WorldWideScience

Sample records for ground ambulance transport

  1. Physical stressors during neonatal transport: helicopter compared with ground ambulance.

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    Bouchut, Jean-Christophe; Van Lancker, Eric; Chritin, Vincent; Gueugniaud, Pierre-Yves

    2011-01-01

    This study was undertaken to assess concurrent mechanical stresses from shock, vibration, and noise to which a critically ill neonate is exposed during emergency transfer. For neonates transported by a French specialized emergency medical service, we measured and analyzed 27 physical parameters recorded during typical transport by ambulance and by helicopter. The noninvasive sensors were placed to allow better representation of the exposure of the newborn to the physical constraints. Based on 10 hours of transport by ambulance and 2 hours by helicopter, noise, whole body vibration, rate of turn, acceleration, and pitch were extracted as the five most representative dynamic harshness indicators. A helicopter produces a higher-level but more stable (lower relative dispersion) whole body dynamic exposure than an ambulance, with a mean noise level of 86 ± 1 dBA versus 67 ± 3 dBA, mean whole body vibration of 1 ± 0.1 meter per second squared (m/s(2)) versus 0.4 6 0.2 m/s(2), and acceleration of 1 6 0.05 m/s(2) versus 0.4 6 0.1 m/s(2). A ground ambulance has many more dynamic effects in terms of braking, shock, and impulsive noise than a helicopter (1 impulsive event per 2 minutes vs. 1 per 11 minutes). Our results show significant exposure of the sick neonate to both stationary and impulsive dynamic physical stressors during transportation, particularly in a ground ambulance. The study suggests opportunities to reduce physical stressors during neonatal transport. Copyright © 2011 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  2. When is the helicopter faster? A comparison of helicopter and ground ambulance transport times.

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    Diaz, Marco A; Hendey, Gregory W; Bivins, Herbert G

    2005-01-01

    A retrospective analysis of 7,854 ground ambulance and 1,075 helicopter transports was conducted. The 911-hospital arrival intervals for three transport methods were compared: ground, helicopter dispatched simultaneously with ground unit, and helicopter dispatched nonsimultaneously after ground unit response. Compared with ground transports, simultaneously dispatched helicopter transports had significantly shorter 911-hospital arrival intervals at all distances greater than 10 miles from the hospital. Nonsimultaneously dispatched helicopter transport was significantly faster than ground at distances greater than 45 miles, and simultaneous helicopter dispatch was faster than nonsimultaneous at virtually all distances. Ground transport was significantly faster than either air transport modality at distances less than 10 miles from the hospital. Ground ambulance transport provided the shortest 911-hospital arrival interval at distances less than 10 miles from the hospital. At distances greater than 10 miles, simultaneously dispatched air transport was faster. Nonsimultaneous dispatched helicopter transport was faster than ground if greater than 45 miles from the hospital.

  3. Effectiveness of helicopter versus ground ambulance services for interfacility transport.

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    Arfken, C L; Shapiro, M J; Bessey, P Q; Littenberg, B

    1998-10-01

    Helicopters provide rapid interfacility transport, but the effect on patients is largely unknown. Patients requested to be transported between facilities by helicopter were followed prospectively to determine survival, disability, health status, and health care utilization. A total of 1,234 patients were transported by the primary aeromedical company; 153 patients were transported by ground and 25 patients were transported by other aeromedical services because of weather or unavailability of aircraft. There were no differences at 30 days for survivors in disability, health status, or health care utilization. Nineteen percent of helicopter-transported patients died compared with 15% of those transported by ground (p=0.21). The patients transported by helicopter did not have improved outcomes compared with patients transported by ground. These data argue against a large advantage of helicopters for interfacility transport. A randomized trial is needed to address these issues conclusively.

  4. Characterizing demographics, injury severity, and intubation status for patients transported by air or ground ambulance to a rural burn center.

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    Ahmed, Azeemuddin; Van Heukelom, Paul; Harland, Karisa; Denning, Gerene; Liao, Junlin; Born, Janelle; Latenser, Barbara

    2014-01-01

    Our study was designed to characterize intubation status among patients transported by air or ground ambulance to a rural burn center. A retrospective chart review of patients arriving at our burn center from January 1, 2005 to December 31, 2009 was completed. Descriptive and multivariate analyses were performed. During the study period, 259 air and 590 ground ambulance patients met inclusion criteria. Air ambulance patients were older and had higher total body surface area burned, lower Glasgow Coma scores, longer lengths of stay, and more frequent inhalation injuries. Approximately 10% of patients arriving by air were intubated after burn center admission, and 49% of intubated patients were extubated within 24 hours of admission. These values were 2% and 40%, respectively, for patients transported by ground. Increasing age and air ambulance transport increased the overall likelihood of change in intubation status. The likelihood of intubation by burn center providers increased with age, with suspicion of inhalation injury, and for patients transported by air. The likelihood of extubation within 24 hours of burn center admission increased with age, decreased with suspected inhalation injury, and was independent of transport mode. Among our patient population, more severely injured patients were being transported by air ambulance. However, age, suspicion of inhalation injury, and mode of transport showed a complex pattern of associations with changes in intubation status, and illustrate the need to develop better prehospital guidelines for intubation in burn patients.

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

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    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.

  6. Should parents accompany pediatric interfacility ground ambulance transports? The parent's perspective.

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    Woodward, G A; Fleegler, E W

    2000-12-01

    Parental accompaniment can be a positive experience for the parent and the patient, as perceived by the parent. It can also be accomplished effectively without hindering the delivery of intratransport medical care by a nurse/nurse or nurse/physician transport team. This survey, along with the responses from other parents, led our team to adopt the position that a parent is welcome and encouraged to accompany the transport team if he or she wishes to. The team has recognized the importance of the family unit during the stressful period surrounding an acute medical issue and interfacility transport. The transport team reserves the option to ask that a parent not ride along if they suspect the parent might not function as a supportive team member (ie, the parent is belligerent, inebriated, or hostile). The parent normally rides in the passenger seat of the ambulance, and we encourage him or her to interact with the patient as much as possible. Occasionally parents ride in the back of the ambulance if the patient's situation allows for that option (ie, no anticipated need for potential interventions, number of team personnel, etc.).

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

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    Alvarado-Socarras, Jorge Luis; Idrovo, Alvaro Javier; Bermon, Anderson

    2016-01-01

    To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. 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. A total of 176 neonates were transported by ambulance (10.22% by air) over six months. The transport distances were longer by air (median: 237.5km) than by ground (median: 11.3km). 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. 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. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  8. Mechanical versus manual chest compression CPR under ground ambulance transport conditions.

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    Fox, Julia; Fiechter, René; Gerstl, Peter; Url, Alfons; Wagner, Heinz; Lüscher, Thomas F; Eriksson, Urs; Wyss, Christophe A

    2013-03-01

    Novel mechanical chest compression devices offer the possibility to transport cardiac arrest patients with ongoing CPR and might shorten significantly the time delay to post-resuscitation care. We simulated an eight-minute cardiac resuscitation situation during ambulance transport using CPR training manikins. We compared teams consisting of two experienced resuscitators with the performance of a mechanical chest compression device (LUCAS). CPR-performance by two experienced resuscitators demonstrated ambivalent results. Whereas mean compression rate was within the recommended range (103/min, 95% CI: 93-113/min), mean compression depth was closely below the actually recommended compression depth of >5 cm (49.7 mm, 95% CI: 46.1-53.3mm). Nevertheless, only a mean of two thirds (67%) of all compressions were classified as manually correct (defined as sternal compression depth >5 cm). In contrast, the LUCAS device showed a constant and reliable CPR performance (99.96% correctly applied chest compressions correctly applied within the device programmed parameters, P = 0.0162) with almost no variance between the different sequences. The LUCAS CPR device represents a reliable alternative to manual CPR in a moving ambulance vehicle during emergency evacuation. Furthermore, it needs less human resources and is safer for the EMS personnel.

  9. CPR variability during ground ambulance transport of patients in cardiac arrest.

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    Roosa, Jason R; Vadeboncoeur, Tyler F; Dommer, Paul B; Panchal, Ashish R; Venuti, Mark; Smith, Gary; Silver, Annemarie; Mullins, Margaret; Spaite, Daniel; Bobrow, Bentley J

    2013-05-01

    High-quality CPR is associated with improved outcomes from out-of-hospital cardiac arrest (OHCA). The purpose of this investigation was to compare the quality of CPR provided at the prehospital scene, during ambulance transport, and during the early minutes in the emergency department (ED). A prospective observational review of consecutive adult patients with non-traumatic OHCA was conducted between September 2008 and February 2010. Patients with initiation of prehospital CPR were included as part of a statewide cardiac resuscitation quality improvement program. A monitor-defibrillator with accelerometer-based CPR measurement capability (E-series, ZOLL Medical) was utilized. CPR quality measures included variability in chest compression (CC) depth and rate, mean depth and rate, and the CC fraction. Variability of CC was defined as the mean of minute-to-minute standard deviation in CC depth or rate. CC fraction was defined as the percent of time that CPR was being performed when appropriate throughout resuscitation. Fifty-seven adult patients with OHCA had electronic CPR data recorded at the scene, in the ambulance, and upon arrival in the ED. Across time periods, there was increased variability in CC depth (scene: 0.20 in.; transport: 0.26 in.; ED: 0.31 in., P<0.01) and rate (scene: 18.2 CC min(-1); transport: 26.1 CC min(-1); ED: 26.3 CC min(-1), P<0.01). The mean CC depth, rate, and the CC fraction did not differ significantly between groups. There was increased CC variability from the prehospital scene to the ED though there was no difference in mean CC depth, rate, or in CC fraction. The clinical significance of CC variability remains to be determined. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene.

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    Cunningham, P; Rutledge, R; Baker, C C; Clancy, T V

    1997-12-01

    Comprehensive emergency medical services and helicopter aeromedical transport systems have been developed based on the principle that early definitive care improves outcome. The purpose of this study was to compare outcomes between patients transported by helicopter and those transported by ground. Data were obtained from the North Carolina Trauma Registry for the period between 1987 and 1993 on all patients transported by helicopter and ground admitted to one of the eight state designated trauma centers. Study patients included only those who were transported directly from the scene of injury to the trauma center (interhospital transfers were excluded). Mortality (outcome) was compared after patient stratification by injury severity and transport time, using Cochran-Mantel-Haenszel statistics and logistic regression-derived probabilities of survival. One thousand three hundred forty-six patients (7.3% of the total) were transported from scene to trauma center by helicopter and 17,144 were transported by ground. In patients transported by helicopter, the mean Trauma Score was lower (12 +/- 3.6) versus 14.3 +/- 3.6 (p ground ambulance have low injury severity measures. Outcomes were not uniformly better among patients transported by helicopter. Only a very small subset of patients transported by helicopter appear to have any chance of improved survival based on their helicopter transport. This study suggests that further effort should be expended to try to better identify patients who may benefit from this expensive and risky mode of transport.

  11. Air ambulance medical transport advertising and marketing.

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    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.

  12. Characteristics of Fixed Wing Air Ambulance Transports in Victoria, Australia.

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    Delorenzo, Ashleigh J; Abetz, Jeremy W; Andrew, Emily; de Wit, Anthony; Williams, Brett; Smith, Karen

    Air medical transport is important for the transfer of patients in the prehospital and interhospital environment. Few studies have described the services provided by fixed wing ambulances or the broader clinical profiles of patients they transport. Such information may be useful for the planning and allocation of resources, assistance with training, and refining clinical protocols. We sought to describe the characteristics of patients transported by fixed wing aircraft at Air Ambulance Victoria (AAV) and the service AAV provides in Victoria, Australia. A retrospective data review of patients transported by AAV fixed wing aircraft between January 1, 2011, and June 30, 2015, was performed. Data were sourced from the Ambulance Victoria data warehouse. Retrievals involving physicians were excluded. A total of 16,579 patients were transported during the study period, with a median age of 66 years. Most patients were male (58.7%), and cardiovascular/hematologic conditions (27.2%) were most common. Overall, 51.7% of cases were prebooked routine transfers, 47.4% were interhospital routine transfers, and 0.9% were primary responses. Caseloads were largest in the regions furthest from the capital city. The AAV fixed wing service in Victoria enables regional and remote patients to be transported to definitive care without major disruption to ground ambulances. Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  13. Ankle Fractures and Modality of Hospital Transport at a Single Level 1 Trauma Center: Does Transport by Helicopter or Ground Ambulance Influence the Incidence of Complications?

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    Greenberg, Sarah E; Ihejirika, Rivka C; Sathiyakumar, Vasanth; Lang, Maximilian F; Estevez-Ordonez, Dagoberto; Prablek, Marc A; Chern, Alexander Y; Thakore, Rachel V; Obremskey, William T; Joyce, David; Sethi, Manish K

    2015-01-01

    In an era of concern over the rising cost of health care, cost-effectiveness of auxiliary services merits careful evaluation. We compared costs and benefits of Helicopter Emergency Medical Service (HEMS) with Ground Emergency Medical Service (GEMS) in patients with an isolated ankle fracture. A medical record review was conducted for patients with an isolated ankle fracture who had been transported to a level 1 trauma center by either HEMS or GEMS from January 1, 2000 to December 31, 2010. We abstracted demographic data, fracture grade, complications, and transportation mode. Transportation costs were obtained by examining medical center financial records. A total of 303 patients was included in the analysis. Of 87 (28.71%) HEMS patients, 53 (60.92%) had sustained closed injuries and 34 (39.08%) had open injuries. Of the 216 (71.29%) GEMS patients, 156 (72.22%) had closed injuries and 60 (27.78%) had open injuries. No significant difference was seen between the groups regarding the percentage of patients with open fractures or the grade of the open fracture (p = .07). No significant difference in the rate of complications was found between the 2 groups (p = 18). The mean baseline cost to transport a patient via HEMS was $10,220 + a $108/mile surcharge, whereas the mean transport cost using GEMS was $976 per patient + $16/mile. Because the HEMS mode of emergency transport did not significantly improve patient outcomes, health systems should reconsider the use of HEMS for patients with isolated ankle fractures. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  14. The carbon footprint of Australian ambulance operations.

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    Brown, Lawrence H; Canyon, Deon V; Buettner, Petra G; Crawford, J Mac; Judd, Jenni

    2012-12-01

    To determine the greenhouse gas emissions associated with the energy consumption of Australian ambulance operations, and to identify the predominant energy sources that contribute to those emissions. A two-phase study of operational and financial data from a convenience sample of Australian ambulance operations to inventory their energy consumption and greenhouse gas emissions for 1 year. State- and territory-based ambulance systems serving 58% of Australia's population and performing 59% of Australia's ambulance responses provided data for the study. Emissions for the participating systems totalled 67 390 metric tons of carbon dioxide equivalents. For ground ambulance operations, emissions averaged 22 kg of carbon dioxide equivalents per ambulance response, 30 kg of carbon dioxide equivalents per patient transport and 3 kg of carbon dioxide equivalents per capita. Vehicle fuels accounted for 58% of the emissions from ground ambulance operations, with the remainder primarily attributable to electricity consumption. Emissions from air ambulance transport were nearly 200 times those for ground ambulance transport. On a national level, emissions from Australian ambulance operations are estimated to be between 110 000 and 120 000 tons of carbon dioxide equivalents each year. Vehicle fuels are the primary source of emissions for ground ambulance operations. Emissions from air ambulance transport are substantially higher than those for ground ambulance transport. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. Ambulance or taxi? High acuity prehospital transports in the Ashanti region of Ghana

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    C. Nee-Kofi Mould-Millman

    2014-03-01

    Conclusion: Although a minority of patients were transported by ambulance, they represented the most acute patients arriving at the KATH EC. Given the limited availability of EMS resources and ambulances in Ashanti, selective ambulance use appears warranted and should inform prehospital care planning.

  16. Modeling of patient's blood pressure variation during ambulance transportation

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    Sakatani, Kenji; Ono, Takahiko; Kobayasi, Yasuhide; Hikita, Shinichi; Saito, Mitsuyuki

    2007-12-01

    In an emergency transportation by ambulance, a patient is transported in a supine position. In this position, a patient's blood pressure (BP) variation depending on an inertial force which occurs when an ambulance accelerates or decelerates. This BP variation causes a critical damage for a patent with brain disorder. In order to keep a patient stable during transportation, it is required to maintain small BP variation. To analyze the BP variation during transportation, a model of the BP variation has so far been made. But, it can estimate the BP variation only in braking. The purpose of this paper is to make a dynamical model of the BP variation which can simulate it in both braking and accelerating. First, to obtain the data to construct the model, we used a tilting bed to measure a head-to-foot acceleration and BP of fingertip. Based on this data, we build a mathematical model whose input is the head-to-foot acceleration and output is the Mean BP variation. It is a switched model which switches two models depending on the jerk. We add baroreceptor reflex to the model as a offset value.

  17. Ambulance Transport of the Oldest Old in Tokyo: A Population-Based Study

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    Tokuda, Yasuharu; Abe, Toshikazu; Ishimatsu, Shinichi; Hinohara, Shigeaki

    2010-01-01

    Background Few studies have investigated ambulance utilization in people aged 85 years or older, ie, the oldest old. Methods We conducted a 1-year population-based observational study of patients transported by ambulance to emergency departments in Tokyo, Japan, which has a population of about 12 million. Demographic data, symptoms/events associated with ambulance transport, and the proportion of hospital admissions were recorded. Transport rates by age and sex were calculated using data for the background population and ambulance transports, and the 10 most frequent symptoms/events requiring transport were compared between the oldest old and those aged 65 to 84 years. Results Of the 642 764 patients who were transported to hospitals by ambulances, 59 570 (9%) were aged ≥85 years; 64% were women. The annual ambulance transport rate for this population was 250 per 1000/year and was significantly greater than the rate (90 per 1000/year) for those aged 65 to 84 years. The highest rate was for men aged 85 to 99 years (292 per 1000/year). Among the oldest old, the most frequent reason for ambulance transport was fall (38.5 per 1000/year), and the symptom most likely to result in hospital admission was dyspnea. Conclusions The ambulance transport rate for the oldest old was high, particularly among men aged ≥95 years. To reduce the need for ambulance transport among the oldest old, preventive care is needed to reduce falls and acute exacerbations of cardiac and respiratory disorders. PMID:20814165

  18. Lower air temperature is associated with ambulance transports and death in Takamatsu area, Japan.

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    Mochimasu, Kazumi Dokai; Miyatake, Nobuyuki; Tanaka, Naoko; Kinoshita, Hiroshi

    2014-07-01

    The aim of this study was to investigate the linkage among ambulance transports, the number of death and air temperature in Takamatsu area, Japan. Monthly data of ambulance transports (total and acute disease) and the number of death from 2004 to 2012 were obtained from Fire Department Service in Takamatsu and Takamatsu city official website, Japan. Climate parameters for required period were also obtained from Japan Meteorological Agency. Population data in Takamatsu area were also used to adjust ambulance transports and the number of death. The linkage among ambulance transports, the number of death and climate parameters was evaluated by ecological analysis. Total ambulance transports (/a hundred thousand people/day) and ambulance transports due to acute disease (/a hundred thousand people/day) were 12.3 ± 0.9 and 6.8 ± 0.7, respectively. The number of death (/a hundred thousand people/day) was 2.5 ± 0.4. By quadratic curve, ambulance transports due to acute disease and the number of death were significantly correlated with the parameters of air temperature. However, the number of death was the highest in January and the lowest in August. Although higher air temperature was only associated with higher ambulance transports, lower air temperature was associated with both higher ambulance transports and the number death in Takamatsu area, Japan.

  19. Ambulance transport of noncritical children: emergency medical service providers' knowledge, opinions, and practice.

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    O'Neil, Joseph; Steele, Gregory K; Weinstein, Elizabeth; Collins, Robert; Talty, Judith; Bull, Marilyn J

    2014-03-01

    Safe ambulance transport of children presents unique challenges. Our study describes child passenger restraint practices during ambulance transport, Emergency Medical Service (EMS) providers' knowledge, training, and use of child passenger restraint devices (CRD). A child passenger safety technician (CPST) recorded restraint used for pediatric ambulance transport. The CPST assessed and documented type of CRD used, securement, and whether the child was properly restrained. EMS providers' knowledge, training, and CRD use for ambulance transport were assessed. The study period spanned July 2009 to July 2010; 63 EMS personnel were interviewed and 40 children were observed. Approximately 75% of emergency medical technicians surveyed felt their knowledge of pediatric transport was adequate. Fourteen percent allowed a stable patient to be transported via parent's lap. Twelve percent were transported unrestrained. None of the 11 patients, birth to 3 years, were found to be transported correctly. Study findings supports education and training of EMS personnel to improve the safe ambulance transport of children.

  20. The Effectiveness Evaluation of Helicopter Ambulance Transport among Neurotrauma Patients in Korea.

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    Park, Kyoung Duck; Seo, Sook Jin; Oh, Chang Hyun; Kim, Se Hyuk; Cho, Jin Mo

    2014-07-01

    Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea. This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT. Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001). In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method.

