. Future exploration of the implications of slow walking speed and reduced stride length on falls and community engagement, and the potential prognostic value of stride length on identifying falls risk is recommended. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.
Morchel, Herman; Ogedegbe, Chinwe; Chaplin, William; Cheney, Brianna; Zakharchenko, Svetlana; Misch, David; Schwartz, Matthew; Feldman, Joseph; Kaul, Sanjeev
To determine if physicians trained in ultrasound interpretation perceive a difference in image quality and usefulness between Extended Focused Assessment with Sonography ultrasound examinations performed at bedside in a hospital vs. by emergency medical technicians minimally trained in medical ultrasound on a moving ambulance and transmitted to the hospital via a novel wireless system. In particular, we sought to demonstrate that useful images could be obtained from patients in less than optimal imaging conditions; that is, while they were in transport. Emergency medical technicians performed the examinations during transport of blunt trauma patients. Upon patient arrival at the hospital, a bedside Extended Focused Assessment with Sonography examination was performed by a physician. Both examinations were recorded and later reviewed by physicians trained in ultrasound interpretation. Data were collected on 20 blunt trauma patients over a period of 13 mo. Twenty ultrasound-trained physicians blindly compared transmitted vs. bedside images using 11 Questionnaire for User Interaction Satisfaction scales. Four paired samples t-tests were conducted to assess mean differences between ratings for ambulatory and base images. Although there is a slight tendency for the average rating across all subjects and raters to be slightly higher in the base than in the ambulatory condition, none of these differences are statistically significant. These results suggest that the quality of the ambulatory images was viewed as essentially as good as the quality of the base images.
Lloyd, Gemma; Dean, Catherine M; Ada, Louise
Recruitment to clinical trials is often slow and difficult, with a growing body of research examining this issue. However there is very little work related to stroke. The aim of this study was to examine the success and efficiency of recruitment of community-dwelling stroke survivors over the first two years of a clinical trial aiming to improve community ambulation. Recruitment strategies fell into 2 broad categories: (i) advertisement (such as newspaper advertising and media releases), and (ii) referral (via hospital and community physiotherapists, a stroke liaison officer and other researchers). Records were kept of the number of people who were screened, were eligible and were recruited for each strategy. The recruitment target of 60 in the first two years was not met. 111 stroke survivors were screened and 57 were recruited (i.e., a recruitment rate of 51%). The most successful strategy was referral via hospital-based physiotherapists (47% of recruited participants) and the least successful were media release and local newspaper advertising. The referral strategies were all more efficient than any of the advertisement strategies. In general, recruitment was inefficient and costly in terms of human resources. Given that stroke research is underfunded, it is important to find efficient ways of recruiting stroke survivors to clinical trials. An Australian national database similar to other disease-specific data bases (such as the National Cancer Database) is under development. In the interim, recruiting for several clinical trials at once may increase efficiency.
Full Text Available Reconstructive surgery following an internal hemipelvectomy for a malignant pelvic tumor is difficult due to the structural complexity of the pelvis and the massive extension of the tumor. While high complication rates have been encountered in various types of reconstructive surgery, resection without reconstruction reportedly involved fewer complications. However, this method often results in limb shortening with resultant instability during walking. We reported herein leg lengthening performed to correct lower limb shortening after an internal hemipelvectomy, which improved ambulatory stability and overall QOL. An 18-year-old male patient came to our hospital to correct a lower limb discrepancy resulting from a left internal hemipelvectomy. His left pelvis and proximal femur had been resected, and the femur remained without an acetabular roof. His left lower limb was about 8 centimeters shorter. The left tibia was lengthened 8 centimeters with an external fixator. After the lengthening, the patient was able to walk without support and his gait remarkably improved. Additionally he no longer required placing a wallet in his back pocket as a pad as a means of raising the left side of his torso while sitting. Leg lengthening was a useful method of improving ambulation after an internal hemipelvectomy.
Russell Esposito, Elizabeth; Lipe, Delbert H; Rábago, Christopher A
Walking in high heels presents biomechanical challenges, yet they remain part of many women's attire. However, women with a lower limb amputation are limited in available footwear options. Case description and methods: This case study is in response to one patient's assertion that she walked better and more symmetrically in heels than flat shoes with her below-knee prosthesis. She underwent gait analysis in athletic shoes and 10-cm stiletto high heels worn with a pediatric running foot to determine if these claims could be substantiated through biomechanical measures. Global gait asymmetry indices were calculated. Findings and outcomes: Asymmetry indices were nearly identical between athletic shoes and heels but joint-level findings differed substantially. Ankle mechanics were more symmetrical in heels but hip mechanics were less. The maintenance of symmetry in stiletto high heels does not imply maintenance of gait quality, as high heels are known to adversely affect some components walking mechanics. Clinical relevance Returning to high-heel wear is achievable for prosthesis users. Accommodations can be made using creativity in prosthetic foot selection to enable successful ambulation; however, attention to gait mechanics may be important for patient safety.
Havel, Christof; Schreiber, Wolfgang; Trimmel, Helmut; Malzer, Reinhard; Haugk, Moritz; Richling, Nina; Riedmüller, Eva; Sterz, Fritz; Herkner, Harald
Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation. To assess the effect of real time automated feedback on the quality of resuscitation in an emergency transportation setting. Randomised cross-over trial. Medical University of Vienna, Vienna Municipal Ambulance Service and Helicopter Emergency Medical Service Unit (Christophorus Flugrettungsverein) in September 2007. European Resuscitation Council (ERC) certified health care professionals performing CPR in a flying helicopter and in a moving ambulance vehicle on a manikin with human-like chest properties. CPR sessions, with real time automated feedback as the intervention and standard CPR without feedback as control. Quality of chest compression during resuscitation. Feedback resulted in less deviation from ideal compression rate 100 min(-1) (9+/-9 min(-1), ptime. Applied work was less in the feedback group compared to controls (373+/-448 cm x compression; ptime automated feedback improves certain aspects of CPR quality in flying helicopters and moving ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
Banitsas, Konstantinos A; Perakis, Konstantinos; Tachakra, Sapal; Koutsouris, Dimitrios
We developed a mobile teleconsultation system based on third-generation mobile phone links. The system comprised a laptop computer and a digital camcorder. It was installed inside an ambulance to allow video-conferencing between the moving vehicle and a doctor at a base station. In addition to video and voice, high-quality still images could also be transmitted. A series of 17 trial runs with real ambulance patients was conducted in the city of Athens. In general, the videoconferencing sessions produced relatively clear video. The bandwidth was high enough for a satisfactory video of 10-15 frames/s. During a total testing period of 23 h and in an area of about 180 km2, there were nine instances of signal loss, amounting to a total of 17 min. The general opinion formed by the doctors was that the system produced good results. All initial diagnoses made using the system agreed with the final diagnoses of the patients. The study showed that the mobile system could reduce the time before an ambulance patient is seen by a doctor.
Andersen, Dorte Raaby; Andersen, Lars Peter; Gadegaard, Charlotte Ann
Objectives The objective of this follow-up study was to investigate associations between individual, occupational and work environment factors and burnout among both uniformed and non-uniformed personnel working in the Danish Prison and Probation Service. Methods The participants (N = 4808......) with client contact received a questionnaire in 2010 and again in 2011. In 2010, 2843 participants responded to the questionnaire (59.1%), and in 2011, 1741 responded to the questionnaire, yielding a response rate of 61.2% of the baseline population, and 36.2% of the invited population. Burnout and work...... characteristics were measured with validated scales from the Copenhagen Psychosocial Questionnaire, and data was analysed by logistic regression. Results Risk factors with the highest impact on burnout were work environmental factors: quantitative demands, emotional demands, involvement in and meaning of work...
Poole, D.E.; Ring, T.
The personnel safety system designed for the SRS at Daresbury is a unified system covering the three accelerators of the source itself, the beamlines and the experimental stations. The system has also been applied to the experimental areas of the Nuclear Structure Facility, and is therefore established as a site standard. A dual guardline interlock module forms a building block for a relay based interlock system completely independent of the machine control system, although comprehensive monitoring of the system status via the control system computer is a feature. An outline of the design criteria adopted for the system is presented together with a more detailed description of the philosophy of the guardline logic and the way this is implemented in a standard modular form. The emphasis is on the design features of a modern microprocessor based variant of the original SRS system. Experience with the original system during build-up and operation of the SRS facility is described. 2 refs., 4 figs
Dear Colleagues, Many important discussions are scheduled for the upcoming Council Week (13-17 June) on topics including the Medium-Term Plan, the Pension Fund and other matters of great relevance to us. I would therefore like to share the main outcome of the week with you and I invite you to join me and the Directors in the Main Auditorium at 10 a.m. on Thursday 23 June. The meeting will last about one hour and a webcast will also be available. Best regards, Fabiola Gianotti DG presentation to personnel Thursday 23 June at 10 am Main Auditorium Retransmission in Council Chamber, IT Auditorium, Kjell Jonhsen Auditorium, Prevessin 864-1-C02 Webcast on cern.ch/webcast More information on the event page.
Roberson, P.L.; Fox, R.A.; Hadley, R.T.; Holbrook, K.L.; Hooker, C.D.; McDonald, J.C.
A base of technical information has been acquire and used to evaluate the calibration, design, and performance of selected personnel systems in use at Department of Energy (DOE) facilites. A technical document was prepared to guide DOE and DOE contractors in selecting and evaluating personnel dosimetry systems and calibration. A parallel effort was initiated to intercompare the adiological calibrations standards used to calibrate DOE personnel dosimeters
.... It implements policy, establishes uniform DoD-wide procedures, provides guidelines and model programs, delegates authority, and assigns responsibilities regarding civilian personnel management within...
Nissen, Lars Ravnborg; Guldager, Bernadette; Gyntelberg, Finn
PURPOSE: To compare the prevalence of musculoskeletal disorders of personnel in the main battle tank (MBT) units in the Danish army with those of personnel in other types of army units, and to investigate associations between job function in the tank, military rank, and musculoskeletal problems......, and ankle. RESULTS AND CONCLUSIONS: There were only 4 women in the MBT group; as a consequence, female personnel were excluded from the study. The participation rate was 58.0% (n = 184) in the MBT group and 56.3% (n = 333) in the reference group. The pattern of musculoskeletal disorders among personnel...
Sapronov, V.G.; Issupov, V.I.
Khmelnitsky nuclear power plant personnel training system improvement is described, including creation of Training center, development of training courses based on SAT methodology, development of training hardware
Included are comments and statistics on current employment levels, projected requirements for future stations, sources of personnel for current and projected stations, and methods of employee selection
Social Security Administration — SSA provides the Office of Personnel Management (OPM) with tax returns, Social Security benefits, and military retirement information for the purpose of correctly...
The basic preconditions are discussed of educating personnel for nuclear power and nuclear technology in Czechoslovakia. In educating specialists, the high societal significance of nuclear power and the need to obtain qualified personnel for safeguarding safety and reliability of nuclear facilities operation should primarily be borne in mind. The system of training applies not only to operating and maintenance personnel of nuclear power plants but also to fuel and power generation, transport, engineering, building industry, health care, education and other personnel. (J.B.)
Krayeva, Yulia V; Brusin, Konstantin M; Bushuev, Alexander V; Kondrashov, Dmitriy L; Sentsov, Valentin G; Hovda, Knut Erik
Large, prospective pre-hospital studies of acute poisonings are scarce. We present the epidemiology of the pre-hospital poisonings, the treatment given, the complications of the poisoning itself and the treatment, predictors for hospitalization, and the safety of the present approach in a large industrial Russian city. Data were collected from March 2009 to March 2010. All adult (≥ 16 years) acute poisonings in the city of Yekaterinburg, Russia were included. The prospective cohort inclusion of data included age, gender, simple clinical features (including consciousness, respiratory status, circulatory status, convulsions, etc.), main toxic agent, reason why poisoning was suspected, treatment given, and outcome. Multivariate logistic regression analysis was used to identify the factors associated with hospitalization of the patients. In total, 1795/2536 patients (71%) were brought to hospitals, 736/2536 (29%) were discharged by the ambulance, and 5/2536 (0.2%) died on scene. The most frequent main agents were opioids (25%), ethanol (9%), benzodiazepines (8%), corrosive substances (7%), carbon monoxide (5%), and neuroleptics (5%). Pre-hospital treatment was given to 73% of patients; 3% were intubated, and antidotes were given in 27% (naloxone 24%, atropine 2%, and flumazenil 0.2%). Gastric lavage was performed in 34%, but only 20% within the first hour after ingestion; 49% had a Glasgow Coma Scale (GCS)treatment practice in most places, especially concerning the use of gastric lavage. Whether the current practice led to an increased morbidity and mortality is uncertain, but it justifies the need for thorough evaluation of clinical practice. These findings highlight the importance of studies like the present to improve diagnostics, triage, and treatment in acute poisonings.
Full Text Available The 6 minute walk test has been recently chosen as the primary outcome measure in international multicenter clinical trials in Duchenne muscular dystrophy ambulant patients. The aim of the study was to assess the spectrum of changes at 3 years in the individual measures, their correlation with steroid treatment, age and 6 minute walk test values at baseline. Ninety-six patients from 11 centers were assessed at baseline and 12, 24 and 36 months after baseline using the 6 minute walk test and the North Star Ambulatory Assessment. Three boys (3% lost the ability to perform the 6 minute walk test within 12 months, another 13 between 12 and 24 months (14% and 11 between 24 and 36 months (12%. The 6 minute walk test showed an average overall decline of -15.8 (SD 77.3 m at 12 months, of -58.9 (SD 125.7 m at 24 months and -104.22 (SD 146.2 m at 36 months. The changes were significantly different in the two baseline age groups and according to the baseline 6 minute walk test values (below and above 350 m (p<0.001. The changes were also significantly different according to steroid treatment (p = 0.01. Similar findings were found for the North Star Ambulatory Assessment. These are the first 36 month longitudinal data using the 6 minute walk test and North Star Ambulatory Assessment in Duchenne muscular dystrophy. Our findings will help not only to have a better idea of the progression of the disorder but also provide reference data that can be used to compare with the results of the long term extension studies that are becoming available.
Pane, Marika; Mazzone, Elena Stacy; Sivo, Serena; Sormani, Maria Pia; Messina, Sonia; D'Amico, Adele; Carlesi, Adelina; Vita, Gianluca; Fanelli, Lavinia; Berardinelli, Angela; Torrente, Yvan; Lanzillotta, Valentina; Viggiano, Emanuela; D Ambrosio, Paola; Cavallaro, Filippo; Frosini, Silvia; Barp, Andrea; Bonfiglio, Serena; Scalise, Roberta; De Sanctis, Roberto; Rolle, Enrica; Graziano, Alessandra; Magri, Francesca; Palermo, Concetta; Rossi, Francesca; Donati, Maria Alice; Sacchini, Michele; Arnoldi, Maria Teresa; Baranello, Giovanni; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Previtali, Stefano; Bruno, Claudio; Politano, Luisa; Comi, Giacomo P; Bertini, Enrico; Mercuri, Eugenio
The 6 minute walk test has been recently chosen as the primary outcome measure in international multicenter clinical trials in Duchenne muscular dystrophy ambulant patients. The aim of the study was to assess the spectrum of changes at 3 years in the individual measures, their correlation with steroid treatment, age and 6 minute walk test values at baseline. Ninety-six patients from 11 centers were assessed at baseline and 12, 24 and 36 months after baseline using the 6 minute walk test and the North Star Ambulatory Assessment. Three boys (3%) lost the ability to perform the 6 minute walk test within 12 months, another 13 between 12 and 24 months (14%) and 11 between 24 and 36 months (12%). The 6 minute walk test showed an average overall decline of -15.8 (SD 77.3) m at 12 months, of -58.9 (SD 125.7) m at 24 months and -104.22 (SD 146.2) m at 36 months. The changes were significantly different in the two baseline age groups and according to the baseline 6 minute walk test values (below and above 350 m) (p<0.001). The changes were also significantly different according to steroid treatment (p = 0.01). Similar findings were found for the North Star Ambulatory Assessment. These are the first 36 month longitudinal data using the 6 minute walk test and North Star Ambulatory Assessment in Duchenne muscular dystrophy. Our findings will help not only to have a better idea of the progression of the disorder but also provide reference data that can be used to compare with the results of the long term extension studies that are becoming available.
Plat, Marie-Christine J.; Westerveld, Gre J.; Hutter, Renée C.; Olff, Miranda; Frings-Dresen, Monique H. W.; Sluiter, Judith K.
This study i) describes the number of police personnel with PTSD who are working and those who are on sick leave before and after an out-patient-clinic treatment program and ii) examines which factors are related to return to work. Police personnel treated for PTSD (n=121). In this retrospective
... 10 Energy 1 2010-01-01 2010-01-01 false Laboratory personnel. 26.155 Section 26.155 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Laboratories Certified by the Department of Health and Human... ensure the continued competency of laboratory personnel by documenting their in-service training...
The principal contributions to the radiation doses of the Swedish power reactor personnel are identified. The possi bilities to reduce these doses are examined. The radiation doses are analyzed according to different personnel categories, specific maintenance operations or inspections and to different radiation activities. Suggestions are given for reducing the radiation doses. (L.E.)
Siegel, A.I.; Bartter, W.D.; Wolf, J.J.; Knee, H.E.; Haas, P.M.
A stochastic computer model for simulating the actions and behavior of nuclear power plant maintenance personnel is described. The model considers personnel, environmental, and motivational variables to yield predictions of maintenance performance quality and time to perform. The mode has been fully developed and sensitivity tested. Additional evaluation of the model is now taking place
... 10 Energy 1 2010-01-01 2010-01-01 false Personnel monitoring. 39.65 Section 39.65 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.65 Personnel monitoring. (a) The licensee may not permit an individual to act as a logging...
... 10 Energy 1 2010-01-01 2010-01-01 false Personnel monitoring. 34.47 Section 34.47 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Radiation Safety Requirements § 34.47 Personnel monitoring. (a) The licensee may not...
... apparel, such as head, face, hand, and arm coverings, shall be worn as necessary to protect drug products... observation) to have an apparent illness or open lesions that may adversely affect the safety or quality of... medical personnel not to jeopardize the safety or quality of drug products. All personnel shall be...
Current trends and conditions in the health physics profession are discussed. The need for health physics personnel in academia, nuclear power plants, other nuclear industry, national laboratories, and other sectors and the shortfall in qualified personnel to fill the available positions is described. Reasons for the present situation and recommendations for alleviating it are presented
Full Text Available This article deals with transition way of economic of the Russian Federation on an innovative way of development. The special attention is given the internal social and economic environment of the organizations which, as a rule, counteracts development of innovative activity of the personnel. Ways of increase of innovative activity of the personnel are offered.
