WorldWideScience

Sample records for ambulances

  1. Ambulance 3G.

    Science.gov (United States)

    Banitsas, Konstantinos; Perakis, Konstantinos; Koutsouris, Dimitrios; Konis, Georgios; Tachakra, Sapal

    2005-01-01

    Minimising the time required for a patient to receive primary care has always been the concern of the Accidents and Emergency units. Ambulances are usually the first to arrive on the scene and to administer first aid. However, as the time that it takes to transfer the patient to the hospital increases, so does the fatality rate. In this paper, a mobile teleconsultation system is presented, based primarily on third generation mobile links and on Wi-Fi hotspots around a city. This system can be installed inside an ambulance and will permit high-resolution videoconferencing between the moving vehicle and a doctor or a consultant within a base station (usually a hospital). In addition to video and voice, high quality still images and screenshots from medical equipment can also be sent. The test was carried out in Athens, Greece where a 3G system was recently deployed by Vodafone. The results show that the system can perform satisfactory in most conditions and can effectively increase the patient's quality of service, while having a modest cost.

  2. Intelligent Ambulance Traffic Assistance System

    Directory of Open Access Journals (Sweden)

    RONOJOY GHOSH

    2013-09-01

    Full Text Available With the increase in traffic road density, several causalities occur due to delay in taking a patient to the hospital in an ambulance. In this paper, we have developed an algorithm to find the shortest path to reach the required destination. As required the software will identify the present location of the vehicle and ask the user for the destination. Then it will show all the available paths, highlighting the shortest one or in several cases the most optimum one. Further we made the traffic signals automated for special vehicles like an ambulance or a fire-engine such that the signals will go green for the ambulance as it comes in the vicinity of the traffic signal, thus providing them with a clear path to reach its destination. The original signal is restored as soon as the ambulance goes undetected by the Bluetooth scanner of the traffic signal.

  3. [Ambulant treatment of alcohol withdrawal].

    Science.gov (United States)

    Nüstedt, Volker

    2016-07-01

    Most of the patients addicted to alcohol are socially well integrated. The offer of a low threshold ambulant withdrawal therapy opens an opportunity to build a sustainable therapeutic relationship. The so started empathic addiction therapy will be well accepted and will lead to a satisfying outcome. Using Clomethiazole or Oxazepam in a daily reduced dose and with daily personal contacts, the ambulant withdrawal in patients without seizures or delir in medical history is a secure and successful therapeutic option.

  4. Physical workload of ambulance assistants.

    Science.gov (United States)

    Doormaal, M T; Driessen, A P; Landeweerd, J A; Drost, M R

    1995-02-01

    The physical workload of ambulance assistants was assessed by means of the Ovako Working posture Analysis System (OWAS) observation method and a Work and Health Questionnaire (WHQ) for measuring perceived workload. In addition, a biomechanical model was applied to several specifically strenuous conditions that were simulated in a laboratory situation. Bad postures were identified for a number of activities: 16% to 29% of a work shift was spent in harmful positions. Strenuous situations occur particularly during rides in emergency situations. The results of observed and perceived workload are generally in agreement. A number of practical recommendations are made. They concern, for example, the equipment in ambulance cars, training of ambulance assistants and adaptations in working procedures.

  5. A Theory of Ambulance Chasing

    CERN Document Server

    Backović, Mihailo

    2016-01-01

    Ambulance chasing is a common socio-scientific phenomenon in particle physics. I argue that despite the seeming complexity, it is possible to gain insight into both the qualitative and quantitative features of ambulance chasing dynamics. Compound-Poisson statistics suffices to accommodate the time evolution of the cumulative number of papers on a topic, where basic assumptions that the interest in the topic as well as the number of available ideas decrease with time appear to drive the time evolution. It follows that if the interest scales as an inverse power law in time, the cumulative number of papers on a topic is well described by a di-gamma function, with a distinct logarithmic behavior at large times. In cases where the interest decreases exponentially with time, the model predicts that the total number of papers on the topic will converge to a fixed value as time goes to infinity. I demonstrate that the two models are able to fit at least 9 specific instances of ambulance chasing in particle physics us...

  6. Riding Third: Social Work in Ambulance Work

    Science.gov (United States)

    Campbell, Hilary; Rasmussen, Brian

    2012-01-01

    This research explored the possible role of social work alongside emergency ambulance services. An ethnographic study included semistructured interviews and direct observations collected over 300 hours while riding in ambulances in an urban setting. The data suggest that social work could play a role by providing needed psychosocial care during…

  7. Air ambulance medical transport advertising and marketing.

    Science.gov (United States)

    2011-01-01

    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.

  8. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Requirements for ambulance suppliers. 410.41... § 410.41 Requirements for ambulance suppliers. (a) Vehicle. A vehicle used as an ambulance must meet the... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with...

  9. Improving community ambulation after stroke: the AMBULATE trial

    Directory of Open Access Journals (Sweden)

    Lindley Richard

    2009-02-01

    Full Text Available Abstract Background It has been reported that following rehabilitation, only 7% of stroke survivors are able to walk at a level commensurate with community participation. Previous research indicates that treadmill and overground walking training can improve walking capacity in people living in the community after stroke. The main objectives of the AMBULATE trial are to determine (i whether a 4-month treadmill walking program is more effective than a 2-month program, compared to control, in improving walking capacity, health and community participation and (ii the "threshold" walking speed that results in sufficient walking capacity that makes walking self-sustaining. Methods/Design A prospective randomised controlled trial of unsupported treadmill training with a 12 month follow-up with concealed allocation and blinded assessment will be conducted. 210 community-dwelling people after stroke who are able to walk independently but slowly will be recruited and randomly allocated to either a 4 month training group, 2 month training group or the control (no intervention group. Intervention for the two training groups will occur 3 days per week for 30 minutes each session. Measurements of walking, health and community participation will be taken at baseline, 2 months, 4 months, 6 months and 12 months. This study has obtained ethical approval from the relevant Human Research Ethics Committees. Discussion By improving stroke survivors' walking ability, it is likely also to improve their general wellbeing by promoting better health and greater community participation. Furthermore, if stroke survivors can reach a point where their walking and community participation is self-sustaining, this will reduce the burden of care on family and friends as well as the economic burden on the health system. Given the major demographic shift in developed nations involving significant growth in the aged population, this research will make an important evidence

  10. Ambulance officers' use of online clinical evidence

    Directory of Open Access Journals (Sweden)

    Westbrook Mary T

    2006-07-01

    Full Text Available Abstract Background Hospital-based clinicians have been shown to use and attain benefits from online evidence systems. To our knowledge there have been no studies investigating whether and how ambulance officers use online evidence systems if provided. We surveyed ambulance officers to examine their knowledge and use of the Clinical Information Access Program (CIAP, an online evidence system providing 24-hour access to information to support evidence-based practice. Methods A questionnaire was completed by 278 ambulance officers in New South Wales, Australia. Comparisons were made between those who used CIAP and officers who had heard of, but not used CIAP. Results Half the sample (48.6% knew of, and 28.8% had used CIAP. Users were more likely to have heard of CIAP from a CIAP representative/presentation, non-users from written information. Compared to ambulance officers who had heard of but had not used CIAP, users were more likely to report better computer skills and that their supervisors regarded use of CIAP as a legitimate part of ambulance officers' clinical role. The main reasons for non-use were lack of access(49.0% and training(31.4%. Of users, 51.3% rated their skills at finding information as good/very good, 67.5% found the information sought all/most of the time, 87.3% believed CIAP had the potential to improve patient care and 28.2% had directly experienced this. Most access to CIAP occurred at home. The databases frequently accessed were MIMS (A medicines information database (73.8% and MEDLINE(67.5%. The major journals accessed were Journal of Emergency Nursing(37.5%, American Journal of Medicine(30.0% and JAMA(27.5%. Conclusion Over half of ambulance officers had not heard of CIAP. The proportion who knew about and used CIAP was also low. Reasons for this appear to be a work culture not convinced of CIAP's relevance to pre-hospital patient care and lack of access to CIAP at work. Ambulance officers who used CIAP accessed it

  11. CERN'S Fire and Rescue Group Gets New Ambulance

    CERN Multimedia

    2000-01-01

    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.

  12. User reflection on actions in ambulance telemedicine systems

    DEFF Research Database (Denmark)

    Hansen, Magnus

    2010-01-01

    Much information is shared, interpreted and recreated between caller, emergency dispatch personnel and ambulance crew during an emergency call. This paper studies the use of reflection in the ambulance control center based on the information an ambulance crew produces during patient treatment in ...... to understand and use the feedback delivered through the system. The paper argues for broadening the scope of telemedicine use outside the boundaries of communication between ambulance and emergency department....... in the ambulance. The study is based on an ethnographical single case study of a Danish ambulance control center that uses a system called “amPHI” to monitor outgoing and homebound ambulance runs from scene of injury to arrival at the emergency department. The paper finds that the control center uses...

  13. Shoes versus sneakers in toddler ambulation.

    Science.gov (United States)

    Gould, N

    1985-10-01

    The purpose of this study was to determine the relative values and differences between shoes and sneakers for young children just learning to walk. In phase 1 of the study, 79 toddlers (47 females and 32 males), ranging in age from 11 months to 3 years, were carefully measured for footwear. Only 15 toddlers (19%) could be properly fitted in the medium-width sneakers that are currently available on the market. The majority of the measured toddlers required widths greater than D, and to accommodate these wider feet, it was necessary to fit them with longer sneakers than they actually needed otherwise, thus making ambulation a bit more difficult and clumsy. In phase 2, eight toddlers, randomly selected except for sex (four male and four female), ranging in age from 11 to 16 months who had been ambulating 2 weeks to 5 months, were tagged with an identifying letter and videotaped in four walking situations: sneakers on tile, shoes on tile, sneakers on rugging, and shoes on rugging. Four hours of video taping was edited down to one-half hour. Twenty-three observers (orthopaedic surgeons, pediatricians, and shoe fitters) carefully reviewed the tape on multiple occasions and came to the following conclusions: better fit, stance, gait, cadence, and stability were noted with shoes in all the toddlers and in all situations. Falls were three times more frequent in sneakers as compared to shoes on tile surfaces and five times more frequent on rugging. It was concluded that the slight economic advantage of sneakers over shoes was not that great to warrant jeopardizing the capabilities of the toddler in the earliest stages of ambulation.

  14. Leg Spasticity and Ambulation in Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Swathi Balantrapu

    2014-01-01

    Full Text Available Background. Spasticity of the legs is common in multiple sclerosis (MS, but there has been limited research examining its association with ambulatory outcomes. Objective. This study examined spasticity of the legs and its association with multiple measures of ambulation in persons with MS. Methods. The sample included 84 patients with MS. Spasticity of the legs was measured using a 5-point rating scale ranging between 0 (normal and 4 (contracted. Patients completed the 6-minute walk (6 MW, timed 25 foot walk (T25FW, and timed up-and-go (TUG, and O2 cost of walking was measured during the 6 MW. The patients undertook two walking trials on a GAITRite (CIR systems, Inc. for measuring spatial and temporal parameters of gait. The patients completed the Multiple Sclerosis Walking Scale-12 (MSWS-12 and wore an accelerometer over a seven-day period. Results. 52% (n=44 of the sample presented with spasticity of the legs. Those with leg spasticity had significantly worse ambulation as measured by 6 MW (P=0.0001, d=-0.86, T25FW (P=0.003,d=0.72, TUG (P=0.001, d=0.84, MSWS-12 (P=0.0001,d=1.09, O2 cost of walking (P=0.001, d=0.75, average steps/day (P<0.05, d=-0.45, and walking velocity (P<0.05, d=-0.53 and cadence (P<0.05, d=-0.46. Conclusion. Leg spasticity was associated with impairments in ambulation, including alterations in spatiotemporal parameters and free-living walking.

  15. Computer assisted assessment and advice for "non-serious" 999 ambulance service callers: the potential impact on ambulance despatch

    OpenAIRE

    Dale, Jeremy; Higgins, J.; Williams, S.; Foster, T.; Snooks, Helen; Crouch, R; Hartley-Sharpe, C; Glucksman, E; Hooper, R.; George, S.

    2003-01-01

    Objective: To investigate the potential impact for ambulance services of telephone assessment and\\ud triage for callers who present with non-serious problems (Category C calls) as classified by ambulance\\ud service call takers.\\ud Design: Pragmatic controlled trial. Calls identified using priority dispatch protocols as non-serious\\ud were allocated to intervention and control groups according to time of call. Ambulance dispatch\\ud occurred according to existing procedures. During intervention...

  16. Actively-controlled Beds for Ambulances

    Institute of Scientific and Technical Information of China (English)

    Takahiko Ono; Hikaru Inooka

    2009-01-01

    During transportation by ambulance,a patient is exposed to inertial acceleration when an ambulance decelerates or turns a corner.Such acceleration often gives a patient physical stress such as blood pressure variation or body sway,which causes strong pain,feeling of discomfort or sometimes critical damage for seriously injured persons.To reduce this undesirable effect of the acceleration,the authors developed the actively-controlled bed (ACB) which controls the posture of a stretcher in real time to reduce foot-to-head and lateral acceleration acting on a supine person.This paper describes development of the ACB,including control system design and performance evaluation.The control system is designed by Zakian's framework,which comprises the principle of matching and the method of inequalities,so that the design specifications on the tracking error and the motor torque are satisfied.From the results of driving experiments and simulation,it is estimated that the ACB can reduce the acceleration acting on a patient by 65% in the foot-to-head direction and by 75% in the lateral direction.

  17. Design of an Efficient Integrated System for Ambulance Management

    Directory of Open Access Journals (Sweden)

    Raid S. Sarhan

    2015-08-01

    Full Text Available Because the increases in accidents and emergencies require less time and faster access whenever possible in order to reduce the chances of death, This study designed an ambulance management system (AMaSy which utilize GIS, GPS, and GPRS that was tested in principle in Al-Mansoura City - EGYPT. The proposed system takes into consideration the emergency cases that could possibly occur. The research work considers all possible cases. While an ambulance could already be occupied with one patient, the system considers it as an available ambulance and requests it for another case, being that the ambulance only needs a short period of time to drop-off the current case and that the second case is relatively close to the ambulance. This forces the ambulance to quicken the processes of drop-off and pick-up between the two cases. The main objective of this research work is to make an ambulance system which enables ambulances to have faster arrivals and take less time to reach accident sites

  18. Offload zone patient selection criteria to reduce ambulance offload delay

    NARCIS (Netherlands)

    Laan, Corine M.; Vanberkel, Peter T.; Boucherie, Richard J.; Carter, Alix J.E.

    2016-01-01

    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 singl

  19. Board Certification. Registered EMT-Paramedic. Registered EMT-Intermediate. Registered EMT-Ambulance. Registered EMT-Non-Ambulance.

    Science.gov (United States)

    National Registry of Emergency Medical Technicians, Columbus, OH.

    These three brochures outline entry requirements and certification information for: (1) emergency medical technician (EMT)-ambulance and EMT-non-ambulance; (2) EMT-intermediate; and (3) EMT-paramedic. Each brochure provides information on entry requirements, including provisional registration and expiration date; lapsed registration; examination…

  20. Understanding the factors that influence patient satisfaction with ambulance services.

    Science.gov (United States)

    Bogomolova, Svetlana; Tan, P J; Dunn, S P; Bizjak-Mikic, M

    2016-01-01

    The quality of ambulance services has an immense impact on patients' future well-being and quality of life. Patient satisfaction is one of the key metrics for evaluating the quality of this service. Yet, the patient satisfaction measurement may be limited in its ability to accurately reflect this service quality, and even reflect factors beyond the patient experiences. We analyze 10 years of survey data to reveal a number of factors that systematically bias ambulance satisfaction ratings. Taking into account these biases provides more robust comparison of ambulance performance over time or across different jurisdictions.

  1. Efficacy and safety of intravenous fentanyl administered by ambulance personnel

    DEFF Research Database (Denmark)

    Friesgaard, Kristian Dahl; Nikolajsen, Lone; Giebner, Matthias

    2016-01-01

    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...

  2. Would You Feel Safe in A Driverless Ambulance?

    Science.gov (United States)

    ... configuration, while they had mixed feelings about the autopilot configuration," said Rice, an associate professor of human ... people's emotional responses to it because ambulances on autopilot aren't a part of our everyday lives ...

  3. Cardiac arrest: comparison of paramedic and conventional ambulance services.

    OpenAIRE

    1983-01-01

    A prospective study conducted in the Greater Vancouver area compared survival rates in prehospital cardiac arrest managed by an advanced life support (paramedic) service with those in cardiac arrest managed by conventional ambulance service. Management by the paramedic service was associated with higher survival rates for patients found in cardiac arrest but not for patients who suffered the arrest while the ambulance was present. Cardiopulmonary resuscitation by bystanders was associated wit...

  4. Superior Ambulance Call Out Rate Forecasting Using Meteorological Data

    Science.gov (United States)

    Mahmood, M. A.; Thornes, J. E.; Bloss, W.; Pope, F.

    2015-12-01

    Ambulances are an integral part of a country's infrastructure ensuring its citizens and visitors are kept healthy. The impact of weather, climate and climate change on ambulance services around the world has received increasing attention in recent years but most studies have been area specific and there is a need to establish basic relationships between ambulance data (both response and illness data) and meteorological parameters. In this presentation, the effects of temperature and relative humidity on ambulance call out rates for different medical categories will be investigated. We use call out data obtained from the London Ambulance Service (LAS) and meteorological data from a central London meteorological station. A time-series analysis was utilized to understand the relation between temperature, relative humidity, air pollutants and different call out categories. There are statistically significant relationships between mean temperature and ambulance callout rate for most of the categories investigated. Most categories show a negative dependence on temperature, i.e. call outs increase with decreasing temperature but some categories showed a positive dependence such as alcohol related call outs. Relative humidity is significant for some categories but in general is much less important than temperature. Significant time lag effects were observed for most of the categories related to infectious illnesses, which are transferrable through human contact. These findings support the opinion that ambulance attendance callouts records are an effective and well-timed source of data and can be used for health early warning systems. Furthermore the presented results can much improve our understanding of the relationships between meteorological conditions and human health thereby allowing for better prediction of ambulance use through the application of long and short-term weather forecasts.

  5. Private Ambulance Services, ambulance zone, Published in 2008, 1:24000 (1in=2000ft) scale, Box Elder County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Private Ambulance Services dataset, published at 1:24000 (1in=2000ft) scale, was produced all or in part from Other information as of 2008. It is described as...

  6. Evaluation on Ambulance Design and Musculoskeletal Disorders Risk Factors among Ambulance Emergency Medical Service Per¬sonnel

    Directory of Open Access Journals (Sweden)

    Baba M. DEROS

    2016-03-01

    Full Text Available Background: Injuries or pains occurred at various body's joints, ligaments, muscles, nerves, tendons, limbs, back and neck are classified as musculoskeletal disorders (MSDs. A single forceful exertion or repeated exposure to force, vibration or awkward posture can result in MSDs. This study was carried out by evaluating the relevant physical measurements of Class B ambulance used in Malaysia. The two main objectives of the study are to evaluate on the ambulance physical dimensions and workstation design and to conduct a Rapid Entire Body Assessment (REBA to examine ambulance’s emergency medical service (EMS workers’ activities and their associated MSDs risk factors.Methods: The two methodologies adopted for the study conducted in 2014 were direct measurement of the ambulance physical dimensions and workstation layout; and in-depth interviews of five EMS workers that provides patient care during transporting patient to a public hospital in Kota Bharu, Kelantan. REBA was conducted on seven commonly performed activities by EMS workers for identifying postural risks.Results: The study found ambulance width is too narrow and workstation layout may exposed EMS workers to MSDs risks. REBA scores for the seven commonly performed activities in the ambulance ranges from medium to very high. Conclusion: Seven important MSDs risk factors to be considered in the design of the Class B ambulance for performing patient care activities that may lead towards EMS workers’ injury are awkward posture, bumping, instability, narrow workspace dimension, inappropriate arrangement of storage cabinet, inappropriate arrangement of medical equipment, inadequate railing and seat, and inappropriate stretcher.  Keywords: Musculoskeletal disorders, Ambulance, EMS, Workers, REBA, Risks

  7. CERN'S Fire and Rescue Group Gets New Ambulance

    CERN Multimedia

    2000-01-01

    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 CERN’s 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 ...

  8. Influence of ambulance use on early reperfusion therapies for acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    SONG Li; HU Da-yi; YAN Hong-bing; YANG Jin-gang; SUN Yi-hong; LI Chao; LIU Shu-shan; WU Dong; FENG Qi

    2008-01-01

    Background Ambulance use expedites the definitive treatment of acute myocardial infarction (AMI). The aim of this study was to evaluate the effect of ambulance use on the administration of early reperfusion therapies for patients with AMI in Beijing, China.Methods Data were prospectively collected from 498 patients with ST-elevation myocardial infarction (STEMI) who were admitted within 12 hours of symptom onset to 19 hospitals in Beijing between November 1,2005 and December 31, 2006. The baseline characteristics of and the initial management of the ambulance users and the non-ambulance users were compared.Results Only 186 (37.3%) patients used an ambulance as transportation to the hospital. Ambulance users were, on average, older and at relatively higher risk on presentation than the non-ambulance users. After adjustment for patient and hospital characteristics, ambulance use was associated with a greater early reperfusion rate, mainly because of a greater incidence of primary percutaneous coronary intervention. In addition, ambulance users had a significantly shorter median door-to-balloon (120 compared with 145 minutes, P<0.001) and symptom onset-to-balloon (223 compared with 300 minutes, P<0.001) time than non-ambulance users.Conclusions Ambulances are underused by AMI patients in Beijing. Ambulance use may lead to more frequent and faster receipt of early reperfusion therapies. New public health strategies should be developed to facilitate an increased use of ambulances by AMI patients.

  9. Health status in the ambulance services: a systematic review

    Directory of Open Access Journals (Sweden)

    Hem Erlend

    2006-07-01

    Full Text Available Abstract Background Researchers have become increasingly aware that ambulance personnel may be at risk of developing work-related health problems. This article systematically explores the literature on health problems and work-related and individual health predictors in the ambulance services. Methods We identified the relevant empirical literature by searching several electronic databases including Medline, EMBASE, PsychINFO, CINAHL, and ISI Web of Science. Other relevant sources were identified through reference lists and other relevant studies known by the research group. Results Forty-nine studies are included in this review. Our analysis shows that ambulance workers have a higher standardized mortality rate, higher level of fatal accidents, higher level of accident injuries and a higher standardized early retirement on medical grounds than the general working population and workers in other health occupations. Ambulance workers also seem to have more musculoskeletal problems than the general population. These conclusions are preliminary at present because each is based on a single study. More studies have addressed mental health problems. The prevalence of post-traumatic stress symptom caseness was > 20% in five of seven studies, and similarly high prevalence rates were reported for anxiety and general psychopathology in four of five studies. However, it is unclear whether ambulance personnel suffer from more mental health problems than the general working population. Conclusion Several indicators suggest that workers in the ambulance services experience more health problems than the general working population and workers in other health occupations. Several methodological challenges, such as small sample sizes, non-representative samples, and lack of comparisons with normative data limit the interpretation of many studies. More coordinated research and replication are needed to compare data across studies. We discuss some strategies for

  10. An integration of Emergency Department Information and Ambulance Systems.

    Science.gov (United States)

    Al-Harbi, Nada; El-Masri, Samir; Saddik, Basema

    2012-01-01

    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.

  11. Masculinity and Lifting Accidents among Danish Ambulance Personnel

    DEFF Research Database (Denmark)

    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. For those 5% scoring lowest on MRNI the probability of reporting lifting alone was 6% while this figure was 17% for those scoring above the 95th percentile. Conclusion This study suggests that male ambulance workers performance of masculinity might pose a threat to their safety. AP...

  12. Risk of Transmission of MRSA on Contact Surfaces in Ambulance

    NARCIS (Netherlands)

    Lukas, R. -P.; Keppler, P. -A.; Brinkrolf, P.; Friedrich, A. W.; Van Aken, H.; Bohn, A.

    2015-01-01

    The gram-positive bacterium methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequent causes of treatment-associated nosocomial infections. The incidence of MRSA among the population and in hospitalised patients is growing worldwide. Ambulance service is an interface between the

  13. 29 CFR 553.215 - Ambulance and rescue service employees.

    Science.gov (United States)

    2010-07-01

    ... employees have received training in the rescue of fire, crime, and accident victims or firefighters or law... REGULATIONS APPLICATION OF THE FAIR LABOR STANDARDS ACT TO EMPLOYEES OF STATE AND LOCAL GOVERNMENTS Fire... rescue service employees. (a) Ambulance and rescue service employees of a public agency other than a...

  14. Is the Ability to Ambulate Associated with Better Employment Outcomes in Participants with Traumatic Spinal Cord Injury?

    Science.gov (United States)

    Krause, James S.

    2010-01-01

    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…

  15. Mobile-Based Medical Emergency Ambulance Scheduling System

    Directory of Open Access Journals (Sweden)

    Bassey Isong

    2016-11-01

    Full Text Available Effective and efficient public service delivery like healthcare services are very important in today's society, especially in the rural areas. People in rural areas are expected to have access to public facilities at all times. However, these services are not always available when they are needed. This paper discusses the problems faced by rural areas of Mafikeng in South Africa (SA when public and basic healthcare facilities like medical ambulance transports are needed during emergency situation. The challenges ranges from poor communication, poor road network and unstructured address to non-arrival of ambulances leading loss of lives that are preventable. This paper designed and implemented a system prototype using mobile application technologies to offer cost-effective services to patients during emergencies. It is intended to reduce long queues in hospitals and long waiting periods for an ambulance via location-based services. By using this application, lives in the rural areas can be made easier and loss of lives prevented by providing timely response from the appropriate healthcare providers during emergencies.

  16. Approach to decreasing emergency department ambulance diversion hours.

    Science.gov (United States)

    Vilke, Gary M; Brown, Lana; Skogland, Patty; Simmons, Charles; Guss, David A

    2004-02-01

    Analysis between two local Emergency Departments (EDs) suggested an oscillatory phenomenon for ambulance diversion: When one hospital went on diversion it led to a disproportionate flow of ambulance traffic to a neighboring facility that subsequently was forced to go on divert. We hypothesized if one hospital could avoid diversion status, the need for diversion could be averted in the neighboring facility. ED A secured additional resources and made a commitment to no diversion for 1 week. No changes in operations occurred in hospital B. We found no differences in ambulance runs or ED census at either facility comparing the week before, during, and after the trial. There was a dramatic decline in diversion hours from 19.7 to 1.4 and 27.7 to 0 at hospitals A and B, respectively, during the trial period (p < 0.05) compared to the weeks before and after. We conclude that reciprocating effects can be decreased with one institution's commitment to avoid diversion, thus decreasing the need for diversion at a neighboring facility.

  17. The Barbados Emergency Ambulance Service: High Frequency of Nontransported Calls

    Directory of Open Access Journals (Sweden)

    Sherwin E. Phillips

    2012-01-01

    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.

  18. Clinical characteristics affecting motor recovery and ambulation in stroke patients

    Science.gov (United States)

    Yetisgin, Alparslan

    2017-01-01

    [Purpose] To describe the clinical characteristics affecting motor recovery and ambulation in stroke patients. [Subjects and Methods] Demographic and clinical characteristics of 53 stroke patients (31 M, 22 F), such as age, gender, etiology, hemiplegic side, Brunnstrom stage, functional ambulation scale scores, history of rehabilitation, and presence of shoulder pain and complex regional pain syndrome were evaluated. [Results] The etiology was ischemic in 79.2% of patients and hemorrhagic in 20.8%. Brunnstrom hand and upper extremity values in females were lower than in males. Complex regional pain syndrome was observed at a level of 18.9% in all patients (more common in females). Brunnstrom hand stage was lower in complex regional pain syndrome patients than in those without the syndrome. Shoulder pain was present in 44.4% of patients. Brunnstrom lower extremity values and functional ambulation scale scores were higher in rehabilitated than in non-rehabilitated cases. [Conclusion] Brunnstrom stages of hand and upper extremity were lower and complex regional pain syndrome was more common in female stroke patients. Shoulder pain and lower Brunnstrom hand stages were related to the presence of complex regional pain syndrome. PMID:28265142

  19. Perioperative transfusion threshold and ambulation after hip revision surgery

    DEFF Research Database (Denmark)

    Nielsen, Kamilla; Johansson, Pär I; Dahl, Benny;

    2014-01-01

    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...... 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....

  20. An exploration of factors influencing ambulance and emergency nurses protocol adherence in the Netherlands

    NARCIS (Netherlands)

    Ebben, Remco; Vloet, Lilian; Mintjes, Joke; Achterberg, Theo van

    2012-01-01

    Adherence to ambulance and ED protocols is often suboptimal. Insight into factors influencing adherence is a requisite for improvement of adherence. This study aims to gain an in-depth understanding of factors that influence ambulance and emergency nurses’ adherence to protocols.

  1. 75 FR 62639 - Air Ambulance and Commercial Helicopter Operations, Part 91 Helicopter Operations, and Part 135...

    Science.gov (United States)

    2010-10-12

    ...--Nautical mile NTSB--National Transportation Safety Board NVG--Night vision goggles NVIS--Night-vision... ambulances have varying situational- awareness technology (such as night vision goggles, HTAWS, radio... during night conditions as four common factors in helicopter air ambulance accidents. A review...

  2. Prognostic Predictors for Ambulation in Thai Children With Cerebral Palsy Aged 2 to 18 Years.

    Science.gov (United States)

    Keeratisiroj, Orawan; Thawinchai, Nuanlaor; Siritaratiwat, Wantana; Buntragulpoontawee, Montana

    2015-11-01

    The objectives of this study were to determine prognostic predictors for ambulation among Thai children with cerebral palsy and identify their ambulatory status. A retrospective cohort study was performed at 6 special schools or hospitals for children with physical disabilities. The prognostic predictors for ambulation were analyzed by multivariable ordinal continuation ratio logistic regression. The 533 participants aged 2 to 18 years were divided into 3 groups: 186 with independent ambulation (Gross Motor Function Classification System [GMFCS I-II]), 71 with assisted ambulation (Gross Motor Function Classification System III), and 276 with nonambulation (Gross Motor Function Classification System IV-V). The significant positive predictors for ambulation were type of cerebral palsy (spastic diplegia, spastic hemiplegia, dyskinesia, ataxia, hypotonia, and mixed type), sitting independently at age 2 years, and eating independently. These predictors were used to develop clinical scoring for predicting the future ability to walk among Thai children with cerebral palsy.

  3. Stylistic analysis of the poem "Ambulance" by Philip Larkin

    Directory of Open Access Journals (Sweden)

    Muhammad Yasir Khan

    2016-09-01

    Full Text Available Philip Larkin is known as a movement poet, because there are many poems which were published in the book of poetic movement, New Lines. This movement was started in 1950, against the unreasonable, inflated and extortionate romanticism of 1930's and 1940's. The common features of movement poetry are; the use of irony and wit, an element of satire, the loneliness of modern man, pessimistic outlook on life, realism, use of ordinary diction, use of symbols, and loss of religious faith. Robert Conquest is known as the representative poet of this movement. The poets of this movement believed that the language of poetry should be simple, lucid and intelligible. The poem Ambulance deals with the important features of movement poetry. Through the stylistics study of this poem the researchers will show the loneliness and concept of death in modern man.

  4. How public ambulance arrivals impact on Emergency Department workload and resource use

    Directory of Open Access Journals (Sweden)

    Enrico Ferri

    2010-03-01

    Full Text Available Objectives: To examine patient’s characteristics associated with ED arrival mode, and to determine EMS impact on ED clinical resource use, workload and crowding. Methods: This is a retrospective study of patients seen at Sant’Andrea Hospital ED. Comparison focused on visit characteristics, and on resource use. Results: The use of EMS ambulance confirms association to older age, higher rate of hospital admission, longer length of stay, and severity of injury. Moreover our data show that ambulance referred patients are triaged into a higher acuity category and have a greater intensive care unit admission. Conclusion: Ambulance arrivals have a significant impact on ED resource use, workload and crowding.

  5. Occupant accelerations and injury potential during an ambulance-to-curb impact.

    Science.gov (United States)

    Lee, Ellen L; Hayes, Wilson C

    2014-04-01

    This paper presents real world acceleration data for an ambulance driving up and over a curb. A full scale reenactment was performed for a litigated case in which a patient on a gurney in an ambulance claimed a variety of bodily injuries after the ambulance struck a curb. A height and weight matched surrogate rode on the gurney during the tests. Results demonstrated that peak vehicle and occupant accelerations never exceeded 1.1g's. To address the claimed injuries, the accelerations likely sustained by the patient were compared to those experienced during daily life. Since ambulances are wide vehicles that travel fast on potentially narrow arterial, collector or local roadways, curb or median impacts may occur during the normal course of driving. Thus, these results may be useful for forensic experts in dealing with similar cases involving claimed injuries following curb impacts.

  6. [Design of a mechanical system for the balanceable system of ambulance].

    Science.gov (United States)

    Zheng, Yi; Luo, Yibin; Zhang, Guangpeng; Zhang, Zhide; Chen, Chaomin

    2010-08-01

    This is the design of a mechanical systems for use in the balanceable system of ambulance, which can keep the medical service bed at the ambulance level, whatever the terrain is. A level detector will detect the level state of the bed and turn it to a signal. The central processing unit will use this signal to analyse and control the movement of the motor. By this design (which uses the rolling rail as a drive transmission and makes three supports of the bed go up and down), the bed will keep level. With the use of this design, the balanceable system of ambulance can counteract 35 degrees. The error is controlled within +/- 1 degree. And the response time is within 0.3 s. The method of registration can be effective for keeping the bed at the ambulance level, and for reducing the chance of making the patient get hurt on the way to hospital.

  7. The Fire Brigade acquires a new ambulance with all the bells and whistles!

    CERN Multimedia

    Anaïs Schaeffer

    2012-01-01

    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...

  8. Improving community ambulation after hip fracture: protocol for a randomised, controlled trial

    Directory of Open Access Journals (Sweden)

    D Orwig

    2017-01-01

    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.

  9. Demand Forecast Using Data Analytics for the Preallocation of Ambulances.

    Science.gov (United States)

    Chen, Albert Y; Lu, Tsung-Yu; Ma, Matthew Huei-Ming; Sun, Wei-Zen

    2016-07-01

    The objective of prehospital emergency medical services (EMSs) is to have a short response time. By increasing the operational efficiency, the survival rate of patients could potentially be increased. The geographic information system (GIS) is introduced in this study to manage and visualize the spatial distribution of demand data and forecasting results. A flexible model is implemented in GIS, through which training data are prepared with user-desired sizes for the spatial grid and discretized temporal steps. We applied moving average, artificial neural network, sinusoidal regression, and support vector regression for the forecasting of prehospital emergency medical demand. The results from these approaches, as a reference, could be used for the preallocation of ambulances. A case study is conducted for the EMS in New Taipei City, where prehospital EMS data have been collected for three years. The model selection process has chosen different models with different input features for the forecast of different areas. The best daily mean absolute percentage error during testing of the EMS demand forecast is 23.01%, which is a reasonable forecast based on Lewis' definition. With the acceptable prediction performance, the proposed approach has its potential to be applied to the current practice.

  10. Weather factors in the short-term forecasting of daily ambulance calls.

    Science.gov (United States)

    Wong, Ho-Ting; Lai, Poh-Chin

    2014-07-01

    The daily ambulance demand for Hong Kong is rising, and it has been shown that weather factors (temperature and humidity) play a role in the demand for ambulance services. This study aimed at developing short-term forecasting models of daily ambulance calls using the 7-day weather forecast data as predictors. We employed the autoregressive integrated moving average (ARIMA) method to analyze over 1.3 million cases of emergency attendance in May 2006 through April 2009 and the 7-day weather forecast data for the same period. Our results showed that the ARIMA model could offer reasonably accurate forecasts of daily ambulance calls at 1-7 days ahead of time and with improved accuracy by including weather factors. Specifically, the inclusion of average temperature alone in our ARIMA model improved the predictability of the 1-day forecast when compared to that of a simple ARIMA model (8.8% decrease in the root mean square error, RMSE=53 vs 58). The improvement in the 7-day forecast with average temperature as a predictor was more pronounced, with a 10% drop in prediction error (RMSE=62 vs 69). These findings suggested that weather forecast data can improve the 1- to 7-day forecasts of daily ambulance demand. As weather forecast data are readily accessible from Hong Kong Observatory's official website, there is virtually no cost to including them in the ARIMA models, which yield better prediction for forward planning and deployment of ambulance manpower.

  11. Health problems and help-seeking in a nationwide sample of operational Norwegian ambulance personnel

    Directory of Open Access Journals (Sweden)

    Ekeberg Øivind

    2008-01-01

    Full Text Available Abstract Background To estimate the prevalence of anxiety and depression symptoms, and their association with professional help-seeking, among operational ambulance personnel and a general working population, and to study the symptoms of musculoskeletal pain and disturbed sleep among ambulance personnel. Methods The results of a comprehensive nationwide questionnaire survey of operational ambulance personnel (n = 1180 were compared with the findings of a population-based Norwegian health study of working people (n = 31,987. The questionnaire included measures of help-seeking, the Hospital Anxiety and Depression Scale, the Subjective Health Complaints Questionnaire, the Karolinska Sleep Questionnaire and the Need for Recovery after Work Scale. Results Compared with those in the reference population, the mean of level anxiety symptoms in the ambulance sample was lower for men (3.5 vs. 3.9, P 0.001 and women (4.0 vs. 4.4, P 0.05, and the mean level of depression symptoms in ambulance workers was lower for men (2.3 vs. 2.8, P 0.05 but not for women (2.9 vs. 3.1, P = 0.22. A model adjusted for anxiety and depression symptoms indicated that ambulance personnel had lower levels of help-seeking except for seeing a chiropractor (12% vs. 5%, P 0.01. In the ambulance sample, symptoms of musculoskeletal pain were most consistently associated with help-seeking. In the adjusted model, only symptoms of disturbed sleep were associated with help-seeking from a psychologist/psychiatrist (total sample = 2.3%. Help-seeking was more often reported by women but was largely unaffected by age. Conclusion The assumption that ambulance personnel have more anxiety and depression symptoms than the general working population was not supported. The level of musculoskeletal pain and, accordingly, the level of help-seeking from a chiropractor were higher for ambulance workers. More research should address the physical strains among ambulance personnel.

  12. Ambulation following spinal cord injury and its correlates

    Directory of Open Access Journals (Sweden)

    Nitin Menon

    2015-01-01

    Full Text Available Objectives: To assess walking ability of spinal cord injury (SCI patients and observe its correlation with functional and neurological outcomes. Patients and Methods: The present prospective, observational study was conducted in a tertiary research hospital in India with 66 patients (46 males between January 2012 and December 2013. Mean age was 32.62 ± 11.85 years (range 16-65 years, mean duration of injury was 85.3 ± 97.6 days (range 14-365 days and mean length of stay in the rehabilitation unit was 38.08 ± 21.66 days (range 14-97 days in the study. Walking Index for spinal cord injury (WISCI II was used to assess ambulation of the SCI patients. Functional recovery was assessed using Barthel Index (BI and Spinal Cord Independence Measures (SCIM. Neurological recovery was assessed using ASIA impairment scale (AIS. We tried to correlate ambulatory ability of the patients with functional and neurological recovery. Results: Ambulatory ability of the patients improved significantly using WISCI II (P < 0.001 when admission and discharge scores were compared (1.4 ± 3.5 vs 7.6 ± 6.03. Similarly, functional (BI: 31.7 ± 20.5 vs 58.4 ± 23.7 and SCIM: 29.9 ± 15.1 vs 56.2 ± 20.6 and neurological recovery were found to be very significant (P < 0.001 when admission vs discharge scores were compared. Improvement in WISCI II scores was significantly correlated with improvement in neurological (using AIS scores and functional status (using BI and SCIM scores (P < 0.001. Conclusions: Significant improvement was seen in WISCI II, BI, and SCIM scores after in-patient rehabilitation. Improvement in WISCI II scores also significantly correlated with functional and neurological recovery.

  13. Ontogeny of sex differences in open-field ambulation in the rat.

    Science.gov (United States)

    Slob, A K; Huizer, T; Van der Werff ten Bosch, J J

    1986-01-01

    The effects of age and gonads were studied in rats subjected to open-field tests, during which ambulation behavior was recorded. Subjects were three groups of male and female rats: sham-operation on day 1 and day 21; gonadectomy on day 1 and sham-operation on day 21; and sham-operation on day 1 and gonadectomy on day 21. Half of each group were tested in a circular open field (3 min/day, 3 consecutive days) on days 28-30; the others were tested on days 47-49. Representatives of both batches were tested again in a square open field on days 76-78. There was a sex difference in ambulation at 77 days, but not at earlier ages. In animals gonadectomized on day 1 or day 21 the sex difference in adulthood failed to occur, because castration caused the males to ambulate as much as sham-operated and ovariectomized females. On the basis of our results and reports in the literature it is suggested that testicular secretions around puberty have an organizing effect on ambulation behavior. The intact adult male rat ambulates less than the adult female and this difference persists after castration in adulthood. Castration well before puberty prevents the development of the adult sex difference.

  14. Variation in ambulance call rates for care homes in Torbay, UK.

    Science.gov (United States)

    Hancock, Jason; Matthews, Justin; Ukoumunne, Obioha C; Lang, Iain; Somerfield, David; Wenman, James; Dickens, Chris

    2016-08-31

    Emergency ambulance calls represent one of the routes of emergency hospital admissions from care homes. We aimed to describe the pattern of ambulance call rates from care homes and identify factors predicting those homes calling for an ambulance most frequently. We obtained data from South Western Ambulance Service NHS Foundation Trust on 3138 ambulance calls relating to people aged 65 and over from care homes in the Torbay region between 1 April 2012 and 31 July 2013. We supplemented this with data from the Care Quality Commission (CQC) website on home characteristics and outcomes of CQC inspections. We used descriptive statistics to identify variation in ambulance call rates for residential and nursing homes and fitted negative binomial regression models to determine if call rates were predicted by home type (nursing versus residential), the five standards in the CQC reports, dementia care status or travel time to hospital. One hundred and forty-six homes (119 residential and 27 nursing) were included in the analysis. The number of calls made ranged from 1 to 99. The median number (IQR; range) of calls per resident per year was 0.51 (0.21-0.89; 0.03-2.45). Nursing homes had a lower call rate than residential homes [adjusted rate ratio (ARR) 0.29; 95% CI: 0.22-0.40; P call rate compared to those who passed (ARR 0.67; 95% CI: 0.50-0.90; P = 0.006); and homes specialising in dementia had a higher call rate compared to those not specialising (ARR 1.56; 95% CI: 1.23-1.96; P call rate variability reflects the different needs of resident populations or differences in care home policies and practice.

  15. Suicidal ideation and suicide attempts in a nationwide sample of operational Norwegian ambulance personnel.

    Science.gov (United States)

    Sterud, Tom; Hem, Erlend; Lau, Bjørn; Ekeberg, Oivind

    2008-01-01

    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.

  16. Mission impossible or border security – Practical and effective infection control on air ambulances

    Directory of Open Access Journals (Sweden)

    M. Kuhn*

    2013-12-01

    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.

  17. Impact of subtropical climate on frequency of ambulance use for trauma patients in a coastal area of China

    Institute of Scientific and Technical Information of China (English)

    Yuqiang Chen; Yucheng Lai; Jiajie Ke; Yuefeng Chen; Yuling Xu; Yuqin Ma; Jiayin Yuan

    2015-01-01

    Purpose:To explore the impact of subtropical maritime monsoon climate on the frequency of ambulance use for trauma patients in a coastal region in China.Method:Statistical analysis of data on ambulance use from the 120 Emergency Command Center in Shantou City,Guangdong Province,from January to December 2012 as well as daily meteorological data from a Shantou observatory was performed to determine how climatic factors (seasons,time,and weather) affect the frequency of ambulance use for trauma patients.Results:The daily ambulance use for trauma patients differed between spring and summer or autumn (p < 0.05),between sunny and rainy days (p < 0.05),and between cloudy and lightly or moderately rainy days (p < 0.05).We found a linear correlation between daily maximum temperature and daily ambulance use for trauma patients (R2 =0.103,p < 0.05).In addition,there was significant difference in ambulance use between good and bad weather (p < 0.05).Conclusion:Frequency of ambulance use for trauma patients is affected by the subtropical maritime monsoon climate in the coastal region.Better weather contributes to increased daily frequency of ambulance use,which is the highest in autumn and lowest in spring.

  18. Ambulation with the reciprocating-gait orthosis - Experience in 15 children with myelomeningocele or paraplegia

    NARCIS (Netherlands)

    GerritsmaBleeker, CLE; Heeg, M; VosNiel, H

    1997-01-01

    We reviewed 15 children with spina bifida or paraplegia who have used a reciprocating-gait orthosis between 1985 and 1995. All were nonfunctional ambulators. The level of the spinal lesions ranged from Th10 to L3. The mean age of fitting the orthosis was 5 years. 8 children have stopped using it at

  19. Community ambulation in patients with chronic stroke : How is it related to gait speed?

    NARCIS (Netherlands)

    van de Port, Ingrid G.; Kwakkel, Gert; Lindeman, Eline

    2008-01-01

    Objective: To explore the strength of the association between gait speed and community ambulation and whether this association is significantly distorted by other variables. Design: Cross-sectional study conducted 3 years after stroke. Subjects: A total of 102 patients after first-ever stroke follow

  20. Spinal fusion in children with spina bifida : influence on ambulation level and functional abilities

    NARCIS (Netherlands)

    Schoenmakers, MAGC; Gulmans, VAM; Gooskens, RHJM; Pruijs, JEH; Helders, PJM

    2005-01-01

    The aim of this study was to determine the influence of spinal fusion on ambulation and functional abilities in children with spina bifida for whom early mobilization was stimulated. Ten children (three males and seven females) with myelomeningocele were prospectively followed. Their mean age at ope

  1. Osteogenesis imperfecta in childhood : effects of spondylodesis on functional ability, ambulation and perceived competence

    NARCIS (Netherlands)

    Tolboom, N; Cats, EA; Helders, PJM; Pruijs, JEH; Engelbert, RHH

    2004-01-01

    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 c

  2. A strategic approach for the ambulance covering of the province of Friesland

    NARCIS (Netherlands)

    Schreuder, J.A.M.; Macfarlane, J.D.

    1998-01-01

    In the summer of 1995 the University of Twente, commissioned by the Province of Friesland, carried out research into the consequences of alternative locations for ambulances. The approach to this research was based on a network model, which represents the area to be covered. With this model the atte

  3. Radiology trainer. Surgical ambulance. 2. rev. and enl. ed.; Roentgen-Trainer. Chirurgische Ambulanz

    Energy Technology Data Exchange (ETDEWEB)

    Ackermann, Ole [Wedau-Kliniken Duisburg (Germany). Klinik fuer Unfallchirurgie; Ruchholtz, Steffen [Universitaetsklinikum Giessen und Marburg GmbH, Marburg (Germany). Klinik fuer Unfall-, Hand- und Wiederherstellungschirurgie; Siemann, Holger [LVR Klinikum Essen (Germany); Barkhausen, Joerg [Universitaetsklinikum Schleswig-Holstein, Luebeck (Germany). Klinik fuer Radiologie und Nuklearmedizin

    2013-08-01

    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.

  4. Design and methods of European Ambulance Acute Coronary Syndrome Angiography Trial (EUROMAX)

    DEFF Research Database (Denmark)

    Steg, Philippe Gabriel; van 't Hof, Arnoud; Clemmensen, Peter;

    2013-01-01

    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...

  5. A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study

    NARCIS (Netherlands)

    Middendorp, J.J. van; Hosman, A.J.F.; Donders, A.R.T.; Pouw, M.H.; Ditunno Jr., J.F.; Curt, A.; Geurts, A.C.H.; Meent, H. van de

    2011-01-01

    BACKGROUND: Traumatic spinal cord injury is a serious disorder in which early prediction of ambulation is important to counsel patients and to plan rehabilitation. We developed a reliable, validated prediction rule to assess a patient's chances of walking independently after such injury. METHODS: We

  6. Cross-cultural validation of the Italian version of the Cumulated Ambulation Score

    DEFF Research Database (Denmark)

    Grana, Elisa; Verzellotti, Simone; Grassi, Federico A;

    2016-01-01

    Hip fractures are common in elderly patients, and walking impairment is a frequent complication. The Cumulated Ambulation Score (CAS) is a validated functional scale used to monitor easily three basic mobility activities in patients with hip fracture. The aim of this study was to translate, cross...

  7. Knee disarticulation : Survival, wound healing and ambulation. A historic cohort study

    NARCIS (Netherlands)

    Ten Duis, K.; Bosmans, J. C.; Voesten, H. G. J.; Geertzen, J. H. B.; Dijkstra, P. U.

    2009-01-01

    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, re-ampu

  8. Self-paced brain-computer interface control of ambulation in a virtual reality environment

    Science.gov (United States)

    Wang, Po T.; King, Christine E.; Chui, Luis A.; Do, An H.; Nenadic, Zoran

    2012-10-01

    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 ambulation after only 10 minutes training. The ability to achieve such BCI control with minimal training indicates that the implementation of future BCI-lower extremity prosthesis systems may be feasible.

  9. Basic life support and automated external defibrillator skills among ambulance personnel: a manikin study performed in a rural low-volume ambulance setting

    Directory of Open Access Journals (Sweden)

    Nielsen Anne

    2012-05-01

    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.

  10. Prosthetic ambulation in a paraplegic patient with a transfemoral amputation and radial nerve palsy.

    Science.gov (United States)

    Shin, J C; Park, C; Kim, D Y; Choi, Y S; Kim, Y K; Seong, Y J

    2000-08-01

    Great importance and caution should be placed on prosthetic fitting for a paraplegic patient with an anesthetic residual limb if functional ambulation is to be achieved. The combination of paraplegia with a transfemoral amputation and radial nerve palsy is a complex injury that makes the rehabilitation process difficult. This article describes a case of L2 paraplegia with a transfemoral amputation and radial nerve palsy on the right side. Following the rehabilitation course, the patient independently walked using a walker at indoor level with a transfemoral prosthesis with ischial containment socket, polycentric knee assembly, endoskeletal shank and multiaxis foot assembly and a knee ankle foot orthosis on the sound side. The difficulties of fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed.

  11. Contributing factors and issues associated with rural ambulance crashes: literature review and annotated bibliography.

    Science.gov (United States)

    Sanddal, Nels D; Albert, Steve; Hansen, Joseph D; Kupas, Douglas F

    2008-01-01

    Ambulance crashes occur with greater frequency and severity than crashes involving vehicles of similar size and weight characteristics. Crashes in rural areas tend to be more severe in terms of injury or death to vehicle occupants. The purpose of this article was to examine the extant literature, as well as summarize and discuss the overlapping findings of that body of literature. A stepwise literature search was conducted using the following MeSH search terms ambulance; accident, traffic; emergency medical technician; occupational health; and rural in descending combination. MEDLINE was used as the primary database but was augmented by searches of Academic Search Premier, Comprehensive Index of Nursing, Allied Health Literature, and ProQuest Dissertation International. The search resulted in 32 article citations, and of these, 28 were included. An annotated bibliography is followed by a discussion and conclusion that identify opportunities for prevention activities in the areas of education, enforcement, and engineering.