  1. Canadian ground ambulance services: provincial funding and standards for equipment and training.

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    Goldstein, D H

    1980-01-01

    There is an increasing demand for improved, up-to-date training and equipment for ground ambulance services across Canada. This paper presents the results of a survey of ambulance operations and their funding by the provinces, as well as a comparison of provincial legislation and recommendations on standards for equipment and the training of ambulance personnel. The training standards were found to be very diverse, and the legislated or recommended equipment standards did not meet those of the American College of Surgeons committee on trauma (ACSCT). The cost of ambulance services per capita and the cost to the user of an average 43-km run varied widely between the provinces. There was no correlation between the second cost and how well the province met the ACSCT's equipment standards. PMID:7260779

  2. Laboratory testing during critical care transport: point-of-care testing in air ambulances.

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    Di Serio, Francesca; Petronelli, Maria Antonia; Sammartino, Eugenio

    2010-07-01

    Air and ground transport are used for prehospital transport of patients in acute life-threatening situations, and increasingly, critically ill patients undergo interhospital transportation. Results from clinical studies suggest that critical tests performed during the transport of critically ill patients presents a potential opportunity to improve patient care. Our project was to identify, according to the recommendations published at this time, a model of point-of-care testing (POCT) (arterial blood gases analysis and glucose, sodium, potassium, ionized calcium, hematocrit/hemoglobin measurements) in air ambulances. In order to identify the key internal and external factors that are important to achieving our objective, an analysis of the Strengths, Weaknesses, Opportunities, and Threats (SWOT analysis) was incorporated into our planning model prior to starting the project. To allow the entire POCT process (pre-, intra-, and post-analytic steps) to be under the control of the reference laboratory, an experimental model of information technology was applied. Real-time results during transport of critically ill patients must be considered to be an integral part of the patient care process and excellent channels of communication are needed between the intensive care units, emergency medical services and laboratories. With technological and computer advances, POCT during critical care transport will certainly increase in the future: this will be a challenge from a laboratory and clinical context.

  3. Design considerations to enhance the safety of patient compartments in ambulance transporters.

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    Byran, Eyal; Gilad, Issachar

    2012-01-01

    The safety of the interior of ambulances is dubious and, in the event of sudden impact during emergency transport, potentially perilous to patients they carry. The workplace ergonomics of the interior of the passenger cabin is lacking. This article discusses an improved ergonomic interior design based on study findings, observations and subjective perception. It suggests design aspects and safety concepts aimed at increasing the safety of patients and paramedic staff inside the ambulance as a mobile workstation.

  4. Interfacility helicopter ambulance transport of neurosurgical patients: observations, utilization, and outcomes from a quaternary level care hospital.

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    Brian P Walcott

    Full Text Available BACKGROUND: The clinical benefit of helicopter transport over ground transportation for interfacility transport is unproven. We sought to determine actual practice patterns, utilization, and outcomes of patients undergoing interfacility transport for neurosurgical conditions. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively examined all interfacility helicopter transfers to a single trauma center during 2008. We restricted our analysis to those transfers leading either to admission to the neurosurgical service or to formal consultation upon arrival. Major exclusion criteria included transport from the scene, death during transport, and transport to any area of the hospital other than the emergency department. The primary outcome was time interval to invasive intervention. Secondary outcomes were estimated ground transportation times from the referring hospital, admitting disposition, and discharge disposition. Of 526 candidate interfacility helicopter transfers to our emergency department in 2008, we identified 167 meeting study criteria. Seventy-five (45% of these patients underwent neurosurgical intervention. The median time to neurosurgical intervention ranged from 1.0 to 117.8 hours, varying depending on the diagnosis. For 101 (60% of the patients, estimated driving time from the referring institution was less than one hour. Four patients (2% expired in the emergency department, and 34 patients (20% were admitted to a non-ICU setting. Six patients were discharged home within 24 hours. For those admitted, in-hospital mortality was 28%. CONCLUSIONS/SIGNIFICANCE: Many patients undergoing interfacility transfer for neurosurgical evaluation are inappropriately triaged to helicopter transport, as evidenced by actual times to intervention at the accepting institution and estimated ground transportation times from the referring institution. In a time when there is growing interest in health care cost containment, practitioners must exercise

  5. Interfacility helicopter ambulance transport of neurosurgical patients: observations, utilization, and outcomes from a quaternary level care hospital.

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    Walcott, Brian P; Coumans, Jean-Valery; Mian, Matthew K; Nahed, Brian V; Kahle, Kristopher T

    2011-01-01

    The clinical benefit of helicopter transport over ground transportation for interfacility transport is unproven. We sought to determine actual practice patterns, utilization, and outcomes of patients undergoing interfacility transport for neurosurgical conditions. We retrospectively examined all interfacility helicopter transfers to a single trauma center during 2008. We restricted our analysis to those transfers leading either to admission to the neurosurgical service or to formal consultation upon arrival. Major exclusion criteria included transport from the scene, death during transport, and transport to any area of the hospital other than the emergency department. The primary outcome was time interval to invasive intervention. Secondary outcomes were estimated ground transportation times from the referring hospital, admitting disposition, and discharge disposition. Of 526 candidate interfacility helicopter transfers to our emergency department in 2008, we identified 167 meeting study criteria. Seventy-five (45%) of these patients underwent neurosurgical intervention. The median time to neurosurgical intervention ranged from 1.0 to 117.8 hours, varying depending on the diagnosis. For 101 (60%) of the patients, estimated driving time from the referring institution was less than one hour. Four patients (2%) expired in the emergency department, and 34 patients (20%) were admitted to a non-ICU setting. Six patients were discharged home within 24 hours. For those admitted, in-hospital mortality was 28%. Many patients undergoing interfacility transfer for neurosurgical evaluation are inappropriately triaged to helicopter transport, as evidenced by actual times to intervention at the accepting institution and estimated ground transportation times from the referring institution. In a time when there is growing interest in health care cost containment, practitioners must exercise discretion in the selection of patients for air ambulance transport--particularly when it

  6. Early Access to Patients with Life-threatening Cardiovascular Disease by an Air Ambulance Service

    National Research Council Canada - National Science Library

    Imaizumi, Takahiro; Hata, Noritake; Kobayashi, Nobuaki; Yokoyama, Shinya; Shinada, Takuro; Tokuyama, Kenichi; Ishikawa, Masahiro; Shiiba, Kunito; Matsumoto, Hisashi; Takuhiro, Kitoji; Mashiko, Kunihiro

    2004-01-01

    ... (doctor helicopter service; DHS) could shorten the prehospital delay. We evaluated the initial treatment time and the transport time in 30 patients transported by DHS and 30 patients transported by ground ambulance service (GAS...

  7. 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.

  8. Mortality following helicopter versus ground transport of injured children.

    Science.gov (United States)

    Polites, Stephanie F; Zielinski, Martin D; Fahy, Aodhnait S; Wagie, Amy E; Moir, Christopher R; Jenkins, Donald H; Zietlow, Scott P; Habermann, Elizabeth B

    2017-05-01

    Injured children may be transported to trauma centers by helicopter air ambulance (HAA); however, a benefit in outcomes to this expensive resource has not been consistently shown in the literature and there is concern that HAA is over-utilized. A study that adequately controls for selection biases in transport mode is needed to determine which injured children benefit from HAA. The purpose of this study was to determine if HAA impacts mortality differently in minimally and severely injured children and if there are predictors of over-triage of HAA in children that can be identified. Children ≤18 years of age transported by HAA or ground ambulance (GA) from scene to a trauma center were identified from the 2010-2011 National Trauma Data Bank. Analysis was stratified by Injury Severity Score (ISS) into low ISS (≤15) and high ISS (>15) groups. Following propensity score matching of HAA to GA patients, conditional multivariable logistic regression was performed to determine if transport mode independently impacted mortality in each stratum. Rates and predictors of over-triage of HAA were also determined. Transport by HAA occurred in 8218 children (5574 low ISS, 2644 high ISS) and by GA in 35305 (30506 low ISS, 4799 high ISS). Overall mortality was greater in HAA patients (4.0 vs 1.4%, p15. Many children with minor injuries are transported by helicopter despite frequent dismissal within 24h and no mortality benefit. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Implementation and Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations and Lifting of the Temporary Moratoria on Enrollment of Part B Emergency Ground Ambulance Suppliers in All Geographic Locations. Extension, implementation, and lifting of temporary moratoria.

    Science.gov (United States)

    2016-08-03

    This document announces the extension of temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance suppliers and Medicare home health agencies (HHAs), subunits, and branch locations in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse. It also announces the implementation of temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance suppliers and Medicare HHAs, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey on a statewide basis. In addition, it announces the lifting of the moratoria on all Part B emergency ground ambulance suppliers. These moratoria, and the changes described in this document, also apply to the enrollment of HHAs and non-emergency ground ambulance suppliers in Medicaid and the Children's Health Insurance Program.

  10. Bi-objective approach for placing ground and air ambulance base and helipad locations in order to optimize EMS response.

    Science.gov (United States)

    Shahriari, Milad; Bozorgi-Amiri, Ali; Tavakoli, Shayan; Yousefi-Babadi, Abolghasem

    2017-06-15

    Shortening the travel time of patient transfer has clinical implications for many conditions such as cardiac arrest, trauma, stroke and STEMI. As resources are often limited precise calculations are needed. In this paper we consider the location problem for both ground and aerial emergency medical services. Given the uncertainty of when patients are in need of prompt medical attention we consider these demand points to be uncertain. We consider various ways in which ground and helicopter ambulances can work together to make the whole process go faster. We develop a mathematical model that minimizes travel time and maximizes service level. We use a compromising programming method to solve this bi-objective mathematical model. For numerical experiments we apply our model to a case study in Lorestan, Iran, using geographical and population data, and the location of the actual hospital based in the capital of the province. Results show that low-accessibility locations are the main focus of the proposed problem and with mathematical modeling access to a hospital is vastly improved. We also found out that once the budget reaches a certain point which suffices for building certain ambulance bases more investments does not necessarily result in less travel time. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. 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

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

    Science.gov (United States)

    Patel, Alka B; Waters, Nigel M; Blanchard, Ian E; Doig, Christopher J; Ghali, William A

    2012-10-03

    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. 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. 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. The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a

  13. Is air transport of stroke patients faster than ground transport? A prospective controlled observational study.

    Science.gov (United States)

    Hesselfeldt, Rasmus; Gyllenborg, Jesper; Steinmetz, Jacob; Do, Hien Quoc; Hejselbæk, Julie; Rasmussen, Lars S

    2014-04-01

    Helicopters are widely used for interhospital transfers of stroke patients, but the benefit is sparsely documented. We hypothesised that helicopter transport would reduce system delay to thrombolytic treatment at the regional stroke centre. In this prospective controlled observational study, we included patients referred to a stroke centre if their ground transport time exceeded 30 min, or they were transported by a secondarily dispatched, physician-staffed helicopter. The primary endpoint was time from telephone contact to triaging neurologist to arrival in the stroke centre. Secondary endpoints included modified Rankin Scale at 3 months, 30-day and 1-year mortality. A total of 330 patients were included; 265 with ground transport and 65 with helicopter, of which 87 (33%) and 22 (34%), received thrombolysis, respectively (p=0.88). Time from contact to triaging neurologist to arrival in the regional stroke centre was significantly shorter in the ground group (55 (34-85) vs 68 (40-85) min, pground group (67 (42-136) km) than in the helicopter group (83 (46-143) km) (pground and helicopter transport. We found significantly shorter time from contact to triaging neurologist to arrival in the regional stroke centre if stroke patients were transported by primarily dispatched ground ambulance compared with a secondarily dispatched helicopter.

  14. Performance of the New South Wales Ambulance Service major trauma transport protocol (T1) at an inner city trauma centre.

    Science.gov (United States)

    Dinh, Michael M; Oliver, Matthew; Bein, Kendall J; Roncal, Susan; Byrne, Christopher M

    2012-08-01

    To evaluate the performance of a newly implemented prehospital trauma triage (T1) protocol in New South Wales for patients transported to an inner city major trauma centre. An observational study was conducted over 1 year. Prehospital data and injury characteristics were collected prospectively for all hospital trauma team activations and injury presentations transported by Ambulance Service of New South Wales. Univariate comparison of T1- and non-T1-transported patients was performed and sensitivity, specificity, overtriage and undertriage rates were calculated. The outcomes studied were Injury Severity Score >15 and major outcome (composite of in-hospital death and/or transferred from the ED to operating theatre or intensive care unit). Factors associated with undertriage were determined with univariate analysis. A total of 2664 ambulance arrivals for trauma were studied with 767(29%) transported on the T1 protocol. T1-transported patients were associated with more severe injury (23% vs 6%, P protocol for severe injury was 63% with a positive predictive value of 23%. The undertriage and overtriage rates for severe injury were 12% and 77%, respectively. Undertriaged patients were elderly with falls as the predominant mechanism of injury. The sensitivity and undertriage rates associated with the T1 protocol indicate the ongoing need for secondary triage at designated trauma centres and refinement of the protocol to include age as a criterion. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. 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

  16. Ambulance need at mass gatherings.

    Science.gov (United States)

    Meites, Elissa; Brown, John F

    2010-01-01

    Scant evidence exists to guide policy-making around public health needs during mass gatherings. In 2006, the City and County of San Francisco began requiring standby ambulances at all mass gatherings with attendance of >15,500 people. The objectives were to evaluate needs for ambulances at mass gatherings, and to make evidence-based recommendations for public health policy-makers. The hypothesis was that the needs for ambulances at mass gatherings can be estimated using community baseline data. Emergency medical services plans were reviewed for all public events with an anticipated attendance of >1,000 people in San Francisco County during the 12-month period 01 August 2006 through 31 July 2007. Ambulance transport data were confirmed by event coordinators and ambulance company records, and the rate was calculated by dividing ambulance transports by event attendance. Baseline ambulance transport rate was calculated by dividing the annual ambulance transports in the county's computer-aided dispatch system by the census population estimate. The risk ratio was calculated using the risk of transport from a mass gathering compared with the baseline risk of ambulance transport for the local community. Significance testing and confidence intervals were calculated. Descriptive information was available for 100% of events and ambulance transport data available for 97% of events. The majority of the mass gatherings (47 unique events; 59 event days) were outdoor, weekend festivals, parades, or concerts, though a large proportion were athletic events. The ambulance transport rate from mass gatherings was 1 per 59,000 people every six hours. Baseline ambulance transport rate in San Francisco was 1 per 20,000 people every six hours. The transport rate from mass gatherings was significantly lower than the community baseline (risk ratio [RR]=0.15, 95% CI=0.10-0.22, pambulance, 46% of ambulances were unused. San Francisco mass gatherings appear to present a lower risk of ambulance

  17. A retrospective comparison of helicopter transport versus ground transport in patients with severe sepsis and septic shock.

    Science.gov (United States)

    Kashyap, Rahul; Anderson, Peter W; Vakil, Abhay; Russi, Christopher S; Cartin-Ceba, Rodrigo

    2016-12-01

    Helicopter emergency medical services (HEMS) extend the reach of a tertiary care center significantly. However, its role in septic patients is unclear. Our study was performed to clarify the role of HEMS in severe sepsis and septic shock. This is a single-center retrospective cohort study. This study was performed at Mayo Clinic, Rochester, MN, in years 2007-2009. This study included a total of 181 consecutive adult patients admitted to the medical intensive care unit meeting criteria for severe sepsis or septic shock within 24 h of admission and transported from an acute care facility by a helicopter or ground ambulance. The primary predictive variable was the mode of transport. Multiple demographic, clinical, and treatment variables were collected and analyzed with univariate analysis followed by multivariate analysis. The patients transported by HEMS had a significantly faster median transport time (1.3 versus 1.7 h, p ground. Distance traveled was not an independent predictor of hospital mortality on multivariate analysis. HEMS transport is associated with faster transport time, carries sicker patients, and is associated with higher hospital mortality compared with ground ambulance services for patients with severe sepsis or septic shock.

  18. [Pediatric cases in preclinical emergency medicine: critical aspects in the range of missions covered by ground ambulance and air rescue services].

    Science.gov (United States)

    Schlechtriemen, T; Masson, R; Burghofer, K; Lackner, C K; Altemeyer, K H

    2006-03-01

    The aim of this study was to demonstrate differences in structure and severity of pediatric emergencies treated by aeromedical (air rescue) or ground ambulances services. Conclusions for the training of emergency physicians are discussed. In a 3-year study period, a total of 9,274 pediatric emergencies covered by the ADAC air rescue service are compared to 4,344 pediatric patients of ground ambulance services in Saarland. In aeromedical services pediatric emergencies are more frequent (12.9% vs. 6.4%), trauma predominates (59.9% vs. 35.6%) and severe injuries or diseases occur more frequently (30.5% vs. 15.0%). In both groups pediatric emergency cases are concentrated into very few diagnostic groups: more than one third of the cases involving pre-school children is due to convulsions. Respiratory diseases and intoxication are the next most frequent causes and are more common in ground ambulance patients. Head trauma is the most common diagnosis in cases of pediatric trauma, followed by musculoskeletal and thoracoabdominal trauma. All types of severe trauma are more frequent in pediatric patients of the aeromedical services. Training of emergency physicians should include pediatric life support and specific information about frequent pediatric emergency situations. For emergency physicians in aeromedical services, an intensive training in pediatric trauma life support is also necessary.

  19. Controlled hypotension in patients suspected of a ruptured abdominal aortic aneurysm: feasibility during transport by ambulance services and possible harm.

    Science.gov (United States)

    Reimerink, J J; Hoornweg, L L; Vahl, A C; Wisselink, W; Balm, R

    2010-07-01

    To evaluate a controlled hypotension protocol for patients suspected of a ruptured aneurysm of the abdominal aorta (RAAA) and to identify possible harm to patients with a final diagnosis other than RAAA. Retrospective analysis of patients suspected of RAAA and transported by Amsterdam ambulance services between January 2006 and October 2007. Protocol was assessed by reviewing systolic blood pressure (100 mmHg), administered fluid volume and verbal responsiveness during transport. Patients who could possibly have been harmed by controlled hypotension were identified by final diagnoses. Fluid administration was according to protocol in 220 of 266 patients analysed for protocol adherence. The remaining patients received too much (21 patients) or too little fluid (25 patients). Data were missing in 29 patients. A RAAA was diagnosed in 81 (27%) of all 295 patients analysed for final diagnosis. Controlled hypotension was achieved in 10% of all patients and in 17% of patients with RAAA. Three patients (1%) with diagnosis other than RAAA were possibly at risk by implementing controlled hypotension. Protocol was followed in 83% and protocol violations occurred in 17% of patients. The risk of implementing controlled hypotension for all patients suspected of an RAAA by the ambulance staff was low. Copyright 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  20. A stabilization device that promotes the efficiency of cardiopulmonary resuscitation during ambulance transportation to the level as under non-moving conditions.

    Science.gov (United States)

    Foo, Ning-Ping; Chang, Jer-Hao; Su, Shih-Bin; Chen, Kow-Tong; Cheng, Ching-Fa; Chen, Pei-Chung; Lin, Tsung-Yi; Guo, How-Ran

    2014-01-01

    The survival rate of patients with out-of-hospital cardiac arrest is low, and measures to improve the quality of cardiopulmonary resuscitation (CPR) during ambulance transportation are desirable. We designed a stabilization device, and in a randomized crossover trial we found performing CPR in a moving ambulance with the device (MD) could achieve better efficiency than that without the device (MND), but the efficiency was lower than that in a non-moving ambulance (NM). To evaluate whether a modified version of the stabilization device, can promote further the quality of CPR during ambulance transportation. Participants of the previous study were recruited, and they performed CPR for 10 minutes in a moving ambulance with the modified version of the stabilization device (MVSD). The primary outcomes were effective chest compressions and no-flow fraction recorded by a skill-reporter manikin. The secondary outcomes included back pain, physiological parameters, and the participants' rating about the device after performing CPR. The overall effective compressions in 10 minutes were 86.4±17.5% for NM, 60.9±14.6% for MND, 69.7±22.4% for MD, and 86.6%±13.2% for MVSD (pambulance to a level similar to that in a non-moving condition without increasing the severity of back pain.