Kinsella, Rita; Collins, Tom; Shaw, Bridget; Sayer, James; Cary, Belinda; Walby, Andrew; Cowan, Sallie
Objective The aim of the present study was to evaluate the role of the Advanced Musculoskeletal Physiotherapist (AMP) in managing patients brought in by ambulance to the emergency department (ED). Methods This study was a dual-centre observational study. Patients brought in by ambulance to two Melbourne hospitals over a 12-month period and seen by an AMP were compared with a matched group seen by other ED staff. Primary outcome measures were wait time and length of stay (LOS) in the ED. Results Data from 1441 patients within the Australasian Triage Scale (ATS) Categories 3-5 with musculoskeletal complaints were included in the analysis. Subgroup analysis of 825 patients aged ≤65 years demonstrated that for Category 4 (semi-urgent) patients, the median wait time to see the AMP was 9.5min (interquartile range (IQR) 3.25-18.00min) compared with 25min (IQR 10.00-56.00min) to see other ED staff (P ≤ 0.05). LOS analysis was undertaken on patients discharged home and demonstrated that there was a 1.20 greater probability (95% confidence interval 1.07-1.35) that ATS Category 4 patients managed by the AMP were discharged within the 4-hour public hospital target compared with patients managed by other ED staff: 87.04% (94/108) of patients managed by the AMPs met this standard compared with 72.35% (123/170) of patients managed by other ED staff (P=0.002). Conclusions Patients aged ≤65 years with musculoskeletal complaints brought in by ambulance to the ED and triaged to ATS Category 4 are likely to wait less time to be seen and are discharged home more quickly when managed by an AMP. This study has added to the evidence that AMPs improve patient flow in the ED, freeing up time for other ED staff to see higher-acuity, more complex patients. What is known about the topic? There is a growing body of evidence establishing that AMPs improve the flow of patients presenting with musculoskeletal conditions to the ED through reduced wait times and LOS and, at the same time
Full Text Available Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third generation.A routine ambulance was equipped with a system for real-time bidirectional audio-video communication, automated transmission of vital parameters, glycemia and electronic patient identification. All patients ( ≥ 18 years transported during emergency missions by a Prehospital Intervention Team of the Universitair Ziekenhuis Brussel were eligible for inclusion. To guarantee mobility and to facilitate 24/7 availability, the teleconsultants used lightweight laptop computers to access a dedicated telemedicine platform, which also provided functionalities for neurological assessment, electronic reporting and prehospital notification of the in-hospital team. Key registrations included any safety issue, mobile connectivity, communication of patient information, audiovisual quality, user-friendliness and accuracy of the prehospital diagnosis.Prehospital teleconsultation was obtained in 41 out of 43 cases (95.3%. The success rates for communication of blood pressure, heart rate, blood oxygen saturation, glycemia, and electronic patient identification were 78.7%, 84.8%, 80.6%, 64.0%, and 84.2%. A preliminary prehospital diagnosis was formulated in 90.2%, with satisfactory agreement with final in-hospital diagnoses. Communication of a prehospital report to the in-hospital team was successful in 94.7% and prenotification of the in-hospital team via SMS in 90.2%. Failures resulted mainly from limited mobile connectivity and to a lesser extent from software, hardware or human error. The user acceptance was high.Ambulance-based telemedicine of the third generation is safe, feasible and reliable but further research and development, especially with regard to high
Full Text Available Pilates, a popular form of exercise, greatly emphasizes on the strengthening of the core muscles; however, the efficacy of exercise program can be impaired in patients with cognitive impairments. To bridge this gap, mental practice of a desired task can help to mentally simulate a given action and retain many properties of the corresponding real action. This study tries to gain preliminary understanding on the effectiveness of the combination of mental practice and core-strengthening Pilates exercises. To explore the effectiveness of mental practice and Pilates-based training on core strength, balance and mobility in multiple sclerosis (MS patients. This study highlights a single center case series describing the outcomes in ambulant patients with MS treated with mental practice and Pilates. Five volunteer ambulant individuals with stable relapsing-remitting MS participated in 20 individualized sessions, spread over 10-week duration. Pilates with mental practice session was delivered by a physiotherapist. Each session comprised 20 min of mental practice followed by 40 min of core-strengthening Pilates exercises. All the included patients were screened with Movement Imagery Questionnaire-Revised Second Version to determine if they are were able to effectively engage in imagery practice. A range of outcomes were measured: Timed up and go, chair stand test, curl-ups, the abdominal angle through leg raises, and the Activities-specific Balance Confidence Scale before and after the intervention. Group data analysis indicated significant improvement between baseline and post-intervention phases for all the tested parameters. This study provides preliminary insight into this novel combination technique to improve balance and mobility in ambulant people with MS. Mental practice played an important role in keeping the patient's compliance, which was analyzed through structured interviews. Variations in response to the intervention are evident.
Toovey, Rachel; Bernie, Charmaine; Harvey, Adrienne R; McGinley, Jennifer L; Spittle, Alicia J
The primary objective is to systematically evaluate the evidence for the effectiveness of task-specific training (TST) of gross motor skills for improving activity and/or participation outcomes in ambulant school-aged children with cerebral palsy (CP). The secondary objective is to identify motor learning strategies reported within TST and assess relationship to outcome. Systematic review. Relevant databases were searched for studies including: children with CP (mean age >4 years and >60% of the sample ambulant); TST targeting gross motor skills and activity (skill performance, gross motor function and functional skills) and/or participation-related outcomes. Quality of included studies was assessed using standardised tools for risk of bias, study design and quality of evidence across outcomes. Continuous data were summarised for each study using standardised mean difference (SMD) and 95% CIs. Thirteen studies met inclusion criteria: eight randomised controlled trials (RCTs), three comparative studies, one repeated-measures study and one single-subject design study. Risk of bias was moderate across studies. Components of TST varied and were often poorly reported. Within-group effects of TST were positive across all outcomes of interest in 11 studies. In RCTs, between-group effects were conflicting for skill performance and functional skills, positive for participation-related outcomes (one study: Life-HABITS performance SMD=1.19, 95% CI 0.3 to 2.07, pmotor function. The quality of evidence was low-to-moderate overall. Variability and poor reporting of motor learning strategies limited assessment of relationship to outcome. Limited evidence for TST for gross motor skills in ambulant children with CP exists for improving activity and participation-related outcomes and recommendations for use over other interventions are limited by poor study methodology and heterogeneous interventions. PROSPERO ID42016036727.
... implementation of a plan to address the current and projected needs for personnel who are qualified in accordance... accordance with paragraph (c) of this section, including personnel from minority backgrounds and personnel... retraining, recruiting, and hiring personnel; (B) The specific time period by which all State unit personnel...
Kristensen, Morten Tange; Andersen, Lene; Bech-Jensen, Rie
OBJECTIVE: To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture. DESIGN: An intertester reliability study....... SETTING: An acute 20-bed orthopaedic hip fracture unit. SUBJECTS: Fifty consecutive patients with a median age of 83 (25-75% quartile, 68-86) years. INTERVENTIONS: The CAS, which describes the patient's independency in three activities - (1) getting in and out of bed, (2) sit to stand from a chair, and (3...
Kristensen, Morten Tange; Jakobsen, Thomas Linding; Nielsen, Jesper Westphal
Regaining basic mobility independence is considered important for elderly hospitalised patients. The Cumulated Ambulation Score (CAS) is a valid tool for evaluating these patients' basic mobility (getting in and out of bed, sit-to-stand from a chair and walking) in orthopaedic wards, and its use ...... is recommended in Denmark for patients with hip fracture. The aims of the present study were to evaluate the feasibility of the CAS in a geriatric ward and to describe its use after hip fracture in Denmark....
Dinh, Michael M; Muecke, Sandy; Berendsen Russell, Saartje; Chalkley, Dane; Bein, Kendall J; Muscatello, David; Nagaraj, Guruprasad; Paoloni, Richard; Ivers, Rebecca
The study aimed to analyze ambulance transportations to Emergency Departments (EDs) in New South Wales (NSW) and to identify temporal changes in demographics, acuity, and clinical diagnoses. This was a retrospective analysis of a population based registry of ED presentations in New South Wales. The NSW Emergency Department data collection (EDCC) collects patient level data on presentations to designated EDs across NSW. Patients that presented to EDs by ambulance between January 2010 and December 2014 were included. Patients dead on arrival, transferred from another hospital, or planned ED presentations were excluded. A total of 10.8 million ED attendances were identified of which 2.6 million (23%) were transported to ED by ambulance. The crude rate of ambulance transportations to EDs across all ages increased by 3.0% per annum over the five years with the highest rate observed in those 85 years and over (620.5 presentations per 1,000 population). There was an increase in the proportion of category 1 and 2 (life-threatening or potentially life-threatening) cases from 18.1% to 24.0%. Demand for ambulance services appears to be driven by older patients presenting with higher acuity problems. Alternative models of acute care for elderly patients need to be planned and implemented to address these changes.
Knobe, M; Rasche, P; Rentemeister, L; Bliemel, C; Bücking, B; Bollheimer, L C; Pape, H-C
An individual's risk of falling is generally difficult to detect and it is likely to be underestimated. Thus, preventive measures are challenging and they demand sufficient integration and implementation into aftercare and outpatient management. The Aachen Falls Prevention Scale (AFPS) is a quick and easy tool for patient-driven fall risk assessment. Older adults' risk of falling is identified in a suitable manner and they then have the opportunity to independently assess and monitor their risk of falling. The aim of the current study was to evaluate the AFPS as a simple screening tool in geriatric trauma patients via the identification of influencing factors, e.g. objective or subjective fall risk, fear of falling (FOF) and demographic data. In this context, we investigated older adults' willingness to take part in special activities concerning fall prevention. Retrospectively, all patients over 70 years of age who received in-hospital fracture treatment between July 2014 and April 2016 were analyzed at a level I trauma center. After identification of 884 patients, participants completed a short questionnaire (47 questions, yes/no, Likert scale) comprising the AFPS. A history of falls in the past year was considered an indicator of a balance disorder. In addition, ambulant patients were invited to participate between July and August 2016. In total, 201 patients (mean 80.4 years, range 63-97 years) performed a self-assessment based on the AFPS. After steps 1 and 2 of the AFPS had been completed, 95 (47%) participants rated their subjective risk of falling as high (more than 5 points). Of the participants 84 (42%) were objectively classified as "fallers" with significant effects on their AFPS evaluation and rating of their subjective risk of falling. Furthermore, 67% of the participants identified a general practitioner as their main contact person, and 43% of the respondents viewed the AFPS as a beneficial screening tool in fall risk evaluation (8
Zhao, Henry; Pesavento, Lauren; Coote, Skye; Rodrigues, Edrich; Salvaris, Patrick; Smith, Karen; Bernard, Stephen; Stephenson, Michael; Churilov, Leonid; Yassi, Nawaf; Davis, Stephen M; Campbell, Bruce C V
Clinical triage scales for prehospital recognition of large vessel occlusion (LVO) are limited by low specificity when applied by paramedics. We created the 3-step ambulance clinical triage for acute stroke treatment (ACT-FAST) as the first algorithmic LVO identification tool, designed to improve specificity by recognizing only severe clinical syndromes and optimizing paramedic usability and reliability. The ACT-FAST algorithm consists of (1) unilateral arm drift to stretcher <10 seconds, (2) severe language deficit (if right arm is weak) or gaze deviation/hemineglect assessed by simple shoulder tap test (if left arm is weak), and (3) eligibility and stroke mimic screen. ACT-FAST examination steps were retrospectively validated, and then prospectively validated by paramedics transporting culturally and linguistically diverse patients with suspected stroke in the emergency department, for the identification of internal carotid or proximal middle cerebral artery occlusion. The diagnostic performance of the full ACT-FAST algorithm was then validated for patients accepted for thrombectomy. In retrospective (n=565) and prospective paramedic (n=104) validation, ACT-FAST displayed higher overall accuracy and specificity, when compared with existing LVO triage scales. Agreement of ACT-FAST between paramedics and doctors was excellent (κ=0.91; 95% confidence interval, 0.79-1.0). The full ACT-FAST algorithm (n=60) assessed by paramedics showed high overall accuracy (91.7%), sensitivity (85.7%), specificity (93.5%), and positive predictive value (80%) for recognition of endovascular-eligible LVO. The 3-step ACT-FAST algorithm shows higher specificity and reliability than existing scales for clinical LVO recognition, despite requiring just 2 examination steps. The inclusion of an eligibility step allowed recognition of endovascular-eligible patients with high accuracy. Using a sequential algorithmic approach eliminates scoring confusion and reduces assessment time. Future
Otimização da localização das bases de ambulâncias e do dimensionamento das suas regiões de cobertura em rodovias Optimizing the location of ambulance bases and the districting of their covering regions on highways
Ana Paula Iannoni
Full Text Available Neste artigo combinamos extensões do modelo hipercubo de filas com algoritmos genéticos para otimizar a configuração e operação de sistemas médicos emergenciais em rodovias. Inicialmente apresentamos um método para localizar as bases de ambulâncias ao longo da rodovia, de forma a otimizar as principais medidas de desempenho do sistema. Em seguida estendemos a abordagem para apoiar duas decisões combinadas: a localização das bases de ambulâncias e o dimensionamento das regiões de cobertura de cada base na rodovia. Por exemplo, a abordagem permite determinar os locais para posicionar as bases de ambulâncias e dimensionar os tamanhos das suas áreas de atuação, tais que minimizem o tempo médio de resposta aos usuários e/ou o desbalanceamento das cargas de trabalho das ambulâncias do sistema. Para ilustrar a aplicação dos métodos propostos, analisamos os resultados de dois estudos de caso em rodovias brasileiras.In this paper we combine extensions of the hypercube queueing model with genetic algorithms to optimize the configuration and operation of emergency medical systems on highways. Initially we present a method to locate the ambulance bases along the highway so that the main system performance measures are optimized. Then we extend the approach to support combined decisions: the location of ambulance bases and the districting of the covering regions of each base on the highway. For instance, the approach can search for locals to place the ambulance bases and determine the sizes of their operation areas, such that the mean user response time and/or the ambulance workload imbalance are minimized. To illustrate the application of the proposed methods, we analyze the results of two case studies of Brazilian highways.
The results are given of measurements of the radiation burden of personnel in departments of nuclear medicine in the years 1979 to 1981 using film dosemeters and ring thermoluminescence dosemeters evaluated by the national personnel dosemeter service. The relations are examined of the exposure of hands and the preparation of radiopharmaceuticals and especially their use for examinations. Certain organizational measures are indicated for reducina radiation burden in a laboratory for the preparation of radiopharmaceuticals. The results of measurements and evaluations of radiation burden of personnel of nuclear medicine departments are confronted with conclusions published in the literature. (author)
Organization of monitoring of overalls and personnel skin contamination wastes is considered. The devices used for this purpose are enumerated. In sanitary sluices through which the personnel leaving the repair zone it is recommended to particularly thoroughly control hand skin contamination and most contaminated parts of overalls (sleeves, breeches lower parts, pockets, stomack region). In sanitary check points during personnel leaving the operator zone monitoring of overalls and skin contamination is performed. The overalls and other individual protective clothing are subjected to control in a special loundry before and after washing (decontamination) [ru
... (CONTINUED) STANDARDS AND CERTIFICATION HOME HEALTH SERVICES General Provisions § 484.4 Personnel... baccalaureate degree in social work, psychology, sociology, or other field related to social work, and has had...
US Agency for International Development — WebPass Explorer (WebPASS Framework): USAID is partnering with DoS in the implementation of their WebPass Post Personnel (PS) Module. WebPassPS does not replace...
Social Security Administration — Each year the Office of Personnel Management (OPM) sends SSA a file to be verified and matched against the Master Earnings File (MEF) and Employer Information File...
Office of Personnel Management — Precursor to the Enterprise Human Resources Integration-Statistical Data Mart (EHRI-SDM). It contains data about the employee and their position, along with various...
Roberson, P.L.; Holbrook, K.L.
This guide describes minimum acceptable performance levels for personnel dosimetry systems used at Department of Energy (DOE) facilities. The goal is to improve both the quality of radiological calibrations and the methods of comparing reported occupational doses between DOE facilities. Reference calibration techniques are defined. A standard for evaluation of personnel dosimetry systems and recommended design parameters for personnel dosimeters are also included. Approximate intervals for the radiation energies for which these guidelines are appropriate are 15 keV to 2 MeV for photons; above 0.3 MeV for beta particles; and 1 keV to 2 MeV for neutrons. An analysis of ANSI N13.11 was completed using performance evaluations of selected personnel dosimetry systems in use at DOE facilities. The results of this analysis are incorporated in the guidelines
The ISO Standard 1757 ''Personnel Photographic Film Dosemeters'', issued in June 1980, is briefly described. UVVVR's own dosemeter developed for use in the national film dosimetry service in Czechoslovakia is evaluated in relation to this ISO Standard. (author)
Linden, Dimitri; Pelt, Dirk; Dunkel, Curtis; Born, Marise
markdownabstractJob Performance: The term job performance can either refer to the objective or subjective outcomes one achieves in a specific job (e.g., the profit of a sales persons, the number of publications of a scientist, the number of successful operations of a surgeon) or to work-related activities (e.g., writing an article, conducting specific surgical acts). In the majority of research on this topic, job performance as an outcome is used. Personnel selection: Personnel selection refe...
Adesesan B. Adeyemo; Oluwafemi Oriola
This paper applies forensic data mining to determine the true status of employees and thereafter provide useful evidences for proper administration of administrative rules in a Typical Nigerian Teaching Service. The conventional technique of personnel audit was studied and a new technique for personnel audit was modeled using Artificial Neural Networks and Decision Tree algorithms. Atwo-layer classifier architecture was modeled. The outcome of the experiment proved that Radial Basis Function ...
The basics of personnel dosimetry technics, used by the Radiologic Protetion and Assessorie Service (SAPRA) are presented, consisting on use of thermoluminescent and CaSO 4 :Dy monitors in aggregated pellets by Teflon. The characteristics of this dosemeters, relating to the sensitivity, energetic dependence, spike temperature, characteristic emission curve, decay and light effect are shown. The thermoluminescent dosemeter measure system and the personnel monitoring system are also described. (C.G.C.) [pt
Joseph H. Schwab
Full Text Available Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity. Purpose. The purpose of our study was to evaluate whether minimally invasive posterior spinal instrumentation provided significant pain relief and improved function. Study Design. We compared pre- and postoperative pain scores as well as ambulatory status in a population of patients suffering from oncologic conditions in the spine. Patient Sample. A consecutive series of patients with spine tumors treated minimally invasively with stabilization were reviewed. Outcome Measures. Visual analog pain scale as well as pre- and postoperative ambulatory status were used as outcome measures. Methods. Twenty-four patients who underwent minimally invasive posterior spinal instrumentation for metastasis were retrospectively reviewed. Results. Seven (29% patients were unable to ambulate secondary to pain and instability prior to surgery. All patients were ambulating within 2 to 3 days after having surgery (=0.01. The mean visual analog scale value for the preoperative patients was 2.8, and the mean postoperative value was 1.0 (=0.001. Conclusion. Minimally invasive posterior spinal instrumentation significantly improved pain and ambulatory status in this series.
Fridman, Masha; Barnes, Vanessa; Whyman, Andrew; Currell, Alex; Bernard, Stephen; Walker, Tony; Smith, Karen L
This study describes the epidemiology of sudden cardiac arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital cardiac arrest (OHCA), which was specified in accordance with observed trends. All cases of cardiac arrest in Victoria that were attended by Victorian ambulance services during the period of 2002-2005. Overall survival to hospital discharge was 3.8% among 18,827 cases of OHCA. Survival was 15.7% among 1726 bystander witnessed, adult cardiac arrests of presumed cardiac aetiology, presenting in ventricular fibrillation or ventricular tachycardia (VF/VT), where resuscitation was attempted. In multivariate logistic regression analysis, bystander CPR, cardiac arrest (CA) location, response time, age and sex were predictors of VF/VT, which, in turn, was a strong predictor of survival. The same factors that affected VF/VT made an additional contribution to survival. However, for bystander CPR, CA location and response time this additional contribution was limited to VF/VT patients only. There was no detectable association between survival and age younger than 60 years or response time over 15min. The new model accounts for relationships among predictors of survival. These relationships indicate that interventions such as reduced response times and bystander CPR act in multiple ways to improve survival.
Yeap, E E; Morrison, J J; Apodaca, A N; Egan, G; Jansen, J O
The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland. We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009-2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification. The level of destination healthcare facility was coded as either a teaching hospital, large general hospital, general hospital, or other type of facility. A total of 64,377 incidents met the inclusion criteria. The majority of incidents occurred in urban areas, which mostly resulted in admission to teaching hospitals. Incidents from other areas resulted in admission to a lower-level facility. The majority of incidents originating in very remote small towns and very remote rural areas were treated in a general hospital. Median call-out times and travel times increased with the degree of rurality, although with some exceptions. Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.