  12. Pre-Hospital Fast Positive Cases Identified by DFB Ambulance Paramedics – Final Clinical Diagnosis

    LENUS (Irish Health Repository)

    Feeney, A

    2016-04-01

    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

  13. Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kehlet, Henrik

    2006-01-01

    to short-term outcome parameters. RESULTS: The cumulated ambulation score was a highly significant predictor for length of hospitalization, time to discharge status, 30-day mortality and postoperative medical complications (P ...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...... 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...

  14. 10-year experience of CO2-laser application in ambulance gynecology

    Science.gov (United States)

    Stachanov, Michael L.; Masychev, Victor I.; Velsher, Leonid Z.; Kirkin, Vladimir V.; Zhashkov, Roman V.; Kocharian, Emilia A.

    2000-10-01

    CO2-laser surgical systems have come to stay in everyday practice of modern physicians and are successfully used in colposcopic and laparoscopic surgery. Results, obtained in ambulance gynecology are especially impressing. CO2- laser provides high medical- and cost-effective treatment. Presented work describes many-years experience of CO2- laser application. 439 patients with various vulvaric and cervix diseases were operated within this period. Laser beam parameters were selected according to requirements ((tau) =4 J/cm2) treatment without carbonization. Analyses of the results showed that the laser successfully destructs uterine cervix erosion, endocervicosis, dysplasia, leukoplakia, eritoplakia of uterine cervix, various benignant pathologies and focus degenerative process in ambulate conditions.

  15. The role of physician-staffed ambulances:the outcome of a pilot study

    Institute of Scientific and Technical Information of China (English)

    A Haner; P rninge; A Khorram-Manesh

    2015-01-01

    Objective:To evaluate the outcome of physician-staffed ambulances in a pilot study. Methods:All physician-staffed ambulance missions conducted in Gothenburg, Sweden, in 2013 were retrospectively reviewed and evaluated for the type of missions and the need of a physician. Results:Out of 1 381 physician-staffed missions, 511 were cancelled or managed by telephone. Around 239 (17%) missions required active intervention, of which only one was considered directly life-saving. Conclusions: Most of the missions neither required the interventional skills of a physician, nor could they be performed at distance. However, the added medical value of physicians was found to be in other prehospital situations, such as critical decision-making, staff education and research.

  16. Neurotherapeutic and neuroprosthetic effects of implanted functional electrical stimulation for ambulation after incomplete spinal cord injury.

    Science.gov (United States)

    Bailey, Stephanie Nogan; Hardin, Elizabeth C; Kobetic, Rudi; Boggs, Lisa M; Pinault, Gilles; Triolo, Ronald J

    2010-01-01

    The purpose of this single-subject study was to determine the neurotherapeutic and neuroprosthetic effects of an implanted functional electrical stimulation (FES) system designed to facilitate walking in an individual with a longstanding motor and sensory incomplete spinal cord injury. An implanted pulse generator and eight intramuscular stimulating electrodes were installed unilaterally, activating weak or paralyzed hip flexors, hip and knee extensors, and ankle dorsiflexors during 36 sessions of gait training with FES. The neurotherapeutic effects were assessed by a comparison of pre- and posttraining volitional walking. The neuroprosthetic effects were assessed by a comparison of posttraining volitional and FES-assisted walking. Treatment resulted in significant (p ambulation to limited community ambulation. Additionally, the subject could perform multiple walks per day when using FES-assisted gait, which was impossible with volitional effort alone.

  17. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty

    DEFF Research Database (Denmark)

    Jenstrup, M T; Jæger, P; Lund, J;

    2012-01-01

    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...... 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....

  18. Ambulance emergency services for patients with coronary heart disease in Lancashire: achieving standards and improving performance

    OpenAIRE

    Stoykova, B; Dowie, R; Bastow, P; Rowsell, K; GREGORY, R.

    2004-01-01

    Methods: Audit datasets on two cohorts of patients with chest pain and suspected AMI were assembled by the Lancashire Ambulance Service NHS Trust in north west England: 3706 patients during 1996/97 and 3423 in 2001. They were transported to four hospitals. The analyses covered journey timings, role of rapid response vehicles (RRV), and clinical procedures and the results were compared with prevailing national standards.

  19. Relation Between Objectively Measured Growth Determinants and Ambulation in Children with Cerebral Palsy

    OpenAIRE

    GÖKKAYA, N. Kutay ORDU; ÇALIŞKAN, Aslı; KARAKUŞ, Dilek; Uçan, Halil

    2009-01-01

    Aims: Cerebral palsy (CP) is a well-known neurodevelopmental condition beginning in early childhood and persisting throughout one´s life span. Feeding problems and eating impairments in CP children are well documented in the literature. The aims of our study were to determine the prevalence of linear growth retardation and the other growth determinants in this patient group and to identify the contributing factors and their relationship with ambulation. Materials and Methods: A cross-section...

  20. Emergency ambulance assistance in The Netherlands: is the Dutch situation optimal?

    Science.gov (United States)

    van Vugt, A B; van Olden, G D; Edwards, M J

    1995-12-01

    The system of prehospital trauma care in the Netherlands is the subject of great concern. Although many improvements have been achieved in the last decade, there are still some deficits. Legislation concerning the minimal level of education for ambulance attendants was recently upgraded to 'registered nurse', a standard which must be achieved by 1997. Standardization with regard to extrication techniques, equipment and methods of treatment in prehospital trauma care does not yet exist. Although aware of the fact that large regional differences exist throughout the USA, a system of care in accordance with the advanced trauma life support (ATLS) standard of the American College of Surgeons (ACS) and by means of prehospital and advanced trauma life support (PHTLS) given according to the standards of the National Association of Emergency Medical Technicians (NAEMS) was considered to be the 'golden standard'. Nineteen ground ambulance and two helicopter services in different states of the USA, working according to ACS/NAEMS standard, were visited to analyse the system of care, with special reference to (para)medical education, communication, logistics, and immobilization materials and techniques. In the Netherlands all 41 central post ambulance services (CPAs) were asked to return a questionnaire. This resulted in a 90% (37 out of 41) response. The deficits of the Dutch system of care related to the PHTLS/ATLS standard are pointed out, resulting in recommendations to improve the Dutch system. The requirements of the dispatcher are far inferior to the optimal situation, which, together with the lack of technical equipment, results in serious communication problems. The Dutch ambulance attendant education, in which in the present system the education level reaches 'registered nurse' in only 91% and specialized courses are not mandatory, should be upgraded to the PHTLS level of care.

  1. Design and validation of a platform robot for determination of ankle impedance during ambulation.

    Science.gov (United States)

    Rouse, Elliott J; Hargrove, Levi J; Peshkin, Michael A; Kuiken, Todd A

    2011-01-01

    In order to provide natural, biomimetic control to recently developed powered ankle prostheses, we must characterize the impedance of the ankle during ambulation tasks. To this end, a platform robot was developed that can apply an angular perturbation to the ankle during ambulation and simultaneously acquire ground reaction force data. In this study, we detail the design of the platform robot and characterize the impedance of the ankle during quiet standing. Subjects were perturbed by a 3° dorsiflexive ramp perturbation with a length of 150 ms. The impedance was defined parametrically, using a second order model to map joint angle to the torque response. The torque was determined using the inverted pendulum assumption, and impedance was identified by the least squares best estimate, yielding an average damping coefficient of 0.03 ± 0.01 Nms/° and an average stiffness coefficient of 3.1 ± 1.2 Nm/°. The estimates obtained by the proposed platform robot compare favorably to those published in the literature. Future work will investigate the impedance of the ankle during ambulation for powered prosthesis controller development.

  2. Manager-employee interaction in ambulance services: an exploratory study of employee perspectives on management communication.

    Science.gov (United States)

    Nordby, Halvor

    2015-01-01

    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.

  3. Feasibility, Reliability and Predictive Value Of In-Ambulance Heart Rate Variability Registration.

    Directory of Open Access Journals (Sweden)

    Laetitia Yperzeele

    Full Text Available 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.We aim to investigate the feasibility and the reliability of in-ambulance HRV registration during emergency interventions, and to evaluate the association between prehospital HRV parameters, patient characteristics, vital parameters and short-term outcome.We conducted a prospective study using a non-invasive 2-lead ECG registration device in 55 patients transported by the paramedic intervention team of the Universitair Ziekenhuis Brussel. HRV assessment included time domain parameters, frequency domain parameters, nonlinear analysis, and time-frequency analysis. The correlation between HRV parameters and patient and outcome characteristics was analyzed and compared to controls.Artifact and ectopic detection rates were higher in patients during ambulance transportation compared to controls in resting conditions, yet technical reasons precluding in-ambulance HRV analysis occurred in only 9.6% of cases. HRV acquisition was possible without safety issues or interference with routine emergency care. Reliability of the results was considered sufficient for Sample entropy (SampEn, good for the ratio of low frequency and high frequency components (LF/HF ratio in the frequency and the time frequency domain, and excellent for the triangular interpolation of the NN interval histogram (TINN, and for the short-term scaling exponent of the detrended fluctuation analysis (DFA α1. HRV indices were significantly reduced inpatients with unfavorable outcome compared to patients with favorable outcome and controls. Multivariate analysis identified lower DFA α1 as an independent predictor of unfavorable outcome (OR, 0.155; 95% CI 0.024-0.966; p = 0.049.In-ambulance HRV registration is technically and operationally feasible and produces reliable results for parameters

  4. Bed rest versus early ambulation with standard anticoagulation in the management of deep vein thrombosis: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Zhenlei Liu

    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.

  5. Daily variations in ambulance calls for selected causes in Arkhangelsk, Russia: potential role of excessive alcohol consumption on weekends

    Directory of Open Access Journals (Sweden)

    Sergei N. Drachev

    2012-11-01

    Full Text Available Objectives. To assess daily variations in ambulance calls for cardiovascular diseases (CVDs, mental and behavioral disorders, and external causes in Arkhangelsk, Northwest Russia, in 2000–2008. Study design. A population-based study. Methods. Data about all ambulance calls during the years 2000–2008 were obtained from the Arkhangelsk ambulance station. Information about patient's gender, age, doctor's diagnosis according to International Classification of Diseases, 10th revision, and the date of call were recorded. Pearson's Chi-squared tests were used for comparing proportions of ambulance calls across the week for CVDs (I00-99, mental and behavioral disorders (F00-F99, and external causes (S00-T98, V01-Y98. The ratio of incidence of ambulance calls on Saturday, Sunday, and Monday versus the rest of week was also calculated. Results. There is a significant daily variation (p < 0.001 in calls for CVDs in men and women aged 18–59 and women aged 60 years and older, with increased numbers of calls on weekends and Mondays varying between 2 and 3% excess calls. For mental and behavioral disorders, a similar pattern was found in the age group of 18–59 year-olds. Ratios for the number of calls during weekends and Mondays vs. the rest of the week were 1.05 (95% CI: 1.02–1.08 among women and 1.02 (95% CI: 1.00–1.05 among men. For external causes, a significant variation and an increase in ambulance calls during Saturdays, Sundays, and Mondays from 4 to 17% excess calls was observed for both age and gender groups. Conclusions. The observed daily variations in ambulance calls with an increased number of calls on weekends and Mondays for CVDs, mental and behavioral disorders, and external causes may be associated with excessive alcohol consumption on the weekends. Further research using data on individual levels of alcohol consumption are warranted.

  6. Configuring a powered knee and ankle prosthesis for transfemoral amputees within five specific ambulation modes.

    Directory of Open Access Journals (Sweden)

    Ann M Simon

    Full Text Available Lower limb prostheses that can generate net positive mechanical work may restore more ambulation modes to amputees. However, configuration of these devices imposes an additional burden on clinicians relative to conventional prostheses; devices for transfemoral amputees that require configuration of both a knee and an ankle joint are especially challenging. In this paper, we present an approach to configuring such powered devices. We developed modified intrinsic control strategies--which mimic the behavior of biological joints, depend on instantaneous loads within the prosthesis, or set impedance based on values from previous states, as well as a set of starting configuration parameters. We developed tables that include a list of desired clinical gait kinematics and the parameter modifications necessary to alter them. Our approach was implemented for a powered knee and ankle prosthesis in five ambulation modes (level-ground walking, ramp ascent/descent, and stair ascent/descent. The strategies and set of starting configuration parameters were developed using data from three individuals with unilateral transfemoral amputations who had previous experience using the device; this approach was then tested on three novice unilateral transfemoral amputees. Only 17% of the total number of parameters (i.e., 24 of the 140 had to be independently adjusted for each novice user to achieve all five ambulation modes and the initial accommodation period (i.e., time to configure the device for all modes was reduced by 56%, to 5 hours or less. This approach and subsequent reduction in configuration time may help translate powered prostheses into a viable clinical option where amputees can more quickly appreciate the benefits such devices can provide.

  7. Configuring a powered knee and ankle prosthesis for transfemoral amputees within five specific ambulation modes.

    Science.gov (United States)

    Simon, Ann M; Ingraham, Kimberly A; Fey, Nicholas P; Finucane, Suzanne B; Lipschutz, Robert D; Young, Aaron J; Hargrove, Levi J

    2014-01-01

    Lower limb prostheses that can generate net positive mechanical work may restore more ambulation modes to amputees. However, configuration of these devices imposes an additional burden on clinicians relative to conventional prostheses; devices for transfemoral amputees that require configuration of both a knee and an ankle joint are especially challenging. In this paper, we present an approach to configuring such powered devices. We developed modified intrinsic control strategies--which mimic the behavior of biological joints, depend on instantaneous loads within the prosthesis, or set impedance based on values from previous states, as well as a set of starting configuration parameters. We developed tables that include a list of desired clinical gait kinematics and the parameter modifications necessary to alter them. Our approach was implemented for a powered knee and ankle prosthesis in five ambulation modes (level-ground walking, ramp ascent/descent, and stair ascent/descent). The strategies and set of starting configuration parameters were developed using data from three individuals with unilateral transfemoral amputations who had previous experience using the device; this approach was then tested on three novice unilateral transfemoral amputees. Only 17% of the total number of parameters (i.e., 24 of the 140) had to be independently adjusted for each novice user to achieve all five ambulation modes and the initial accommodation period (i.e., time to configure the device for all modes) was reduced by 56%, to 5 hours or less. This approach and subsequent reduction in configuration time may help translate powered prostheses into a viable clinical option where amputees can more quickly appreciate the benefits such devices can provide.

  8. Emerging organizational structures in the ambulance industry in the United States.

    Science.gov (United States)

    Narad, R A

    2000-01-01

    This analysis seeks to identify emerging forms of organizations in emergency medical services (EMS) in the United States, to provide examples of them, to relate them to changes in healthcare generally, and to apply a classification scheme. Public policy issues related to these new forms of organizations and lessons from other areas of the healthcare system are identified. Recent changes in the healthcare system in the United States have been marked by modifications in the structure of organizations that provide and pay for health services. New forms of organizations and alliances among existing organizations have emerged in an effort to improve the efficiency of the services provided and to improve organizations' market positions. Reflecting increased competition within EMS and the demands of the changing health-care delivery system, several types of organizations have begun to emerge in EMS that resemble those occurring in health care generally. These include forms of horizontal integration, such as consolidated ambulance services and various models of ambulance service networks; and forms of vertical integration, such as demand management programs and public-private joint ventures. The ultimate end might be complete integration with a carve-out of all non-scheduled care. Although changes in EMS organizations result largely from marketplace decisions by sellers and purchasers, this does not mean that there is no public policy role. While new organizational forms may increase the ambulance industry's efficiency, public policy makers must be concerned about quality and access as well. Some policy responses will promote marketplace changes, others will accept them generally, but will seek to correct problems, and a third group will attempt to restrain the market.

  9. EFFECT OF SHOE RAISE ALONG WITH MOTOR RELEARNING PROGRAMME (MRP ON AMBULATION IN CHRONIC STROKE

    Directory of Open Access Journals (Sweden)

    Gajanan Bhalerao

    2016-06-01

    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.

  10. Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton.

    Science.gov (United States)

    Asselin, Pierre K; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M

    2016-06-16

    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.

  11. The equestrian sport-related injury workload of a regional doctor-led air ambulance unit.

    Science.gov (United States)

    Bleetman, David

    2012-12-01

    The Great Western Ambulance Service Air Support Unit (ASU) was established in July 2007. The helicopter carries a doctor, providing a Helicopter Emergency Medical Service (HEMS) model of care. Equestrian sport-related injuries account for 6.8% of the unit's total attended case load. Horse riding has a higher rate of severe injury than motorcycle racing and 45% of patients admitted with equestrian injuries require surgical intervention. Orthopaedic injuries to the extremities are commonest, superseding head injuries since the introduction of protective headwear. The majority of equestrian sport-related injuries occur in areas inaccessible to land crews. We conducted a retrospective analysis of the ASU mission database from July 2008 to December 2009 (18 months) and identified 29 patients that were attended to by the ASU. The patient cohort had a female majority with an average age of 31.9. 10 Patients (34.5%) were under the age of 20. The ISS ranged from 1 to 75 (mean, 4.8; median, 1) and injuries to the extremities were commonest. The location of the accident was inaccessible to land ambulance in 55.2% of missions. The average mission time was over 2h. Doctors delivered more advanced (medical) interventions in 20.7% of missions. In 41.4% of missions, there were no such interventions performed by the attending doctor and no access to land ambulance. We therefore conclude that a large proportion of ASU dispatches were due to limited access rather than for the delivery of advanced interventions. However, our results support the opinion that horse riding carries some risk of serious injury and when employed appropriately, HEMS doctors on the ASU are a useful resource for a minority of equestrian sport-related injuries.

  12. Preoperative Predictors of Ambulation Ability at Different Time Points after Total Hip Arthroplasty in Patients with Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Akiko Kamimura

    2014-01-01

    Full Text Available The aims of this study were to identify the preoperative factors influencing ambulation ability at different postoperative time points after total hip arthroplasty (THA and to examine the cutoff values of predictive preoperative factors by receiver operating characteristic (ROC curves. Forty-eight women with unilateral THA were measured for hip extensor, hip abductor, and knee extensor muscle strength in both legs; hip pain (visual analog scale, VAS; and the Timed Up and Go (TUG test pre- and postoperatively. Multiple regression analysis indicated that preoperative knee extensor strength (β=-0.379,R2=0.409 at 3 weeks, hip abductor strength (β=-0.572,R2=0.570 at 4 months, and age (β=0.758,R2= 0.561 at 7 months were strongly associated with postoperative ambulation, measured using the TUG test. Optimal preoperative cutoff values for ambulation ability were 0.56 Nm/kg for knee extensor strength, 0.24 Nm/kg for hip abductor strength, and 73 years of age. Our results suggest that preoperative factors predicting ambulation ability vary by postoperative time point. Preoperative knee extensor strength, hip abductor strength, and age were useful predictors of ambulation ability at the early, middle, and late time points, respectively, after THA.

  13. Risk Management Analysis of Air Ambulance Blood Product Administration in Combat Operations

    Science.gov (United States)

    2014-11-01

    Combat Operations 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Nicole Powell-Dunford, Jose F. Quesada , Robert F...Analysis of Air Ambulance Blood Product Administration in Combat Operations Nicole Powell-Dunford , Jose F. Quesada , Robert F. Malsby , Victoria...Schofi eld Barracks, Wahiawa, HI; Jose F. Quesada , M.S., M.D., 440th Blood Support Detachment, and Robert Gerhardt, M.D., M.P.H., FACEP, U.S. Army

  14. Why did the patient die? The relationship between ambulance accidents and death of patients: forensic medical issues.

    Science.gov (United States)

    Ersoy, Gokhan; Ersoy, Ozlem; Yuksekbas, Ozlem; Kurnaz, Gulay; Akyildiz, Elif Ulker; Ekemen, Suheyla

    2012-11-01

    This article's aim is investigating traumatic consequences of ambulance accident on patients and discussing difficulties to give a decision about the relation between death and accident at these cases. The cases were selected among the forensic medical reports concluded between 1996 and 2005 years. They were documented for age, sex, causes of urgent call, localization and extent of traumatic lesion, properties of events and board decisions. A total of 21 cases were found. 15 cases died on the day of the accident. Skin injuries at head (8 cases) and legs (6 cases) were most common traumatic lesions. Totally 6 deaths were found related with ambulance accident. Death of patient after ambulance accidents may not be associated easily to the accident. Delay due to accident or concomitant contributing medical conditions may also facilitate the death in this type of cases. Reliable medical records were needed for accurate medicolegal evaluation.

  15. Neurotherapeutic and neuroprosthetic effects of implanted functional electrical stimulation for ambulation after incomplete spinal cord injury

    Directory of Open Access Journals (Sweden)

    Ronald J. Triolo, PhD

    2010-03-01

    Full Text Available The purpose of this single-subject study was to determine the neurotherapeutic and neuroprosthetic effects of an implanted functional electrical stimulation (FES system designed to facilitate walking in an individual with a long-standing motor and sensory incomplete spinal cord injury. An implanted pulse generator and eight intramuscular stimulating electrodes were installed unilaterally, activating weak or paralyzed hip flexors, hip and knee extensors, and ankle dorsiflexors during 36 sessions of gait training with FES. The neurotherapeutic effects were assessed by a comparison of pre- and posttraining volitional walking. The neuroprosthetic effects were assessed by a comparison of posttraining volitional and FES-assisted walking. Treatment resulted in significant (p < 0.005 volitional improvements in 6-minute walking distance and speed, speed during maximum walk, double support time, and 10 m walking speed. Posttraining FES-assisted walking resulted in significant additional improvements in all these measures, except 10 m walking speed. When the subject was using FES-assisted gait, maximum walking distance, peak knee flexion in swing, peak ankle dorsiflexion in swing, and knee extension moment also significantly increased. Neuroprosthetic gains were sufficient to enable the subject to advance from household ambulation to limited community ambulation. Additionally, the subject could perform multiple walks per day when using FES-assisted gait, which was impossible with volitional effort alone.

  16. Benefits of microprocessor-controlled prosthetic knees to limited community ambulators: systematic review.

    Science.gov (United States)

    Kannenberg, Andreas; Zacharias, Britta; Pröbsting, Eva

    2014-01-01

    The benefits of microprocessor-controlled prosthetic knees (MPKs) have been well established in community ambulators (Medicare Functional Classification Level [MFCL]-3) with a transfemoral amputation (TFA). A systematic review of the literature was performed to analyze whether limited community ambulators (MFCL-2) may also benefit from using an MPK in safety, performance-based function and mobility, and perceived function and satisfaction. We searched 10 scientific databases for clinical trials with MPKs and identified six publications with 57 subjects with TFA and MFCL-2 mobility grade. Using the criteria of a Cochrane Review on prosthetic components, we rated methodological quality moderate in four publications and low in two publications. MPK use may significantly reduce uncontrolled falls by up to 80% as well as significantly improve indicators of fall risk. Performance-based outcome measures suggest that persons with MFCL-2 mobility grade may be able to walk about 14% to 25% faster on level ground, be around 20% quicker on uneven surfaces, and descend a slope almost 30% faster when using an MPK. The results of this systematic review suggest that trial fittings may be used to determine whether or not individuals with TFA and MFCL-2 mobility grade benefit from MPK use. Criteria for patient selection and assessment of trial fitting success or failure are proposed.

  17. Ambulation and independence among Veterans with nontraumatic bilateral lower–limb loss

    Directory of Open Access Journals (Sweden)

    Sherene E. Sharath, MPH

    2015-11-01

    Full Text Available In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17 were bilateral transfemoral amputations (TFAs; bilateral transtibial amputations (TTAs and TFA–TTA accounted for the rest (33% and 25%, respectively. Of the 19 (48% patients who were ambulatory prior to bilateral amputation, only 2 (11% remained ambulatory after the second amputation, while 17 (89% patients lost ambulatory capabilities. Compared with those who were ambulate precontralateral amputation (p = 0.03. All patients with bilateral TFA were nonambulatory. Independence postcontralateral amputation decreased from 88% (35 to 53% (21. When data were available (58%, pre and post Functional Independence Measure scores showed a decrease in 74% of patients, while 22% showed an increase. In conclusion, bilateral lower–limb amputation among dysvascular Veterans is highly associated with a loss of ambulation.

  18. Improving community ambulation after hip fracture: protocol for a randomised, controlled trial

    Science.gov (United States)

    Orwig, D; Mangione, KK; Baumgarten, M; Terrin, M; Fortinsky, R; Kenny, AM; Gruber-Baldini, AL; Beamer, B; Tosteson, ANA; Shardell, M; Magder, L; Binder, E; Koval, K; Resnick, B; Craik, RL; Magaziner, J

    2017-01-01

    Introduction After a hip fracture in older persons, significant disability often remains; dependency in functional activities commonly persists beyond 3 months after surgery. Endurance, dynamic balance, quadriceps strength, and function are compromised, and contribute to an inability to walk independently in the community. In the United States, people aged 65 years and older are eligible to receive Medicare funding for physiotherapy for a limited time after a hip fracture. A goal of outpatient physiotherapy is independent and safe household ambulation 2 to 3 months after surgery. Current Medicare-reimbursed post-hip-fracture rehabilitation fails to return many patients to pre-fracture levels of function. Interventions delivered in the home after usual hip fracture physiotherapy has ended could promote higher levels of functional independence in these frail and older adult patients. Primary objective To evaluate the effect of a specific multicomponent physiotherapy intervention (PUSH), compared with a non-specific multi-component control physiotherapy intervention (PULSE), on the ability to ambulate independently in the community 16 weeks after randomisation. Design Parallel, two-group randomised multicentre trial of 210 older adults with a hip fracture assessed at baseline and 16 weeks after randomisation, and at 40 weeks after randomisation for a subset of approximately 150 participants. Participants and setting A total of 210 hip fracture patients are being enrolled at three clinical sites and randomised up to 26 weeks after admission. Study inclusion criteria are: closed, non-pathologic, minimal trauma hip fracture with surgical fixation; aged ≥ 60 years at the time of randomisation; community residing at the time of fracture and randomisation; ambulating without human assistance 2 months prior to fracture; and being unable to walk at least 300 m in 6 minutes at baseline. Participants are ineligible if the interventions are deemed to be unsafe or unfeasible

  19. Using HSPA to improve the telemedical links on a moving ambulance.

    Science.gov (United States)

    Banitsas, Konstantinos; Tachakra, Sapal; Stefanidis, Euclid; Boletis, Konstantinos

    2008-01-01

    As the demand for faster and more effective health care increases, there is a growing need to establish mobile, high-speed communications between a moving ambulance and a consultation point (usually a hospital). The recent addition of HSPA (HSDPA and HSUPA) into the UMTS suite provides higher bandwidth and reduced delays, making this choice ideal for real-time telemedical applications. In this paper, we will describe a set of scenarios that took place in a typical large city area, along with their equivalent results: a moving ambulance was linked with a consultation station using HSPA and several videoconferencing sessions were initiated. Best-case, worst-case and average scenarios were recorded. Furthermore, in areas where the UMTS reception was marginal, a repeater was placed on top of the vehicle to boost up the signal power and thus maintain the higher bandwidth. Finally, treating doctors were asked to evaluate the effectiveness of this system's outputs, based on a variety of objective and subjective criteria.

  20. Humeral fracture in non-ambulant infants - a possible accidental mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Somers, John M.; Halliday, Katharine E. [Nottingham University Hospitals, Radiology Department, Nottingham (United Kingdom); Chapman, Stephen [Birmingham Children' s Hospital, Birmingham (United Kingdom)

    2014-10-15

    Humeral fracture in a non-ambulant infant younger than 1 year is suspicious for a non-accidental injury unless there is a credible accidental explanation. A previously unrecognised accidental mechanism was described in 1996 whereby a 5-month-old infant was rolled by a 3-year-old sibling from a prone to a supine position. To investigate the widely accepted view that an infant with limited mobility cannot sustain a fracture of the humerus by his or her own actions in the absence of the intervention of an external party. We present seven cases of non-ambulant infants between 4 and 7 months of age in whom an isolated humeral fracture was the only injury present. In each case the caregiver described the fracture occurring when the child rolled over, trapping the dependent arm, without the intervention of another party. There is no proof for this mechanism in the form of an independent witness or video recording. However, we propose that this mechanism is worthy of further consideration as a rare and unusual cause for the injury. Further study is required. (orig.)

  1. Four Square Step Test in ambulant persons with multiple sclerosis: validity, reliability, and responsiveness.

    Science.gov (United States)

    Wagner, Joanne M; Norris, Rosemary A; Van Dillen, Linda R; Thomas, Florian P; Naismith, Robert T

    2013-09-01

    The aim of this study was to establish the concurrent validity and relative and absolute reliability, define the minimal detectable change, and evaluate the floor and ceiling effects of the Four Square Step Test (FSST) in ambulant persons with multiple sclerosis (pwMS). Twenty-five pwMS performed the FSST on two occasions, 8.1±4.1 days apart. During the first testing, session participants also reported their fall history, performed the Berg Balance Scale, Dynamic Gait Index, and completed the Activities-Specific Balance Confidence Scale. Performance on the FSST was significantly (P<0.001) and strongly associated with performance on the Berg Balance Scale (rs=-0.84), Dynamic Gait Index (rs=-0.81), and Activities-Specific Balance Confidence Scale (rs=-0.78). Relative reliability of the FSST was excellent (ICC2,1=0.922). The minimal detectable change estimate for the FSST was 4.6 s. The FSST is a valid and reliable measure of dynamic standing balance in ambulant pwMS. However, because a substantial change (43%) is required to demonstrate a real change in individual performance, the FSST is unlikely to be sensitive in detecting longitudinal change in dynamic standing balance.

  2. Benefits of microprocessor-controlled prosthetic knees to limited community ambulators: Systematic review

    Directory of Open Access Journals (Sweden)

    Andreas Kannenberg, MD, PhD

    2015-03-01

    Full Text Available The benefits of microprocessor-controlled prosthetic knees (MPKs have been well established in community ambulators (Medicare Functional Classification Level [MFCL]-3 with a transfemoral amputation (TFA. A systematic review of the literature was performed to analyze whether limited community ambulators (MFCL-2 may also benefit from using an MPK in safety, performance-based function and mobility, and perceived function and satisfaction. We searched 10 scientific databases for clinical trials with MPKs and identified six publications with 57 subjects with TFA and MFCL-2 mobility grade. Using the criteria of a Cochrane Review on prosthetic components, we rated methodological quality moderate in four publications and low in two publications. MPK use may significantly reduce uncontrolled falls by up to 80% as well as significantly improve indicators of fall risk. Performance-based outcome measures suggest that persons with MFCL-2 mobility grade may be able to walk about 14% to 25% faster on level ground, be around 20% quicker on uneven surfaces, and descend a slope almost 30% faster when using an MPK. The results of this systematic review suggest that trial fittings may be used to determine whether or not individuals with TFA and MFCL-2 mobility grade benefit from MPK use. Criteria for patient selection and assessment of trial fitting success or failure are proposed.

  3. The Medical Duty Officer: An Attempt to Mitigate the Ambulance At-Hospital Interval

    Directory of Open Access Journals (Sweden)

    Megan H. Halliday

    2016-09-01

    Full Text Available Introduction: A lack of coordination between emergency medical services (EMS, emergency departments (ED and systemwide management has contributed to extended ambulance at-hospital times at local EDs. In an effort to improve communication within the local EMS system, the Baltimore City Fire Department (BCFD placed a medical duty officer (MDO in the fire communications bureau. It was hypothesized that any real-time intervention suggested by the MDO would be manifested in a decrease in the EMS at-hospital time. Methods: The MDO was implemented on November 11, 2013. A senior EMS paramedic was assigned to the position and was placed in the fire communication bureau from 9 a.m. to 9 p.m., seven days a week. We defined the pre-intervention period as August 2013 - October 2013 and the post-intervention period as December 2013 - February 2014. We also compared the post-intervention period to the “seasonal match control” one year earlier to adjust for seasonal variation in EMS volume. The MDO was tasked with the prospective management of city EMS resources through intensive monitoring of unit availability and hospital ED traffic. The MDO could suggest alternative transport destinations in the event of ED crowding. We collected and analyzed data from BCFD computer-aided dispatch (CAD system for the following: ambulance response times, ambulance at-hospital interval, hospital diversion and alert status, and “suppression wait time” (defined as the total time suppression units remained on scene until ambulance arrival. The data analysis used a pre/post intervention design to examine the MDO impact on the BCFD EMS system. Results: There were a total of 15,567 EMS calls during the pre-intervention period, 13,921 in the post-intervention period and 14,699 in the seasonal match control period one year earlier. The average at-hospital time decreased by 1.35 minutes from pre- to post-intervention periods and 4.53 minutes from the pre- to seasonal match

  4. What an ambulance nurse needs to know: a content analysis of curricula in the specialist nursing programme in prehospital emergency care.

    Science.gov (United States)

    Sjölin, Helena; Lindström, Veronica; Hult, Håkan; Ringsted, Charlotte; Kurland, Lisa

    2015-04-01

    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.

  5. Evaluation of an algorithm for estimating a patient's life threat risk from an ambulance call

    Directory of Open Access Journals (Sweden)

    Moriwaki Yoshihiro

    2009-10-01

    Full Text Available Abstract Background Utilizing a computer algorithm, information from calls to an ambulance service was used to calculate the risk of patients being in a life-threatening condition (life threat risk, at the time of the call. If the estimated life threat risk was higher than 10%, the probability that a patient faced a risk of dying was recognized as very high and categorized as category A+. The present study aimed to review the accuracy of the algorithm. Methods Data collected for six months from the Yokohama new emergency system was used. In the system, emergency call workers interviewed ambulance callers to obtain information necessary to assess triage, which included consciousness level, breathing status, walking ability, position, and complexion. An emergency patient's life threat risk was then estimated by a computer algorithm applying logistic models. This study compared the estimated life threat risk occurring at the time of the emergency call to the patients' state or severity of condition, i.e. death confirmed at the scene by ambulance crews, resulted in death at emergency departments, life-threatening condition with occurrence of cardiac and/or pulmonary arrest (CPA, life-threatening condition without CPA, serious but not life-threatening condition, moderate condition, and mild condition. The sensitivity, specificity, predictive values, and likelihood ratios of the algorithm for categorizing A+ were calculated. Results The number of emergency dispatches over the six months was 73,992. Triage assessment was conducted for 68,692 of these calls. The study targets account for 88.8% of patients who were involved in triage calls. There were 2,349 cases where the patient had died or had suffered CPA. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of the algorithm at predicting cases that would result in a death or CPA were 80.2% (95% confidence interval

  6. Effect of Planned Early Recommended Ambulation Technique on Selected Post caesarean Biophysiological Health Parameters

    Directory of Open Access Journals (Sweden)

    Jyoti V. Dube

    2014-01-01

    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

  7. Emergency obstetric referral in rural Sierra Leone: what can motorbike ambulances contribute? A mixed-methods study.

    Science.gov (United States)

    Bhopal, Sunil S; Halpin, Stephen J; Gerein, Nancy

    2013-08-01

    Giving birth remains a dangerous endeavour for many of the world's women. Progress to improve this has been slow in sub-Saharan Africa. The second delay, where transport infrastructure is key in allowing a woman to reach care, has been a relatively neglected field of study. Six eRanger motorbike ambulances, specifically engineered for use on poor roads in resource-poor situations were provided in 2006 as part of an emergency referral system in rural Sierra Leone. The aim of this study was to evaluate the implementation of this referral system in terms of its use, acceptability and accessibility. Data were collected from usage records, and a series of semi-structured interviews and focus groups conducted to provide deeper understanding of the service. A total of 130 records of patients being transported to a health facility were found, 1/3 of which were for obstetric cases. The ambulance is being used regularly to transport patients to a health care facility. It is well known to the communities, is acceptable and accessible, and is valued by those it serves. District-wide traditional birth attendant training and the sensitisation activities provided a foundation for the introduction of the ambulance service, creating a high level of awareness of the service and its importance, particularly for women in labour. Motorbike ambulances are suited to remote areas and can function on poor roads inaccessible to other vehicles.

  8. Feasibility of AmbulanCe-Based Telemedicine (FACT) Study : Safety, Feasibility and Reliability of Third Generation Ambulance Telemedicine

    NARCIS (Netherlands)

    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

    2014-01-01

    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

  9. High intertester reliability of the cumulated ambulation score for the evaluation of basic mobility in patients with hip fracture

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Andersen, Lene; Bech-Jensen, Rie;

    2009-01-01

    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....

  10. Early ambulance initiation versus in-hospital initiation of high dose clopidogrel in ST-segment elevation myocardial infarction

    NARCIS (Netherlands)

    Postma, S.; Dambrink, J.H.; Ottervanger, J.P.; Gosselink, A.T.M.; Koopmans, P.C.; Berg, J.M. van den; Suryapranata, H.; Hof, A.W. van 't

    2014-01-01

    Pre-hospital infarct diagnosis gives the opportunity to start anti-platelet and anti-thrombotic agents before arrival at the PCI centre. However, more evidence is necessary to demonstrate whether high dose (HD) clopidogrel (600 mg) administered in the ambulance is associated with improved initial pa

  11. Cumulated Ambulation Score to evaluate mobility is feasible in geriatric patients and in patients with hip fracture

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Jakobsen, Thomas Linding; Nielsen, Jesper Westphal;

    2012-01-01

    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...

  12. Use of Functional Ambulation Performance Score as measurement of gait ability: Review

    Directory of Open Access Journals (Sweden)

    Arnaud Gouelle, PhD

    2014-09-01

    Full Text Available Gait analysis systems are widely used for the assessment of gait disabilities and provide more accurate and detailed information than clinical tests. Scores and indexes have been proposed to summarize the large volume of data produced, each emphasizing different aspects of gait. Based on specific spatiotemporal gait parameters, the Functional Ambulation Performance Score (FAPS quantifies gait at a self-selected speed. Integrated within electronic walkways, the FAPS is commonly used for clinical evaluations and has been used in an increasing number of publications over the past few years. However, its use is sometimes distorted by misunderstandings of its composition and calculation, practical and/or conceptual limits, and even the meaning of the score. This technical report reviews the use of the FAPS for the evaluation of gait based on peer-reviewed articles and clinical experience and addresses important issues that must be considered for an optimal unbiased understanding and analysis of the score.

  13. [The evaluation of health of medical personnel of ambulance care and impacting factors].

    Science.gov (United States)

    2012-01-01

    The analysis of self-assessment of medical personnel of ambulance care revealed that 13.2% of respondents consider themselves as healthy persons, 35.1%--as practically healthy, 39.2%--as rarely being ill, 12%--as often being ill According to the poll data, deterioration of health is promoted by such personal factors as disregard of one's health (35%) and chronic diseases (25.3%). Its own role play such external factors as professional characteristics (34%). ecological conditions (23%), poor conditions of work (22.2%). The amelioration of health is supported mainly by sport exercises (42.8%). The significant role in this process play the improvement of work conditions, the enhancement of quality of medical examninations and the introduction of professional dispanserization.

  14. Geographic information system data from ambulances applied in the emergency department: effects on patient reception

    DEFF Research Database (Denmark)

    Raaber, Nikolaj; Pedersen, Iben Duvald; Riddervold, Ingunn Skogstad;

    2016-01-01

    BACKGROUND: 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...... 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....... DISCUSSION: 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...

  15. Design and Development of an Intelligent Mobile Health Tele-assistance System in Ambulance Practice Service

    Directory of Open Access Journals (Sweden)

    Rachid Merzougui

    2013-01-01

    Full Text Available Our attention has focused on the choice of a relevant work. It concerns an implemented and conceived service of medical Teleassistance for monitoring risky persons brought by ambulance service. Thus, a medical bulletin is automatically filled on mobile terminal, immediately transmitted to the service of the emergency (on doctors mobile terminal, data base of clinic. This paper recalls a complete architecture of an economic wireless transmission system with the implementation of an effective application, adapted to the portable phone, allowing the doctor to have the medical information of patients who have a risk of accident. Thus, the stakes of setting up such systems are numerous, so much for patients, medical staff and the society in general.

  16. Early ambulation and prevention of post-operative thrombo-embolic risk.

    Science.gov (United States)

    Talec, P; Gaujoux, S; Samama, C M

    2016-12-01

    The prevention of post-operative risk of venous thrombo-embolism (VTE) is of fundamental importance, but preventive methods have progressed with the introduction of direct oral anticoagulants (DOAC), the development of ambulatory surgery and enhanced recovery programs (ERP) after surgery. Surgery is, inherently a trigger for venous thrombo-embolic disease, as is prolonged immobilization. However, the risk of VTE is very low following ambulatory surgery, especially in this selected population. ERP, consists of a set of measures to optimize the patient's peri-operative management while reducing length of stay, costs and morbidity and mortality; one measure is the encouragement of early ambulation. This will undoubtedly have an impact on the incidence of VTE and lessen the need for prolonged thrombo-prophylaxis.

  17. Reducing Ambulance Diversion at Hospital and Regional Levels: Systemic Review of Insights from Simulation Models

    Directory of Open Access Journals (Sweden)

    M Kit Delgado

    2013-09-01

    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.

  18. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    Directory of Open Access Journals (Sweden)

    James R. Langabeer II

    2016-11-01

    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.

  19. How urgent are cases brought to the emergency department by ambulance?

    Directory of Open Access Journals (Sweden)

    Melih Yuksel

    2015-06-01

    Full Text Available Objective: Emergency departments are the first places to which patients present with unexpected or unforeseen health problems. The purpose of this study was to assess the urgency of cases brought by ambulance to the Hospital on the basis of a three-level triage system. Methods: This study was performed between 01.06.2013 and 31.09.2013 at the Diyarbakır Education and Research Hospital. Our emergency service unit is a third degree service for all adult patient groups and all child trauma types. Triage of patients brought to the emergency department by ambulance was performed by emergency medicine specialists. Patients’ vital findings, identity data and triage categories were assessed. Results: 712 patients were included, 382 (53.7% male and 330 (46.3% female, with a mean age of 45. In this study, 619 (86.9% patients were transferred from the scene and 93 (13.1 between hospitals, 483 (67.8% patients were brought by emergency medicine technician (EMT teams, 107 (15% by physician-led teams, 107 (15 by paramedic teams and 15 (2.1% by other teams, 442 (62.1% patients were assessed as yellow, 141 (19.8% as green and 129 (19.1% as red zone. Five hundred eighty (81.5% patients were discharged and 115 (15.9% were hospitalized. Conclusion: Emergency health services are clearly developing rapidly in Turkey. In order for pre-hospital emergency health services not to be abused, we think that these services should be up to the standards of those in developed countries and that public awareness needs to be increased, particularly with regard to triage. J Clin Exp Invest 2015; 6 (2: 126-129

  20. Effects of Weather and Heliophysical Conditions on Emergency Ambulance Calls for Elevated Arterial Blood Pressure

    Directory of Open Access Journals (Sweden)

    Jone Vencloviene

    2015-02-01

    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.

  1. Planning like an Olympian. How London Ambulance Service successfully handled their 'summer of sport'.

    Science.gov (United States)

    Killens, Jason

    2013-03-01

    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

  2. L’ambulantage : Représentations du commerce ambulant ou informel et métropolisation

    OpenAIRE

    MONNET, Jérôme

    2006-01-01

    Les représentations sociales font du commerce dit ambulant, informel ou de rue un ensemble flou d’activités liées à l’illégalité, à l’archaïsme et au sous-développement. En première partie, une cybergéographie de ces représentations présente les trois identifications dominantes de ce type de commerce et différencie des approches selon que l’on s’exprime en anglais ou en français et en espagnol. Cependant, elles ont en commun de marginaliser le commerce ambulant, et en particulier de ne pas co...

  3. Differences in police, ambulance, and emergency department reporting of traffic injuries on Karachi-Hala road, Pakistan

    Directory of Open Access Journals (Sweden)

    Lagarde Emmanuel

    2011-03-01

    Full Text Available Abstract Background Research undertaken in developing countries has assessed discrepancies in police reporting of Road Traffic Injury (RTI for urban settings only. The objective of this study was to assess differences in RTI reporting across police, ambulance, and hospital Emergency Department (ED datasets on an interurban road section in Pakistan. Methods The study setting was the 196-km long Karachi-Hala road section. RTIs reported to the police, Edhi Ambulance Service (EAS, and five hospital EDs in Karachi during 2008 (Jan to Dec were compared in terms of road user involved (pedestrians, motorcyclists, four-wheeled vehicle occupants and outcome (died or injured. Further, records from these data were matched to assess ascertainment of traffic injuries and deaths by the three datasets. Results A total of 143 RTIs were reported to the police, 531 to EAS, and 661 to hospital EDs. Fatality per hundred traffic injuries was twice as high in police records (19 per 100 RTIs than in ambulance (10 per 100 RTIs and hospital ED records (9 per 100 RTIs. Pedestrian and motorcyclist involvement per hundred traffic injuries was lower in police records (8 per 100 RTIs than in ambulance (17 per 100 RTIs and hospital ED records (43 per 100 RTIs. Of the 119 deaths independently identified after matching, police recorded 22.6%, EAS 46.2%, and hospital ED 50.4%. Similarly, police data accounted for 10.6%, EAS 43.5%, and hospital ED 54.9% of the 1 095 independently identified injured patients. Conclusions Police reporting, particularly of non-fatal RTIs and those involving vulnerable road users, should be improved in Pakistan.

  4. Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in prehospital emergency care – an intervention study

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    Jonas Aléx

    2015-09-01

    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.

  5. Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis

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    Schaffer Andrea

    2012-01-01

    Full Text Available Abstract Background From January 30-February 6, 2011, New South Wales was affected by an exceptional heat wave, which broke numerous records. Near real-time Emergency Department (ED and ambulance surveillance allowed rapid detection of an increase in the number of heat-related ED visits and ambulance calls during this period. The purpose of this study was to quantify the excess heat-related and all-cause ED visits and ambulance calls, and excess all-cause mortality, associated with the heat wave. Methods ED and ambulance data were obtained from surveillance and administrative databases, while mortality data were obtained from the state death registry. The observed counts were compared with the average counts from the same period from 2006/07 through 2009/10, and a Poisson regression model was constructed to calculate the number of excess ED visits, ambulance and deaths after adjusting for calendar and lag effects. Results During the heat wave there were 104 and 236 ED visits for heat effects and dehydration respectively, and 116 ambulance calls for heat exposure. From the regression model, all-cause ED visits increased by 2% (95% CI 1.01-1.03, all-cause ambulance calls increased by 14% (95% CI 1.11-1.16, and all-cause mortality increased by 13% (95% CI 1.06-1.22. Those aged 75 years and older had the highest excess rates of all outcomes. Conclusions The 2011 heat wave resulted in an increase in the number of ED visits and ambulance calls, especially in older persons, as well as an increase in all-cause mortality. Rapid surveillance systems provide markers of heat wave impacts that have fatal outcomes.

  6. Strategies to reduce the configuration time for a powered knee and ankle prosthesis across multiple ambulation modes.

    Science.gov (United States)

    Simon, Ann M; Fey, Nicholas P; Finucane, Suzanne B; Lipschutz, Robert D; Hargrove, Levi J

    2013-06-01

    Recently developed powered lower limb prostheses allow users to more closely mimic the kinematics and kinetics of non-amputee gait. However, configuring such a device, in particular a combined powered knee and ankle, for individuals with a transfemoral amputation is challenging. Previous attempts have relied on empirical tuning of all control parameters. This paper describes modified stance phase control strategies - which mimic the behavior of biological joints or depend on the instantaneous loads within the prosthesis - developed to reduce the number of control parameters that require individual tuning. Three individuals with unilateral transfemoral amputations walked with a powered knee and ankle prosthesis across five ambulation modes (level ground walking, ramp ascent/descent, and stair ascent/descent). Starting with a nominal set of impedance parameters, the modified control strategies were applied and the devices were individually tuned such that all subjects achieved comfortable and safe ambulation. The control strategies drastically reduced the number of independent parameters that needed to be tuned for each subject (i.e., to 21 parameters instead of a possible 140 or approximately 4 parameters per mode) while relative amplitudes and timing of kinematic and kinetic data remained similar to those previously reported and to those of non-amputee subjects. Reducing the time necessary to configure a powered device across multiple ambulation modes may allow users to more quickly realize the benefits such powered devices can provide.

  7. [Implantation of the emergency ambulance service in Salvador, Bahia: reality and challenges].

    Science.gov (United States)

    Vieira, Célia Maria Sales; Mussi, Fernanda Carneiro

    2008-12-01

    The goal of this study was to describe the implementation of the emergency ambulance service of Salvador, Bahia (SAMU-192). The Ministry of Health provided the legal basis and regulations for its implementation. The main purpose of this service is the provision of free primary level healthcare to individuals, with clinical, surgical, traumatic and psychiatric aggravations that cause suffering, sequels or death and occur outside the hospital environment. The specific goals of SAMU-192 was to grant free healthcare to urgency and emergency situations, under the hierarchy and regulations of the Single Health System (SUS) of the Brazilian government, assuring that public resources will be available and integrated to the complementary healthcare network. Investments for the installation of the service were agreed on in the city and with federal and state management commissions. To turn SAMU-192 into reality, several challenges need to be accomplished, including community education, professional qualification and evaluation of human and material resources so as to provide basic emergency care with the appropriate quality.

  8. [Helpful Factors of Ambulant Art Therapy in the Group and Changes of Experiences in Psychosomatic Patients].

    Science.gov (United States)

    Oster, Jörg; Moser, Anna Sophie; Danner-Weinberger, Alexandra; von Wietersheim, Jörn

    2016-02-01

    The aim of this study was to analyze the experiences of patients suffering from mostly chronic psychosomatic disorders in an ambulant art therapy in the group. Especially, the focus was on the experienced changes, helpful factors and specifics of the therapy as well as on the experienced benefit. For this, 30 patients were interviewed in a semi-standardized way. Additionally, the symptom-based strain was psychometrically recorded in a part of the patients (21) at the beginning of the therapy and after at least 6 months of participation. The evaluation of those interviews with the qualitative analysis of the therapy subjects surrendered an improvement of the health state in most of the participants. Especially group factors, art as a mean of communication, becoming aware of feelings but also diversion and fun were proved to be beneficial. The art therapy also serves for structuring the week as well as a contact point and a resource in the interpersonal communication of everyday life. Nearly all of the patients referred to some important turning point pictures. Mostly, the benefit was valued as being high. But, in contrast, the psychometric measure did not show any significant change. The results emphasize the stabilizing function of art therapy in the examined patients, whereat the classification of the psychometric result is complicated by the absence of a control group.