  1. Air versus ground transport of the major trauma patient: a natural experiment.

    Science.gov (United States)

    McVey, Jennifer; Petrie, David A; Tallon, John M

    2010-01-01

    1) To compare the outcomes of adult trauma patients transported to a level I trauma center by helicopter vs. ground ambulance. 2) To determine whether using a unique "natural experiment" design to obtain the ground comparison group will reduce potential confounders. Outcomes in adult trauma patients transported to a tertiary care trauma center by air were compared with outcomes in a group of patients who were accepted by the online medical control physician for air transport, but whose air missions were aborted for aviation reasons (weather, maintenance, out on a mission); these patients were subsequently transported by ground ambulance instead. Outcomes were also analyzed for a third ground control group composed of all other adult trauma patients transported by ground during this time period. Data were collected by retrospective database review of trauma patients transferred between July 1, 1997, and June 30, 2003. Outcomes were measured by Trauma Injury Severity Score (TRISS) analysis. Z and W scores were calculated. Three hundred ninety-seven missions were flown by LifeFlight during the study period vs. 57 in the clinical accept-aviation abort ground transport group. The mean ages, gender distributions, mechanisms of injury, and Injury Severity Scores (ISSs) were similar in the two groups. Per 100 patients transported, 5.61 more lives were saved in the air group vs. the clinical accept-aviation abort ground transport group (Z = 3.37). As per TRISS analysis, this is relative to the expected mortality seen with a similar group in the Major Trauma Outcomes Study (MTOS). The Z score for the clinical accept-aviation abort ground transport group was 0.4. The 1,195 patients in the third all-other ground control group had a higher mean age, lower mean ISS, and worse outcomes according to TRISS analysis (W = -2.02). This unique natural experiment led to better matched air vs. ground cohorts for comparison. As per TRISS analysis, air transport of the adult major trauma

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

    Directory of Open Access Journals (Sweden)

    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

  3. Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation.

    Science.gov (United States)

    Brändström, Helge; Sundelin, Anna; Hoseason, Daniela; Sundström, Nina; Birgander, Richard; Johansson, Göran; Winsö, Ola; Koskinen, Lars-Owe; Haney, Michael

    2017-05-12

    Post-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to observed intracranial air volumes, hypothetical sea level pre-transport ICP, and different potential flight levels and cabin pressures. A cohort of consecutive subdural hematoma evacuation patients from one University Medical Centre was assessed with post-operative intracranial air volume measurements by computed tomography. Intracranial pressure changes related to estimated intracranial air volume effects of changing atmospheric pressure (simulating flight and cabin pressure changes up to 8000 ft) were simulated using an established model for intracranial pressure and volume relations. Approximately one third of the cohort had post-operative intracranial air. Of these, approximately one third had intracranial air volumes less than 11 ml. The simulation estimated that the expected changes in intracranial pressure during 'flight' would not result in intracranial hypertension. For intracranial air volumes above 11 ml, the simulation suggested that it was possible that intracranial hypertension could develop 'inflight' related to cabin pressure drop. Depending on the pre-flight intracranial pressure and air volume, this could occur quite early during the assent phase in the flight profile. DISCUSSION: These findings support the idea that there should be radiographic verification of the presence or absence of intracranial air after craniotomy for patients planned for long distance air transport. Very small amounts of air are clinically inconsequential. Otherwise, air transport with maintained ground-level cabin pressure should be a priority for these patients.

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

    Directory of Open Access Journals (Sweden)

    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

  5. Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations. Extension of temporary moratoria.

    Science.gov (United States)

    2017-07-28

    This document announces the extension of statewide temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers and Medicare home health agencies, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey, as applicable, to prevent and combat fraud, waste, and abuse. This extension also applies to the enrollment of new non-emergency ground ambulance suppliers and home health agencies, subunits, and branch locations in Medicaid and the Children's Health Insurance Program in those states.

  6. Prevalence of Positive Carriage of Tuberculosis, Methicillin-resistant Staphylococcus aureus, and Vancomycin-resistant Enterococci in Patients Transported by Ambulance: A Single Center Observational Study

    Science.gov (United States)

    Ro, Young Sun; Noh, Hyun; Cho, Sung-Il

    2012-01-01

    Objectives An ambulance can be a potential source of contagious or droplet infection of a community. We estimated the prevalence of positive carriage of tuberculosis (TB), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE) in patients transported by ambulance. Methods This was a retrospective observational study. We enrolled all patients who visited a tertiary teaching hospital emergency department (ED). Blood, sputum, urine, body fluid, and rectal swab samples were taken from patients when they were suspected of TB, MRSA, or VRE in the ED. The patients were categorized into three groups: pre-hospital ambulance (PA) group; inter-facility ambulance (IA) group; and non-ambulance (NA) group. Adjusted odds ratio (OR) and 95% confidence intervals (CI) were calculated using a multivariable logistic regression model for the prevalence of each infection. Results The total number of patients was 89206. Of these, 9378 (10.5%) and 4799 (5.4%) were in the PA and IA group, respectively. The prevalence of TB, MRSA, and VRE infection were 0.3%, 1.1%, and 0.3%, respectively. In the PA group, the prevalence of TB, MRSA, and VRE were 0.3%, 1.8%, and 0.4%. In the IA group, the prevalence of TB, MRSA, and VRE were 0.7%, 4.6%, and 1.5%, respectively. The adjusted ORs (95% CI) of the PA and IA compared to the NA group were 1.02 (0.69 to 1.53) and 1.83 (1.24 to 2.71) for TB, 2.24 (1.87 to 2.69) and 5.47 (4.63 to 6.46) for MRSA, 2.59 (1.78 to 3.77) and 8.90 (6.52 to 12.14) for VRE, respectively. Conclusions A high prevalence of positive carriage of TB, MRSA, and VRE in patients transported by metropolitan ambulances was found. PMID:22712044

  7. Is air transport of stroke patients faster than ground transport?

    DEFF Research Database (Denmark)

    Hesselfeldt, Rasmus; Gyllenborg, Jesper; Steinmetz, Jacob;

    2014-01-01

    BACKGROUND: Helicopters are widely used for interhospital transfers of stroke patients, but the benefit is sparsely documented. We hypothesised that helicopter transport would reduce system delay to thrombolytic treatment at the regional stroke centre. METHODS: In this prospective controlled...... observational study, we included patients referred to a stroke centre if their ground transport time exceeded 30 min, or they were transported by a secondarily dispatched, physician-staffed helicopter. The primary endpoint was time from telephone contact to triaging neurologist to arrival in the stroke centre...

  8. Large Payload Ground Transportation and Test Considerations

    Science.gov (United States)

    Rucker, Michelle A.

    2016-01-01

    Many spacecraft concepts under consideration by the National Aeronautics and Space Administration’s (NASA’s) Evolvable Mars Campaign take advantage of a Space Launch System payload shroud that may be 8 to 10 meters in diameter. Large payloads can theoretically save cost by reducing the number of launches needed--but only if it is possible to build, test, and transport a large payload to the launch site in the first place. Analysis performed previously for the Altair project identified several transportation and test issues with an 8.973 meters diameter payload. Although the entire Constellation Program—including Altair—has since been canceled, these issues serve as important lessons learned for spacecraft designers and program managers considering large payloads for future programs. A transportation feasibility study found that, even broken up into an Ascent and Descent Module, the Altair spacecraft would not fit inside available aircraft. Ground transportation of such large payloads over extended distances is not generally permitted, so overland transportation alone would not be an option. Limited ground transportation to the nearest waterway may be possible, but water transportation could take as long as 67 days per production unit, depending on point of origin and acceptance test facility; transportation from the western United States would require transit through the Panama Canal to access the Kennedy Space Center launch site. Large payloads also pose acceptance test and ground processing challenges. Although propulsion, mechanical vibration, and reverberant acoustic test facilities at NASA’s Plum Brook Station have been designed to accommodate large spacecraft, special handling and test work-arounds may be necessary, which could increase cost, schedule, and technical risk. Once at the launch site, there are no facilities currently capable of accommodating the combination of large payload size and hazardous processing such as hypergolic fuels

  9. Reduction in STEMI transfer times utilizing a municipal "911" ambulance service.

    Science.gov (United States)

    Tennyson, Joseph C; Quale, Mark R

    2014-02-01

    The time interval from diagnosis to reperfusion therapy for patients experiencing ST-segment elevation myocardial infarction (STEMI) has a significant impact on morbidity and mortality. It is hypothesized that the time required for interfacility patient transfers from a community hospital to a regional percutaneous coronary intervention (PCI) center using an Advanced Life Support (ALS) transfer ambulance service is no different than utilizing the "911" ALS ambulance. Quality assurance data collected by a tertiary care center cardiac catheterization program were reviewed retrospectively. Data were collected on all patients with STEMI requiring interfacility transfer from a local community hospital to the tertiary care center's PCI suite, approximately 16 miles away by ground, 12 miles by air. In 2009, transfers of patients with STEMI were redirected to the municipal ALS ambulance service, instead of the hospital's contracted ALS transfer service. Data were collected from January 2007 through May 2013. Temporal data were compared between transports initiated through the contracted ALS ambulance service and the municipal ALS service. Data points included time of initial transport request and time of ambulance arrival to the sending facility and the receiving PCI suite. During the 4-year study period, 63 patients diagnosed with STEMI and transferred to the receiving hospital's PCI suite were included in this study. Mean times from the transport request to arrival of the ambulance at the sending hospital's emergency department were six minutes (95% CI, 4-7 minutes) via municipal ALS and 13 minutes (95% CI, 9-16 minutes) for the ALS transfer service. The mean times from the ground transport request to arrival at the receiving hospital's PCI suite when utilizing the municipal ALS ambulance and hospital contracted ALS ambulance services were 48 minutes (95% CI, 33-64 minutes) and 56 minutes (95% CI 52-59 minutes), respectively. This eight-minute period represented a 14% (P

  10. 42 CFR 414.617 - Transition from regional to national ambulance fee schedule.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Transition from regional to national ambulance fee... SERVICES Fee Schedule for Ambulance Services § 414.617 Transition from regional to national ambulance fee... the ground ambulance base rate is subject to a floor amount determined by establishing nine fee...

  11. Optimal ambulance dispatching

    NARCIS (Netherlands)

    C.J. Jagtenberg (Caroline); S. Bhulai (Sandjai); R.D. van der Mei (Rob)

    2017-01-01

    textabstractThis chapter considers the ambulance dispatch problem, in which one must decide which ambulance to send to an incident in real time. In practice as well as in literature, it is commonly believed that the closest idle ambulance is the best choice. This chapter describes alternatives to

  12. The Tesat transportable adaptive optical ground station

    Science.gov (United States)

    Saucke, Karen; Seiter, Christoph; Heine, Frank; Gregory, Mark; Tröndle, Daniel; Fischer, Edgar; Berkefeld, Thomas; Feriencik, Mikael; Feriencik, Marco; Richter, Ines; Meyer, Rolf

    2016-03-01

    Tesat together with Synopta have built a Transportable Adaptive Optical Ground Station (TAOGS) under contract of German Aerospace Center DLR for communication with the 1st and 2nd generation of Tesat's spaceborne Laser Communication Terminals (LCTs), which employ coherent homodyne optical communication with 1064 nm and binary phase shift keying (BPSK) modulation. The TAOGS is able to communicate with space segments on low earth orbit (LEO, high pointing and tracking dynamics, 5.625 Gbps), and with space segments on geostationary orbit (GEO, low pointing dynamics, up to 40,000 km distance, optical data rate of 2.8125 Gbps and user data rate of 1.8 Gbps). After an alignment and testing phase at the location of Izana, Tenerife, using the TDP1 LCT on geostationary Alphasat as counter terminal, the TAOGS is now fully functioning. Several up-links, down-links and bi-directional links have been performed. Experimental results of some of these links are presented. An outlook to further activities is given.

  13. 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.

  14. 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...

  15. Nosocomial infections in ambulances and effectiveness of ambulance fumigation techniques in Saudi Arabia. Phase I study.

    Science.gov (United States)

    Alrazeeni, Daifallah; Al Sufi, Mohammed S

    2014-11-01

    To evaluate infection control and the incidence of bacterial pathogens in Emergency Medical Service (EMS) ambulances in Riyadh, Saudi Arabia. The effectiveness of fumigation techniques used for these ambulances to minimize the spread of infection to transported patients and pre-hospital care providers was also assessed. Based on previous literature review indicating a higher propensity of microbial load, 3 areas within the ambulance, such as, stretcher handle, oxygen flow meter knob, and interior handle of the rear door were selected for specimen collection. Swab samples were collected both in the day and night shift, after the intended disinfection and cleaning (before and after fumigation). Micro-organisms were identified using standard procedures. This phase-I study was conducted at the Emergency Medical Services Department, Prince Sultan Bin AbdulAziz College of Emergency Medical Services, Al Malaz, King Saud University, Riyadh, Saudi Arabia between October and November 2013, wherein a total of 10 ambulances from the Saudi Red Crescent Authority in Riyadh were selected for inclusion in the study. The specimens from all 10 ambulances showed similar results. In post disinfection and before fumigation, swab samples showed positive cultures that grew moderate to large quantities of environmental and skin flora. However, almost all organisms were susceptible to the fumigation technique. This study confirms the importance of evaluating the frequency and efficiency of various fumigation techniques as an ambulance is a potential reservoir for microbial transmission to patients and staff.

  16. Nosocomial infections in ambulances and effectiveness of ambulance fumigation techniques in Saudi Arabia

    Science.gov (United States)

    Alrazeeni, Daifallah; Al Sufi, Mohammed S.

    2014-01-01

    Objectives: To evaluate infection control and the incidence of bacterial pathogens in Emergency Medical Service (EMS) ambulances in Riyadh, Saudi Arabia. The effectiveness of fumigation techniques used for these ambulances to minimize the spread of infection to transported patients and pre-hospital care providers was also assessed. Methods: Based on previous literature review indicating a higher propensity of microbial load, 3 areas within the ambulance, such as, stretcher handle, oxygen flow meter knob, and interior handle of the rear door were selected for specimen collection. Swab samples were collected both in the day and night shift, after the intended disinfection and cleaning (before and after fumigation). Micro-organisms were identified using standard procedures. This phase-I study was conducted at the Emergency Medical Services Department, Prince Sultan Bin Abdulaziz College of Emergency Medical Services, Al Malaz, King Saud University, Riyadh, Saudi Arabia between October and November 2013, wherein a total of 10 ambulances from the Saudi Red Crescent Authority in Riyadh were selected for inclusion in the study. Results: The specimens from all 10 ambulances showed similar results. In post disinfection and before fumigation, swab samples showed positive cultures that grew moderate to large quantities of environmental and skin flora. However, almost all organisms were susceptible to the fumigation technique. Conclusion: This study confirms the importance of evaluating the frequency and efficiency of various fumigation techniques as an ambulance is a potential reservoir for microbial transmission to patients and staff. PMID:25399212

  17. Training of Ambulance Personnel and Others Responsible for Emergency Care of the Sick and Injured at the Scene and During Transport.

    Science.gov (United States)

    National Academy of Sciences - National Research Council, Washington, DC. Div. of Medical Sciences.

    Ambulance personnel must be able to (1) appraise the extent of first aid rendered by others, (2) carry out additional measures at the scene and en route, (3) operate vehicles safely, (4) maintain communication with traffic authorities, dispatchers, and emergency departments, and (5) keep records for medical and other authorities. Guidelines for…

  18. 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.

  19. Trajectories For Space Ambulance

    Science.gov (United States)

    Nelson, Walter C.; Furakawa, Shiro

    1988-01-01

    Report presents concept for space ambulance that moves as quickly and economically as possible between orbits. Describes variety of rendezvous maneuvers between space stations in geocentric orbits at altitudes ranging from 200 km to geosynchronous altitude. Analyzes minimum times to complete rendezvous with orbiting medical station.

  20. Ambulance use in Pakistan: an analysis of surveillance data from emergency departments in Pakistan.

    Science.gov (United States)

    Zia, Nukhba; Shahzad, Hira; Baqir, Syed; Shaukat, Shahab; Ahmad, Haris; Robinson, Courtland; Hyder, Adnan A; Razzak, Junaid

    2015-01-01

    The utilization of ambulances in low- and middle-income countries is limited. The aim of this study was to ascertain frequency of ambulance use and characteristics of patients brought into emergency departments (EDs) through ambulance and non-ambulance modes of transportation. The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a pilot active surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan between November 2010 and March 2011. Univariate and multivariate logistic regression was performed to investigate the factors associated with ambulance use. Out of 274,436 patients enrolled in Pak-NEDS, the mode of arrival to the ED was documented for 94. 9% (n = 260,378) patients, of which 4.1% (n = 10,546) came to EDs via ambulances. The mean age of patients in the ambulance group was significantly higher compared to the mean age of the non-ambulance group (38 ± 18.4 years versus 32.8 ± 14.9 years, p-value ambulance group was head injury (12%) while among non-ambulance users it was fever (12%). Patients of all age groups were less likely to use an ambulance compared to those >45 years of age (p-value ambulances for those with injuries was 3.5 times higher than those with non-injury complaints (p-value ambulance were 7.2 times more likely to die in the ED than non-ambulance patients after adjustment for other variables in the model. Utilization of ambulances is very low in Pakistan. Ambulance use was found to be more among the elderly and those presenting with injuries. Patients presenting via ambulances were more likely to die in the ED.

  1. Wake Vortex Transport and Decay in Ground Effect: Vortex Linking with the Ground

    Science.gov (United States)

    Proctor, Fred H.; Hamilton, David W.; Han, Jongil

    2000-01-01

    Numerical simulations are carried out with a three-dimensional Large-Eddy Simulation (LES) model to explore the sensitivity of vortex decay and transport in ground effect (IGE). The vortex decay rates are found to be strongly enhanced following maximum descent into ground effect. The nondimensional decay rate is found to be insensitive to the initial values of circulation, height, and vortex separation. The information gained from these simulations is used to construct a simple decay relationship. This relationship compares well with observed data from an IGE case study. Similarly, a relationship for lateral drift due to ground effect is constructed from the LES data. In the second part of this paper, vortex linking with the ground is investigated. Our numerical simulations of wake vortices for IGE show that a vortex may link with its image beneath the ground, if the intensity of the ambient turbulence is moderate to high. This linking with the ground (which is observed in real cases)gives the appearance of a vortex tube that bends to become vertically oriented and which terminates at the ground. From the simulations conducted, the linking time for vortices in the free atmosphere; i.e., a function of ambient turbulence intensity.

  2. Chest Compression Fraction between Mechanical Compressions on a Reducible Stretcher and Manual Compressions on a Standard Stretcher during Transport in Out-of-Hospital Cardiac Arrests: The Ambulance Stretcher Innovation of Asian Cardiopulmonary Resuscitation (ASIA-CPR) Pilot Trial.

    Science.gov (United States)

    Kim, Tae Han; Shin, Sang Do; Song, Kyoung Jun; Hong, Ki Jeong; Ro, Young Sun; Song, Sung Wook; Kim, Chu Hyun

    2017-01-01

    Cardiopulmonary resuscitation (CPR) with the use of mechanical devices is recommended during ambulance transport. However, the CPR quality en route and while in transfer to the emergency department (ED) for out-of-hospital cardiac arrests (OHCAs) remains uncertain. We developed a mechanical CPR device outfitted on a reducible stretcher (M-CPR) and compared with standard manual CPR on a standard stretcher (S-CPR) to evaluate CPR quality. Adult OHCAs transported by five ambulances in a metropolitan area with a population of 3.5 million (many of whom lived in high-rise buildings) from September to October (before-phase) and November to December (after-phase) in 2015 were collected. The reducible stretcher was developed for use in a small elevator during the transfer from scene to ambulance, and the AutoPulse® (ZOLL Medical, Chelmsford, MA, USA) was used for M-CPR. Chest compression fraction (CCF) was measured by transthoracic impedance data using an X-series® cardiac monitor (ZOLL Medical) during time from attachment to patient to arrival to the ED. A comparison of CCF using a Wilcoxon signed-rank test evaluated the difference between the before- and after-phases. Of the eligible 49 OHCAs, 31 (21 in the before-phase and 10 in the after-phase) were analyzed, excluding patients for whom CCF was not measured, for whom M-CPR was not used, who had a return of spontaneous circulation in the field before transport, or who collapsed during transport. There were no differences in demographic data. Median total CCF (median, q1-q3) was significantly higher in the after-phase M-CPR group (85.2, 83.4-86.3) than in the before-phase S-CPR group (80.1, 68.0-85.2) (p = 0.03). Mechanical CPR on the reducible stretcher during the transport of OHCAs to the ED showed a much higher chest compression fraction than standard manual CPR.

  3. Sustainable ground transportation – review of technologies, challenges and opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Agarwal, Ramesh K. [Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO 63130 (United States)

    2013-07-01

    Currently there are nearly 750 million ground vehicles in service worldwide. They are responsible for 50% of petroleum (oil) consumption and 60% of all greenhouse gas (GHG) emissions worldwide. The number of vehicles is forecasted to double by 2050. Therefore the environmental issues such as noise, emissions and fuel burn have become important for energy and environmental sustainability. This paper provides an overview of specific energy and environmental issues related to ground transportation. The technologies related to reduction in energy requirements such as reducing the vehicle mass by using the high strength low weight materials and reducing the viscous drag by active flow control and smoothing the operational profile, and reducing the contact friction by special tire materials are discussed along with the portable energy sources for reducing the GHG emissions such as low carbon fuels (biofuels), Lithium-ion batteries with high energy density and stability, and fuel cells. The technological challenges and opportunities for innovations are discussed.