Sommers, Juultje; Wieferink, Denise C; Dongelmans, Dave A; Nollet, Frans; Engelbert, Raoul H H; van der Schaaf, Marike
Early mobilisation is advocated to improve recovery of intensive care unit (ICU) survivors. However, severe weakness in combination with tubes, lines and machinery are practical barriers for the implementation of ambulation with critically ill patients. The aim of this study was to explore the feasibility of Body Weight-Supported Treadmill Training (BWSTT) in critically ill patients in the ICU. A custom build bedside Body Weight-Supported Treadmill was used and evaluated in medical and surgical patients in the ICU. Feasibility was evaluated according to eligibility, successful number of BWSTT, number of staff needed, adverse events, number of patients that could not have walked without BWSTT, patient satisfaction and anxiety. Twenty participants, underwent 54 sessions BWSTT. Two staff members executed the BWSTT and no adverse events occurred. Medical equipment did not have to be disconnected during all treatment sessions. In 74% of the sessions, the participants would not have been able to walk without the BWSTT. Patient satisfaction with BWSTT was high and anxiety low. This proof of concept study demonstrated that BWSTT is safe, reduces staff resource, and facilitates the first time to ambulation in critically ill patients with severe muscle weakness in the ICU. Copyright © 2017 Elsevier Inc. All rights reserved.
Chan, Herbert; Brasher, Penelope; Erdelyi, Shannon; Desapriya, Edi; Asbridge, Mark; Purssell, Roy; Macdonald, Scott; Schuurman, Nadine; Pike, Ian
Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. PMID:25121822
Gonzalez Anez, Francisco; Agueero Agueero, Jorge
The continuous evolution and improvement of safety-related processes has included the analysis, design and development of training plans for the qualification of maintenance nuclear power plant personnel. In this respect, the international references in this area recommend the establishment of systematic qualification programmes for personnel performing functions or carrying out safety related tasks. Maintenance personnel qualification processes have improved significantly, and training plans have been designed and developed based on Systematic Approach to Training methodology to each job position. These improvements have been clearly reflected in recent training programmes with new training material and training facilities focused not only on developing technical knowledge and skills but also on improving attitudes and safety culture. The objectives of maintenance training facilities such as laboratories, mock-ups real an virtual, hydraulic loops, field simulators and other training material to be used in the maintenance training centre are to cover training necessities for initial and continuous qualification. Evidently, all these improvements made in the qualification of plant personnel should be extended to include supplemental personnel (external or contracted) performing safety-related tasks. The supplemental personnel constitute a very spread group, covering the performance of multiple activities entailing different levels of responsibility. Some of these activities are performed permanently at the plant, while others are occasional or sporadic. In order to establish qualification requirements for these supplemental workers, it is recommended to establish a rigorous analysis of job positions and tasks. The objective will be to identify the qualification requirements to assure competence and safety. (authors)
Full Text Available Background: Occupational stress and associated physical and mental health related issues are not addressed in Indian police personnel with adequate importance. Methods: Cross-sectional survey was conducted among police personnel (both male and female in Calicut urban police district, Kerala state, India. Police personnel from all designations (ranks, except from the all India services (Indian Police Service were included in the study. Data were collected using a specifically designed datasheet covering socio-demographic profile, physical and mental health related details which was prepared by researchers. Occupational stress was measured using Operational Police Stress Questionnaire (PSQ-OP and Organisational Police Stress Questionnaire (PSQ-ORG. Result: The study found that both operational and organisational stress was significant among the police officers. Organisational stress was experienced in moderate level by 68% and in high level by 14%. Operational stress scores were in the moderate range in 67% and in high range in 16.5%. The younger age group (21-35 years and lower level rank police personnel had higher stress. Stress was higher among female police personnel compared to males. While 23% of them had been diagnosed with physical illnesses, a significant four per cent of them with mental illness, and 29% of them reported substance abuse. Conclusion: The results point to the high level of stress among Indian police personnel and the need for urgent interventions from the government to address the occupational stress.
.... Surveys of military personnel show that, particularly for junior personnel, financial problems constitute a major source of stress, subordinate only to increased workload and family separation...
Barreto,Bruno; Alexandrino,Fernando; Coelho,Ormeu
Resumo: A configuração de redes logísticas para serviços de emergência é questão estratégica de imensa importância, visto que pequenas variações no tempo de resposta podem implicar na morte do solicitante. Partindo dessa premissa, o trabalho propõe novas alternativas de posicionamento para as ambulâncias do sistema SAMU na cidade de Duque de Caxias, RJ, capazes de reduzir o tempo de resposta do serviço. Essas propostas de reposicionamento das ambulâncias foram construídas em duas etapas: na p...
Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik; Hansen, Steen Møller; Gerds, Thomas A; Kragholm, Kristian; Hansen, Carolina Malta; Karlsson, Lena; Lippert, Freddy K; Køber, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian
response time in this study) to 5 minutes. The absolute survival associated with bystander CPR declined rapidly with time. Yet bystander CPR while waiting for an ambulance was associated with a more than doubling of 30-day survival even in case of long ambulance response time. Decreasing ambulance response time by even a few minutes could potentially lead to many additional lives saved every year. © 2016 American Heart Association, Inc.
... 32 National Defense 5 2010-07-01 2010-07-01 false Service of process upon personnel. 720.20... DELIVERY OF PERSONNEL; SERVICE OF PROCESS AND SUBPOENAS; PRODUCTION OF OFFICIAL RECORDS Service of Process and Subpoenas Upon Personnel § 720.20 Service of process upon personnel. (a) General. Commanding...
The Guidebook will prove especially useful for, and is addressed primarily to: nuclear power operating organizations establishing or upgrading their NPP personnel training systems; regulatory personnel responsible for setting requirements and/or evaluating NPP personnel training; and organizations (within or outside the operating organization) responsible for the development, implementation and evaluation of training programmes for NPP personnel. Figs, tabs
Griffith, R.V.; Hankins, D.E.
NTA film and albedo detectors represent the major portion of personnel dosimeters now used for occupational neutron monitoring. However, recent attention to the spectral response of these systems has demonstrated the need for detectors that have a better match to the fields being monitored. Recent developments in direct recoil track etch dosimeters present some intriguing alternatives, and careful use of 237 Np fission fragment detectors offers the advantage of a good dose equivalent spectral match. Work continues on a number of other new detector mechanisms, but problems with sensitivity, energy response, gamma interference, etc., continue to prevent development of most mechanisms into viable personnel dosimeters. Current dosimeter limitations make a systematic approach to personnel neutron monitoring particularly important. Techniques have been developed and tested, using available portable survey instruments, that significantly improve the quality of dosimeter interpretation. Even simple spectrometry can be done with modest effort, significantly improving the health physicists ability to provide accurate neutron monitoring
The management principles in this publication were developed by a committee of senior utility officials with assistance by the staff of the Institute of Nuclear Power Operations (INPO) and with input from virtually all U.S. nuclear utilities. The principles are aimed at creating an environment within a nuclear power plant that promotes a healthy respect for the unique technology that nuclear electric power represents and, thus, to promote great care and conservative, thoughtful decision-making by the nuclear plant staff. The scope of the principles includes all nuclear personnel and gives guidance in the selection and development of management and supervisory personnel and other key individuals in the areas of operations, maintenance, technical support and engineering. Utility managers are encouraged to make in-depth comparisons between these principles and their day-to-day policies and practices, and to use such efforts as opportunities to communicate their organization's management philosophy to all nuclear personnel.
For the past decade, the demand for health physics personnel, at both the professional and technical levels, has been increasing, and indeed has become quite acute in recent years. The need for health physics personnel is demonstrated by a summary of projected requirements and potential candidates by the year 1991. Suggestions made for ensuring the availability of qualified health physics personnel includes: 1) a characterization study of health physicists should be conducted, with emphasis on industry, to determine qualifications, job satisfaction factors, and other data pertinent to entry and retention in the field; 2) the curricula currently offered by post-secondary schools should be evaluated for quality and relevance; and 3) an industry standard or protocol for qualification and training of health physics should be developed and implemented
Clauss, D.B.; Parks, M.B.; Julien, J.T.; Peters, S.W.
Sandia National Laboratories (Sandia) is investigating the leakage potential of mechanical penetrations as part of a research program on containment integrity under severe accident loads for the U.S. Nuclear Regulatory Commission (NRC). Barnes et al. (1984) and Shackelford et al. (1985) identified leakage from personnel airlocks as an important failure mode of containments subject to severe accident loads. However, these studies were based on relatively simple analysis methods. The complex structural interaction between the door, gasket, and bulkhead in personnel airlocks makes analytical evaluation of leakage difficult. In order to provide data to validate methods for evaluating the leakage potential, a full-size personnel airlock was subject to simulated severe accident loads consisting of pressure and temperature up to 300 psig and 800 degrees F. The test was conducted at Chicago Bridge and Iron under contract to Sandia. The authors provide a detailed report on the test program
It is said that Physical Protection (PP) has two purposes. One is to prevent from occurring risks of threat and terrorism and the other is to minimize damages which will be happened in case of unusual conditions or emergency situation. To achieve this goal, personnel who perform their duties should have professional knowledge and skills concerning security. However, since newcomers rarely satisfy their knowledge and skill for nuclear security in most cases. Therefore, we have to provide adequate education and training after they joined to our company. To this end, our company, located in Aomori Prefecture focused on security and physical protection for nuclear related facilities. In this paper, personnel training and challenges in order to bring up security personnel at our company will be introduced. (author)
The management principles in this publication were developed by a committee of senior utility officials with assistance by the staff of the Institute of Nuclear Power Operations (INPO) and with input from virtually all U.S. nuclear utilities. The principles are aimed at creating an environment within a nuclear power plant that promotes a healthy respect for the unique technology that nuclear electric power represents and, thus, to promote great care and conservative, thoughtful decision-making by the nuclear plant staff. The scope of the principles includes all nuclear personnel and gives guidance in the selection and development of management and supervisory personnel and other key individuals in the areas of operations, maintenance, technical support and engineering. Utility managers are encouraged to make in-depth comparisons between these principles and their day-to-day policies and practices, and to use such efforts as opportunities to communicate their organization's management philosophy to all nuclear personnel
Armstrong, Stephanie; Langlois, Adele; Laparidou, Despina; Dixon, Mark; Appleton, Jason P; Bath, Philip M; Snooks, Helen; Siriwardena, A Niroshan
We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting. A systematic review of the literature on randomised controlled trials in ambulance settings was undertaken. A search of eight databases identified published studies involving recruitment of ambulance service users. Four independent authors undertook abstract and full-text reviews to determine eligibility and extract relevant data. The data extraction concentrated on ethical considerations, with any discussion of ethics being included for further analysis. The resultant data were combined to form a narrative synthesis. In all, 56 papers were identified as meeting the inclusion criteria. Issues relating to consent were the most significant theme identified. Type of consent differed depending on the condition or intervention being studied. The country in which the research took place did not appear to influence the type of consent, apart from the USA where exception from consent appeared to be most commonly used. A wide range of terms were used to describe consent. Consent was the main ethical consideration in published ambulance based research. A range of consent models were used ranging from informed consent to exception from consent (waiver of consent). Many studies cited international guidelines as informing their choice of consent model but diverse and sometimes confused terms were used to describe these models. This suggests that standardisation of consent models and the terminology used to describe them is warranted.
Ringh, Mattias; Fredman, David; Nordberg, Per; Stark, Tomas; Hollenberg, Jacob
In a two-parted study, evaluate a new concept were mobile phone technology is used to dispatch lay responders to nearby out-of-hospital cardiac arrests (OHCAs). Mobile phone positioning systems (MPS) can geographically locate selected mobile phone users at any given moment. A mobile phone service using MPS was developed and named Mobile Life Saver (MLS). Simulation study: 25 volunteers named mobile responders (MRs) were connected to MLS. Ambulance time intervals from 22 consecutive OHCAs in 2005 were used as controls. The MRs randomly moved in Stockholm city centre and were dispatched to simulated OHCAs (identical to controls) if they were within a 350 m distance. Real life study: during 25 weeks 1271-1801 MRs trained in CPR were connected to MLS. MLS was activated at the dispatch centre in parallel with ambulance dispatch when an OHCA was suspected. The MRs were dispatched if they were within 500 m from the suspected OHCA. Simulation study: mean response time for the MRs compared to historical ambulance time intervals was reduced by 2 min 20s (44%), pMobile phone technology can be used to identify and recruit nearby CPR-trained citizens to OHCAs for bystander CPR prior to ambulance arrival. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Abstract Background We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting. Methods A systematic review of the literature on randomised controlled trials in ambulance settings was undertaken. A search of eight databases identified published studies involving recruitment of ambulance service users. Four independent authors undertook abstract and full-text reviews to determine eligibility and extract relevant data. The data extraction concentrated on ethical considerations, with any discussion of ethics being included for further analysis. The resultant data were combined to form a narrative synthesis. Results In all, 56 papers were identified as meeting the inclusion criteria. Issues relating to consent were the most significant theme identified. Type of consent differed depending on the condition or intervention being studied. The country in which the research took place did not appear to influence the type of consent, apart from the USA where exception from consent appeared to be most commonly used. A wide range of terms were used to describe consent. Conclusions Consent was the main ethical consideration in published ambulance based research. A range of consent models were used ranging from informed consent to exception from consent (waiver of consent. Many studies cited international guidelines as informing their choice of consent model but diverse and sometimes confused terms were used to describe these models. This suggests that standardisation of consent models and the terminology used to describe them is warranted.
Valenzuela Espinoza, Alexis; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Fernandez Tellez, Helio; Dupont, Alain; Putman, Koen; Brouns, Raf
In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB) to facilitate a wider spread of the knowledge regarding this technique. Successful execution of the project involved the development and validation of a novel stroke scale, design and creation of specific hardware and software solutions, execution of field tests for mobile internet connectivity, design of new care processes and information flows, recurrent training of all professional caregivers involved in acute stroke management, extensive testing on healthy volunteers, organisation of a 24/7 teleconsultation service by trained stroke experts and 24/7 technical support, and resolution of several legal issues. In all, it took 41 months of research and development to confirm the safety, technical feasibility, reliability, and user acceptance of the PreSSUB approach. Stroke-specific key information can be collected safely and reliably before and during ambulance transportation and can adequately be communicated with the inhospital team awaiting the patient. This paper portrays the key steps required and the lessons learned for successful implementation of a 24/7 expert telemedicine service supporting patients with acute stroke during ambulance transportation to the hospital. © 2016 S. Karger AG, Basel.
Takeuchi, Ryohei; Harada, Hiroshi; Masuda, Kohji; Ota, Gen-ichiro; Yokoi, Masaki; Teramura, Nobuyasu; Saito, Tomoyuki
We report the testing of a mobile Robotic Tele-echo system that was placed in an ambulance and successfully transmitted clear real time echo imaging of a patient's abdomen to the destination hospital from where this device was being remotely operated. Two-way communication between the paramedics in this vehicle and a doctor standing by at the hospital was undertaken. The robot was equipped with an ultrasound probe which was remotely controlled by the clinician at the hospital and ultrasound images of the patient were transmitted wirelessly. The quality of the ultrasound images that were transmitted over the public mobile telephone networks and those transmitted over the Multimedia Wireless Access Network (a private networks) were compared. The transmission rate over the public networks and the private networks was approximately 256 Kbps, 3 Mbps respectively. Our results indicate that ultrasound images of far higher definition could be obtained through the private networks.
The Emergency Medical Video Multiplexing Transport System (EMTS) is designed to support prehospital cares by delivering high quality live video streams of patients in an ambulance to emergency doctors in a remote hospital via satellite communications. The important feature is that EMTS divides a patient's live video scene into four pieces and transports the four video streams on four separate network channels. By multiplexing four video streams, EMTS is able to transport high quality videos through low data transmission rate networks such as satellite communications and cellular phone networks. In order to transport live video streams constantly, EMTS adopts Real-time Transport Protocol/Real-time Control Protocol as a network protocol and video stream data are compressed by Moving Picture Experts Group 4 format. As EMTS combines four video streams with checking video frame numbers, it uses a refresh packet that initializes server's frame numbers to synchronize the four video streams.
Hoefert, M.; Raffnsoe, R.C.; Tuyn, J.W.N.; Wittekind, D.
From following the development of personnel doses at CERN over the past six years it has become evident that work in areas of induced radioactivity is the principal cause of exposure. The results of photon dose measurements free-in-air and around a phantom are presented and discussed in the light of new quantities in individual monitoring. The importance of these results, with respect to the practical situation, is discussed and the problem of phantom size is mentioned. Finally, the results of dose measurements in the phantom are presented, since such information is important in cases where it becomes necessary to transform personnel doses into personal doses. (author)
With the ultimate aim of reducing the possibility of human error in nuclear power plant operations, the Guidebook discusses the organizational aspects, the staffing requirements, the educational systems and qualifications, the competence requirements, the ways to establish, preserve and verify competence, the specific aspects of personnel management and training for nuclear power plant operations, and finally the particular situations and difficulties to be overcome by utilities starting their first nuclear power plant. An important aspect presented in the Guidebook is the experience in training and qualification of nuclear power plant personnel in various countries: Argentina, Belgium, Canada, Czechoslovakia, France, Federal Republic of Germany, Spain, Sweden, United Kingdom and United States of America
A survey about training places and the volume of the training program for reactor personnel in the Federal Republic of Germany is given. Paragraph 7 of the atomic energy act, which imposes on the operators of nuclear energy plants the qualifired training of the personnel, is refered to. Positive experiences with the use of simulation equipment for training have led to the planning of a simulator-centre which is expected to be ready for operation in 1977. The versatile program of this centre is briefly reported. (ORU) [de
The personnel dosimetry monitoring program at the Portsmouth uranium enrichment facility has been improved by using thermoluminescent dosimetry to monitor for ionizing radiation exposure, and by automating most of the operations and all of the associated information handling. A thermoluminescent dosimeter (TLD) card, worn by personnel inside security badges, stores the energy of ionizing radiation. The dosimeters are changed-out periodically and are loaded 150 cards at a time into an automated reader-processor. The resulting data is recorded and filed into a useful form by computer programming developed for this purpose
Current performance estimates for personnel access control systems use estimates of Type I and Type II verification errors. A system performance equation which addresses normal operation, the insider, and outside adversary attack is developed. Examination of this equation reveals the inadequacy of classical Type I and II error evaluations which require detailed knowledge of the adversary threat scenario for each specific installation. Consequently, new performance measures which are consistent with the performance equation and independent of the threat are developed as an aid in selecting personnel access control systems
Anspach, D.A.; Anspach, J.P.; Crain, B. Jr.