  9. Solving the dynamic ambulance relocation and dispatching problem using approximate dynamic programming.

    Science.gov (United States)

    Schmid, Verena

    2012-06-16

    Emergency service providers are supposed to locate ambulances such that in case of emergency patients can be reached in a time-efficient manner. Two fundamental decisions and choices need to be made real-time. First of all immediately after a request emerges an appropriate vehicle needs to be dispatched and send to the requests' site. After having served a request the vehicle needs to be relocated to its next waiting location. We are going to propose a model and solve the underlying optimization problem using approximate dynamic programming (ADP), an emerging and powerful tool for solving stochastic and dynamic problems typically arising in the field of operations research. Empirical tests based on real data from the city of Vienna indicate that by deviating from the classical dispatching rules the average response time can be decreased from 4.60 to 4.01 minutes, which corresponds to an improvement of 12.89%. Furthermore we are going to show that it is essential to consider time-dependent information such as travel times and changes with respect to the request volume explicitly. Ignoring the current time and its consequences thereafter during the stage of modeling and optimization leads to suboptimal decisions.

  10. Leg Lengthening as a Means of Improving Ambulation Following an Internal Hemipelvectomy

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    Wakyo Sato

    2016-01-01

    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.

  11. Powered ankle-foot prosthesis for the improvement of amputee ambulation.

    Science.gov (United States)

    Au, Samuel K; Herr, Hugh; Weber, Jeff; Martinez-Villalpando, Ernesto C

    2007-01-01

    This paper presents the mechanical design, control scheme, and clinical evaluation of a novel, motorized ankle-foot prosthesis, called MIT Powered Ankle-Foot Prosthesis. Unlike a conventional passive-elastic ankle-foot prosthesis, this prosthesis can provide active mechanical power during the stance period of walking. The basic architecture of the prosthesis is a unidirectional spring, configured in parallel with a force-controllable actuator with series elasticity. With this architecture, the anklefoot prosthesis matches the size and weight of the human ankle, and is also capable of delivering high mechanical power and torque observed in normal human walking. We also propose a biomimetic control scheme that allows the prosthesis to mimic the normal human ankle behavior during walking. To evaluate the performance of the prosthesis, we measured the rate of oxygen consumption of three unilateral transtibial amputees walking at self-selected speeds to estimate the metabolic walking economy. We find that the powered prosthesis improves amputee metabolic economy from 7% to 20% compared to the conventional passive-elastic prostheses (Flex-Foot Ceterus and Freedom Innovations Sierra), even though the powered system is twofold heavier than the conventional devices. This result highlights the benefit of performing net positive work at the ankle joint to amputee ambulation and also suggests a new direction for further advancement of an ankle-foot prosthesis.

  12. Calls Forecast for the Moscow Ambulance Service. The Impact of Weather Forecast

    Science.gov (United States)

    Gordin, Vladimir; Bykov, Philipp

    2015-04-01

    We use the known statistics of the calls for the current and previous days to predict them for tomorrow and for the following days. We assume that this algorithm will work operatively, will cyclically update the available information and will move the horizon of the forecast. Sure, the accuracy of such forecasts depends on their lead time, and from a choice of some group of diagnoses. For comparison we used the error of the inertial forecast (tomorrow there will be the same number of calls as today). Our technology has demonstrated accuracy that is approximately two times better compared to the inertial forecast. We obtained the following result: the number of calls depends on the actual weather in the city as well as on its rate of change. We were interested in the accuracy of the forecast for 12-hour sum of the calls in real situations. We evaluate the impact of the meteorological errors [1] on the forecast errors of the number of Ambulance calls. The weather and the Ambulance calls number both have seasonal tendencies. Therefore, if we have medical information from one city only, we should separate the impacts of such predictors as "annual variations in the number of calls" and "weather". We need to consider the seasonal tendencies (associated, e. g. with the seasonal migration of the population) and the impact of the air temperature simultaneously, rather than sequentially. We forecasted separately the number of calls with diagnoses of cardiovascular group, where it was demonstrated the advantage of the forecasting method, when we use the maximum daily air temperature as a predictor. We have a chance to evaluate statistically the influence of meteorological factors on the dynamics of medical problems. In some cases it may be useful for understanding of the physiology of disease and possible treatment options. We can assimilate some personal archives of medical parameters for the individuals with concrete diseases and the relative meteorological archive. As a

  13. Characterization of Artifacts produced by gel displacement on non-invasive Brain-Machine Interfaces during ambulation

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    Alvaro eCosta

    2016-02-01

    Full Text Available So far, Brain-Machine Interfaces (BMIs have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals. To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training and one movement-free condition (BMI motor imagery task are compared to perform this study.Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions.

  14. Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators.

    Science.gov (United States)

    Cho, Duk Youn; Park, Si-Woon; Lee, Min Jin; Park, Dae Sung; Kim, Eun Joo

    2015-10-01

    [Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training.

  15. Response times of ambulances to calls from Midwife Obstetric Units of the Peninsula Maternal and Neonatal Service (PMNS in Cape Town

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    J.K. Marcus

    2009-09-01

    Full Text Available Response times of ambulances to calls from Midwife Obstetric Units, although varied, are perceived as slow. Delays in transporting women experiencing complications during or after their pregnancies to higher levels of care may have negative consequences such as fetal, neonatal or maternal morbidity or death. An exploratory descriptive study was undertaken to investigate the response times of ambulances of the Western Cape Emergency Medical Services to calls from midwife obstetric units (MOUs in the Peninsula Maternal and Neonatal Services (PMNS in Cape Town. Response times were calculated from data collected in specific MOUs using a specifically developed instrument. Recorded data included time of call placed requesting transfer, diagnosis or reason for transfer, priority of call and the time of arrival of ambulance to the requesting facility. Mean, median and range of response times, in minutes, to various MOUs and priorities of calls were calculated. These were then compared using the Kruskal-Wallis test. A comparison was then made between the recorded and analysed response times to national norms and recommendations for ambulance response times and maternal transfer response times respectively.A wide range of response times was noted for the whole sample. Median response times across all priorities of calls and to all MOUs in sample fell short of national norms and recommendations. No statistical differences were noted between various priorities of calls and MOUs.The perception of delayed response times of ambulances to MOUs in the PMNS was confirmed in this pilot study.

  16. Indications and results of the unilateral /sup 123/I-hippurate-clearance in an ambulant urological-nephrological patients collective

    Energy Technology Data Exchange (ETDEWEB)

    Mariss, P.; Haubold, E.

    1988-02-01

    In 572 nephrological-urological ambulant patients 688 estimations of unilateral renal plasma flow were performed after application of 300 kBq/kg /sup 123/I-hippurate using a large field scintillation camera, external scintillation probe over the right shoulder and a computer system. The indications were patients with hypertension, chronic pyelonephritis, unilateral nephrocirrhosis, exclusion or approval of renal failure, furthermore diverse malformations of the urovesical system, nephrolithiasis and follow-up after urological operations. The unilateral renal clearance by /sup 123/I-hippurate represents an important diagnostic tool in urological-nephrological patients with special diseases in addition to morphological and microbiological methods.

  17. Ambulant photodynamic therapy of superficial malignomas with 5-ALA in combination with folic acid and use of noncoherent light.

    Science.gov (United States)

    Jindra, R H; Kubin, A; Kolbabek, H; Alth, G; Dobrowsky, W

    1999-01-01

    This study reports our first results of ambulant photodynamic treatment with 5-aminolevulinic acid (5-ALA) in combination with folic acid and subsequent illumination with a noncoherent light source. The compound was topically applied to avoid total body skin sensitivity which occurs in the case of systemic administration. If no therapeutic response could be proved, we added folic acid to 5-ALA for a further treatment attempt. Illumination was performed by broad band red thermic light to also excitate reaction products with absorption bands located near to that of the sensitizer. As a result, we observed a response in all cases, however, in some cases only after the addition of folic acid.

  18. 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

    Directory of Open Access Journals (Sweden)

    Ana Paula Iannoni

    2008-01-01

    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.

  19. Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel - a cross-sectional study

    DEFF Research Database (Denmark)

    Hansen, Claus D; Rasmussen, Kurt; Kyed, Morten

    2012-01-01

    Background Reviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance......,691) and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality. Results Ambulance personnel have half the prevalence of poor self...... and meaningfulness of and commitment to work, and substantially lower levels of quantitative demands and influence at work. Only one out of ten aspects of physical work environment was consistently associated with higher levels of musculoskeletal pain. Emotional demands was the only psychosocial work factor...

  20. Living in critical times: The impact of critical incidents on frontline ambulance personnel--a qualitative perspective.

    LENUS (Irish Health Repository)

    Gallagher, Sharon

    2007-01-01

    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.

  1. Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center

    Directory of Open Access Journals (Sweden)

    Jorge Luis Alvarado-Socarras

    2016-06-01

    Full Text Available Abstract Objective: To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. Methods: Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS, and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations. Results: A total of 176 neonates were transported by ambulance (10.22% by air over six months. The transport distances were longer by air (median: 237.5 km than by ground (median: 11.3 km. Mortality was higher among neonates transported by air (33.33% than by ground (7.79%. No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted. 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.

  2. Minimally Invasive Posterior Stabilization Improved Ambulation and Pain Scores in Patients with Plasmacytomas and/or Metastases of the Spine

    Directory of Open Access Journals (Sweden)

    Joseph H. Schwab

    2011-01-01

    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.

  3. Transporte de crianças em ambulâncias terrestres: segurança e conhecimentos dos profissionais

    Directory of Open Access Journals (Sweden)

    Sílvia Faria

    2017-01-01

    Full Text Available Introdução: O transporte de crianças em ambulâncias terrestres é uma problemática ainda insuficientemente investigada em todo o mundo. Neste contexto pretende-se conhecer as medidas de segurança usadas no transporte de crianças em ambulâncias terrestres e identificar o conhecimento dos profissionais acerca das medidas a adotar para este tipo de transporte. Materiais e Métodos: Estudo quantitativo, exploratório descritivo. A análise das medidas de segurança usadas no transporte de crianças tem por base as recomendações da National Highway Traffic Safety Administration. Aplicado um questionário a 135 enfermeiros e bombeiros/tripulantes de ambulâncias portuguesas baseado em 4 possíveis situações de transporte e abrangendo 5 faixas etárias pediátricas. Resultados: Os profissionais adotam uma grande variedade de medidas de segurança na prática havendo uma diferença significativa entre a forma como transportam as crianças e o modo que consideram ser o ideal. Os resultados da avaliação do transporte situam-se mais próximos dos níveis de segurança aceitáveis do que dos níveis recomendados como ideais. Verifica-se que mulheres, profissionais graduados e enfermeiros de pediatria transportam as crianças em ambulâncias com mais segurança. Discussão e Conclusões: Muitos profissionais desconhecem as possibilidades de transporte seguro para as crianças nem conhecem recomendações para este tipo de transporte. A dispersão apurada na forma como o transporte é efetuado e os resultados obtidos sugerem a necessidade de regulamentação deste transporte, de investimento na formação dos profissionais e de sensibilização das instituições de saúde para a importância do uso de sistemas de retenção para crianças durante o seu transporte. Cómo citar este artículo: Faria S, Lomba L, Carvalhais M, Apóstolo J. Transporte de crianças em ambulâncias terrestres: segurança e conhecimentos dos profissionais. Rev Cuid

  4. Comparative evaluation of ambulation patterns and isokinetic muscle strength for the application of rehabilitation exercise in patients with patellofemoral pain syndrome.

    Science.gov (United States)

    Kim, Soonyoung

    2016-12-01

    [Purpose] The aim of this study was to evaluate the differences in the ambulation patterns and knee joint performance between people with and without patellofemoral pain. The present study also aimed to utilize these results as a basis for the development of pain-alleviating and performance-improving treatment programs. [Subjects and Methods] Subjects consisted of 32 adult females diagnosed with patellofemoral pain syndrome and 25 adult females without patellofemoral pain (controls). Contact ratio patterns during ambulation and isokinetic muscle strength around the knee joint were measured in both groups and then compared. [Results] Ambulation patterns, specifically the contact ratios of the left forefoot and right forefoot, differed significantly between patients with patellofemoral pain syndrome and controls. An isokinetic muscle strength test demonstrated that left and right knee extensor and flexor torques also significantly differed between these two groups. [Conclusion] Basic analysis based on ambulation patterns and muscle strength can be used to indicate functional recovery from patellofemoral pain syndrome and provide insight into improving the rehabilitation of patients.

  5. Field testing of a remote controlled robotic tele-echo system in an ambulance using broadband mobile communication technology.

    Science.gov (United States)

    Takeuchi, Ryohei; Harada, Hiroshi; Masuda, Kohji; Ota, Gen-ichiro; Yokoi, Masaki; Teramura, Nobuyasu; Saito, Tomoyuki

    2008-06-01

    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.

  6. A atividade de trabalho de motoristas de ambulância sob o ponto de vista ergológico

    Directory of Open Access Journals (Sweden)

    Francinaldo do Monte Pinto

    Full Text Available Objetivo: analisar a atividade dos motoristas de ambulância do Serviço Móvel de Urgência (SAMU. Métodos: foi empregada a perspectiva ergológica, que se opera a partir da concepção de vida-saúde-doença postulada por George Canguilhem, e a Ergonomia da Atividade. Foram realizadas onze entrevistas dialógicas com motoristas da Unidade de Terapia Intensiva Móvel, em 2010, no estado da Paraíba. Resultados: os motoristas atribuem as principais dificuldades para realizar o trabalho ao modo de organização prescrita do trabalho no SAMU, à gestão temporal da atividade, à atividade no trânsito, à relação com a população usuária e ao risco de contrair doenças. Em contraposição, os motoristas adquirem sentido no trabalho ao salvarem vidas, em uma conjunção de valores – solidariedade, confiança e cooperação – em relação aos socorridos e aos seus acompanhantes. Quando essa possibilidade não se concretiza, o coletivo de trabalho serve de apoio para que permaneçam na profissão, apesar das frustrações. Conclusão: evidenciou-se que, mesmo diante das variabilidades cotidianas da atividade de trabalho, os motoristas de ambulâncias produzem modos operatórios para dar conta das situações de trabalho, cooperando para solução dos problemas e/ou manejando as imprevisibilidades no trabalho em equipe.

  7. Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review

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    Ong Marcus

    2012-06-01

    Full Text Available Abstract Aims The aim of this paper was to conduct a systematic review of the published literature to address the question: “In pre-hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and Ventricular Fibrillation, does the use of mechanical Cardio-Pulmonary Resuscitation (CPR devices compared to manual CPR during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR, Return Of Spontaneous Circulation, Survival”. Methods Databases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials, Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included manikin and human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports. Results Out of 88 articles identified, only 10 studies met the inclusion criteria for further review. Of these 10 articles, 1 was Level of Evidence (LOE 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4 studies evaluated the quality of CPR in terms of compression adequacy while the remaining six studies evaluated on clinical outcomes in terms of return of spontaneous circulation (ROSC, survival to hospital admission, survival to discharge and Cerebral Performance Categories (CPC. 7 studies were supporting the clinical question, 1 neutral and 2 opposing. Conclusion In this review, we found insufficient evidence to support or refute the use of mechanical CPR devices in settings of out-of-hospital cardiac arrest and during ambulance transport. While there is some low quality evidence suggesting that mechanical CPR can improve consistency and reduce interruptions in chest compressions, there is no

  8. Upper limb strength and function changes during a one-year follow-up in non-ambulant patients with Duchenne Muscular Dystrophy: an observational multicenter trial.

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    Andreea Mihaela Seferian

    Full Text Available INTRODUCTION: Upper limb evaluation of patients with Duchenne Muscular Dystrophy is crucially important to evaluations of efficacy of new treatments in non-ambulant patients. In patients who have lost ambulation, there are few validated and informative outcome measures. In addition, longitudinal data demonstrating sensitivity to clinical evolution of outcome measures over short-term periods are lacking. PATIENTS AND METHODS: We report here the results of a one-year multicenter study using specifically designed tools to assess grip, pinch strength, and hand function in wheelchair-bound patients. Our study assessed 53 non-ambulant patients with Duchenne muscular dystrophy aged 17.1 ± 4.8 years (range: 9 - 28.1 years. The average Brooke functional score of these patients was 4.6 ± 1.1. The average forced vital capacity was 44.5% predicted and 19 patients used non-invasive ventilation. Patients were assessed at baseline, 6 months, and one year using the Motor Function Measure and innovative devices (namely the MyoSet composed of MyoGrip, MyoPinch, and MoviPlate. RESULTS: Our study confirmed preliminary data previously reported regarding feasibility of use and of reliability of the MyoSet and the correlation at baseline between distal strength and clinical outcomes such as FVC, Brooke score, age, and duration since loss of ambulation. A significant correlation was observed between the distal upper limb strength and clinical variables. The sensitive dynamometers (MyoGrip and MyoPinch and MoviPlate captured a 12-month change in non-ambulant Duchenne muscular dystrophy patients of all ages. TRIAL REGISTRATION: ClinicalTrials.gov NCT00993161 NCT00993161.

  9. Análise da configuração de SAMU utilizando múltiplas alternativas de localização de ambulâncias Analysis of SAMU configuration using multiple alternatives of ambulance location

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    Regiane Máximo de Souza

    2013-06-01

    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

  10. A Case of Blunt Traumatic Cardiac Tamponade Successfully Treated by Out-of-hospital Pericardial Drainage in a "Doctor-helicopter" Ambulance Staffed by Skilled Emergency Physicians.

    Science.gov (United States)

    Otsuka, Hiroyuki; Sato, Toshiki; Morita, Seiji; Nakagawa, Yoshihide; Inokuchi, Sadaki

    2016-03-20

    We report a 55-year-old man who relapsed into a state of shock in an ambulance before arriving at our critical care center after a fall injury. The diagnosis of cardiac tamponade was made by portable ultrasound, and immediate pericardiocentesis and drainage were performed at the heliport. He was then transported immediately to our hospital with continuous drainage and surgery was performed. After surgery, the patient was transferred to the intensive care unit in stable condition. After undergoing rehabilitation, he made a full recovery and was discharged. This case illustrates that such patients can be treated reliably by pericardial drainage performed by skilled emergency physicians in the field by making use of the "doctor-helicopter" ambulance transportation system, followed by emergency surgery in a critical care center.

  11. Quality Control Circle of Standard Management of Ambulance%提高抢救车规范管理达标率的品管圈实践

    Institute of Scientific and Technical Information of China (English)

    刘晓梅; 张国梅; 邵继凤; 张玉莲; 刘红梅

    2016-01-01

    Objective To explore the practice and effect of quality control circle (QCC) in the standard management of ambulance. Methods A QCC team was established then improvement measures were formulated after the analysis of the reasons for non-standard management of ambulances then the effect of 6-month practice was assessed. Results The rate of standard management of ambulance was improved from 49% to 79% after QCC practice and memebers in QCC team regarded that the practice benefited the improvement of management awareness and working ability. Conclusion QCC practice benefits the management of ambulances and the improvement of QCC team members ’ ability, which promotes nursing management and nursing quality.%目的:探讨品管圈活动在抢救车规范管理中的实践和效果。方法成立品管圈小组,应用品管圈活动步骤,对全院57辆抢救车管理不规范原因进行分析,制定改进措施,规范抢救车管理,实施6个月后评价效果。结果实施品管圈活动后,抢救车规范管理达标率由活动前的49%提高到活动后的79%,圈员认为本次品管圈活动提升了参与管理的意识和工作能力。结论开展品管圈活动规范了全院抢救车的管理,提高了圈员能力,对提高精细化管理水平、提升护理质量起到了积极推动的作用。

  12. Skylab IMSS checklist application study for emergency medical care. [emergency medical care operations involving the use and operation of the portable ambulance module

    Science.gov (United States)

    Carl, J. G.; Furukawa, S.

    1975-01-01

    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.

  13. Posicionamento de ambulâncias do SAMU através de Programação Inteira e Teoria de Filas

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    Bruno Barreto

    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.

  14. Pilot Field Test: The Ability to Ambulate After Landing as Assessed with Seat Egress, Walk, and Obstacle Test

    Science.gov (United States)

    Fisher, E. A.; Fomina, E. V.; Reschke, M. F.; Cerisano, J. M.; Kofman, I. S.; Gadd, N. E.; Phillips, T. R.; Lee, S. M. C.; Laurie, S. S.; Stenger, M. B.; Bloomberg, J. J.; Mulavara, A. P.; Kozlovskaya, I. B.; Tomilovskaya, E. S.

    2016-01-01

    Astronauts experience alterations in multiple physiological systems due to exposure to the microgravity conditions of space flight. These changes lead to disruption in the ability to ambulate and perform functional tasks during the initial reintroduction to a gravitational environment. Figure 1 shows a schematic representation of the components involved in postflight ataxia. Full functional recovery has not been sufficiently investigated for long-duration crewmembers. The joint U.S./Russian Pilot Field Test (PFT) experiment (a pre-cursor to Field Test (FT)) was developed to address this gap in knowledge. The PFT was conducted on crewmembers traveling on Soyuz expeditions 34S - 41S and was comprised of several tasks designed to study the recovery of sensorimotor abilities of crewmembers during the first 24 hours after landing and for several days thereafter. Closing this gap will allow us to characterize the ability of crewmembers to perform critical mission tasks that they will be expected to perform after an unassisted landing following 6 to 12 months in microgravity. The Seat Egress, Walk and Obstacle (SEWO) Test will be discussed in this poster.

  15. Advanced glycation end-products in the peritoneal fluid and in the peritoneal membrane of continuous ambulant peritoneal dialysis patients.

    Science.gov (United States)

    Mahiout, A; Ehlerding, G; Brunkhorst, R

    1996-01-01

    In patients on continuous ambulant peritoneal dialysis (CAPD) treatment, the peritoneal membrane is continuously exposed to the high glucose concentration contained in the dialysate. This may lead to the local generation of advanced glycation end-products (AGEs). To test this hypothesis we evaluated the plasma and dialysate AGE concentrations in five CAPD patients. The dialysate was measured after a 1 h and after a 12 h dwell time. Additionally, in two patients an immunohistochemical investigation of the peritoneal membrane for AGE was performed. For the determination of AGE an ELISA using a polyclonal antibody against AGE bovine serum albumin was used; the immunohistochemical staining was performed using the streptavidin-biotin complex method. We found only low concentrations of AGE in the dialysate after a 1 h dwell time; after 12 h, however, the dialysate AGE was even greater than the plasma concentration. In both peritoneal specimens we found positive staining for AGE in the interstitium of the mesothelial layer. The dialysate AGE contained a high proportion of high-molecular-weight AGE proteins and low-molecular-weight AGE was found to be in the same concentration range as the total serum AGE. We conclude that there is local generation of AGE in the peritoneal membrane and a 'washing out' of AGE from the peritoneal membrane during longer dwell times. We speculate that the accumulation of AGE might lead to some of the functional and morphological alterations observed after long-term CAPD.

  16. The effect of active warming in prehospital trauma care during road and air ambulance transportation - a clinical randomized trial

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    Naredi Peter

    2011-10-01

    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

  17. An art therapy intervention for cancer patients in the ambulant aftercare - results from a non-randomised controlled study.

    Science.gov (United States)

    Geue, K; Richter, R; Buttstädt, M; Brähler, E; Singer, S

    2013-05-01

    Art therapy in psycho-oncology is gaining increasing importance, but systematic evaluations of its effects are rare. The aim of this study is to investigate the effects of an art therapy intervention for cancer patients in ambulant aftercare on psychological distress and coping. The intervention consisted of 22 sessions. At three points of measurement (t1: before intervention, t2: following intervention, t3: 6 months after t2), participants responded to questionnaires (Freiburg Questionnaire on Coping with Illness, Perceived Adjustment to Chronic Illness Scale, Hospital Anxiety and Depression Scale). A group of haemato-oncological patients served as the comparison group (CG). Pre-post comparisons and analyses of variance were applied for statistical analysis. Relevant confounders were controlled. Fifty-four patients (intervention group, IG) with various cancer diagnoses completed the intervention. One hundred and twenty-nine data sets were available for the CG. Analyses of variance included group membership (IG vs. CG) and the following factors: gender, other psychosocial help and major life events. None of these variables was a predictor for changes in depression, anxiety and coping. Therefore, we could not prove intervention effects over time. Our results contradict those of preliminary studies and raise important questions. Further work on evaluating art therapy is necessary to explore which intervention concepts in which setting at which treatment stage show significant effects. Therefore, controlling for relevant confounders is needed.

  18. Short-term exposure to ambient particulate matter and emergency ambulance dispatch for acute illness in Japan.

    Science.gov (United States)

    Tasmin, Saira; Ueda, Kayo; Stickley, Andrew; Yasumoto, Shinya; Phung, Vera Ling Hui; Oishi, Mizuki; Yasukouchi, Shusuke; Uehara, Yamato; Michikawa, Takehiro; Nitta, Hiroshi

    2016-10-01

    Short-term exposure to air pollution may be linked to negative health outcomes that require an emergency medical response. However, few studies have been undertaken on this phenomenon to date. The aim of this study therefore was to examine the association between short-term exposure to ambient suspended particulate matter (SPM) and emergency ambulance dispatches (EADs) for acute illness in Japan. Daily EAD data, daily mean SPM and meteorological data were obtained for four prefectures in the Kanto region of Japan for the period from 2007 to 2011. The area-specific association between daily EAD for acute illness and SPM was explored using generalized linear models while controlling for ambient temperature, relative humidity, seasonality, long-term trends, day of the week and public holidays. Stratified analyses were conducted to evaluate the modifying effects of age, sex and medical conditions. Area-specific estimates were combined using meta-analyses. For the total study period the mean level of SPM was 23.7μg/m(3). In general, higher SPM was associated with a significant increase in EAD for acute illness [estimated pooled relative risk (RR): 1.008, 95% CI: 1.007 to 1.010 per 10μg/m(3) increase in SPM at lag 0-1]. The effects of SPM on EAD for acute illness were significantly greater for moderate/mild medical conditions (e.g. cases that resulted in 3weeks hospitalization or which resulted in death). Using EAD data, this study has shown the adverse health effects of ambient air pollution. This highlights the importance of reducing the level of air pollution in order to maintain population health and well-being.

  19. A cross-sectional study of Victorian mobile intensive care ambulance paramedics knowledge of the Valsalva manoeuvre

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    Boyle Malcolm J

    2009-12-01

    Full Text Available Abstract Background The Valsalva Manoeuvre (VM is a primary measure for terminating haemodynamically stable supraventricular tachycardia (SVT in the emergency care setting. The clinical use and termination success of the VM in the prehospital setting has not been investigated to date. The objective of this study was to determine Melbourne Mobile Intensive Care Ambulance (MICA Paramedic knowledge of the VM, and to compare this understanding with an evidence-based model of VM performance. Methods A cross-sectional study in the form of a face-to-face interview was used to determine Melbourne MICA Paramedic understanding of VM instruction between January and February, 2008. The results were then compared with an evidence-based model of VM performance to ascertain compliance with the three criteria of position, pressure and duration. Ethics approval was granted. Results There were 28 participants (60.9% who elected a form of supine posturing, some 23 participants (50% selected the syringe method of pressure generation, with 16 participants (34.8% selecting the "as long as you can" option for duration. On comparison, one out of 46 MICA Paramedics correctly identified the three evidence-based criteria. Conclusions The formal education of Melbourne's MICA Paramedics would benefit from the introduction of an evidence based model of VM performance, which would impact positively on patient care and may improve reversion success in the prehospital setting. The results of this study also demonstrate that an opportunity exists to promote the evidence-based VM criteria across the primary emergency care field.

  20. Development of an implanted intramuscular EMG-triggered FES system for ambulation after incomplete spinal cord injury.

    Science.gov (United States)

    Dutta, Anirban; Kobetic, Rudi; Triolo, Ronald

    2009-01-01

    Ambulation after spinal cord injury is possible with the aid of neuroprosthesis employing functional electrical stimulation (FES). Individuals with incomplete spinal cord injury (iSCI) retain partial volitional control of muscles below the level of injury, necessitating careful integration of FES with intact voluntary motor function for efficient walking. In this study, the intramuscular electromyogram (iEMG) was used to detect the intent to step and trigger FES-assisted walking in a volunteer with iSCI via an implanted neuroprosthesis consisting of two channels of bipolar iEMG signal acquisition and 12 independent channels of stimulation. The detection was performed with two types of classifiers- a threshold-based classifier that compared the running mean of the iEMG with a discrimination threshold to generate the trigger and a pattern recognition classifier that compared the time-history of the iEMG with a specified template of activity to generate the trigger whenever the cross-correlation coefficient exceeded a discrimination threshold. The pattern recognition classifier generally outperformed the threshold-based classifier, particularly with respect to minimizing False Positive triggers. The overall True Positive rates for the threshold-based classifier were 61.6% and 87.2% for the right and left steps with overall False Positive rates of 38.4% and 33.3%. The overall True Positive rates for the left and right step with the pattern recognition classifier were 57.2% and 93.3% and the overall False Positive rates were 11.9% and 24.4%. The subject showed no preference for either the threshold or pattern recognition-based classifier as determined by the Usability Rating Scale (URS) score collected after each trial and both the classifiers were perceived as moderately easy to use.

  1. A Movement Monitor Based on Magneto-Inertial Sensors for Non-Ambulant Patients with Duchenne Muscular Dystrophy: A Pilot Study in Controlled Environment.

    Directory of Open Access Journals (Sweden)

    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

  2. Efficiency of the prehospital cardiopulmonary resuscitation of 785 patients treaded by the team of the Berlin-Friedrichshain-ambulance between 1995 and 1998

    OpenAIRE

    2010-01-01

    Between 1995 and 1998 the Berlin-Friedrichshain-Ambulance (BFA) started 785 cardiopulmonary resuscitations (CPR) (96,2 % adults). Registered are 498 (66,0 %) male and 257 (34,0 %) female persons at the age between 18 and 94 years (ys) (63,7 ± 16,7 ys). In 40,7 % the CPR has been initial successful. 37 patients have been discharged from the hospital. That means only 4,9 % of all registered adults (n = 755) have been discharged, it also means that 12,1 % of the initial successful treated...

  3. Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest: a prospective cohort analysis.

    Directory of Open Access Journals (Sweden)

    Akihito Hagihara

    Full Text Available The presence of a physician seems to be beneficial for pre-hospital cardiopulmonary resuscitation (CPR of patients with out-of-hospital cardiac arrest. However, the effectiveness of a physician's presence during CPR before hospital arrival has not been established. We conducted a prospective, non-randomized, observational study using national data from out-of-hospital cardiac arrests between 2005 and 2010 in Japan. We performed a propensity analysis and examined the association between a physician's presence during an ambulance car ride and short- and long-term survival from out-of-hospital cardiac arrest. Specifically, a full non-parsimonious logistic regression model was fitted with the physician presence in the ambulance as the dependent variable; the independent variables included all study variables except for endpoint variables plus dummy variables for the 47 prefectures in Japan (i.e., 46 variables. In total, 619,928 out-of-hospital cardiac arrest cases that met the inclusion criteria were analyzed. Among propensity-matched patients, a positive association was observed between a physician's presence during an ambulance car ride and return of spontaneous circulation (ROSC before hospital arrival, 1-month survival, and 1-month survival with minimal neurological or physical impairment (ROSC: OR = 1.84, 95% CI 1.63-2.07, p = 0.00 in adjusted for propensity and all covariates; 1-month survival: OR = 1.29, 95% CI 1.04-1.61, p = 0.02 in adjusted for propensity and all covariates; cerebral performance category (1 or 2: OR = 1.54, 95% CI 1.03-2.29, p = 0.04 in adjusted for propensity and all covariates; and overall performance category (1 or 2: OR = 1.50, 95% CI 1.01-2.24, p = 0.05 in adjusted for propensity and all covariates. A prospective observational study using national data from out-of-hospital cardiac arrests shows that a physician's presence during an ambulance car ride was independently associated with

  4. Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial

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    Freeman Jennifer

    2012-04-01

    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

  5. Oregon Air Ambulance Services.

    Science.gov (United States)

    1986-01-01

    34 SECURITY CLASSIFICATION OF THjIS PAGE (147.- D.In Enieod) REPORT DO~ CUMEN ~TATIONI PAGE REAL) 1NST1RucTrIONSMB 1E1ORE COMP1LETI-’YNG FORM 1 . REPORT NUMBER... reactions to flight must be guarded. 4. Aeromedical Transport. A breakdown of the 152 patients transported by agency is presented on Table 8. Agency No. 11

  6. The Groningen Ambulance Study

    NARCIS (Netherlands)

    Svilaas, T; Dijk, WA; Busman, JP; Dassen, WRM; de Vos, R; Zijlstra, F

    2005-01-01

    This paper describes the effects of a treatment protocol for patients with ST elevation myocardial infarction, which was introduced in 2004. The setup of the new approach is described. The principle goal is to minimize time between onset of symptoms associated with acute myocardial infarction and re

  7. Investigation of the contamination of air and articles in ambulance and the effect of disinfection observation%救护车内空气、物品染菌量调查及干预效果观察

    Institute of Scientific and Technical Information of China (English)

    杨丽萍

    2011-01-01

    Objective: To investigate the bacterial contamination of air and articles in ambulance, and observe the effect of disinfection. Methods: The bacterial contamination of the air and articles in one ambulance were detected before and after disinfection in early,middle and end per month from May. 2009 to Oct. 2009. Results :The pollution situation of air and articles in ambulance was serious before disinfection. The bacterial contamination was decreased significantly after disinfection. And the difference was statistically significant( P < 0.01 ). Conclusions: The pollution situation of air and articles in ambulance is serious. It is necessary to establish a strict disinfection management system.%目的:调查救护车内空气、物品的染菌量情况,观察消毒处理的效果.方法:2009年5~10月的每月上、中、下旬对3辆救护车内空气和物品表面进行消毒前后染菌量监测.结果:消毒前救护车内空气和物品的污染情况严重,消毒后染菌量明显下降(P<0.01).结论:救护车内空气和物品的污染状况严重,需加强其消毒和监测工作.

  8. A comparison of adherence to correctly documented triage level of critically ill patients between emergency department and the ambulance service nurses.

    Science.gov (United States)

    Jönsson, Kenneth; Fridlund, Bengt

    2013-07-01

    Priority or triage has always occurred in emergency care. Today it is performed by both nurses in emergency departments (EDs) and ambulance services (ASs) to ensure patient safety. Recent studies have shown that nurses are unlikely to change their first impressions and patients suffering from blunt trauma are undertriaged. Our study aimed to compare and evaluate the adherence to correct triage level documentation, between nurses in the ED and the AS, according to current regulations. Of 592 analysed triage records from a university, a central and a district hospital, the adherence was 64% by ED nurses and 43% by AS nurses (pnurses do not adhere to the triage system and do not correctly document the triage level. Internal feedback and control are two approaches to improve the patient outcome, indicating that organisational actions must be taken.

  9. Anàlisi dels referents culturals en les traduccions catalana i castellana de la pel·lícula 'El castell ambulant'

    OpenAIRE

    Gorgas Canals, Maria

    2016-01-01

    Els referents culturals són un fenomen que ha estat molt estudiat en el camp de la traducció a causa de la complexitat que suposa expressar una realitat pròpia d'una llengua i d'una cultura en una altra llengua diferent. En aquest treball de final de grau es pretén realitzar una anàlisi i una classificació dels referents culturals que apareixen a la pel•lícula d'animació japonesa d'El Castell Ambulant i de la traducció que se n'ha fet a les versions espanyola i catalana. Aprofitant que dispos...

  10. Weakness and the Inability to Ambulate in a 14-Month-Old Female: A Case Report and Concise Review of Guillain-Barre Syndrome

    Directory of Open Access Journals (Sweden)

    Scott A. Bloch

    2013-01-01

    Full Text Available Guillain-Barre syndrome (GBS is an acquired disease of the peripheral nervous system which causes demyelination and leads to weakness, ataxia, and areflexia. There are a variety of forms of the syndrome, and although it is found in all age groups, it is rare in children less than two years of age. The present complaint of weakness, ataxia, or lower extremity pain in the pediatric population should cause the practitioner to consider GBS in the differential. We describe a case of a 14-month-old girl presenting with weakness and the inability to ambulate who was diagnosed with GBS. The purpose of this paper is to review the emergency medicine diagnosis and management of Guillain-Barre syndrome in children.

  11. On-scene alternatives for emergency ambulance crews attending patients who do not need to travel to the accident and emergency department: a review of the literature.

    Science.gov (United States)

    Snooks, H A; Dale, J; Hartley-Sharpe, C; Halter, M

    2004-03-01

    With rising demand and recognition of the variety of cases attended by emergency ambulance crews, services have been considering alternative ways of providing non-urgent care. This paper describes and appraises the research literature concerning on-scene alternatives to conveyance to an emergency department, focusing on the: (1) profile and outcomes of patients attended but not conveyed by emergency crews; (2) triage ability of crews; (3) effectiveness and safety of protocols that allow crews to convey patients to alternative receiving units or to self care. The literature search was conducted through standard medical databases, supplemented with manual searches. Very few "live" studies were identified, and fewer still that included a control group. Findings indicated a complex area, with the introduction of protocols allowing crews to leave patients at scene carrying clinical risk. Robust research evidence concerning alternatives to current emergency care models is needed urgently to inform service and practice development.

  12. An artificial neural network to safely reduce the number of ambulance ECGs transmitted for physician assessment in a system with prehospital detection of ST elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Forberg Jakob L

    2012-02-01

    Full Text Available Abstract Background Pre-hospital electrocardiogram (ECG transmission to an expert for interpretation and triage reduces time to acute percutaneous coronary intervention (PCI in patients with ST elevation Myocardial Infarction (STEMI. In order to detect all STEMI patients, the ECG should be transmitted in all cases of suspected acute cardiac ischemia. The aim of this study was to examine the ability of an artificial neural network (ANN to safely reduce the number of ECGs transmitted by identifying patients without STEMI and patients not needing acute PCI. Methods Five hundred and sixty ambulance ECGs transmitted to the coronary care unit (CCU in routine care were prospectively collected. The ECG interpretation by the ANN was compared with the diagnosis (STEMI or not and the need for an acute PCI (or not as determined from the Swedish coronary angiography and angioplasty register. The CCU physician's real time ECG interpretation (STEMI or not and triage decision (acute PCI or not were registered for comparison. Results The ANN sensitivity, specificity, positive and negative predictive values for STEMI was 95%, 68%, 18% and 99%, respectively, and for a need of acute PCI it was 97%, 68%, 17% and 100%. The area under the ANN's receiver operating characteristics curve for STEMI detection was 0.93 (95% CI 0.89-0.96 and for predicting the need of acute PCI 0.94 (95% CI 0.90-0.97. If ECGs where the ANN did not identify a STEMI or a need of acute PCI were theoretically to be withheld from transmission, the number of ECGs sent to the CCU could have been reduced by 64% without missing any case with STEMI or a need of immediate PCI. Conclusions Our ANN had an excellent ability to predict STEMI and the need of acute PCI in ambulance ECGs, and has a potential to safely reduce the number of ECG transmitted to the CCU by almost two thirds.

  13. Upper limb evaluation and one-year follow up of non-ambulant patients with spinal muscular atrophy: an observational multicenter trial.

    Directory of Open Access Journals (Sweden)

    Andreea Mihaela Seferian

    Full Text Available Assessment of the upper limb strength in non-ambulant neuromuscular patients remains challenging. Although potential outcome measures have been reported, longitudinal data demonstrating sensitivity to clinical evolution in spinal muscular atrophy patients are critically lacking. Our study recruited 23 non-ambulant patients, 16 patients (males/females = 6/10; median age 15.4 years with a range from 10.7 to 31.1 years with spinal muscular atrophy type II and 7 patients (males/females = 2/5; median age 19.9 years with a range from 8.3 to 29.9 years with type III. The Brooke functional score was on median 3 with a range from 2 to 6. The average total vital capacity was 46%, and seven patients required non-invasive ventilation at night. Patients were assessed at baseline, 6 months, and 1 year using the Motor Function Measure and innovative devices MyoGrip, MyoPinch, and MoviPlate, which assess handgrip strength, key pinch strength, and hand/finger extension-flexion function, respectively. The study demonstrated the feasibility and reliability of these measures for all patients, and sensitivity to negative changes after the age of 14 years. The younger patients showed an increase of the distal force in the follow-up period. The distal force measurements and function were correlated to different functional scales. These data represent an important step in the process of validating these devices as potential outcome measures for future clinical trials.

  14. Effects of different kinds of artificial airway in prehospital ambulance%不同人工气道在院外救护车内的应用

    Institute of Scientific and Technical Information of China (English)

    张吉新; 李士华; 张颖; 毕宝林; 崔兆伟

    2013-01-01

    Objective To compare the effects in cardiopulmonary resuscitation of 3 kinds of artificial airway: conventional tracheal intubation, blind insertion of laryngeal mask, and esophageal-tracheal combined tube in prehospital ambulance.Methods 328 cases undergoing CPR in the prehospital ambulance were Randomly divided into 3 groups: Group A (n=68) undergoing conventional tracheal intubation, Group B (n=140) undergoing blind insertion of laryngeal mask, and Group C (n=l 10) undergoing insertion of esophageal-tracheal combined tube. The time needed to establish artificial airway, one-time success rate of insertion, and resuscitation success rate were compared among these 3 groups. Results The time needed to establish artificial airway of Group B was (26±11.3) s, significantly shorter than those of Groups A and C[(l46±14.7)s and (81±16.5)s respectively , both P0.05). There were not significant differences in the resuscitation success rate among these 3 groups (26.5%,25.7% and 27.3%). Conclusion blind insertion of laryngeal mask is the best choice for CPR in prehospital ambulance, followed by insertion of esophageal tracheal combitube.%目的 探讨院外急救车上心肺复苏(CPR)建立人工气道通气的最佳方法和对复苏成功率的影响.方法 对院外急救车上发生心跳呼吸骤停患者318例,根据当时CPR时对患者随机建立人工气道的3种不同方法,将其分为3组,进行回顾性分析,A组68例,常规行气管导管插管;B组140例,盲插喉罩通气;C组110例,食管气管联合导管通气.结果 B组建立人工通气需(26±11.3)s,显著短于A组和C组[分别为(146±14.7)s和(81±16.5),均P<0.05].A组建立人工通气所需时间显著长于C组(P<0.05).盲插喉罩通气时间最短,其次是食管气管联合导管插管术,气管插管术最慢.B组一次插管成功率为100%,显著高于A组(60.3%,P<0.05),与C组的差异无显著性(98.2%,P>0.05).B组与C组之间差异无统计学意义(P>0.05).A

  15. Determining the Feasibility of Ambulance-Based Randomised Controlled Trials in Patients with Ultra-Acute Stroke: Study Protocol for the "Rapid Intervention with GTN in Hypertensive Stroke Trial" (RIGHT, ISRCTN66434824).

    Science.gov (United States)

    Ankolekar, Sandeep; Sare, Gillian; Geeganage, Chamila; Fuller, Michael; Stokes, Lynn; Sprigg, Nikola; Parry, Ruth; Siriwardena, A Niroshan; Bath, Philip M W

    2012-01-01

    Background. Time from acute stroke to enrolment in clinical trials needs to be reduced to improve the chances of finding effective treatments. No completed randomised controlled trials of ambulance-based treatment for acute stroke have been reported in the UK, and the practicalities of recruiting, consenting, and treating patients are unknown. Methods. RIGHT is an ambulance based, single-blind, randomised controlled trial with blinded-outcome assessment. The trial will assess feasibility of using ambulance services to deliver ultra-acute stroke treatments; a secondary aim is to assess the effect of glyceryl trinitrate (GTN) on haemodynamic variables and functional outcomes. Initial consent, randomisation, and treatment are performed by paramedics prior to hospitalisation. Patients with ultra-acute stroke (≤4 hours of onset) are randomised to transdermal GTN (5 mg/24 hours) or gauze dressing daily for 7 days. The primary outcome is systolic blood pressure at 2 hours. Secondary outcomes include feasibility, haemodynamics, dependency, and other functional outcomes. A nested qualitative study is included. Trial Status. The trial has all relevant ethics and regulatory approvals and recruitment started on February 15, 2010. The trial stopped recruitment in December 2011 after 41 patients were recruited. Trial Registration. The trial registration number is ISRCTN66434824 and EudraCT number is 2007-004766-40.

  16. Immediate Return to Ambulation and Improved Functional Capacity for Rehabilitation in Complex Regional Pain Syndrome following Early Implantation of a Spinal Cord Stimulation System

    Directory of Open Access Journals (Sweden)

    Brandon Jesse Goff

    2014-01-01

    Full Text Available Complex regional pain syndrome (CRPS is a neuropathic pain condition that is characterized by vasomotor, sensory, sudomotor, and motor symptoms. Spinal cord stimulation (SCS has been successfully utilized for the treatment of pain refractory to conventional therapies. We present a case of a previously highly functioning 54-year-old female who developed a rarely reported case of idiopathic CRPS of the right ankle which spontaneously occurred four months after an uncomplicated anterior cervical disc fusion. This condition resulted in severe pain and functional impairment that was unresponsive to pharmacological management. The patient’s rehabilitation was severely stymied by her excruciating pain. However, with the initiation of spinal cord stimulation, her pain was adequately controlled allowing for progression to full unassisted ambulation, advancing functional capacity, and improving quality of life. This case report supports the concept that rapid progression to neuromodulation, rather than delays that occur due to attempts at serial sympathetic blocks, may better control symptoms leading allowing for a more meaningful recovery.

  17. Integrated Suit Test 1 - A Study to Evaluate Effects of Suit Weight, Pressure, and Kinematics on Human Performance during Lunar Ambulation

    Science.gov (United States)

    Gernhardt, Michael L.; Norcross, Jason; Vos, Jessica R.

    2008-01-01

    In an effort to design the next generation Lunar suit, NASA has initiated a series of tests aimed at understanding the human physiological and biomechanical affects of space suits under a variety of conditions. The first of these tests was the EVA Walkback Test (ICES 2007-01-3133). NASA-JSC assembled a multi-disciplinary team to conduct the second test of the series, titled Integrated Suit Test 1 (IST-1), from March 6 through July 24, 2007. Similar to the Walkback Test, this study was performed with the Mark III (MKIII) EVA Technology Demonstrator suit, a treadmill, and the Partial Gravity Simulator in the Space Vehicle Mock-Up Facility at Johnson Space Center. The data collected for IST-1 included metabolic rates, ground reaction forces, biomechanics, and subjective workload and controllability feedback on both suited and unsuited (shirt-sleeve) astronaut subjects. For IST-1 the center of gravity was controlled to a nearly perfect position while the weight, pressure and biomechanics (waist locked vs. unlocked) were varied individually to evaluate the effects of each on the ability to perform level (0 degree incline) ambulation in simulated Lunar gravity. The detailed test methodology and preliminary key findings of IST-1 are summarized in this report.

  18. Neutral Caregivers or Military Support? The British Red Cross, the Friends’ Ambulance Unit, and the Problems of Voluntary Medical Aid in Wartime

    Science.gov (United States)

    2015-01-01

    During the First World War the British Red Cross Society (BRCS) served as the coordinating body for voluntary medical aid giving in Britain. Among the many units which came within its purview was the Friends’ Ambulance Unit (FAU), formed by a group of young men whose desire to serve their nation in wartime conflicted with their pacifist principles. Both the BRCS and the FAU were wracked by ideological conflicts in the years which preceded and throughout the war. These struggles over voluntarist identity highlight the contested meanings of service and conscience in wartime. Through a critical examination of the language of official histories and biographies, this article will argue that the war formed a key moment in the relationship between the British state and voluntary medical aid, with the state’s increasing role in the work of such organizations raising questions about the voluntarist principles to which aid organizations laid claim. The struggles that both organizations and individuals within them faced in reconciling the competing pressures that this new relationship created form a legacy of the war which continues to have important implications for the place of medical voluntarism in wartime today. PMID:26213442

  19. Neutral Caregivers or Military Support? The British Red Cross, the Friends' Ambulance Unit, and the Problems of Voluntary Medical Aid in Wartime.

    Science.gov (United States)

    Meyer, Jessica

    2015-05-01

    During the First World War the British Red Cross Society (BRCS) served as the coordinating body for voluntary medical aid giving in Britain. Among the many units which came within its purview was the Friends' Ambulance Unit (FAU), formed by a group of young men whose desire to serve their nation in wartime conflicted with their pacifist principles. Both the BRCS and the FAU were wracked by ideological conflicts in the years which preceded and throughout the war. These struggles over voluntarist identity highlight the contested meanings of service and conscience in wartime. Through a critical examination of the language of official histories and biographies, this article will argue that the war formed a key moment in the relationship between the British state and voluntary medical aid, with the state's increasing role in the work of such organizations raising questions about the voluntarist principles to which aid organizations laid claim. The struggles that both organizations and individuals within them faced in reconciling the competing pressures that this new relationship created form a legacy of the war which continues to have important implications for the place of medical voluntarism in wartime today.

  20. Monitoring the effect of air pollution episodes on health care consultations and ambulance call-outs in England during March/April 2014: A retrospective observational analysis.

    Science.gov (United States)

    Elliot, Alex J; Smith, Sue; Dobney, Alec; Thornes, John; Smith, Gillian E; Vardoulakis, Sotiris

    2016-07-01

    There is an increasing body of evidence illustrating the negative health effects of air pollution including increased risk of respiratory, cardiac and other morbid conditions. During March and April 2014 there were two air pollution episodes in England that occurred in close succession. We used national real-time syndromic surveillance systems, including general practitioner (GP) consultations, emergency department attendances, telehealth calls and ambulance dispatch calls to further understand the impact of these short term acute air pollution periods on the health seeking behaviour of the general public. Each air pollution period was comparable with respect to particulate matter concentrations (PM10 and PM2.5), however, the second period was longer in duration (6 days vs 3 days) and meteorologically driven 'Sahara dust' contributed to the pollution. Health surveillance data revealed a greater impact during the second period, with GP consultations, emergency department attendances and telehealth (NHS 111) calls increasing for asthma, wheeze and difficulty breathing indicators, particularly in patients aged 15-64 years. Across regions of England there was good agreement between air quality levels and health care seeking behaviour. The results further demonstrate the acute impact of short term air pollution episodes on public health and also illustrate the potential role of mass media reporting in escalating health care seeking behaviour.