  4. Sustainable ground transportation – review of technologies, challenges and opportunities

    Directory of Open Access Journals (Sweden)

    Ramesh K. Agarwal

    2013-01-01

    Full Text Available Currently there are nearly 750 million ground vehicles in service worldwide. They are responsible for 50% of petroleum (oil consumption and 60% of all greenhouse gas (GHG emissions worldwide. The number of vehicles is forecasted to double by 2050. Therefore the environmental issues such as noise, emissions and fuel burn have become important for energy and environmental sustainability. This paper provides an overview of specific energy and environmental issues related to ground transportation. The technologies related to reduction in energy requirements such as reducing the vehicle mass by using the high strength low weight materials and reducing the viscous drag by active flow control and smoothing the operational profile, and reducing the contact friction by special tire materials are discussed along with the portable energy sources for reducing the GHG emissions such as low carbon fuels (biofuels, Lithium-ion batteries with high energy density and stability, and fuel cells. The technological challenges and opportunities for innovations are discussed.

  5. Laser based bi-directional Gbit ground links with the Tesat transportable adaptive optical ground station

    Science.gov (United States)

    Heine, Frank; Saucke, Karen; Troendle, Daniel; Motzigemba, Matthias; Bischl, Hermann; Elser, Dominique; Marquardt, Christoph; Henninger, Hennes; Meyer, Rolf; Richter, Ines; Sodnik, Zoran

    2017-02-01

    Optical ground stations can be an alternative to radio frequency based transmit (forward) and receive (return) systems for data relay services and other applications including direct to earth optical communications from low earth orbit spacecrafts, deep space receivers, space based quantum key distribution systems and Tbps capacity feeder links to geostationary spacecrafts. The Tesat Transportable Adaptive Optical Ground Station is operational since September 2015 at the European Space Agency site in Tenerife, Spain.. This paper reports about the results of the 2016 experimental campaigns including the characterization of the optical channel from Tenerife for an optimized coding scheme, the performance of the T-AOGS under different atmospheric conditions and the first successful measurements of the suitability of the Alphasat LCT optical downlink performance for future continuous variable quantum key distribution systems.

  6. 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

  7. 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.

  8. Ambulance referral for emergency obstetric care in remote settings.

    Science.gov (United States)

    Tsegaye, Ademe; Somigliana, Edgardo; Alemayehu, Tadesse; Calia, Federico; Maroli, Massimo; Barban, Paola; Manenti, Fabio; Putoto, Giovanni; Accorsi, Sandro

    2016-06-01

    To evaluate the functionality of an ambulance service dedicated to emergency obstetric care (EmOC) that referred pregnant women to health centers for delivery assistance or to a hospital for the management of obstetric complications. A retrospective study investigated an ambulance referral system for EmOC in a rural area of Ethiopia between July 1 and December 31, 2013. The service was available 24h a day and was free of charge. Women requesting referral were transported to nearby health centers. Assistance was provided locally for uncomplicated deliveries. Women with obstetric complications were referred from health centers to a hospital. A total of 528 ambulance referrals were recorded. The majority of patients (314 [59.5%]) were transported from villages to health centers. The remaining individuals were brought to a hospital, having been referred from health centers (179 [33.9%]) or were referred directly from villages owing to hospital proximity (35 [6.6%]). Of the 179 patients referred to the hospital from health centers, 84 (46.9%) were diagnosed with major direct obstetric complications. No maternal deaths were recorded among patients using the ambulance service. The cost of the ambulance service was US$ 18.47 per referred patient. An ambulance service dedicated to EmOC that interconnected health centers and a hospital facilitated referrals and better utilized local resources. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  9. Ambulance Crash Characteristics in the US Defined by the Popular Press: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Teri L. Sanddal

    2010-01-01

    Full Text Available Ambulance crashes are a significant risk to prehospital care providers, the patients they are carrying, persons in other vehicles, and pedestrians. No uniform national transportation or medical database captures all ambulance crashes in the United States. A website captures many significant ambulance crashes by collecting reports in the popular media (the website is mentioned in the introduction. This report summaries findings from ambulance crashes for the time period of May 1, 2007 to April 30, 2009. Of the 466 crashes examined, 358 resulted in injuries to prehospital personnel, other vehicle occupants, patients being transported in the ambulance, or pedestrians. A total of 982 persons were injured as a result of ambulance crashes during the time period. Prehospital personnel were the most likely to be injured. Provider safety can and should be improved by ambulance vehicle redesign and the development of improved occupant safety restraints. Seventy-nine (79 crashes resulted in fatalities to some member of the same groups listed above. A total of 99 persons were killed in ambulance crashes during the time period. Persons in other vehicles involved in collisions with ambulances were the most likely to die as a result of crashes. In the urban environment, intersections are a particularly dangerous place for ambulances.

  10. Potential risk of microplastics transportation into ground water

    Science.gov (United States)

    Huerta, Esperanza; Gertsen, Hennie; Gooren, Harm; Peters, Piet; Salánki, Tamás; van der Ploeg, Martine; Besseling, Ellen; Koelmans, Albert A.; Geissen, Violette

    2016-04-01

    Microplastics, are plastics particles with a size smaller than 5mm. They are formed by the fragmentation of plastic wastes. They are present in the air, soil and water. But only in aquatic systems (ocean and rivers) are studies over their distribution, and the effect of microplastics on organisms. There is a lack of information of what is the distribution of microplastics in the soil, and in the ground water. This study tries to estimate the potential risk of microplastics transportation into the ground water by the activity of earthworms. Earthworms can produce burrows and/or galleries inside the soil, with the presence of earthworms some ecosystem services are enhanced, as infiltration. In this study we observed after 14 days with 5 treatments (0, 7, 28 and 60% w/w microplastics mixed with Populus nigra litter) and the anecic earthworm Lumbricus terrestris, in microcosms (3 replicas per treatment) that macroplastics are indeed deposit inside earthworms burrows, with 7% microplastics on the surface is possible to find 1.8 g.kg-1 microplastics inside the burrows, with a bioaumentation factor of 0.65. Burrows made by earthworms under 60% microplastics, are significant bigger (pmicroplastics in their soil surface. The amount of litter that is deposit inside the burrows is significant higher (pmicroplastics on the surface than without microplastics. The microplastics size distribution is smaller inside the burrows than on the surface, with an abundance of particles under 63 μm.

  11. Ambulance use is associated with higher self-rated illness seriousness: user attitudes and perceptions.

    Science.gov (United States)

    Toloo, Ghasem Sam; FitzGerald, Gerry J; Aitken, Peter J; Ting, Joseph Y S; McKenzie, Kirsten; Rego, Joanna; Enraght-Moony, Emma

    2013-06-01

    The objective was to study the role and effect of patients' perceptions on reasons for using ambulance services in Queensland, Australia. A cross-sectional survey was conducted of patients (n = 911) presenting via ambulance or self-transport at eight public hospital emergency departments (EDs). The survey included perceived illness severity, attitudes toward ambulance, and reasons for using ambulance. A theoretical framework was developed to inform this study. Ambulance users had significantly higher self-rated perceived seriousness, urgency, and pain than self-transports. They were also more likely to agree that ambulance services are for everyone to use, regardless of the severity of their conditions. In compared to self-transports, likelihood of using an ambulance increased by 26% for every unit increase in perceived seriousness; and patients who had not used an ambulance in the 6 months prior to the survey were 66% less likely to arrive by ambulance. Patients who had presented via ambulance stated they considered the urgency (87%) or severity (84%) of their conditions as reasons for calling the ambulance. Other reasons included requiring special care (76%), getting higher priority at the ED (34%), not having a car (34%), and financial concerns (17%). Understanding patients' perceptions is essential in explaining their actions and developing safe and effective health promotion programs. Individuals use ambulances for various reasons and justifications according to their beliefs, attitudes, and sociodemographic conditions. Policies to reduce and manage demand for such services need to address both general opinions and specific attitudes toward emergency health services to be effective. © 2013 by the Society for Academic Emergency Medicine.

  12. Comparison of ambulance dispatch protocols for nontraumatic abdominal pain.

    Science.gov (United States)

    Lammers, R L; Roth, B A; Utecht, T

    1995-11-01

    To compare rates of undertriage and overtriage of six ambulance dispatch protocols for the presenting complaint of nontraumatic abdominal pain, and to identify the optimal protocol. Retrospective prehospital and emergency department chart review to classify patients' conditions as "emergency" or "nonemergency." Utility analysis was used to identify the preferred protocol and monetary cost-effectiveness analysis to identify the least expensive protocol. County emergency medical services (EMS) system with five receiving hospitals serving a mainly urban population of approximately 350,000. Records of 902 patients who called 911 for nontraumatic abdominal pain were reviewed; patients not transported were excluded. Twenty-seven county EMS medical directors completed questionnaires. Six ambulance dispatch protocols for nontraumatic abdominal pain were developed: indiscriminate-dispatch, four selective protocols, and no-dispatch. A dichotomous classification system was derived prospectively from the prehospital and medical records of patients who had activated the EMS system before the study period to define "emergency" and "nonemergency" conditions associated with nontraumatic abdominal pain. Emergency criteria identified patients with conditions requiring medical treatment within 1 hour. Reviewers determined, for each patient, whether an ambulance would have been dispatched by each of the protocols. Undertriage and overtriage rates were calculated for each protocol. County EMS medical directors assigned utility values to four potential outcomes of ambulance dispatch by the direct scaling method. The outcomes comprised correct and incorrect decisions to dispatch ambulances to patients with and without emergencies. The protocols were compared by decision analysis. A cost analysis was also performed, using an estimated marginal cost per transport of $302. Sensitivity analysis demonstrated the effect of varying the cost of an undertriage error and the cost per response. Of

  13. Recommendations on ambulance cardiopulmonary resuscitation in basic life support systems.

    Science.gov (United States)

    Hock Ong, Marcus Eng; Shin, Sang Do; Sung, Soon Swee; Tanaka, Hideharu; Huei-Ming, Matthew; Song, Kyoung Jun; Nishiuchi, Tatsuya; Leong, Benjamin Sieu-Hon; Karim, Sarah Abdul; Lin, Chih-Hao; Ryoo, Hyun Wook; Ryu, Hyun Ho; Iwami, Taku; Kajino, Kentaro; Ko, Patrick Chow-In; Lee, Kyung Won; Sumetchotimaytha, Nathida; Swor, Robert; Myers, Brent; Mackey, Kevin; McNally, Bryan

    2013-01-01

    Cardiopulmonary resuscitation (CPR) during ambulance transport can be a safety risk for providers and can affect CPR quality. In many Asian countries with basic life support (BLS) systems, patients experiencing out-of-hospital cardiac arrest (OHCA) are routinely transported in ambulances in which CPR is performed. This paper aims to make recommendations on best practices for CPR during ambulance transport in BLS systems. A panel consisting of 20 experts (including 4 North Americans) in emergency medical services (EMS) and resuscitation science was selected, and met over two days. We performed a literature review and selected 33 candidate issues in five core areas. Using Delphi methodology, the issues were classified into dichotomous (yes/no), multiple choice, and ranking questions. Primary consensus between experts was reached when there was more than 70% agreement. Questions with 60-69% agreement were made more specific and were submitted for a second round of voting. The panel agreed upon 24 consensus statements with more than 70% agreement (2 rounds of voting). The recommendations cover the following: length of time on the scene; advanced airway at the scene; CPR prior to transport; rhythm analysis and defibrillation during transport; prehospital interventions; field termination of resuscitation (TOR); consent for TOR; destination hospital; transport protocol; number of staff members; restraint systems; mechanical CPR; turning off of the engine for rhythm analysis; alternative CPR; and feedback for CPR quality. Recommendations for CPR during ambulance transport were developed using the Delphi method. These recommendations should be validated in clinical settings.

  14. 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.

  15. [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.

  16. 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...

  17. [Status of Ambulant Geriatrics].

    Science.gov (United States)

    Kraft, Johannes W

    2017-06-01

    Ambulante Gesundheitsversorgung im Alter Aktuelle Bedarfsplanung und Versorgungsrealität weichen zunehmend auseinander. Geriatrie erfolgt idealerweise als abgestufte Versorgung in einem regionalen Netzwerk. Hausärztlich-geriatrische Grundversorgung Das Basisassessment ermöglicht die Integration geriatrischer Screening-Diagnostik in den Praxisalltag. Ein vernetztes Konzept haus- und fachärztlicher Versorgung mit einer spezialisierten ambulanten Versorgung hat das Potenzial, stationäre Einweisungen zu vermeiden und die Qualität der ambulanten Versorgung geriatrischer Patienten zu steigern. KBV-Entwurf „Spezifische geriatrische Versorgung“ Die Kassenärztliche Bundesvereinigung (KBV) hat im ambulanten kassenärztlichen Bereich eine Zwischenstufe zwischen spezialisierter Versorgung durch Geriater an Kliniken und niedergelassenen Kassenärzten skizziert. Spezialisierte Versorgung nach EBM-Abschnitt 30.13 Seit dem 1.7.2016 können Hausärzte Patienten die Chance auf spezialisierte geriatrische Beratung und Diagnostik eröffnen. Sie wird in Verbindung mit kooperierenden Therapieteams von zugelassenen niedergelassenen Geriatern oder an geriatrischen Institutsambulanzen auf Zuweisung erbracht. Neue Modelle erweiterter geriatrischer Institutsambulanzen/Ausblick Die kooperative Zusammenarbeit von Hausärzten mit ambulant tätigen Geriatern eröffnet Chancen, präventive, akutmedizinische, rehabilitative und palliative Leistungen regional abgestimmt und bedarfsgerecht weiter zu entwickeln.

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

    Science.gov (United States)

    Friesgaard, K D; Nikolajsen, L; Giebner, M; Rasmussen, C-H; Riddervold, I S; Kirkegaard, H; Christensen, E F

    2016-04-01

    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. 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. Secondary outcomes included the number of patients with reduction in pain intensity during transport (NRS ≥ 2), the number of patients with NRS > 3 at hospital arrival, and potential fentanyl-related side effects. Fentanyl reduced pain from before treatment (8, IQR 7-9) to hospital arrival (4, IQR 3-6) (NRS reduction: 3, IQR 2-5; P = 0.001), 79.3% of all patients had a reduction in > 2 on the NRS during transport, and 58.4% of patients experienced pain at hospital arrival (NRS > 3). Twenty-one patients (0.9%) had oxygen saturation ambulance personnel. Many patients had moderate to severe pain at hospital arrival. As the protocol allowed higher doses of fentanyl, feedback on effect and safety should be part of continuous education of ambulance personnel. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  19. Can Medical Decision-making at the Scene by EMS Staff Reduce the Number of Unnecessary Ambulance Transportations, but Still Be Safe?

    Science.gov (United States)

    Peyravi, Mahmoudreza; Örtenwall, Per; Khorram-Manesh, Amir

    2015-06-30

    The aim of this study was to evaluate the procedures adopted by the staff of the Shiraz Emergency Medical Services (EMS) and the outcome of the patients discharged from the scene over a one-year period.   Unnecessary use of ambulances results in the overloading of EMS and the over-crowding of emergency departments. Medical assessment at the scene by EMS staff may reduce these issues. In an earlier study in Shiraz, 36% of the patients were left at home/discharged directly from the scene with or without treatment by EMS staff after consulting a physician at the dispatch center. However, there has been no evaluation of this system with regard to mortality and morbidity.   Retrospective data on all missions performed by the Shiraz EMS (2012-2013) were reviewed. All the patients discharged from the scene by the EMS staff on the 5th, 15th, and 25th days of each month were included. A questionnaire with nine questions was designed, and available patients/relatives were interviewed prospectively (2014; follow-up period 4-12 months).   Out of 3019 cases contacted, 994 (almost 33%) replied. There were 26%-93% reductions in the complaints in all disease categories. A group of the patients left the scene at their own will. Of those who were discharged by the EMS staff at the scene, over 60% were without any complaints. Twelve out of 253 patients died after they were sent home by the EMS staff.   Patients may be discharged at the scene by EMS staff and after consulting a physician. However, there is a need for a solid protocol to ensure total patient safety. This calls for a prospective study.

  20. Ambulance patients with nondocumented sepsis have a high mortality risk: a retrospective study.

    Science.gov (United States)

    Roest, Asselina A; Stoffers, Judith; Pijpers, Evelien; Jansen, Jochen; Stassen, Patricia M

    2017-02-01

    Sepsis is a serious disease leading to high mortality. Early recognition is important because treatment is most effective when started quickly.The primary aim of this retrospective cohort study was to assess how many sepsis patients are documented as septic by ambulance staff. The secondary aims were to investigate how many sepsis patients are transported by ambulance, to compare them with patients transported otherwise, to investigate which factors influence documentation of sepsis and to assess whether documentation influences mortality. We retrieved all data from ambulance and emergency department charts of patients who visited the internist in the emergency department from March 2011 to July 2012. In total, 47.4% (n=363) sepsis patients were transported by ambulance. These patients were older (71.5 vs. 55.7 years, Pambulance patients, sepsis was not documented by ambulance staff. Measurement of temperature was important for documentation of sepsis (odds ratio 11.2, 95% confidence interval 5.2-24.4). In 32.1% of ambulance patients, sepsis could have been identified by assessing vital signs. Mortality in these nondocumented patients was higher than that in documented patients (25.7 vs. 12.9%, P=0.003). Ambulance patients are seriously ill, but sepsis is often not documented by ambulance staff. Nondocumentation is associated with high mortality and could be resolved by assessing vital signs, particularly the temperature.

  1. Factors influencing ambulance use in patients with ST-elevation myocardial infarction in Beijing, China

    Institute of Scientific and Technical Information of China (English)

    YAN Hong-bing; HU Da-yi; SONG Li; CHEN Hui; ZHANG Jian; LI Shi-ying; LI Qing-xiang; CHENG Shu-juan; WANG Jian; ZHAO Han-jun

    2009-01-01

    Background Emergency medical service plays a key role in the early recognition and treatment of ST-elevation myocardial infarction (STEMI), but studies indicate that the patients experiencing STEMI symptoms often fail to call an ambulance as recommended. This study aimed to examine the current ambulance transport frequency and ascertain predictors and reasons for not choosing ambulance transportation by the patients with STEMI in Beijing.Methods A prospective, cross-sectional survey was conducted from January 1,2006 through until June 30, 2007 in two tertiary hospitals in Beijing and included consecutive patients with STEMI admitted within 24 hours of onset of symptoms. Data were collected by structured interviews and medical records review.Results Of the 572 patients, only 172 (30.1%) used an ambulance, and the remaining 400 (69.9%) presented by self-transport. Multivariate analysis showed that age <65 years (OR: 1.220; 95% CI: 1.001-2.043), lower education level (OR: 1.582; 95% CI: 1.003-2.512), presence of pre-infarction angina (OR: 1.595; 95% CI: 1.086-2.347), and attribution of symptoms to non-cardiac origin (OR: 1.519; 95% CI: 1.011-2.284) were independent predictors for not using an ambulance. However, history of coronary artery disease (CAD), dyspnea, perceiving symptoms to be serious, and knowing the meaning of cardiopulmonary resuscitation appeared to be independent predictors of ambulance use. The main reasons for not using an ambulance were convenience and quickness of self-transport and the decreased severity of symptoms.Conclusions A large proportion of patients in Beijing do not call for an ambulance after onset of STEMI symptoms. Several factors including demographics, previous CAD, symptoms and cognitive factors of patients are associated with the ambulance use. The public should be educated that an ambulance is not merely a transportation modality and that it also provides rapid diagnosis and treatment.

  2. Feasibility of a computer-assisted feedback system between dispatch centre and ambulances.

    Science.gov (United States)

    Lindström, Veronica; Karlsten, Rolf; Falk, Ann-Charlotte; Castrèn, Maaret

    2011-06-01

    The aim of the study was to evaluate the feasibility of a newly developed computer-assisted feedback system between dispatch centre and ambulances in Stockholm, Sweden. A computer-assisted feedback system based on a Finnish model was designed to fit the Swedish emergency medical system. Feedback codes were identified and divided into three categories; assessment of patients' primary condition when ambulance arrives at scene, no transport by the ambulance and level of priority. Two ambulances and one emergency medical communication centre (EMCC) in Stockholm participated in the study. A sample of 530 feedback codes sent through the computer-assisted feedback system was reviewed. The information on the ambulance medical records was compared with the feedback codes used and 240 assignments were further analyzed. The used feedback codes sent from ambulance to EMCC were correct in 92% of the assignments. The most commonly used feedback code sent to the emergency medical dispatchers was 'agree with the dispatchers' assessment'. In addition, in 160 assignments there was a mismatch between emergency medical dispatchers and ambulance nurse assessments. Our results have shown a high agreement between medical dispatchers and ambulance nurse assessment. The feasibility of the feedback codes seems to be acceptable based on the small margin of error. The computer-assisted feedback system may, when used on a daily basis, make it possible for the medical dispatchers to receive feedback in a structural way. The EMCC organization can directly evaluate any changes in the assessment protocol by structured feedback sent from the ambulance.