There is a need for an automated system for protecting and monitoring sensitive or classified parts and material. Sandia has developed a real-time personnel and material tracking system (PAMTRAK) that has been installed at selected DOE facilities. It safeguards sensitive parts and material by tracking tags worn by personnel and by monitoring sensors attached to the parts or material. It includes remote control and alarm display capabilities and a complementary program in Keyhole to display measured material attributes remotely. This paper describes the design goals, the system components, current installations, and the benefits a site can expect when using PAMTRAK
Myers, J A; Powell, D M C; Aldington, S; Sim, D; Psirides, A; Hathaway, K; Haney, M F
The relationship between fatigue-related risk and impaired clinical performance is not entirely clear. Non-technical factors represent an important component of clinical performance and may be sensitive to the effects of fatigue. The hypothesis was that the sum score of overall non-technical performance is degraded by fatigue. Nineteen physicians undertook two different simulated air ambulance missions, once when rested, and once when fatigued (randomised crossover design). Trained assessors blinded to participants' fatigue status performed detailed structured assessments based on expected behaviours in four non-technical skills domains: teamwork, situational awareness, task management, and decision making. Participants also provided self-ratings of their performance. The primary endpoint was the sum score of overall non-technical performance. The main finding, the overall non-technical skills performance rating of the clinicians, was better in rested than fatigued states (mean difference with 95% CI, 2.8 [2.2-3.4]). The findings remained consistent across individual non-technical skills domains; also when controlling for an order effect and examining the impact of a number of possible covariates. There was no difference in self-ratings of clinical performance between rested and fatigued states. Non-technical performance of critical care air transfer clinicians is degraded when they are fatigued. Fatigued clinicians may fail to recognise the degree to which their performance is compromised. These findings represent risk to clinical care quality and patient safety in the dynamic and isolated environment of air ambulance transfer. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Olia, P M; Mollica, T V; Querci, A
The aim of the present study was to analyse the types of calls attended by the authors in their ambulance, assigned to one sector of the urban area of Prato. We analysed 1060 consecutive calls carried out by our ambulance; 33 calls (3.1%), cancelled for various reasons, were excluded from statistical analysis. The calls regarded 1027 patients, 549 (53.5%) males and 478 (46.5%) females. 46% of calls concerned non trauma cases, 17% trauma cases and 7.2% transfers between hospitals. Calls in the non trauma group were for dyspnea (16.7%), unconsciousness (16.6%), chest pain (11.8%), cerebrovascular pathology (7.7%), mental disorders (7.1%), abdominal pain (5.1%), use of psychotropic substances (4%) and convulsions (3.2%). Support to patients with terminal cancer accounted for 2.3% of cases, metabolic disorders 2.2%, hypertensive events 2.1%, tachycardia 1.9%, vertigo 1.9%, allergies 1%, obstetric pathology 0.5% and cardiorespiratory resuscitation 2,2%. Thirteen point seven percent were miscellaneous, including poisonings, migraines, haemorrhages and flu syndromes. Trauma cases included road accidents (62.6%), falls (27%), aggression (6.9%), work-related accidents (3.5%). The percentage of trauma cases (17%) was similar to that reported for a Swedish urban area (20%). Cases of cardiorespiratory resuscitation were 1.65% of our calls, compared to 1.73% and 1.8% reported in Northeastern Germany and Taiwan. Although prehospital emergency medical services are organised differently in different countries, our data suggest that emergency medical services in our area have a percentage distribution of case types similar to services in other countries.
Full Text Available Emergency work can expose personnel to sleep restriction. Inadequate amounts of sleep can negatively affect physiological and psychological stress responses. This review critiqued the emergency service literature (e.g., firefighting, police/law enforcement, defense forces, ambulance/paramedic personnel that has investigated the effect of sleep restriction on hormonal, inflammatory and psychological responses. Furthermore, it investigated if a psycho-physiological approach can help contextualize the significance of such responses to assist emergency service agencies monitor the health of their personnel. The available literature suggests that sleep restriction across multiple work days can disrupt cytokine and cortisol levels, deteriorate mood and elicit simultaneous physiological and psychological responses. However, research concerning the interaction between such responses is limited and inconclusive. Therefore, it is unknown if a psycho-physiological relationship exists and as a result, it is currently not feasible for agencies to monitor sleep restriction related stress based on psycho- physiological interactions. Sleep restriction does however, appear to be a major stressor contributing to physiological and psychological responses and thus, warrants further investigation.
Wolkow, Alexander; Ferguson, Sally; Aisbett, Brad; Main, Luana
Emergency work can expose personnel to sleep restriction. Inadequate amounts of sleep can negatively affect physiological and psychological stress responses. This review critiqued the emergency service literature (e.g., firefighting, police/law enforcement, defense forces, ambulance/paramedic personnel) that has investigated the effect of sleep restriction on hormonal, inflammatory and psychological responses. Furthermore, it investigated if a psycho-physiological approach can help contextualize the significance of such responses to assist emergency service agencies monitor the health of their personnel. The available literature suggests that sleep restriction across multiple work days can disrupt cytokine and cortisol levels, deteriorate mood and elicit simultaneous physiological and psychological responses. However, research concerning the interaction between such responses is limited and inconclusive. Therefore, it is unknown if a psycho-physiological relationship exists and as a result, it is currently not feasible for agencies to monitor sleep restriction related stress based on psycho- physiological interactions. Sleep restriction does however, appear to be a major stressor contributing to physiological and psychological responses and thus, warrants further investigation. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
Chemperek, Ewa; Mikuła, Agnieszka; Goniewicz, Mariusz; Krawczyk, Wojciech
The major causes of deaths all over the world are circulatory system diseases, neoplasms and injuries. Each man can become a participant of the event which results in life-threatening emergencies and the most immediate possible actions are essential. The period of time for starting efficient life-restoration actions is very short, estimated at 4-5 minutes. Ambulance Service is a medical organization created to apply aid in life-threatening emergencies. The standards of the developed western countries determine the arrival time at 7-10 minutes from the call time. Both first-aid applied by the accident witnesses and efficient actions of ambulance service have significance for effective pre-hospital aid and increasing the chances of survival of people in need. The study analysed emergency records of the ambulance cars of the Regional Unit of Ambulance Service - Sródmieście Station in Lublin in the year 2000. 3,723 calls were recorded. In 142 cases complete resuscitation actions were carried out due to circulatory and respiratory arrest. The records selected this way went through a detailed analysis. In 3.8% of the interventions of emergency teams the necessity of applying advanced life support was observed. The time of arrival at the scene, transport of the patient to the admission room as well as efficiency of resuscitation comply with the European standards. The efficiency of resuscitation actions estimated at 51.4% depended on the age of the patient, the cause of circulatory and respiratory arrest and ambulance arrival time. Taking up basic life support by witnesses of the event was observed in 2.8% of cases, in 8.5% aid was applied by the medical staff members who happened to be at the scene.
It is argued that the penalty for most mistakes made by security is the payment of money by the utility. The security personnel has only to act reasonably and not in a negligent manner. Preventing of sabotage is more important than obtaining a conviction, so it is better to search and not get a conviction than it is not to search
The most important requirements for the emergency team can be summarized in three points. 1) The emergency team must be made up of top personnel from all fields and it should be functionally equiped. 2) The emergency teams must have complete command of their equipment. 3) The members of the team must be well motivated. 1 fig
Sturrock, J.C.; Gallegos, F.R.; Hall, M.J.
The Radiation Security System (RSS) at the Los Alamos Neutron Science Center (LANSCE) provides personnel protection from prompt radiation due to accelerated beam. The Personnel Access Control System (PACS) is a component of the RSS that is designed to prevent personnel access to areas where prompt radiation is a hazard. PACS was designed to replace several older personnel safety systems (PSS) with a single modem unified design. Lessons learned from the operation over the last 20 years were incorporated into a redundant sensor, single-point failure safe, fault tolerant, and tamper-resistant system that prevents access to the beam areas by controlling the access keys and beam stoppers. PACS uses a layered philosophy to the physical and electronic design. The most critical assemblies are battery backed up, relay logic circuits; less critical devices use Programmable Logic Controllers (PLCs) for timing functions and communications. Outside reviewers have reviewed the operational safety of the design. The design philosophy, lessons learned, hardware design, software design, operation, and limitations of the device are described
Neal W. Tamayo
As a consultant for a government agency, this paper will design recommendations and improvements for the agency’s public personnel administration. In order to do this, the consultant has to become familiar with the agency, its departments and also understand the key factors. The department chosen from the government for this paper is the Social Security Administration (Kestenbaum, 2014).
... belongings, eat food, drink beverages, chew gum, or use tobacco in any form in areas where food or food... FOOD PRODUCTS INSPECTION AND CERTIFICATION Inspection and Certification of Establishments and Fishery... Basis 1 § 260.104 Personnel. The establishment management shall be responsible for taking all...
The purpose was to provide applied and research dosimetrists with sufficient information to evaluate the status and direction of their programs relative to the latest guidelines and techniques. A technical program was presented concerning experience, requirements, and advances in gamma, beta, and neutron personnel dosimetry.
nutbers of available youth. John haisbitt, author of Megatrends, predicts that labor short.ges are beginning to occur and will continue throughout the...available resources (e.g., personnel and material). 81. Your work group’s performance in compariscn to similar work groups is very high. ORGANIZATION CLIMA "E
... Physical Therapy and Speech-Language Pathology Services § 485.705 Personnel qualifications. (a) General... involved in the furnishing of outpatient physical therapy, occupational therapy, and speech-language...) of the Act and the requirements in part 484 of this chapter. (2) For a speech-language pathologist...
Health is the most important issue when an employer is deciding whether to hire a worker, according to a new study from the Netherlands. The research looked at the results of a ‘vignette’ study on employer preferences when hiring or retaining personnel. It also showed that when an employer is
It is argued that the penalty for most mistakes made by security is the payment of money by the utility. The security personnel has only to act reasonably and not in a negligent manner. Preventing of sabotage is more important than obtaining a conviction, so it is better to search and not get a conviction than it is not to search. (DLC)
The purpose was to provide applied and research dosimetrists with sufficient information to evaluate the status and direction of their programs relative to the latest guidelines and techniques. A technical program was presented concerning experience, requirements, and advances in gamma, beta, and neutron personnel dosimetry
... GOOD MANUFACTURING PRACTICE FOR BLOOD AND BLOOD COMPONENTS Organization and Personnel § 606.20... testing, storage or distribution of blood or blood components shall be adequate in number, educational... areas where the collection, processing, compatibility testing, storage or distribution of blood or blood...
Schein, Edgar H.
Arguing that the personnel manager will increasingly have to become a change agent and process consultant, the author discusses tasks involved and skills required for the new role. A shift in focus toward top management as the primary client and utilization of more flexible intervention into organizational processes are predicted. (JT)
Wangler, Lawrence A.
Discusses personnel profession's increased responsibilities which are due to (1) consolidation of the Equal Employment Opportunity Commission, (2) labor law reform, (3) privacy legislation, (4) social security legislation, (5) open retirement, (6) medical plan costs, (7) codetermination, (8) labor scarcity, (9) top management compensation, and…
KOROTKOVA M.V.; RYBKINA M.V.; NIKITINA S.O.; SCHERNYKH A.V.
The article analyzes the strategic human resource management in an educational institution. Analyzes the basic normative-legal documents regulating educational activities, including the part of management. Particular importance is given to the types of educational institutions (budgetary, state, and autonomous). The stages of strategic management of staff in educational institutions and development model of strategic management personnel are shown.
Procopio, Michael J.
We present the Sandia Advanced Personnel Locator Engine (SAPLE) web application, a directory search application for use by Sandia National Laboratories personnel. SAPLE's purpose is to return Sandia personnel 'results' as a function of user search queries, with its mission to make it easier and faster to find people at Sandia. To accomplish this, SAPLE breaks from more traditional directory application approaches by aiming to return the correct set of results while placing minimal constraints on the user's query. Two key features form the core of SAPLE: advanced search query interpretation and inexact string matching. SAPLE's query interpretation permits the user to perform compound queries when typing into a single search field; where able, SAPLE infers the type of field that the user intends to search on based on the value of the search term. SAPLE's inexact string matching feature yields a high-quality ranking of personnel search results even when there are no exact matches to the user's query. This paper explores these two key features, describing in detail the architecture and operation of SAPLE. Finally, an extensive analysis on logged search query data taken from an 11-week sample period is presented.
In 1996, the IAEA published Technical Reports Series No. 380, Nuclear Power Plant Personnel Training and its Evaluation: A Guidebook. This publication provides guidance for the development, implementation and evaluation of training programmes for all nuclear power plant personnel using the systematic approach to training (SAT) methodology. The SAT methodology has since been adopted and used for the development and implementation of training programmes for all types of nuclear facility and activities in the nuclear industry. The IAEA Technical Working Group on Training and Qualification of Nuclear Power Plant Personnel recommended that an additional publication be prepared to provide further guidance concerning competency assessments used for measuring the knowledge, skills and attitudes of personnel as the result of training. This publication has been prepared in response to that recommendation. A critical component of SAT (as part of the implementation phase) is the assessment of whether personnel have achieved the standards identified in the training objectives. The nuclear industry spends a significant amount of resources conducting competency assessments. Competency assessments are used for employee selection, trainee assessment, qualification, requalification and authorization (in some Member States the terminology may be 'certification' or 'licensing'), and job advancement and promotion. Ineffective testing methods and procedures, or inappropriate interpretation of test results, can have significant effects on both human performance and nuclear safety. Test development requires unique skills and, as with any skill, training and experience are needed to develop and improve them. Test item and examination development, use, interpretation of results and examination refinement, like all other aspects of SAT, should be part of an ongoing, systematic process. This publication is primarily intended for use by personnel responsible for developing and administering
Briso, Hugo A.
The accelerated process of globalization affecting mankind doesn't exclude safety matters. Indeed, some trans national corporations are increasingly offering specialized engineering services such as industrial radiography or well lodging. As well, a growing scientific exchange involves the mobility of nuclear researchers in different areas, for instance radiochemistry, nuclear medicine and radiotherapy. Such a breakdown in the technological frontiers must necessarily be reflected by the regulatory solutions. Particularly, diverse levels of theoretical-practical training for radiation exposed personnel coexist in the Latin-American Region, being an especially sensitive problem for radiation protection matters. The spectrum goes from post-graduate courses required for radiation protection officers in some countries, while in others only basic recommendations are required for the operating personnel. Another scheme consists of medium level course for the operating personnel, while radiation protection officers don't have special requirements. Many educational private institutions teach non standardized courses which only give broad concepts of radiation protection. On the other hand, usually nothing is said about the operational training, or else its certification is entrusted to the employer itself. In some countries multiple Regulatory Authorities apply dissimilar criteria to assess safety matters, including the evaluation of workers applications. The necessary regional integration makes indispensable to establish common standards for granting authorizations. Having similar or homogeneous requirements for the universe of radiation exposed personnel, i.e. source operators, radiation protection officers, qualified experts and technical support people would be easier for the Regulatory Authorities to have common methodologies of evaluation for the applicants. An IAEA supported technical cooperation project related to this paper seeks to establish standardized
Regiane Máximo de Souza
Full Text Available O Sistema de Atendimento Móvel de Urgência (SAMU no Brasil é um sistema médico emergencial de responsabilidade do poder público, em que a demanda de usuários em uma região urbana é usualmente separada por subregiões e classes de chamados emergenciais. Essa demanda pode mudar de forma significativa ao longo do dia, geograficamente e temporalmente, devido à sua natureza aleatória, mas também devido aos diferentes padrões de comportamentos da população ao longo do dia. Por exemplo, tipicamente há menos demanda durante a noite do que de dia. Os objetivos deste trabalho são: verificar se o conhecido modelo hipercubo de filas espacialmente distribuídas é adequado para analisar medidas de desempenho do SAMU, tais como tempos médios de resposta aos usuários, e utilizar este modelo para analisar múltiplas alternativas de localização das ambulâncias, explorando variações importantes da demanda e do serviço ao longo do dia. Para verificar a viabilidade e a aplicabilidade desta abordagem, foi realizado um estudo de caso no SAMU de Ribeirão Preto-SP.The Brazilian emergency medical system SAMU (Sistema de Atendimento Móvel de Urgência is an emergency medical system of public government liability, in which the users' service demand in an urban region is usually separated into subregions and classes of emergency calls. This demand can change substantially during the day, geographically and temporally, due to its random nature and also to the different behavior patterns of the population throughout the day. For instance, typically there is less demand during the night hours than during the day. The goals of this study are to verify whether the hypercube queuing model is adequate to analyze performance measures of SAMU, such as mean response times to the users, and use this model to analyze multiple alternatives of ambulance location considering significant variations in the demand and service throughout the day. In order to verify
Myers, Julia A; Powell, David M C; Psirides, Alex; Hathaway, Karyn; Aldington, Sarah; Haney, Michael F
In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. In the first phase of the project the anaesthetists' non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors. The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (r(s) = 0.4, p = 0
Liao, C J; Kao, C Y
Suggests that with the shortage of nursing personnel, hospital administrators have to pay more attention to the needs of nurses to retain and recruit them. Also asserts that improving nurses' schedules is one of the most economic ways for the hospital administration to create a better working environment for nurses. Develops an algorithm for scheduling nursing personnel. Contrary to the current hospital approach, which schedules nurses on a person-by-person basis, the proposed algorithm constructs schedules on a day-by-day basis. The algorithm has inherent flexibility in handling a variety of possible constraints and goals, similar to other non-cyclical approaches. But, unlike most other non-cyclical approaches, it can also generate a quality schedule in a short time on a microcomputer. The algorithm was coded in C language and run on a microcomputer. The developed software is currently implemented at a leading hospital in Taiwan. The response to the initial implementation is quite promising.
In Germany, professional training of power plant operating personnel became an important issue in the fifties, when power plant parameters as well as complexity of instrumentation and control increased considerably. Working Groups of VGB Technische Vereiningung der Grosskraftwerketreiber e.v. (Association of Large Power Plant Operators) developed a professional career for power plant operating personnel and defined pre-requisites, scope and objectives of training. In 1957 the German utilities founded KRAFTWERKSSCHULE E.V. (kws) as a school for theoretical training and for guidance of practical training in the power plants. KWS is a non-profit organisation and independent of authorities. Today KWS has 127 members in Germany and in 6 other countries. The objectives of KWS include the training of: -Kraftwerker (control room operators; - Kraftwerksmesiter (shift supervisors); and - shift engineers; according the guidelines of the VGB
Anant V. Khandekar
Full Text Available Overall competency of the working personnel is often observed to ultimately affect the productivity of an organization. The globalised competitive atmosphere coupled with technological improvements demands for efficient and specialized manpower for the industrial operations. A set of typical technological skills and attitudes is thus demanded for every job profile. Most often, these skills and attitudes are expressed imprecisely and hence, necessitating the support of fuzzy sets for their effective understanding and further processing. In this paper, a method based on fuzzy axiomatic design principles is applied for solving the personnel selection problems. Selecting a middle management staff of a service department for a large scale organization is demonstrated here as a real life example. Five shortlisted candidates are assessed with respect to a set of 18 evaluation criteria, and the selection committee with experts from the related fields also realizes the outcome of the adopted approach to be quite appropriate, befitting and in agreement with their expectations.
In September of 1983, a mail survey was conducted to determine the status of external personnel gamma and neutron radiation dosimetry programs at international agencies. A total of 130 agencies participated in this study including military, regulatory, university, hospital, laboratory, and utility facilities. Information concerning basic dosimeter types, calibration sources, calibration phantoms, corrections to dosimeter responses, evaluating agencies, dose equivalent reporting conventions, ranges of typical or expected dose equivalents, and degree of satisfaction with existing systems was obtained for the gamma and neutron personnel monitoring programs at responding agencies. Results of this survey indicate that to provide the best possible occupational radiation monitoring programs and to improve dosimetry accuracy in performance studies, facility dosimetrists, regulatory and standards agencies, and research laboratories must act within their areas of responsibility to become familiar with their radiation monitoring systems, establish common reporting guidelines and performance standards, and provide opportunities for dosimetry testing and evaluation. 14 references, 10 tables
Simulator training and retraining of operations personnel is essential for their acquiring the necessary knowledge, skills and qualification for operating a nuclear power plant, and for effective feedback of experience including human based operating errors. Simulator training is the most effective way by far of training operations personnel in co-operation and communication in a team, which also involves instilling attitudes and approaches for achieving excellence and individual responsibility and alertness. This technical document provides guidance to Member States on the procurement, setting up and utilization of a simulator training centre; it will also be useful for organizations with previous experience in the use of simulators for training. The document is the result of a series of advisory and consultants meetings held in the framework of the International Working Group on Nuclear Power Plant Control and Instrumentation in 1989-1992. 17 refs, 2 tabs
The basic training of nuclear power reactor personnel should be given very close attention since it constitutes the foundation of their knowledge of nuclear technology. Emphasis should be given on the thorough understanding of basic nuclear concepts in order to have reasonable assurance of successful assimilation by those personnel of more specialized and advanced concepts to which they will be later exposed. Basic training will also provide a means for screening to ensure that those will be sent for further spezialized training will perform well. Finally, it is during the basic training phase when nuclear reactor operators will start to acquire and develop attitudes regarding reactor operation and it is important that these be properly founded. (orig.)