  1. Application of trans-theoretical model of behavior in ambulation training of stroke hemiplegic patients%行为转变理论在脑卒中偏瘫患者步行训练中的应用

    Institute of Scientific and Technical Information of China (English)

    张艳; 陈剑苹; 蒋辛

    2015-01-01

    Objective To study the effect of trans-theoretical model of behavior on ambulation training in stroke hemiplegic patients. Methods Sixty hospitalized stroke hemiplegic patients from June to December 2013 were selected as control group. The control group was treated with routine nursing and ambulation training guidance. Sixty-two hospitalized stroke hemiplegia patients, from January 2014 to June 2014, were selected as intervention group. Patients in the intervention group received trans-theoretical model of behavior together with ambulation training guidance for 3 weeks and follow-up record for 6 months. Holden functional ambulation categories ( FAC ) and Bathel index were used to evaluate the effect of ambulation training . Result Trans-theoretical model of behavior training improved the walking function and activities of daily living in intervention group patients , compared with those of the control group. Conclusions Taking trans-theoretical model of behavior in walking training health education can improve the ambulation ability and ability of daily living of stroke hemiplegic patients. Therefore this theory can enhance the stroke hemiplegic patients′life quality.%目的:探讨行为转变理论在脑卒中偏瘫患者步行训练中的应用效果。方法将2013年6~12月在本院住院60例脑卒中偏瘫患者设为对照组,实施常规的护理及步行训练指导;将2014年1~6月在本院住院62例脑卒中偏瘫患者设为干预组,将行为转变理论应用于患者步行训练健康教育中,干预时间3周,随访时间6个月。采用Holden步行功能分级(functional ambulation categories, FAC)和Bathel指数对患者进行测评。结果训练后两组患者FAC测评结果和Bathel得分比较,差异均有统计学意义(P<0.05),干预组患者步行功能和日常活动能力均优于对照组。结论将行为转变理论应用于脑卒中偏瘫患者步行训练健康教育中,可提高患者步行能

  2. Robot-assisted gait training improves brachial–ankle pulse wave velocity and peak aerobic capacity in subacute stroke patients with totally dependent ambulation

    Science.gov (United States)

    Han, Eun Young; Im, Sang Hee; Kim, Bo Ryun; Seo, Min Ji; Kim, Myeong Ok

    2016-01-01

    Abstract Objective: Brachial–ankle pulse wave velocity (baPWV) evaluates arterial stiffness and also predicts early outcome in stroke patients. The objectives of this study were to investigate arterial stiffness of subacute nonfunctional ambulatory stroke patients and to compare the effects of robot-assisted gait therapy (RAGT) combined with rehabilitation therapy (RT) on arterial stiffness and functional recovery with those of RT alone. Method: The RAGT group (N = 30) received 30 minutes of robot-assisted gait therapy and 30 minutes of conventional RT, and the control group (N = 26) received 60 minutes of RT, 5 times a week for 4 weeks. baPWV was measured and calculated using an automated device. The patients also performed a symptom-limited graded exercise stress test using a bicycle ergometer, and parameters of cardiopulmonary fitness were recorded. Clinical outcome measures were categorized into 4 categories: activities of daily living, balance, ambulatory function, and paretic leg motor function and were evaluated before and after the 4-week intervention. Results: Both groups exhibited significant functional recovery in all clinical outcome measures after the 4-week intervention. However, peak aerobic capacity, peak heart rate, exercise tolerance test duration, and baPWV improved only in the RAGT group, and the improvements in baPWV and peak aerobic capacity were more noticeable in the RAGT group than in the control group. Conclusion: Robot-assisted gait therapy combined with conventional rehabilitation therapy represents an effective method for reversing arterial stiffness and improving peak aerobic capacity in subacute stroke patients with totally dependent ambulation. However, further large-scale studies with longer term follow-up periods are warranted to measure the effects of RAGT on secondary prevention after stroke. PMID:27741123

  3. Aplicação do modelo hipercubo de filas para avaliar a descentralização de ambulâncias em um sistema urbano de atendimento médico de urgência

    Directory of Open Access Journals (Sweden)

    Renata Algisi Takeda

    2004-04-01

    Full Text Available Uma das maiores preocupações de sistemas urbanos de atendimento médico-emergencial é a rapidez no atendimento às vítimas. Os tempos de resposta dependem de diversos fatores como condições de tráfego local, dia da semana e período do dia, tipo e número de veículos disponíveis, localização destes veículos, políticas de despacho, etc. Neste trabalho apresenta-se uma análise dos efeitos da descentralização de ambulâncias que operam no sistema de atendimento médico-emergencial (SAMU-192 de Campinas, SP. O problema é tratado por meio do modelo hipercubo de filas espacialmente distribuídas, que considera variações aleatórias dos processos de chegada e atendimento dos chamados emergenciais. A aplicação do modelo produz uma ampla variedade de indicadores de desempenho para o sistema, que são comparados com os valores reais observados. Os resultados obtidos com a descentralização das ambulâncias mostraram uma significativa elevação do nível de serviço oferecido aos usuários.One of the major concerns of urban emergency medical systems is to provide the fastest possible first care medical assistance to the victims. The response times depend on different aspects such as: local traffic conditions, weekday and time, type and number of available vehicles, location of these vehicles, dispatching policies, etc. This work analyzes the effects of decentralizing ambulances in the emergency medical system (SAMU-192 of Campinas, SP. The problem is dealt with the hypercube queuing model, which considers stochastic variations of the arrival and service processes of the emergency calls. The application of the model produces a wide variety of system performance indicators, which are compared to the actual observed values. The results obtained with ambulance decentralization showed a significant increase in the service level offered to the users.

  4. Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Provider Enrollment Moratoria Access Waiver Demonstration of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Moratoria-Designated Geographic Locations. Implementation of the waiver demonstration.

    Science.gov (United States)

    2016-08-03

    This notice announces the Provider Enrollment Moratoria Access Waiver Demonstration of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in 6 states. The demonstration is being implemented in accordance with section 402 of the Social Security Amendments of 1967 and gives CMS the authority to grant waivers to the statewide enrollment moratoria on a case-by-case basis in response to access to care issues, and to subject providers and suppliers enrolling via such waivers to heightened screening, oversight, and investigations.

  5. Ambulation and spinal cord injury.

    Science.gov (United States)

    Hardin, Elizabeth C; Kobetic, Rudi; Triolo, Ronald J

    2013-05-01

    Walking is possible for many patients with a spinal cord injury. Avenues enabling walking include braces, robotics and FES. Among the benefits are improved musculoskeletal and mental health, however unrealistic expectations may lead to negative changes in quality of life. Use rigorous assessment standards to gauge the improvement of walking during the rehabilitation process, but also yearly. Continued walking after discharge may be limited by challenges, such as lack of accessibility in and outside the home, and complications, such as shoulder pain or injuries from falls. It is critical to determine the risks and benefits of walking for each patient.

  6. Application of 4 different sterilization methods applied for ambulance air disinfection%4种消毒方法在急救车物体表面消毒的应用效果

    Institute of Scientific and Technical Information of China (English)

    舒艳; 杨建国; 李素英; 王梅; 陈明

    2011-01-01

    目的 通过对北京市救护车污染状况、污染菌种的分析,研究探讨快速、有效、规范的救护车的消毒方法及卫生学监测标准. 方法 将164辆急救车分为4组,紫外线组、臭氧组、二氧化氯消毒剂组为3个试验组,清水组为对照组;每次急救车使用后及清洗消毒后对物体表面采样,并进行细菌培养计数及细菌鉴定. 结果 对照组、紫外线组、臭氧组及二氧化氯消毒剂组清洗消毒后菌落数分别是0.68、0.56、0.24、0.36 CFU/m2,均能达到消毒技术管理规范要求,符合Ⅲ类环境物体表面菌落总数≤10 CFU/m2范围,杀菌率分别为71.5%、82.9%、87.1%及82.1%,二氧化氯消毒剂擦拭的消毒效果明显好于对照组,差异有统计学意义(P<0.05),紫外线和臭氧的消毒效果与对照比较,差异无统计学意义. 结论 二氧化氯消毒剂擦拭方法快速、有效,适用于急救车内壁及院外急救设备的卫生学监测标准.%OBJECTIVE To explore a rapid, effective and normative disinfection method and hygiene monitoring standard by analyzing ambulance pollution status and bacteria species. METHODS A total of 164 ambulances were divided into 4 groups, namely UV group, Ozone group, chlorine dioxide disinfectant group was set as experimental group and pure water group as control group. Every time after the use of ambulance and disinfection,the surfaces of ambulances were sampled, bacterial culture counts and the bacterial identification were performed.RESULTS After being disinfected, the colonies of 4 different methods were 0. 68,0. 56,0. 24 and 0. 36 CFU/m2 ,respectively, which met the requirement of management regulation and the No. 3 environmental standard on the total number of surface colonies (≤ 10 CFU/m2 ). The sterilization rates were 71. 5 %, 82. 9%, 87. 1 % and 82. 1 %, respectively. By pairwise comparison, the effect of chlorine dioxide aerosols was significantly better than that of control group (P<0

  7. Occupational accidents among ambulance drivers in the emergency relief Accidentes del trabajo de conductores de ambulancia que brindan atención de urgencia Acidentes de trabalho com motoristas de ambulâncias que realizam socorro de urgência

    Directory of Open Access Journals (Sweden)

    Elisabete Takeda

    2007-06-01

    Full Text Available 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.Fue estudiada la frecuencia de accidentes del trabajo (AT con chóferes de ambulancia que brinda Atención de Urgencia (AU, buscando encontrar los tipos de accidentes y sus causas. La investigación fue cuanti-cualitativa, para lo cual fueron entrevistados 22 trabajadores de una ciudad en el Estado de São Paulo. Los sujetos eran de sexo masculino, con edades entre 36 y 40 años (40,9%, casados (81,82%, con educación primaria incompleta (40,9%, sueldo individual (90,9%, sueldo familiar (54,55% entre dos y cuatro sueldos mínimos y sin otra ocupación (45,45%. La gran mayoría de los AT fueron típicos, por exceso de ejercicios, movimientos enérgicos y repetidos (42,11% y daño por fuerza corporal y otras formas (26,33%. Los AT se dieron principalmente porque los chóferes realizaban actividades que no iban de acuerdo con su formación profesional.Estudou-se a ocorrência de acidentes de trabalho (AT com motoristas de ambulância que realizam Socorro de Urgência (SU, buscando evidenciar os tipos desses eventos e suas causas. A investigação foi quanti-qualitativa, entrevistando-se 22 trabalhadores que atuam em uma cidade paulista. Os

  8. Effects of weight relieving ambulator on walking function of hemiplegic patients with cerebral stroke%减重步态机器人对脑卒中偏瘫患者步行功能的影响

    Institute of Scientific and Technical Information of China (English)

    程明; 崔微; 王雪梅; 余茜

    2013-01-01

    目的 研究步态机器人训练对脑卒中偏瘫患者运动功能的影响.方法 将50例偏瘫患者分为2组,综合康复组行常规康复及减重步态机器人治疗,普通康复组行单纯康复治疗,疗程均为一个月,采用Carr-Shepherd运动功能评定(MAS)中的步行评定法对两组步行能力及临床疗效进行评定并且比较.结果 综合康复组患者步行能力较普通康复组改善明显,总有效率明显高于普通康复组(P<0.05).结论 减重步态机器人对偏瘫患者的恢复步行能力及改善异常步态有积极的作用.%Objective To study the effects of weight relieving ambulator on walking function of hemiplegic patients suffered from cerebral stroke. Methods Fifty hemiplegic patients were randomly divided into two groups: the comprehensive rehabilitation group and the general rehabilitation group. The comprehensive rehabilitation group was treated in the conventional method combined with weight relieving ambulator, while the general rehabilitation group was treated with the conventional method only. The period of treatment was one month. After treatment, the Carr-Shepherd assessment of motor function ( MAS ) was used to compare the walking function between the two groups. Results Patients of the comprehensive rehabilitation group had more improvements in walking ability than those of the general rehabilitation group did. Conclusion It is concluded that the weight relieving ambulator has a positive effect on the improvement of walking ability and abnormal gait of hemiplegic patients.

  9. Direct ambulance transport to catheterization laboratory reduces door-to-balloon time in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the DIRECT-STEMI study

    Institute of Scientific and Technical Information of China (English)

    QIU Jian-ping; ZHANG Qi; LU Ji-de; WANG Hai-rong; LIN Jie; GE Zhi-ru; ZHANG Rui-yan; SHEN Wei-feng

    2011-01-01

    Background Primary percutaneous coronary intervention (PCI) has been clearly identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction (STEMI). The importance of reducing door-to-balloon (D2B) time has gained increased recognition. This study aimed to assess the feasibility, safety and efficacy of the strategy of direct ambulance transportation of patients with acute STEMI to catheterization lab to receive primary PCI.Methods The study population included 141 consecutive patients with chest pain and ST-segment elevation who were admitted to the catheterization laboratory directly by the ambulance and underwent primary PCI (DIRECT group).Another 145 patients with STEMI randomly selected from the PCI database, were served as control group (conventional group); they were transported to catheterization laboratory from emergency room (ER). The primary endpoint of D2B time,and secondary endpoint of in-hospital and 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization) were compared.Results Baseline and procedural characteristics between the two groups were comparable, except more patients in the DIRECT group presented TIMI 0-1 flow in culprit vessel at initial angiogram (80.1% and 73.8%, P=0.04). Comparing to conventional group, the primary endpoint of D2B time was reduced ((54±18) minutes and (112±55) minutes, P <0.0001)and the percentage of patients with D2B <90 minutes was increased in the DIRECT group (96.9% and 27.0%, P<0.0001).The success rate of primary PCI with stent implantation with final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was significantly higher in the DIRECT group (93.8% and 85.2%, P=0.03). Although no significant difference was found at 30-day MACE free survival rate between the two groups (95.0% and 89.0%, P=0.06), a trend in improving survival status in the DIRECT group was demonstrated by Kaplan-Meier analysis

  10. Evaluation of the effects of botulinum toxin A injections when used to improve ease of care and comfort in children with cerebral palsy whom are non-ambulant: a double blind randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Thorley Megan

    2012-08-01

    Full Text Available Abstract Background Children with cerebral palsy (CP whom are non-ambulant are at risk of reduced quality of life and poor health status. Severe spasticity leads to discomfort and pain. Carer burden for families is significant. This study aims to determine whether intramuscular injections of botulinum toxin A (BoNT-A combined with a regime of standard therapy has a positive effect on care and comfort for children with CP whom are non-ambulant (GMFCS IV/V, compared with standard therapy alone (cycle I, and whether repeated injections with the same regime of adjunctive therapy results in greater benefits compared with a single injecting episode (cycle II. The regime of therapy will include serial casting, splinting and/or provision of orthoses, as indicated, combined with four sessions of goal directed occupational therapy or physiotherapy. Method/design This study is a double blind randomized controlled trial. Forty participants will be recruited. In cycle I, participants will be randomized to either a treatment group who will receive BoNT-A injections into selected upper and/or lower limb muscles, or a control group who will undergo sham injections. Both groups will receive occupational therapy and /or physiotherapy following injections. Groups will be assessed at baseline then compared at 4 and 16 weeks following injections or sham control. Parents, treating clinicians and assessors will be masked to group allocation. In cycle II, all participants will undergo intramuscular BoNT-A injections to selected upper and/or lower limb muscles, followed by therapy. The primary outcome measure will be change in parent ratings in identified areas of concern for their child’s care and comfort, using the Canadian Occupational Performance Measure (COPM. Secondary measures will include the Care and Comfort Hypertonicity Scale (ease of care, the Cerebral Palsy Quality of Life Questionnaire (CP QoL–Child (quality of life, the Caregiver Priorities and Child

  11. ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Van't Hof, Arnoud; Giannini, Francesco; Ten Berg, Jurrien;

    2015-01-01

    BACKGROUND: Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin...... with electrocardiographic data available in 824 patients (95%). Residual ST-segment deviation one hour after PCI was 3.8±4.9 mm versus 3.9±5.2 mm for bivalirudin and heparin+GPI, respectively (p=0.0019 for non-inferiority). Overall, there were no differences between randomized treatments in any measures of ST......-segment resolution either before or after the index procedure. CONCLUSIONS: Pre-hospital treatment with bivalirudin is non-inferior to pre-hospital heparin + GPI with regard to residual ST-segment deviation or ST-segment resolution, reflecting comparable myocardial reperfusion with the two strategies....

  12. 关于化解院前急救救护车压担架难题的思考%Thoughts of resolving the ambulance retention of pre-hospital emergency

    Institute of Scientific and Technical Information of China (English)

    田建广; 朱勤忠

    2014-01-01

    介绍了近几年上海市院前急救救护车压担架状况、国外急诊预检分级救治的经验、我国急诊预检分级的机制和实践探索,并分析了影响急诊预检分级制度推行的相关问题。%This paper introduced the status of the ambulance retention in recent years,the overseas experience of emergency triage grading treatment,the exploration of the mechanism and the practice of emergency triage classification in China,and analyzed related problems affecting the implementation of emergency triage grading system.

  13. 院前急救调度质量控制对救护车空返率的影响%Effects of scheduling quality control on empty return rate of ambulance in prehospital emergency care

    Institute of Scientific and Technical Information of China (English)

    李丽梅; 刘菁; 胡远扬

    2015-01-01

    Objective To investigate the effect of scheduling quality control on ambulance empty return rate in prehospital e-mergency care.Methods New formulation of scheduling quality implementation method is launched in 2013, the record of dispatc-hing prehospital emergency care ambulances in Quanzhou Emergency Command Center were selected, then empty return rate and scheduling quality of 2012 and 2013 were compared.Results In 2012, a total of 13 639 ambulances were dispatched.In 2013, a to-tal of 13 245 ambulances, empty return rate in 2012 was higher than in 2013(19.80% vs 17.98%), the difference was statistically significance(χ2 =14.392,P<0.001);The average response time(4.3 s vs 4.1 s) and processing time(56.3 s vs 48 s) of dispatch-ers’ answering alarm and off-hook in 2012 is higher than that in 2013, frequency of the processing time longer than 90 s was signifi-cantly declined in 2013(χ2 =105.820,P<0.001).Conclusions Through the improvement of prehospital emergency system, and strengthen the implementation of dispatchers’ quality control.It can effectively reduce the empty return rate, and improve the prehospi-tal emergency rescue efficiency.%目的:探讨调度质量控制对救护车空返率的影响。方法2013年泉州市急救指挥中心启用新制定的调度质量实施方法,选取统计其2012年和2013年院前急救出车情况,并比较两年的救护车空返率和调度质量。结果2012年共出车13639车次,2013年共出车13245车次,其中2012年空返率高于2013年(19.80% vs 17.98%),差异有统计学意义(χ2=14.392,P<0.001);2012年调度员接警摘机平均反应时间(4.3 s vs 4.1 s),平均受理时间(56.3 s vs 48.0 s)均高于2013年,其中2013年的受理时间大于90 s的次数明显下降(χ2=105.820,P<0.001)。结论通过完善院前急救体制和加强实施中心调度员质量控制,可以有效地降低院前急救空返率、提高院前急救抢救效率。

  14. Characteristics analysis of pneumatic artificial muscle isolation system of vehicle-mounted stretcher on ambulance%救护车载 PAM担架缓冲系统特性分析

    Institute of Scientific and Technical Information of China (English)

    孙大刚; 高蓬; 宋勇; 梁培根; 沈毅

    2015-01-01

    Based on the analysis of the vibration isolation system of ambulance stretcher and the study on its dynamic model,a new buffer system of stretcher based on pneumatic artificial muscle was proposed.Then a vehicle-stretcher-human vibration model was built up,and a semi-active neural network PID controller for stretcher vibration control based on pneumatic artificial muscle was designed.The vibration isolation system performances were simulated by using the Simulation software,and the simulation results were analysed.The results show that compared with traditional system,the pneumatic artificial muscle buffer system using neural network PID control has more obvious isolation effect on stretcher and patient vibration,indicating the feasibility of using pneumatic artificial muscle in buffer system of ambulance stretcher.%经对救护车担架隔振系统及动力学模型研究分析,提出气动人工肌肉(PAM)救护车担架隔振系统。建立车体-担架-分段人体振动模型,设计基于该系统的半主动神经网络 PID 控制器,并用 Simulink 对隔振系统进行性能仿真分析。仿真结果表明,与被动系统相比,采用神经网络 PID 控制的气动人工肌肉隔振系统对担架及人体有明显隔振效果,气动人工肌肉用于救护车担架隔振系统具有可行性。

  15. Relations of compassion fatigue to occupational stress and job burnout in ambulance nurses%院前急救护士共情疲劳与职业应激、职业倦怠关系研究

    Institute of Scientific and Technical Information of China (English)

    魏华; 黄敬堂; 申培红

    2016-01-01

    Objective To explore the relationship of compassion fatigue and occupational stress and job burnout in ambulance nurses.Methods By stratified cluster random sampling method, a total of 380 ambulance nurses from 5 cities in Henan Province were selected as objects, and 261 emergency nurses from the same hospital were selected as control.A assessment survey was performed using the Chinese version of Professional Quality of Life, the Maslach Burnout Inventory ( MBI) , and the Chinese Nursing Stressor Scale ( NSS) which included the stressor related to working expectation ( factor 1), the stressor related to family (factor 2), the stressor related to interpersonal relationships (factor 3), the stressor related to job specification (factor 4), related to patients (factor 5), and to the working load (factor 6).Results The ambulance nurses had higher compassion fatigue scores than the emergency nurses ( P <0.01 ) .One-way analysis of variance showed that the ambulance nurses with length of service less than 3.0 years had higher compassion fatigue scores than those with 3.0 or more years and those with over 10.0 years of service length ( P<0.05 ) .The compassion fatigue scores of general nurses were higher than those professional titled as senior nurses and nurse supervisors or above ( P<0.05).The correlation analysis showed that the compassion fatigue scores of ambulance nurse were positively correlated with the factor 2, 3, 4, 5 and 6 of NSS scores and MBI scores [the correlation coefficients (r) were 0.15, 0.28, 0.25, 0.34, 0.32 and 0.36, P<0.05].The MBI scores were positively correlated with all the 6 factors of NSS (r were 0.31, 0.25, 0.36, 0.32, 0.37 and 0.31, respectively, P<0.05).The multiple linear regression analysis results showed that the regression correlations among MBI score, NSS factor 5 score, interaction effect of MBI and NSS factor 5 and the compassion fatigue score were confirmed (the standardized partial regression coefficient were 0.39, 0.24 and 0

  16. Random Vibration Analysis of an Integrated Airborne Aid Unit on Ambulance Helicopter%救护直升机机载急救单元随机振动分析

    Institute of Scientific and Technical Information of China (English)

    刘孝辉; 徐新喜; 白松; 谭树林; 杨猛

    2013-01-01

    为了解某救护直升机机载综合急救单元随机振动响应特性,针对载机平台振动特点,将载机宽带随机叠加正弦振动激励谱转换为ANSYS软件可用的纯随机振动谱,在ANSYS软件中建立了机载综合急救单元有限元模型,通过模态分析,获取了机载综合急救单元固有频率和振型。在此基础上施加转换后的载机振动谱并进行随机振动分析,得到了机载综合急救单元不同部位在激励频带范围内的动力响应及危险频率点,并对单元结构动强度进行了校核。仿真分析结果可为机载综合急救单元的抗减振设计提供参考依据。%To understand the random vibration reponse characteristics of the integrated airborne aid unit on ambulance helicopter, the finite element model of the unit was built by using ANSYS software. According to the vibration characteris-tics of the airborne platform of the ambulance helicopter, the randomly superimposed sinusoidal excitation spectrum of the airborne broadband was converted into a pure random vibration spectrum useable directly for ANSYS. The natural frequen-cies and modals of the unit were obtained by modal analysis. On this basis, the converted vibration spectrum was exerted so that the dynamic response and the critical frequencies in different positions of the integrated airborne aid unit were derived by the random vibration analysis. Meanwhile, the dynamic strength of the unit structure was checked up. The result of the analysis has provided a reference for anti-vibration design of the integrated airborne aid unit.

  17. Effect of High-Dose Vitamin D3 Intake on Ambulation, Muscular Pain and Bone Mineral Density in a Woman with Multiple Sclerosis: A 10-Year Longitudinal Case Report

    Directory of Open Access Journals (Sweden)

    François Feron

    2012-10-01

    Full Text Available Mounting evidence correlate vitamin D3 (cholecalciferol supplementation or higher serum levels of vitamin D (25(OHD with a lower risk of developing multiple sclerosis (MS, reduced relapse rate, slower progression or fewer new brain lesions. We present here the case of a woman who was diagnosed with MS in 1990. From 1980 to 2000, her ability to walk decreased from ~20 to 1 km per day. Since January 2001, a vitamin D3 supplement was ingested daily. The starting dose was 20 mcg (800 IU/day and escalated to 100 mcg (4000 IU/day in September 2004 and then to 150 mcg (6000 IU/day in December 2005. Vitamin D3 intake reduced muscular pain and improved ambulation from 1 (February 2000 to 14 km/day (February 2008. Vitamin D intake over 10 years caused no adverse effects: no hypercalcaemia, nephrolithiasis or hypercalciuria were observed. Bowel problems in MS may need to be addressed as they can cause malabsorption including calcium, which may increase serum PTH and 1,25(OH2D levels, as well as bone loss. We suggest that periodic assessment of vitamin D3, calcium and magnesium intake, bowel problems and the measurement of serum 25(OHD, PTH, Ca levels, UCa/Cr and bone health become part of the integral management of persons with MS.

  18. Optimal Design of Vibration Reduction for the Integrated Airborne Aid Unit on Ambulance Helicopter%救护直升机机载急救单元减振优化设计

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    According to the vibration characteristics of an ambulance helicopter, the optimum design for vibration isolation of integrated airborne aid unit was done using the tunable metal dry-friction damping. Within the adjustment range of the isolator’s dry friction damping, curves of the friction force of the vibration isolator were obtained by testing, and the harmonic-wave superposition method was used to simulate the cabin-floor excitation of the helicopter. Meanwhile, the optimum curve of the friction force was made based on the optimization simulation, and then the best working condition of the isolator damping was determined. Results of the optimization show that the RMS of the acceleration can be reduced by 78.755 % with the use of the isolator in the airborne aid unit, the isolator has a good vibration isolation damping performance and is suitable for the airborne vibration environment of the helicopter.%  针对某型救护直升机振动特点,采用金属干摩擦阻尼可调式隔振器对机载综合急救单元进行隔振优化设计,在隔振器干摩擦阻尼调节范围内,测试多组隔振器摩擦力曲线,应用谐波叠加法模拟直升机客舱底板激励,并通过仿真优化计算确定最佳摩擦力曲线,进而确定隔振器阻尼最佳工作状态。优化结果表明机载综合急救单元采用该型隔振器,能使加速度均方根响应降低78.75%,说明该隔振器具有良好的隔振减振性能,适用于直升机机载振动环境。

  19. Information support for the ambulant health worker.

    Science.gov (United States)

    Merrell, Ronald C; Merriam, Nathaniel; Doarn, Charles

    2004-01-01

    Health workers are trained to work in information-rich environments. Nineteen medical students evaluated 2700 patients in four villages in Kenya where there was no power or phone. A model of information support included personal digital assistants (PDA), electronic medical records (EMR), satellite telecommunications, medical software, and solar power. The students promptly found the advantages of PDA over paper. By using software for decision support and interacting with the EMR data for medical expertise, very few live telemedicine consults were needed. The cost of this information support was only US 0.28 dollars per patient visit. We conclude information resources can be provided in remote environments at reasonable cost.

  20. Characterization of ankle function during stair ambulation

    OpenAIRE

    Gates, Deanna H.; Lelas, Jennifer L.; Della Croce, Ugo; Herr, Hugh; Bonato, Paolo

    2004-01-01

    The aim of this study was to examine the ankle joint during level walking, stair ascent, and stair descent to determine models for use in the design of prosthetic and orthotic systems. Ten healthy subjects were asked to walk (1) across a level walkway, (2) up, and (3) down an instrumented stairway. Sagittal plane kinematic and kinetic data were analyzed to obtain ankle biomechanics during the stance phase of each task. Each stance phase was broken down into sub-phases based on the power traje...

  1. Teknologiers mellemkomst i ambulant behandling og egenomsorg

    DEFF Research Database (Denmark)

    Ballegaard, Stinne Aaløkke; Aarhus, Rikke

    2009-01-01

    Vigtige tendenser i den danske sundhedssektor i disse år er centralisering af behandling og øget egenomsorg. Teknologi ses ofte som en del af denne udvikling, omend der eksisterer både dystopiske og utopiske forestillinger om, hvorvidt teknologi fremmedgør eller støtter patienten. I denne artikel...

  2. Measuring physical strain during ambulation with accelerometry

    NARCIS (Netherlands)

    Bussmann, J B; Hartgerink, I; van der Woude, L H; Stam, H J

    2000-01-01

    PURPOSE: To study the feasibility of ambulatory accelerometry in the evaluation of physical strain in walking at different speeds and different levels of economy. METHODS: Twelve able-bodied subjects performed a walking test on a treadmill with increasing walking speed. After a 6-wk period, these me

  3. Upper extremity joint stresses during walkerassisted ambulation in post-surgical patients Estresse articular no membro superior durante marcha assistida por andador em pacientes pós-cirúrgicos

    Directory of Open Access Journals (Sweden)

    Kevin J. Mcquade

    2011-08-01

    Full Text Available BACKGROUND: A walker is a common device prescribed for ambulatory assistance for individuals with balance difficulties or to reduce lower extremity demands following injury or surgery. The long-term use of a walker imposes significant demands on the patient's upper extremities that may lead to increased risk for development of secondary conditions such as wrist, elbow or shoulder pain. OBJECTIVE: To describe the joint kinematics, forces and moments of the wrist, elbow and shoulder in a sample of twenty patients that were using a walker as a result of total joint surgery of the hips and knees. METHODS: Three-dimensional upper extremity kinematics were recorded using a motion capture system synchronized with forces and torques transmitted through a walker instrumented with force transducers in the handles. RESULTS: Compressive forces were found to be nearly 20% of the body weight at each of the upper extremity joints, both surgical and non-surgical sides, being the greatest force at the wrist and decreasing proximally. Compression forces were greater in the non-surgical side limb at the wrist and at the elbow. CONCLUSION: Our findings indicated that loads on upper extremity joints associated with the use of a walker for assisted ambulation are high and further studies are needed to address the cause-effect relationship between the actual joint loading and the development of secondary musculoskeletal upper extremity complaints in more frail patients.CONTEXTUALIZAÇÃO: Um andador é um dispositivo frequentemente prescrito para auxiliar a marcha de indivíduos com dificuldades de equilíbrio ou para reduzir demandas à extremidade inferior após cirurgia ou lesão. O uso prolongado de um andador impõe significante demanda para a extremidade superior do paciente, o que pode levar a um risco aumentado de desenvolver condições secundárias, como dor no punho, cotovelo e ombro. OBJETIVO: Descrever a cinemática articular, forças e momentos do punho

  4. 基于模拟退火法的某履带式急救车减振系统等效物理参数辨识%Equivalent Physical Parameters Identification of Tracked Emergency Ambulance's Damping System Using Simulated Annealing

    Institute of Scientific and Technical Information of China (English)

    杨猛; 徐新喜; 白松; 苏琛; 刘孝辉; 谭树林

    2013-01-01

    Objective To identify the equivalent physical parameters of the tracked emergency ambulance's damping system. Methods According to the function and physical characteristics of the tracked emergency ambulance's damping system between carriage and coach chassis, the model for the damping system was reasonably simplified. Taking coach chassis longitudinal beam's motion as the system inputs, a 1 DOF vibration model for sprung mass was set up and the frequency response function for the acceleration of sprung mass was derived. Using the test data of proving ground, data fitting was conducted by a Matlab program written based on Simulated Annealing, and the equivalent physical parameters (stiffness and damping) of damping system under different road conditions were obtained. Results The verification of equivalent physical parameters was conducted through a kinematics differential equation built in Simulink of Matlab. The result showed that equivalent physical parameters were rather reliable. Conclusion The equivalent physical parameters identification of the tracked emergency ambulance's damping system is well done by simulated annealing. The Equivalent Physical Parameters can be used as the basis for vibration damping system optimization and have a high engineering practical significance.%目的:辨识某履带式急救车减振系统的等效物理参数.方法:针对某履带式急救车大板车箱与底盘之间减振系统的功能及物理特性,对减振系统进行了合理简化.以底盘纵梁的运动为系统输入,建立了簧载质量的单自由度模型,推导了簧载质量的加速度频响函数;利用汽车试验场道路试验数据,通过模拟退火法编写Matlab程序进行数据拟合,得到了减振系统在不同路面情况下的等效物理参数.结果:通过Matlab的Simulink模块建立减振系统运动微分方程模型对等效物理参数进行验证,结果表明等效物理参数具有较高可信度.结论:模拟退火法可以很

  5. Perfil funcional de locomoção em um grupo de pacientes com lesão medular atendidos em um centro de reabilitação Perfil funcional de locomoción en un grupo de pacientes con lesión medular atendidos en un centro de rehabilitación Functional ambulation profile in a group of spinal cord injured patients attended at a rehabilitation center

    Directory of Open Access Journals (Sweden)

    Ana Cristina Franzoi

    2009-12-01

    Full Text Available OBJETIVO: descrever o perfil de locomoção de um grupo de pacientes com lesão medular (LM, correlacionando-o com as características da amostra. MÉTODOS: setenta pacientes (50 com LM traumática e 20 com LM não-traumática. Instrumentos: Classificação Funcional da Marcha Modificada (CFMM, WISCI-II, Escala de Ashworth Modificada (EAM, Classificação AIS, Lower Extremities Muscle Score (AIS-LEMS. Estatística: descritiva, comparação entre grupos, testes de correlação considerando pOBJETIVO: describir el perfil de locomoción de un grupo de pacientes con lesión medular (LM, correlacionándolo con las características de la muestra. MÉTODOS: setenta pacientes (50 con LM traumática y 20 con LM no traumática. Instrumentos: Clasificación Funcional de la Marcha Modificada (CFMM, WISCI-II, Escala de Ashworth Modificada (EAM, Clasificación AIS, AIS Lower Extremities Muscle Score (AIS-LEMS. Estadística: descriptiva, comparación entre grupos, testes de correlación considerando un pOBJECTIVE: to describe the locomotion profile of a group of spinal cord injured (SCI patients and its correlation with the sample features. METHODS: seventy patients (50 with traumatic SCI and 20 non-traumatic were assessed. Instruments: Modified Functional Ambulation Classification (MFAC, Walking Index for Spinal Cord Injury II (WISCI-II, Modified Ashworth Scale (MAS, American Spinal Injury Association Impairment Scale (AIS and AIS Lower Extremities Muscle Score (AIS-LEMS. Statistics: descriptive, comparison between groups, correlation tests (considering p<0,05. RESULTS: average values were: age: 36 years, 72.9% males, average time of lesion 4.7 years. AIS A, 38.6%; AIS B, 10%; AIS C, 22.8%; AIS D, 28.6%. Level of lesion: 32.8% cervical, 52.9% thoracic, 14.3% lumbar. More prevalent etiologies: gunshot wounds 30% and car accidents 18%. MFAC: Non-ambulation, 34.3%; Therapeutic ambulation 20%, Household ambulation 12.8%, community ambulation (32.9%; WISCI-II: 7

  6. Effect of Electroacupuncture at the Balance Area on Ambulation and Quality of Life in Patients with Cerebral Stroke%电针平衡区对脑卒中患者步行能力及生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    朱敏; 楚佳梅; 曾友华

    2016-01-01

    目的:观察电针平衡区对卒中患者步行能力及生活质量的影响。方法将100例脑卒中患者随机分为治疗组和对照组,每组50例。治疗组采用电针平衡区配合康复治疗,对照组采用常规针刺配合康复治疗。两组治疗前后分别采用 Berg平衡量表评分、Holden步行能力分级评分及改良Barthel指数评分对患者步行能力及生活质量进行评定。结果两组治疗1、2个疗程后Berg平衡量表评分、Holden步行能力分级评分及改良Barthel指数评分与同组治疗前比较,差异均具有统计学意义(P<0.01)。治疗组治疗1个疗程后Berg平衡量表评分、Holden步行能力分级评分及改良Barthel指数评分与对照组比较,差异均具有统计学意义(P<0.05)。结论电针平衡区能有效提高脑卒中患者平衡功能,增加步行能力,提高生活质量。%Objective To observe the effect of electroacupuncture at the Balance Area on ambulation and quality of life in patients with cerebral stroke.Method A hundred patients with cerebral stroke were randomized into a treatment group and a control group, 50 cases in each group. The treatment group was intervened by electroacupuncture at the Balance Area plus rehabilitation, while the control group was by conventional acupuncture plus rehabilitation. The Berg Balance Scale (BBS), Holden ambulation grading score, and modified Barthel Index (BI) were adopted to evaluate the walk ability and quality of life.Result The BBS score, Holden grading score, and modified BI score respectively after 1 treatment course and 2 treatment courses were significantly different from that before intervention in both groups (P<0.01). After 1 treatment course, the BBS score, Holden grading score, and BI score of the treatment group were significantly different from that of the control group (P<0.05).Conclusion Electroacupuncture at the Balance Area can effectively enhance the balance function of cerebral stroke

  7. 新入职院前急救护士职业应激、心理资本与共情疲劳感的关系分析%Relationship of compassion fatigue, occupational stress and psychological capital among new graduate ambulance nurses

    Institute of Scientific and Technical Information of China (English)

    魏华; 董越娟; 邹涛; 王永革; 陈妍; 段梅艳

    2015-01-01

    Objective To explore the relationship of compassion fatigue, occupational stress and psychological capital among new graduate ambulance nurses. Methods A total of 253 new graduate nurses were selected and followed-up in ambulance department. They were assessed by Professional Quality of Life(ProQOL-V), Chinese Nursing Stressor Scale (CNSS) and Psychological Capital Questionnaire-24 (PCQ-24). Results After six months, the scores of CNSS, CNSS-4 and CNSS-6 were (100. 21 ± 14. 82), (185. 54 ± 50. 54) and (165. 54 ± 51. 87), which were significantly higher than those at the first and third month (F=14. 53, 17. 41, 14. 89, respectively;P<0. 05). The score of CNSS was negatively correlated with the score of PCQ-24 (r=-0. 45,P<0. 05) and was positively correlated with the scores of CNSS-1, CNSS-2, CNSS-4 and CNSS-6 (r=0. 28, 0. 15, 0. 37, 0. 36, respectively;P<0. 05). The score of PCQ-24 was negatively correlated with the scores of CNSS-1, CNSS-2, CNSS-3, CNSS-4 and CNSS-6 (r= -0. 30, -0. 30, -0. 27, -0. 34, -0. 23, respectively;P<0. 05). Conclusions It suggests that the compassion fatigue is prevalence among new graduate nurses in ambulance department and it may be positively correlated with the occupational stress and negatively correlated with the psychological capital.%目的:探讨新入职院前急救护士职业应激、心理资本与共情疲劳感的关系。方法选取入职1个月的253名院前急救护士为研究对象,采用护士专业生活品质量表( ProQOL-V)、心理资本问卷(PCQ-24)和护士应激源量表(CNSS)进行测评,入职后3,6个月进行追踪测评。结果入职后6个月院前急救护士CNSS得分、CNSS-4得分、CNSS-6得分分别为(100.21±14.82),(185.54±50.54),(165.54±51.87)分,分别优于入职后1,3个月,差异有统计学意义(F值分别为14.53,17.41,14.89;P<0.05)。新入职院前急救护士 CNSS得分与 PCQ-24得分呈负相关(r=-0.45,P<0.05),与 CNSS-1、CNSS-2、CNSS-4、CNSS-6得分呈正相关(r=0

  8. 院内专业化救护路径在高原地区批量地震伤员救治中的应用%Application of Plateau Specialized Hospital Ambulance Transport Path in Batch of Wounded Rescue in the Earthquake

    Institute of Scientific and Technical Information of China (English)

    乔够梅; 杏玲芝; 李娟; 汉瑞娟; 陆皓

    2014-01-01

    Objective To explore organization and management of the plateau specialized hospital ambu-lance transport path in batch of wounded rescue in the earthquake.Methods 3 1 patients were selected and explicitly checked by using a unified classification system,and responsible by rescue teams,open green life channel,earthquakes bulk of wounded patients transport,provide personalized specialist treatment plan,psychological support and other hospital professionalize rescue path to perform emergency surgery and postoperative treatment and clinical outcomes.Results The survival rate was 100% with no adverse outcome due to no one rescue was not timely,lack of prompt rescue and triage was not timely,no doctor-patient conflict,3 1 patients were all covered and stable and had continues treatment in the local hospital.Conclusion Plateau specialization hospital ambulance transport path mode can enhance the plateau nursing care ability and disaster nursing care ability to ensure the quality and efficiency of the plateau emergency care.%目的:探讨院内专业化救护路径在高原地区批量地震伤员救治中的应用。方法2013年7月批量收治31例地震伤员,采用统一明确检查分类、实施救护小组负责制、开放绿色生命通道、批量地震伤员转运、提供个性化专科救治方案、对伤员有效心理支持等院内专业化救护路径对其进行院内急救、手术与术后处理及临床治疗。结果31例伤员的抢救成功率为100%,无一例伤员因抢救不及时或接诊、分诊不及时而造成不良后果,无一起医患纠纷,31例伤员均康复出院或病情稳定后回当地医院继续治疗。结论院内专业化救护路径模式提高了医疗团队的高原护理能力及灾后护理能力,确保了高原地区的应急救护质量和效率。

  9. Adaptação para a língua portuguesa do Questionário de Experiências Dissociativas Peritraumáticas (QEDP numa amostra de bombeiros Portuguese adaptation of the Peritraumatic Dissociation Experiences Questionnaire (PDEQ in a sample of ambulance personal

    Directory of Open Access Journals (Sweden)

    Ângela Costa Maia

    2009-01-01

    Full Text Available CONTEXTO: A dissociação peritraumática é uma resposta no momento da exposição a uma situação ameaçadora que tem se mostrado um preditor significativo de perturbação psicológica a longo prazo, nomeadamente perturbação pós-estresse traumático. OBJETIVOS: Fazer a adaptação para português do Peritraumatic Dissociation Experiences Questionnaire numa população altamente exposta a situações traumáticas, como é o caso dos bombeiros. MÉTODO: Após a tradução e o estudo dos itens, fizeram-se a aplicação e a análise psicométrica com uma amostra de 170 bombeiros, que relataram exposição traumática e que também preencheram uma escala de Perturbação de Pós-Estresse Traumático. RESULTADOS: Os dados indicam que se trata de um instrumento com uma boa consistência interna (alfa de Cronbach = 0,87 e cuja validade de construto o torna adequado para a avaliação das respostas dessa população no exercício da sua profissão. Para além disso, a correlação elevada com os sintomas de perturbação pós-estresse traumático sugere ainda uma boa validade convergente. DISCUSSÃO: Atendendo ao fato de que a dissociação peritraumática prevê PPST, o recurso a um instrumento que revela boas capacidades psicométricas pode ajudar a identificar as pessoas que desenvolverão perturbação após exposição a trauma.BACKGROUND: Peritraumatic dissociation is a reaction that occurs in the moment someone is exposed to a threatening situation and has shown to be an important predictor of long term psychological disorder, including post traumatic stress disorder. OBJECTIVES: To make the psychometric adaptation of Peritraumatic Dissociation Experiences Questionnaire in Portuguese ambulance personnel that report high exposure to trauma. The instrument has been widely used in research, and was initially designed to analyse peritraumatic dissociation in emergency personnel. METHODS: After items translation and study, 170 ambulance

  10. Numerical Simulation and Experimental Research on Air Pattern and Temperature Distribution Inside Compartment of All-Terrain Emergency Ambulance Vehicle%全地形履带式卫生急救车车厢内气流组织及温度分布的数值模拟与试验研究

    Institute of Scientific and Technical Information of China (English)

    赵秀国; 徐新喜; 刘亚军; 崔向东

    2011-01-01

    运用计算流体动力学方法,对全地形履带式卫生急救车车厢内的气流组织和温度分布进行了数值模拟,分析了车厢内气流组织形式和温度分布规律,同时将数值模拟结果与试验结果进行了对比分析,验证了数值模拟结果的准确性。结果表明:在人员活动的绝大部分区域内气流速度分布在0.5 m/s以下,仅在空调送风口射流区域内,气流速度较高,整个车厢内气流速度分布较均匀;车厢内垂直方向和前后方向上不存在明显的温度梯度,整个车厢内温度分布均匀性较好,温度分布在27.5℃左右,温差较小;车厢内人员的舒适性较好,能够满足相关医学作业要求。%The air pattern and the temperature distribution inside the compartment of all-terrain emergency ambulance vehicle are simulated by the technique of computational fluid dynamics(CFD),the air pattern and the temperature distribu-tion are analysed and the simulation result are compared with experimental result.The results show that the air velocity is under 0.5 m/s in the most zone of person activity and the air velocity is distributed uniformly in compartment.The high air velocity exists in the jet zone of the air conditioning.The obvious temperature gradient doesn’t exist in the vertical plane and the anteroposterior of the compartment.The temperature distribution in the compartment is quite uniform and the tempera-ture is almost at 27.5℃ with little temperature difference.The human thermal comfort is good in the compartment and the environment in the compartment can satisfy requirements of the medical operation.

  11. 42 CFR 410.40 - Coverage of ambulance services.

    Science.gov (United States)

    2010-10-01

    ... MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.40... following conditions are met: (1) The supplier meets the applicable vehicle, staff, and billing and reporting requirements of § 410.41 and the service meets the medical necessity and origin and...

  12. Feasibility of Suited 10-km Ambulation "Walkback" on the Moon

    Science.gov (United States)

    Norcross, Jason; Lee, Lesley; DeWitt, John K.; Klein, Jill; Wessell, James; Gernhardt, Michael L.

    2008-01-01

    This viewgraph presentation reviews a study that examined the feasibility of having astronauts walk about 10 kilometers to the base in the event of a breakdown of the lunar rover. This was done in part to examine the possibility of having a single rover on the lunar exploration missions. Other objectives of the study are to: (1) Understand specific biomedical and human performance limitations of the suit compared to matched shirt-sleeve controls; (2) Collect metabolic and ground-reaction force data to develop an EVA simulator for use on future prebr eathe protocol verification tests (3) Provide data to estimate consum ables usage for input to suit and portable life support system (PLSS) design (4) Assess the cardiovascular and resistance exercise associa ted with partialgravity EVA for planning appropriate exploration exer cise countermeasures

  13. `Stop' that ambulance! New physics at the LHC?

    CERN Document Server

    Kim, Jong Soo; Sakurai, Kazuki; Tattersall, Jamie

    2014-01-01

    A number of LHC searches now display intriguing excesses. Most prominently, the measurement of the $W^+W^-$ cross-section has been consistently $\\sim 20\\%$ higher than the theoretical prediction across both ATLAS and CMS for both 7 and 8 TeV runs. More recently, supersymmetric searches for final states containing two or three leptons have also seen more events than predicted in certain signal regions. We show that a supersymmetric model containing a light stop, winos and binos can consistently match the data. We perform a fit to all measurements and searches that may be sensitive to our model and find a reduction in the log-likelihood of 13.3 compared to the Standard Model which corresponds to 3.2-$\\sigma$ once the extra degrees of freedom in the fit are considered.

  14. A implantação do projeto de atendimento Móvel de Urgência em Salvador/BA: panorama e desafios La implantación del proyecto de Atención de Urgencia Móvil en Salvador/BAHIA: panorama y retos Implantation of the Emergency Ambulance Service in Salvador, Bahia: reality and challenges

    Directory of Open Access Journals (Sweden)

    Célia Maria Sales Vieira

    2008-12-01

    retos en la dinámica y calidad de la atención: educación comunitaria, capacitación profesional, evaluación de recursos humanos y materiales.The goal of this study was to describe the implementation of the emergency ambulance service of Salvador, Bahia (SAMU-192. The Ministry of Health provided the legal basis and regulations for its implementation. The main purpose of this service is the provision of free primary level healthcare to individuals, with clinical, surgical, traumatic and psychiatric aggravations that cause suffering, sequels or death and occur outside the hospital environment. The specific goals of SAMU-192 was to grant free healthcare to urgency and emergency situations, under the hierarchy and regulations of the Single Health System (SUS of the Brazilian government, assuring that public resources will be available and integrated to the complementary healthcare network. Investments for the installation of the service were agreed on in the city and with federal and state management commissions. To turn SAMU-192 into reality, several challenges need to be accomplished, including community education, professional qualification and evaluation of human and material resources so as to provide basic emergency care with the appropriate quality.

  15. Reflexões sobre deambulação e posição materna no trabalho de parto e parto Reflexiones sobre deambulación y posición materna en el trabajo de parto y parto Reflection on ambulation and maternal position during labor and delivery

    Directory of Open Access Journals (Sweden)

    Fabiana Villela Mamede

    2007-06-01

    place to other ones that valued the technology, the medicalization and the intervention. Such changes didn't make possible a significant reduction in the mother mortality and neonatal, in other way, they promoted the lack of humanization in the assistance. A new look on the ambulation effect and the position during labor and delivery is been encouraged and giving opportunity to became evident a variety of vantages and benefits to the mother and child.

  16. Fluid and salt supplementation effect on body hydration and electrolyte homeostasis during bed rest and ambulation

    Science.gov (United States)

    Zorbas, Yan G.; Kakurin, Vassily J.; Kuznetsov, Nikolai A.; Yarullin, Vladimir L.

    2002-06-01

    Bed rest (BR) induces significant urinary and blood electrolyte changes, but little is known about the effect of fluid and salt supplements (FSS) on catabolism, hydration and electrolytes. The aim was to measure the effect of FSS on catabolism, body hydration and electrolytes during BR. Studies were done during 7 days of a pre-bed rest period and during 30 days of a rigorous bed rest period. Thirty male athletes aged, 24.6±7.6 years were chosen as subjects. They were divided into three groups: unsupplemented ambulatory control subjects (UACS), unsupplemented bed rested subjects (UBRS) and supplemented bed rested subjects (SBRS). The UBRS and SBRS groups were kept under a rigorous bed rest regime for 30 days. The SBRS daily took 30 ml water per kg body weight and 0.1 sodium chloride per kg body weight. Plasma sodium (Na), potassium (K), calcium (Ca) and magnesium (Mg) levels, urinary Na, K, Ca and Mg excretion, plasma osmolality, plasma protein level, whole blood hemoglobin (Hb) and hematocrit (Hct) level increased significantly ( p≤0.05), while plasma volume (PV), body weight, body fat, peak oxygen uptake, food and fluid intake decreased significantly ( p≤0.05) in the UBRS group when compared with the SBRS and UACS groups. In contrast, plasma and urinary electrolytes, osmolality, protein level, whole blood Hct and Hb level decreased significantly ( p≤0.05), while PV, fluid intake, body weight and peak oxygen uptake increased significantly ( p≤0.05) in the SBRS group when compared with the UBRS group. The measured parameters did not change significantly in the UACS group when compared with their baseline control values. The data indicate that FSS stabilizes electrolytes and body hydration during BR, while BR alone induces significant changes in electrolytes and body hydration. We conclude that FSS may be used to prevent catabolism and normalize body hydration status and electrolyte values during BR.

  17. [The correlation between personality characteristics and burnout syndrome in emergency ambulance workers].