  3. Insights on the effects of patient perceptions and awareness on ambulance usage in Karachi, Pakistan.

    Science.gov (United States)

    Chandran, Aruna; Ejaz, Kiran; Karani, Rabia; Baqir, Muhammad; Razzak, Junaid; Hyder, Adnan A

    2014-12-01

    Prehospital care is a vital part of emergency medical care. Countries with decentralised ambulance systems, such as Pakistan, require patient knowledge as to when to call an ambulance and which service to call. Little is known about how patient perceptions of ambulance services affect ambulance usage in most low- and middle-income countries (LMIC). The purpose of our study was to analyse patient perspectives of the ambulance system in Karachi to understand how to improve ambulance use. Indepth interviews were conducted with 30 individuals selected by convenience sampling representing patients who came to the emergency department by private transport versus one of two of the main ambulance service providers in Karachi. Similar to what has been shown in some LMIC contexts, two of the major themes that emerged which affect patient decision making with regard to ambulance use were a mistrust of the ambulance system or providers and a sense of inadequacy of the local system as compared with international standards. In addition, which has not been shown in previous studies, there was a fundamental misunderstanding of the role of ambulance services in the healthcare infrastructure. Insight into the main issues affecting patient decisions to use an ambulance service offers possible targets for patient education that could result in an increase in the proper usage of ambulances and thus optimise outcomes from serious injury and illness in an LMIC context. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands

    NARCIS (Netherlands)

    Giannakopoulos, G.F.; Lubbers, W.D.; Christiaans, H.M.T.; van Exter, P.; Bet, P.; Hugen, P.J.C.; Innemee, G.; Schubert, E.; de Lange-Klerk, E.S.M.; Goslings, J.C.; Jukema, G.N.

    2010-01-01

    The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much

  5. 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

  6. 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.

  7. 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

  8. A biomechanical and subjective comparison of two powered ambulance cots.

    Science.gov (United States)

    Sommerich, Carolyn M; Lavender, Steven A; Radin Umar, Radin Zaid; Li, Jing; Park, SangHyun; Dutt, Mohini

    2015-01-01

    This study investigated biomechanical effects of different leg folding/unfolding mechanisms used for loading/unloading two powered cots (Cots A and B) into and from a simulated ambulance. Sixteen experienced emergency medical service (EMS) workers loaded and unloaded cots with weights of 45, 68 and 91 kg placed on the cots to simulate patients. Peak back and shoulder/arm muscle activity was reduced 52-87% when using Cot A in comparison to Cot B. Peak ground reaction force (PGRF) was reduced by 74% with Cot A. Adding weight resulted in increased muscle activity and PGRF when using Cot B, but had little effect when using Cot A. Task time was longer with Cot A, though was not perceived unfavourably by participants. This study confirmed that it is possible to substantially reduce physical stress imposed on EMS workers when loading and unloading a cot to and from an ambulance through improvements in cot design. This study compared two powered ambulance cots, one that lifts/lowers the front and rear wheels independently and one that lifts/lowers the four wheels simultaneously during ambulance loading and unloading. Measured muscle activity, ground reaction forces and operator perceptions support using cot designs that lift/lower the front and rear wheels independently.

  9. Route less travelled? Ambulance use for children with high-acuity acute illness.

    Science.gov (United States)

    Hopgood, Timothy; Shepherd, Michael

    2014-04-01

    Ambulance transportation offers important supportive care and treatment en route to definitive treatment. However, children may be at risk of under-utilising ambulance transportation, where private vehicle is possible. This study aims to determine how many of the sickest children present to hospitals in Auckland via ambulance and whether certain population groups are lower users of ambulance services. Transportation, demographic and outcome data were collected and analysed for children presenting to Starship Children's Health (Starship) from 1 January to 31 December 2011), who were 'self referrals' to hospital, less than 15 years of age, and assigned triage category 1 and 2 on presentation. There were 1047 presentations to Starship identified that met inclusion criteria. Of these, 256 of the 341 triage one presentations (75.1%) and 217 of the 706 triage two presentations (30.7%) were transported by ambulance.Ambulance use was higher among older children (P ambulance, particularly those aged less than 1 year. This has the potential to result in worse health outcomes. There were no identified associations with patient demographics, and further research is required to better understand this problem and develop solutions. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  10. 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

  11. Critical care transport.

    Science.gov (United States)

    Williams, Kenneth A; Sullivan, Francis M

    2013-12-03

    Critical care transport (CCT) is the segment of the Emergency Medical Services (EMS) system that transports patients who are critically ill or injured. Nearly 1,000 medical helicopters affiliated with over 300 transport programs, hundreds of fixed-wing aircraft, and many, many ground ambulances assisting adult, pediatric and neonatal CCT teams are operating in the United States.1 This article reviews the history of and indications for CCT, team qualifications, vehicle options, safety, CCT system design, and physician involvement in CCT. It concludes with a brief review of CCT services in Rhode Island.

  12. 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.

  13. Variations in Ambulance Use in the United States: the Role of Health Insurance

    Science.gov (United States)

    Meisel, Zachary F.; Pines, Jesse M.; Polsky, Daniel E.; Metlay, Joshua P.; Neuman, Mark D.; Branas, Charles C.

    2011-01-01

    Objectives The purpose of this study was to describe the associations between individual health insurance and ambulance utilization using a national sample of patients who receive emergency department (ED) care. Methods The data source was the National Hospital Ambulatory Medical Care Survey, years 2004 through 2006. Non-institutionalized patients between ages 18 and 65 years were included. The primary dependant variable was ambulance use. Multivariable logistic regression methods were used to assess the associations between health insurance status and ambulance use, and to adjust for confounders. Results A total of 61,013 ED visits were included, representing a national sample of approximately 70 million annual ED visits over three years. Ambulance transport was used in 11% of private insurance visits, 16% of Medicaid visits, and 13% of uninsured visits. In the adjusted model, visits by patients with Medicaid (aOR 1.60, 99% confidence interval (CI) = 1.37 to 1.86) and the uninsured (aOR 1.43, 99% CI = 1.23 to 1.66) were more likely to arrive by ambulance than visits by patients with private insurance. Ambulance use among the uninsured was most pronounced in metropolitan areas. Conclusions Ambulance use varies by health insurance status. Medicaid coverage and lack of insurance are each independently associated with increased odds of ambulance use, suggesting a disproportionate role for EMS in the care of patients with limited financial resources. PMID:21996068

  14. 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...

  15. Emergency Department Overcrowding and Ambulance Turnaround Time.

    Science.gov (United States)

    Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul

    2015-01-01

    The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance.

  16. Modelling of the reactive transport of organic pollutants in ground water; Modellierung des reaktiven Transports organischer Schadstoffe im Grundwasser

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, W. [Heidelberg Univ. (Germany). Inst. fuer Umweltphysik

    1999-07-01

    The book describes reactive transport of organic pollutants in ground water and its quantitative monitoring by means of numerical reaction transport models. A brief introduction dealing with the importance of and hazards to ground water and opportunities for making use of ground water models is followed by a more detailed chapter on organic pollutants in ground water. Here the focus is on organochlorine compounds and mineral oil products. Described are propagation mechanisms for these substances in the ground and, especially, their degradability in ground water. A separate chapter is dedicated to possibilities for cleaning up polluted ground water aquifers. The most important decontamination techniques are presented, with special emphasis on in-situ processes with hydraulic components. Moreover, this chapter discusses the self-cleaning capability of aquifers and the benefits of the application of models to ground water cleanup. In the fourth chapter the individual components of reaction transport models are indicated. Here it is, inter alia, differences in the formulation of reaction models as to their complexity, and coupling between suspended matter transport and reaction processes that are dealt with. This chapter ends with a comprehensive survey of literature regarding the application of suspended matter transport models to real ground water accidents. Chapter 5 consists of a description of the capability and principle of function of the reaction transport model TBC (transport biochemism/chemism). This model is used in the two described applications to the reactive transport of organic pollutants in ground water. (orig.) [German] Inhalt des vorliegenden Buches ist die Darstellung des reaktiven Transports organischer Schadstoffe im Grundwasser und dessen quantitative Erfassung mithilfe numerischer Reaktions-Transportmodelle. Auf eine kurze Einleitung zur Bedeutung und Gefaehrdung von Grundwasser und zu den Einsatzmoeglichkeiten von Grundwassermodellen folgt ein

  17. Assessment of ground transportation stress in juvenile Kemp's ridley sea turtles (Lepidochelys kempii).

    Science.gov (United States)

    Hunt, Kathleen E; Innis, Charles J; Kennedy, Adam E; McNally, Kerry L; Davis, Deborah G; Burgess, Elizabeth A; Merigo, Constance

    2016-01-01

    Sea turtle rehabilitation centres frequently transport sea turtles for long distances to move animals between centres or to release them at beaches, yet there is little information on the possible effects of transportation-related stress ('transport stress') on sea turtles. To assess whether transport stress is a clinically relevant concern for endangered Kemp's ridley sea turtles (Lepidochelys kempii), we obtained pre-transport and post-transport plasma samples from 26 juvenile Kemp's ridley sea turtles that were transported for 13 h (n = 15 turtles) or 26 h (n = 11 turtles) by truck for release at beaches. To control for effects of handling, food restriction and time of day, the same turtles were also studied on 'control days' 2 weeks prior to transport, i.e. with two samples taken to mimic pre-transport and post-transport timing, but without transportation. Blood samples were analysed for nine clinical health measures (pH, pCO2, pO2, HCO3, sodium, potassium, ionized calcium, lactate and haematocrit) and four 'stress-associated' parameters (corticosterone, glucose, white blood cell count and heterophil-to-lymphocyte ratio). Vital signs (heart rate, respiratory rate and cloacal temperature) were also monitored. Corticosterone and glucose showed pronounced elevations due specifically to transportation; for corticosterone, this elevation was significant only for the longer transport duration, whereas glucose increased significantly after both transport durations. However, clinical health measures and vital signs showed minimal or no changes in response to any sampling event (with or without transport), and all turtles appeared to be in good clinical health after both transport durations. Thus, transportation elicits a mild, but detectable, adrenal stress response that is more pronounced during longer durations of transport; nonetheless, Kemp's ridley sea turtles can tolerate ground transportation of up to 26 h in good health. These results are likely

  18. Targeted response? An exploration of why ambulance services find government targets particularly challenging.

    Science.gov (United States)

    Durham, Mark; Faulkner, Mark; Deakin, Charles

    2016-12-01

    Ambulance services have historically found their targets particularly challenging. This article explores some areas of this multifaceted problem. Research articles, government publications and published audit data. Demand is increasing in many areas of healthcare, but whilst hospitals saw a 7% increase in demand in recent times, ambulance services saw nearly double that. The services ambulance trusts provide have evolved from that of a transport service to that of a mobile health provider, and they have become victims of their own success. Ambulance targets have never evolved to match evolving care. Ambulance personnel strive to avoid hospital attendance where appropriate, but this can be difficult for a 24-hour service, when not all referral pathways have 24-hour referral systems. We discuss why demand might be growing disproportionately for ambulance services, and challenge the appropriateness of the targets themselves. Possible formats for revised ambulance targets are discussed. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. INTRODUKSI TEKNOLOGI INOVASI AMBUL UNTUK BUDIDAYA TANAMAN SAYURAN DI KALIMANTAN TENGAH

    Directory of Open Access Journals (Sweden)

    HASTIN ERNAWATI NUR CHUSNUL CHOTIMAH

    2014-04-01

    Full Text Available Arut Bawah is a settlement that is always flooded every year due to Kahayan river run off . Residents perform various activities on the water, and transportation between housing residents with one another, using wooden boards. The conditions is not possible if it is used to grow crops. It is certainly limiting factor for household food needs, including the need for vegetables. Flooded land use around residential has not been done because the technology is not yet known. Through these activities, the community is expected to implement one of the local knowledges of the environment-friendly cultivation in swampy areas with ambul system so that people can still grow crops to sustain life. It consists of meeting nutritional needs, as well as improving food security in water-saturated soil conditions. This community service was conducted by the various stages of 1 outreach and dissemination of technology ambul 2 training of making ambul and 3 planting a variety of vegetables in ambul. The results showed that ambul can be used as a technology for cultivation in flooded areas. The introduction of technology ambul got a positive response from residents Arut Bawah Palangkaraya Central Kalimantan. Keywords: ambul, vegetables and flooded areas.

  20. 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.

  1. An assembly model for simulation of large-scale ground water flow and transport.

    Science.gov (United States)

    Huang, Junqi; Christ, John A; Goltz, Mark N

    2008-01-01

    When managing large-scale ground water contamination problems, it is often necessary to model flow and transport using finely discretized domains--for instance (1) to simulate flow and transport near a contamination source area or in the area where a remediation technology is being implemented; (2) to account for small-scale heterogeneities; (3) to represent ground water-surface water interactions; or (4) some combination of these scenarios. A model with a large domain and fine-grid resolution will need extensive computing resources. In this work, a domain decomposition-based assembly model implemented in a parallel computing environment is developed, which will allow efficient simulation of large-scale ground water flow and transport problems using domain-wide grid refinement. The method employs common ground water flow (MODFLOW) and transport (RT3D) simulators, enabling the solution of almost all commonly encountered ground water flow and transport problems. The basic approach partitions a large model domain into any number of subdomains. Parallel processors are used to solve the model equations within each subdomain. Schwarz iteration is applied to match the flow solution at the subdomain boundaries. For the transport model, an extended numerical array is implemented to permit the exchange of dispersive and advective flux information across subdomain boundaries. The model is verified using a conventional single-domain model. Model simulations demonstrate that the proposed model operated in a parallel computing environment can result in considerable savings in computer run times (between 50% and 80%) compared with conventional modeling approaches and may be used to simulate grid discretizations that were formerly intractable.

  2. 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…

  3. 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…

  4. Simulation of ground-water flow and transport of chlorinated hydrocarbons at Graces Quarters, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Tenbus, Frederick J.; Fleck, William B.

    2001-01-01

    Military activity at Graces Quarters, a former open-air chemical-agent facility at Aberdeen Proving Ground, Maryland, has resulted in ground-water contamination by chlorinated hydrocarbons. As part of a ground-water remediation feasibility study, a three-dimensional model was constructed to simulate transport of four chlorinated hydrocarbons (1,1,2,2-tetrachloroethane, trichloroethene, carbon tetrachloride, and chloroform) that are components of a contaminant plume in the surficial and middle aquifers underlying the east-central part of Graces Quarters. The model was calibrated to steady-state hydraulic head at 58 observation wells and to the concentration of 1,1,2,2-tetrachloroethane in 58 observation wells and 101direct-push probe samples from the mid-1990s. Simulations using the same basic model with minor adjustments were then run for each of the other plume constituents. The error statistics between the simulated and measured concentrations of each of the constituents compared favorably to the error statisticst,1,2,2-tetrachloroethane calibration. Model simulations were used in conjunction with contaminant concentration data to examine the sources and degradation of the plume constituents. It was determined from this that mixed contaminant sources with no ambient degradation was the best approach for simulating multi-species solute transport at the site. Forward simulations were run to show potential solute transport 30 years and 100 years into the future with and without source removal. Although forward simulations are subject to uncertainty, they can be useful for illustrating various aspects of the conceptual model and its implementation. The forward simulation with no source removal indicates that contaminants would spread throughout various parts of the surficial and middle aquifers, with the100-year simulation showing potential discharge areas in either the marshes at the end of the Graces Quarters peninsula or just offshore in the estuaries. The

  5. Ground water flow in a desert basin: challenges of simulating transport of dissolved chromium.

    Science.gov (United States)

    Andrews, Charles B; Neville, Christopher J

    2003-01-01

    A large chromium plume that evolved from chromium releases in a valley near the Mojave River was studied to understand the processes controlling fate and migration of chromium in ground water and used as a tracer to study the dynamics of a basin and range ground water system. The valley that was studied is naturally arid with high evapotranspiration such that essentially no precipitation infiltrates to the water table. The dominant natural hydrogeologic processes are recharge to the ground water system from the Mojave River during the infrequent episodes when there is flow in the river, and ground water flow toward a playa lake where the ground water evaporates. Agricultural pumping in the valley from the mid-1930s to the 1970s significantly altered ground water flow conditions by decreasing water levels in the valley by more than 20 m. This pumping declined significantly as a result of dewatering of the aquifer, and water levels have since recovered modestly. The ground water system was modeled using MODFLOW, and chromium transport was simulated using MT3D. Several innovative modifications were made to these modeling programs to simulate important processes in this ground water system. Modifications to MODFLOW include developing a new well package that estimates pumping rates from irrigation wells at each time step based on available drawdown. MT3D was modified to account for mass trapped above the water table when the water table declines beneath nonirrigated areas and to redistribute mass to the system when water levels rise.

  6. A Critical Review of the Transport and Decay of Wake Vortices in Ground Effect

    Science.gov (United States)

    Sarpkaya, T.

    2004-01-01

    This slide presentation reviews the transport and decay of wake vortices in ground effect and cites a need for a physics-based parametric model. The encounter of a vortex with a solid body is always a complex event involving turbulence enhancement, unsteadiness, and very large gradients of velocity and pressure. Wake counter in ground effect is the most dangerous of them all. The interaction of diverging, area-varying, and decaying aircraft wake vortices with the ground is very complex because both the vortices and the flow field generated by them are altered to accommodate the presence of the ground (where there is very little room to maneuver) and the background turbulent flow. Previous research regarding vortex models, wake vortex decay mechanisms, time evolution within in ground effect of a wake vortex pair, laminar flow in ground effect, and the interaction of the existing boundary layer with a convected vortex are reviewed. Additionally, numerical simulations, 3-dimensional large-eddy simulations, a probabilistic 2-phase wake vortex decay and transport model and a vortex element method are discussed. The devising of physics-based, parametric models for the prediction of (operational) real-time response, mindful of the highly three-dimensional and unsteady structure of vortices, boundary layers, atmospheric thermodynamics, and weather convective phenomena is required. In creating a model, LES and field data will be the most powerful tools.

  7. Hourly associations between heat and ambulance calls.

    Science.gov (United States)

    Guo, Yuming

    2017-01-01

    The response speed of ambulance calls is very crucial to rescue patients suffering immediately life threatening conditions. The serious health outcomes might be caused by exposing to extreme heat only several hours before. However, limited evidence is available on this topic. This study aims to examine the hourly association between heat and ambulance calls, to improve the ambulance services and to better protect health. Hourly data on ambulance calls for non-accidental causes, temperature and air pollutants (PM10, NO2, and O3) were collected from Brisbane, Australia, during 2001 and 2007. A time-stratified case-crossover design was used to examine the associations between hourly ambulance calls and temperature during warm season (Nov, Dec, Jan, Feb, and Mar), while adjusting for potential confounders. Stratified analyses were performed for sex and age groups. Ambulance calls peaked at 10am for all groups, except those aged heat-ambulance calls relationships were non-linear for all groups, with thresholds between 27 °C and 31 °C. The associations appeared immediately, and lasted for about 24 h. There were no significant modification effect by sex and age. The findings suggest that hot hourly temperatures (>27 °C) increase the demands of ambulance. This information is helpful to increase the efficiency of ambulance service then save lives, for example, preparing more ambulance before appearance of extremely hot temperature in combination with weather forecast. Also, people should better arrange their time for outdoor activities to avoid exposing to extreme hot temperatures. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. To surrender in dependence of another: the relationship with the ambulance clinicians as experienced by patients.

    Science.gov (United States)

    Holmberg, Mats; Forslund, Kerstin; Wahlberg, Anna Carin; Fagerberg, Ingegerd

    2014-09-01

    Historically, the ambulance care has focused on acute transports and medical treatment, although ambulance care has also been reported as complex, encompassing more than just medical treatment and transports. Previous studies, on ambulance clinicians, have pointed out the importance of interpersonal caring activities complementary to the medical treatment. Those activities can be understood as taking part in the relationship between patients and ambulance clinicians, earlier described as essential and a core component of care. The aim of this study was to elucidate the meaning of the relationship with the ambulance clinicians as experienced by patients. Twenty ambulance patients were interviewed in the study. The interviews were transcribed verbatim and analysed with a phenomenological hermeneutical method to grasp meanings in the patients' experiences. The regional ethical committee approved the study. In the result emerged one main theme: To surrender in dependence of another. The main theme includes four themes: Being in the hands of another, Being in a caring temporary presence, Being important while involved and Being powerless while insignificant, and the themes comprise eleven subthemes. The main theme meant to have no other option than to surrender and to put their life into the hand of another. This surrender also meant to adapt to the clinicians' views even if not shared. This is experienced as excessive care. Summarised, the patients' experiences were both positive and negative and the findings provide a complex understanding of the relationship between the patient and the ambulance clinicians. Overall, the relationship embraces the whole person without reducing the patient to be a recipient of an objectified ambulance care. © 2013 Nordic College of Caring Science.