Katagiri, Hisako; Yamagata, Junko
We introduce our efforts to utilize education, training, competence assessment, and quality control of personnel engaged in urinary sediment and blood cell morphology examinations in our laboratory. There are no standard samples for these morphological examinations, and standardization has not been completed for all types of blood cells or urinary sediment components. We had been carrying out simultaneous microscopic examination involving trainee staff and senior laboratory technologists as a means of education and evaluation, but acceptance criteria were unclear. Moreover, we had continued our operation without assessment of the level of achievement of routine works or the competence of individual staff members. Taking the opportunity of receiving ISO 15189 certification, we have been able to establish clear standards for evaluating personnel education and training in morphological examinations. We will continuously make efforts to maintain and manage this system.
A collection is presented containing 11 papers submitted at a conference on the selection and education of specialists for operation and maintenance of nuclear power plants. The conference was attended by specialists from universities and colleges, research institutes and production plants. It debated the methods and aims of both general and specialized theoretical and practical personnel education, the proposals for teaching centre equipment, the use of simulators, computers and other aids in the teaching process; training on school reactors was included. A proposal was put forward of the system of education, the teaching process itself, the content of the basic theoretical subjects, and the method of testing pupils' knowledge. The importance was stressed of establishing a national coordination centre to safeguard the syllabus, methodology, teaching aids, and also the training proper. The system of personnel education in the Paks nuclear power plant, Hungary, is presented as an example. (M.S.)
Hankins, D.E.; Homann, S.; Westermark, J.
We developed a personnel neutron dosimetry system based on the electrochemical etching of CR-39 plastic at elevated temperatures. The doses obtained using this dosimeter system are more accurate than those obtained using other dosimetry systems, especially when varied neutron spectra are encountered. This CR-39 dosimetry system does not have the severe energy dependence that exists with albedo neutron dosimeters or the fading and reading problems encountered with NTA film. 3 refs., 4 figs
The purpose of this report is to present the evaluated data from external exposures of 1268 radiation workers in Guatemala carried out in the period of 1997-2000. The collective dose in medicine, industry and other applications shown a tendency to increase in the period of study, radiology is the practice that shown a trend to decrease, that could be explained as a result of inspections and personnel training carried out in this practice
Procedure for education and training of all the personnel employed at Bohunice Nuclear power plant is presented in detail describing the training system structure, kinds of training, staff members qualification development, short term and long term tasks needed to assure attaining the training objectives. The proposed Staff Members Lifetime education implementation project contains basic starting points, measures to be implemented by 1998. It was prepared on the basis of a primary analysis which confirmed the existing need for implementing the lifetime education system
Marina V. Polevaya
Full Text Available The article deals with the training of spe-cialists in the eld of labor and the house-keeper personnel management within the federal state educational standards of higher education. The analysis of the possibility of training in these specialties in the various educational standards. The necessity of focusing on the prepara-tion of these destinations within certain standards.
Vora, K.G.; Nagpal, J.S.; Pendurkar, H.K.; Gangadharan, P.
A pocket type thermoluminescent personnel dosemeter using CaSO 4 : Dy phosphor is described. Two glass capillaries containing the phosphor are fitted into a plastic tube and covered by a cylindrical filter. The combination is fitted into an ink barrel of a fountain pen. The response of this Dy glass dosimeter was studied for various incident photon energies. A uniform response over the energy range from 33 keV to 1250 keV is achieved. (A.K.)
This report examined specific functional components of the routine external personnel dosimeter program at Hanford. Components studied included: dosimeter readout; dosimeter calibration; dosimeter field response; dose calibration algorithm; dosimeter design; and TLD chip acceptance procedures. Additional information is also presented regarding the dosimeter response to light- and medium-filtered x-rays, high energy photons and neutrons. This study was conducted to clarify certain data obtained during the FY-1980 studies
The starting point in deriving the requirement profile for the shift personnel in the control rooms of nuclear power stations is information of a technical, organisational and ergonomic kind. The technique used, the distribution of work to different work areas and the configuration of the workplace is determined by the tasks and the environmental conditions in which they have to be done. (orig./DG) [de
programs. 8. Target Audience Description ( TAD ) The TAD is the initial description of the number and type of personnel required to operate, maintain...requirements, etc.) describing the Soldiers operating or maintaining the system. In cases where operating a system requires a security clearance, the TAD ...Authority. Milestone Decision Authority Target Audience Description ( TAD ) AR 602-2 AR 611-1 DA Pam 611-21 X X X X X X The TAD lists
Picazo, T.; Llorca, N.; Alabau, J.
In this paper it is proposed to consider the mode of the frequency distribution of the low dose dosemeters from each clinic that uses X rays as the background environmental dose that should be subtracted from the personnel dosimetry to evaluate the doses due to practice. The problems and advantages of this indirect method to estimate the environmental background dose are discussed. The results for 60 towns are presented. (author)
Frengopoulos, Courtney; Payne, Michael W C; Holmes, Jeffrey D; Viana, Ricardo; Hunter, Susan W
Gait is a complex process that involves coordinating motor and sensory systems through higher-order cognitive processes. Walking with a prosthesis after lower extremity amputation challenges these processes. However, the factors that influence the cognitive-motor interaction in gait among lower extremity amputees has not been evaluated. To assess the interaction of cognition and mobility, individuals must be evaluated using the dual-task paradigm. To investigate the effect of etiology and time with prosthesis on dual-task performance in those with lower extremity amputations. Cross-sectional study. Outpatient and inpatient amputee clinics at an academic rehabilitation hospital. Sixty-four individuals (aged 58.20±12.27 years; 74.5% male) were stratified into 3 groups; 1 group of new prosthetic ambulators with transtibial amputations (NewPA) and 2 groups of established ambulators: transtibial amputations of vascular etiology (TTA-vas), transtibial amputations of nonvascular etiology (TTA-nonvas). Not applicable. Time to complete the L Test measured functional mobility under single and dual-task conditions. A serial arithmetic task (subtraction by 3s) was paired with the L Test to create the dual-task test condition. Single-task performance on the cognitive arithmetic task was also recorded. Dual-task costs (DTCs) were calculated for performance on the cognitive and gait tasks. Analysis of variance determined differences between groups. A performance-resource operating characteristic (POC) graph was used to graphically display DTCs. Gait performance was worse under dual-task conditions for all groups. Gait was significantly slower under dual-task conditions for the TTA-vas (P Dual-task conditions also had a negative impact on cognitive task performance for the TTA-nonvas (P = .02) and NewPA groups (P dual-task conditions and has a positive DTCcog as a result (P = .04). However, no between-group differences were seen for DTCcog. The POC graph demonstrated that many
Temporary work for children of members of the personnel During the period mid-June to mid-September 2005, a limited number of vacancies for temporary work at CERN (normally unskilled work of a routine nature) will be available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children having previously worked at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks and the allowance for the period will be CHF 1621.- net. Candidates should apply via the HR Department's electronic recruitment system (E-rt) : http://humanresources.web.cern.ch/humanresources/internal/personnel/pmd/cr/Staff-kids-05.pdf Completed application forms must be returned to this Service by 8 April 2005 ...
Temporary work for children of members of the personnel During the period mid-June to mid-September 2003, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1582.- for this period. Application form can be obtained from Martine PLAZA, HR Division (by using the slip in the bulletin or by electronic mail to Martine.Plaza@cern.ch) or at http://cern.ch/hr-web/internal/general/HN-personnel/ Completed application forms must be returne...
Temporary work for children of members of the personnel During the period mid-June to mid-September 2003, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1582.- for this period. Application form can be obtained from Martine PLAZA, HR Division (by electronic mail to Martine.Plaza@cern.ch) or at http://cern.ch/hr-web/internal/general/HN-personnel/ Completed application forms must be returned to this service by 2 May 2003 at th...
Temporary work for children of members of the personnel During the period mid-June to mid-September 2003, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1582.- for this period. Application form can be obtained from Martine PLAZA, HR Division (by electronic mail to Martine.Plaza@cern.ch) or at http://cern.ch/hr-web/internal/general/HN-personnel/ Completed application forms must be returned to this service by 2 May 2003 at t...
Full Text Available Increased noise, which is also below the occupational exposure values and is “hearing safe” noise, affects the exposed person’s health as a non-specific stressor. Increased noise level also creates an environment for additional vocal apparatus load. The objective of this study was to determine preschool personnel occupational noise and its relationship with subjective health complaints. Data were obtained with survey assistance through subjective answers of respondents about health complaints and noise exposure among Rīga preschool personnel. Objective noise measurements were made to assess real noise levels in the preschool environment. Data from 155 respondents and objective measurements of 37 preschool classrooms were obtained. The results showed that the average 8-h noise exposure among Rīga preschool educational institutions was 70 dB(A, which did not exceed the Latvian work environment noise limits, but exceeded the 35–40 dB(A noise limit in the educational environment guidelines recommended by the WHO. The survey results showed that loud noise is one of the most important workplace environmental factors (~70% of respondents feel a necessity to increase voice because of noise. A constant feeling of fatigue, headache, irritable feeling, and a desire to isolate oneself from others more often occurred in respondents exposed to increased noise, compared with those who noted that they were not exposed to increased noise. In general, loud noise was associated with increased subjective health complaints in preschool education institution personnel.
In the first period of the development of nuclear technology specialists received mainly theoretical training in brief study courses and training sessions. These courses did not place high demands on training methods. In the subsequent period long-term, well-conceived and costly systems of training were developed placing emphasis on specialized knowledge and especially on practical training. The third stage has now been launched which is characterized by the departure from classical control rooms to data collection and processing in centralized information systems, selective recording according to situation and choice, etc. This stage is passing on to the system of the minimization of the human factor error. A significant problem of the human factor in nuclear technology is the time aspect. Schools specializing in the education and training of specialists, technical personnel and workers for the nuclear programme have been established. Following such education personnel are selected for specialized training in training centres which have been equipped with costly training equipment including simulators. With regard to the importance of the human factor in nuclear installations, control computers are being introduced to an increasing extent and individuals and groups of workers and personnel are trained in operation. (E.S.)
Pribozic, F.; Krajnc, J.
Acquisition of a full scope replica simulator represents an important achievement for Nuclear power Plant Krsko. Operating nuclear power plant systems is definitely a set of demanding and complex tasks. The most important element in the goal of assuring capabilities for handling such tasks is efficient training of operations personnel who manipulate controls in the main control room. Use of a simulator during the training process is essential and can not be substituted by other techniques. This article gives an overview of NPP Krsko licensed personnel training historical background, current experience and plans for future training activities. Reactor operator initial training lasts approximately two and a half years. Training is divided into several phases, consisting of theoretical and practical segments, including simulator training. In the past, simulator initial training and annual simulator retraining was contracted, thus operators were trained on non-specific full scope simulators. Use of our own plant specific simulator and associated infrastructure will have a significant effect on the operations personnel training process and, in addition, will also support secondary uses, with the common goal to improve safe and reliable plant operation. A regular annual retraining program has successfully started. Use of the plant specific simulator assures consistent training and good management oversight, enhances conformity of operational practices and supports optimization of operating procedures. (author)
Personnel Recruitment and Retention Strategies in Lagos State Civil Service of Nigeria. ... The results show that the strategy for personnel recruitment into the CS is based on mixtures of merit and political ... AJOL African Journals Online.
Personnel management and job satisfaction in academic libraries: a case study of ... the level of staff development, identify the motivational factors of the library personnel, ... Questionnaire was used for this research as the main data collection ...
This bibliography contains references on: specific thermoluminescent dosemeters used for personnel dosimetry; comparisons of thermoluminescent and other dosemeters for personnel monitoring and read-out apparatus for thermoluminescent dosemeters. An appendix contains selected foreign language references. (author)
A Personnel Utilization System has been designed at Broward Community College, which combines payroll, personnel, course, and function information in order to determine the actual duties performed by personnel for the amount of remuneration received. Objectives of the system are (1) to define the tasks being performed by faculty, staff, and…
... 25 Indians 1 2010-04-01 2010-04-01 false Leave system for education personnel. 38.12 Section 38.12 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION EDUCATION PERSONNEL § 38.12 Leave system for education personnel. (a) Full-time school-term employees. Employees on a full-time school-term...
Iyer, V.S.; Alok, M.; Chandel, B.S.
The principle objective of personnel monitoring system is to prevent overexposure and avoid unnecessary exposure of personnel working with various sources of radiation. The adequate system of personnel monitoring must provide for the measurement. evaluation and recording of significant doses accumulated by individuals together with a recording of conditions under which these doses are received
... 45 Public Welfare 2 2010-10-01 2010-10-01 false Personnel merit system review. 201.11 Section 201... STATES FOR PUBLIC ASSISTANCE PROGRAMS Review and Audits § 201.11 Personnel merit system review. A personnel merit system review is carried out by the Office of State Merit Systems of the Office of the...
... 49 Transportation 9 2010-10-01 2010-10-01 false Law enforcement personnel. 1542.217 Section 1542... Law enforcement personnel. (a) Each airport operator must ensure that law enforcement personnel used... the criminal laws of the State and local jurisdictions in which the airport is located— (1) A crime...
... 49 Transportation 9 2010-10-01 2010-10-01 false Law enforcement personnel. 1544.217 Section 1544... AND COMMERCIAL OPERATORS Operations § 1544.217 Law enforcement personnel. (a) The following applies to... for law enforcement personnel meeting the qualifications and standards specified in §§ 1542.215 and...
... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Health and hygiene of personnel. 590.560 Section 590.560 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF..., Processing, and Facility Requirements § 590.560 Health and hygiene of personnel. (a) Personnel facilities...
... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Personnel hoists and elevators. 77.1400 Section 77.1400 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS, SURFACE COAL MINES AND SURFACE WORK AREAS OF UNDERGROUND COAL MINES Personnel Hoisting § 77.1400 Personnel...
Problems of the NPP personnel education are discussed during radical reorganization of the state regulation of energy production and distribution when nuclear energetics will appears in the market conditions. Effective methods of the NPP personnel training developed by the corporation GPU Nuclear are given. Potentials of the application of simulators and computerized programs for increasing the NPP personnel education efficiency are considered
... 32 National Defense 1 2010-07-01 2010-07-01 false Evaluation of personnel security information... SECURITY DEPARTMENT OF DEFENSE PERSONNEL SECURITY PROGRAM REGULATION Adjudication § 154.42 Evaluation of personnel security information. (a) The criteria and adjudicative policy to be used in applying the...
Data on annual individual doses for personnel of national economy enterprises, research institutes, high schools, medical establishments dealing with ionizing radiation sources are presented. It is shown that radiation dose for the personnel constitutes only shares of standards established by sanitary legislation. Numeral values of individual doses of the personnel are determined by the type, character and scope of using ionizing radiation sources
... 34 Education 1 2010-07-01 2010-07-01 false Use of public school personnel. 76.659 Section 76.659... Be Met by the State and Its Subgrantees? Participation of Students Enrolled in Private Schools § 76.659 Use of public school personnel. A subgrantee may use program funds to make public personnel...
Carl, J. G.; Furukawa, S.
A manual is presented that provides basic technical documentation to support the operation and utilization of the Portable Ambulance Module (PAM) in the field. The PAM is designed to be used for emergency resuscitation and victim monitoring. The functions of all the controls, displays, and stowed equipment of the unit are defined. Supportive medical and physiological data in those areas directly related to the uses of the PAM unit are presented.
Williams, Heather; Pountney, Teresa
This study investigated the effects of exercise on the motor function of 11 young people (10 females, one male; age range 11-15y; mean age 12y 7mo [SD 1y 4mo]) with cerebral palsy (CP) who were non-ambulant (Gross Motor Function Classification System Levels IV or V), using an adapted static bicycle. Three participants had dyskinetic quadriplegia,…
Lester, Robert M; Gorgey, Ashraf S
To determine whether an individual with C4 incomplete spinal cord injury (SCI) with limited hand functions can effectively operate a powered exoskeleton (Ekso) to improve parameters of physical activity as determined by swing-time, up-time, walk-time, and total number of steps. A 21-year-old male with incomplete chronic (>1 year postinjury) SCI C4, participated in a clinical exoskeleton program to determine the feasibility of standing up and walking with limited hand functions. The participant was invited to attend 3 sessions including fitting, familiarization and gait training separated by one week intervals. Walk-time, up-time and total number of steps were measured during each training session. A complete body composition assessment using dual-energy X-ray absorptiometry (DXA) of the spine, knees and hips was conducted before training.Using a platform walker and cuffing both hands, the participant managed to stand up and ambulate successfully using exoskeleton. Over the course of 2 weeks, maximum walk-time increased from 7 to 17 min and number of steps increased from 83 to 589 steps. The total up-time increased from 19 to 31 min. Exoskeleton training may be a safe and feasible approach for persons with higher levels of SCI after effectively providing a supportive assistive device for weight shifting. The current case study demonstrates the use of a powered exoskeleton for an individual with high level tetraplegia (C4 and above) and limited hand functions.
Byrne, Eamonn; Bury, Gerard
Incident reporting is vital to identifying pre-hospital medication safety issues because literature suggests that the majority of errors pre-hospital are self-identified. In 2016, the National Ambulance Service (NAS) reported 11 medication errors to the national body with responsibility for risk management and insurance cover. The Health Information and Quality Authority in 2014 stated that reporting of clinical incidents, of which medication errors are a subset, was not felt to be representative of the actual events occurring. Even though reporting systems are in place, the levels appear to be well below what might be expected. Little data is available to explain this apparent discrepancy. To identify, investigate and document the barriers to medication error reporting within the NAS. An independent moderator led four focus groups in March of 2016. A convenience sample of 18 frontline Paramedics and Advanced Paramedics from Cork City and County discussed medication errors and the medication error reporting process. The sessions were recorded and anonymised, and the data was analysed using a process of thematic analysis. Practitioners understood the value of reporting errors. Barriers to reporting included fear of consequences and ridicule, procedural ambiguity, lack of feedback and a perceived lack of both consistency and confidentiality. The perceived consequences for making an error included professional, financial, litigious and psychological. Staff appeared willing to admit errors in a psychologically safe environment. Barriers to reporting are in line with international evidence. Time constraints prevented achievement of thematic saturation. Further study is warranted.
Full Text Available Abstract Background Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientifical evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients. Methods Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored. Results Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C to 36.0°C (95% CI; 35.7-36.3°C (p Conclusions In mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response. Trial Registration ClinicalTrials.gov: NCT01400152
Lundgren, Peter; Henriksson, Otto; Naredi, Peter; Björnstig, Ulf
Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientific evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients. Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored. Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C) to 36.0°C (95% CI; 35.7-36.3°C) (p transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response. ClinicalTrials.gov: NCT01400152.
Full Text Available Resumo: A configuração de redes logísticas para serviços de emergência é questão estratégica de imensa importância, visto que pequenas variações no tempo de resposta podem implicar na morte do solicitante. Partindo dessa premissa, o trabalho propõe novas alternativas de posicionamento para as ambulâncias do sistema SAMU na cidade de Duque de Caxias, RJ, capazes de reduzir o tempo de resposta do serviço. Essas propostas de reposicionamento das ambulâncias foram construídas em duas etapas: na primeira, dois modelos de Programação Inteira foram aplicados para se obter soluções que provejam maior cobertura à população. Posteriormente, o Modelo do Hipercubo foi empregado para avaliar a disponibilidade dos servidores, dentre outros indicadores de desempenho relevantes, como o tempo médio de resposta e a taxa de ocupação das ambulâncias.