    Science.gov (United States)

    Berkhmiller, A; Zavgorodny, I; Zavgorodnyaya, N; Kapustnik, V; Bekkel'mann, I

    2016-01-01

    Цель исследования. Врач выездной бригады неотложной и скорой помощи — профессия, характеризующаяся высокой психологической и эмоциональной нагрузкой. Целью работы было определение вероятности развития профессионального выгорания у врачей бригад скорой помощи, а также выявление зависимости между его возникновением и особенностями личности врачей. Материал и методы. С использованием опросника MBI-GS и Фрайбургского личностного опросника (FPI) были опрошены 97 врачей скорой помощи, 57 женщин и 40 мужчин. Средний возраст опрошенных был 37,0±12,21 года. Связь между переменными определялась методами корреляционного и регрессионного анализа. Результаты и заключение. Риск развития синдрома профессионального выгорания был установлен у 9 (11,5%) опрошенных. У 28 (35,9%) врачей были выявлены отдельные симптомы выгорания. В возрастной группе 45 лет и старше риск эмоционального выгорания диагностирован не был. Сделан вывод, что сотрудники скорой помощи в целом характеризуются устойчивыми свойствами личности, тем не менее подчеркивается необходимость выявления симптомов профессионального выгорания для его профилактики и разработки программ проведения мероприятий по повышению персональной стрессоустойчивости работающих.

  18. Possibility of leg muscle hypertrophy by ambulation in older adults: a brief review

    Directory of Open Access Journals (Sweden)

    Ozaki H

    2013-03-01

    Full Text Available Hayao Ozaki,1 Jeremy P Loenneke,2 Robert S Thiebaud,2 Joel M Stager,3 Takashi Abe31Juntendo University, Inzai, Chiba, Japan; 2Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA; 3Department of Kinesiology, Indiana University, Bloomington, IN, USAAbstract: It is known that ambulatory exercises such as brisk walking and jogging are potent stimuli for improving aerobic capacity, but it is less understood whether ambulatory exercise can increase leg muscle size and function. The purpose of this brief review is to discuss whether or not ambulatory exercise elicits leg muscle hypertrophy in older adults. Daily ambulatory activity with moderate (>3 metabolic equivalents [METs], which is defined as the ratio of the work metabolic rate to the resting metabolic rate intensity estimated by accelerometer is positively correlated with lower body muscle size and function in older adults. Although there is conflicting data on the effects of short-term training, it is possible that relatively long periods of walking, jogging, or intermittent running for over half a year can increase leg muscle size among older adults. In addition, slow-walk training with a combination of leg muscle blood flow restriction elicits muscle hypertrophy only in the blood flow restricted leg muscles. Competitive marathon running and regular high intensity distance running in young and middle-aged adults may not produce leg muscle hypertrophy due to insufficient recovery from the damaging running bout, although there have been no studies that have investigated the effects of running on leg muscle morphology in older subjects. It is clear that skeletal muscle hypertrophy can occur independently of exercise mode and load.Keywords: aerobic exercise, muscle mass, aging, strength, sarcopenia

  19. Ambulant neuropsykologisk opfølgning af patienter indlagt med aseptisk meningitis

    DEFF Research Database (Denmark)

    Damsgaard Gunst, Jesper; Klostergaard, Kirsten Rose; Leutscher, Peter Derek Christian

    2014-01-01

    Aseptic meningitis is considered to be a benign illness with mild symptoms, and the prognosis is usually good. However, retrospective studies have demonstrated that these patients may experience cognitive sequelae. A neuropsychologist was affiliated to the Department of Infectious Diseases......, and neuropsychological findings in patients with aseptic meningitis were assessed. In conclusion, at twelve months of follow-up cognitive dysfunction persist among the majority of patients; 75% had mental fatigue and 45% had changed their work status....

  20. Expected Annual Emergency Miles per Ambulance: An Indicator for Measuring Availability of Emergency Medical Services Resources

    Science.gov (United States)

    Patterson, P. Daniel; Probst, Janice C.; Moore, Charity G.

    2006-01-01

    Context: To ensure equitable access to prehospital care, as recommended by the Rural and Frontier Emergency Medical Services (EMS) Agenda for the Future, policymakers will need a uniform measure of EMS infrastructure. Purpose and Methods: This paper proposes a county-level indicator of EMS resource availability that takes into consideration…

  1. Mission Analysis and Conceptual Design of a Space Ambulance Utilizing the Boeing X-37B Platform

    Science.gov (United States)

    Blaesser, Nathaniel James

    This paper discusses the concept of operations and modifications for a crew return vehicle from the International Space Station based on the Boeing X-37B platform. The modifications necessary include accommodating a three person crew, adding an environmental control and life support system and modifying the propulsion system to be more conducive to a fast evacuation. Two crew seating configurations were considered and traded for vehicle mass, crew envelope and ease of loading and unloading the injured patient. Computer models were generated to determine key parameters, and the models were validated using physical mock-ups. The mission is considerably shorter than the design reference mission, meaning that there are significant reductions in propellant mass and volume. The results showed that by utilizing the space saved from smaller propellant tanks, and combining the crew's oxygen supply with the propulsion system, the vehicle can be retooled without modifying the outer mold line..

  2. Volitional control of ankle plantar flexion in a powered transtibial prosthesis during stair-ambulation.

    OpenAIRE

    Kannape, Oliver; Herr, Hugh M.

    2014-01-01

    Although great advances have been made in the design and control of lower extremity prostheses, walking on different terrains, such as ramps or stairs, and transitioning between these terrains remains a major challenge for the field. In order to generalize biomimetic behaviour of active lower-limb prostheses top-down volitional control is required but has until recently been deemed unfeasible due to the difficulties involved in acquiring an adequate electromyographic (EMG) signal. In this stu...

  3. Svær dehydrering hos nyfødt efter ambulant fødsel

    DEFF Research Database (Denmark)

    Thøstesen, Lisbeth Marianne; Fenger-Grøn, Jesper

    2011-01-01

    in Denmark. The case emphasizes the necessity of a sufficient safety net beneath the newborn children in order to minimise the risk of breast-feeding problems and re-hospitalizing. Neonatal problems such as marked weight loss, dehydration, hypernatremia and marked jaundice are potentially preventable.......A nine day-old girl was hospitalised because of breast-feeding problems and life-threatening hypernatremic dehydration; weight loss was 30% of birth weight and s-Na 187 mmol/l. The question is raised whether there could be an association to the current changes in the perinatal health care...

  4. Possibility of leg muscle hypertrophy by ambulation in older adults: a brief review.

    Science.gov (United States)

    Ozaki, Hayao; Loenneke, Jeremy P; Thiebaud, Robert S; Stager, Joel M; Abe, Takashi

    2013-01-01

    It is known that ambulatory exercises such as brisk walking and jogging are potent stimuli for improving aerobic capacity, but it is less understood whether ambulatory exercise can increase leg muscle size and function. The purpose of this brief review is to discuss whether or not ambulatory exercise elicits leg muscle hypertrophy in older adults. Daily ambulatory activity with moderate (>3 metabolic equivalents [METs], which is defined as the ratio of the work metabolic rate to the resting metabolic rate) intensity estimated by accelerometer is positively correlated with lower body muscle size and function in older adults. Although there is conflicting data on the effects of short-term training, it is possible that relatively long periods of walking, jogging, or intermittent running for over half a year can increase leg muscle size among older adults. In addition, slow-walk training with a combination of leg muscle blood flow restriction elicits muscle hypertrophy only in the blood flow restricted leg muscles. Competitive marathon running and regular high intensity distance running in young and middle-aged adults may not produce leg muscle hypertrophy due to insufficient recovery from the damaging running bout, although there have been no studies that have investigated the effects of running on leg muscle morphology in older subjects. It is clear that skeletal muscle hypertrophy can occur independently of exercise mode and load.

  5. Quality of Ambulant Measures of Distance, Speed, Load and Energy Consumption During Military Operations

    Science.gov (United States)

    2009-10-01

    Monitors During Free-Living Conditions. Medicine & Science in Sports & Exercise , 39 (5), Supplement, p S183. [3] Malavolti, A., Pietrobelli, A...Activity Monitoring and Energy Expenditure in COPD Patients: A Validation Study, COPD : Journal of Chronic Obstructive Pulmonary Disease, 4 (2), 107-112...Assess the Energie Expenditure of Yoga Exercise . Medicine & Science in Sports & Exercise , 39 (5), Supplement, p S177. [6] Gallagher, K. I. FACSM

  6. Musculoskeletal neck-shoulder pain : a new ambulant myofeedback intervention approach

    NARCIS (Netherlands)

    Voerman, Gerritje Evelien

    2007-01-01

    Persisting musculoskeletal complaints in the neck-shoulder region are highly prevalent and associated with high health care and community costs in industrialized countries. The mechanisms underlying the development and perpetuation of these complaints have not fully been identified yet, but explanat

  7. Trauma-informed care for children in the ambulance: international survey among pre-hospital providers

    Science.gov (United States)

    Alisic, Eva; Tyler, Mark P.; Giummarra, Melita J.; Kassam-Adams, Rahim; Gouweloos, Juul; Landolt, Markus A.; Kassam-Adams, Nancy

    2017-01-01

    ABSTRACT Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers’ knowledge of traumatic stress in children, attitudes towards psychosocial aspects of care, and confidence in providing psychosocial care, (b) variations in knowledge, attitudes, and confidence according to demographic and professional characteristics, and (c) training preferences of pre-hospital providers regarding psychosocial care to support paediatric patients and their families. Method: We conducted a cross-sectional, online survey among an international sample of 812 pre-hospital providers from high-income countries. The questionnaire was adapted from a measure for a similar study among Emergency Department staff, and involved 62 items in 7 main categories (e.g. personal and work characteristics, knowledge of paediatric traumatic stress, and confidence regarding 18 elements of psychosocial care). The main analyses comprised descriptive statistics and multiple regression analyses. Results: On average, respondents answered 2.7 (SD = 1.59) out of seven knowledge questions correctly. Respondents with higher knowledge scores were more often female, parent of a child under 17, and reported that at least 10% of their patients were children. A majority of participants (83.5%) saw all 18 aspects of psychosocial care as part of their job. Providers felt moderately confident (M = 3.2, SD = 0.45) regarding their skills in psychosocial care, which was predicted by gender (female), having more experience, having a larger proportion of child patients, and having received training in psychosocial care in the past five years. Most respondents (89.7%) wanted to gain more knowledge and skills regarding psychosocial care for injured children. In terms of training format, they preferred an interactive website or a one-off group training. Conclusions: There appears to be both a need and an opportunity for education initiatives regarding paediatric traumatic stress in the pre-hospital context.

  8. Elderly and Nonelderly Use of a Dedicated Ambulance Corps’ Emergency Medical Services in Taiwan

    Directory of Open Access Journals (Sweden)

    Chien-Chia Huang

    2016-01-01

    Full Text Available Backgrounds and Aim. Taiwan’s population is gradually aging; however, there are no comparative data on emergency medical services (EMS use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years and nonelderly (<65 years. Nontransport and transport calls were compared between the groups for demographic characteristics, transport time, reasons for calling EMS, vital signs, and emergency management. Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P<0.05 fewer (28 (9.2% nontransport calls than did the nonelderly (136 (21.4%. In the transport calls, 276 (35.6% were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson’s disease, and Alzheimer’s disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now.

  9. Possibility of leg muscle hypertrophy by ambulation in older adults: a brief review

    OpenAIRE

    Ozaki H; Loenneke JP; Thiebaud RS; Stager JM; Abe T

    2013-01-01

    Hayao Ozaki,1 Jeremy P Loenneke,2 Robert S Thiebaud,2 Joel M Stager,3 Takashi Abe31Juntendo University, Inzai, Chiba, Japan; 2Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA; 3Department of Kinesiology, Indiana University, Bloomington, IN, USAAbstract: It is known that ambulatory exercises such as brisk walking and jogging are potent stimuli for improving aerobic capacity, but it is less understood whether ambulatory exercise can increase leg muscle size and...

  10. Optimal Control and Biomechanics of Ambulation with Spring-Loaded Crunches

    Directory of Open Access Journals (Sweden)

    Guangyu Liu

    2011-08-01

    Full Text Available Standard underarm or forearm crutches have some drawbacks induced by their rigid legs. Sping‐ loaded crutches can reduce the impact effect. However, whether or not they also improve propulsion is an open problem. We formulate a problem of the optimal performance of spring‐loaded crutches and propose a numerical approach to solve the problem. Then, the numerical optimal values are incorporated to the innovative design of a pair of spring‐loaded crutches. To evaluate the crutchesʹ performance, we have conducted standard biomechanical experiments for a number of male subjects under two conditions: walking with standard crutches and with spring‐loaded crutches. Three dimensional kinematic data and ground reaction force were recorded and analysed. It was observed that optimized spring‐loaded crutches can efficiently propel the crutch walkers, which conforms to the theory.

  11. Objectively measured work load, health status and sickness absence among Danish ambulance personnel. A longitudinal study

    DEFF Research Database (Denmark)

    Hansen, Claus D.

    2013-01-01

    levels of self-rated health (OR: 1.79), higher levels of musculoskeletal pain (OR: 1.16) but was unrelated to mental health. In addition, increasing work load was associated with higher levels of emotional demands and work pace (p

  12. Activation of catheterization lab in ambulance: new direction in ST-elevation myocardial infarction care

    Institute of Scientific and Technical Information of China (English)

    YAN Hong-bing

    2011-01-01

    @@ Primary percutaneous coronary intervention (PPCI) is the cornerstone of treatment to reduce infarct size and improve outcomes in patients with ST-elevation myocardial infarction (STEMI).1 The optimal site for initiation of reperfusion strategies is the patient's home or place where the infarction occurs.

  13. Chasing the ambulance. The emerging crisis in the preservation of modern health records.

    Science.gov (United States)

    Higgs, E; Melling, J

    1997-04-01

    In this brief essay we argue that the best efforts of archivists, scholars, and practitioners within the National Health Service have not prevented the wholesale destruction of the bulk of patient records created during the twentieth century. This is a matter of vital concern not merely for historians of modern medicine. Important clinical work has frequently been undertaken on materials which have survived, usually by chance or by the foresight of physicians, matrons, and administrators. Even the significant fragments of historical documents which remain in the hands of the health authorities have been threatened by the continuing drive to reduce storage and maintenance costs within hospitals. Archivists and academics have struggled to address the problems of sampling, storage, and access which the enormous bulk of modern records present. In this essay we suggest that the first step must be to raise awareness amongst professionals and the public of the extent to which any future history of the medical services and of patient care will depend on a reasonable rate of survival of these records. The second step must be to confront the problem of resources and the inevitable task of selection which must form the foundations of any long-term policy of preservation. An initial survey of archival materials in Devon indicates that the records of community health care form a substantial and potentially invaluable research source for future historians, though their relevance has rarely been recognized within the academic community.

  14. Interface shear stresses during ambulation with a below-knee prosthetic limb.

    Science.gov (United States)

    Sanders, J E; Daly, C H; Burgess, E M

    1992-01-01

    Shear stresses on a residual limb in a prosthetic socket are considered clinically to contribute to tissue breakdown in below-knee amputees. When applied simultaneously with normal stresses, they can cause injury within the skin or can generate an abrasion on the surface. To gain insight into shear stresses and parameters that affect them, interface stresses were recorded on below-knee amputee subjects during walking trials. On the tibial flares, resultant shear ranged from 5.6 kPa to 39.0 kPa, while on the posterior surface it ranged from 5.0 kPa to 40.7 kPa. During stance phase, anterior resultant shears on a socket were directed toward the apex while posterior resultant shears were directed downward approximately perpendicular to the ground. Waveform shapes were usually double-peaked, with the first peak at 25% to 40% into stance phase and the second peak at 65% to 85% into stance. Application of these results to residual limb tissue mechanics and prosthetic design is discussed.

  15. The role of physician–staffed ambulances: the outcome of a pilot study

    Directory of Open Access Journals (Sweden)

    A Haner

    2015-03-01

    Conclusions: Most of the missions neither required the interventional skills of a physician, nor could they be performed at distance. However, the added medical value of physicians was found to be in other prehospital situations, such as critical decision-making, staff education and research.

  16. A validation of ground ambulance pre-hospital times modeled using geographic information systems

    Directory of Open Access Journals (Sweden)

    Patel Alka B

    2012-10-01

    Full Text Available Abstract Background Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS using geographic information systems (GIS. The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. Methods The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval. The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. Results There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7–8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. Conclusions The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a non-US context. The preference for researchers should be to use actual EMS trip records from the proposed research study area. In the absence of EMS trip data researchers should determine which modeling assumptions more accurately reflect the EMS protocols across their study area.

  17. The Relationship between Manual Ability and Ambulation in Adolescents with Cerebral Palsy

    Science.gov (United States)

    Majnemer, Annette; Shikako-Thomas, Keiko; Shevell, Michael; Poulin, Chantal; Lach, Lucyna; Law, Mary; Schmitz, Norbert

    2013-01-01

    This study examined the relationship between gross motor function and manual ability in 120 adolescents with cerebral palsy (CP) (15.2, SD 2.1 years, 59.8% male). Adolescents were evaluated using the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). A neurologist classified CP subtype. Most…

  18. Walk-in ambulant lungefunktionsservice for rygere i Kobenhavn--etarsopgorelse

    DEFF Research Database (Denmark)

    Backer, V.; Bolton, S.; Ehlers, H.D.

    2008-01-01

    participants about their lung function level and all received a preventive talk about tobacco consumption. Those with signs of COPD spoke with the doctor immediately. RESULTS: A total of 1169 subjects, 59% women, with a mean (SD) age of 60 years (15), visited the walk-in services, 602 (52%) of whom visited...... the walk-in service at the clinic. Among the participants, 826 (71%) were smokers (n=452) or former smokers (n=374). The mean tobacco consumption was 32 (18) packs a year. We found that more current smokers visited the walk-in service at the clinic (45% versus 33%), whereas more ex-smokers visited the lung...... function service at the mall (38% versus 25%) (p tobacco consumption was 32 (18) packs a year, with a difference between those visiting the mall and the clinic (32 (20) versus 23 (16), p

  19. An intent recognition strategy for transfemoral amputee ambulation across different locomotion modes.

    Science.gov (United States)

    Young, Aaron J; Simon, Ann; Hargrove, Levi J

    2013-01-01

    Powered lower limb prostheses, capable of multiple locomotion modes, are being developed for transfemoral amputees. Current devices do not seamlessly transition between modes such as level walking, stairs and slopes. The purpose of this study was to develop an intent recognition system and test its performance across five different modes. A Dynamic Bayesian Network (DBN) was used for classification of neural and mechanical signals while four amputees completed a circuit containing level-walking, ramp ascent, ramp descent, stair ascent and stair descent. Our results indicate that transitional and steady-state stair steps had a high recognition rate (>99%), while ramp steps were significantly more difficult to classify (pamputees to naturally transition between locomotion modes on powered prostheses.

  20. Ambulant Measurements of Physiological Status and Cognitive Performance during Sustained Operations

    Science.gov (United States)

    2009-10-01

    moment where the soldiers face either physical or mental strain. Rather, physical and mental strains are generally experienced concurrently...training on heart rate. A longitudinal study. Annales Medicinae Experimentalis et Biologiae Fenniae 35: 307-315, 1957 [8] Monk TH. A Visual Analogue Scale

  1. Clinical algorithm for improved prediction of ambulation and patient stratification after incomplete spinal cord injury.

    Science.gov (United States)

    Zörner, Björn; Blanckenhorn, Wolf U; Dietz, Volker; Curt, Armin

    2010-01-01

    The extent of ambulatory recovery after motor incomplete spinal cord injury (miSCI) differs considerably amongst affected persons. This makes individual outcome prediction difficult and leads to increased within-group variation in clinical trials. The aims of this study on subjects with miSCI were: (1) to rank the strongest single predictors and predictor combinations of later walking capacity; (2) to develop a reliable algorithm for clinical prediction; and (3) to identify subgroups with only limited recovery of walking function. Correlation and logistic regression analyses were performed on a dataset of 90 subjects with tetra- or paraparesis, recruited in a prospective European multicenter study. Eleven measures obtained in the subacute injury period, including clinical examination, tibial somatosensory evoked potentials (tSSEP), and demographic factors, were related to ambulatory outcome (WISCI II, 6minWT) 6 months after injury. The lower extremity motor score (LEMS) alone and in combination was identified as most predictive for later walking capacity in miSCI. Ambulatory outcome of subjects with tetraparesis was correctly predicted for 92% (WISCI II) or 100% (6minWT) of the cases when LEMS was combined with either tSSEP or the ASIA Impairment Scale, respectively. For individuals with paraparesis, prediction was less distinct, mainly due to low prediction rates for individuals with poor walking outcome. A clinical algorithm was generated that allowed for the identification of a subgroup composed of individuals with tetraparesis and poor ambulatory recovery. These data provide evidence that a combination of predictors enables a reliable prediction of walking function and early patient stratification for clinical trials in miSCI.

  2. New horizons for orthotic and prosthetic technology: artificial muscle for ambulation

    Science.gov (United States)

    Herr, Hugh M.; Kornbluh, Roy D.

    2004-07-01

    The rehabilitation community is at the threshold of a new age in which orthotic and prosthetic devices will no longer be separate, lifeless mechanisms, but intimate extensions of the human body-structurally, neurologically, and dynamically. In this paper we discuss scientific and technological advances that promise to accelerate the merging of body and machine, including the development of actuator technologies that behave like muscle and control methodologies that exploit principles of biological movement. We present a state-of-the-art device for leg rehabilitation: a powered ankle-foot orthosis for stroke, cerebral palsy, or multiple sclerosis patients. The device employs a forcecontrollable actuator and a biomimetic control scheme that automatically modulates ankle impedance and motive torque to satisfy patient-specific gait requirements. Although the device has some clinical benefits, problems still remain. The force-controllable actuator comprises an electric motor and a mechanical transmission, resulting in a heavy, bulky, and noisy mechanism. As a resolution of this difficulty, we argue that electroactive polymer-based artificial muscle technologies may offer considerable advantages to the physically challenged, allowing for joint impedance and motive force controllability, noise-free operation, and anthropomorphic device morphologies.

  3. The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai B; Kristensen, Morten Tange; Jensen, Pia Søe;

    2009-01-01

    BACKGROUND: Perioperative anemia leads to increased morbidity and mortality and potentially inhibits rehabilitation after hip fracture surgery. As such, the optimum transfusion threshold after hip fracture surgery is unknown. PATIENTS AND METHODS: A total of 120 elderly, cognitively intact hip...

  4. Pilot Field Test: The Ability to Ambulate Following Landing as Assessed with Seat Egress, Walk and Obstacle Testing

    Science.gov (United States)

    Fisher, E. A.; Fomina, E. V; Reschke, M. F.; Cerisano, J. M.; Kofman, I. S.; Gadd, N. E.; Phillips, T. R.; Lee, S. M. C.; Laurie, S. S.; Stenger, M. B.; Bloomberg, J. J.; Mulavara, A. P.; Kozlovskaya, I. B.; Tomilovskaya, E. S.

    2016-01-01

    To date, changes in functional performance have been systematically studied after short-duration space flight. As important as the postflight functional changes have been, full functional recovery has never been investigated or established for long-duration flights. The Pilot Field Test (PFT) experiment, conducted with participation of ISS crewmembers traveling on Soyuz expeditions 34S - 41S, is comprised of several tasks designed to study the recovery of sensorimotor abilities of astronauts during the first 24 hours after landing and beyond. The objective of the Seat Egress - Walk and Obstacle Test, developed by NASA's Russian collaborators at the Institute for Biomedical Problems, is to address this gap in knowledge. This will allow us to characterize the ability of crewmembers to perform critical mission requirements that they will be expected to perform after an unassisted landing following 6 to 12 months in microgravity.

  5. Characteristics of out-of-hospital paediatric emergencies attended by ambulance- and helicopter-based emergency physicians

    NARCIS (Netherlands)

    Eich, Christoph; Russo, Sebastian G.; Heuer, Jan F.; Timmermann, Arnd; Gentkow, Uta; Quintel, Michael; Roessler, Markus

    2009-01-01

    Background: In Germany, as in many other countries, for the vast majority of cases, critical out-of-hospital (OOH) paediatric emergencies are attended by non-specialised emergency physicians (EPs). As it is assumed that this may lead to deficient service we aimed to gather robust data on the charact

  6. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Science.gov (United States)

    2010-10-01

    ... offering the MA plan. (2) MA organization financial responsibility. The MA organization is financially... condition regardless of final diagnosis; (iv) For which a plan provider or other MA organization... improve or resolve the enrollee's condition. (2) MA organization financial responsibility. The...

  7. The Angio-Seal™ femoral closure device allows immediate ambulation after coronary angiography and percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hvelplund, Anders; Jeger, Raban; Osterwalder, Remo;

    2011-01-01

    Aims: To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device. Methods and results: First, a randomised controlled trial of immediate mobilisation vs. delayed a...

  8. Successful trans-Atlantic air ambulance transfer of a patient supported by a bi-ventricular assist device.

    Science.gov (United States)

    McLean, Neilson; Copeland, Ryan; Casey, Neil; Samoukovic, Gordon; Quigley, Robert

    2011-08-01

    The ventricular assist device (VAD) is a hemodynamic support device that augments cardiac output for patients with severe ventricular dysfunction. With improved reliability and technological advances, the use of VADs to support patients is increasing. Many VAD-dependent patients ultimately require heart transplants that are only available in specialized centers, necessitating an interhospital transfer. To date there are few reports of long-distance fixed wing aeromedical transport of patients dependent on a VAD. Here we describe the successful transfer of a patient supported by a biventricular assist device (BiVAD) from Cambridge, UK, to Durham, NC, via fixed-wing jet aircraft. During this transfer, we observed hemodynamic alterations secondary to gravitational forces, which should be anticipated and may be mitigated with simple maneuvers. With high-level logistical planning and appropriate medical oversight, patients dependant on BiVADs can be safely transported by fixed wing aircraft over long distances.

  9. Association of bystander cardiopulmonary resuscitation and survival according to ambulance response-times after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik;

    2016-01-01

    chances decreased both for patients with bystander CPR and those without. However, the contrast between the survival chances of patients with vs. without bystander CPR increased over time: within 5 minutes, 30-day survival was 14.5% (95% CI: 12.8-16.4) vs. 6.3% (95% CI: 5.1-7.6), corresponding to 2.......3 times higher chances of survival associated with bystander CPR; within 10 minutes, 30-day survival chances were 6.7% (95% CI: 5.4-8.1) vs. 2.2% (95% CI: 1.5-3.1), corresponding to 3.0 times higher chances of 30-day survival associated with bystander CPR. The contrast in 30-day survival became...... statistically insignificant when response time exceeded 13 minutes (bystander CPR vs. no bystander CPR: 3.7% [95% CI: 2.2-5.4] vs. 1.5% [95% CI: 0.6-2.7]) but 30-day survival was still 2.5 times higher associated with bystander CPR. Based on the model and Danish OHCA Statistics, an additional of 233 patients...

  10. Controlled Study of the Effects of Continuous Intrathecal Baclofen Infusion in Non-Ambulant Children with Cerebral Palsy

    Science.gov (United States)

    Morton, Richard E.; Gray, Natalie; Vloeberghs, Michael

    2011-01-01

    Aim: To measure changes in children with severe spastic cerebral palsy (CP) after continuous intrathecal baclofen (ITB) infusion over 18 months and to compare the results with those of a comparison group awaiting treatment. Method: Thirty-eight children with severe spastic CP considered suitable for ITB were assessed when first seen, just before…

  11. Threshold electrical stimulation (TES) in ambulant children with CP: a randomized double-blind placebo-controlled clinical trial

    DEFF Research Database (Denmark)

    Dali, Christine í; Hansen, Flemming Juul; Pedersen, Søren Anker;

    2002-01-01

    A randomized double-blind placebo-controlled clinical trial was carried out to determine whether a group of stable children with cerebral palsy (36 males, 21 females; mean age 10 years 11 months, range 5 to 18 years) would improve their motor skills after 12 months of threshold electrical...... stimulation (TES). Two thirds received active and one third received inactive stimulators. For the primary outcome we constructed a set of plausible motor function tests and studied the change in summary indices of the performance measurements. Tests were videotaped and assessed blindly to record qualitative...

  12. Threshold electrical stimulation (TES) in ambulant children with CP: a randomized double-blind placebo-controlled clinical trial

    DEFF Research Database (Denmark)

    Dali, Christine í; Hansen, Flemming Juul; Pedersen, Søren Anker;

    2002-01-01

    A randomized double-blind placebo-controlled clinical trial was carried out to determine whether a group of stable children with cerebral palsy (36 males, 21 females; mean age 10 years 11 months, range 5 to 18 years) would improve their motor skills after 12 months of threshold electrical stimula...

  13. Interobserver Agreement of the Gross Motor Function Classification System in an Ambulant Population of Children with Cerebral Palsy

    Science.gov (United States)

    McDowell, Brona C.; Kerr, Claire; Parkes, Jackie

    2007-01-01

    Gross Motor Function Classification System (GMFCS) level was reported by three independent assessors in a population of children with cerebral palsy (CP) aged between 4 and 18 years (n=184; 112 males, 72 females; mean age 10y 10mo [SD 3y 7mo]). A software algorithm also provided a computed GMFCS level from a regional CP registry. Participants had…

  14. Assessment of Objective Ambulation in Lower Extremity Sarcoma Patients with a Continuous Activity Monitor: Rationale and Validation

    Directory of Open Access Journals (Sweden)

    Kenneth R. Gundle

    2014-01-01

    Full Text Available In addition to patient reported outcome measures, accelerometers may provide useful information on the outcome of sarcoma patients treated with limb salvage. The StepWatch (SW Activity Monitor (SAM is a two-dimensional accelerometer worn on the ankle that records an objective measure of walking performance. The purpose of this study was to validate the SW in a cross-sectional population of adult patients with lower extremity sarcoma treated with limb salvage. The main outcome was correlation of total steps with the Toronto Extremity Salvage Score (TESS. In a sample of 29 patients, a mean of 12 days of SW data was collected per patient (range 6–16, with 2767 average total steps (S.D. 1867; range 406–7437. There was a moderate positive correlation between total steps and TESS (r=0.56,  P=0.002. Patients with osseous tumors walked significantly less than those with soft tissue sarcoma (1882 versus 3715, P<0.01. This study supports the validity of the SAM as an activity monitor for the objective assessment of real world physical function in sarcoma patients.

  15. Impact of elosulfase alfa in patients with morquio A syndrome who have limited ambulation: An open-label, phase 2 study.

    Science.gov (United States)

    Harmatz, Paul R; Mengel, Eugen; Geberhiwot, Tarekegn; Muschol, Nicole; Hendriksz, Christian J; Burton, Barbara K; Jameson, Elisabeth; Berger, Kenneth I; Jester, Andrea; Treadwell, Marsha; Sisic, Zlatko; Decker, Celeste

    2017-02-01

    Efficacy and safety of elosulfase alfa enzyme replacement therapy (ERT) were assessed in an open-label, phase 2, multi-national study in Morquio A patients aged ≥5 years unable to walk ≥30 meters in the 6-min walk test. Patients received elosulfase alfa 2.0 mg/kg/week intravenously for 48 weeks. Efficacy measures were functional dexterity, pinch/grip strength, mobility in a modified timed 25-foot walk, pain, quality of life, respiratory function, and urine keratan sulfate (KS). Safety/tolerability was also assessed. Fifteen patients received elosulfase alfa, three patients discontinued ERT due to adverse events (two were grade 3 drug-related adverse events, the other was not drug-related), and two patients missed >20% of planned infusions; 10 completed treatment through 48 weeks and received ≥80% of planned infusions (Modified Per Protocol [MPP] population). The study population had more advanced disease than that enrolled in other trials. From baseline to week 48, MPP data showed biochemical efficacy (urine KS decreased 52.4%). The remaining efficacy results were highly variable due to challenges in test execution because of severe skeletal and joint abnormalities, small sample sizes, and clinical heterogeneity among patients. Eight patients showed improvements in one or more outcome measures; several patients indicated improvements not captured by the study assessments (e.g., increased energy, functional ability). The nature of adverse events was similar to other elosulfase alfa studies. This study illustrates the considerable challenges in objectively measuring impact of ERT in very disabled Morquio A patients and highlights the need to examine results on an individual basis. © 2016 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.

  16. Air ambulance and hospital services for critically ill and injured in Greenland, Iceland and the Faroe Islands: how can we improve?

    Science.gov (United States)

    Gunnarsson, Björn; Jensen, Niels S Kieler; Garði, Tummas I; Harðardóttir, Helga; Stefánsdóttir, Lilja; Heimisdóttir, María

    2015-01-01

    The Nordic Atlantic Cooperation (NORA) is an intergovernmental organization under the auspices of the Nordic Council of Ministers. The NORA region comprises Greenland, Iceland, Faroe Islands and western coastal areas of Norway. Historical, cultural and institutional links bind these nations together in multiple ways, and regional co-operation has in recent years become a focus of interest. This commentary addresses air medical services (AMSs) and available advanced hospital services in the 3 smallest NORA countries challenged sparse populations, hereafter referred to as the region. It seems likely that strengthened regional co-operation can help these countries to address common challenges within health care by exchanging know-how and best practices, pooling resources and improving the efficiency of care delivery. The 4 largest hospitals in the region, Dronning Ingrids Hospital in Nuuk (Greenland), Landspítali in Reykjavík and Sjúkrahúsið á Akureyri, (both in Iceland) and Landssjúkrahúsið Tórshavn on the Faroe Islands, have therefore undertaken the project Network for patient transport in the North-West Atlantic (in Danish: Netværk for patienttransport i Vest-Norden). The goal of the project, and of this article, is to exchange information and provide an overview of current AMSs and access to acute hospital care for severely ill or injured patients in the 3 participating countries. Of equal importance is the intention to highlight the need for increased regional co-operation to optimize use of limited resources in the provision of health care services.

  17. Association between Community Ambulation Walking Patterns and Cognitive Function in Patients with Parkinson’s Disease: Further Insights into Motor-Cognitive Links

    Directory of Open Access Journals (Sweden)

    Aner Weiss

    2015-01-01

    Full Text Available Background. Cognitive function is generally evaluated based on testing in the clinic, but this may not always reflect real-life function. We tested whether parameters derived from long-term, continuous monitoring of gait are associated with cognitive function in patients with Parkinson’s disease (PD. Methods. 107 patients with PD (age: 64.9 ± 9.3 yrs; UPDRS motor sum “off”: 40.4 ± 13.2; 25.23% women wore a 3D accelerometer on their lower back for 3 days. Computerized measures of global cognitive function, executive function, attention, and nonverbal memory were assessed. Three-day acceleration derived measures included cadence, variability, bilateral coordination, and dynamic postural control. Associations between the acceleration derived measures and cognitive function were determined. Results. Linear regression showed associations between vertical gait variability and cadence and between global cognitive score, attention, and executive function (p≤0.048. Dynamic postural control was associated with global cognitive score and attention (p≤0.027. Nonverbal memory was not associated with the acceleration-derived measures. Conclusions. These findings suggest that metrics derived from a 3-day worn body-fixed sensor reflect cognitive function, further supporting the idea that the gait pattern may be altered as cognition declines and that gait provides a window into cognitive function in patients with PD.

  18. Préambule au numéro 12 de Questions vives sur l’évaluation des enseignants et des formateurs

    Directory of Open Access Journals (Sweden)

    Yvan Abernot

    2011-01-01

    Full Text Available Evaluer les enseignants n’est pas une idée nouvelle, mais dans cette période ne donnant guère d’assurance pour le futur proche ou celui de nos enfants, la tendance à rechercher des responsables est exacerbée. Toutes les professions sont stigmatisées d’une manière ou d’une autre, celles de l’enseignement et de la formation n’y échappent pas. Parallèlement, l’espoir justifié d’un redressement par l’éducation n’est certainement pas sans attiser le désir de voir cette profession stimulée par un r...

  19. Fire and EMS Districts, ESN Districts, Ambulance Districts, Published in 2008, 1:24000 (1in=2000ft) scale, Lafayette County Land Records.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Fire and EMS Districts dataset, published at 1:24000 (1in=2000ft) scale, was produced all or in part from Hardcopy Maps information as of 2008. It is described...

  20. Normal height and weight in a series of ambulant Duchenne muscular dystrophy patients using the 10 day on/10 day off prednisone regimen.

    NARCIS (Netherlands)

    Dam, K. ten; Groot, I.J.M. de; Noordam, C.; Alfen, N. van; Hendriks, J.C.M.; Sie, L.T.L.

    2012-01-01

    Prednisone treatment delays the progressive course of Duchenne muscular dystrophy. The aim of this study was to determine the influence of the 10 day on/10 day off treatment on height and weight. We retrospectively reviewed the growth and weight charts of Duchenne patients born between 1988 and 2006

  1. De acute arsine-intoxicatie. Richtlijnen voor opvang door EHBO'ers, ambulance-personeel en (bedrijfs)arts van slachtoffers van expositie aan arsine

    NARCIS (Netherlands)

    Remmert HP; Cremers PMA

    1987-01-01

    De gevaren verbonden aan de expositie aan arsine maken het wenselijk dat een protocol beschikbaar is waarbij minimaal de hoofdlijnen zijn aangegeven hoe bij dergelijke ongevallen te handelen. Dit document bevat een voorstel daartoe, waarin vooral aandacht is besteed aan de medische aspecten bij

  2. Patients' priorities for ambulant hospital care centres: a survey and discrete choice experiment among elderly and chronically ill patients of a Dutch hospital.

    NARCIS (Netherlands)

    Albada, A.; Triemstra, M.

    2009-01-01

    Objective: This study established patients' preferences regarding the facilities in an adjacent centre for ambulatory hospital care. It also identified determinants of patients' choice to visit this centre instead of the regional hospital. Methods: A questionnaire survey among 1477 elderly and chron

  3. Normal and shear stresses on a residual limb in a prosthetic socket during ambulation: comparison of finite element results with experimental measurements.

    Science.gov (United States)

    Sanders, J E; Daly, C H

    1993-01-01

    Interface stresses on a below-knee amputee residual limb during the stance phase of gait calculated using an analytical finite element model were compared with experimental interface stress measurements. The model was quasi-static and linear. Qualitatively, shapes of analytical and experimental interface stress waveforms were similar in that they were double-peaked with some distinct features apparent. However, quantitatively analytical resultant shear stress magnitudes were less than experimental values at all transducer measurement sites. Analytical normal stresses were less than experimental values at postero-proximal, postero-distal, and anteromedial proximal sites, but were greater than experimental values at antero-lateral distal and antero-lateral proximal sites. Anterior resultant shear angles were directed more distally in the model than in clinical data, an expected result since there was no relief for the tibial crest in the model. Model sensitivity analyses to shank loads showed interface normal and resultant shear stresses were most sensitive to axial force, sagittal bending moment, or sagittal shear force. The finite element model presented in this paper is significant because it contributes toward development of an analytical modeling technique to predict interface stress distributions for proposed prosthetic designs, provides insight into physical explanations of features apparent in interface stress waveforms (thereby enhancing understanding of interface mechanics), and provides insight into nonlinear characteristics that need to be added to improve the model.

  4. 对中国古代日月食救护仪式异同的分析%Analysis of Similarities and Differences about Eclipses Ambulance Ceremony in China Ancient

    Institute of Scientific and Technical Information of China (English)

    朱海糰; 孙亭

    2015-01-01

    The records of solar eclipse and the eclipse records are systematic and complete in rich astronomical material of ancient China.We are not difficult to find the following phenomenon from the existing records and the historical data.The rulers and common people are going to implement the "rescue"ceremony for rescuing the sun and the moon when the eclipse occurs in ancient China.This traditional ritual from Zhou Dai has been extended to the late Qing Dynasty.We can find the solar eclipse and the eclipse of the "rescue"ceremony from different tends to be the same by tracing the solar eclipse and eclipse "rescue"ceremony.It not only has historical significance and academic significance,but also contribute to a better understanding of the ancient China traditional concepts and the mainstream ideology that research and systematic analyze the change.%中国古代丰富的天象记录中,日食与月食的记录比较系统和完备。从现有的记录和史料中,我们不难发现这一现象:在中国古代,当有日食或月食发生,上至统治者下至平民百姓都要施行相应的“救护”仪式,用以救护日月,这一传统礼制从周代一直延续至清末。追溯日食与月食的“救护”仪式从不同趋于相同,研究这一变化并且进行系统分析,不仅具有历史意义和学术意义,也有助于更好的了解中国古代的传统观念与主流思想。

  5. ENERGY-COST DURING AMBULATION IN TRANSFEMORAL AMPUTEES - A KNEE-JOINT WITH A MECHANICAL SWING PHASE-CONTROL VS A KNEE-JOINT WITH A PNEUMATIC SWING PHASE-CONTROL

    NARCIS (Netherlands)

    BOONSTRA, AM; SCHRAMA, J; FIDLER, [No Value; EISMA, WH

    1995-01-01

    The aim of the study was (i) to evaluate the preference of transfemoral amputees for a 4-bar linked knee joint with either a mechanical swing phase control or a pneumatic swing phase control, and (ii) to compare the energy expenditure in transfemoral amputees using a prosthesis with a mechanical swi

  6. Thoracolumbar spine fractures in the geriatric fracture center : early ambulation leads to good results on short term and is a successful and safe alternative compared to immobilization in elderly patients with two-column vertebral fractures

    NARCIS (Netherlands)

    Weerink, L B M; Folbert, E C; Kraai, M; Smit, R S; Hegeman, J H; van der Velde, D

    2014-01-01

    INTRODUCTION: Thoracolumbar spine fractures are common osteoporotic fractures among elderly patients. Several studies suggest that these fractures can be treated successfully with a nonoperative management. The aim of this study is to evaluate the conservative treatment of elderly patients with a ve

  7. Fire and EMS Districts, Areas defining emergency response assignments for fire, ambulance, first responders, and law enforcement., Published in 2008, 1:2400 (1in=200ft) scale, Portage County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Fire and EMS Districts dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Published Reports/Deeds information as of 2008. It is...

  8. 脑卒中偏瘫患者下肢功能与ADL移动动作能力的关系%Relationship between the function of the paretic lower limb and ambulation of ADL function in hemiparetic stroke patients

    Institute of Scientific and Technical Information of China (English)

    瓮长水; 毕胜; 杨娟; 刘忠文; 任学军; 秦茵; 于增志

    2004-01-01

    目的:改善ADL能力是脑卒中康复主要目标.本文通过对脑卒中偏瘫患者ADL移动动作能力与患侧下肢功能之间关系的研究,判别影响ADL移动动作能力的下肢功能因素.方法:对55例患者用功能独立性测量中的转移和行进项目来评价患者的ADL移动动作能力,用简式Fugl-Meyer评价法评价下肢运动功能,用Motricity指数评价患侧下肢肌力,用Berg平衡量表评价患者的平衡能力.用Pearson相关分析方法来确定ADL移动动作能力和下肢功能之间的相关性;然后以ADL移动动作能力作为因变量用多元回归分析法的逐步回归法和路径分析法来确定影响ADL移动动作能力的下肢功能因素.结果:患者患侧下肢功能与ADL移动动作能力之间呈高度相关(r=0.54l-0.670,P<0.001);其中平衡功能是影响ADL移动动作能力最重要的直接因素(R2=0.45,P<0.05).结论:脑卒中偏瘫患者的下肢功能尤其是平衡功能是影响ADL移动动作能力的重要因素.

  9. Case management in oncology rehabilitation (CAMON: The effect of case management on the quality of life in patients with cancer after one year of ambulant rehabilitation. A study protocol for a randomized controlled clinical trial in oncology rehabilitation

    Directory of Open Access Journals (Sweden)

    Bardheci Katarina

    2011-04-01

    Full Text Available Abstract Background Cancer diseases and their therapies have negative effects on the quality of life. The aim of this study is to assess the effectiveness of case management in a sample of oncological outpatients with the intent of rehabilitation after cancer treatment. Case management wants to support the complex information needs of the patients in addition to the segmented structure of the health care system. Emphasis is put on support for self-management in order to enhance health - conscious behaviour, learning to deal with the burden of the illness and providing the opportunity for regular contacts with care providers. We present a study protocol to investigate the efficacy of a case management in patients following oncology rehabilitation after cancer treatment. Methods The trial is a multicentre, two-arm randomised controlled study. Patients are randomised parallel in either 'usual care' plus case management or 'usual care' alone. Patients with all types of cancer can be included in the study, if they have completed the therapy with chemo- and/or radiotherapy/surgery with curative intention and are expected to have a survival time >1 year. To determine the health-related quality of life the general questionnaire FACT G is used. The direct correlation between self-management and perceived self-efficacy is measured with the Jerusalem & Schwarzer questionnaire. Patients satisfaction with the care received is measured using the Patient Assessment of Chronic Illness Care 5 As (PACIC-5A. Data are collected at the beginning of the trial and after 3, 6 and 12 months. The power analysis revealed a sample size of 102 patients. The recruitment of the centres began in 2009. The inclusion of patients began in May 2010. Discussion Case management has proved to be effective regarding quality of life of patients with chronic diseases. When it comes to oncology, case management is mainly used in cancer treatment, but it is not yet common in the rehabilitation of cancer patients. Case management in oncology rehabilitation is not well-established in Switzerland. A major challenge of the study will therefore probably be the recruitment of the patients due to the physicians' and patients' scarcely existing awareness of this issue. Trial registration ISRCTN41474586

  10. Emergency Medical Service

    Science.gov (United States)

    1980-01-01

    Lewis Research Center helped design the complex EMS Communication System, originating from space operated telemetry, including the telemetry link between ambulances and hospitals for advanced life support services. In emergency medical use telemetry links ambulances and hospitals for advanced life support services and allows transmission of physiological data -- an electrocardiogram from an ambulance to a hospital emergency room where a physician reads the telemetered message and prescribes emergency procedures to ambulance attendants.

  11. Intensivering af præhospital hjertestopbehandling øger antallet af overlevende med god cerebral funktion

    DEFF Research Database (Denmark)

    Nielsen, J R; Gram, L; Larsen, C F;

    1990-01-01

    Psychological assessment in the form of a test for dementia was carried out in 69 individuals. Thirty of these were survivors of cardiac arrest outside hospital. Seven of these were brought to hospital in ordinary emergency ambulances, 14 in heart ambulances and nine in medically staffed ambulances...

  12. Art to Heart: The Effects of Staff- Created Art on the Postoperative Rehabilitation of Cardiovascular Surgery Patients.

    Science.gov (United States)

    Bowen, Mary Gwyn; Wells, Nancy L; Dietrich, Mary S; Sandlin, Victoria

    2015-01-01

    Postoperative ambulation is important for reducing complications following surgery. The type of art patients view on the ambulation route may influence the distance patients walk. In this study, patients ambulated greater distances when staff-created art was placed on hallway walls.

  13. Simulation of Emergency Medical Services Delivery Performance Based on Real Map

    Directory of Open Access Journals (Sweden)

    Mohd Hafiz Azizan

    2013-06-01

    Full Text Available Performance of Emergency Medical Services (EMS delivery is normally measured via ambulance response time. Quick ambulance response can effectively reduce the disability, morbidity and mortality of the emergency patients. Ambulance dispatch policy and ambulance location model both have a significant impact on the ambulance response time. In this paper, we present a prototype of simulation framework to study the performance of local EMS delivery in terms of a simulation model that consists of both ambulance dispatch policy and ambulance location model. Several real-life dispatch policies are simulated in a real map to evaluate the efficiency of local EMS delivery in Johor Bahru. By using a suitable dispatch policy, the results show an improvement in average response time for higher priority call. The total calls covered are also found to increase significantly with the application of Maximal Covering Location Problem (MCLP, especially at a bigger fleet size.

  14. Den præhospitale service i Danmark

    DEFF Research Database (Denmark)

    Trier, H; Larsen, C F

    1993-01-01

    In Denmark, emergency ambulances are dispatched by 41 centres manned either by trained firemen (in Copenhagen) or policemen (outside Copenhagen). In 1990, emergency ambulance calls totalled 284,000. Utilisation of emergency ambulance services increases with urbanisation. A doctor-manned ambulance...... is in operation in Copenhagen, and in some other large towns anaesthesiology and intensive care teams can be dispatched from hospital to give on-the-spot care. In less populated areas, some general practitioners give advanced life-support. Although many areas are serviced by ambulances equipped...... with defibrillators, the majority of patients receive only basic life-support from ambulance personnel. New initiatives resulting from a recent report by a commission appointed by central authorities, and focused on prehospital treatment, are expected to improve the service by raising the level of training given...

  15. Veterans Medical Care: FY2010 Appropriations

    Science.gov (United States)

    2010-01-21

    medical services such as: medical, surgical, and mental health care, including care for substance abuse; prescription drugs, including over-the- counter...travel payments to eligible veterans were paid when specialized modes of transportation, such as ambulance or wheelchair van, were medically required...reimbursement who are traveling by special modes of transportation such as ambulance, air ambulance, wheelchair van, or to receive a compensation and pension

  16. 29 CFR 4.130 - Types of covered service contracts illustrated.

    Science.gov (United States)

    2010-07-01

    ...) Aerial reconnaissance for fire detection. (3) Ambulance service. (4) Barber and beauty shop services. (5... maintenance and operation and engineering support services. (16) Exploratory drilling (other than part...

  17. O efeito da deambulação na duração da faze ativa do trabalho de parto El efecto de la deambulación en la duración de la fase activa del trabajo de parto The ambulation effect in the active stage duration of the labor

    Directory of Open Access Journals (Sweden)

    Fabiana Villela Mamede

    2007-09-01

    Full Text Available O trabalho teve como objetivo analisar a associação entre a deambulação e a duração da fase ativa do trabalho de parto. Metodologia: estudo analítico de intervenção do tipo quase experimental. Fizeram parte do estudo 80 parturientes primíparas, admitidas em trabalho de parto espontâneo, no início da fase ativa. Instrumentos de coleta de dados: podômetro para medir a distância percorrida em metros, Escala Visual Numérica (EVN de dor, formulário para o registro de dados. Resultados: as participantes percorreram uma distância média de 1.624 metros, 63,09% da fase ativa do trabalho de parto e em um tempo médio de 5 horas. Verificou-se que a quantidade deambulada durante as três primeiras horas da fase ativa está associada a um encurtamento do trabalho de parto, sendo que a cada 100 metros percorridos ocorreu uma diminuição de 22 minutos na primeira hora, 10 minutos na segunda hora e 6 minutos na terceira hora.La finalidad de este trabajo fue la de analizar la asociación entre la deambulación y el tiempo de la fase activa del trabajo de parto. Metodología: estudio analítico de intervención del tipo casi experimental. Participaron del estudio 80 parturientes primíparas, admitidas en trabajo de parto espontáneo, en el inicio de la fase activa. Instrumentos de recopilación de datos: podómetro para medir la distancia transcurrida en metros, Escala visual numérica de dolor, Formulario para el registro de datos. Resultados: las participantes transcurrieron una distancia media de 1624metros, 63,09% de la fase activa del trabajo de parto y en un tiempo promedio de 5 horas. Se verificó que la cantidad deambulada durante las tres primeras horas de la fase activa está asociada a un acortamiento del trabajo de parto. Para cada 100 metros transcurridos ocurrió una disminución de 22 minutos en la primera hora, 10 minutos en la segunda hora y 6 minutos en la tercera hora.This study aimed to analyze the association between walking and the duration of the active phase of labor. Methodology: We realized an analytic, an almost experimental intervention study. Study participants were 80 primiparous parturient women, who were admitted during spontaneous labor, at the start of the active phase. Data collection instruments: podometer to measure the distance walked in meters, numerical visual pain scale, and form for data registration. Results: the parturient women walked an average distance of 1624 meters, 63.09% of the active phase of labor and during an average time of 5 hours. We observed that the distance walked during the first three hours of the active phase is associated with a shorter labor time. For every 100 meters walked, duration decreased by 22 minutes during the first hour, by 10 minutes during the second hour and by 6 minutes during the third hour.