  9. Assessment of ground transportation stress in juvenile Kemp’s ridley sea turtles (Lepidochelys kempii)

    Science.gov (United States)

    Hunt, Kathleen E.; Innis, Charles J.; Kennedy, Adam E.; McNally, Kerry L.; Davis, Deborah G.; Burgess, Elizabeth A.; Merigo, Constance

    2016-01-01

    Sea turtle rehabilitation centres frequently transport sea turtles for long distances to move animals between centres or to release them at beaches, yet there is little information on the possible effects of transportation-related stress (‘transport stress’) on sea turtles. To assess whether transport stress is a clinically relevant concern for endangered Kemp’s ridley sea turtles (Lepidochelys kempii), we obtained pre-transport and post-transport plasma samples from 26 juvenile Kemp’s ridley sea turtles that were transported for 13 h (n = 15 turtles) or 26 h (n = 11 turtles) by truck for release at beaches. To control for effects of handling, food restriction and time of day, the same turtles were also studied on ‘control days’ 2 weeks prior to transport, i.e. with two samples taken to mimic pre-transport and post-transport timing, but without transportation. Blood samples were analysed for nine clinical health measures (pH, pCO2, pO2, HCO3, sodium, potassium, ionized calcium, lactate and haematocrit) and four ‘stress-associated’ parameters (corticosterone, glucose, white blood cell count and heterophil-to-lymphocyte ratio). Vital signs (heart rate, respiratory rate and cloacal temperature) were also monitored. Corticosterone and glucose showed pronounced elevations due specifically to transportation; for corticosterone, this elevation was significant only for the longer transport duration, whereas glucose increased significantly after both transport durations. However, clinical health measures and vital signs showed minimal or no changes in response to any sampling event (with or without transport), and all turtles appeared to be in good clinical health after both transport durations. Thus, transportation elicits a mild, but detectable, adrenal stress response that is more pronounced during longer durations of transport; nonetheless, Kemp’s ridley sea turtles can tolerate ground transportation of up to 26 h in good health. These

  10. 75 FR 8412 - Office of New Reactors: Interim Staff Guidance on Assessing Ground Water Flow and Transport of...

    Science.gov (United States)

    2010-02-24

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Office of New Reactors: Interim Staff Guidance on Assessing Ground Water Flow and Transport of... Sections 2.4.12 and 2.4.13 regarding the assessment of ground water flow and transport of...

  11. Ambulance services as part of the district health system in low-income countries: a feasibility study from Cambodia.

    Science.gov (United States)

    Jacobs, Bart; Men, Cheanrithy; Sam, Oeun Sam; Postma, Sjoerd

    2016-10-01

    Emergency referral care is considered an essential component of the district health system. Nevertheless, the establishment of effective and durable transport arrangements of such referral care by use of an ambulance is considered controversial in low-income countries. We aim to assess the extent to which an ambulance service as part of the district health system is feasible in rural Cambodia. In a rural health district, we assessed the population's perception of the ambulance service, its recurrent costs requirements, government financial contribution to its operations, profile and medical conditions of ambulance (non)users, reasons for (non)use of the ambulance and contextual factors required for the ambulance services to operate. This observation was obtained through nine key informant interviews, five focus group discussions, structured interviews with 225 caretakers of admitted patients, a 1-month census of admitted emergency cases and assessment of annual recurrent costs for the ambulance services. The ambulance services were well received by the population and authorities and appeared to reinforce an appreciation of the hospital. Ambulance services were mainly used by the poor and by women, especially for emergency obstetric care. Less than half the number of transported patients, 44%, was considered a medical emergency. The direct cost to the hospital per collected emergency case was $34.4. When certain conditions are met, effective ambulance services can be an integral part of the district health system and positively contribute to the population's appreciation of the hospital services and respective district health system. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  12. Ambulance demand: random events or predicable patterns?

    Science.gov (United States)

    Cantwell, Kate; Dietze, Paul; Morgans, Amee E; Smith, Karen

    2013-11-01

    Occupational, social and recreational routines follow temporal patterns, as does the onset of certain acute medical diseases and injuries. It is not known if the temporal nature of injury and disease transfers into patterns that can be observed in ambulance demand. This review examines eligible study findings that reported temporal (time of day, day of week and seasonal) patterns in ambulance demand. Electronic searches of Medline and Cumulative Index of Nursing and Allied Health Literature were conducted for papers published between 1980 and 2011. In addition, hand searching was conducted for unpublished government and ambulance service documents and reports for the same period. 38 studies examined temporal patterns in ambulance demand. Six studies reported trends in overall workload and 32 studies reported trends in a subset of ambulance demand, either as a specific case type or demographic group. Temporal patterns in overall demand were consistent between jurisdictions for time of day but varied for day of week and season. When analysed by case type, all jurisdictions reported similar time of day patterns, most jurisdictions had similar day of week patterns except for out-of-hospital cardiac arrest and similar seasonal patterns, except for trauma. Temporal patterns in case types were influenced by age and gender. Temporal patterns are present in ambulance demand and importantly these populations are distinct from those found in hospital datasets suggesting that variation in ambulance demand should not be inferred from hospital data alone. Case types seem to have similar temporal patterns across jurisdictions; thus, research where demand is broken down into case types would be generalisable to many ambulance services. This type of research can lead to improvements in ambulance service deliverables.

  13. 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...

  14. 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.

  15. The on-line electric vehicle wireless electric ground transportation systems

    CERN Document Server

    Cho, Dong

    2017-01-01

    This book details the design and technology of the on-line electric vehicle (OLEV) system and its enabling wireless power-transfer technology, the “shaped magnetic field in resonance” (SMFIR). The text shows how OLEV systems can achieve their three linked important goals: reduction of CO2 produced by ground transportation; improved energy efficiency of ground transportation; and contribution to the amelioration or prevention of climate change and global warming. SMFIR provides power to the OLEV by wireless transmission from underground cables using an alternating magnetic field and the reader learns how this is done. This cable network will in future be part of any local smart grid for energy supply and use thereby exploiting local and renewable energy generation to further its aims. In addition to the technical details involved with design and realization of a fleet of vehicles combined with extensive subsurface charging infrastructure, practical issues such as those involved with pedestrian safety are c...

  16. Swedish ambulance managers' descriptions of crisis support for ambulance staff after potentially traumatic events.

    Science.gov (United States)

    Hugelius, Karin; Berg, Sara; Westerberg, Elin; Gifford, Mervyn; Adolfsson, Annofie

    2014-12-01

    Ambulance staff face complex and sometimes stressful or potentially traumatic situations, not only in disasters but also in their routine daily work. The aim of this study was to survey ambulance managers' descriptions of crisis support interventions for ambulance staff after potential traumatic events (PTEs). Semistructured interviews with a qualitative descriptive design were conducted with six ambulance managers in a health care region in central Sweden. The data was analyzed using content analysis. Five categories were found in the result: (1) description of a PTE; (2) description and performance of crisis support interventions; (3) impact of working in potentially traumatic situations; (4) the ambulance managers' role in crisis support interventions; and (5) the ambulance managers' suggestions for improvement. Ambulance managers described crisis support interventions after a PTE as a single, mandatory group meeting with a structure reminiscent of debriefing. The ambulance managers also expressed doubts about the present structures for crisis support and mentioned an alternative approach which is more in line with present evidence-based recommendations. The results indicated a need for increased understanding of the importance of the managers' attitudes for ambulance staff; a need for further implementation of evidence-based recommendations for crisis support interventions was also highlighted.

  17. Ambulance Reasonable Charge Public Use Files

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulance Reasonable Charge public use files for calendar years (CY) 2003 through 2005 are located in the Downloads section below. These public use files are...

  18. Occupational hazards in a public ambulance service.

    Science.gov (United States)

    Constantin, Brânduşa; Morariu, S; Duma, Olga Odetta

    2013-01-01

    To identify the occupational risks in an ambulance service and to assess their impact on the health of employees. Two marched groups (number, sex, age, length of exposure) from two different work sectors were selected. A 60 item questionnaire was used. The 60 items were grouped into four categories related to work organization, work environment, neuropsychosensorial risk factors and health system and occupational safety-related risk factors and hazards. The data were statistically processed, significant correlations between the risk factors and the associated symptoms being found. Compared to the control group, significantly higher values (pground, carrying weight, vicious postures) were found in ambulance service staff; cervical and lumbar spine problems were the most common complaints of ambulance service staff. The specific risk factors for ambulance service employees directly related to musculoskeletal disorders have been established.

  19. How the context of ambulance care influences learning to become a specialist ambulance nurse a Swedish perspective.

    Science.gov (United States)

    Axelsson, Christer; Herrera, Maria Jimenez; Bång, Angela

    2016-02-01

    Ambulance emergency care is multifaceted with extraordinary challenges to implement accurate assessment and care. A clinical learning environment providing opportunities for mastering these essential skills is a key component in ensuring that prehospital emergency nurse (PEN) students acquire the necessary clinical competence. The aim is to understand how PEN students experience their clinically based training, focusing on their learning process. We applied content analysis with its qualitative method to our material that consisted of three reflections each by 28 PEN students over their learning process during their 8 weeks of clinical ambulance practice. The research was carried out at the Center for Prehospital Care, University of Borås, Sweden. The broad spectrum of ambulance assignments seems to awaken great uncertainty and excessive respect in the students. Student vulnerability appears to decrease when the clinical supervisor behaves calmly, knowledgeably, confidently and reflectively. Early traumatic incidents on the other hand may increase the students' anxiety. Each student is offered a unique opportunity to learn how to approach patients and relatives in their own environments, and likewise an opportunity to gather information for assessment. Infrequency of missions seems to make PEN students less active in their student role, thereby preventing them from availing themselves of potential learning situations. Fatigue and hunger due to lack of breaks or long periods of transportation also inhibit learning mode. Our findings suggest the need for appraisal of the significance of the clinical supervisor, the ambulance environment, and student vulnerability. The broad spectrum of conditions in combination with infrequent assignments make simulation necessary. However, the unique possibilities provided for meeting patients and relatives in their own environments offer the PEN student excellent opportunities for learning how to make assessments. Copyright

  20. [Examination of work-related stress and coping strategies among ambulance- and air-ambulance workers].

    Science.gov (United States)

    Schiszler, Bence; Karamánné Pakai, Annamária; Szabó, Zoltán; Raposa, László Bence; Pónusz, Róbert; Radnai, Balázs; Endrei, Dóra

    2016-11-01

    Among Hungary's health sector workers the presence of a high level of stress is known, which can affect the individual. The aim of the authors was to uncover major risk factors causing work-related stress, as well as its extent, and positive and negative coping strategies among ground and aerial rescue workers. From June until October 2015, a national survey was conducted among Hungarian rescue workers. An own questionnaire and Rahe Stress and coping validated short questionnaire online form were used. A total of 141 persons took part in the survey. As compared to air-ambulance workers, ground rescue workers were exposed to higher work-related stress effects (p<0.01), resulting in a much larger variety of physical and psychological symptoms (p<0.05). Based on Global Stress and Coping Index effective coping mechanisms were observed among air rescue workers (p<0.01). It is important to perform regular professional theoretical and practical training. Human resource management should pay attention on occupational stress reduction. Orv. Hetil., 2016, 157(45), 1802-1808.

  1. Transport and distribution of nutrients in anchovy spawning ground to the southern waters of Shandong Peninsula

    Institute of Scientific and Technical Information of China (English)

    Gao Shengquan; Lin Yi'an; Jin Mingming; Liu Xiaoya

    2003-01-01

    The distribution of nutrients and the effect of side transport of nutrients on anchovy spawning ground to the southern waters of Shandong Peninsula are discussed based on the data collected in June 2000, May and June 2001. The coastal current and upwelling are the main physical processes of nutrient transport to the southern waters of Shandong Peninsula. The concentrations of nutrients, Chla, the density of anchovy eggs, larva and juvenile fish increase obviously where they are greatly affected by these processes, while the contents of nutrients and Chl-a, the density of anchovy eggs, larva and juvenile fish decrease significantly where these processes diminish or disappear. The investigation suggest that the side transport of nutrients by Lubei (North Shandong) coastal current in the northern area causes the Chl-a content to be high and dense anchovy eggs, larva and juvenile fish to be dense in the coastal area of the Chengshan Cape. In the southern area, the riverine input from Subei irrigation ditch with high content of nutrients inshore and upwelling in the western edge of the Huanghai Sea Cold Water offshore should be responsible for high Chl-a concentration and dense anchovy eggs, larva and juvenile fish.It is possible that these processes of nutrient transport have controlled the anchovy spawning ground to the southem waters of Shandong Peninsula.

  2. 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

  3. Universal access to ambulance does not increase overall demand for ambulance services in Queensland, Australia.

    Science.gov (United States)

    Tippett, Vivienne C; Toloo, Ghasem Sam; Eeles, David; Ting, Joseph Y S; Aitken, Peter J; Fitzgerald, Gerard J

    2013-02-01

    To determine the impact of the introduction of universal access to ambulance services via the implementation of the Community Ambulance Cover (CAC) program in Queensland in 2003-04. The study involved a 10-year (2000-01 to 2009-10) retrospective analysis of routinely collected data reported by the Queensland Ambulance Service (QAS) and by the Council of Ambulance Authorities. The data were analysed for the impact of policy changes that resulted in universal access to ambulance services in Queensland. QAS is a statewide, publically funded ambulance service. In Queensland, ambulance utilisation rate (AUR) per 1000 persons grew by 41% over the decade or 3.9% per annum (10-year mean=149.8, 95% CI: 137.3-162.3). The AUR mean after CAC was significantly higher for urgent incidents than for non-urgent ones. However projection modelling demonstrates that URs after the introduction of CAC were significantly lower than the projected utilisation for the same period. The introduction of universal access under the Community Ambulance Cover program in Queensland has not had any significant independent long-term impact on demand overall. There has been a reduction in the long-term growth rate, which may have been contributed to by an 'appropriate use' public awareness program.

  4. Is helicopter evacuation effective in rural trauma transport?

    Science.gov (United States)

    Rose, Melanie K; Cummings, G R; Rodning, Charles B; Brevard, Sid B; Gonzalez, Richard P

    2012-07-01

    Helicopter transport for trauma remains controversial because its appropriate utilization and efficacy with regard to improved survival is unproven. The purpose of this study was to assess rural trauma helicopter transport utilization and effect on patient survival. A retrospective chart review over a 2-year period (2007-2008) was performed of all rural helicopter and ground ambulance trauma patient transports to an urban Level I trauma center. Data was collected with regard to patient mortality and Injury Severity Score (ISS). Miles to the Level I trauma center were calculated from the point where helicopter or ground ambulance transport services initiated contact with the patient to the Level I trauma center. During the 2-year period, 1443 rural trauma patients were transported by ground ambulance and 1028 rural trauma patients were transported by helicopter. Of the patients with ISS of 0 to 10, 471 patients were transported by helicopter and 1039 transported by ground. There were 465 (99%) survivors with ISS 0 to 10 transported by helicopter with an average transport distance of 34.6 miles versus 1034 (99.5%) survivors with ISS 0 to 10 who were transported by ground an average of 41.0 miles. Four hundred and twenty-one patients with ISS 11 to 30 were transported by helicopter an average of 33.3 miles with 367 (87%) survivors versus a 95 per cent survival in 352 patients with ISS 11 to 30 who were transported by ground an average of 39.9 miles. One hundred and thirty-six patients with ISS > 30 were transported by helicopter an average of 32.8 miles with 78 (57%) survivors versus a 69 per cent survival in 52 patients with ISS > 30 who were transported by ground an average of 33.0 miles. Helicopter transport does not seem to improve survival in severely injured (ISS > 30) patients. Helicopter transport does not improve survival and is associated with shorter travel distances in less severely injured (ISS < 10) patients in rural areas. This data questions effective

  5. 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....

  6. A Prevalence and Management Study of Acute Pain in Children Attending Emergency Departments by Ambulance.

    Science.gov (United States)

    Murphy, Adrian; McCoy, Siobhan; O'Reilly, Kay; Fogarty, Eoin; Dietz, Jason; Crispino, Gloria; Wakai, Abel; O'Sullivan, Ronan

    2016-01-01

    Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (ambulance, of which 2,635 (41.4%, 95% confidence interval 40.2-42.3%) had pain as a documented symptom on the ambulance patient care report (PCR) form. Overall 32% (n = 856) of children who complained of pain were subject to a formal pain assessment during the prehospital phase of care. Younger age, short transfer time to the ED, and emergency calls between midnight and 6 am were independently associated with decreased likelihood of having a documented assessment of pain intensity during the prehospital phase of care. Of the 2,635 children who had documented pain on the ambulance PCR, 26% (n = 689) received some form of analgesic agent prior to ED arrival. Upon ED arrival 54% (n = 1,422) of children had a documented pain assessment and some form of analgesic agent was administered to 50% (n = 1,324). Approximately 41% of children who attend EDs in Ireland by ambulance have pain documented as their primary symptom. This study suggests that the management of acute pain in children transferred by ambulance to the ED in Ireland is currently poor, with documentary evidence of only 26% receiving prehospital analgesic agents.

  7. A comparison of actual versus predicted emergency ambulance journey times using generic Geographic Information System software.

    Science.gov (United States)

    McMeekin, Peter; Gray, Jo; Ford, Gary A; Duckett, Jay; Price, Christopher I

    2014-09-01

    The planning of regional emergency medical services is aided by accurate prediction of urgent ambulance journey times, but it is unclear whether it is appropriate to use Geographical Information System (GIS) products designed for general traffic. We examined the accuracy of a commercially available generic GIS package when predicting emergency ambulance journey times under different population and temporal conditions. We undertook a retrospective cohort study of emergency ambulance admissions to three emergency departments (ED) serving differing population distributions in northeast England (urban/suburban/rural). The transport time from scene to ED for all the highest priority dispatches between 1 October 2009 and 30 September 2010 was compared with predictions made by generic GIS software. For 10,156 emergency ambulance journeys, the mean prediction discrepancy between actual and predicted journey times across all EDs was an underprediction of 1.6 min (SD 4.9). Underprediction was statistically significant at all population densities, but unlikely to be of clinical significance. Ambulances in urban areas were able to exceed general traffic speed, whereas, the opposite effect was seen in suburban and rural road networks. There were minor effects due to travel outside the busiest traffic times (mean overprediction 0.8 min) and during winter months (mean underprediction 0.4 min). It is reasonable to estimate emergency ambulance journey times using generic GIS software, but in order to avoid insufficient regional ambulance provision it would be necessary to make small adjustments because of the tendency towards systematic underprediction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. 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......-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...

  9. Technology benefits and ground test facilities for high-speed civil transport development

    Science.gov (United States)

    Winston, Matthew M.; Shields, Elwood M.; Morris, Shelby J., Jr.

    1992-01-01

    The advanced technology base necessary for successful twenty-first century High-Speed Civil Transport (HSCT) aircraft will require extensive ground testing in aerodynamics, propulsion, acoustics, structures, materials, and other disciplines. This paper analyzes the benefits of advanced technology application to HSCT concepts, addresses the adequacy of existing groundbased test facilities, and explores the need for new facilities required to support HSCT development. A substantial amount of HSCT-related ground testing can be accomplished in existing facilities. The HSCT development effort could also benefit significantly from some new facilities initially conceived for testing in other aeronautical research areas. A new structures testing facility is identified as critically needed to insure timely technology maturation.

  10. Factors associated with ambulance use among patients with low-acuity conditions.

    Science.gov (United States)

    Durant, Edward; Fahimi, Jahan

    2012-01-01

    The use of ambulances for low-acuity medical complaints depletes emergency medical services (EMS) resources that could be used for higher-acuity conditions and contributes to emergency department (ED) overcrowding and ambulance diversion. Objective. We sought to understand the characteristics of patients who use ambulances for low-acuity conditions. We hypothesized that patients who arrive to the ED by ambulance for low-acuity conditions are more likely to be members of vulnerable populations. A secondary analysis was performed on the National Hospital Ambulatory Medical Care Survey (NHAMCS). We included only patients aged 18 years or older who were triaged to the "nonurgent" category upon presentation to the ED. To compare patients who arrived by ambulance with those who arrived by all other modes, multivariate logistic regression was performed using a generalized linear model, and adjusted relative risks (ARRs) were calculated. A total of 16,109 records from 1997 to 2008 (excluding 2001-2002) were included in the analysis. Significantly higher rates of ambulance use for low-acuity conditions were associated with: 1) older age (ARR 1.30, 95% confidence interval [CI]: 1.18-1.43; per 10 years); 2) Medicare or Medicaid insurance (ARR 1.81, 95% CI: 1.36-2.41, and ARR 1.46, 95% CI: 1.12-1.91, respectively); 3) homelessness (ARR 3.30, 95% CI: 1.61-6.78); 4) arrival between 11 pm and 6:59 am (ARR 1.80, 95% CI: 1.43-2.27); and 5) certain chief complaint categories: psychiatric (ARR 1.78, 95% CI: 1.03-3.07), toxicologic/poisoning (ARR 3.26, 95% CI: 1.85-5.76), and neurologic/psychological (ARR 1.71, 95% CI: 1.34-2.18). Patients who arrived by ambulance were more likely than nonambulance patients to receive laboratory diagnostic tests (ARR 3.50, 95% CI: 2.80-4.39), radiographic imaging (ARR 2.26, 95% CI: 1.91-2.68), and admission to the hospital (ARR 3.99, 95% CI: 3.03-5.27). Our study builds on a body of work highlighting the factors associated with ambulance transport to

  11. 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

  12. 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.