Activities of IAEA concerning training and qualification of NPP personnel consider the availability of sufficient number of competent personnel which is one of the most critical requirements for safe and reliable NPP operation and maintenance. Competence of personnel is essential for reducing the frequency of events connected to human errors and equipment failures. The IAEA Guidebook on Nuclear Power Plant Personnel Training and its Evaluation incorporates the experience gained worldwide and provides recommendations on the use of SAT being the best practice for attaining and maintaining the qualification and competence of NPP personnel and for quality assurance of training
Gavrilov, S.L.; Kiselev, V.P.; Krasnoperov, S.N.; Kudeshov, E.V.; Maslov, S.Y.; Semin, N.N.; Sirotinskiy, S.E.; Yakovlev, V.Y. [Nuclear Safety Institute of the Russian Academy of Sciences (NSI RAS), Moscow (Russian Federation)
Currently, Web-GIS technologies are widely used to generate a reliable and intuitive web-based interface to monitor the current radiation situation in various regions of the Russian Federation. The developed 'Server Web-Monitoring' web-application is intended for duty personnel and can operate not only on desktop computers but also on mobile devices. The subsystem of duty personnel notification about any Off-Normal Situation (ONS) (such as: critical threshold exceedances or failures in operation of monitoring systems) is also considered in the paper. Three types of Automated Radiation Monitoring Systems (ARMS) are available for monitoring: - regional ARMS; - facility-level ARMS; - ARMS of nuclear power plant surveillance areas. Google Maps and Google Maps API toolbox are used as the cartographic basis. In the general-monitoring window only general information on each of the local systems is available. Next, the operator can move to monitoring of local ARMS he is interested in. The operator can either view a list of Radiation Situation Monitoring Posts (RSMP) showing the current data in the right frame or hide it and use the map only. Viewing the log of critical threshold exceedances for 24 hours and a report on all RSMPs of a given system over the last 7 days is also possible. The report contains maximum values of measurements for every day and for each RSMP. The developed web-application includes: - monitoring of the radiation situation and its changes on the general map of the Russian Federation and on maps of local ARMS; - displaying 7-day reports for all RSMPs of the selected ARMS; - displaying the log of critical threshold exceedances recorded over the past day. The notification subsystem informs duty personnel on all ONS, namely, on critical threshold exceedances in the incoming data and failures in operation of monitoring systems. The key features of the notification subsystem are: - round-the-clock functioning; - automatic notification in case of
One of the lessons learned from the Three Mile Island (TMI) accident was that the nuclear industry was ineffective in learning from previous events at other plants. As training programs and methods have improved since TMI, the nuclear industry has searched for effective methods to teach the lessons learned from industry events. The case study method has great potential as a solution. By reviewing actual plant events in detail, trainees can be challenged with solving actual problems. When used in a seminar or discussion format, these case studies also help trainees compare their decision-making processes with other trainees, the instructor, and the personnel involved in the actual case study event
This paper briefly summarises the results of a survey of the health of Australian personnel who took part in the U.K. atomic weapons tests between 1952 and 1957. The study identified indications of radiation exposure among participants and examined their health in relation to the answers they gave. For example, the study compared the health of those participants who said they cleaned up radioactive areas after tests with the health of those who said they had not. There was no excess of disease or death for any disease group studied in those members of the workforce who had film badge evidence of exposure to radiation
McCall, R.C.; Jenkins, T.M.; Shore, R.A.; LaRiviere, P.D.
For medical accelerators, neutron penetration through the room entry door is the major personnel hazard. Most therapy accelerator rooms are designed with at least a rudimentary maze to avoid the use of massive doors. Often, however, the maze may be similar to those shown in scale outline drawings of some medical electron accelerator rooms where the authors have made neutron measurements outside the doors which were of different thicknesses and compositions. The results are tabulated. It should be noted that there can be significant dose equivalents (H) at the door when a maze is inadequate, and that all three components - fast neutron, thermal neutron, and neutron capture γ rays - can be equally important
The TLD system uses Li 2 B 4 O 7 :Mn, Si sintered tablets which are heated by hot nitrogen. The slide which holds the tablets is coded by a self adhesive polyester-aluminium tape. This tape is BCD coded in an ordinary tape punch. The information on the punched tape includes a ten digit social-security number and a two digit information on location and type of dosimetry. By this system dosimetric data is directly transfered into a central dose register for Sweden. All personnel doses are there stored on social-security numbers. (author)
A specialized training course for Nevada's law enforcement personnel has been conducted by Reynolds Electrical and Engineering Co., Inc. for the US Department of Energy since February 1981. This course is designed for those persons who are first to arrive at a transportation accident scene. The course provides a basic understanding of radiation protection, the prevention of contamination spread from the accident site, use of radiation detection equipment, and decontamination procedures. The Department of Energy's Nevada Operations Office provides the training at no cost to Nevada agencies. Each agency selects its attendees. Details of the course are given
Since 1976 the Department for Radiation Protection of the Austrian Research Centre Seibersdorf has been operating a TLD Personnel Monitoring Service, which presently covers about 18,000 radiation workers in Austria, with monthly monitoring periods. We have been the first accredited monitoring service in Europe, which fully converted from film dosimetry to TLD. From the beginning up to 1991 the service was based on three automated TLD systems Model 2271 from HARSHAW, USA. After extensive testing and comparisons, since almost four years now, the monitoring service has been operating on two HARSHAW 8800 systems, which are described in more detail below. (author)
The safe operation of a research reactor requires that reactor personnel be fully trained and certified by the relevant authorities. Reactor operators at PUSPATI TRIGA Reactor underwent extensive training and are certified, ever since the reactor first started its operation in 1982. With the emphasis on enhancing reactor safety in recent years, reactor operator training and certification have also evolved. This paper discusses the changes that have to be implemented and the challenges encountered in developing a new training programme to be in line with the national standards. (author)
Duftschmid, K E [Oesterreichisches Forschungszentrum Seibersdorf GmbH (Austria)
Since 1976 the Department for Radiation Protection of the Austrian Research Centre Seibersdorf has been operating a TLD Personnel Monitoring Service, which presently covers about 18,000 radiation workers in Austria, with monthly monitoring periods. We have been the first accredited monitoring service in Europe, which fully converted from film dosimetry to TLD. From the beginning up to 1991 the service was based on three automated TLD systems Model 2271 from HARSHAW, USA. After extensive testing and comparisons, since almost four years now, the monitoring service has been operating on two HARSHAW 8800 systems, which are described in more detail below. (author).
Nantel, Marc; Fox, Bradley; Gelsthorpe, Leanne; Hamilton, Roxy; Marshall, Robert; Williamson, Guida
Employers clamour for more "Highly-Qualified Personnel" (HQP) to hire, and photonics is no exception. The challenge facing all new graduates lies in what actually constitutes a Highly-Qualified Person. Yesterday, an HQP was often understood to be a graduate with a Bachelor's, Master's or Ph.D. degree. Today, industry is demanding that an HQP be either a university or college graduate with strong academic standing AND a sound business and communications skill set. In this paper, we introduce the concept of "Value-Added Personnel" (VAP), which marries both scientific and "soft-skills" aspects, and we present a new program in Ontario to produce VAPs.
Tarykin, V. [Operation Personnel Training Department, Khmelnitsky NPP, Training Center, Neteshin 30100, Khmelnitsky region (Ukraine)]. E-mail: email@example.com
Modern personnel training and retraining system is a guarantee of NPPs safe reliable operation. Since the time when independence of Ukraine was proclaimed personnel training system was created directly at NPPs. This system is based on the latest legislation framework, developed subject to IAEA recommendations, gained international experience in the field of personnel training in view of increased demands to personnel qualification. Training Centers, formed at each plant, form one of the main components of NPP personnel training. Personnel training at Training Centers is performed in accordance with standard programmes. Simulator training base was created by joint efforts of specialists from the USA, Russia and Ukraine. Establishing manager training system and replacement reserves for National Nuclear Energy Generating Company 'ENERGOATOM' (NNEGC 'ENERGOATOM') managerial personnel, including training programme and training materials development, teacher selection and training, is under way. (author)
Methods applied in the choice of personnel include: the assessment of personnel files, references, interviews, examinations, long-term observation of the respective person. Investment intents go hand in hand with the concept of labour demands. The planned employment of personnel takes place from the very beginning of the construction of the power plant. At the Bohunice V-1 nuclear power plant 23 university graduates, 29 secondary school graduates and 64 graduates of vocational schools were employed every year. Social measures and complex care are being implemented. Personnel is being selected also on the basis of an assessment of their psychic qualities which are very important in view of the high personal and social responsibility of nuclear power plant personnel. The high technical standard of the equipment places high demands on the education level of all personnel, high demands on training, high remuneration and high level of allround care of personnel. (M.D.)
ICRP Recommendations-1990, Notice 60 was used as a basis for new NRBU-97 norms in Ukraine and also for Russian NRB-96 and reviewed NRB-99. These recommendations caused negative treatment among rather authoritative organizations and individual scientists of France, USA, Russia and other countries. Till 1988, norms NRB-76/87 were operated in Ukraine. ICRP Recommendations-1976, Notice 26 was used under their development, and dosage limits included into them surely provided radiation protection for Nuclear Power Units personnel and population during long-term period. But some leaders being affected by Chernobyl syndrome and radio phobia put strong pressure upon ICRP that resulted in Notice 60 appearance where dosage limits for personnel and population were sufficiently understated without any scientific ground. According to literary sources survey, it is shown that usage of dose-effect non threshold linear dependence concept essentially exaggerates the real danger. According to the concept, principles of regulation the exposure standards are suggested, which considered to be actual as large-scale works on dismantling the reactors and ChNPP Units equipment are expected soon on the phase of their decommissioning and also the conducting of works on Unit 'Shelter' transformation into ecologically safe system
Since the United Kingdom's defence nuclear industry was founded in the late 1940s, Service and civilian personnel have been exposed to ionising radiation. During the last forty years, as knowledge about the effects of radiation exposure has grown, concern to ensure adequate protection against exposure has also increased,. As part of our continuing scrutiny of the Ministry of Defence (MoD), we have undertaken a short inquiry to examine MoD's current and future policy and practice on radiological protection. The principal work involving exposure of Service and civilian personnel to significant levels of radiation falls into two discrete areas: the nuclear weapons programme and the nuclear propulsion programme. The nuclear weapons programme involves research, the production of nuclear warheads and their deployment with Her Majesty's Forces. The nuclear propulsion programme involves research, production, operation, refitting and decommissioning of pressurised water reactors as a source of propulsion power in Royal Navy submarines. These two nuclear programmes are not the only sources of ionising radiation within MoD's responsibility: it also arises from research, non-destructive testing and medical applications, most notably conventional radiography. In this Report we have concentrated upon ionising radiation arising from the two defence nuclear programmes. (author)
Griffith, R.V.; Hankins, D.E.
In selection, calibration and interpretation of personnel neutron dosimeters used in radiation protection, adequate attention is often not given to matching the characteristics of the dosimeter with the quality of the neutron field. A particular concern is the use of albedo detectors which have little energy response similarity to the neutron dose equivalent conversion curve. At the Lawrence Livermore Laboratory we have developed a system for dosimeter calibration and neutron field characterization using Bonner spheres and remmeters. Rapid surveys of the work area with detectors in 3-in and 9-in polyethylene spheres establish a qualitative estimate of spectral variation found in the facility. We also use this data to determine the appropriate albedo dosimeter calibration factors. At several locations representing the spectral range, multisphere spectra measure-ments are made and the spectrum weighted dose equivalent rates calculated. These rates are compared with survey instrument results to establish correction factors for the relative over- or under-response expected from these instruments, particularly in highly moderated neutron fields where remmeters overrespond. We also use the spectral information to determine the appropriateness of dosimeters considered for future use. This technique has been applied at power reactors to provide information valuable to selection of proper personnel dosimeters. We find that the spectral range is sufficiently narrow that albedo detectors can be used with confidence. On the other hand, most of the dose occurs at energies below the effective threshold NTA film. (author)
Summer work for children of members of the personnel During the period from 13 June to 16 September 2011 inclusive, there will be a limited number of jobs for summer work at CERN (normally unskilled work of a routine nature), which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of all contracts will be 4 weeks and the allowance will be 1717 CHF for this period. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_intranet/wd_pds?p_web_site_id=1&p_web_page_id=8886&p_no_apply=&p_show=N Completed application forms must be returned by 11 April 2011 at the latest. The results of the selection will be available by the end of May 2011. For further information, please con...
During the period mid-June to mid-September 2001, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of a routine nature) which will be made available to children of members of the personnel (that is, anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1538.- net for this period. Application forms can be obtained via the Web at the following address: http://cern.web.cern.ch/CERN/Divisions/PE/ under the heading 'Other Useful Links' or from Paula Barriere, Personnel Management Group (by using the slip below or by electronic mail to Paula.Barriere@.cern.ch). Completed applic...
Koster, J.E.; Bounds, K.A.; Kerr, P.L.; Steadman, P.A.; Whitley, C.R.
A project between Fernald EMP and LANL is to field a monitor for the detection of alpha-emitting contamination on a human body. Traditional personnel monitoring for alpha emitters involves either frisking with a probe or pressing against large detectors in order to overcome the short range of alpha particles. These methods have a low alpha collection efficiency, and can miss contamination on less accessible surfaces. The authors have investigated the sensitivity and practicality of measuring the entire subject simultaneously using the technique of ionization monitoring. The goal is to create a booth that personnel step into quickly during egress from radiological facilities. The detection technique relies on a breeze of air passing over the subject. Alpha emission produces copious ions in the ambient air which are transported by the air current to an ion collector, resulting in a small electrical current proportional to the amount of contamination. Results indicate a conservative sensitivity of 3,000 disintegrations per minute localized to one of five areas of the body in a measurement lasting less than 2 minutes
Chiaro, P.J. Jr.
Due to recent technological advances, substantial improvements have been made in personnel contamination monitoring. In all likelihood, these advances will close out the days of manually frisking personnel for radioactive contamination. Unfortunately, as microprocessor-based monitors become more widely used, not only at commercial power reactors but also at government facilities, questions concerning their trustworthiness arise. Algorithms make decisions that were previously made by technicians. Trust is placed not in technicians but in machines. In doing this it is assumed that the machine never misses. Inevitably, this trust drops, due largely to open-quotes false alarms.close quotes This is especially true when monitoring for alpha contamination. What is a open-quotes false alarm?close quotes Do these machines and their algorithms that we put our trust in make mistakes? An analysis was performed on half-body and hand-and-foot monitors at Oak Ridge National Laboratory (ORNL) in order to justify the suggested confidence level used for alarm point determination. Sources used in this analysis had activities approximating ORNL's contamination limits
Chiaro, P.J. Jr.
Due to recent technological advances, substantial improvements have been made in personnel contamination monitoring. In all likelihood, these advances will close out the days of manually frisking personnel for radioactive contamination. Unfortunately, as microprocessor-based monitors become more widely used, not only at commercial power reactors but also at government facilities, questions concerning their trustworthiness arise. Algorithms make decisions that were previously made by technicians. Trust is placed not in technicians but in machines. In doing this it is assumed that the machine never misses. Inevitably, this trust drops, due largely to ''false alarms''. This is especially true when monitoring for alpha contamination. What is a ''false alarm''? Do these machines and their algorithms that we put our trust in make mistakes? An analysis was performed on half-body and hand-and-foot monitors at Oak Ridge National Laboratory (ORNL) in order to justify the suggested confidence level used for alarm point determination. Sources used in this analysis had activities approximating ORNL's contamination limits
Aalto-Korte, Kristiina; Alanko, Kristiina; Kuuliala, Outi; Jolanki, Riitta
Methacrylates are important allergens in dentistry. The study aimed to analyse patch test reactivity to 36 acrylic monomers in dental personnel in relation to exposure. We reviewed the test files at the Finnish Institute of Occupational Health from 1994 to 2006 for allergic reactions to acrylic monomers in dental personnel and analysed the clinical records of the sensitized patients. 32 patients had allergic reactions to acrylic monomers: 15 dental nurses, 9 dentists, and 8 dental technicians. The dentists and dental nurses were most commonly exposed to 2-hydroxyethyl methacrylate (2-HEMA), triethyleneglycol dimethacrylate (TREGDMA), and 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA). 8 dentists and 12 dental nurses were allergic to 2-HEMA. The remaining dentist was positive to bis-GMA and other epoxy acrylates. The remaining 3 dental nurses reacted to diethyleneglycol diacrylate (DEGDA) or triethyleneglycol diacrylate (TREGDA), but not to monofunctional and multifunctional methacrylates. Our dental technicians were mainly exposed and sensitized to methyl methacrylate (MMA) and ethyleneglycol dimethacrylate (EGDMA). 1 technician reacted only to 2-HEMA, and another to ethyl methacrylate (EMA) and ethyl acrylate (EA). 2-HEMA was the most important allergen in dentists and dental nurses, and MMA and EGDMA in dental technicians. Reactions to bis-GMA, DEGDA, TREGDA, EMA and EA were relevant in some patients.
Full text: Renentech Laboratories is the first Private Enterprise in India to have been chosen to provide Personnel radiation monitoring services to radiation workers at different parts of the country. Since 1992 the Company has been manufacturing TLD phosphor powder of requisite quality and from 1995 commenced the production of TLD cards for radiation monitoring. After getting the necessary approval from the competent authorities in the country, the company undertook a rigorous quality assurance programme and received the accreditation in 1999 to carry out the personnel monitoring of radiation. Since then the trained staff of the Company is covering 1200 institutions in 16 states where radiation is being used. This translates to processing of 60,000 Till cards annually, the maximum limit permitted by BARC. Processing of exposure data is done strictly according well-laid guidelines. Any cases of overexposure are immediately referred to Calibration and Dose Record Section of BARC to meet the regulatory requirements. Necessary procedural guidelines are followed to handle such cases. In this lecture, learning, operation and implementation experience of a typical Private Company in a task, which, hitherto had been regarded as exclusive responsibility of state owned institution, is enumerated
Vazquez Lopez, C.; Saez, J.C.; Labarta, T.
Various tests carried out to characterize a Thermoluminiscence Personnel Dosimetry Automatic System, based on the optical heating of a multielement dosemeter are presented. The dosemeter consists of Lithium Borate (Copper) and Calcium Sulphate (Thallium) phosphors. The Dosimetric System shows some outstanding features, such as its simplicity (no aditional annealing procedures are required), its short reading cycle (160 TLD per hour and its data handling capabilities (RS-232C and Parallel Printer digital ports and four analigic outputs for Glow Curve Adquisition). The tests performed have been designed to conform with the different existing international Standards and Recommendations (ANSI: N13.11-1983; IEC:Draft 45B-1987, ISO:DP 8034-1984) The new radiological quantities (I.C.R.U.-19855) have been used for calibration. The results obtained (linearity, repeatibility, detection threshold, residue, stability of stored information, etc) show the optimum performance of this dosimetric system in its aplication to routine personnel dose monitoring. Based on the dosemeter energy discriminating response, an algorithm for dose assesment has been developed. The method allows personal dose calculations within 10% and gives valuable information on the quality and energy of incident radiation, for photons from 30 to 2000 keV and for Beta penetrating radiation (Sr/Y, U). (Author)
Temporary work for children of members of the personnel During the period from 15 June to 11 September 2009 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of routine nature), which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of all appointments will be 4 weeks and the allowance will be CHF 1717. - for this period. Candidates should apply via HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6970 Completed application forms must be returned by 10 April 2009 at the latest. The results of the selection will be available on 22 May 2009. For further information, please contact: mailto:Inger.Carriero@cern.c...
Temporary work for children of members of the personnel During the period from 15 June to 11 September 2009 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of a routine nature), which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of all appointments will be 4 weeks and the allowance will be CHF 1717. - for this period. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6970 Completed application forms must be returned by 10 April 2009 at the latest. The results of the selection will be available on 22 May 2009. For further information, please contact: mailto:Inger.Carriero@...
Temporary work for children of members of the personnel During the period from 16 June to 12 September 2008 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of a routine nature), which will be open to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of appointments will be 4 weeks and the allowance for this period will be 1663.- CHF. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6160 Completed application forms must be made on-line by 13 April 2008 at the latest. The results of the selection will be available on 18 May 2008. For further information, please contact: Geraldine.Ballet@cern.ch HR ...