  18. 重复经颅磁刺激对不完全性脊髓损伤患者运动和步行功能的疗效%Effect of Repetitive Transcranial Magnetic Stimulation on Motor and Ambulation Function for Incomplete Spinal Cord Injury

    Institute of Scientific and Technical Information of China (English)

    潘钰; 郄淑燕; 刘畅; 甄巧霞; 刘晓磊; 丁永红; 杨等; 邰志红

    2013-01-01

    Objective To assess the effect of repetitive transcranial magnetic stimulation (rTMS) on motor and ambulatory function in incomplete spinal cord injury (SCI) patients. Methods 18 incomplete SCI patients (AIS D) were randomized to treatment group (n=10) and control group (n=8). The treatment group received rTMS while the control group received sham stimulation for 2 weeks. All the patients re-ceived routine rehabilitation. They were assessed with Lower Extremity Motor Score (LEMS), 10 m Walking Test for Walking Speed, modi-fied Ashworth scale (MAS), Walking Index for SCI Scale II(WISCI II), and Spinal Cord Independence Measure (SCIM) before and after treatment, and followed up for 2 weeks after treatment. Results The treatment group significantly improved in LEMS, walking speed, and SCIM after treatment and during follow up (P0.05)。结论 rTMS可进一步改善不完全性脊髓损伤患者的下肢运动功能。

  19. The effects of training abductors of hip on balance function and ambulation safety in hemiplegic patients%强化髋外展肌群对脑卒中偏瘫患者平衡功能和步行安全性的影响

    Institute of Scientific and Technical Information of China (English)

    郭京伟; 谢欲晓; 黄学英; 孙启良

    2008-01-01

    目的:探讨强化髋外展肌群对脑卒中偏瘫患者平衡功能和步行安全性的影响.方法:将符合入选标准的脑卒中偏瘫患者随机分为观察组(20例)和对照组(20例),两组患者均采用以Bobath为主的现代康复技术进行平衡训练和步行训练,在此基础上,观察组加入强化髋外展肌群的训练方法,在治疗前和6周治疗结束后,分别用Berg平衡评分量表和Holden功能步行分类对两组患者进行平衡功能和步行能力的评定.随访并统计治疗结束后半年期间两组患者的跌倒发生率.结果:6周治疗后,两组的BBS和Holden功能步行分类的级别均较治疗前有明显提高(P<0.01).观察组的BBS和Holden功能步行分类的级别均优于对照组,差异具有显著性意义(P<0.05,P<0.01).通过随访,治疗结束半年内观察组的跌倒发生率比对照组低,差异有非常显著性意义(19<0.01).结论:在常规平衡训练的基础上,强化患侧髋外展肌群的训练.能更有效地提高脑卒中偏瘫患者的平衡功能,增加步行的安全性.

  20. 42 CFR 413.70 - Payment for services of a CAH.

    Science.gov (United States)

    2010-10-01

    ... compensating these specified medical emergency room staff are allowable only if the costs are incurred under... or the entity is the only provider or supplier of ambulance services located within a 35-mile drive... only if the CAH or the entity is the only provider or supplier of ambulance services located within...

  1. Mobile Intensive Care Unit: Technical and clinical aspects of interhospital critical care transport

    NARCIS (Netherlands)

    van Lieshout, E.J.

    2016-01-01

    The Mobile Intensive Care Unit (MICU) is a combination of i) a team of critical care nurse, physician and ambulance driver, ii) a MICU-trolley (i.e. equipped with cardiovascular monitor, mechanical ventilator, syringe pumps etc. indispensable for safe transport and iii) an Intensive Care ambulance.

  2. Striding Towards Better Physical Therapy

    Science.gov (United States)

    2003-01-01

    This paper presents a discussion on a new rehabilitative device that promises to improve physical therapy for patients working to regain the ability to walk after facing traumatic injuries or a degenerative illness. Produced by Enduro Medical Technology, of East Hartford, Connecticut, the Secure Ambulation Module (S.A.M.) creates a stable and secure environment for patients as they stand during ambulation therapy.

  3. Making Facilities Accessible to the Physically Handicapped.

    Science.gov (United States)

    State Univ. Construction Fund, Albany, NY.

    Guidelines on performance criteria for the State University of New York consider two main types of handicapped: the ambulant and semi-ambulant, including some physically handicapped, the visually and aurally handicapped, and persons with cardiac conditions; and persons confined to wheel chairs. The handicapped and planning for them are discussed.…

  4. Logistics of emergency response vehicles : facility location, routing, and shift scheduling

    NARCIS (Netherlands)

    P.L. van den Berg (Pieter)

    2016-01-01

    textabstractThis thesis discusses different aspects of the logistics of emergency response vehicles. In most parts, we consider providers of ambulance care in the Netherlands. However, also firefighters and air ambulance providers in both Canada and Norway are considered. Even though significant dif

  5. A Task Analysis of Emergency Prehospital Care. Allied Health Professions Project.

    Science.gov (United States)

    Byers, Bruce B.; And Others

    A selected sample of ambulance service units in the commonwealth of Pennsylvania was surveyed during May and June 1973. The purpose of the survey was to determine the performance of work activities by various levels of workers within each of the ambulance services. The results of the survey are analyzed and reported. The data obtained are used for…

  6. Clobazam-clonazepam combination effective for stimulus-induced falling in hyperekplexia.

    Science.gov (United States)

    McAbee, Gary N

    2015-01-01

    A child with the major form of hyperekplexia is presented who stopped ambulating because of frequent unexpected falls associated with acoustic and visual stimuli. A combination of clobazam and clonazepam was well tolerated and was rapidly and dramatically effective in eliminating the falls and restoring ambulation.

  7. Balancing Machine Work, Comfort Work, and Sentimental Work

    DEFF Research Database (Denmark)

    Pedersen, Maria Ie; Hansen, Magnus; Hertzum, Morten

    2011-01-01

    and attention. We investigate ambulance care in three of Denmark’s five healthcare regions, which staff ambulances with emergency medical technicians, paramedics, and physicians. Using the concept of illness trajectory we analyse how the ambulance crews balance machine work, which involves continuously...... work, but also that this has negative consequences. Equipment for use in ambulances should aim at supporting the ambulance crews in competently and dynamically balancing the different types of work and should, consequently, avoid binding the crew’s attention for unbroken periods of time....... monitoring the equipment, comfort work, which is actions taken to relieve the pain or discomfort of the patient, and sentimental work, which is care for the patient’s physical and mental well-being, often verbal in nature. The analysis shows that comfort and sentimental work often takes priority over machine...

  8. An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England.

    Directory of Open Access Journals (Sweden)

    Christopher I Price

    Full Text Available OBJECTIVE: Effective provision of urgent stroke care relies upon admission to hospital by emergency ambulance and may involve pre-hospital redirection. The proportion and characteristics of patients who do not arrive by emergency ambulance and their impact on service efficiency is unclear. To assist in the planning of regional stroke services we examined the volume, characteristics and prognosis of patients according to the mode of presentation to local services. STUDY DESIGN AND SETTING: A prospective regional database of consecutive acute stroke admissions was conducted in North East, England between 01/09/10-30/09/11. Case ascertainment and transport mode were checked against hospital coding and ambulance dispatch databases. RESULTS: Twelve acute stroke units contributed data for a mean of 10.7 months. 2792/3131 (89% patients received a diagnosis of stroke within 24 hours of admission: 2002 arrivals by emergency ambulance; 538 by private transport or non-emergency ambulance; 252 unknown mode. Emergency ambulance patients were older (76 vs 69 years, more likely to be from institutional care (10% vs 1% and experiencing total anterior circulation symptoms (27% vs 6%. Thrombolysis treatment was commoner following emergency admission (11% vs 4%. However patients attending without emergency ambulance had lower inpatient mortality (2% vs 18%, a lower rate of institutionalisation (1% vs 6% and less need for daily carers (7% vs 16%. 149/155 (96% of highly dependent patients were admitted by emergency ambulance, but none received thrombolysis. CONCLUSION: Presentations of new stroke without emergency ambulance involvement were not unusual but were associated with a better outcome due to younger age, milder neurological impairment and lower levels of pre-stroke dependency. Most patients with a high level of pre-stroke dependency arrived by emergency ambulance but did not receive thrombolysis. It is important to be aware of easily identifiable

  9. Førstehjælp ved observeret hjertestop uden for hospital

    DEFF Research Database (Denmark)

    Lybecker, H; Andersen, C; Frandsen, F;

    1990-01-01

    In connection with participation of doctors in the emergency ambulance service in Odense, the number of cases of observed cardiac arrest outside hospital was registered during a period of six months. The object was to assess how often primary treatment for cardiac arrest was instituted by passers......-by before arrival of the ambulance. Seventy-four cases of observed cardiac arrest occurred. In 11 of these (15%) primary resuscitation was attempted outside hospital. In only three (4%) cases the primary resuscitation was undertaken by lay persons. Treatment of cardiac arrest before arrival of the ambulance...

  10. Evaluation of intensified prehospital treatment in out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Frandsen, F; Nielsen, J R; Gram, L

    1991-01-01

    by personnel on basic, intermediate, or advanced care training. When ordinary ambulances (basic EMS) were used, 8 (5%) patients were discharged alive. When ambulances with specially trained paramedics (intermediate EMS) were used, 2 (1%) patients were discharged. Finally medically staffed ambulances...... with doctors collaborating (advanced EMS) were used, and 11 (13%) patients were discharged. The intermediate EMS system was used in another area with 45,000 inhabitants/population density of 340/km2, and in this area 20 (18%) patients were discharged. Among the survivors a psychological assessment in form...

  11. Perfil funcional de locomoção em um grupo de pacientes com lesão medular atendidos em um centro de reabilitação Perfil funcional de locomoción en un grupo de pacientes con lesión medular atendidos en un centro de rehabilitación Functional ambulation profile in a group of spinal cord injured patients attended at a rehabilitation center

    OpenAIRE

    Ana Cristina Franzoi; Ana Luiza Baptista; Ana Maria Carvalho; Wagner Gonçalves; Anna Christina Boari Rosa; Alexandre Pinto; Kátia Regina Carvalho

    2009-01-01

    OBJETIVO: descrever o perfil de locomoção de um grupo de pacientes com lesão medular (LM), correlacionando-o com as características da amostra. MÉTODOS: setenta pacientes (50 com LM traumática e 20 com LM não-traumática). Instrumentos: Classificação Funcional da Marcha Modificada (CFMM), WISCI-II, Escala de Ashworth Modificada (EAM), Classificação AIS, Lower Extremities Muscle Score (AIS-LEMS). Estatística: descritiva, comparação entre grupos, testes de correlação considerando p

  12. Ebola (Ebola Virus Disease): Treatment

    Science.gov (United States)

    ... Handoff SOP Ambulance Decontamination Hospitals Infection Control Acute Hemodialysis Pregnant Women Handling Human Remains Neonatal Care Outpatient ... Screening of Patients Within the Healthcare System Case Definitions for Evaluating Suspected Ebola Patients Hand Hygiene Personal ...

  13. Ebola (Ebola Virus Disease): Signs and Symptoms

    Science.gov (United States)

    ... Handoff SOP Ambulance Decontamination Hospitals Infection Control Acute Hemodialysis Pregnant Women Handling Human Remains Neonatal Care Outpatient ... Screening of Patients Within the Healthcare System Case Definitions for Evaluating Suspected Ebola Patients Hand Hygiene Personal ...

  14. Questions and Answers about Ebola, Pets, and Other Animals

    Science.gov (United States)

    ... Handoff SOP Ambulance Decontamination Hospitals Infection Control Acute Hemodialysis Pregnant Women Handling Human Remains Neonatal Care Outpatient ... Screening of Patients Within the Healthcare System Case Definitions for Evaluating Suspected Ebola Patients Hand Hygiene Personal ...

  15. Ebola (Ebola Virus Disease): Diagnosis

    Science.gov (United States)

    ... Handoff SOP Ambulance Decontamination Hospitals Infection Control Acute Hemodialysis Pregnant Women Handling Human Remains Neonatal Care Outpatient ... Screening of Patients Within the Healthcare System Case Definitions for Evaluating Suspected Ebola Patients Hand Hygiene Personal ...

  16. Ebola (Ebola Virus Disease): Transmission

    Science.gov (United States)

    ... Handoff SOP Ambulance Decontamination Hospitals Infection Control Acute Hemodialysis Pregnant Women Handling Human Remains Neonatal Care Outpatient ... Screening of Patients Within the Healthcare System Case Definitions for Evaluating Suspected Ebola Patients Hand Hygiene Personal ...

  17. Ebola (Ebola Virus Disease)

    Science.gov (United States)

    ... Handoff SOP Ambulance Decontamination Hospitals Infection Control Acute Hemodialysis Pregnant Women Handling Human Remains Neonatal Care Outpatient ... Screening of Patients Within the Healthcare System Case Definitions for Evaluating Suspected Ebola Patients Hand Hygiene Personal ...

  18. Acute stent thrombosis after primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Wiberg, Sebastian; Van't Hof, Arnoud;

    2015-01-01

    OBJECTIVES: This study sought to determine clinical, procedural, and treatment factors associated with acute stent thrombosis (AST) in the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial. BACKGROUND: Bivalirudin started during transport for primary percutaneous coronary int...

  19. 48 CFR 22.1003-5 - Some examples of contracts covered.

    Science.gov (United States)

    2010-10-01

    ..., engines, electrical motors, vehicles, and electronic, office and related business and construction... CFR 4.130 for additional examples): (a) Motor pool operation, parking, taxicab, and ambulance services... detection. (h) Some support services at installations, including grounds maintenance and landscaping....

  20. 49 CFR 325.1 - Scope of the rules in this part.

    Science.gov (United States)

    2010-10-01

    ... valid noise emission measurement; (4) An emergency motor vehicle, such as a fire engine, an ambulance, a....1 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GENERAL REGULATIONS COMPLIANCE WITH INTERSTATE...

  1. NIOSH Mobile Emergency Medical Service (EMS) Work Environment Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — The NIOSH Mobile Emergency Medical Service (EMS) Work Environment Laboratory is a 2005 Wheeled Coach Type III ambulance mounted on a Ford E-450 cut-away van chassis....

  2. Kolmekesi ühest Peipsi-äärsest asjast / Tiit Lepp

    Index Scriptorium Estoniae

    Lepp, Tiit

    2007-01-01

    Annika Haasi, Birgit Püve ja Age Petersoni fotonäitus "Prichudie, Revisited" Peipsiääre valla inimestest ja elust-olust kunstikeskuses AmbulARToorium Tartumaaal. Kommenteerinud Annika Haas, Birgit Püve, Age Peterson

  3. Intermittent prednisone therapy in Duchenne muscular dystrophy : A randomized controlled trial

    NARCIS (Netherlands)

    Beenakker, EAC; Fock, JM; Van Tol, M; Maurits, NM; Koopman, HM; Brouwer, OF; Van der Hoeven, JH

    2005-01-01

    Background: Prednisone treatment is used to prolong ambulation in patients with Duchenne muscular dystrophy (DMD). However, since severe adverse effects often accompany prednisone treatment, it is debatable whether the benefits of prednisone treatment outweigh its adverse effects. Objectives: To stu

  4. 75 FR 81335 - Reasonable Charges for Medical Care or Services; 2011 Calendar Year Update

    Science.gov (United States)

    2010-12-27

    ... professional charges for anesthesia services and dental services; pathology and laboratory charges; observation... and other professional charges, including professional charges for anesthesia services and dental services; pathology and laboratory charges; observation care facility charges; ambulance and...

  5. 78 FR 76413 - Reasonable Charges for Medical Care or Services; V3.14, 2014 Calendar Year Update and National...

    Science.gov (United States)

    2013-12-17

    ... professional charges for anesthesia services and dental services; pathology and laboratory charges; observation...; physician and other professional charges, including professional charges for anesthesia services and dental services; pathology and laboratory charges; observation care facility charges; ambulance and...

  6. 75 FR 41923 - Public Meeting on Draft Recommendations for Safely Transporting Children in Specific Situations...

    Science.gov (United States)

    2010-07-19

    ...) protect the head, neck and spine of all children transported in ground ambulances. By ensuring that these... the FOR FURTHER INFORMATION CONTACT section of this notice. Speakers must also make arrangements...

  7. 42 CFR 410.10 - Medical and other health services: Included services.

    Science.gov (United States)

    2010-10-01

    ... other diagnostic tests. (f) X-ray therapy and other radiation therapy services. (g) Medical supplies, appliances, and devices. (h) Durable medical equipment. (i) Ambulance services. (j) Rural health...

  8. Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement

    Directory of Open Access Journals (Sweden)

    Nikolai M Kliushin

    2016-01-01

    Conclusion: The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.

  9. 38 CFR 21.3300 - Special restorative training.

    Science.gov (United States)

    2010-07-01

    ... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Survivors' and Dependents' Educational Assistance Under... vocational rehabilitation counselor, after consulting with the Vocational Rehabilitation Panel, may prescribe... writing, (6) Training in ambulation, (7) One-hand typewriting, (8) Nondominant handwriting, (9)...

  10. Prosthetic options available for the diabetic lower limb amputee.

    Science.gov (United States)

    Chitragari, Gautham; Mahler, David B; Sumpio, Brandon J; Blume, Peter A; Sumpio, Bauer E

    2014-01-01

    Although the rate of lower limb amputation in patients with diabetes is decreasing, amputation still remains a major complication of diabetes. Prosthetics have been long used to help amputees ambulate. The last decade has seen many advances in prostheses with the enhanced understanding of the mechanics of ambulation and improved use of technology. This review describes the different types of prosthetic options available for below knee, ankle, and foot amputees, emphasizing the latest advances in prosthetic design.

  11. Burn Rehabilitation and Research: Proceedings of a Consensus Summit

    Science.gov (United States)

    2009-08-01

    device (donut) Peroneal Excessive frog lying position Pressure from dressings or splinting Excessive edema formation and proliferation Foot digital... prosthesis .287,293 Pylons and other temporary devices are introduced to assist with ambulation and upper extremity function. The timing of pylon use...Heimbach DM. Early ambulation and discharge in 100 patients with burns of the foot treated by grafts. J Trauma 1992;33:662–4. 82. Harnar T, Engrav LH

  12. Association between Bone Mineral Density and Clinical Parameters in Traumatic Brain Injury Patients

    Directory of Open Access Journals (Sweden)

    Murat Ersöz,

    2016-04-01

    Full Text Available Objective: Determine the association between the bone mineral density and traumatic brain injury (TBI. Materials and Methods: Twenty-two patients with TBI included to the study. Dual energy X-ray absorptiometry measurements which determines the femur neck and L1-4 vertebrate T scores in patients was performed via Lunar Prodigy DPX system. Clinical parameters such as types of involvements (plegia, upper-lower extremity spasticity values, presence of heterotypic ossification, ambulation levels were determined and their relations with femur neck and L1-4 vertebrate T scores were examined with Mann-Whitney U Test. Results: In the comparison of sub groups of type of plegia (tetraplegic/hemi-paraplegic, lower extremity spasticity values [Ascworth score 0/1-2-3-4, presence of heterotopic ossification no statistically significant (p>0.05 difference was found in the femur neck and L1-4 vertebrate T scores. On the other hand, in the subgroups determined according to ambulatory levels of the patients (confined to bed-wheelchair/ ambulated (orthesis-hand support-independent] significant difference was observed in the femur neck T scores (p=0.044. Femur neck T scores were significantly high in ambulated patients (p=0.044. Conclusion: In TBI cases ambulation level is a factor which significantly affect bone mineral density. It is necessary to ambulate patients with potential as soon as possible and to plan alternative approaches in patient could not be ambulated.

  13. Prehospital transported patients

    DEFF Research Database (Denmark)

    Bech, Camilla Louise Nørgaard; Brabrand, M.; Lassen, Annmarie Touborg

    2015-01-01

    Introduction The survival of patients transported by ambulance to the emergency department (ED) depends on clinical conditions, patient-related factors and organisational prehospital set up. Data and information concerning patients in the prehospital system could form a valuable resource for asse......Introduction The survival of patients transported by ambulance to the emergency department (ED) depends on clinical conditions, patient-related factors and organisational prehospital set up. Data and information concerning patients in the prehospital system could form a valuable resource...... for assessing potential risk factors associated with adverse outcomes and mortality. Our aim was to describe ambulance transports to the ED and identify prognostic factors accessible in the prehospital phase and associated with 7-day mortality. Methods We included all adult patients (>18 years) with a first......-time ambulance transport to the ED at Odense University Hospital in the period 1 April 2012 to 30 September 2013. Ambulance personnel recorded vital signs and other clinical findings on a structured form on paper during the ambulance transport. Each contact was linked to information from population...

  14. Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet.

    Science.gov (United States)

    Portnoy, Sigal; Kristal, Anat; Gefen, Amit; Siev-Ner, Itzhak

    2012-01-01

    The prosthetic foot plays an important role in propelling, breaking, balancing and supporting body loads while the amputee ambulates on different grounds. It is therefore important to quantify the effect of the prosthetic foot mechanism on biomechanical parameters, in order to prevent pressure ulcers and deep tissue injury. Our aim was to monitor the internal stresses in the residuum of transtibial amputation (TTA) prosthetic-users ambulating on different terrains, which the amputees encounter during their daily activities, i.e. paved floor, grass, ascending and descending stairs and slope. We specifically aimed to compare between the internal stresses in the TTA residuum of amputees ambulating with a novel hydraulic prosthetic foot compared to conventional energy storage and return (ESR) prosthetic feet. Monitoring of internal stresses was accomplished using a portable subject-specific real-time internal stress monitor. We found significant decrease (phydraulic foot, compared to walking with ESR feet. The loading rate calculated while ambulating with the hydraulic foot was at least three times lower than the loading rate calculated while ambulating with the ESR foot. Although the average decrease in internal stresses was ≈ 2-fold larger when replacing single-toe ESR feet with the hydraulic foot than when replacing split-toed ESR feet with the hydraulic foot, the differences were statistically insignificant. Our findings suggest that using a hydraulic prosthetic foot may protect the distal tibial end of the TTA residuum from high stresses, therefore preventing pressure-related injury and pain.

  15. Clinical usefulness of Adeli suit therapy for improving gait function in children with spastic cerebral palsy: a case study

    Science.gov (United States)

    Lee, Byoung-Hee

    2016-01-01

    [Purpose] The purpose of this study was to determine the effects of Adeli suit therapy (AST) on gross motor function and gait function in children with cerebral palsy. [Subjects and Methods] Two participants with spastic cerebral palsy were recruited to undergo AST. AST was applied in 60-minute sessions, five times per week, with 20 sessions total over 4 weeks. Assessments of gross motor function, spatiotemporal parameters, and functional ambulation performance for gait were conducted. [Results] Gross motor function, cadence, and functional ambulation performance improved after the intervention in both cases. [Conclusion] Although additional follow-up studies are required, the results demonstrated improved gross motor function and functional ambulation performance in the children with cerebral palsy. These findings suggest a variety of applications for conservative therapeutic methods that require future clinical trials in children with cerebral palsy. PMID:27390453

  16. Age effects on the social interaction test in early adulthood male rats.

    Science.gov (United States)

    Garau, A; Martí, M A; Sala, J; Balada, F

    2000-01-01

    The effects of age on active and passive social interaction were studied in Wistar rats using the social interaction test (S.I.T.). Individual behaviors such as ambulation, rearing, and defecation were also studied. Despite the widespread use of the S.I.T. in anxiety research, the effects of age on the S.I.T. have not been studied thoroughly. Male Wistar rats of 75, 135, and 180 days old were used. Our results showed age effects on active social contact, passive social contact, ambulation, rearing, and defecation. At 135 days old, animals presented the lowest scores on active social behavior and the highest scores on defecation. Moreover, exploratory behavior measured by ambulation and rearing decreased with age. These results suggest that age could be a relevant variable in the social interaction test.

  17. Do traditional male role norms modify the association between high emotional demands in work, and sickness absence?

    DEFF Research Database (Denmark)

    Labriola, Merete; Hansen, Claus D.; Lund, Thomas

    2011-01-01

    if adherence to traditional male role norms modifies the effect of emotional demands on sickness absence/presenteeism. Methods Data derive from MARS (Men, accidents, risk and safety), a two-wave panel study of ambulance workers and fire fighters in Denmark (n = 2585). Information was collected from......Objectives Ambulance workers are exposed to high levels of emotional demands, which could affect sickness absence. Being a male dominated occupation, it is hypothesised that ambulance workers adhere to more traditional male role norms than men in other occupations. The aim is to investigate...... of emotional demands on mental health varies according to adherence to traditional male role norms. The presentation will furthermore include results from prospective analyses on not-yet collected follow-up data on absenteeism taken from a national register....

  18. The role of pain for early rehabilitation in fast track surgery.

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis;

      Introduction: The purpose of this study was to investigate the relationship between early functional mobility and pain intensity on the first day after surgery and on the planned day of discharge in a well-defined fast-track programme after total knee arthroplasty (TKA) using the local injections...... the clinical pathway for fast track programs, including transfer and ambulation from day one, with further physiotherapy daily. Patients were discharged, according to the following discharge criteria: Independence in transfer and ambulation, able to walk with crutches, independence in toileting and dressing......, which was assessed together with pain intensity, measured by Visual Analog Scale (VAS), active range of knee extension-flexion, functional mobility using "Timed Up & Go" (TUG), walking distance and length of stay (LOS). Results: On POD 1, 84% of the patients were able to transfer and 89% to ambulate...

  19. EMS in Mauritius.

    Science.gov (United States)

    Ramalanjaona, Georges; Brogan, Gerald X

    2009-02-01

    Mauritius lies in the southwest Indian Ocean about 1250 miles from the African coast and 500 miles from Madagascar. Mauritius (estimated population 1,230,602) became independent from the United Kingdom in 1968 and has one of the highest GDP per capita in Africa. Within Mauritius there is a well established EMS system with a single 999 national dispatch system. Ambulances are either publicly or privately owned. Public ambulances are run by the Government (SAMU). Megacare is a private subscriber only ambulance service. The Government has recently invested in new technology such as telemedicine to further enhance the role of EMS on the island. This article describes the current state of EMS in Mauritius and depicts its development in the context of Government effort to decentralise and modernise the healthcare system.

  20. Feasibility and Inter-Rater Reliability of Physical Performance Measures in Acutely Admitted Older Medical Patients

    DEFF Research Database (Denmark)

    Bodilsen, Ann Christine; Juul-Larsen, Helle Gybel; Petersen, Janne

    2015-01-01

    chair stand. Absolute reliability was expressed as the standard error of measurement and the smallest real difference as a percentage of their respective means (SEM% and SRD%). RESULTS: The primary reasons for admission of the 52 included patients were infectious disease and cardiovascular illness......-meter gait speed, 30-s chair stand and Cumulated Ambulation Score. Relative reliability was expressed as weighted kappa for the Cumulated Ambulation Score or as intra-class correlation coefficient (ICC1,1) and lower limit of the 95%-confidence interval (LL95%) for grip strength, gait speed, and 30-s....... The mean± SD age was 78±8.3 years, and 73.1% were women. All patients performed grip strength and Cumulated Ambulation Score testing, 81% performed the gait speed test, and 54% completed the 30-s chair stand test (46% were unable to rise without using the armrests). No systematic bias was found between...

  1. A retrospective quality assessment of pre-hospital emergency medical documentation in motor vehicle accidents in south-eastern Norway

    Directory of Open Access Journals (Sweden)

    Staff Trine

    2011-03-01

    Full Text Available Abstract Background Few studies have evaluated pre-hospital documentation quality. We retrospectively assessed emergency medical service (EMS documentation of key logistic, physiologic, and mechanistic variables in motor vehicle accidents (MVAs. Methods Records from police, Emergency Medical Communication Centers (EMCC, ground and air ambulances were retrospectively collected for 189 MVAs involving 392 patients. Documentation of Glasgow Coma Scale (GCS, respiratory rate (RR, and systolic blood pressure (SBP was classified as exact values, RTS categories, clinical descriptions enabling post-hoc inference of RTS categories, or missing. The distribution of values of exact versus inferred RTS categories were compared (Chi-square test for trend. Results 25% of ground and 11% of air ambulance records were unretrieveable. Patient name, birth date, and transport destination was documented in >96% of ambulance records and 81% of EMCC reports. Only 54% of patient encounter times were transmitted to the EMCC, but 77% were documented in ground and 96% in air ambulance records. Ground ambulance records documented exact values of GCS in 48% and SBP in 53% of cases, exact RR in 10%, and RR RTS categories in 54%. Clinical descriptions made post-hoc inference of RTS categories possible in another 49% of cases for GCS, 26% for RR, and 20% for SBP. Air ambulance records documented exact values of GCS in 89% and SBP in 84% of cases, exact RR in 7% and RR RTS categories in 80%. Overall, for lower RTS categories of GCS, RR and SBP the proportion of actual documented values to inferred values increased (All: p Conclusion EMS documentation of logistic and mechanistic variables was adequate. Patient physiology was frequently documented only as descriptive text. Our finding indicates a need for improved procedures, training, and tools for EMS documentation. Documentation is in itself a quality criterion for appropriate care and is crucial to trauma research.

  2. How do patients come to the Accident and Emergency Department of RIPAS Hospital?

    Directory of Open Access Journals (Sweden)

    Po Thaw DA

    2012-06-01

    Full Text Available Introduction: The mode and speed of transportation to the Accident and Emergency Department (AED of hospitals is very important for critically ill patients. This study looked at the mode of transportation to the AED at the Raja Isteri Pengiran Anak Saleha (RIPAS Hospital. Materials and Methods: Three different time periods: Period A from 15th May to 31st May 2004, (17 days, n=2,170 without prioritising, Period B from 1st January 2004 to 31st July 2006 (31 months, n=235 dead on arrival and resuscitation cases, and Period C from 20th to 26th November 2006 (7 days, all Priority Cases 1 to 3 were reviewed. Data on mode of transportation and triage categories were extracted from the ambulance response sheets. Results: During Period A, the main mode of transportation to the AED was private vehicles (90.7% followed by ambulance (7.9%, and other transportation (1.4%. During study Period B, the main mode of transportation was also private transports (50.2% followed closely by ambulance (48.5% and other transportation (1.3%. During Period C, Priority 1 cases (life-threatening conditions, n=7, most were transported with private transport (71.4% followed by ambulance (28.6%; Priority 2 (n=232 cases, majority were transported with private transport (89.2%, followed by ambulance (10.3%, and one case used police transportation; and in Priority 3 cases (non-life threatening conditions, n=1,010, almost all were transported with private transport (98.7%, followed by police (0.9% and ambulance (0.4% respectively. Conclusion: Utilisation of designated emergency transportation is low especially for the moderate to seriously ill (Priority 1 and 2 patients when compared to other well developed countries. More needs to be done to improve the usage of emergency transportations especially for the seriously ill cases.

  3. Physique statistique des Fluides Classiques

    OpenAIRE

    Aslangul, Claude

    2006-01-01

    0 - Préambule.Préambule, table des matières1 - Rappels sur la description d'un système à l'équilibre thermodynamiqueQuelques propriétés des systèmes macroscopiques. Nature statistique de l'entropie. Grandeurs internes et grandeurs externes. Relations thermodynamiques fondamentales. Potentiels thermodynamiques. Ensembles microcanonique, canonique, grand-canonique et isotherme - isobare. Exemple: fonction de partition d'un fluide classique. Principe variationnel pour l'énergie libre.2 - Stabili...

  4. Ambulantage et métropolisation

    Directory of Open Access Journals (Sweden)

    Jérôme Monnet

    2007-04-01

    Full Text Available « L’ambulantage » renvoie bien sûr au commerce ambulant, mais ce néologisme a pour but de dépasser la vision trop restrictive qui se concentre exclusivement sur les vendeurs ambulants en les associant le plus souvent à l’économie dite informelle ou souterraine. Cependant, il ne s’agit pas ici de nier l’importance de cette économie, que les conditions de la globalisation postfordiste et du capitalisme flexible semblent favoriser. De fait, les articles réunis dans ce dossier parlent tous de ven...

  5. Ambulanceservice til patienter med akutte hjertelidelser i Danmark - en status

    DEFF Research Database (Denmark)

    Lybecker, H; Larsen, C F; Nielsen, J R;

    1990-01-01

    In 1985, the Danish Board of Health published a review of the therapeutic value of heart ambulances. A report is presented here concerning the extent to which prehospital treatment of cardiac arrest recommended by the Board of Health has been intensified after publication of the review. The preho......In 1985, the Danish Board of Health published a review of the therapeutic value of heart ambulances. A report is presented here concerning the extent to which prehospital treatment of cardiac arrest recommended by the Board of Health has been intensified after publication of the review...

  6. Telemedicinsk praehospital diagnostik og visitation af en patient med akut lungeemboli

    DEFF Research Database (Denmark)

    Terkelsen, Astrid J.; Nielsen-Kudsk, Jens Erik; Andersen, Henning Rud

    2008-01-01

    pulmonary embolism. The ambulance was referred directly to the nearest department of cardiology where acute CT and echocardiography confirmed the diagnosis. Acute trombolysis was successful. Telemedicine may be beneficial in other medical emergencies than acute myocardial infarction. Udgivelsesdato: 2008......Mortality in untreated pulmonary embolism is high and short-term outcome depends on a timely diagnosis. In this case telemedicine involving 12-lead ECG and GSM-based communication between the patient in the ambulance and the telemedical staff resulted in remote pre-hospital suspicion of acute...

  7. Ambulanceudrykning i København, Odense og Ringkøbing Amt. Resultater fra Sundhedsministeriets og Amtsrådsforeningens stikprøveundersøgelse 1990. 1. Epidemiologiske data

    DEFF Research Database (Denmark)

    Trier, H; Larsen, C F

    1992-01-01

    In 1990, The Danish Ministry of Health and the County Council Association undertook a spot test investigation of the activities in connection with 3,182 emergency ambulance services (AU) in the Municipality of Copenhagen (a city), the Odense district (a large provincial town) and the County...... of Ringkøbing (a mixed rural and urban region). The investigation included data collected by the ambulance staff before hospitalization and the diagnoses on discharge from casualty and hospital departments. The frequency of AU per 1,000 population was found to be 101 annually in Copenhagen, 44 in Odense and 19...

  8. Evaluation Of Gait Symmetry In Amputees Who Use Below Knee Prosthesis With Dynamic Foot

    Directory of Open Access Journals (Sweden)

    Yasin Yurt

    2012-06-01

    Full Text Available Purpose: To assess inter limb symmetry while walking in unilateral transtibial amputees which use dynamic foot. Method: Gait velocity, cadence, step length, stance percentages and ambulation index results of amputees (n=20 were recorded. Comparison was made with control group. (n=21 Results: Gait velocity, cadence and ambulation index results were greater for control group. Cases had longer stance time on their intact limb than amputated side. Stance time difference between limbs were higher for amputee group than control group. Conclusion: Amputees had higher stance percentage on their intact limb than sound limb with regard to healthy people.

  9. Postmobilization Training Resource Requirements. Army National Guard Heavy Enhanced Brigades

    Science.gov (United States)

    1996-01-01

    Geier, Captain Andy Cox, and Captain Gutierrez at the 2nd Reserve Training Brigade; Brigadier General William Wallace, Brigadier General James P. O’Neal...affairs team 5 Medical Medical detachment 151 Sanitation detachment 10 Dental 23 Air ambulance 130 Military Police CID detachment 11 Combat support

  10. [Mistakes and complications in the diagnosis and medical services for persons with closed thoraco-abdominal injuries during pre-hospitalization stage].

    Science.gov (United States)

    Baramiia, N M; Antoniuk, M H; Zaruts'kyĭ, Ia L; Dorosh, V M; Sabov, V I

    2003-07-01

    Results of medical care, given to injured persons with closed thoracoabdominal trauma on the prehospital stage were analyzed. Lacks and complications in tactic of treatment and diagnosis were determined. Mistakes of the medical ambulance care physicians were noted in 51.3% of observations.

  11. Salmonella spinal osteomyelitis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Acharya Shankar

    2004-10-01

    Full Text Available A case of vertebral osteomyelitis is presented where initial presumptive diagnosis of tuberculous infection was made on clinico-radiological grounds but eventually turned out to be Salmonella infection upon exploration, biopsy and culture. Patient recovered completely following debridement and appropriate antibiotics (fluoro-quinolones for a period of six weeks. Internal fixation allowed early ambulation.

  12. Prehospital Unassisted Assessment of Stroke Severity Using Telemedicine A Feasibility Study

    NARCIS (Netherlands)

    Van Hooff, Robbert-Jan; Cambron, Melissa; Van Dyck, Rita; De Smedt, Ann; Moens, Maarten; Espinoza, Alexis Valenzuela; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; De Keyser, Jacques; Brouns, Raf

    2013-01-01

    Background and Purpose We evaluated the feasibility and the reliability of remote stroke severity quantification in the prehospital setting using the Unassisted TeleStroke Scale (UTSS) via a telestroke ambulance system and a fourth-generation mobile network. Methods The technical feasibility and the

  13. FreeCall, a system for emergency-call-handling support

    NARCIS (Netherlands)

    Post, W.M.; Koster, W.; Šrámek, M.; Schreiber, G.; Zocca, V.; Vries, B. de

    1996-01-01

    This article describes a system for the optimization of the prehospital assessment of emergency, in cases involving thoraco-abdominal complaints and consciousness problems. This assessment is performed by nurses on the basis of a telephone interview at ambulance dispatch centers. The system has a bo

  14. The assisted 6-minute cycling test to assess endurance in children with a neuromuscular disorder

    NARCIS (Netherlands)

    Jansen, M.; Jong, M. de; Coes, H.M.; Eggermont, F.; Alfen, N. van; Groot, I.J. de

    2012-01-01

    Introduction: For late- or non-ambulant children with a neuromuscular disorder no suitable endurance tests are currently available. We developed the assisted 6-minute cycling test (A6MCT) for the legs and arms and investigated its psychometric properties in healthy boys and boys with Duchenne muscul

  15. 42 CFR 413.65 - Requirements for a determination that a facility or an organization has provider-based status.

    Science.gov (United States)

    2010-10-01

    ... director or individual responsible for daily operations at the entity— (A) Maintains a reporting... or an organization has provider-based status. (a) Scope and definitions.(1) Scope. (i) This section...) Ambulances. (L) Rural health clinics (RHCs) affiliated with hospitals having 50 or more beds. (2)...

  16. Occupational Research; Health Occupations Education Abstracts of Iowa Research, 1960-1968.

    Science.gov (United States)

    Tibbits, Thomas F., Comp.

    Thirty-five abstracts represent studies on administration, ambulance service, comprehensive health manpower planning, curriculum, dental hygiene, graduate follow-up, hospital inservice training, the medical-surgical staff nurse position, nonprofessional rehabilitation personnel, economics of collective bargaining by nurses, operating room…

  17. Physical activity, immobilization and the risk of venous thrombosis

    NARCIS (Netherlands)

    Stralen, Karlijn Janneke van

    2008-01-01

    Deep venous thrombosis is a common disease. Already in 1856 it was suggested that immobilization could cause venous thrombosis. However, so far little research has shown whether exercise or ambulation could decrease the risk of venous thrombosis. We performed a historical review regarding the role o

  18. Functional Grouping in Residential Homes for People with Intellectual Disabilities.

    Science.gov (United States)

    Mansell, Jim; Beadle-Brown, Julie; Macdonald, Susan; Ashman, Bev

    2003-01-01

    The effects of functional grouping of 303 people with intellectual disabilities on care practices in English group homes were investigated. Residents who were non-ambulant were rated as receiving care with less interpersonal warmth and residents with severe challenging behavior were rated as receiving care with less interpersonal warmth and…

  19. Computer-assisted oblique single-cut rotation osteotomy to reduce a multidirectional tibia deformity: case report.

    Science.gov (United States)

    Dobbe, J G G; du Pré, K J; Blankevoort, L; Streekstra, G J; Kloen, P

    2017-03-01

    The correction of multiplanar deformity is challenging. We describe preoperative 3-D planning and treatment of a complex tibia malunion using an oblique single-cut rotation osteotomy to correct deformity parameters in the sagittal, coronal and transverse plane. At 5 years postoperatively, the patient ambulates without pain with a well-aligned leg.

  20. Development of a cosmetic knee disarticulation prosthesis : A single-patient case study

    NARCIS (Netherlands)

    de Laat, Fred A.; de Vos, Wouter; Geertzen, Jan; Roorda, Leo D.

    2015-01-01

    Background and aim: If a person does not become ambulant after an amputation, a knee disarticulation (KD) shouldbe considered and the person may then benefit from a cosmetic KD prosthesis. The features of a cosmetic KD prosthesis are, however, seldom described. The aim of this clinical note is to de

  1. Ambulanceudrykning i København, Odense og Ringkøbing Amt. Resultater fra Sundhedsministeriets og Amtsrådsforeningens stikprøveundersøgelse 1990. 2. Ambulancemandskabets behandling, lægestøtte og diagnosemønster

    DEFF Research Database (Denmark)

    Larsen, C F; Trier, H

    1992-01-01

    district with smaller towns (the County of Ringkøbing). The conditions of the patients were assessed by the ambulance staff: 7-12% of the patients transported had visible haemorrhage, 5-8% were unconscious, 4-7% were cyanotic, 2-3% had seizures and 1-2% had pareses. The serious cases tended to be most...

  2. Influence of timing on the effect of continuous extradural analgesia with bupivacaine and morphine after major abdominal surgery

    DEFF Research Database (Denmark)

    Dahl, J B; Hansen, B L; Hjortsø, N C;

    1992-01-01

    differences between the groups in pain scores (visual analogue scale or verbal) during rest or ambulation at any time of measurement. These results do not suggest that timing of analgesia with a conventional extradural regimen is of major clinical importance in patients undergoing colonic surgery....

  3. Automated Analysis of Vital Signs Identified Patients with Substantial Bleeding Prior to Hospital Arrival

    Science.gov (United States)

    2015-10-01

    culminating with the first and only deployment of an automated emergency care decision system on board active air ambulances: the APPRAISE system, a...hardware/software platform for automated , real-time analysis of vital-sign data. After developing the APPRAISE system using data from trauma patients

  4. Sudden Infant Death Syndrome (SIDS): The Quiet Killer.

    Science.gov (United States)

    Creely, Daniel

    This material was developed to be used by instructors in the health related fields who have contact with nurses, doctors, ambulance crews, emergency medical technicians, and paramedics. The essay is a summary from various portions of an educational unit. The objective of the essay is to provide the reader with current up-to-date factual…

  5. Treadmill Training with Partial Body-Weight Support in Children with Cerebral Palsy: A Systematic Review

    Science.gov (United States)

    Mutlu, Akmer; Krosschell, Kristin; Spira, Deborah Gaebler

    2009-01-01

    OKAim: The aim of this systematic review was to examine the literature on the effects of partial body-weight support treadmill training (PBWSTT) in children with cerebral palsy (CP) on functional outcomes and attainment of ambulation. Method: We searched the relevant literature from 1950 to July 2007. We found eight studies on the use of PWSBTT on…

  6. Implementation of a prehospital triage system for patients with chest pain and logistics for primary percutaneous coronary intervention in the region of Amsterdam, the Netherlands.

    Science.gov (United States)

    Adams, Rob; Appelman, Yolande; Bronzwaer, Jean G; Slagboom, Ton; Amoroso, Giovanni; van Exter, Pieternel; Tijssen, G P Jan; de Winter, Robbert J

    2010-10-01

    We aimed to describe the logistics of a prehospital triage system for patients with acute chest pain in the region of Amsterdam, The Netherlands. Ambulance electrocardiograms (ECGs) were evaluated immediately in 1 of the percutaneous coronary intervention (PCI)-capable centers. Patients accepted for primary PCI (PPCI) were directly transferred to the catheterization laboratory. Two thousand three hundred fifty ECGs of 2,192 patients were transmitted to the region's intervention centers. Median duration of chest complaints before ambulance dispatch was 67 minutes; ambulance crews recorded the first ECG within 7 minutes after arrival. Actual transmission of the ECG took an additional (median) 10 minutes. Seven hundred eleven patients (32.4%) were transported to the catheter laboratory and were treated with PPCI. Time between first prehospital ECG and start of PPCI procedure was 66 minutes. The PPCI procedure started 36 minutes after ambulance arrival at the hospital. In conclusion, the results of this study compare favorably to other reported performances of prehospital triage systems of PPCI for ST-segment elevated myocardial infarction and demonstrate that the European Society of Cardiology and American Heart Association guidelines for treatment of patients with ST-segment elevated myocardial infarction can be met.

  7. Walking adaptability therapy after stroke: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Timmermans, C.; Roerdink, M.; Ooijen, van M.W.; Meskens, C.G.; Janssen, T.W.J.; Beek, P.J.

    2016-01-01

    Background: Walking in everyday life requires the ability to adapt walking to the environment. This adaptability is often impaired after stroke, and this might contribute to the increased fall risk after stroke. To improve safe community ambulation, walking adaptability training might be beneficial

  8. Custom-made footwear in diabetes: Offloading, usability and ulcer recurrence

    NARCIS (Netherlands)

    Arts, M.L.J.

    2013-01-01

    Foot ulceration is a serious long term complication in patients with diabetes mellitus and polyneuropathy, which increases the risk of infection and lower limb amputation. Loss of protective sensation and high levels of plantar foot pressure during ambulation are the main causative factors. These pa

  9. The influence of low dystrophin levels on disease pathology in mouse models for Duchenne Muscular Dystrophy

    NARCIS (Netherlands)

    Putten, Maaike van

    2013-01-01

    Duchenne muscular dystrophy (DMD) is the most prevalent neuromuscular disorder, caused by mutations in the DMD gene that prevent synthesis of dystrophin. Fibers that lack dystrophin are sensitive to exercise-induced damage, resulting in progressive muscle wasting, loss of ambulation and premature de

  10. Operation REDWING, Report of the Manager Albuquerque Operations

    Science.gov (United States)

    1983-01-31

    administrative charge of the medical facilities in the Doctor’s absence. Processes immunization of employees by keeping suspense file of immunization shots...Power Site Jeep Pickup Wagon WC-PC -JM Trucks Scooters Bus-Ambulance Total, 5 4 124 2 0 26 0 0 8 0 0 U 0 0 12 0 0 11 1 2 31

  11. Preparing for major incidents in Kenya

    Directory of Open Access Journals (Sweden)

    B.W. Wachira*

    2013-12-01

    This report provides a review of some of the major incidents in Kenya for the period 2000–2012, with the hope of highlighting the importance of developing an integrated and well-trained Ambulance and Fire and Rescue service appropriate for the local health care system.

  12. De verkeersonveiligheid van hulpverleningsvoertuigen. Consult ten behoeve van de Koninklijke Nederlandse Toeristenbond ANWB.

    NARCIS (Netherlands)

    Oei, H.-l.

    1986-01-01

    Drivers on emergency vehicles (ambulances, fire engines, police cars) which have to fulfil an urgent task and which make use of particular competencies, show often a driving behaviour with an increased risk. Each year more than hundred victims are killed or injured in accidents in which emergency ve

  13. Effects of acarbose (Glucobay) in persons with type 1 diabetes : a multicentre study

    NARCIS (Netherlands)

    Sels, J P; Verdonk, H E; Wolffenbuttel, B H

    1998-01-01

    The aim of this multicentre study was to investigate the effect--in everyday life--of long term administration of acarbose on parameters of glycaemic control, daily insulin requirements, lipid parameters and tolerability in ambulant type 1 diabetic subjects insufficiently controlled with diet and in

  14. Don't Take a Chance with a Heart Attack: Know the Facts and Act Fast

    Science.gov (United States)

    ... a Heart Attack: Know the Facts and Act Fast “ One evening I felt pressure in my chest ... re having a heart attack. Here’s why: ◆◆ Acting fast can save your life. ◆◆ An ambulance is the ...

  15. 78 FR 25089 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Science.gov (United States)

    2013-04-29

    ... must directly pay hospitals, physicians and ambulance providers (including Indian Health Service... certification by providers of the veracity of their requests for payment. Both forms have been established to... HUMAN SERVICES Centers for Medicare & Medicaid Services [Document Identifiers: CMS-1984-14,...

  16. The Rescue911 Emergency Response Information System (ERIS): A Systems Development Project Case

    Science.gov (United States)

    Cohen, Jason F.; Thiel, Franz H.

    2010-01-01

    This teaching case presents a systems development project useful for courses in object-oriented analysis and design. The case has a strong focus on the business, methodology, modeling and implementation aspects of systems development. The case is centered on a fictitious ambulance and emergency services company (Rescue911). The case describes that…

  17. Neuroprotection in acute ischemic stroke

    NARCIS (Netherlands)

    De Keyser, Jacques; Uyttenboogaart, Maarten; Koch, Marcus W; Elting, Jan Willem; Sulter, Geert; Vroomen, Patrick C; Luijckx, Gert Jan

    2005-01-01

    Neuroprotection of patients with acute ischemic stroke should start at the scene and continue in the ambulance with the assessment and treatment of the airway, breathing, circulation, body temperature, and blood glucose. The key goal in eligible patients should be fast vessel recanalization with int

  18. Coaching Communication Partners: A Preliminary Investigation of Communication Intervention during Mealtime in Rett Syndrome

    Science.gov (United States)

    Bartolotta, Theresa E.; Remshifski, Patricia A.

    2013-01-01

    Rett syndrome (RTT) occurs primarily in females and is characterized by deficits in cognition, communication, hand use and ambulation. This quasi-experimental study explored the use of a coaching program to increase communicative interactions between girls with RTT and their communication partners. Communication coaching strategies were provided…

  19. Library Students Are "Breaking Good" with Saul Goodman's Advice

    Science.gov (United States)

    Turkewitz, Deborah

    2014-01-01

    Graduate students are taking big steps and stretching themselves, whether returning to school midpoint in their lives, taking classes on unfamiliar topics, or starting internships and trying to put theory into practice. Who better to offer advice to these graduate students than America's favorite hilarious, morally ambiguous, ambulance-chasing,…

  20. The management of acute asthma.

    Science.gov (United States)

    Cross, S

    1997-04-01

    Health professionals likely to come into contact with people experiencing an acute episode of asthma, such as school nurses, ambulance personnel and A&E staff, need clear guidelines on management. The British Thoracic Society guidelines, revised this year, advise on the categorisation of asthma, assessment and treatment.