  13. ECONOMIC AND LEGAL GROUNDS FOR INVESTMENT IN DEVELOPMENT OF TRANSPORT INFRASTRUCTURE

    Directory of Open Access Journals (Sweden)

    V. V. Zhelezniak

    2017-02-01

    Full Text Available Purpose. In Ukraine, as in many countries of the world, transport is one of the most fundamental sectors of the national economy, important part of the industrial and social spheres. But in the conditions of industry reforming there are problems of investing in development of rail transport. So the work is devoted to the grounds of potentially available sources of investment in infrastructure of railway transport of Ukraine. The work stresses the importance of the problem of attracting foreign investment in the economy, highlights the proposals to solve this problem. Methodology. To solve the problems of this class the work presents the proposed methods of analysis, synthesis and comparison, deduction, induction, logic and abstraction. It becomes necessary to search for and study of new conceptual approaches to organization of investment processes at railway transport enterprises, appropriate management and financial decisions and schemes of railway infrastructure development. Findings. The paper shows ways to optimize investment for modernization and technical re-equipment of the transport complex of Ukraine. It proposes the ways of attracting capital of investors for development of transport infrastructure: compliance with European laws and regulations; reforming of the tax system of Ukraine; combating corruption in the country; implementation of public-private partnership tools into the mechanism of state regulation of investment processes; creating a favourable investment climate for implementation of rail transport infrastructure projects; creating a system of compensation to investors; guarantees of transport infrastructure investment protection. Originality. The work offers the sources of investment for development of railway infrastructure in Ukraine, which should include: state budget funds, use of targeted loans and leasing. The main direction of the state policy concerning infrastructure should be a gradual transition of activity in

  14. Reactive chemical transport in ground-water hydrology: Challenges to mathematical modeling

    Energy Technology Data Exchange (ETDEWEB)

    Narasimhan, T.N.; Apps, J.A.

    1990-07-01

    For a long time, earth scientists have qualitatively recognized that mineral assemblages in soils and rocks conform to established principles of chemistry. In the early 1960's geochemists began systematizing this knowledge by developing quantitative thermodynamic models based on equilibrium considerations. These models have since been coupled with advective-dispersive-diffusive transport models, already developed by ground-water hydrologists. Spurred by a need for handling difficult environmental issues related to ground-water contamination, these models are being improved, refined and applied to realistic problems of interest. There is little doubt that these models will play an important role in solving important problems of engineering as well as science over the coming years. Even as these models are being used practically, there is scope for their improvement and many challenges lie ahead. In addition to improving the conceptual basis of the governing equations, much remains to be done to incorporate kinetic processes and biological mediation into extant chemical equilibrium models. Much also remains to be learned about the limits to which model predictability can be reasonably taken. The purpose of this paper is to broadly assess the current status of knowledge in modeling reactive chemical transport and to identify the challenges that lie ahead.

  15. Association between ambulance dispatch priority and patient condition.

    Science.gov (United States)

    Ball, Stephen J; Williams, Teresa A; Smith, Karen; Cameron, Peter; Fatovich, Daniel; O'Halloran, Kay L; Hendrie, Delia; Whiteside, Austin; Inoue, Madoka; Brink, Deon; Langridge, Iain; Pereira, Gavin; Tohira, Hideo; Chinnery, Sean; Bray, Janet E; Bailey, Paul; Finn, Judith

    2016-12-01

    To compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition. This was a retrospective whole-of-population study of emergency ambulance dispatch in Perth, Western Australia, 1 January 2014 to 30 June 2015. Dispatch priority was categorised as either Priority 1 (high priority), or Priority 2 or 3. Patient condition was categorised as time-critical for patient(s) transported as Priority 1 to hospital or who died (and resuscitation was attempted by paramedics); else, patient condition was categorised as less time-critical. The χ(2) statistic was used to compare chief complaints by false omission rate (percentage of Priority 2 or 3 dispatches that were time-critical) and positive predictive value (percentage of Priority 1 dispatches that were time-critical). We also reported sensitivity and specificity. There were 211 473 cases of dispatch. Of 99 988 cases with Priority 2 or 3 dispatch, 467 (0.5%) were time-critical. Convulsions/seizures and breathing problems were highlighted as having more false negatives (time-critical despite Priority 2 or 3 dispatch) than expected from the overall false omission rate. Of 111 485 cases with Priority 1 dispatch, 6520 (5.8%) were time-critical. Our analysis highlighted chest pain, heart problems/automatic implanted cardiac defibrillator, unknown problem/collapse, and headache as having fewer true positives (time-critical and Priority 1 dispatch) than expected from the overall positive predictive value. Scope for reducing under-triage and over-triage of ambulance dispatch varies between chief complaints of the Medical Priority Dispatch System. The highlighted chief complaints should be considered for future research into improving ambulance dispatch system performance. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  16. PHAST--a program for simulating ground-water flow, solute transport, and multicomponent geochemical reactions

    Science.gov (United States)

    Parkhurst, David L.; Kipp, Kenneth L.; Engesgaard, Peter; Charlton, Scott R.

    2004-01-01

    The computer program PHAST simulates multi-component, reactive solute transport in three-dimensional saturated ground-water flow systems. PHAST is a versatile ground-water flow and solute-transport simulator with capabilities to model a wide range of equilibrium and kinetic geochemical reactions. The flow and transport calculations are based on a modified version of HST3D that is restricted to constant fluid density and constant temperature. The geochemical reactions are simulated with the geochemical model PHREEQC, which is embedded in PHAST. PHAST is applicable to the study of natural and contaminated ground-water systems at a variety of scales ranging from laboratory experiments to local and regional field scales. PHAST can be used in studies of migration of nutrients, inorganic and organic contaminants, and radionuclides; in projects such as aquifer storage and recovery or engineered remediation; and in investigations of the natural rock-water interactions in aquifers. PHAST is not appropriate for unsaturated-zone flow, multiphase flow, density-dependent flow, or waters with high ionic strengths. A variety of boundary conditions are available in PHAST to simulate flow and transport, including specified-head, flux, and leaky conditions, as well as the special cases of rivers and wells. Chemical reactions in PHAST include (1) homogeneous equilibria using an ion-association thermodynamic model; (2) heterogeneous equilibria between the aqueous solution and minerals, gases, surface complexation sites, ion exchange sites, and solid solutions; and (3) kinetic reactions with rates that are a function of solution composition. The aqueous model (elements, chemical reactions, and equilibrium constants), minerals, gases, exchangers, surfaces, and rate expressions may be defined or modified by the user. A number of options are available to save results of simulations to output files. The data may be saved in three formats: a format suitable for viewing with a text editor; a

  17. 29 CFR 553.215 - Ambulance and rescue service employees.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Ambulance and rescue service employees. 553.215 Section 553... Protection and Law Enforcement Employees of Public Agencies Exemption Requirements § 553.215 Ambulance and rescue service employees. (a) Ambulance and rescue service employees of a public agency other than a fire...

  18. Transportable optical ground station for high-speed free-space laser communication

    Science.gov (United States)

    Shrestha, Amita; Brechtelsbauer, Martin

    2012-10-01

    Near real-time data downlinks from aircrafts, satellites and high altitude platforms via high-speed laser commu- nication links is an important research topic at the Institute of Communications and Navigation of the German Aerospace Center (DLR). Ground stations for such scenarios are usually fixed at a certain location. With a mo- tivation to provide a ground station that is quickly and easily deployed anywhere in the world, a transportable optical ground station (TOGS) has been developed. TOGS features a pneumatically deployable Cassegrain-type telescope with main mirror diameter of 60 cm, including optical tracking and receiving system. For calibration of position and attitude, multiple sensors like dual-antenna GPS and inclination sensors have been installed. In order to realize these systems, robust software that operates and controls them is essential. The software is platform independent and is aimed to be used on both mobile and ground terminals. It includes implementa- tion of accurate pointing, acquisition and tracking algorithms, hardware drivers, and user interfaces. Important modules of the software are GPS tracking, optical tracking, star- and satellite tracking, and calibration of the TOGS itself. Recently, a first successful data-downlink from an aircraft to TOGS using GPS tracking has been performed. To streamline the software development and testing process, some simulation environments like mount simulator, aircraft path simulator, tracking camera simulator and tracking error analysis tool have also been developed. This paper presents the overall hardware/software structure of the TOGS, and gives results of the tracking accuracy improvement techniques like GPS extrapolation and optical tracking.

  19. Dynamic ambulance reallocation for the reduction of ambulance response times using system status management.

    Science.gov (United States)

    Lam, Sean Shao Wei; Zhang, Ji; Zhang, Zhong Cheng; Oh, Hong Choon; Overton, Jerry; Ng, Yih Yng; Ong, Marcus Eng Hock

    2015-02-01

    Dynamically reassigning ambulance deployment locations throughout a day to balance ambulance availability and demands can be effective in reducing response times. The objectives of this study were to model dynamic ambulance allocation plans in Singapore based on the system status management (SSM) strategy and to evaluate the dynamic deployment plans using a discrete event simulation (DES) model. The geographical information system-based analysis and mathematical programming were used to develop the dynamic ambulance deployment plans for SSM based on ambulance calls data from January 1, 2011, to June 30, 2011. A DES model that incorporated these plans was used to compare the performance of the dynamic SSM strategy against static reallocation policies under various demands and travel time uncertainties. When the deployment plans based on the SSM strategy were followed strictly, the DES model showed that the geographical information system-based plans resulted in approximately 13-second reduction in the median response times compared to the static reallocation policy, whereas the mathematical programming-based plans resulted in approximately a 44-second reduction. The response times and coverage performances were still better than the static policy when reallocations happened for only 60% of all the recommended moves. Dynamically reassigning ambulance deployment locations based on the SSM strategy can result in superior response times and coverage performance compared to static reallocation policies even when the dynamic plans were not followed strictly. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Guide to the Revised Ground-Water Flow and Heat Transport Simulator: HYDROTHERM - Version 3

    Science.gov (United States)

    Kipp, Kenneth L.; Hsieh, Paul A.; Charlton, Scott R.

    2008-01-01

    The HYDROTHERM computer program simulates multi-phase ground-water flow and associated thermal energy transport in three dimensions. It can handle high fluid pressures, up to 1 ? 109 pascals (104 atmospheres), and high temperatures, up to 1,200 degrees Celsius. This report documents the release of Version 3, which includes various additions, modifications, and corrections that have been made to the original simulator. Primary changes to the simulator include: (1) the ability to simulate unconfined ground-water flow, (2) a precipitation-recharge boundary condition, (3) a seepage-surface boundary condition at the land surface, (4) the removal of the limitation that a specified-pressure boundary also have a specified temperature, (5) a new iterative solver for the linear equations based on a generalized minimum-residual method, (6) the ability to use time- or depth-dependent functions for permeability, (7) the conversion of the program code to Fortran 90 to employ dynamic allocation of arrays, and (8) the incorporation of a graphical user interface (GUI) for input and output. The graphical user interface has been developed for defining a simulation, running the HYDROTHERM simulator interactively, and displaying the results. The combination of the graphical user interface and the HYDROTHERM simulator forms the HYDROTHERM INTERACTIVE (HTI) program. HTI can be used for two-dimensional simulations only. New features in Version 3 of the HYDROTHERM simulator have been verified using four test problems. Three problems come from the published literature and one problem was simulated by another partially saturated flow and thermal transport simulator. The test problems include: transient partially saturated vertical infiltration, transient one-dimensional horizontal infiltration, two-dimensional steady-state drainage with a seepage surface, and two-dimensional drainage with coupled heat transport. An example application to a hypothetical stratovolcano system with unconfined

  1. Sound and vibration: effects on infants' heart rate and heart rate variability during neonatal transport.

    Science.gov (United States)

    Karlsson, Björn-Markus; Lindkvist, Marie; Lindkvist, Markus; Karlsson, Marcus; Lundström, Ronnie; Håkansson, Stellan; Wiklund, Urban; van den Berg, Johannes

    2012-02-01

    To measure the effect of sound and whole-body vibration on infants' heart rate and heart rate variability during ground and air ambulance transport. Sixteen infants were transported by air ambulance with ground ambulance transport to and from the airports. Whole-body vibration and sound levels were recorded and heart parameters were obtained by ECG signal. Sound and whole-body vibration levels exceeded the recommended limits. Mean whole-body vibration and sound levels were 0.19 m/s(2) and 73 dBA, respectively. Higher whole-body vibration was associated with a lower heart rate (p < 0.05), and higher sound level was linked to a higher heart rate (p = 0.05). The heart rate variability was significantly higher at the end of the transport than at the beginning (p < 0.01). Poorer physiological status was associated with lower heart rate variability (p < 0.001) and a lower heart rate (p < 0.01). Infants wearing earmuffs had a lower heart rate (p < 0.05). Sound and whole-body vibration during neonatal transport exceed recommended levels for adults, and sound seem to have a more stressful effect on the infant than vibrations. Infants should wear earmuffs during neonatal transport because of the stress-reducing effect. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

  2. Characterization of the Hanford 300 area burial grounds. Task IV. Biological transport

    Energy Technology Data Exchange (ETDEWEB)

    Fitzner, R.E.; Gano, K.A.; Rickard, W.H.; Rogers, L.E.

    1979-10-01

    The characteristics of radioactive waste burial sites at the 300 area burial grounds on the Department of Energy's Hanford Site, southeastern Washington were studied. The potential vectors of radionuclide transport studied were vegetation and animals. The overall results showed a low potential for uptake and transport of radionuclides from the 300 area sites. However, additional methods to control physical and biological mechanisms may contribute to the effectiveness of waste burial practices. From the results, the Biological Transport task recommended field studies which include reduction of soil erosion and addition of biobarriers to plants and animals. Vegetation plays a major role in reducing soil erosion, and thereby maintaining the backfill over the burial sites. Of the several species found on the 300 area sites, cheatgrass (Bromus tectorum) appears to be the most desirable as a cover. Besides retarding erosion, it has a shallow root system (does not easily penetrate buried material); it has a low affinity for radionuclide uptake; and its tissues are not easily blown away. Small mammals (specifically, mice) appear to have the most potential for radionuclide exposure and uptake. Small mammals were live-trapped within 10 x 10-meter trap grids. Each animal trapped was surgically implanted with a thermoluminescent dosimeter. When the animal was recaptured, the dosimeter was removed and read for exposure. Exposures were reported in milli-Roentgens. The most consistently trapped small mammals were the Great Basin pocket mouse (Perognathus parvus) and the deer mouse (Peromyscus maniculatus). Results from the dosimeter readings showed that some of those animals had higher than background exposures. Biobarriers to animals could be considered as a mechanism to reduce the potential for radionuclide transport.

  3. 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。

  4. 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...

  5. A Systems Approach to Developing an Affordable Space Ground Transportation Architecture using a Commonality Approach

    Science.gov (United States)

    Garcia, Jerry L.; McCleskey, Carey M.; Bollo, Timothy R.; Rhodes, Russel E.; Robinson, John W.

    2012-01-01

    This paper presents a structured approach for achieving a compatible Ground System (GS) and Flight System (FS) architecture that is affordable, productive and sustainable. This paper is an extension of the paper titled "Approach to an Affordable and Productive Space Transportation System" by McCleskey et al. This paper integrates systems engineering concepts and operationally efficient propulsion system concepts into a structured framework for achieving GS and FS compatibility in the mid-term and long-term time frames. It also presents a functional and quantitative relationship for assessing system compatibility called the Architecture Complexity Index (ACI). This paper: (1) focuses on systems engineering fundamentals as it applies to improving GS and FS compatibility; (2) establishes mid-term and long-term spaceport goals; (3) presents an overview of transitioning a spaceport to an airport model; (4) establishes a framework for defining a ground system architecture; (5) presents the ACI concept; (6) demonstrates the approach by presenting a comparison of different GS architectures; and (7) presents a discussion on the benefits of using this approach with a focus on commonality.

  6. Computer model of two-dimensional solute transport and dispersion in ground water

    Science.gov (United States)

    Konikow, Leonard F.; Bredehoeft, J.D.

    1978-01-01

    This report presents a model that simulates solute transport in flowing ground water. The model is both general and flexible in that it can be applied to a wide range of problem types. It is applicable to one- or two-dimensional problems involving steady-state or transient flow. The model computes changes in concentration over time caused by the processes of convective transport, hydrodynamic dispersion, and mixing (or dilution) from fluid sources. The model assumes that the solute is non-reactive and that gradients of fluid density, viscosity, and temperature do not affect the velocity distribution. However, the aquifer may be heterogeneous and (or) anisotropic. The model couples the ground-water flow equation with the solute-transport equation. The digital computer program uses an alternating-direction implicit procedure to solve a finite-difference approximation to the ground-water flow equation, and it uses the method of characteristics to solve the solute-transport equation. The latter uses a particle- tracking procedure to represent convective transport and a two-step explicit procedure to solve a finite-difference equation that describes the effects of hydrodynamic dispersion, fluid sources and sinks, and divergence of velocity. This explicit procedure has several stability criteria, but the consequent time-step limitations are automatically determined by the program. The report includes a listing of the computer program, which is written in FORTRAN IV and contains about 2,000 lines. The model is based on a rectangular, block-centered, finite difference grid. It allows the specification of any number of injection or withdrawal wells and of spatially varying diffuse recharge or discharge, saturated thickness, transmissivity, boundary conditions, and initial heads and concentrations. The program also permits the designation of up to five nodes as observation points, for which a summary table of head and concentration versus time is printed at the end of the

  7. Ground transport stress affects bacteria in the rumen of beef cattle: A real-time PCR analysis.

    Science.gov (United States)

    Deng, Lixin; He, Cong; Zhou, Yanwei; Xu, Lifan; Xiong, Huijun

    2016-10-03

    Transport stress syndrome often appears in beef cattle during ground transportation, leading to changes in their capacity to digest food due to changes in rumen microbiota. The present study aimed to analyze bacteria before and after cattle transport. Eight Xianan beef cattle were transported over 1000 km. Rumen fluid and blood were sampled before and after transport. Real-time PCR was used to quantify rumen bacteria. Cortisol and adrenocorticotrophic hormone (ACTH) were measured. Cortisol and ACTH were increased on day 1 after transportation and decreased by day 3. Cellulolytic bacteria (Fibrobacter succinogenes and Ruminococcus flavefaciens), Ruminococcus amylophilus and Prevotella albensis were increased at 6 h and declined by 15 days after transport. There was a significant reduction in Succinivibrio dextrinosolvens, Prevotella bryantii, Prevotella ruminicola and Anaerovibrio lipolytica after transport. Rumen concentration of acetic acid increased after transport, while rumen pH and concentrations of propionic and butyric acids were decreased. Body weight decreased by 3 days and increased by 15 days after transportation. Using real-time PCR analysis, we detected changes in bacteria in the rumen of beef cattle after transport, which might affect the growth of cattle after transport.