Temporary work for children of members of the personnelDuring the period 12 June to 15 September 2006 included, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of jobs available, no children who have previously worked at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1640.- for this period. Candidates should apply via HR department's electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=4691 Completed application forms must be returned to this service by 17 April 2006 at the latest. The results of t...
Temporary work for children of members of the personnel During the period from 16 June to 12 September 2008 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of a routine nature), which will be open to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of appointments will be 4 weeks and the allowance for this period will be 1663 CHF. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6160 Completed application forms must be submitted on-line by 13 April 2008 at the latest. The results of the selection will be available on 18 May 2008. For further information, please contact: mailto:Geraldine.Ballet@cern....
Summer work for children of members of the personnel During the period from 14 June to 17 September 2010 inclusive, a limited number of jobs for summer work at CERN (normally unskilled work of a routine nature) will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of all contracts will be 4 weeks and the allowance will be 1717 CHF for this period. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=7716 Completed application forms must be returned by 9 April 2010 at the latest. The results of the selection will be available on 21 May 2010. For further information, please contact: Inger.Carriero@cern.ch Tel. 71372
Temporary work for children of members of the personnelDuring the period 12 June to 15 September 2006 included, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of jobs available, no children who have previously worked at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1640.- for this period. Candidates should apply via HR department's electronic recruitment system (E-rt) : https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=4691 Completed application forms must be returned to this service by 17 April 2006 at the latest. The results of ...
Temporary work for children of members of the personnel During the period from 16 June to 12 September 2008 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of routine nature), which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of appointments will be 4 weeks and the allowance for this period will be 1663.- CHF. Candidates should apply via HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6160 Completed application forms must be made on-line by 13 April 2008 at the latest. The results of the selection will be available on 18 May 2008. For further information, please contact: mailto:Geraldine.Ballet@cer...
Temporary work for children of members of the personnel During the period from 15 June to 11 September 2009 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of a routine nature), which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of all appointments will be 4 weeks and the allowance will be CHF 1717. - for this period. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6970 Completed application forms must be returned by 10 April 2009 at the latest. The results of the selection will be available on 22 May 2009. For further information, please contact: mailto:Inger.Carriero...
Chiaro, P.J. Jr.
Due to recent technological advances, substantial improvements have been made in personnel contamination monitoring. In all likelihood, these advances will close out the days of manually frisking personnel for radioactive contamination. Unfortunately, as microprocessor-based monitors become more widely used, not only at commercial power reactors but also at government facilities, questions concerning their trustworthiness arise. Algorithms make decisions that were previously made by technicians. Trust is placed not in technicians but in machines. In doing this it is assumed that the machine never misses. Inevitably, this trust drops, due largely to ''false alarms''. This is especially true when monitoring for alpha contamination. What is a ''false alarm''? Do these machines and their algorithms that they put their trust in make mistakes? An analysis was performed on half-body and hand-and-foot monitors at Oak Ridge National Laboratory (ORNL) in order to justify the suggested confidence level used for alarm point determination. Sources used in this analysis had activities approximating ORNL's contamination limits
A survey is given about those essential aspects of qualification and organization of personnel in nuclear power plants, that are already regulated in laws or guidelines. The considerations of the BMI concerning further developments of these requirements are outlined. (orig.) [de
Full Text Available Circadian rhythm influences the physiology of the cardiovascular system, inducing diurnal variation of blood pressure. We investigated the association between daily emergency ambulance calls (EACs for elevated arterial blood pressure during the time intervals of 8:00–13:59, 14:00–21:59, and 22:00–7:59 and weekly fluctuations of air temperature (T, barometric pressure, relative humidity, wind speed, geomagnetic activity (GMA, and high-speed solar wind (HSSW. We used the Poisson regression to explore the association between the risk of EACs and weather variables, adjusting for seasonality and exposure to CO, PM10, and ozone. An increase of 10 °C when T > 1 °C on the day of the call was associated with a decrease in the risk of EACs during the time periods of 14:00–21:59 (RR (rate ratio = 0.78; p < 0.001 and 22:00–7:59 (RR = 0.88; p = 0.35. During the time period of 8:00–13:59, the risk of EACs was positively associated with T above 1 °C with a lag of 5–7 days (RR = 1.18; p = 0.03. An elevated risk was associated during 8:00–13:59 with active-stormy GMA (RR = 1.22; p = 0.003; during 14:00–21:59 with very low GMA (RR = 1.07; p = 0.008 and HSSW (RR = 1.17; p = 0.014; and during 22:00–7:59 with HSSW occurring after active-stormy days (RR = 1.32; p = 0.019. The associations of environmental variables with the exacerbation of essential hypertension may be analyzed depending on the time of the event.
Lovach-Chepujnoska, Margarita; Nojkov, Jordan; Joshevska-Jovanovska, Slagjana; Domazetov, Robert
The advantages of patient-controlled epidural analgesia (PCEA) for delivery compared with continuous epidural analgesia (CEA) have been a point of interest in research obstetric anaesthesia for more than two decades. The aim of this single blind randomized controlled study was to evaluate the incidence of motor block and ability to perform partial knee flexion in women who received CEA or PCEA. Fifty-one healthy nulliparous women were included in this study. After an initial dose and established sensory block at Th 10, parturients were randomized into two groups: group CEA (10 ml/h), and group PCEA (bolus - 5 ml, lockout interval - 15 minutes, basal rate - 0 ml) with bupivacaine 0.08% and fentanyl 2 µg/ml. The motor function of the lower limbs was evaluated by modified Bromage scale at regular hourly intervals until full cervical dilatation. The quality of analgesia was assessed using a visual analogue pain scale (VAPS) and maternal satisfaction. Mode of delivery, the total number of additional rescue boluses, foetal and neonatal outcomes were recorded. Motor block was significantly lower in the third (33.3% vs. 4.35%; p = 0.008), fourth (57.9% vs. 6.3%; p = 0.003) and fifth hour (75.0% vs. 18.2%; p = 0.001) in the PCEA group. Ambulation occurred in 18% in the CEA and 46% in the PCEA group (p = 0.036). VAPS was with borderline significance in the second (p = 0.076) and significantly lower in the fourth hour (p = 0.034). Compared with CEA, PCEA provided less motor block and better first-stage analgesia, which leads to the conclusion that patient-controlled analgesia techniques are the preferred model in obstetric anesthesia.
M.A. This study looks into the types of stressors specific to the Emergency Medical Services. The study was undertaken over a period of two years with the following objectives: • A literature survey regarding stress, organisational stress in general and stress in the context of Emergency Medical Services in particular. • An investigation of the personnel of the Emergency Medical Services to ascertain the stressors perceived as stressful by them. • Recommendations on how to prevent or lower...
In 1999 the Nuclear Regulatory Authority of the Slovak Republic (UJD) focused on the overall training system and on developing programmes for individual categories for NPP V-1 Bohunice, NPP V-2 Bohunice, NPP Mochovce and SE-VYZ. The fundamental theoretical and periodical training for both Bohunice and Mochovce NPPs personnel, simulator training for NPP Bohunice, and periodical simulator training for Bohunice personnel is carried out by the VUJE Training center in Trnava, whereas the simulator training and periodical training for NPP Mochovce is carried at Mochovce plant. Based on a successful passing of examination before the examining committee, UJD issues, a certificate on special professional skills of selected staff of nuclear installations for specific activity for the given type of nuclear installation and for the following positions: (a)Shift manager for scientific start up with the right of manipulation; (b) Shift supervisor; (c) Unit supervisor; (d) Primary circuit operator; (e) Secondary circuit operator; (f) Reactor physicist; (g) Shift manager for scientific start up without the right of manipulation. Examination of selected personnel is described. Last year the examining committee held twelve session for oral theoretical examination. The number of licenses issued in 1999 and the total number of valid licenses is given.Conclusions from inspections carried out by UJD and inspections and tests carried out by the NPP operators in 1999, as well as results from operation and start up of nuclear units confirm that the standard of professional skills of the staff at nuclear installations a high standard of operational safety is being achieved on a permanent basis. Increasing the qualification of UJD staff was done in a form of training and courses scheduled in the plan of training for the staff for 1999. These training, composed of specialized qualification study, functional study, as well as study aimed at maintaining qualification. Training courses organized
Anatoliy Alexandrovich Malyuk
Full Text Available During the formation of information society the problem of determining the demand for IS personnel (DfISP, consisting of IS specialists and IS practitioners, is of particular relevance at present. The goal of the paper is to calculate the demand for IS specialists (DfISS. To achieve it we used the informal heuristic methods and introduced some important indicators for DfISP forecast. As a validation of the conceptual approach proposed we show how to apply it on the regional level of one country on one real-world example. All the reasoning and calculations can be narrowed down to the DfISS forecasting within one corporation or IS professionals of a specific profile.
Kunz, W.E.; Chambers, W.H.; Henry, C.N.; France, S.W.; Millegan, D.R.; Hastings, R.D.; Worth, G.M.
A light, rugged monitor has been developed for special nuclear materials (SNM) searches at material-access and protection-area exits. This monitor accepts gamma-ray pulses from a NaI(Tl) detector, integrates for a preset counting interval (typically 0.3 s), and produces an audible alarm whenever the counts in the interval exceed the trip level that is a preset multiple of the stored background count. Because the monitor is silent except when the alarm is operating, personnel with little special training can conduct more effective searches in a noisy and distracting environment than they can with conventional audible monitoring of individual radiation counts. The monitor is also more sensitive than conventional monitors that provide audible indication of the count rate
Since its formation, the Office of Health (EH-40) has stressed the importance of the exchange of information related to and improvements in neutron dosimetry. This Workshop was the eleventh in the series sponsored by the Department of Energy (DOE). It provided a forum for operational personnel at DOE facilities to discuss current issues related to neutron dosimetry and for leading investigators in the field to discuss promising approaches for future research. A total of 26 papers were presented including the keynote address by Dr. Warren K. Sinclair, who spoke on, ''The 1990 Recommendations of the ICRP and their Biological Background.'' The first several papers discussed difficulties in measuring neutrons of different energies and ways of compensating or deriving correction factors at individual facilities. Presentations were also given by the US Navy and Air Force. Current research in neutron dosimeter development was the subject of the largest number of papers. These included a number on the development of neutron spectrometers
The code of practice presented here as part of the Agency's Safety Standards deals with the problem of personnel monitoring in establishments in which, or in part of which, work is primarily with radiation sources. It is a development of the fundamental requirements on the subject contained in the Agency's Basic Safety Standards. The code has been prepared by the Secretariat of the Agency on the basis of the work of a panel of experts drawn from a number of Member States. In addition, representatives of several interested international organizations participated in the work of the panel. The Board of Governors of the Agency considered this code of practice in September 1964 and authorized its application to Agency and Agency-assisted operations and recommended to Member States that it be taken into account in the formulation of national regulations or recommendations.
Burt, G.L.; Stibbs, W.
The decade of the 1980s saw dramatic changes in the Drilling Industry worldwide; from record high utilization rates for mobile rigs to total depression and bankruptcies; from a strong market in the Gulf of Mexico to the steady flow of rigs to operating locations outside North America. A major drilling contractor operating on land and offshore, long known as an industry leader in training, has tripled its employee development efforts in the last five years to prepare for this challenge. This paper describes the Contractor's current program of training and highlights the commitment in resources required in order to provide for the operational continuity, manpower capability and safety objectives of the future. The paper clarifies the relationship it anticipates between the coming manpower shortage, development of personnel and the safety of its people and environment. It discusses plans already in place to effectively develop drilling expertise in lesser developed countries of operation
Maxwell, R.L.; Wright, L.J.
Personnel identity verification devices, which are based on the examination and assessment of a body feature or a unique repeatable personal action, are steadily improving. These biometric devices are becoming more practical with respect to accuracy, speed, user compatibility, reliability and cost, but more development is necessary to satisfy the varied and sometimes ill-defined future requirements of the security industry. In an attempt to maintain an awareness of the availability and the capabilities of identity verifiers for the DOE security community, Sandia Laboratories continues to comparatively evaluate the capabilities and improvements of developing devices. An evaluation of several recently available verifiers is discussed in this paper. Operating environments and procedures more typical of physical access control use can reveal performance substantially different from the basic laboratory tests
Ande, C.D.; Sneha, C.; Madhumita, B.; Bakshi, A.K.; Datta, D.
In India, personnel monitoring of radiation workers for X-, beta- and gamma- radiation is carried out using a thermoluminescence dosemeter (TLD) system based on CaSO 4 :Dy Teflon TLD disc. A large number of radiation workers get very low occupational doses and their doses are reported as zero since it is not above detectable limits. Therefore, the detection of low levels of occupational dose over and above the natural background assumes great importance. In the present system, the estimation of the background dose is achieved by use of control dosemeters. An analysis of the readings of the control dosimeters sent to various institutions was carried out to arrive at conclusions regarding the validity of the use of control dosimeter
The NPP engineering support functional area comprises seven common positions: reactor engineer, in-service inspection engineer, performance reliability engineer, system-maintenance engineer, station modification engineer, quality assurance engineer, and regulatory compliance engineer. The primary duties and tasks of each was presented. In Spain, a simplified SAT approach was used to analyze the training needs of these positions. The basic difference between the comprehensive SAT and the simplified method is that the simplified approach uses no taxonomy codes and the task elements are not analyzed to obtain the knowledge and skills. Resulting in an economy of time and personnel resources, this process makes use of job competencies and a top table analysis conducted by subject matter experts. An example of a JPM prepared using the simplified SAT approach was shown. Examples of the simplified approaches used in Russia, France, and USA were also discussed
This Code of Practice sets forth the objectives of an adequate system of personnel monitoring for radiation workers. It covers individual dosimetry, including internal radiation monitoring, and area monitoring to the extent required for the assessment of individual radiation doses. The responsibilities of authorities for organizing monitoring of radiation workers are discussed, together with brief descriptions of monitoring methods and the rules governing their application. The general principles to be considered in selecting instrumentation and the appropriate monitoring techniques are described, as well as calibration techniques, methods of data handling and record keeping. Current concepts and recommendations of the International Commission on Radiological Protection, as presented in ICRP Publication No.26, have been incorporated. New developments in techniques and instruments have been reflected, and several sections such as calibration and record keeping have been elaborated. The bibliography has been updated and new annexes added.
Taiwan Power Company has established a nuclear manpower program to identify human resources, selection and recruitment of entry level engineers and technicians of Nuclear Energy Group. The methodology to estimate the future nuclear manpower demand of Taipower has been clearly described in this article. Also, the manpower program is being used as the bases for nuclear training program development. For safe, reliable and efficient operation of nuclear power plants, Taipower has established a systematic training program for nuclear power stations and headquarter personnel. The training program has been implemented in three stages with different patterns of training program. The first stage of nuclear training before 1975 was completed successfully. The second stage of nuclear training currently conducted since 1975 enlarges domestic training capability. The third stage of nuclear training with a long term training program is now under a systematic and compositive development effort
Landauer, Inc. has gained approval to provide personnel dosimetry services in several countries. Each experiene reflects the different concerns adopted by national approval agencies. None have adopted ISO 9000 registration as evidence of a suitable quality system of management. Instead, each organization has prepared its own set of requirements with no provisions for recognizing the results of performance tests or audits conducted by other approval organizations. As ISO 9000 has become a communication symbol for commercial organizations dealing with each other, it has not been similarly viewed by radiation regulation bodies. A key reason arises from a tradition to regulate bodies. A key reason arises from a tradition to regulate, not promote, international trade, not encourage innovation, nor foster economic competition. A second reason is the inability to separate the technical requirements from quality assurance. ISO 9000 may become useful once the national technical organizations learn to trust those of other countries
Busick, D.D.; Warren, G.J.
Within a few months of the discovery of x-rays the first radiation injuries were reported (ta71). During the past thirty years both the number and complexity of x-ray analytical units have increased markedly. The world-wide number of incidents leading to severe injury has also increased. For analytical x-ray machines the need for engineered and administrative safeguards has long been recognized. At Stanford Synchrotron Radiation Laboratory (SSRL) the personnel protection system has been carefully designed to maximize safety and minimize experimental interference. However, all possible experimental configurations cannot be anticipated and some interference is to be expected. There are means by which safeguards can be substituted as long as these substitutions do not degrade the existing degree of safety. any substitutions must be evaluated by the Radiation Safety Committee, the SSRL staff and Operational Health Physics. Some studies have indicated that between fifty and ninety percent of serious radiation accidents are directly related to human errors, i.e., ignoring administrative proccedures, by-passing engineered safeguards or by inadequate training. Lindell has estimated the annual probability of serious injury to be about 1:100 per macchine. No matter what the real probability of serious injury is the personnel protection system should reduce this risk to a value that approaches zero. It is hoped that this manual will bring into sharper focus some of the more serious results of unnecessary risk taking. We also hope that it will convey the very real necessity for safeguards which may at times appear to be arbitrary and unnecessary impediments to experimental purposes
Swaja, R.E.; Chou, T.L.; Sims, C.S.; Greene, R.T.
The Tenth Personnel Dosimetry Intercomparison Study was conducted at the Oak Ridge National Laboratory during April 9-11, 1984. Dosemeter badges from 31 participating organizations were mounted on 40cm Lucite phantoms and exposed to a range of dose equivalents which could be encountered during routine personnel monitoring in mixed radiation fields. The Health Physics Research Reactor served as the only source of radiation for eight of the ten irradiations which included a low (approx. 0.50 mSv) and high (approx. 10.00 mSv) neutron dose equivalent run for each of four shield conditions. Two irradiations were also conducted for which concrete- and Lucite-shield reactor irradiations were gamma-enhanced using a 137 Cs source. Results indicated that some participants had difficulty obtaining measurable indication of neutron and gamma exposures at dose equivalents less than about 0.50 mSv and 0.20 mSv, respectively. Albedo dosemeters provided the best overall accuracy and precision for the neutron measurements. Direct interaction TLD systems showed significant variation in accuracy with incident spectrum, and threshold neutron dosemeters (film and recoil track) underestimated reference values by more than 50%. Gamma dose equivalents estimated in the mixed fields were higher than reference values with TL gamma dosemeters generally yielding more accurate results than film. Under the conditions of this study in which participants had information concerning exposure conditions and radiation field characteristics prior to dosemeter evaluation, only slightly more than half of all reported results met regulatory standards for neutron and gamma accuracy. 19 refs., 2 figs., 29 tabs
Brackenbush, L.W.; Endres, G.W.R.; Selby, J.M.; Vallario, E.J.
This study assesses the state of personnel neutron dosimetry at DOE facilities. A survey of the personnel dosimetry systems in use at major DOE facilities was conducted, a literature search was made to determine recent advances in neutron dosimetry, and several dosimetry experts were interviewed. It was concluded that personnel neutron dosimeters do not meet current needs and that serious problems exist now and will increase in the future if neutron quality factors are increased and/or dose limits are lowered
Award Number: W81XWH-11-2-0161 TITLE: Detection of Early lung Cancer Among Military Personnel (DECAMP) PRINCIPAL INVESTIGATOR: Avrum E. Spira...W81XWH-11-2-0161 Detection of Early lung Cancer Among Military Personnel (DECAMP) 5b. GRANT NUMBER W81XWH-11-2-0161 5c. PROGRAM ELEMENT NUMBER 6...biomarkers found in blood, tissues, or other bodily fluids, which may be used for the early detection of lung cancer among military personnel and
Darchenko Nataliya D.
The goal of the article lies in the study of a possibility to manage fluctuation of personnel at a modern enterprise through application of the motivational monitoring and in identification of some methodical aspects of formation of the system of monitoring the fluctuation of personnel. The article considers the essence, tasks and main directions of motivational monitoring at an enterprise and offers its classification. It proves urgency of the problem of fluctuation of personnel at enterpris...