  1. Hartbewaking in de pre-hospitale fase : onderzoek naar de activiteiten van de ambulanceverpleegkundigen van de G. G. en G.D. Rotterdam voor en tijdens het vervoer van patiënten met een vermoedelijk acuut ischaemisch hartlijden

    NARCIS (Netherlands)

    H.N. Hart

    1978-01-01

    textabstractHet feit, dat 50-60% van alle sterfgevallen tengevolge van een acuut myocardinfarct buiten het ziekenhuis plaatsvond, werd voor het eerst door Pantridge et al. (1967, 1971) in Belfast vastgelegd. Op grond daarvan veranderden zij enkele ambulances in rijdende coronary care units en noemde

  2. Elastomeer-infuuspompen getest voor de praktijk

    NARCIS (Netherlands)

    Woerdenbag, Herman J.; Dillingh, Jan H.; Wanders, Jacquelien T. M.; Boer, E. Jildau; Frijlink, Henderik W.; Kosterink, Jos G. W.; Schellekens, Reinout C. A.

    2011-01-01

    OBJECTIVE: To test short-term and long-term elastomeric infusion pumps for applicability in hospital practice and for ambulant patients at home. DESIGN AND METHODS: Four short-term elastomeric infusion pumps (Accufuser C1000M, Easypump ST 100-1, Infusor Intermate SV-100, Surefuser Plus 100 ml) and f

  3. Grounding Symbolic Operations in Modality-Specific Processing

    Science.gov (United States)

    2007-07-01

    Real sugar crystal comet harpsichord ear aluminum ranch brand helicopter hedge butterfly ambulance calculator cover skyscraper nutmeg fridge bracelet...widely as a function of the type of person distressed (e.g., mother , child, lawyer). Interestingly, locations are less likely to be affected by the head

  4. Early treatment of trans-tibial amputees: retrospective analysis of early fitting and elastic bandaging

    NARCIS (Netherlands)

    Velzen, van A.D.; Nederhand, M.J.; Emmelot, C.H.; IJzerman, M.J.

    2005-01-01

    This study investigates the effects of early fitting in trans-tibial amputees. The assumption is that compared to elastic bandaging, the use of a rigid dressing in early fitting will result in quicker wound healing and earlier ambulation. A retrospective file search was carried out in three differen

  5. Prosthetic knee stability during the push-off phase of walking - experimental findings

    NARCIS (Netherlands)

    Koopman, Bart F.J.M.; Hendriks, Paul J.H.; Grootenboer, Henk J.

    1996-01-01

    Most of the energy needed for ambulation is generated during the double support phase of walking. Knee flexion during push-off is crucial to maintain the walking velocity. Since users of an above-knee prosthesis have to stabilize the knee with the hip muscles, and regular knee mechanisms are not sta

  6. Feasibility of using 6F angiographic catheters for primary percutaneous coronary intervention in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    CHEN Yan-qing; HOU Lei; WEI Yi-dong; LI Wei-ming; XU Ya-wei

    2010-01-01

    @@ The transradial access has been used for percutaneous coronary intervention (PCI) for more than 10 years.1-3Many studies have confirmed several advantages of a radial route over the traditional transfemoral approach, some of which include a decreased incidence of access site complications, an earlier ambulation after the procedure which helps make patients more comfortable after the procedure.

  7. Oxygen costs using a reciprocating gait orthosis in a paraplegic (T9) patient with a bilateral below-knee amputation: case report.

    Science.gov (United States)

    Smith, W E; Clark, P F; MacArthur, D; Allatt, R D; Hayes, K C; Cunningham, D A

    1997-02-01

    The Reciprocating Gait Orthosis (RGO) is a useful aid to ambulation for patients with paraplegia. Its use has been described previously though not in conjunction with limb prostheses. We report here the energy costs of ambulation of a patient, disabled by paraplegia at T9 and bilateral below-knee amputations, walking at her preferred rate using an RGO while gas exchange was measured by the Douglas bag method. Oxygen uptake (VO2) rose from 0.198 1 min-1 at rest to 0.582 1 min-1 in the last minute of exercise, representing a VO2 of 14.3 ml kg-1 min-1. During the fourth minute of ambulation, energy consumption was 30.44 J kg-1 s-1 with an energy cost of 4.17 J kg-1 m-1 at a velocity of 0.13 m s-1, Ambulation with this combination of disability is possible with the aid of limb prostheses and an RGO though it is slow and the energy expenditure as consumption per second and cost per metre are high.

  8. Initial experience in setting up a medical student first responder scheme in South Central England.

    Science.gov (United States)

    Seligman, William H; Ganatra, Sameer; England, David; Black, John J M

    2016-02-01

    Prehospital emergency medicine (PHEM) is a recently recognised subspecialty of emergency medicine, and anaesthetics, intensive care and acute medicine, in the UK, and yet it receives little to no mention in many undergraduate medical curricula. However, there is growing interest in PHEM among medical students and junior doctors. Several programmes are in existence across the UK that serve to provide teaching and exposure of prehospital care to medical students and junior doctors. However, relatively few students are able to gain significant first-hand experience of treating patients in the prehospital phase. In this short report, we discuss our experience of launching the student first responder (SFR) scheme across three counties in the Thames Valley. Medical students are trained by the regional ambulance service and respond to life-threatening medical emergencies in an ambulance response vehicle. The scheme is likely to benefit the ambulance service by providing a wider pool of trained volunteer first responders able to attend to emergency calls, to benefit patients by providing a quick response at their time of need, and to benefit medical students by providing first-hand experience of medical emergencies in the community. In its first 15 months of operation, SFRs were dispatched to 343 incidents. This scheme can serve as a training model for other ambulance services and medical schools across the UK.

  9. Salud/Servicios Personales. Libro del Profesor. (Health/Personal Services. Teacher's Guide). B2. CHOICE (Challenging Options in Career Education).

    Science.gov (United States)

    Mid-Hudson Migrant Education Center, New Paltz, NY.

    Written in Spanish, the guide comprises the first grade unit of a career education curriculum developed for migrant students. The guide covers 12 health and personal service occupations--blacksmith, television repairer, hairdresser/barber, day care worker, waitress, gas station attendant, family doctor, ambulance driver/attendant, dietician,…

  10. VehiHealth: An Emergency Routing Protocol for Vehicular Ad Hoc Network to Support Healthcare System.

    Science.gov (United States)

    Bhoi, S K; Khilar, P M

    2016-03-01

    Survival of a patient depends on effective data communication in healthcare system. In this paper, an emergency routing protocol for Vehicular Ad hoc Network (VANET) is proposed to quickly forward the current patient status information from the ambulance to the hospital to provide pre-medical treatment. As the ambulance takes time to reach the hospital, ambulance doctor can provide sudden treatment to the patient in emergency by sending patient status information to the hospital through the vehicles using vehicular communication. Secondly, the experienced doctors respond to the information by quickly sending a treatment information to the ambulance. In this protocol, data is forwarded through that path which has less link breakage problem between the vehicles. This is done by calculating an intersection value I v a l u e for the neighboring intersections by using the current traffic information. Then the data is forwarded through that intersection which has minimum I v a l u e . Simulation results show VehiHealth performs better than P-GEDIR, GyTAR, A-STAR and GSR routing protocols in terms of average end-to-end delay, number of link breakage, path length, and average response time.

  11. Walking in postpoliomyelitis syndrome: The relationships between time-scored tests, walking in daily life and perceived mobility problems

    NARCIS (Netherlands)

    H.L.D. Horemans (Herwin); J.B.J. Bussmann (Hans); A. Beelen (Anita); H.J. Stam (Henk); F. Nollet (Frans)

    2005-01-01

    textabstractObjective: To compare walking test results with walking in daily life, and to investigate the relationships between walking tests, walking activity in daily life, and perceived mobility problems in patients with post-poliomyelitis syndrome. Subjects: Twenty-four ambulant patients with po

  12. Heart rate and oxygen demand of powered exoskeleton–assisted walking in persons with paraplegia

    Directory of Open Access Journals (Sweden)

    Pierre Asselin, MS

    2015-06-01

    Full Text Available Historically, persons with paralysis have limited options for overground ambulation. Recently, powered exoskeletons, which are systems that translate the user’s body movements to activate motors that move the lower limbs through a predetermined gait pattern, have become available. As part of an ongoing clinical study (NCT01454570, eight nonambulatory persons with paraplegia were trained to ambulate with a powered exoskeleton. Measurements of oxygen uptake (VO2 and heart rate (HR were recorded for 6 min each during each maneuver while sitting, standing, and walking. The average value of VO2 during walking (11.2 +/– 1.7 mL/kg/min was significantly higher than for sitting and standing (3.5 +/– 0.4 and 4.3 +/– 0.9 mL/kg/min, respectively; p < 0.001. The HR response during walking was significantly greater than that of either sitting or standing (118 +/– 21 vs 70 +/– 10 and 81 +/– 12 beats per minute, respectively; p < 0.001. Persons with paraplegia were able to ambulate efficiently using the powered exoskeleton for overground ambulation, providing the potential for functional gain and improved fitness.

  13. Duchenne muscular dystrophy quantification of muscular parameters and prednisone therapy

    NARCIS (Netherlands)

    Beenakker, Ernesto Alexander Christiaan

    2005-01-01

    The aims of the study described in this thesis were: 1. to establish reference values for muscle force, functional ability, calf circumference and echogenitcity of muscle tissue; 2. to assess disease severity in ambulant DMD patients by using these reference values;3. to determine the effects of pre

  14. Prednisone Therapy for Duchenne Dystrophy

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2005-02-01

    Full Text Available The effects of prednisone on muscle function and the extent of steroid-related adverse effects were studied in 17 ambulant children with Duchenne muscular dystrophy (DMD at University Hospital, Groningen; Rehabilitation Centre, Utrecht; and Leiden University Medical Centre, the Netherlands.

  15. Healthcare PANs: Personal Area Networks for trauma care and home care

    NARCIS (Netherlands)

    Jones, V.M.; Bults, R.G.A.; Konstantas, D.; Vierhout, P.A.M.

    2001-01-01

    The first hour following the trauma is of crucial importance in trauma care. The sooner treatment begins, the better the ultimate outcome for the patient. Generally the initial treatment is handled by paramedical personnel arriving at the site of the accident with an ambulance. There is evidence to

  16. Evaluation of Dutch Helicopter Emergency Medical Services in transporting children

    NARCIS (Netherlands)

    Peters, J.H.; Beekers, C.; Eijk, R.J.R.; Edwards, M.J.; Hoogerwerf, N.

    2014-01-01

    OBJECTIVE: In the Netherlands, helicopter emergency medical services (HEMS) function as an adjunct to paramedic ambulance service delivering hospital-level medical care to a prehospital location. The main goal of Dutch HEMS is to provide on-scene medical expertise and not primarily to serve as trans

  17. Case Study – Idling Reduction Technologies for Emergency Service Vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Laughlin, Michael [Argonne National Lab. (ANL), Argonne, IL (United States); Owens, Russell J. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-01-01

    This case study explores the use of idle reduction technologies (IRTs) on emergency service vehicles in police, fire, and ambulance applications. Various commercially available IRT systems and approaches can decrease, or ultimately eliminate, engine idling. Fleets will thus save money on fuel, and will also decrease their criteria pollutant emissions, greenhouse gas emissions, and noise.

  18. Early results from an angiosome-directed open surgical technique for venous arterialization in patients with critical lower limb ischemia

    DEFF Research Database (Denmark)

    Houlind, Kim Christian; Hallenberg, Christian; Christensen, Johnny

    2013-01-01

    the original wound, of incisional wounds on the foot, or persisting pain at rest. In three cases, the bypass was open at the time of amputation. Two patients experienced complete wound healing after 231 and 342 days, respectively. By the end of follow-up, the last patient was ambulating with slow wound healing...

  19. Burnout and Connectedness among Australian Volunteers: A Test of the Job Demands-Resources Model

    Science.gov (United States)

    Lewig, Kerry A.; Xanthopoulou, Despoina; Bakker, Arnold B.; Dollard, Maureen F.; Metzer, Jacques C.

    2007-01-01

    This study used the Job Demands-Resources (JD-R) model, developed in the context of occupational well-being in the paid workforce, to examine the antecedents of burnout and connectedness in the formal volunteer rural ambulance officer vocation (N=487). Structural equation modeling using self-reports provide strong evidence for the central…

  20. The effects of orthoses, footwear, and walking aids on the walking ability of children and adolescents with spina bifida : A systematic review using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a reference framework

    NARCIS (Netherlands)

    Ivanyi, Barbara; Schoenmakers, Marja; van Veen, Natasja; Maathuis, Karel; Nollet, Frans; Nederhand, Marc

    2015-01-01

    BACKGROUND: To date no review has been published that analyzes the efficacy of assistive devices on the walking ability of ambulant children and adolescents with spina bifida and, differentiates between the effects of treatment on gait parameters, walking capacity, and walking performance. OBJECTIVE

  1. Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine

    DEFF Research Database (Denmark)

    Møiniche, S; Hjortsø, N C; Blemmer, T

    1993-01-01

    at 24 h) or in number of episodes of dizziness, nausea or vomiting during rest or mobilisation. These results do not support the common belief that low-dose thoracic epidural bupivacaine/morphine may prevent ambulation due to sympathetic blockade or to impaired cardiovascular adaptation to the upright...

  2. Early Mobilization after Free-flap Transfer to the Lower Extremities: Preferential Use of Flow-through Anastomosis

    Directory of Open Access Journals (Sweden)

    Shimpei Miyamoto, MD

    2014-03-01

    Conclusions: This study demonstrates that early mobilization after free-flap transfer to the lower extremity is made possible by flow-through anastomosis for both arteries and veins. Flow-through flaps have stable circulation from the acute phase and can tolerate early dangling and ambulation.

  3. Are they really refusing to travel? A qualitative study of prehospital records

    Directory of Open Access Journals (Sweden)

    Christopher Sarah

    2006-09-01

    Full Text Available Abstract Background Refusal by the patient to travel after calling an emergency ambulance may lead to a preventable waste of scarce resources if it can be shown that an alternative more appropriate response could be employed. A greater understanding is required of the reasons behind 'refusal to travel' (RTT in order to find appropriate solutions to address this issue. We sought to investigate the reasons why patients refuse to travel following emergency call-out in a rural county. Methods Written records made by ambulance crews for patients (n = 397 who were not transported to hospital following an emergency call-out during October 2004 were retrospectively analysed. Results Twelve main themes emerged for RTT which included non injury or minor injury, falls and recovery after treatment on scene; other themes included alternative supervision, follow-up and treatment arrangements or patients arranging their own transport. Importantly, only 8% of the sample was recorded by ambulance crews as truly refusing to travel against advice. Conclusion A system that facilitates standardised recording of RTT information including social reasons for non-transportation needs to be designed. 'Refused to travel' disclaimers need to reflect instances when crew and patient are satisfied that not going to hospital is the right outcome. These recommendations should be considered within the context of the plans for widening the role of ambulance services.

  4. DIAGNOSTIC SIGNIFICATION OF EXANTHEMA IN THE PREHOSPITAL CARE IN INFECTIOUS DISEASES

    Directory of Open Access Journals (Sweden)

    N. F. Plavunov

    2016-01-01

    Full Text Available Disease, with exanthema, pose a significant differential diagnostic difficulty for physicians multidisciplinary hospitals and require the consultation of an infectious disease physician. The article highlights the problem of early diagnostics of acute infectious diseases proceeding with exanthema. The analysis of quality of diagnostics of infectious disease on the outcomes of the consultative infectious ambulance team for 2013-2014.

  5. Colonic sensory and motor function in irritable bowel syndrome and diverticular disease

    NARCIS (Netherlands)

    Clemens, C.H.M. (Cornelis Hermanus Maria)

    2003-01-01

    Chapter 1 is a general introduction. Chapter 2: left-colonic motility patterns were studied in fully ambulant non-constipated IBS patients compared to healthy controls. (HAPCs) were identified. In IBS the descending colon had a decreased overall frequency of phasic contractions and motility index a

  6. [Anorexia nervosa].

    Science.gov (United States)

    Herzog, W; Friederich, H C; Wild, B; Löwe, B; Zipfel, S

    2006-08-01

    Anorexia nervosa differs distinctly from other psychogenic eating disorders. Well known for the past 300 years, anorexia occurs consistently and is one of the most serious illnesses to be found for a certain age group. Three-quarters of the patients are healed or improve their condition long-term; one-quarter has a chronic course frequently including somatic complications and death. Because of the long healing process as well as the extensive chronification and complication rate, an individual treatment plan should be set up at the beginning of therapy to allow for a long-term structure of the course of therapy. Depending on the severity, phase and co-morbidity, inpatient and ambulant therapies are indicated. Depending on the duration of therapy, adequate weight (BMI > 15 kg/m2), good motivation, and lack of complications, an ambulant therapy is justified. Inpatient treatment is multimodal corresponding to the multifactorial etiology of anorexia nervosa. Weight gain is an important primary goal of therapy and a prerequisite for a conflict oriented, ambulant psychotherapy to be carried on after inpatient treatment. Ambivalent psychotherapy motivation and the necessity of symptom orientation demand technical modification both for inpatient as well as ambulant psychotherapy.

  7. Selected contents in J Head Trauma Rehabilitation%精 选 目 次 :

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@Supported treadmill ambulation training after spinal cord injury: A pilot study. 2001 Jun;82(6):825-831   脊 髓 损 伤 后 的 支 持 性 踏 车 运 动 训 练 : 实 验 性 研 究   

  8. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients.

    NARCIS (Netherlands)

    Middendorp, J.J. van; Hosman, A.J.F.; Pouw, M.H.; Meent, H. van de

    2009-01-01

    STUDY DESIGN: Prospective multicenter longitudinal cohort study. OBJECTIVE: To validate the prognostic value of the acute phase sacral sparing measurements with regard to chronic phase-independent ambulation in patients with traumatic spinal cord injury (SCI). SETTING: European Multicenter Study of

  9. Music as support and challenge

    DEFF Research Database (Denmark)

    Bonde, Lars Ole

    2010-01-01

    Første del af forskningsrapport om gruppemusikterapi med psykiatriske patienter i ambulant behandling. Metoden kaldes "Musiklytning og indre billeder" og der anvendes klassisk musik med såvel støttende som udfordrende elementer. Den artikel opridser den teoretiske baggrund for anvendelsen af denne...

  10. Manual wheelchairs : Research and innovation in rehabilitation, sports, daily life and health

    NARCIS (Netherlands)

    van der Woude, Lucas H V; de Groot, Sonja; Janssen, Thomas W J

    2006-01-01

    Those with lower limb disabilities are often dependent on manually propelled wheelchairs for their mobility, in Europe today some 3.3 million people. This implies a transfer from leg to arm work for ambulation and all other activities of daily living (ADL). Compared to the legs, arm work is less eff

  11. Developing a Framework and Priorities to Promote Mobility among Older Adults

    Science.gov (United States)

    Anderson, Lynda A.; Slonim, Amy; Yen, Irene H.; Jones, Dina L.; Allen, Peg; Hunter, Rebecca H.; Goins, R. Turner; Leith, Katherine H.; Rosenberg, Dori; Satariano, William A.; McPhillips-Tangum, Carol

    2014-01-01

    Mobility, broadly defined as movement in all of its forms from ambulation to transportation, is critical to supporting optimal aging. This article describes two projects to develop a framework and a set of priority actions designed to promote mobility among community-dwelling older adults. Project 1 involved a concept-mapping process to solicit…

  12. Emergency Victim Care. A Textbook for Emergency Medical Personnel.

    Science.gov (United States)

    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…

  13. Deficits in motor response to avoid sudden obstacles during gait in functional walkers poststroke

    NARCIS (Netherlands)

    Swigchem, R. van; Duijnhoven, H.J. van; Boer, J. den; Geurts, A.C.H.; Weerdesteijn, V.G.

    2013-01-01

    BACKGROUND: . Safe community ambulation requires the capacity to adapt gait to environmental changes on short notice. Reduced adaptability may contribute to an increased risk for falls. OBJECTIVE: . This study investigated gait adaptability in community-dwelling persons poststroke and sought to unde

  14. A Study of Real-time Peak Oxygen Consumption and Six-minute Walk Test

    Institute of Scientific and Technical Information of China (English)

    Guolin Zhang; Lan Guo; He Li; Jingzhuang Mai; Zhi Liu; Sixian Huang

    2007-01-01

    To assess the relationship between peak oxygen consumption( PVO2 ) and the ambulation distance in six-minute walk test (6MWT)among the healthy subjects.Methods The 51 healthy subjects were recruited for the six-minute walk test.Data of pulmonary gas exchange breath by breath,such as VO2,VCO2 were real-time measured with wireless remote sensing K4B2,so to study the relationship between peak oxygen uptake and the ambulation distance.Results It was noticed that there was a positive linear correlation between the ambulation distance and PVO2 ( r =0.619,P <0.001 ) in six-minute walk test.The regression equation was set up (VO2/kg =0.05D-6.331,P <0.001 ).PVO2 > PVCO2 ,R < 1 were found,which suggested that 6MWT was a test below anaerobic threshold.Conclusions There was a closely positive linear correlation between the ambulation distance and PVO2,which is safety,convenient and valuable for the evaluation of cardiopulmonary function and the treatment of cardiopulmonary rehabilitation.

  15. Upper Limb Evaluation in Duchenne Muscular Dystrophy: Fat-Water Quantification by MRI, Muscle Force and Function Define Endpoints for Clinical Trials

    Science.gov (United States)

    Ricotti, Valeria; Evans, Matthew R. B.; Sinclair, Christopher D. J.; Butler, Jordan W.; Ridout, Deborah A.; Hogrel, Jean-Yves; Emira, Ahmed; Morrow, Jasper M.; Reilly, Mary M.; Hanna, Michael G.; Janiczek, Robert L.; Matthews, Paul M.; Yousry, Tarek A.; Muntoni, Francesco; Thornton, John S.

    2016-01-01

    Objective A number of promising experimental therapies for Duchenne muscular dystrophy (DMD) are emerging. Clinical trials currently rely on invasive biopsies or motivation-dependent functional tests to assess outcome. Quantitative muscle magnetic resonance imaging (MRI) could offer a valuable alternative and permit inclusion of non-ambulant DMD subjects. The aims of our study were to explore the responsiveness of upper-limb MRI muscle-fat measurement as a non-invasive objective endpoint for clinical trials in non-ambulant DMD, and to investigate the relationship of these MRI measures to those of muscle force and function. Methods 15 non-ambulant DMD boys (mean age 13.3 y) and 10 age-gender matched healthy controls (mean age 14.6 y) were recruited. 3-Tesla MRI fat-water quantification was used to measure forearm muscle fat transformation in non-ambulant DMD boys compared with healthy controls. DMD boys were assessed at 4 time-points over 12 months, using 3-point Dixon MRI to measure muscle fat-fraction (f.f.). Images from ten forearm muscles were segmented and mean f.f. and cross-sectional area recorded. DMD subjects also underwent comprehensive upper limb function and force evaluation. Results Overall mean baseline forearm f.f. was higher in DMD than in healthy controls (pfat transformation of muscle with loss of muscle force and function. PMID:27649492

  16. Idling Reduction for Emergency and Other Service Vehicles

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-05-07

    This is a fact sheet about reducing idling for emergency and service vehicles. Emergency vehicles, such as police cars, ambulances, and fire trucks, along with other service vehicles such as armored cars, are often exempt from laws that limit engine idling. However, these vehicles can save fuel and reduce emissions with technologies that allow them to perform vital services without idling.

  17. Indoor fire in a nursing home : evaluation of the medical response to a mass casualty incident based on a standardized protocol

    NARCIS (Netherlands)

    Koning, S. W.; Ellerbroek, P. M.; Leenen, L. P. H.

    2015-01-01

    This retrospective study reports the outcome of a mass casualty incident (MCI) caused by a fire in a nursing home. Data from the medical charts and registration system of the Major Incident Hospital (MIH) and ambulance service were analyzed. The evaluation reports from the MIH and an independent res

  18. Emergency care center turnaround time--an improvement story.

    Science.gov (United States)

    Gelrud, Joan; Burroughs, Helen; Koterwas, Joanne

    2008-01-01

    Emergency department overcrowding is a nationally recognized barrier to patient safety. Other obstacles to efficiency and adequate care in emergency rooms include lengthy patient waits and side-tracked ambulances. This article explores one community hospital's approach to significantly decreasing emergency visit turnaround times while increasing patient satisfaction.

  19. Caring about the young

    NARCIS (Netherlands)

    John Stevens; Evert Pommer; Hetty van Kempen; Elke Zeijl; Isolde Woittiez; Klarita Sadiraj; Rob Gilsing; Saskia Keuzenkamp

    2009-01-01

    Original title: De jeugd een zorg. Youth care services are going through major changes. This has created a need for a better insight into the demand that is likely to be placed on these services in the future at both national and regional level. This report suggests that the use of ambulant care w

  20. Human Performance in Simulated Reduced Gravity Environments

    Science.gov (United States)

    Cowley, Matthew; Harvill, Lauren; Rajulu, Sudhakar

    2014-01-01

    NASA is currently designing a new space suit capable of working in deep space and on Mars. Designing a suit is very difficult and often requires trade-offs between performance, cost, mass, and system complexity. Our current understanding of human performance in reduced gravity in a planetary environment (the moon or Mars) is limited to lunar observations, studies from the Apollo program, and recent suit tests conducted at JSC using reduced gravity simulators. This study will look at our most recent reduced gravity simulations performed on the new Active Response Gravity Offload System (ARGOS) compared to the C-9 reduced gravity plane. Methods: Subjects ambulated in reduced gravity analogs to obtain a baseline for human performance. Subjects were tested in lunar gravity (1.6 m/sq s) and Earth gravity (9.8 m/sq s) in shirt-sleeves. Subjects ambulated over ground at prescribed speeds on the ARGOS, but ambulated at a self-selected speed on the C-9 due to time limitations. Subjects on the ARGOS were given over 3 minutes to acclimate to the different conditions before data was collected. Nine healthy subjects were tested in the ARGOS (6 males, 3 females, 79.5 +/- 15.7 kg), while six subjects were tested on the C-9 (6 males, 78.8 +/- 11.2 kg). Data was collected with an optical motion capture system (Vicon, Oxford, UK) and was analyzed using customized analysis scripts in BodyBuilder (Vicon, Oxford, UK) and MATLAB (MathWorks, Natick, MA, USA). Results: In all offloaded conditions, variation between subjects increased compared to 1-g. Kinematics in the ARGOS at lunar gravity resembled earth gravity ambulation more closely than the C-9 ambulation. Toe-off occurred 10% earlier in both reduced gravity environments compared to earth gravity, shortening the stance phase. Likewise, ankle, knee, and hip angles remained consistently flexed and had reduced peaks compared to earth gravity. Ground reaction forces in lunar gravity (normalized to Earth body weight) were 0.4 +/- 0.2 on

  1. Assesment of Osteoporosis in Medulla Spinalis Injured Patients

    Directory of Open Access Journals (Sweden)

    Zuhal Bayırlı Karakoyun

    2011-12-01

    Full Text Available Aim: To investigate the relationship between osteoporosis and demographic features, clinical characteristics,risk factors in younger SCI patients. Materials and Methods: Between January-June 2009, all SCI patients admitted to our hospital evaluated and 58 patients who were younger than 50 years who had osteoporosis were enrolled.Patients age, gender, educational status, duration of injury, smoking, sunlight exposure and dietary habits were questioned. Neurological level, completeness, ambulation status and spasticity were assessed. Relationship between these findings with the severity of osteoporosis has been viewed. Results: There were 19 women. Mean age was 35,7 years. The mean time since injury were 117.7 months. 42 patients were paraplegia (17 complete, 16 were tetraplegia (4 complete.The most common osteoporotic site where the legs. There was no correlation between BMD values with age. In men, the legs and total body BMD were significantly lower.The effect of educational level on BMD was not found. No significant correlation was found between time since injury and BMD. In paraplegics, femoral neck and total femur Z-scores were significantly lower. In tetraplegics, Z scores of the arms were lower, but was not significant. Lumbar BMD values of complete patients were significantly lower than incompletes. Sunlight exposure and consumption of milk/milk products had not a significant positive effect on BMD. 8 patients had therapeutic ambulation, whereas 23 of them had community ambulation. Ambulation status of patients and the presence of spasticity was no effect on BMD. There was no significant correlation between BMD and the severity of spasticity. Smokers (n=19, bone density was lower in all regions except for femoral neck but were not significantly. Conclusion: Male gender, paraplegia, and incompleteness negatively effects the bone density. Age, time since injury, education level, spasticity, ambulation level, smoking, sunlight exposure and

  2. Modelo de fila hipercubo com múltiplo despacho e backup parcial para análise de sistemas de atendimento médico emergenciais em rodovias

    Directory of Open Access Journals (Sweden)

    Ana Paula Iannoni

    2006-12-01

    Full Text Available O modelo hipercubo é um modelo de filas espacialmente distribuídas baseado em aproximações Markovianas para analisar a configuração e operação de sistemas emergenciais servidor-para-cliente, em que os servidores se deslocam até os clientes. Neste estudo adaptamos este modelo para tratar sistemas de atendimento médico emergenciais (SAEs em rodovias com políticas particulares de despacho, em que somente algumas ambulâncias do sistema podem atender chamadas em uma dada região (backup parcial, e duas ou mais ambulâncias idênticas ou diferenciadas podem atender uma única chamada (múltiplo despacho. Também consideramos situações em que uma ambulância pode se encontrar ocupada em sua própria base atendendo uma chamada não emergencial, isto é, sem ter que se deslocar na rodovia. Resultados computacionais da aplicação do modelo num estudo de caso de um SAE de uma concessionária de rodovias no interior de São Paulo são apresentados e analisados.The hypercube is a spatially distributed queuing model based on Markovian analysis approximations to analyze the configuration and operation of server-to-customer emergency systems, in which servers travel to the locations of the customers. In the present study we adapt the model to analyze emergency medical systems (EMS on highways operating with particular dispatching policies, which considers that only certain ambulances in the system can service calls in a given region (partial backup, and two or more identical or distinct ambulances can simultaneously service a single call (multiple dispatch. We also consider the situations in which an ambulance is busy in its base servicing a non-emergency call (i.e. it does not need to travel along the highway. Computational results of the model application to a case study of an EMS operating on highways in São Paulo state are presented and analyzed.

  3. Pre-hospital treatment of acute poisonings in Oslo

    Directory of Open Access Journals (Sweden)

    Nore Anne K

    2008-11-01

    Full Text Available Abstract Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40% were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84% were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%, were frequently comatose (35%, had respiratory depression (37%, and many received naloxone (49%. The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%, fewer were comatose (10%, and they rarely had respiratory depression (4%. Among the hospitalized, pharmaceutical poisonings were most common (58%, 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often

  4. On the influence of space storms on the frequency of infarct-myocardial, brain strokes, and hard car accidents; possible using of CR for their forecasting

    Science.gov (United States)

    Dorman, L. I.; Iucci, N.; Ptitsyna, N. G.; Villoresi, G.

    We consider the influence of space storms as strong interplanetary shock waves causing great cosmic ray Forbush-decreases and big geomagnetic storms on the people health at the ground level We used data of more than 7 millions ambulance cases in Moscow and St Petersburg included information on daily numbers of the hard traffic accidents infarctions and brain strokes We found that during space storms the average daily numbers of hard traffic accidents with using ambulances as well as infarctions and brain strokes confirmed by medical personal increase by 17 4 pm 3 1 10 5 pm 1 2 and 7 0 pm 1 7 respectively We show that the forecasting of these dangerous apace phenomena can be done partly by using cosmic ray data on pre-increase and pre-decrease effects as well as on the change of 3-D cosmic ray anisotropy

  5. Relationship between socket pressure and EMG of two muscles in trans-femoral stumps during gait.

    Science.gov (United States)

    Hong, Jung Hwa; Mun, Mu Seong

    2005-04-01

    The biomechanical interaction between the leg stump and the prosthetic socket is critical in achieving close-to-normal ambulation. Although many investigations have been performed to understand the biomechanics of trans-tibial sockets, few studies have measured the socket interface pressure for transfemoral amputees. Furthermore, no report has examined how the residual muscle activities in the transfemoral stump affect the socket interface pressure characteristics during gait. In this study, an experimental method was developed to measure the trans-femoral socket interface pressures and EMG of muscles in the stumps of two trans-femoral amputees. Also, the measurement of three-dimensional prosthetic locomotion was synchronized to understand detailed socket biomechanics. Based on the experimental results, a significant correlation (P socket-interface pressure changes during ambulation.

  6. Hjertestop uden for hospital

    DEFF Research Database (Denmark)

    Frandsen, F; Nielsen, J R; Gram, L;

    1989-01-01

    During the period 1.10.1986-30.9.1987, all patients with cardiac arrest outside hospital brought to the casualty department in Odense Hospital were registered. Out of 160 patients, 133 (83%) could be primarily resuscitated, 19 (12%) were resuscitated but died later in hospital and eight patients (5......%) were resuscitated and could be discharged alive from hospital. Out of the eight patients who were discharged alive, only two (1%) had retained reasonable cerebral function as assessed by dementia testing. Treatment of the cardiac arrest prior to the arrival of the ambulance, duration of the cardiac...... arrest for less than six minutes and staffing of the ambulance with three first-aid men were factors of decisive importance for survival of the patients. The results of this investigation demonstrate that treatment of cardiac arrest outside hospital is unsatisfactory. Proposals for improvement...

  7. Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment

    DEFF Research Database (Denmark)

    Simonsen, Sofie; Andresen, Morten; Michelsen, Lene;

    2014-01-01

    BackgroundEffective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during...... a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009.MethodsWe performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch...... of the ambulance to arrival at the scene, on-scene time and transport time to the hospital¿in total, alarm-to-door time. In addition, we noted baseline characteristics.ResultsWe reviewed 481 records (58% male, median age 66 years). The median (IQR) alarm-to-door time in minutes was 41 (33¿52), of which 18 (12...

  8. Pre-hospital identification and post-recovery challenges of intoxication with synthetic cannabinoid containing legal high products such as 'Exodus Damnation'.

    Science.gov (United States)

    Fitzpatrick, David; O'Meara, Patrick; Cunningham, Andrew

    2016-11-01

    This short report describes the case of a young adult male who had smoked a synthetic cannabinoid legal high product called 'Exodus Damnation'. The patient's presentation was atypical from that described in the literature, with hypotension and hypoxaemia. Of note was the rapid recovery after pre-hospital intervention with high-flow oxygen therapy and intravenous fluids. The patient refused on-going care, despite repeated advice to attend the Emergency Department. The distinct lack of specialist support and referral to drug treatment for this patient population, with whom ambulance services are coming into contact with increasing frequency, is reported. For those patients with the capacity to refuse on-going care, ambulance services may be in an opportune position to actively promote referral to support services for these vulnerable individuals.

  9. Isochrones as Indicators of the Influence of Traffic in Public Health: A Visual Simulation Application in Ávila, Spain

    Directory of Open Access Journals (Sweden)

    F. Javier Otamendi

    2015-10-01

    Full Text Available It is well known that excessive rescue times after traffic accidents negatively affect the health of those injured. There is a need to quantitatively measure the impact of unexpected events like ambulance availability, weather, floating population and congestion in those rescue times. A family of indicators based on isochrones is disguised and proposed to understand the risk of the whole population as the probability of not being assisted on time. Indicators of health risk for local towns are also defined. The indicators are calculated using a simulation model and visualized in web format. The framework of analysis is validated using Ávila (Spain and the problem of the optimal deployment of ambulances as a test-bench.

  10. Magnetic resonance imaging to detect vesico-symphyseal fistula following robotic prostatectomy

    Directory of Open Access Journals (Sweden)

    Ryan C. Hutchinson

    2013-04-01

    Full Text Available Pubic complications following radical prostatectomy are rare. Osteitis pubis typically presents with symptoms related to irritation of the pubic rami including pain with ambulation and adduction of the leg. A 60-year-old male with prostatic adenocarcinoma underwent uneventful robotic assisted laparoscopic prostatectomy. The patient noted the onset of severe pubic pain exacerbated by ambulation approximately one month post-surgery. An abdominal/pelvic CT scan was negative for acute pathology. Due to continued discomfort, a multiplanar MRI of the pelvis was performed with and without intravenous contrast material (20 ml Omniscan. The MRI demonstrated irregularity of the bladder base and proximal urethra with a fistulous tract extending anteriorly in direct communication with the pubic symphysis joint space. Vague periarticular marrow edema-like signal and enhancement at the pubic symphysis was thought to represent osteitis pubis. The patient's symptoms resolved after one month of urethral catheter drainage, intravenous antibiotics, and anti-inflammatory therapy.

  11. Preoperative teaching and hysterectomy outcomes.

    Science.gov (United States)

    Oetker-Black, Sharon L; Jones, Susan; Estok, Patricia; Ryan, Marian; Gale, Nancy; Parker, Carla

    2003-06-01

    This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

  12. Decreased heart rate variability responses during early postoperative mobilization

    DEFF Research Database (Denmark)

    Jans, Øivind; Brinth, Louise; Kehlet, Henrik;

    2015-01-01

    BACKGROUND: Intact orthostatic blood pressure regulation is essential for early mobilization after surgery. However, postoperative orthostatic hypotension and intolerance (OI) may delay early ambulation. The mechanisms of postoperative OI include impaired vasopressor responses relating to postope......BACKGROUND: Intact orthostatic blood pressure regulation is essential for early mobilization after surgery. However, postoperative orthostatic hypotension and intolerance (OI) may delay early ambulation. The mechanisms of postoperative OI include impaired vasopressor responses relating...... to postoperative autonomic dysfunction. Thus, based on a previous study on haemodynamic responses during mobilization before and after elective total hip arthroplasty (THA), we performed secondary analyses of heart rate variability (HRV) and aimed to identify possible abnormal postoperative autonomic responses...... in relation to postural change. METHODS: A standardized mobilization protocol before, 6 and 24 h after surgery was performed in 23 patients scheduled for elective THA. Beat-to-beat arterial blood pressure was measured by photoplethysmography and HRV was derived from pulse wave interbeat intervals and analysed...

  13. Automated electrocardiogram interpretation programs versus cardiologists' triage decision making based on teletransmitted data in patients with suspected acute coronary syndrome

    DEFF Research Database (Denmark)

    Clark, Elaine N; Ripa, Maria Sejersten; Clemmensen, Peter;

    2010-01-01

    The aims of this study were to assess the effectiveness of 2 automated electrocardiogram interpretation programs in patients with suspected acute coronary syndrome transported to hospital by ambulance in 1 rural region of Denmark with hospital discharge diagnosis used as the gold standard...... and to assess the effectiveness of cardiologists' triage decisions for these patients based on initial electrocardiogram. Twelve-lead electrocardiograms were recorded in ambulances using a LIFEPAK 12 monitor/defibrillator (Physio-Control, Inc., Redmond, Washington) and transmitted digitally to an attending...... cardiologist. If a diagnosis of ST elevation myocardial infarction was made, a patient was taken to a regional interventional center for primary percutaneous coronary intervention or to a local hospital. One thousand consecutive digital electrocardiograms and corresponding interpretations from LIFEPAK 12 were...

  14. Anaesthesiologists in prehospital care make a difference to certain groups of patients

    DEFF Research Database (Denmark)

    Christensen, Erika Frischknecht; Melchiorsen, Hanne; Kilsmark, J.;

    2003-01-01

    ACKGROUND: Knowledge of the population using prehospital emergency services is scarce except for selected subgroups. Interventions are often made without evaluation. The aim of this study was (1) to describe mortality, hospitalization and the diagnostic pattern among emergency ambulance users...... and (2) to evaluate the impact of one mobile emergency care unit (MECU) staffed by an anesthesiologist. DESIGN AND METHODS: A descriptive and quasi-experimental study of consecutive emergency ambulance users during two 3-month periods: before the MECU (Period 1) and after (Period 2). Hospitalization......, diagnostic and 0-180-day mortality data were requested from national registers. Diagnoses were according to the International Classification of Diseases (ICD). RESULTS: Periods 1 and 2 included 2950 and 2869 users, respectively. The MECU attended 27.7% in Period 2. Fewer users were brought to hospital...

  15. Mental function and morbidity after acute hip surgery during spinal and general anaesthesia.

    Science.gov (United States)

    Bigler, D; Adelhøj, B; Petring, O U; Pederson, N O; Busch, P; Kalhke, P

    1985-07-01

    Forty elderly patients (mean age 78.9 years) undergoing acute surgery for hip fracture were given at random either spinal analgesia with bupivacaine 0.75% or general anaesthesia with diazepam, fentanly and N2O/O2. Mental function was studied pre-operatively with an abbreviated mental test and 1 week and 3 months postoperatively in both groups. Mortality and number of complications was similar in the two groups, but a shorter time of ambulation was seen in the spinal group compared to the general anaesthetic group. No persistent impairment in mental function was found after acute hip surgery under spinal or general anaesthesia and the only advantage of regional technique was a shorter time of ambulation.

  16. Feasibility of Using Microsoft Kinect to Assess Upper Limb Movement in Type III Spinal Muscular Atrophy Patients

    Science.gov (United States)

    Siebourg-Polster, Juliane; Wolf, Detlef; Czech, Christian; Bonati, Ulrike; Fischer, Dirk; Khwaja, Omar; Strahm, Martin

    2017-01-01

    Although functional rating scales are being used increasingly as primary outcome measures in spinal muscular atrophy (SMA), sensitive and objective assessment of early-stage disease progression and drug efficacy remains challenging. We have developed a game based on the Microsoft Kinect sensor, specifically designed to measure active upper limb movement. An explorative study was conducted to determine the feasibility of this new tool in 18 ambulant SMA type III patients and 19 age- and gender-matched healthy controls. Upper limb movement was analysed elaborately through derived features such as elbow flexion and extension angles, arm lifting angle, velocity and acceleration. No significant differences were found in the active range of motion between ambulant SMA type III patients and controls. Hand velocity was found to be different but further validation is necessary. This study presents an important step in the process of designing and handling digital biomarkers as complementary outcome measures for clinical trials. PMID:28122039

  17. Evaluation of a temporary prosthetic insert in the rehabilitation of elderly ischaemic below-knee amputees: a pilot study.

    Science.gov (United States)

    Hallam, F M; Jull, G A

    1988-01-01

    The physiotherapy management of elderly, ischaemic below knee amputees is often compromised by delayed and/or complicated wound healing. Such patients are often unable to ambulate on a prosthesis for prolonged periods. Problems concommitant with immobilization such as weakness, contractures, and decreased morale tend to arise. This pilot study investigated the efficacy of incorporating a shaped Dunlopillo insert into a temporary prosthetic socket to allow the at risk group to ambulate as soon as the sutures were removed regardless of the state of wound healing. Two parameters were evaluated, namely wound healing and stump maturation. A total of eighteen subjects were observed in a control and an experimental group. Both wound healing (p < 0.05) and stump maturation (p < 0.05) were significantly enhanced by the inclusion of a Dunlopillo insert.

  18. Rehabilitation in limb deficiency. 1. Gait and motion analysis.

    Science.gov (United States)

    Czerniecki, J M

    1996-03-01

    This self-directed learning module highlights new advances in this topic area. It is part of the chapter on rehabilitation in limb deficiency in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses normal gait, the influence of prosthetic alignment on amputee function, and the effects of prosthetic components on the metabolic costs and the biomechanical function of the amputee. The biomechanics of normal ambulation are presented as a background to enable the practitioner to gain an understanding of the typical gait adaptations that occur in below-knee and above-knee amputees. The effects of newer prosthetic components and socket designs on the biomechanical adaptations are reviewed. The metabolic costs of amputee ambulation are significantly greater than normal. The theoretical mechanisms for this are discussed, and the effects of newer socket designs, ultra-light-weight components, and energy-storing prosthetic components are presented.

  19. Remote medicine

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-04-29

    The international oil industry, catalyzed by a surge in exploration and production projects in remote regions, is giving health care for its travelers and expatriates a high priority. L.R. Aalund, the Journal`s Managing Editor--Technology, reports on why and how this is happening now. He covers this in articles on: health care in Russia, air ambulance evacuations, and the deployment of remote paramedics. Aalund gathered the information during trips to Finland and Russia and interviews with oil industry personnel, physicians, and other medical professionals in North America, Europe, and Siberia. Titles of the four topics presented in this special section on remote medicine are as follows: Oil companies focus on emergency care for expats in Russia; Air ambulance plan can be critical; Remote paramedics have high level of training; and Other facets of remote medicine.

  20. Work-related well-being

    Directory of Open Access Journals (Sweden)

    Melinda Soh

    2016-02-01

    Full Text Available This study aimed to investigate the different dimensions of well-being (namely, work engagement, job satisfaction, and psychological stress and possible predictors such as personality and perceived organizational support. A cross-sectional survey design was used, with a sample of 490 ambulance personnel in the United Kingdom. Significant correlations were found between the dimensions of job satisfaction, engagement, and stress. The results also supported a hierarchical model with job satisfaction, stress, and engagement loading onto one higher order factor of work well-being. Emotional stability and perceived organizational support were identified as significant predictors of well-being. The findings suggest the importance of measuring the work-related well-being of ambulance personnel holistically and present perceived organizational support as a possible area for interventions to improve well-being.

  1. Analgesic effect of perioperative escitalopram in high pain catastrophizing patients after total knee arthroplasty

    DEFF Research Database (Denmark)

    Lunn, Troels H; Frokjaer, Vibe G; Hansen, Torben Bæk

    2015-01-01

    has not previously been investigated. The authors hypothesized that perioperative escitalopram would reduce pain after TKA in high pain catastrophizing patients. METHODS: A total of 120 pain catastrophizing patients (selected using the pain catastrophizing scale as preoperative screening tool......) scheduled for TKA were randomized in a double-blind manner to either 10 mg escitalopram or placebo daily from preanesthesia to postoperative day 6 in addition to a standardized analgesic regime. The primary outcome was pain upon ambulation 24 h after surgery. Secondary outcomes were overall pain during well......-defined mobilizations and at rest from 2 to 48 h and from days 2 to 6, morphine equivalents, anxiety, depression, and side effects. RESULTS: Pain upon ambulation (mean [95% CI]) 24 h after surgery in the escitalopram versus placebo group was 58 (53 to 64) versus 64 (58 to 69), the mean difference being -5 (-13 to 3), P...

  2. From Wheelchair to Cane: Elective Transtibial Amputations in a Patient with Spina Bifida.

    Science.gov (United States)

    Mayo, Amanda; Berbrayer, David

    2015-11-01

    Spina bifida is associated with foot deformities, which may lead to foot ulcers, osteomyelitis, and limb amputation. Calcanectomy and Symes amputations have been reported successful in spina bifida. There is lack of evidence for transtibial amputations. This case describes a 27-yr-old woman with L4 level spina bifida who underwent bilateral transtibial amputations. She ambulated with bilateral ankle foot orthoses and canes until age 22. At age 22, she had bilateral foot reconstructive surgeries complicated by nonunion, ulcerations, and osteomyelitis. She was using a wheelchair by age 25. She had elective bilateral transtibial amputations at age 27 for progressive osteomyelitis. Four weeks after amputations, she was fit with bilateral prostheses. On completion of 2 mos of rehabilitation, she ambulated with a cane. This case demonstrates good functional outcomes after transtibial amputations in a young spina bifida patient. Prosthetic fitting should be considered for similar, previously high functioning spina bifida patients with transtibial amputation(s).

  3. Feasibility of Using Microsoft Kinect to Assess Upper Limb Movement in Type III Spinal Muscular Atrophy Patients.

    Science.gov (United States)

    Chen, Xing; Siebourg-Polster, Juliane; Wolf, Detlef; Czech, Christian; Bonati, Ulrike; Fischer, Dirk; Khwaja, Omar; Strahm, Martin

    2017-01-01

    Although functional rating scales are being used increasingly as primary outcome measures in spinal muscular atrophy (SMA), sensitive and objective assessment of early-stage disease progression and drug efficacy remains challenging. We have developed a game based on the Microsoft Kinect sensor, specifically designed to measure active upper limb movement. An explorative study was conducted to determine the feasibility of this new tool in 18 ambulant SMA type III patients and 19 age- and gender-matched healthy controls. Upper limb movement was analysed elaborately through derived features such as elbow flexion and extension angles, arm lifting angle, velocity and acceleration. No significant differences were found in the active range of motion between ambulant SMA type III patients and controls. Hand velocity was found to be different but further validation is necessary. This study presents an important step in the process of designing and handling digital biomarkers as complementary outcome measures for clinical trials.

  4. Pre-hospital care--current concepts.

    Science.gov (United States)

    Boyington, T; Williams, D

    1995-01-01

    After a brief outline of past developments in the training of ambulance personnel, this paper traces the adoption in the UK of Pre-Hospital Trauma Life Support (PHTLS) courses from the US. The 1991 World Student Games in Sheffield, UK led to liaison between training staff from South Yorkshire Metropolitan Ambulance and Paramedic Service (SYMAPS) and from Western New York Medical Training Institute. As a result, the trauma care policy of SYMAPS was altered from aiming to stabilise the patient at the scene of the accident to emphasising rapid and thorough assessment, packaging and transport. This is a resume of the scope of the PHTLS provider course. The course concentrates on the principles of PHTLS for the multisystems trauma victim.

  5. Using a business rule management system to improve disposition of traumatized patients.

    Science.gov (United States)

    Neuhaus, Philipp; Noack, Oliver; Majchrzak, Tim; Uckert, Frank

    2010-01-01

    We propose a business rule management system that is used to optimize the dispatchment on a mass casualty incident. Using geospatial information from available ambulances and rescue helicopters, a business rule engine calculates an optimized transportation plan for injured persons. It automatically considers special needs like ambulances equipped for baby transportation or special decontamination equipment, e.g. to deal with an accident in a chemical factory. The rules used in the system are not hardcoded; thus, it is possible to redefine them on the fly without changing the program's source code. It is possible to load and save a rule set in case of a catastrophe. Furthermore, it is possible to automatically recalculate an already planned operation if it becomes clear that the rescue vehicles assigned are needed by a person with life-threatening injuries.

  6. Praehospitalt hjertestop i Danmark. Er beredskabet effektivt?

    DEFF Research Database (Denmark)

    Hallas, P

    2000-01-01

    The chain-of-survival concept is an established principle in the treatment of out-of-hospital cardiac arrest. Survival is improved when out-of-hospital cardiac arrest is followed by a sequence of events: early access to help, early cardiopulmonary resuscitation, early defibrillation and early adv...... is the time between the emergency call and the start of adequate treatment. Options for defibrillation and--in some cities--advanced life support are good, but hard to exploit as ambulances frequently arrive too late for treatment to be effective....... advanced care. The Danish emergency medical system is only to some extent in accordance with the standards of the chain-of-survival concept. The current way of evaluating the efficiency of the system is based mainly upon the driving time for the ambulance, but the time that counts for the patient...

  7. Aortic valve replacement in a patient with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Bhuvnesh Kansara

    2013-01-01

    Full Text Available Valvular heart disease in systemic lupus erythematosus (SLE is associated with substantial morbidity and mortality. Current therapy includes symptomatic measures and valve replacement. SLE can present major challenges because of accrued organ damage, coagulation defects and complex management regimes. The peri-operative goals are to maintain strict asepsis, avoid use of nephrotoxic drugs and thereby renal insult, and to promote early ambulation post-operatively.

  8. Preparing for the Proven Inevitable: An Urban Operations Training Strategy for America’s Joint Force

    Science.gov (United States)

    2006-01-01

    windows, and inter- nal rooms. Many have additional supporting elements of infrastruc- ture such as rail lines, streetlights , and signage. Official...minimal. State prisoners convicted of nonviolent crimes provide labor in support of both these activities at Muscatatuck, so post-training repairs entail...A fully equipped medical clinic with ambulance; • An airstrip (~5,000 ft); • Wide streets with streetlights ; • Three water wells; • An elevated

  9. Modelo hipercubo integrado a um algoritmo genético para análise de sistemas médicos emergenciais em rodovias The hypercube queuing model integrated to a genetic algorithm to analyze emergency medical systems on highways

    Directory of Open Access Journals (Sweden)

    Ana Paula Iannoni

    2006-04-01

    Full Text Available O modelo hipercubo, conhecido na literatura de problemas de localização de sistemas servidor para cliente, é um modelo baseado em teoria de filas espacialmente distribuídas e aproximações Markovianas. O modelo pode ser modificado para analisar os sistemas de atendimentos emergenciais (SAEs em rodovias, considerando as particularidades da política de despacho destes sistemas. Neste estudo, combinou-se o modelo hipercubo com um algoritmo genético para otimizar a configuração e operação de SAEs em rodovias. A abordagem é efetiva para apoiar decisões relacionadas ao planejamento e operação destes sistemas, por exemplo, em determinar o tamanho ideal para as áreas de cobertura de cada ambulância, de forma a minimizar o tempo médio de resposta aos usuários e o desbalanceamento das cargas de trabalho das ambulâncias. Os resultados computacionais desta abordagem foram analisados utilizando dados reais do sistema Anjos do Asfalto (rodovia Presidente Dutra.The hypercube model, well-known in the literature on problems of server-to-customer localization systems, is based on the spatially distributed queuing theory and Markovian analysis approximations. The model can be modified to analyze Emergency Medical Systems (EMSs on highways, considering the particularities of these systems' dispatching policies. In this study, we combine the hypercube model with a genetic algorithm to optimize the configuration and operation of EMSs on highways. This approach is effective to support planning and operation decisions, such as determining the ideal size of the area each ambulance should cover to minimize not only the average time of response to the user but also ambulance workload imbalances, as well as generating a Pareto efficient boundary between these measures. The computational results of this approach were analyzed using real data Anjos do Asfalto EMS (which covers the Presidente Dutra highway.

  10. [The contributin of medical supply experts into military health care during the Great Patriotic War].

    Science.gov (United States)

    Miroshnichenko, Yu V; Bunin, S A; Kononov, V N; Perfilev, A G

    2015-05-01

    During the Great Patriotic War edical supply experts to solve complex problems for the "smooth and full achievement of medical supplies of the army, the development of official documents, creation of new samples of complete- standard-issue equipment, ambulance and medical equipment. The experience gained on the battlefield and during the post-war period, allowed progressively improving the functioning of. the medical supply troops (forces), successfully and consistently carried out in the framework of its organizational planning and other activities.

  11. TOTAL JOINT REPLACEMENT OF THE LOWER EXTREMITY IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

    OpenAIRE

    Стюарт Б. Гудмэн

    2014-01-01

    Joint replacement of the lower extremity in Juvenile Idiopathic Arthritis (JIA) is becoming more commonly performed worldwide. These young adults experience severe pain and disability from end-stage arthritis, and require joint replacement of the hip or knee to alleviate pain, and restore ambulation and function. These procedures are very challenging from the anesthesia and surgical point of view, due to small overall proportions, numerous bony and other deformities and soft tissue contractur...

  12. [From Carl Ferdinand von Graefe (1787-1840) to Gustav Biedermann Günter (1801-1866) and his school].

    Science.gov (United States)

    Klimpel, V

    1994-09-01

    A for the most part unknown surgical school in Germany is presented. She begins and ends in Saxony and reaches from the 18th to the begin of the 20th century. The protagonists of this school are Carl Ferdinand von Graefe and Gustav Biedermann Günther. Their characteristics are a strict indication, the surgery of skin, bones and joints as well as the ambulance surgery. Beside plastic surgery this school brought out many other specialties too.

  13. Assessment on self-care, mobility and social function of children with spina biifda in Turkey

    Institute of Scientific and Technical Information of China (English)

    Hulya Sirzai; Beril Dogu; Selamet Demir; Figen Yilmaz; Banu Kuran

    2014-01-01

    The aim of the study was to investigate the functional performance in children with spina biifda, using the Pediatric Evaluation of Disability Inventory (PEDI) to look into capacity of twen-ty-eight children with spina biifda with lesions at different levels in different dimensions of self-care, mobility and social function. Mean age of the patients was 3.5 ± 2.3 (1-10) years. In the muscle test carried out, 13 patients (44.8%) had no movements including pelvic elevation in lower extremity muscles and they were at level 5. Sixteen patients (54%) were non-ambulatory according to the Hoofer ambulation classiifcation. Raw and scale scores in the self-care, mobil-ity and social function domains both in the functional skill scale and in the caregiver scale were found to be lower compared to the data of the normal population. A statistically significant correlation was observed in the self-care values of the Functional Skills Scales and the Caregiver Assistance Scale measurements, which was positive for age and negative for Functional Ambu-lation Scale and muscle test (P< 0.05). A positive relation was found between the Functional Skills Scales-mobility area and age while a negative relation was observed between Functional Ambulation Scale and muscle test (P < 0.005). A negative relation was also found between Care-giver Assistance Scale-mobility and Functional Ambulation Scale and muscle test (P < 0.005). In our study, the functional performance of the children was found to be low. Low-level lesions, encouraging muscular strength and independence in mobility are all very important factors for functional independence.

  14. Maximizing resource efficiency in rural prehospital emergency medical services through call frequency analysis

    OpenAIRE

    Flynn, Andrew

    2013-01-01

    Rural prehospital emergency medical services are often lacking when compared with their urban counterparts in terms of resources and coordinated resource use: can only employ important resources, such as paramedics, during limited shifts. This project demonstrates a method for determining the most effective use of these limited resources in a rural Red Cross ambulance service in Guápiles, Costa Rica. In this community, paramedic services are only available six days a week for twelve hours. Em...

  15. 救护车

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    5GHz W-LAN Trials for High Speed Mobile Applications - Trials on An Express Train and on An Ambulance Car, Active noise control for sound of siren using the DXHS algorithm with frequency and secondary path delay estimation, Analytical study of emergency medical service rescue time, Application of distributed traffic simulation to evaluate traffic signal controller algorithms,Enterprise modeling and decision-support for automating the business rules lifecycle。

  16. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions-A nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske;

    2010-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...... providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases....

  17. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske;

    2011-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...... providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases....

  18. Prehospital randomised assessment of a mechanical compression device in cardiac arrest (PaRAMeDIC) trial protocol

    OpenAIRE

    McCabe Chris; Lamb Sarah E; Lall Ranjit; Horton Jessica; Deakin Charles; Cooke Matthew W; Woollard Malcolm; Perkins Gavin D; Quinn Tom; Slowther Anne; Gates Simon

    2010-01-01

    Abstract Background Survival after out-of-hospital cardiac arrest is closely linked to the quality of CPR, but in real life, resuscitation during prehospital care and ambulance transport is often suboptimal. Mechanical chest compression devices deliver consistent chest compressions, are not prone to fatigue and could potentially overcome some of the limitations of manual chest compression. However, there is no high-quality evidence that they improve clinical outcomes, or that they are cost ef...

  19. [French military nurses during the First World War (1914-1918)].

    Science.gov (United States)

    Garcia, Julien; Lefort, Hugues; Lamache, Christophe; Tabbagh, Xavier; Olier, François

    2014-06-01

    In 1914, beingthe heirs of the ambulance soldiers who had been created during the time of the Empire, the military males-nurses were overwhelmed by the armies huge needs in paramedics. Facing both the callings of commandment which demanded the recruitment of soldiers and the necessity--which had been set up as a duty by the health service--to attend the doctors, the military male-nurse gave way, in 1918 to a new comer: the female military nurse.

  20. The Changes of Henry's Character in Hemingway's A FAREWELL TO ARMS

    Institute of Scientific and Technical Information of China (English)

    樊东辉

    2002-01-01

    During the First World War, Fredeik Henry isblindly moved by the American government's slogan-“save the world for democracy. ” He volunteers to jointhe Italian Army as an officer in the ambulance crops.He wants to search for some values and do some usefulthings for society, but the cruel reality of war disturbsthe quiet in his heart. He becomes void, and even loseshis aim of life.

  1. Operational Helicopter Aviation Medicine

    Science.gov (United States)

    1978-12-01

    limited to citizens of the NATO nations. The content of this publication has been reproduced directly from material supplied by AGARD or the authors...work will help him meet and perhaps solve perplexing questions we all face. VA no CONTENTS pope PANEL AND MEETING OFFICERS iU SESSION CHAIRMEN iv...dans un service cardlo- vasculaire . D’une part, par suite d’une situation conflictuelle, aucune ambulance routi~re n’Lstait disponible, d’autre part, la

  2. Prehospital score for acute disease: a community-based observational study in Japan

    Directory of Open Access Journals (Sweden)

    Fujiwara Hidekazu

    2007-10-01

    Full Text Available Abstract Background Ambulance usage in Japan has increased consistently because it is free under the national health insurance system. The introduction of refusal for ambulance transfer is being debated nationally. The purpose of the present study was to investigate the relationship between prehospital data and hospitalization outcome for acute disease patients, and to develop a simple prehospital evaluation tool using prehospital data for Japan's emergency medical service system. Methods The subjects were 9,160 consecutive acute disease patients aged ≥ 15 years who were transferred to hospital by Kishiwada City Fire Department ambulance between July 2004 and March 2006. The relationship between prehospital data (age, systolic blood pressure, pulse rate, respiration rate, level of consciousness, SpO2 level and ability to walk and outcome (hospitalization or non-hospitalization was analyzed using logistic regression models. The prehospital score component of each item of prehospital data was determined by beta coefficients. Eligible patients were scored retrospectively and the distribution of outcome was examined. For patients transported to the two main hospitals, outcome after hospitalization was also confirmed. Results A total of 8,330 (91% patients were retrospectively evaluated using a prehospital score with a maximum value of 14. The percentage of patients requiring hospitalization rose from 9% with score = 0 to 100% with score = 14. With a cut-off point score ≥ 2, the sensitivity, specificity, positive predictive value and negative predictive value were 97%, 16%, 39% and 89%, respectively. Among the 6,498 patients transported to the two main hospitals, there were no deaths at scores ≤ 1 and the proportion of non-hospitalization was over 90%. The proportion of deaths increased rapidly at scores ≥ 11. Conclusion The prehospital score could be a useful tool for deciding the refusal of ambulance transfer in Japan's emergency medical

  3. Effects of Hydrogen Peroxide on Common Aviation Textiles

    Science.gov (United States)

    2009-08-01

    peroxide has been used for years as a disinfectant in the medical community and is under consideration in the dilute vapor form as a decontaminant... disinfectant /sterilant for transportation vehicles like aircraft, buses, subway trains, ambulances, etc. Although the biological efficacy of STERIS...10-min dip in 35% liquid H2O2 . 13 (a) (b) Figure 15. (a) Vertical and (b) horizontal flammability test results for nylon. 14 (a) (b) Figure 16. (a

  4. “The Forgotten Helpers? Life After the Emergency Services”

    OpenAIRE

    2015-01-01

    Background: The impact of emergency service work on the health and well-being of personnel has been well documented in the literature. Despite this, however, very little is known about the experiences of emergency service retirees and their Quality of Life (QoL). Aims: The principal aim of this study was to assess the overall QoL and wellbeing of retired emergency services (ambulance and fire) personnel. The specific objectives of the study were to: (1) ascertain the possible l...

  5. Notärztliche Entscheidungen am Einsatzort

    OpenAIRE

    2014-01-01

    Background Calls are increasingly being voiced for re-evaluating the necessity of emergency physicians in German emergency services. Although studies have shown that severely ill patients benefit from a medical treatment conducted by emergency physicians, a higher efficiency can only be derived with some reservations. In order to define the importance of emergency physicians for ambulance services the subsequent study will examine how often emergency physicians come to specific deci...

  6. Development and evaluation of a novel, real time mobile telesonography system in management of patients with abdominal trauma: study protocol

    Science.gov (United States)

    2012-01-01

    Background Despite the use of e-FAST in management of patients with abdominal trauma, its utility in prehospital setting is not widely adopted. The goal of this study is to develop a novel portable telesonography (TS) system and evaluate the comparability of the quality of images obtained via this system among healthy volunteers who undergo e-FAST abdominal examination in a moving ambulance and at the ED. We hypothesize that: (1) real-time ultrasound images of acute trauma patients in the pre-hospital setting can be obtained and transmitted to the ED via the novel TS system; and (2) Ultrasound images transmitted to the hospital from the real-time TS system will be comparable in quality to those obtained in the ED. Methods Study participants are three healthy volunteers (one each with normal, overweight and obese BMI category). The ultrasound images will be obtained by two ultrasound-trained physicians The TS is a portable sonogram (by Sonosite) interfaced with a portable broadcast unit (by Live-U). Two UTPs will conduct e-FAST examinations on healthy volunteers in moving ambulances and transmit the images via cellular network to the hospital server, where they are stored. Upon arrival in the ED, the same UTPs will obtain another set of images from the volunteers, which are then compared to those obtained in the moving ambulances by another set of blinded UTPs (evaluators) using a validated image quality scale, the Questionnaire for User Interaction Satisfaction (QUIS). Discussion Findings from this study will provide needed data on the validity of the novel TS in transmitting live images from moving ambulances to images obtained in the ED thus providing opportunity to facilitate medical care of a patient located in a remote or austere setting. PMID:23249290

  7. The legal duty of physicians and hospitals to provide emergency care

    OpenAIRE

    Walker, Anne F.

    2002-01-01

    ACCESSIBILITY OF HOSPITAL EMERGENCY SERVICES HAS BEEN an issue of increasing concern and was recently brought into public focus in Ontario by the tragic death of Joshua Fleuelling, whose ambulance was redirected from the nearest hospital. As will be reviewed, the limited case law has identified a legal duty for physicians and hospitals to provide treatment to people in need of emergency care, a duty that should be considered when formulating hospital policies. The impact of this duty of care ...

  8. Effectiveness of Installation Aeromedical Evacuation

    Science.gov (United States)

    2013-12-13

    Standing Operating Procedures TDA Table of Distribution and Allowances TRADOC Training and Doctrine Command USAAAD US Army Air Ambulance Detachment...and allowances ( TDA ), modified table of organization and equipment (TOE), and Department of the Army special authorization documents (Department of...22,376 Aviation Center of Excellence TDA USAAAD Rucker 8x UH-72 Joint Readiness Training Center TDA USAAAD Polk 8x UH-72 Yakima Training Center

  9. Development and evaluation of a novel, real time mobile telesonography system in management of patients with abdominal trauma: study protocol

    Directory of Open Access Journals (Sweden)

    Ogedegbe Chinwe

    2012-12-01

    Full Text Available Abstract Background Despite the use of e-FAST in management of patients with abdominal trauma, its utility in prehospital setting is not widely adopted. The goal of this study is to develop a novel portable telesonography (TS system and evaluate the comparability of the quality of images obtained via this system among healthy volunteers who undergo e-FAST abdominal examination in a moving ambulance and at the ED. We hypothesize that: (1 real-time ultrasound images of acute trauma patients in the pre-hospital setting can be obtained and transmitted to the ED via the novel TS system; and (2 Ultrasound images transmitted to the hospital from the real-time TS system will be comparable in quality to those obtained in the ED. Methods Study participants are three healthy volunteers (one each with normal, overweight and obese BMI category. The ultrasound images will be obtained by two ultrasound-trained physicians The TS is a portable sonogram (by Sonosite interfaced with a portable broadcast unit (by Live-U. Two UTPs will conduct e-FAST examinations on healthy volunteers in moving ambulances and transmit the images via cellular network to the hospital server, where they are stored. Upon arrival in the ED, the same UTPs will obtain another set of images from the volunteers, which are then compared to those obtained in the moving ambulances by another set of blinded UTPs (evaluators using a validated image quality scale, the Questionnaire for User Interaction Satisfaction (QUIS. Discussion Findings from this study will provide needed data on the validity of the novel TS in transmitting live images from moving ambulances to images obtained in the ED thus providing opportunity to facilitate medical care of a patient located in a remote or austere setting.

  10. Performance management tools motivate change at the frontlines.

    Science.gov (United States)

    Smith, Christopher; Christiansen, Tanya; Dick, Don; Howden, Jane Squire; Wasylak, Tracy; Werle, Jason

    2014-01-01

    Performance management tools commonly used in business, such as incentives and the balanced scorecard, can be effectively applied in the public healthcare sector to improve quality of care. The province of Alberta applied these tools with the Institute for Health Improvement Learning Collaborative method to accelerate adoption of a clinical care pathway for hip and knee replacements. The results showed measurable improvements in all quality dimensions, including shorter hospital stays and wait times, higher bed utilization, earlier patient ambulation, and better patient outcomes.

  11. New concepts in lower limb orthotics.

    Science.gov (United States)

    Loke, M

    2000-08-01

    Lower limb orthotics is in the process of a default transformation because of its association with lower limb prosthetics, a mechanical discipline that has translated component and material innovations into balance and velocity function gains to achieve a level of ambulation not possible a generation ago. This article discusses the fundamental mechanical similarities and differences of lower limb orthotics to prosthetics and their application to orthoses designed to improve the gait outcome of patients requiring orthotic intervention.

  12. Dietary Protection Against Pulmonary Oxygen Poisoning.

    Science.gov (United States)

    1980-12-31

    with non- reconstructible ierterial occlusion, ischemic forefoot lesions, and unbearable foot pain. Under most circumstances, iimbs of patients with...the forefoot and paralysis of the intrinsic nbot muscles. pro)prioception is not lost, and ambulation offers no difficult-,,. Local ischemic lesions...not as complete as that of patients without neuropathyv. Scrupuious hemostasis must be maintained during surgery . since the vasa vasorum or nervosvrn

  13. Early Detection of Disease Outbreaks

    OpenAIRE

    2005-01-01

    BACKGROUND: The ability to detect disease outbreaks early is important in order to minimize morbidity and mortality through timely implementation of disease prevention and control measures. Many national, state, and local health departments are launching disease surveillance systems with daily analyses of hospital emergency department visits, ambulance dispatch calls, or pharmacy sales for which population-at-risk information is unavailable or irrelevant. METHODS AND FINDINGS: We propose a pr...

  14. System of Acute Medical Support to Emergency during Dental Treatment in Japan

    OpenAIRE

    Kawahara, Michio; Takeshita, Takahisa; AKITA, SUSUMU

    1986-01-01

    The Resuscitation Committee of Hiroshima City Dental Association was established in 1983 in order to provide acute medical support in case of emergency during dental treatment at private dental clinics. This Committee is composed of representatives from the Hiroshima City Dental Association, Hiroshima University School of Dentistry, Hiroshima University School of Medicine, Hiroshima City Health Bureau, and Hiroshima City Fire and Ambulance Department. A portable ECG monitor with defibrillator...

  15. Dial "120" for Emergencies

    Institute of Scientific and Technical Information of China (English)

    1994-01-01

    AN ambulance sped along the highway to Dongling, a scenic spot in a suburb of Beijing. A few minutes earlier, Beijing Emergency Medical Center’s "120" service received a phone call from Dongling Hospital where a Japanese tourist named Ishisaka Teru had been brought in. When he was touring Dongling, he begun to sweat, felt he couldn’t breathe which developed into an arrhythmia and then he went into shock. He needed immediate medical attention.

  16. A Prospective, Randomized Investigation of Plasma First Resuscitation for Traumatic Hemorrhage and Attenuation of the Acute Coagulopathy of Trauma

    Science.gov (United States)

    2013-08-01

    heuristic observation of such factors as penetrating torso wounds and an unstable pelvis.1 Ambulances could carry S/DFDP and ascorbic acid solution units for...coagulopathy. Giving FFP soon after injury is paramount, because the sur- vival benefit is primarily in the first 24 hours.1 Yet, ratios of FFP to packed...lyophilization or cryodessication). Because freeze or spray drying removes CO2 and water, FDP should be reconsti- tuted with a weak acid . FDP has a

  17. Emergency-Evacuation Cart

    Science.gov (United States)

    Fedor, Otto H.; Owens, Lester J.

    1988-01-01

    Proposed cart designed to remove injured worker from vicinity of hazardous chemical spill. Self-propelled cart enables rescuer to move victim of industrial accident quickly away from toxic, flammable, explosive, corrosive, carcinogenic, asphyxiating, or extremely cold liquids. Intended for use where too dangerous for ambulances and other vehicles to approach accident site. Constructed of high-strength tubing, rides on bicycle wheels with balloon tires. Rescuer steers cart with handle at rear. Estimated mass of fully equipped vehicle is 650 lb.

  18. 14A. Pelvic Pain and Headache in an Adolescent Female: A Case of Self-determination and Healthful Recovery

    OpenAIRE

    Daut, Alexys

    2013-01-01

    Focus Areas: Integrative Approaches to Care, Pediatrics, Alleviating Pain A 16-year-old previously healthy white female presented to our office with complaints of a 1-year history of chronic severe pelvic pain, leg pain, and severe daily headaches that were adversely affecting her school performance. Her leg and pelvic pain caused weakness and discomfort to the point that she used a walker or a wheelchair when she had to ambulate distances longer than 20 feet. She had been disenrolled from sc...

  19. EEG analysis of gait movement preparation in the normal state and in the abnormal state of Parkinsonʼs disease with freezing of gait /

    OpenAIRE

    Velu, Priya D.

    2014-01-01

    The cortical control of gait is an important aspect of locomotive function in healthy and diseased states. Here we used electroencephalography (EEG), signal processing, and machine learning methods to capture neural signals related to movement preparation of gait in healthy controls and in Parkinson's disease patients with freezing of gait (FOG). We focused on pre-movement EEG in tasks that required natural ambulation of the subjects through the environment with the ultimate goal of applicati...

  20. Evaluation of Abelmoschus moschatus seed extract in psychiatric and neurological disorders

    Directory of Open Access Journals (Sweden)

    Haja Sherief Sheik

    2014-10-01

    Results: In the open field test, AEAM (200 and 400 mg/kg increased the numbers of rearing. However, the number of central motor and ambulation were reduced. The number of entries and the time spent in the open arm were increased, whereas the number of locomotion was decreased (pA. moschatus is an alternative source for CNS drug development. [Int J Basic Clin Pharmacol 2014; 3(5.000: 845-853

  1. Evaluation of publicly financed and privately delivered model of emergency referral services for maternal and child health care in India.

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    Full Text Available BACKGROUND: Emergency referral services (ERS are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. METHODS: Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. RESULTS: On an average, an ambulance transported 3-4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7 per patient transported or INR 21 (USD 0.35 per km travelled. CONCLUSION: Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system.

  2. Sir Geoffrey Marshall (1887-1982): respiratory physician, catalyst for anaesthesia development, doctor to both Prime Minster and King, and World War I Barge Commander.

    Science.gov (United States)

    Metcalfe, Neil H

    2011-02-01

    Sir Geoffrey Marshall was a remarkable, hard-working man who helped in the development of anaesthesia and respiratory medicine. Both were in someway helped by his military experiences in World War I, first when working on an ambulance barge and then in the Casualty Clearing Stations researching the increasing problem of surgical shock. Among a multitude of high-ranking medical posts he also acted as Physician to King George VI and Sir Winston Churchill when they developed respiratory conditions.

  3. Spondyloarthritis: A Gouty Display

    OpenAIRE

    Gongidi, Preetam; Gough-Fibkins, Shawn

    2010-01-01

    Gout is a systemic, metabolic disease that typically affects the peripheral joints. We describe an unusual presentation of gout affecting the facet joints and costovertebral joints in the thoracic and lumbar spine. A 54-year old man presents to the emergency department with increasing swelling and pain at the left elbow for one week and difficulty ambulating. The imaging work-up included plain radiographs of the left elbow, left wrist, and chest with subsequent admission for possible septic a...

  4. Submaximal Exercise Testing Treadmill and Floor Walking.

    Science.gov (United States)

    1978-05-01

    Association, 65(Suppl 1): 18-25, 1969. 35. Traugh, G. H., Corcoran, P. J., and Reyes , R. L., "Energy Expenditure of Ambulation in Patients with Above Knee...subjects were measured over three walking velocities. 1 No comments were offered on the subjects attire during the testa or the experimental conditions...Testing," Journal of the South Carolina Medical Association, 65(Suppl 1): 18- ,- _19-69.7 .. i 35. Traugh, G. H., Corcoran, P. J., and Reyes , R. L

  5. [Use the Netherlands Triage Standard for children].

    Science.gov (United States)

    Drijver, C R Roeland

    2015-01-01

    Studies have shown that the reliability and validity of the Netherlands Triage Standard (NTS) is comparable to the Manchester Triage System. The NTS has good sensitivity and specificity in the emergency room. The Dutch Society of Emergency and Accident Nurses, the Dutch College of General Practitioners and Ambulancezorg Nederland use the NTS as the guideline for both physical and telephone triage in ambulance care, primary care and hospital care with the competence of the triage nurse in a pivotal role.

  6. Preclinical evidence supporting the clinical development of central pattern generator-modulating therapies for chronic spinal cord-injured patients

    OpenAIRE

    Pierre eGuertin

    2014-01-01

    Ambulation or walking is one of the main gaits of locomotion. In terrestrial animals, it may be defined as a series of rhythmic and bilaterally coordinated movement of the limbs which creates a forward movement of the body. This applies regardless of the number of limbs - from arthropods with six or more limbs to bipedal primates. These fundamental similarities among species may explain why comparable neural systems and cellular properties have been found, thus far, to control in similar wa...

  7. Preclinical evidence supporting the clinical development of central pattern generator-modulating therapies for chronic spinal cord-injured patients

    OpenAIRE

    Guertin, Pierre A.

    2014-01-01

    Ambulation or walking is one of the main gaits of locomotion. In terrestrial animals, it may be defined as a series of rhythmic and bilaterally coordinated movement of the limbs which creates a forward movement of the body. This applies regardless of the number of limbs—from arthropods with six or more limbs to bipedal primates. These fundamental similarities among species may explain why comparable neural systems and cellular properties have been found, thus far, to control in similar ways l...

  8. The Military Technology of the Polish People’s Army, 30 Years of Development,

    Science.gov (United States)

    1983-12-20

    faster first aid, diagnosis, therapy and rehabilitation. p. 239 ., The UAZ-452A four-person ambulance J~ Ř = � ’-A- .4 "-" 𔃾 p.237 The silx...various medical fields (diagnosis, therapy , mechanical replacement of organs and their functioning, equipment for scientific research). Bionics...field of hydraulic drive, has led to the start of production of domestic clutches and hydrokinetic transmissions, as well as a series of machinery with

  9. Below knee prosthetic socket designs and suspension systems.

    Science.gov (United States)

    Edwards, M L

    2000-08-01

    The prosthetic socket must act as a customized connection between the residual limb's surrounding tissues and the prosthetic components. The socket must be designed to control weight bearing, suspension, and ambulation stability. When making a below-the-knee socket, the prosthetist attempts to maximize loading and minimize displacements, such as vertical, transverse, or rotational. This article discusses the engineering designs or shapes of the two basic forms of below-the-knee prosthetic sockets used today.

  10. Rehabilitation of a triple amputee including a hip disarticulation.

    Science.gov (United States)

    Shin, J C; Park, C I; Kim, Y C; Jang, S H; Bang, I K; Shin, J S

    1998-12-01

    A multiple amputee more severe than a triple amputee is uncommon. There have been no reports on the rehabilitation outcome of a triple amputee, including hip disarticulation and transtibial amputation. The authors report the rehabilitation of a patient with left hip disarticulation, right trans-tibial amputation, and left trans-humeral amputation due to a train accident. He has successfully completed the rehabilitation programme and has become independent in prosthetic ambulation, activities of daily living, and driving.

  11. Extreme sports: extreme physiology. Exercise-induced pulmonary oedema.

    Science.gov (United States)

    Ma, Joyce Lok Gee; Dutch, Martin John

    2013-08-01

    We report five patients who presented to an on-site medical team with concurrent haemoptysis and shortness of breath at a recent triathlon event. After initial management in the field, three of the five patients were transported to hospital via ambulance for further management, resulting in patients with haemoptysis and dyspnoea being 17 times more likely to require hospital transport. It is important to consider the differential diagnoses for this presentation, particularly exercise-induced pulmonary oedema.

  12. Are the 10 meter and 6 minute walk tests redundant in patients with spinal cord injury?

    Directory of Open Access Journals (Sweden)

    Gail F Forrest

    Full Text Available OBJECTIVE: To evaluate the relationship and redundancy between gait speeds measured by the 10 Meter Walk Test (10MWT and 6 Minute Walk Test (6MWT after motor incomplete spinal cord injury (iSCI. To identify gait speed thresholds supporting functional ambulation as measured with the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI. DESIGN: Prospective observational cohort. SETTING: Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN. PARTICIPANTS: 249 NRN patients with American Spinal Injury Association Impairment Scale (AIS level C (n = 20, D (n = 179 and (n = 50 iSCI not AIS evaluated, from February 2008 through April 2011. INTERVENTIONS: Locomotor training using body weight support and walking on a treadmill, overground and home/community practice. MAIN OUTCOME MEASURE(S: 10MWT and 6MWT collected at enrollment, approximately every 20 sessions, and upon discharge. RESULTS: The 10MWT and 6MWT speeds were highly correlated and the 10MWT speeds were generally faster. However, the predicted 6MWT gait speed from the 10MWT, revealed increasing error with increased gait speed. Regression lines remained significantly different from lines of agreement, when the group was divided into fast (≥0.44 m/s and slow walkers (<0.44 m/s. Significant differences between 6MWT and 10MWT gait speeds were observed across SCI-FAI walking mobility categories (Wilcoxon sign rank test p<.001, and mean speed thresholds for limited community ambulation differed for each measure. The smallest real difference for the 6MWT and 10MWT, as well as the minimally clinically important difference (MCID values, were also distinct for the two tests. CONCLUSIONS: While the speeds were correlated between the 6MWT and 10MWT, redundancy in the tests using predictive modeling was not observed. Different speed thresholds and separate MCIDs were defined for community ambulation for each test.

  13. Custom-made footwear in diabetes: Offloading, usability and ulcer recurrence

    OpenAIRE

    Nollet, F.; Bus, S.A.; Haart, de, M.; Arts, M.L.J.

    2013-01-01

    Foot ulceration is a serious long term complication in patients with diabetes mellitus and polyneuropathy, which increases the risk of infection and lower limb amputation. Loss of protective sensation and high levels of plantar foot pressure during ambulation are the main causative factors. These patients are often prescribed with custom-made therapeutic footwear, which aims to offload high-risk plantar foot sites through pressure redistribution, however, scientific evidence for its use is me...

  14. Förebyggande metoder och behandlingar för Posttraumatiskt stressyndrom (PTSD): : Systematisk litteraturstudie

    OpenAIRE

    Brinkman, Johan

    2012-01-01

    Aim: The aim of this study was to describe the impact of debriefing, brief eclectic psychotherapy, cognitive behavioral therapy and EMDR therapy for PTSD and other stress-like reactions in emergency personnel. Background: In 1980, PTSD got a name and a place in the modern psychiatric diagnosis. Interest in the treatment and prevention of PTSD has increased over the past 20 years. Responders (ambulance, police and firefighters) are professionals who often meet human pain and suffering and are ...

  15. The RAPID protocol enhances patient recovery after both laparoscopic and open colorectal resections.

    LENUS (Irish Health Repository)

    Lloyd, G M

    2010-06-01

    Enhanced recovery after surgery (ERAS) programs can accelerate recovery and shorten the hospital stay after colorectal resections. The RAPID (remove, ambulate, postoperative analgesia, introduce diet) protocol is a simplified ERAS program that consists of a simplified, user-friendly single-page pro forma schedule. This study aimed to evaluate the impact of the RAPID protocol on patients undergoing both laparoscopic and open colorectal resections in two specialized colorectal units.

  16. [Geriatrics for internists in primary care].

    Science.gov (United States)

    Swoboda, W; Hermens, T

    2011-08-01

    Internal medicine specialists involved in primary care will have a leading part in the treatment of geriatric patients with complex healthcare needs in the future. Approved models like specialized geriatric practices, ambulant or mobile geriatric rehabilitation and special geriatric services for nursing homes are available. Essential is a geriatric qualification that fits with the tasks of an internist in primary care. An incentive payment system has to be created for this purpose to improve the treatment of elderly patients.

  17. Current and emerging treatment strategies for Duchenne muscular dystrophy

    OpenAIRE

    Mah JK

    2016-01-01

    Jean K Mah Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Abstract: Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in childhood. It is caused by mutations of the DMD gene, leading to progressive muscle weakness, loss of independent ambulation by early teens, and premature death due to cardiorespiratory complications. The diagnosis can usually be made after careful review of the...

  18. Aerospace Power Journal. Volume 15, Number 4, Winter 2001

    Science.gov (United States)

    2001-01-01

    Command (AMC), is now under way. A brief history of AE will set the stage for that trans- formation . An Illustrious History The concept of moving the...their own money, they built and flew the world’s first air ambulance at Fort Barrancas , Florida, in 1910. Unfortunately, on its first test flight, it... formation technology, education, training, and awareness. This team generated a com­ prehensive final report—the road map to im­ plement recommendations

  19. Journal of Rehabilitation Research and Development. Volume 27 Number 3, Summer 1990

    Science.gov (United States)

    1990-01-01

    Health Sciences, School of Physiotherapy , Lidcombe NSW 334 GERIATRICS 2141, Australia 335 HEAD TRAUMA and STROKE 336 MISCELLANEOUS 2. Ankle Weighting...locomotor process, such as may SF/SL = 0.43). Latent work, herein defined as work divided result from injury, stroke , or amputation, causes an altera- by...accompanying a for processing. recent stroke patient just learning to ambulate with a walker. Once the low speed was achieved, subjects were instructed

  20. Robot-assisted practice of gait and stair climbing in nonambulatory stroke patients

    OpenAIRE

    Stefan Hesse, MD; Christopher Tomelleri, PhD; Anita Bardeleben, MA; Cordula Werner, MA; Andreas Waldner, MD

    2012-01-01

    A novel gait robot enabled nonambulatory patients the repetitive practice of gait and stair climbing. Thirty nonambulatory patients with subacute stroke were allocated to two groups. During 60 min sessions every workday for 4 weeks, the experimental group received 30 min of robot training and 30 min of physiotherapy and the control group received 60 min of physiotherapy. The primary variable was gait and stair climbing ability (Functional Ambulation Categories [FAC] score 0–5); secondary vari...

  1. Approach to low back pain. Chiropractic.

    Science.gov (United States)

    French, Simon; Werth, Peter; Walker, Bruce

    2014-01-01

    Case study. A man aged 42 years, who works as a police officer, presented with severe lower back pain, which he had experienced for 24 hours after spending the previous day helping his brother to move house. He had difficulty ambulating and most movements aggravated the pain. There were no lower limb symptoms and no red flags present on history or examination. He was otherwise well and was not taking any regular medications.

  2. Paravertebral block can be an alternative to unilateral spinal anaesthesia for inguinal hernia repair

    Directory of Open Access Journals (Sweden)

    M C Mandal

    2011-01-01

    Full Text Available Background: Inguinal hernia repair can be performed under satisfactory anaesthetic conditions using general, regional and peripheral nerve block anaesthesia. Unilateral spinal anaesthesia provides optimal anaesthesia, with stable haemodynamics and minimal adverse events. The paravertebral block, being segmental in nature, can be expected to produce some advantages regarding haemodynamic stability and early ambulation and may be a viable alternative. Methods: Fifty-four consenting male patients posted for inguinal hernia repair were randomized into two groups, to receive either the two-segment paravertebral block (group-P, n=26 at T10 and L1 or unilateral spinal anaesthesia (group-S, n=28, respectively. The time to ambulation (primary outcome, time to the first analgesic, total rescue analgesic consumption in the first 24-hour period and adverse events were noted. Results: Block performance time and time to reach surgical anaesthesia were significantly higher in the patients of group-P (P<0.001. Time to ambulation was significantly shorter in group-P compared to group-S (P<0.001, while postoperative sensory block was prolonged in patients of group-S; P<0.001. A significantly higher number of patients could bypass the recovery room in group-P compared to group-S, (45% versus 0%, respectively, P<0.001. No statistically significant difference in adverse outcomes was recorded. Conclusion: Both the paravertebral block and unilateral spinal anaesthesia are effective anaesthetic techniques for uncomplicated inguinal hernia repair. However, the paravertebral block can be an attractive alternative as it provides early ambulation and prolonged postoperative analgesia with minimal adverse events.

  3. Assessment of growth, nutritional status, and bone health in children with cerebral palsy

    OpenAIRE

    Finbråten, Ane-Kristine

    2015-01-01

    Cerebral palsy (CP) is the most common cause of chronic motor disability in childhood. Children with CP experience motor difficulties as well as a number of associated impairments, such as feeding problems, malnutrition, and poor growth. Children with physical disabilities that limit ambulation usually have low bone mineral density (BMD), and many will sustain fractures. Impaired growth and feeding problems are common among children with CP. It is important to monitor nutrition...

  4. Hospital admissions. Cold remedies.

    Science.gov (United States)

    Pascoe, S; Pratt, J

    1998-12-10

    The closure of a casualty department provoked a crisis in Hillingdon in the winter of 1996-97. Worried by the publicity, elderly people contacted the health authority to ask what would happen to them if they became ill. An all-day workshop, attended by elderly people, chief executives, nurses, social workers and representatives from the community health council and ambulance services, led to several initiatives, including a rapid response home service, which helped prevent a crisis last winter.

  5. Swimmer syndrome in a Devon rex kitten and an English bulldog puppy.

    Science.gov (United States)

    Verhoeven, G; de Rooster, H; Risselada, M; Wiemer, P; Scheire, L; van Bree, H

    2006-10-01

    A three-week-old Devon rex kitten and a four-week-old English bulldog puppy were presented with "swimmer syndrome". The owners consulted several veterinarians who suggested euthanasia as the only possible solution for this condition. Physiotherapy in the puppy, and physiotherapy and bandaging in the kitten led to the resolution of the clinical signs and resulted in normal ambulation after several weeks. The authors concluded that intensive physiotherapy and dedication of the owner can lead to success.

  6. Influence of The Education and Training of Prehospital Medical Crews on Measures of Performance and Patient Outcomes

    OpenAIRE

    Blomberg, Hans

    2013-01-01

    Prehospital care has developed dramatically the last decades with the implementation of new devices and educational concepts. Clinical decisions and treatments have moved out from the hospitals to the prehospital setting. In Sweden this has been accompanied by an increase in the level of competence, i.e. by introducing nurses in the ambulances. With some exceptions the scientific support for these changes is poor. This thesis deals with such changes in three different subsets of prehospital c...

  7. China Report, Economic Affairs.

    Science.gov (United States)

    2007-11-02

    in the nation’s key cotton-producing areas, and, on Hainan Island, export commodity production bases for tea, black pepper, coffee , and three other...be further opened up. Fire trucks, ambulances, cold storage trucks, oil tankers, police cars, and bee-breeding trucks will be marketable. The supply...difference. Then, "grain used for other purposes" (including foods and beverages, nonstaple foods, brewed products, etc.) should be supplied at the

  8. Compromised genomic integrity impedes muscle growth after Atrx inactivation

    OpenAIRE

    Huh, Michael S.; Price O’Dea, Tina; Ouazia, Dahmane; Bruce C McKay; Parise, Gianni; Robin J Parks; Rudnicki, Michael A.; Picketts, David J.

    2012-01-01

    ATR-X syndrome is a severe intellectual disability disorder caused by mutations in the ATRX gene. Many ancillary clinical features are attributed to CNS deficiencies, yet most patients have muscle hypotonia, delayed ambulation, or kyphosis, pointing to an underlying skeletal muscle defect. Here, we identified a cell-intrinsic requirement for Atrx in postnatal muscle growth and regeneration in mice. Mice with skeletal muscle–specific Atrx conditional knockout (Atrx cKO mice) were viable, but b...

  9. Hi-Tech Living

    Institute of Scientific and Technical Information of China (English)

    TANG YUANKAI

    2010-01-01

    @@ On a recent cold winter night,a child passed out at his home in Beijing.His mother pushed the button of an emergency alarm system installed in their home.The system immediately put her through to Beijing 999 Emergency Aid Center,but she was too panicked to remember her home address.Emergency aid staff quickly identified her exact location and an ambulance arrived quickly.

  10. Semesterprojekt 3

    DEFF Research Database (Denmark)

    Sørensen, John Aasted; Holst-Christensen, Bo; Tolstrup Jensen, Jytte;

    2011-01-01

    Projektet er opdelt i følgende to mål: 1.At planlægge videreførelsen af en prototype til et system, der hånd-terer patientkontakt før, mellem og efter indlæggelser samt ambulant behandling. 2.At planlægge og konstruere en Matlab baseret simulator til et patient monitoreringssystem for fysiologisk...

  11. Developing an analytical tool for evaluating EMS system design changes and their impact on cardiac arrest outcomes: combining geographic information systems with register data on survival rates

    Directory of Open Access Journals (Sweden)

    Sund Björn

    2013-02-01

    Full Text Available Abstract Background Out-of-hospital cardiac arrest (OHCA is a frequent and acute medical condition that requires immediate care. We estimate survival rates from OHCA in the area of Stockholm, through developing an analytical tool for evaluating Emergency Medical Services (EMS system design changes. The study also is an attempt to validate the proposed model used to generate the outcome measures for the study. Methods and results This was done by combining a geographic information systems (GIS simulation of driving times with register data on survival rates. The emergency resources comprised ambulance alone and ambulance plus fire services. The simulation model predicted a baseline survival rate of 3.9 per cent, and reducing the ambulance response time by one minute increased survival to 4.6 per cent. Adding the fire services as first responders (dual dispatch increased survival to 6.2 per cent from the baseline level. The model predictions were validated using empirical data. Conclusion We have presented an analytical tool that easily can be generalized to other regions or countries. The model can be used to predict outcomes of cardiac arrest prior to investment in EMS design changes that affect the alarm process, e.g. (1 static changes such as trimming the emergency call handling time or (2 dynamic changes such as location of emergency resources or which resources should carry a defibrillator.

  12. STUDI KASUS HUBUNGAN SENAM NIFAS DENGAN STATUS KESEHATAN IBU NIFAS

    Directory of Open Access Journals (Sweden)

    Gurendro Putro

    2012-11-01

    Full Text Available Background: During pregnancy and birth period there are physical changes, some of muscle experiencing lengthening, especially uterus muscle and stomach muscle. After bearing, uterus was not back quickly like before, but through a process. Health recover process at post-partum was important thing for mother after birth period. Therefore, for turning back at early condition or recover period better so that body always health needed a exercise which popular as post-partum exercise. Methods: This research executed was prospective cohort design with quantitative approach. Interview was executed at 30 respondents post-partum mother. Subject got from population with simple random sampling. Depth interview was executed to get depth information about research which observed. Independent variables at this research were participation postparfum exercise and dependent variables are complication, narrow of uterus, swell oedema, treatment of stitching hurt loctation, early ambulation, urinate, defecate, drink and eat pattern. Results: Chi square result indicated difference health status between does exercise and neither was only early ambulation and defecates from other some variable. Variables early ambulation (p = 0.001 and deficate (p = 0.001 significant with exercise. But variables involution utery, oedema treatment of stitching hurt and drink and eat pattern not significant with exercise.Key words: post-parfum exercise, health status

  13. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

    Science.gov (United States)

    Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y.; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

    2017-01-01

    This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients’ biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient’s biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios. PMID:28117724

  14. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

    Directory of Open Access Journals (Sweden)

    Tan-Hsu Tan

    2017-01-01

    Full Text Available This study presents a new ubiquitous emergency medical service system (UEMS that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients’ biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient’s biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.

  15. Comparison of a priori calibration models for respiratory inductance plethysmography during running.

    Science.gov (United States)

    Leutheuser, Heike; Heyde, Christian; Gollhofer, Albert; Eskofier, Bjoern M

    2014-01-01

    Respiratory inductive plethysmography (RIP) has been introduced as an alternative for measuring ventilation by means of body surface displacement (diameter changes in rib cage and abdomen). Using a posteriori calibration, it has been shown that RIP may provide accurate measurements for ventilatory tidal volume under exercise conditions. Methods for a priori calibration would facilitate the application of RIP. Currently, to the best knowledge of the authors, none of the existing ambulant procedures for RIP calibration can be used a priori for valid subsequent measurements of ventilatory volume under exercise conditions. The purpose of this study is to develop and validate a priori calibration algorithms for ambulant application of RIP data recorded in running exercise. We calculated Volume Motion Coefficients (VMCs) using seven different models on resting data and compared the root mean squared error (RMSE) of each model applied on running data. Least squares approximation (LSQ) without offset of a two-degree-of-freedom model achieved the lowest RMSE value. In this work, we showed that a priori calibration of RIP exercise data is possible using VMCs calculated from 5 min resting phase where RIP and flowmeter measurements were performed simultaneously. The results demonstrate that RIP has the potential for usage in ambulant applications.

  16. Medial opening wedge high tibial osteotomy alters knee moments in multiple planes during walking and stair ascent.

    Science.gov (United States)

    Leitch, Kristyn M; Birmingham, Trevor B; Dunning, Cynthia E; Giffin, J Robert

    2015-07-01

    Medial opening wedge high tibial osteotomy is a surgical procedure intended to redistribute loads on the knee in patients with medial compartment knee osteoarthritis (OA). The surgery may affect moments in multiple planes during ambulation, with potential beneficial or detrimental effects on joint loads. The objective of this study was to investigate three-dimensional external knee moments before and after medial opening wedge high tibial osteotomy during level walking and during stair ascent. Fourteen patients with varus alignment and osteoarthritis primarily affecting the medial compartment of the tibiofemoral joint were assessed. Three-dimensional motion analyses during level walking and stair ascent was evaluated using inverse dynamics before, 6 and 12 months after surgery. Mean changes at 12 months suggested decreases in the peak knee adduction, flexion and internal rotation moments, with standardized response means ranging from 0.15 to 2.54. These decreases were observed despite increases in speed. Changes in alignment were associated with changes in the adduction and internal rotation moments, but not the flexion moment. Both pre- and postoperatively, the peak knee adduction moment was significantly lower (p=0.001) during stair ascent than during level walking, while the flexion and internal rotation moments were significantly higher (pplanes of motion during ambulation, suggesting substantial alterations of the loads on the knee during ambulation.

  17. Prehospital care in Hong Kong.

    Science.gov (United States)

    Lo, C B; Lai, K K; Mak, K P

    2000-09-01

    A quick and efficient prehospital emergency response depends on immediate ambulance dispatch, patient assessment, triage, and transport to hospital. During 1999, the Ambulance Command of the Hong Kong Fire Services Department responded to 484,923 calls, which corresponds to 1329 calls each day. Cooperation between the Fire Services Department and the Hospital Authority exists at the levels of professional training of emergency medical personnel, quality assurance, and a coordinated disaster response. In response to the incident at the Hong Kong International Airport in the summer of 1999, when an aircraft overturned during landing, the pre-set quota system was implemented to send patients to designated accident and emergency departments. Furthermore, the 'first crew at the scene' model has been adopted, whereby the command is established and triage process started by the first ambulance crew members to reach the scene. The development of emergency protocols should be accompanied by good field-to-hospital and interhospital communication, the upgrading of decision-making skills, a good monitoring and auditing structure, and commitment to training and skills maintenance.

  18. ParaMED Home: A protocol for a randomised controlled trial of paramedic assessment and referral to access medical care at home

    Directory of Open Access Journals (Sweden)

    Johnston Steven

    2011-06-01

    Full Text Available Abstract Background In Australia approximately 25% of Emergency Department (ED attendances are via ambulance. ED overcrowding in Australia, as in many countries, is common. Measures to reduce overcrowding include the provision of enhanced timely primary care in the community for appropriate low risk injury and illness. Therefore paramedic assessment and referral to a community home hospital service, in preference to transfer to ED, may confer clinical and cost benefit. Methods/Design A randomised controlled trial. Consenting adult patients that call an ambulance and are assessed by paramedics as having an eligible low risk problem will be randomised to referral to ED via ambulance transfer or referral to a rapid response service that will assess and treat the patient in their own residence. The primary outcome measure is requirement for unplanned medical attention (in or out of hospital in the first 48 hours. Secondary outcomes will include a number of other clinical endpoints. A cost effectiveness analysis will be conducted. Discussion If this trial demonstrates clinical non-inferiority and cost savings associated with the primary assessment service, it will provide one means to safely address ED overcrowding. Trial Registration Australian and New Zealand Clinical Trials Registry Number 12610001064099

  19. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation.

    Science.gov (United States)

    Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

    2017-01-21

    This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients' biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient's biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.

  20. Prosthetic restoration in patient with incomplete spinal cord injury.

    Science.gov (United States)

    Mustafah, Nadia Mohd; Bakar, Noriani Abu; Yang, Chung Tze

    2016-01-01

    We describe a case of 55-years-old man with a known T11 AIS C since 1985. The muscle strength of his left leg is better than the right leg and he is an active community ambulator. He walks using his right knee ankle foot orthosis without a knee lock. However, on April 2012 he had undergone a left transtibial amputation secondary to infected diabetic foot ulcer. He only had his first contact with rehabilitation team 2 months after the amputation and started on gait retraining since. Given the fact that he is a K3 level as he used to climb Batu Caves which is known to have 272 steps and he plans to continue this activity for his religious purposes, we prescribed him with prosthesis - patella tendon bearing socket, pin and lock suspension, silicone liner and energy storing foot. In conclusion, a community ambulator in dual disabilities, that is, spinal cord injury and amputee is hardly encountered due to multiple confounding factors. However, the right prosthetic prescription in patient with good prognosticating factors to ambulate will determine successful rehabilitation.