Neetzel, C.R.; Rochetti, Luis
An operative system for the measurement and on-line processing of personnel dosimetry data is described. The aim is to organize and rationalize the work involved in a personnel dosimetry service. The method considers the application to other areas of radiation protection, as well as the connection and exchange of files among the different personnel monitoring groups. The system can be interfaced with different computers (M.E.L.) [es
Zahra Zamanian; Mansooreh Dehghani; Heidar Mohammady; Mohammadtaghi Rezaeiani; Hadi Daneshmandi
In today’s advanced world resulting from the improvement of technology, societies tend to encounter a large number of problems and accidents. As we know, university’s security personnel are classified as shift workers and are exposed to health disturbing factors. The aim of this study was investigation of shiftwork disorders among security personnel of the hospitals Affiliated to Shiraz University of Medical Sciences, Central. This case-control study was conducted among 130 security personnel...
Uses Getzels and Guba's view of social behavior as theoretical framework for discussion. Points out importance of bureaucratic structure and personnel functions as factors affecting coordinator's role. (CJ)
NĂSTASIE MIHAELA – ANDREEA
Full Text Available General research area of this article is the motivation of personnel, essential tool in the management process, and also a component derived from human resource management. In economic activity, personnel motivation should be regarded as an internal process, not as an imperative that can be imposed from outside the economic entity. Managers of economic entities must, first, understand personnel motivation strategies, how they influence positively or negatively the internal motivations of employees. Personnel motivation by itself attracts an end, just as profitable and moral, individual and social welfare making.
The training of nuclear facility personnel has been a requirement of the reactor licensing process for over two decades. However, the training of nuclear facility personnel remains a combination of boon and boondoggle. The opportunity to develop elite, well trained, professionally aggressive reactor operation staffs is not being realized to its full potential. Improvements in the selection of personnel, training programs, operational tools and professional pride can result in improved plant operation and contribute to improved plant capacity factors. Industry, regulatory agencies, professional societies and universities can do much to improve standards and quality of the training of nuclear facility personnel and to improve the professional level of plant operation
The development of the nuclear industry in the Federal Republic of Germany can be phased as follows: Phase 1 (1956-1968): initial stage, Phase 2 (1968-1975): expansion of the business volume, Phase 3 (1975-1982): decreasing business volume, more conditions and technical requirements, Phase 4 (after 1982): consolidation of technologies and project management. Accordingly, the requirements made on the personnel employed in the nuclear industry had to change. Between 1982 and today, there has been a decrease of personnel employed in nuclear industry to about 35.000. This decrease is mainly due to the supplying industry. Adding to this figure the number of people employed in research centres, authorities and experts, there are over 40.000 nuclear technology jobs, a figure which, taking into account indirect employment effect, could be in the range of 100.000 to 150.000. (orig./HSCH) [de
Badiali, Stefano; Giugni, Aimone; Marcis, Lucia
START (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether "last-minute" START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients. In this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group). The START group received last-minute START training. Each group examined 6000 patients, obtained from the Emergo Train System (ETS Italy, Bologna, Italy) victims database, and assigned patients a triage code (black-red-yellow-green) along with a reason for the assignment. Each rescuer triaged 30 patients within a 30-minute time frame. Results were analyzed according to Fisher's exact test for a P valueSTART group completed the evaluations in 15 minutes, whereas the non-START group took 30 minutes. The START group correctly triaged 94.2% of their patients, as opposed to 59.83% of the non-START group (PSTART group versus 13.67% and 26.5% for the non-START group. The non-START group had 458 "preventable deaths" on 6000 cases because of incorrect triage, whereas the START group had 91. Even a "last-minute" training on the START triage protocol allows nonmedical personnel to better identify and triage the victims of a disaster or MCI, resulting in more effective and efficient medical intervention. (Disaster Med Public Health Preparedness. 2017;11:305-309).
Park, Hyun-Ju; Oh, Duck-Won; Choi, Jong-Duk; Kim, Jong-Man; Kim, Suhn-Yeop; Cha, Yong-Jun; Jeon, Su-Jin
To investigate the effects of action observation training involving community-based ambulation for improving walking ability after stroke. Randomized, controlled pilot study. Inpatient rehabilitation hospital. A total of 25 inpatients with post-stroke hemiparesis were randomly assigned to either the experimental group ( n = 12) or control group ( n = 13). Subjects of the experimental group watched video clips demonstrating four-staged ambulation training with a more complex environment factor for 30 minutes, three times a week for four weeks. Meanwhile, subjects of the control group watched video clips, which showed different landscape pictures. Walking function was evaluated before and after the four-week intervention using a 10-m walk test, community walk test, activities-specific balance confidence scale, and spatiotemporal gait measures. Changes in the values for the 10-m walk test (0.17 ±0.19 m/s vs. 0.05 ±0.08 m/s), community walk test (-151.42 ±123.82 seconds vs. 67.08 ±176.77 seconds), and activities-specific balance confidence (6.25 ±5.61 scores vs. 0.72 ±2.24 scores) and the spatiotemporal parameters (i.e. stride length (19.00 ±11.34 cm vs. 3.16 ±11.20 cm), single support (5.87 ±5.13% vs. 0.25 ±5.95%), and velocity (15.66 ±12.34 cm/s vs. 2.96 ±10.54 cm/s)) indicated a significant improvement in the experimental group compared with the control group. In the experimental group, walking function and ambulation confidence was significantly different between the pre- and post-intervention, whereas the control group showed a significant difference only in the 10-m walk test. Action observation training of community ambulation may be favorably used for improving walking function of patients with post-stroke hemiparesis.
Ambulant transbrachial 4-french-arteriograhy with special reference to the aorto-femoral territory. Ambulante transbrachiale 4-French-Arteriographie unter besonderer Beruecksichtigung der aortofemoralen Strombahn
Spindler-Thiele, S. (Klinikum Ingolstadt (Germany). Inst. fuer Strahlendiagnostik); Schmitt, R. (Klinikum Ingolstadt (Germany). Inst. fuer Strahlendiagnostik); Helmberger, T. (Klinikum Ingolstadt (Germany). Inst. fuer Strahlendiagnostik); Pogan, J. (Klinikum Ingolstadt (Germany). Inst. fuer Strahlendiagnostik); Gullotta, U. (Klinikum Ingolstadt (Germany). Inst. fuer Strahlendiagnostik)
Arteriograms were carried out on 176 patients using 4-F catheters through a transbrachial approach. Criteria for exclusion from the series were injuries to the upper limb, hemiparesis or poor pulses in the presence of a normal femoral pulse. There were no local vascular complications requiring treatment. On two occasions the brachial artery could not be punctured. Acute posterior cerebral infarction was the only serious complication (0.5%). 67% of the patients were examined on an outpatient basis and this did not appear to increase the risk of complication. We regard this as a suitable method for demonstrating the pelvic and lower limb arteries on ambulant patients. (orig.)
Singh, Samiksha; Doyle, Pat; Campbell, Oona Mr; Oakley, Laura; Rao, Gv Ramana; Murthy, Gvs
To estimate the proportion of interfacility transfers (IFTs) transported by '108' ambulances and to compare the characteristics of the IFTs and non-IFTs to understand the pattern of use of '108' services for pregnant women in India. A cross-sectional analysis of '108' ambulance records from five states for the period April 2013 to March 2014. Data were obtained from the call centre database for the pregnant women, who called '108'. Proportion of all pregnancies and institutional deliveries in the population who were transported by '108', both overall and for IFT. Characteristics of the women transported; obstetric emergencies, the distances travelled and the time taken for both IFT and non-IFT. The '108' ambulances transported 6 08 559 pregnant women, of whom 34 993 were IFTs (5.8%) in the five states. We estimated that '108' transferred 16.5% of all pregnancies and 20.8% of institutional deliveries. Only 1.2% of all institutional deliveries in the population were transported by '108' for IFTs-lowest 0.6% in Gujarat and highest 3.0% in Himachal Pradesh. Of all '108' IFTs, only 8.4% had any pregnancy complication. For all states combined, on adjusted analysis, IFTs were more likely than non-IFTs to be for older and younger women or from urban areas, and less likely to be for women from high-priority districts, from backward or scheduled castes, or women below the poverty line. Obstetric emergencies were more than twice as likely to be IFTs as pregnant women without obstetric emergencies (OR=2.18, 95% CI 2.09 to 2.27). There was considerable variation across states. Only 6% institutional deliveries made use of the '108' ambulance for IFTs in India. The vast majority did not have any complication or emergency. The '108' service may need to consider strategies to prioritise the transfer of women with obstetric emergency and those requiring IFT, over uncomplicated non-IFT. © Article author(s) (or their employer(s) unless otherwise stated in the text of the
Anne-Gaëlle Le Moing
Full Text Available Measurement of muscle strength and activity of upper limbs of non-ambulant patients with neuromuscular diseases is a major challenge. ActiMyo® is an innovative device that uses magneto-inertial sensors to record angular velocities and linear accelerations that can be used over long periods of time in the home environment. The device was designed to insure long-term stability and good signal to noise ratio, even for very weak movements. In order to determine relevant and pertinent clinical variables with potential for use as outcome measures in clinical trials or to guide therapy decisions, we performed a pilot study in non-ambulant neuromuscular patients. We report here data from seven Duchenne Muscular Dystrophy (DMD patients (mean age 18.5 ± 5.5 years collected in a clinical setting. Patients were assessed while wearing the device during performance of validated tasks (MoviPlate, Box and Block test and Minnesota test and tasks mimicking daily living. The ActiMyo® sensors were placed on the wrists during all the tests. Software designed for use with the device computed several variables to qualify and quantify muscular activity in the non-ambulant subjects. Four variables representative of upper limb activity were studied: the rotation rate, the ratio of the vertical component in the overall acceleration, the hand elevation rate, and an estimate of the power of the upper limb. The correlations between clinical data and physical activity and the ActiMyo® movement parameters were analyzed. The mean of the rotation rate and mean of the elevation rate appeared promising since these variables had the best reliability scores and correlations with task scores. Parameters could be computed even in a patient with a Brooke functional score of 6. The variables chosen are good candidates as potential outcome measures in non-ambulant patients with Duchenne Muscular Dystrophy and use of the ActiMyo® is currently being explored in home environment
Le Moing, Anne-Gaëlle; Seferian, Andreea Mihaela; Moraux, Amélie; Annoussamy, Mélanie; Dorveaux, Eric; Gasnier, Erwan; Hogrel, Jean-Yves; Voit, Thomas; Vissière, David; Servais, Laurent
Measurement of muscle strength and activity of upper limbs of non-ambulant patients with neuromuscular diseases is a major challenge. ActiMyo® is an innovative device that uses magneto-inertial sensors to record angular velocities and linear accelerations that can be used over long periods of time in the home environment. The device was designed to insure long-term stability and good signal to noise ratio, even for very weak movements. In order to determine relevant and pertinent clinical variables with potential for use as outcome measures in clinical trials or to guide therapy decisions, we performed a pilot study in non-ambulant neuromuscular patients. We report here data from seven Duchenne Muscular Dystrophy (DMD) patients (mean age 18.5 ± 5.5 years) collected in a clinical setting. Patients were assessed while wearing the device during performance of validated tasks (MoviPlate, Box and Block test and Minnesota test) and tasks mimicking daily living. The ActiMyo® sensors were placed on the wrists during all the tests. Software designed for use with the device computed several variables to qualify and quantify muscular activity in the non-ambulant subjects. Four variables representative of upper limb activity were studied: the rotation rate, the ratio of the vertical component in the overall acceleration, the hand elevation rate, and an estimate of the power of the upper limb. The correlations between clinical data and physical activity and the ActiMyo® movement parameters were analyzed. The mean of the rotation rate and mean of the elevation rate appeared promising since these variables had the best reliability scores and correlations with task scores. Parameters could be computed even in a patient with a Brooke functional score of 6. The variables chosen are good candidates as potential outcome measures in non-ambulant patients with Duchenne Muscular Dystrophy and use of the ActiMyo® is currently being explored in home environment. ClinicalTrials.gov NCT
Full Text Available Abstract Background People with Multiple Sclerosis (MS frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect. This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of: 1 Establishing the effectiveness of core stability training 2 Comparing core stability training with standardised physiotherapy exercise 3 Exploring underlying mechanisms of change associated with this intervention Methods This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control. All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12, the Functional Reach (forwards and lateral, a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC Scale. In addition, ultrasound imaging of the
Freeman, Jennifer; Fox, Esther; Gear, Margaret; Hough, Alan
People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK) provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect.This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of: 1 Establishing the effectiveness of core stability training; 2 Comparing core stability training with standardised physiotherapy exercise; 3 Exploring underlying mechanisms of change associated with this intervention This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control). All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12), the Functional Reach (forwards and lateral), a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC) Scale. In addition, ultrasound imaging of the abdominal muscles will be performed before
Guedj, Pauline; P. Santiago, Jorge
En France, depuis le début des années 2000, l’analyse des pratiques musicales est devenue un champ particulièrement dynamique de l’anthropologie. La musique, tout comme la danse, constituent des objets stimulants pour notre discipline, que les anthropologues investissent et qui les positionnent dans un dialogue sans cesse renouvelé avec des ethnomusicologues, des historiens de la musique, des sociologues de l’art, des philosophes et des géographes. Pour ces anthropologues, la musique revêt p...
The overall training system and the development of projects for training of all categories of NPP V-1, NPP V-2 Bohunice, SE-VYZ and NPP Mochovce staff were the subject of Nuclear Regulatory Authority of the Slovak Republic (UJD) attention. During 2000, the following inspections were carried out on nuclear personnel training: (a) NPP Bohunice: an inspection focused on compliance with requirements for staff qualifications and compliance with the prescribed training of Bohunice plant staff ; (b) NPP Mochovce: an inspection focused on compliance with the requirements for staff qualifications and compliance with the prescribed training of NPP Mochovce staff; an inspection focused on verifying the simulator aided training; an inspection focused on checking the preparedness of NPP Mochovce operation and technical personnel for NPP Mochovce Unit 2 operation; (c) Technology for treatment and conditioning of radioactive waste Bohunice (BSC): an inspection focused on compliance with the requirements for staff qualifications and compliance with the prescribed training of SE-VYZ staff; VUJE Trnava: verification of technical equipment and professional skills of VUJE Trnava staff and tasks arising out of the 'Authorisation on nuclear installation staff training'. Examinations of selected personnel were scheduled according to the plan of examining committee meetings. For each examined person written tests are generated by the computer from the database of test questions at the Training Centre of VUJE Trnava for individual positions - categories of selected staff of NPP V-1 and NPP V-2 Bohunice and NPP Mochovce so that the examination questions both in written and oral part equally cover individual facilities and regimes of operation of NPP. The database is continuously updated, thereby containing new questions resulting from the recent changes carried out at NPPs. A part of the examination in case of promotion to a higher position is the practical part, which is conducted under
Elwood, T W
Upon learning that 95% of all fatal traffic accidents occur within three miles of one's home, an acquaintance moved to another residence four miles away and is still alive today. The world might be a much better place if most obstacles could be overcome this handily. Unfortunately, the problem of allied health personnel shortages appears to be more intractable. Because the situation is complicated in nature, it is most unlikely that any single remedy will suffice. Public and private interests have joined forces in many states, but it is abundantly clear that conventional market forces are unlikely to prevail. These forces usually focus on supply and demand. While shortages may cause entry-level salaries to rise, they do not stimulate academic institutions to increase their output nor will they affect the availability of research funding and/or doctoral training programs. Current market forces compel health facilities to engage in bidding wars for scarce manpower. Although individual job seekers may benefit, this practice does not increase the number of training program graduates. The federal government has a decisive role to play in assuring an adequate number of personnel to meet this nation's health care needs. Assistance is necessary in the form of providing entry- and advanced-level traineeships to accelerate the flow of part-time students pursuing doctorates, and to fund model student recruitment/retention projects. This role should encompass attracting students (particularly from minority and underserved portions of the population) to academic programs. The Disadvantaged Minority Health Improvement Act, PL 101-527 that was enacted in November 1990, contains only minimal provisions for allied health. Eligibility for student scholarship assistance is restricted to a small handful of allied health professions. Moreover, allied health is not eligible for the loan repayment program aimed at individuals who agree to serve on the faculty of health professions
PROFESSIONAL STATUS AND THE. PERSONNEL FUNCTIONARY IN THE SADF. By R Adm R. Eberlein*. Introduction. During the last year or so there has developed an increasing awareness among personnel functionaries in the SA Defence Force of a move- ment aimed at obtaining recognition of the pro- fessional ...
understanding work rules and procedures, provide you with the resources you need, as well as guide you through Employee Training Exit Survey HR Forms New Employee Orientation For Admin Staff Classification Form Packets Personnel Memoranda Personnel Rules Policies and Procedures Recruitment Services Reports Sections Director's
S.T. Mol (Stefan)
textabstractPersonnel selection is one of the main activities of the industrial and organizational psychologist. Yet, little is known about whether principles of personnel selection that have been developed in domestic and mainly Western (i.e., North American and European) contexts will apply in
California State Dept. of Motor Vehicles, Sacramento.
The development of a 6-hour motorcycle course of instruction for personnel responsible for motorcycle licensing is described in this project report. The primary goals are stated and include (1) training driver licensing personnel in motorcycle safety and principles of operation, and (2) purchasing and installing appropriate motorcycle skill…
Poplavskij, K.K.; Popov, A.O.
Problems of deontology in the process of liquidation of radiation accident consequences are considered in the article. It is noted, that shortages of ethical nature in the activities of physicians are related to insufficient qualification of medical personnel in the area of radiation medicine. Problems of medical personnel participation in the large scale propaganda activities among various groups of population are considered. 5 refs
The personnel function in industrial society has been marked by crisis, reappraisals, struggles for power, and guilty conscience. The profession is again under pressure; company management often questions its contribution to the solution of strategic personnel matters, while employees and their unions question its values, and wish to place its…
... 49 Transportation 9 2010-10-01 2010-10-01 false Law enforcement personnel. 1546.211 Section 1546... § 1546.211 Law enforcement personnel. (a) At airports within the United States not governed by part 1542...) When using a screening system required by § 1546.101(a), (b), or (c), provide for law enforcement...
... 7 Agriculture 3 2010-01-01 2010-01-01 false Health and hygiene of personnel. 56.77 Section 56.77 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... EGGS Grading of Shell Eggs Facility Requirements § 56.77 Health and hygiene of personnel. (a) No person...
Bridges, Edwin M.; Groves, Barry R.
Explicates a conceptual framework for analyzing the politics of personnel evaluation in an educational context. Using several elements of the framework, discusses the politics of teacher evaluation in California in relation to the types of personnel evaluation decisions, the actors, their access to these decisions, sources and levels of power, and…
... 39 Postal Service 1 2010-07-01 2010-07-01 false Interim personnel regulations. 211.4 Section 211.4... under the Postal Reorganization Act. (b) Continuation of Personnel Provisions of Former title 39, U.S.C... collective bargaining agreement under the Postal Reorganization Act, all provisions of former title 39, U.S.C...
Francis, E. E.
Niles Township School District 219, Skokie, Illinois, has rebuilt its personnel and payroll program. The new system provides a data bank for storage of any and all information required by both the personnel and payroll departments on each district employee. (Author/MLF)
Openly? There are 18 countries that allow transgender personnel to serve openly in their mili- taries: Australia, Austria, Belgium, Bolivia , Canada...clinical and cultural competence for the proper care of transgender patients. Surgical procedures quite similar to those used for gender transition...tries that allow transgender personnel to serve openly in their militaries: Austra- lia, Austria, Belgium, Bolivia , Canada, Czech Republic, Denmark
... 32 National Defense 4 2010-07-01 2010-07-01 true Training of law enforcement personnel. 634.33 Section 634.33 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS MOTOR VEHICLE TRAFFIC SUPERVISION Traffic Supervision § 634.33 Training of law enforcement personnel. (a) A...