  8. Factors associated with mode of transport decision making for pediatric-neonatal interfacility transport.

    Science.gov (United States)

    Quinn, Janis M; Pierce, Mary Clyde; Adler, Mark

    2015-01-01

    Transport professionals must routinely engage in complex decision making. One challenging decision is the determination of mode of transport. This study explores the decisional factors involved in the determination of mobilizing ground ambulance versus helicopter for pediatric-neonatal interfacility transport. The aim was to gather initial qualitative data to aid in the development of an objective scoring tool that would be used to guide the mode of transport decision for pediatric and neonatal interfacility transport. The focus of the study was to elicit the factors that influence the mode of transport decision among professionals who are involved in this decision. This study was conducted in an urban, freestanding children's hospital with a dedicated pediatric/neonatal transport team. Subjects were given written scenarios that represented a phone call requesting transport from a referring hospital. Subjects were asked to choose between 2 modes of transport: ambulance or helicopter. Weather was assumed to be clear. Decision-making factors were gathered and tallied. For group comparison, the Fisher exact, Pearson chi-square, Student t, or Wilcoxon rank sum tests for scale data was used. A multivariate logistic regression was performed to assess factors associated with the mode of transport decision. Responses were received from a total of 19 subjects. Nurses represented 58% (11) of the respondents, and physicians represented 42% (8). The nurses were all either currently employed on the transport team or had left the team within the past 2 years. The physicians were all critical care or emergency medicine fellows and attending physicians who serve in the medical control role for the transport team. All subjects reported a minimum of five years in their respective professions. The decision to mobilize a helicopter for interfacility transport was significantly associated with the provider's level of clinical concern in conjunction with the perceived distance and if

  9. Air ambulance tasking: mechanism of injury, telephone interrogation or ambulance crew assessment?

    Science.gov (United States)

    Wilmer, Ian; Chalk, Graham; Davies, Gareth Edward; Weaver, Anne Elizabeth; Lockey, David John

    2015-10-01

    The identification of serious injury is critical to the tasking of air ambulances. London's Air Ambulance (LAA) is dispatched by a flight paramedic based on mechanism of injury (MOI), paramedical interrogation of caller (INT) or land ambulance crew request (REQ).This study aimed to demonstrate which of the dispatch methods was most effective (in accuracy and time) in identifying patients with serious injury. A retrospective review of 3 years of data (to December 2010) was undertaken. Appropriate dispatch was defined as the requirement for LAA to escort the patient to hospital or for resuscitation on-scene. Inaccurate dispatch was where LAA was cancelled or left the patient in the care of the land ambulance crew. The χ(2) test was used to calculate p values; with significance adjusted to account for multiple testing. There were 2203 helicopter activations analysed: MOI 18.9% (n=417), INT 62.4% (n=1375) and REQ 18.7% (n=411). Appropriate dispatch rates were MOI 58.7% (245/417), INT 69.7% (959/1375) and REQ 72.2% (297/411). INT and REQ were both significantly more accurate than MOI (pground ambulance crew requests, and both are significantly better than MOI in identifying serious injury. Overtriage remains an issue with all methods. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. A new vibration isolation bed stage with magnetorheological dampers for ambulance vehicles

    Science.gov (United States)

    Chae, Hee Dong; Choi, Seung-Bok

    2015-01-01

    The vibration experienced in an ambulance can lead to secondary injury to a patient and discourage a paramedic from providing emergency care. In this study, with the goal of resolving this problem, a new vibration isolation bed stage associated with magnetorheological (MR) dampers is proposed to ensure ride quality as well as better care for the patient while he/she is being transported. The bed stage proposed in this work can isolate vibrations in the vertical, rolling and pitching directions to reflect the reality that occurs in the ambulance. Firstly, an appropriate-sized MR damper is designed based on the field-dependent rheological properties of MR fluid, and the damping force characteristics of a MR damper are evaluated as a function of the current. A mechanical model of the proposed vibration isolation bed stage is then established to derive the governing equations of motion. Subsequently, a sliding mode controller is formulated to control the vibrations caused from the imposed excitation signals; those signals are directly measured using a real ambulance subjected to bump-and-curve road conditions. Using the controller based on the dynamic motion of the bed stage, the vibration control performance is evaluated in both the vertical and pitch directions. It is demonstrated that the magnitude of the vibration in the patient compartment of the ambulance can be significantly reduced by applying an input current to the MR dampers installed for the new bed stage.

  11. Transport and fate of nitrate at the ground-water/surface-water interface

    Science.gov (United States)

    Puckett, L.J.; Zamora, C.; Essaid, H.; Wilson, J.T.; Johnson, H.M.; Brayton, M.J.; Vogel, J.R.

    2008-01-01

    Although numerous studies of hyporheic exchange and denitrification have been conducted in pristine, high-gradient streams, few studies of this type have been conducted in nutrient-rich, low-gradient streams. This is a particularly important subject given the interest in nitrogen (N) inputs to the Gulf of Mexico and other eutrophic aquatic systems. A combination of hydrologic, mineralogical, chemical, dissolved gas, and isotopic data, were used to determine the processes controlling transport and fate of NO3- in streambeds at five sites across the USA. Water samples were collected from streambeds at depths ranging from 0.3 to 3 m at three to five points across the stream and in two to five separate transects. Residence times of water ranging from 0.28 to 34.7 d m-1 in the streambeds of N-rich watersheds played an important role in allowing denitrification to decrease NO3- concentrations. Where potential electron donors were limited and residence times were short, denitrification was limited. Consequently, in spite of reducing conditions at some sites, NO3- was transported into the stream. At two of the five study sites, NO3- in surface water infiltrated the streambeds and concentrations decreased, supporting current models that NO3- would be retained in N-rich streams. At the other three study sites, hydrogeologic controls limited or prevented infiltration of surface water into the streambed, and ground-water discharge contributed to NO 3- loads. Our results also show that in these low hydrologic-gradient systems, storm and other high-flow events can be important factors for increasing surface-water movement into streambeds. Copyright ?? 2008 by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America. All rights reserved.

  12. [Treatment of liver cirrhosis - actually possibility of ambulant internist].

    Science.gov (United States)

    Ehrmann, Jiří; Aiglová, Květa; Konečný, Michal; Procházka, Vlastimil; Vrzalová, Drahomíra

    There are 40 000-60 000 patients with cirrhosis in the Czech Republic. 2 000 die of this disease yearly. This group of patients needs a complex treatment and it is mostly an internist cooperating with other specialists. The most important for an ambulant internist is to diagnose the disease as soon as possible and start with treatment of chronic liver disease that could lead to a cirrhosis. It means especially chronic viral hepatitis, alcoholic or non-alcoholic steatosis/steatohepatitis, auto-immune liver damage and metabolic disease. The next step is to diagnose the cirrhosis in time when it is in no manifest stage. The third step is to diagnose and treat the liver decompensation. It means consequences of the portal hypertension, it is ascit, esophageal or gastric varices, hepatorenal syndrome. Next there are consequences of the metabolic insufficiency, it is icterus, coagulopathy and hepatic encephalopathy. It is necessary to diagnose and cure cholestasis from the very first extrahepatic causes. For a successful treatment of the hepatocellular carcinoma originated almost exclusively in the grounds of the cirrhosis must be early diagnosed. The ambulant internist respective hepatologist must diagnose the stage of the cirrhosis and decide when a hospitalization is necessary. Also a close cooperation with other specialists is urgent if it is about a liver transplantation. The treatment of successive stages of the cirrhosis is a topic of the showed educational article. compensated/decompensated liver cirrhosis - diet/nutrition in liver cirrhosis - etiology and diagnose of liver cirrhosis - treatment of liver insufficiency/failure - treatment of portal hypertension and its complications.

  13. Biogeochemical Processes Responsible for the Enhanced Transport of Plutonium Under transient Unsaturated Ground Water Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Fred J. Molz, III

    2010-05-28

    to Pu uptake by corn roots and xylem transport. Plants were started in wet paper wrapped around each corn seed. When the tap roots were sufficiently long, the seedlings were transplanted to a soil container with the tap root extending out the container bottom. The soil container was then placed over a nutrient solution container, and the solution served as an additional medium for root growth. To conduct an uptake study, a radioactive substance, such as Pu complexed with the bacterial siderophore DFOB, was added to the nutrient solution. After a suitable elapsed time, the corn plant was sacrificed, cut into 10 cm lengths, and the activity distribution measured. Experimental results clarified the basic nature of Pu uptake and transport in corn plants, and resulting simulations suggested that each growing season Pu in the SRS lysimeters would move into the plant shoots and be deposited on the soil surface during the Fall dieback. Subsequent isotope ratio analyses showed that this did happen. OVERALL RESULTS AND CONCLUSIONS - (1) Pu transport downward from the source is controlled by advection, dispersion and adsorption, along with surface-mediated REDOX reactions. (2) Hysteresis, extreme root distribution functions, air-content dependent oxidation rate constants, and large evaporation rates from the soil surface were not able to explain the observed upward migration of Pu. (3) Small amounts of Pu uptake by plant roots and translocation in the transpiration stream creates a realistic mechanism for upward Pu migration (4) Realistic xylem cross-sectional areas imply high flow velocities under hot, wet conditions. Such flow velocities produce the correct shape for the observed activity distributions in the top 20 cm of the lysimeter soil. (5) Simulations imply that Pu should have moved into the above-ground grass tissue each year during the duration of the experiments, resulting in an activity residual accumulating on the soil surface. An isotope ratio analysis showed that

  14. 42 CFR 414.615 - Transition to the ambulance fee schedule.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Transition to the ambulance fee schedule. 414.615... Ambulance Services § 414.615 Transition to the ambulance fee schedule. The fee schedule for ambulance... the fee schedule payment for ambulance services and the amount the program would have paid absent the...

  15. 42 CFR 424.124 - Conditions for payment for physician services and ambulance services.

    Science.gov (United States)

    2010-10-01

    ... ambulance services. 424.124 Section 424.124 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... and ambulance services. (a) Basic rules. Medicare Part B pays for physician and ambulance services if... furnishes the services. (c) Ambulance services. The ambulance services are— (1) Necessary because the use of...

  16. 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.

  17. Digital-transport model study of Diisopropylmethylphosphonate (DIMP) ground-water contamination at the Rocky Mountain Arsenal, Colorado

    Science.gov (United States)

    Warner, James W.

    1979-01-01

    Diisopropylmethylphosphonate (DIMP) is an organic compound produced as a by-product of the manufacture and detoxification of GB nerve gas. Ground-water contamination by DIMP from the disposal of wastes into unlined surface ponds at the Rocky Mountain Arsenal occurred from 1952 to 1956. A digital-transport model was used to determine the effects on ground-water movement and on DIMP concentrations in the ground water of a bentonite barrier in the aquifer near the northern boundary of the arsenal. The transport model is based on an iterative-alternating-direction-implicit mathematical solution of the ground-water-flow equation coupled with a method-of-characteristics solution of the solute-transport equation. The model assumes conservative (nonreactive) transient transport of DIMP and steady-state ground-water flow. In the model simulations, a bentonite barrier was assumed that was impermeable and penetrated the entire saturated thickness of the aquifer. Ground water intercepted by the barrier was assumed to be pumped by wells located south (upgradient) of the barrier, to be treated to remove DIMP, and to be recharged by pits or wells to the aquifer north (downgradient) of the barrier. The amount of DIMP transported across the northern boundary of the arsenal was substantially reduced by a ground-water-barrier system of this type. For a 1,500-foot-long bentonite barrier located along the northern boundary of the arsenal near D Street, about 50 percent of the DIMP that would otherwise cross the boundary would be intercepted by the barrier. This barrier configuration and location were proposed by the U.S. Army. Of the ground water with DIMP concentrations greater than 500 micrograms per liter, the safe DIMP-concentration level determined by the U.S. Army, about 72 percent would be intercepted by the barrier system. The amount of DIMP underflow intercepted may be increased to 65 percent by doubling the pumpage, or to 73 percent by doubling the length of the barrier

  18. 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...

  19. 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.

  20. 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.

  1. Disaster planning: transportation resources and considerations for managing a burn disaster.

    Science.gov (United States)

    Kearns, Randy D; Hubble, Michael W; Holmes, James H; Cairns, Bruce A

    2014-01-01

    A disaster scenario with a significant number of burn-injured patients creates a tremendous challenge for disaster planners. Directing the transport of patients to the most appropriate receiving facility as soon as reasonably possible remains the aim. This review focused on both the overall process as well as an analysis of one specific state (as an example). This included the capability and limitations of the intrastate and interstate resources should a burn disaster occur. Although the results for one state may be interesting, it is the process that is essential for those involved in burn disaster planning. An overview of the quantity and quality of available ambulances and how to access these resources is provided. Ground-based ambulances have an array of capacities and levels of services ranging from basic life support to advanced (paramedic) services and include ambulance buses. This review also included private and hospital-based specialty care ambulances and aeromedical services. Finally, the review identified military or federal resources that may be an option as well. There are various local, state, and federal resources that can be called upon to meet the transportation needs of these critically injured patients. Yet, there are barriers to access and limitations to their response. It is just as important to know both availability and capability as it is to know how to access these resources. A disaster is not the time to realize these hurdles.

  2. Ambulance nurses' experiences of nursing critically ill and injured children: A difficult aspect of ambulance nursing care.

    Science.gov (United States)

    Nordén, Charlotte; Hult, Karin; Engström, Åsa

    2014-04-01

    Ambulance nurses work daily in both emergency and non-emergency situations that can be demanding. One emotionally demanding situation for ambulance nurses is to nurse children who are ill. The aim of this study was to describe ambulance nurses' experiences of nursing critically ill or injured children. Eight specialist ambulance nurses were interviewed and the interviews were analyzed using qualitative content analysis. The analysis resulted in one theme, a difficult aspect of ambulance nursing care, with five categories. The security of both child and parents was considered to be paramount. Ambulance nurses felt relieved when they handed over the responsibility and the child to the receiving unit. The ambulance nurses felt that more training, education and follow-up was desirable in order to increase their security when nursing children. Ambulance nurses are subject to stressful feelings while nursing children. As providing reassurance to the child and its parents is a cornerstone of the treatment, it is important for the ambulance nurses to take the time to build up a trusting relationship in such an encounter. Skill development in the area might lead to increased security and reduce the mental burden resulting from negative stress. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Infradian rhythms in medical ambulance team dispatches

    Science.gov (United States)

    Dudin, S. A.

    2012-12-01

    We describe the results of a spectral and correlation analysis of changes in the daily dispatches of ambulance teams over 3 years. The results show fluctuations with periods of 7, 41, 50-51, 68-82, 136, 227, and 310-365 days and small-amplitude fluctuations with periods of 11, 13-14, 17-18, 23, 29, 31, 36, and 58 days. Some of these coincide with the predictions of Tibetan medical sources. The periods under observation closely match the changes in the gradient of the Earth's electric field potential.

  4. Atmospheric effects on infrared measurements at ground level: Application to monitoring of transport infrastructures

    Science.gov (United States)

    Boucher, Vincent; Dumoulin, Jean

    2014-05-01

    Being able to perform easily non-invasive diagnostics for surveillance and monitoring of critical transport infrastructures is a major preoccupation of many technical offices. Among all the existing electromagnetic methods [1], long term thermal monitoring by uncooled infrared camera [2] is a promising technique due to its dissemination potential according to its low cost on the market. Nevertheless, Knowledge of environmental parameters during measurement in outdoor applications is required to carry out accurate measurement corrections induced by atmospheric effects at ground level. Particularly considering atmospheric effects and measurements in foggy conditions close as possible to those that can be encountered around transport infrastructures, both in visible and infrared spectra. In the present study, atmospheric effects are first addressed by using data base available in literature and modelling. Atmospheric attenuation by particles depends greatly of aerosols density, but when relative humidity increases, water vapor condenses onto the particulates suspended in the atmosphere. This condensed water increases the size of the aerosols and changes their composition and their effective refractive index. The resulting effect of the aerosols on the absorption and scattering of radiation will correspondingly be modified. In a first approach, we used aerosols size distributions derived from Shettle and Fenn [3] for urban area which could match some of experimental conditions encountered during trials on transport infrastructures opened to traffic. In order to calculate the influence of relative humidity on refractive index, the Hänel's model [4] could be used. The change in the particulate size is first related to relative humidity through dry particle radius, particle density and water activity. Once the wet aerosol particle size is found, the effective complex refractive index is the volume weighted average of the refractive indexes of the dry aerosol substance

  5. Ground-based research of crystal growth of II-VI compound semiconductors by physical vapor transport

    Science.gov (United States)

    Volz, M. P.; Gillies, D. C.; Szofran, F. R.; Lehoczky, S. L.; Su, Ching-Hua; Sha, Yi-Gao; Zhou, W.; Dudley, M.; Liu, Hao-Chieh; Brebrick, R. F.; Wang, J. C.

    1994-01-01

    Ground-based investigation of the crystal growth of II-VI semiconductor compounds, including CdTe, CdS, ZnTe, and ZnSe, by physical vapor transport in closed ampoules was performed. The crystal growth experimental process and supporting activities--preparation and heat treatment of starting materials, vapor partial pressure measurements, and transport rate measurements are reported. The results of crystal characterization, including microscopy, microstructure, optical transmission photoluminescence, synchrotron radiation topography, and chemical analysis by spark source mass spectrography, are also discussed.

  6. 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

  7. 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

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

    NARCIS (Netherlands)

    Laan, Corine Maartje; Vanberkel, Peter T.; Boucherie, Richardus 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

  9. Medical Requirements for Ambulance Design and Equipment. Emergency Health Series.

    Science.gov (United States)

    National Academy of Sciences - National Research Council, Washington, DC. Div. of Medical Sciences.

    A vehicle must meet certain specific requirements to be classified as an ambulance if it is to satisfy the demands of the physician in terms of emergency care for which properly trained ambulance attendants can be held responsible. Developed by professional and lay experts for use by automotive designers and manufacturing, this publication would…

  10. 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.

  11. Reducing ambulance response times using discrete event simulation.

    Science.gov (United States)

    Wei Lam, Sean Shao; Zhang, Zhong Cheng; Oh, Hong Choon; Ng, Yih Ying; Wah, Win; Hock Ong, Marcus Eng

    2014-01-01

    The objectives of this study are to develop a discrete-event simulation (DES) model for the Singapore Emergency Medical Services (EMS), and to demonstrate the utility of this DES model for the evaluation of different policy alternatives to improve ambulance response times. A DES model was developed based on retrospective emergency call data over a continuous 6-month period in Singapore. The main outcome measure is the distribution of response times. The secondary outcome measure is ambulance utilization levels based on unit hour utilization (UHU) ratios. The DES model was used to evaluate different policy options in order to improve the response times, while maintaining reasonable fleet utilization. Three policy alternatives looking at the reallocation of ambulances, the addition of new ambulances, and alternative dispatch policies were evaluated. Modifications of dispatch policy combined with the reallocation of existing ambulances were able to achieve response time performance equivalent to that of adding 10 ambulances. The median (90th percentile) response time was 7.08 minutes (12.69 minutes). Overall, this combined strategy managed to narrow the gap between the ideal and existing response time distribution by 11-13%. Furthermore, the median UHU under this combined strategy was 0.324 with an interquartile range (IQR) of 0.047 versus a median utilization of 0.285 (IQR of 0.051) resulting from the introduction of additional ambulances. Response times were shown to be improved via a more effective reallocation of ambulances and dispatch policy. More importantly, the response time improvements were achieved without a reduction in the utilization levels and additional costs associated with the addition of ambulances. We demonstrated the effective use of DES as a versatile platform to model the dynamic system complexities of Singapore's national EMS systems for the evaluation of operational strategies to improve ambulance response times.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

    2015-01-01

    The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care. A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, 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. The use of active heat from underneath increases the patients' thermal comfort and may prevent the negative consequences of cold stress.

  14. Factors influencing ambulance nurses' adherence to a national protocol ambulance care: an implementation study in the Netherlands

    NARCIS (Netherlands)

    Ebben, R.H.; Vloet, L.C.M.; Grunsven, P.M. van; Breeman, W.; Goosselink, B.; Lichtveld, R.A.; Groot, J. de; Achterberg, T. van

    2015-01-01

    OBJECTIVES: Adherence to prehospital guidelines and protocols is suboptimal. Insight into influencing factors is necessary to improve adherence. The aim of this study was to identify factors that influence ambulance nurses' adherence to a National Protocol Ambulance Care (NPAC). METHODS: A

  15. 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…

  16. 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.

  17. Placebo-controlled double-blind clomipramine trial for the treatment of anxiety or fear in beagles during ground transport.

    Science.gov (United States)

    Frank, Diane; Gauthier, Audrey; Bergeron, Renée

    2006-11-01

    The purpose of this explorative study was, first, to document changes in physiological parameters and behavior observed in dogs following ground transport and, second, to measure the effects on the above variables of a short-term administration of clomipramine, anecdotally already prescribed in private veterinary practice to reduce fear, anxiety, or both. Twenty-four beagles were randomly allocated to either clomipramine (2 mg/kg, q12h for 7 d) or placebo treatment, and then transported 3 times in a truck for 1 hour. Physiological parameters (cortisol, neutrophil:lymphocyte (N:L) ratio, heart rate) and behavior were recorded and analyzed. Clomipramine significantly reduced plasma cortisol (P anxiety, or both during transport. More research is needed to confirm the efficacy of this treatment and the appropriate dosage.

  18. Orbit design for a space ambulance vehicle

    Science.gov (United States)

    Nelson, Walter C.

    A number of rendezvous maneuvers between space stations in geocentric orbits at altitudes ranging between 200 km and geosynchronous altitude are examined. Minimum time to complete rendezvous is studied for purposes of expediting crew patient transfer to an orbiting medical base station (MBS) for the stabilization of trauma and definitive care. The vehicle to be used for the crew patient transfer to the MBS is the space ambulance vehicle (SAV). The SAV is assumed to use two velocity impulses to complete rendezvous maneuvers between an SS and the MBS: an accelerating impulse when departing the SS and a second decelerating impulse prior to docking with the MBS. Recommendations are made concerning the planning of space operations which will reduce both time and propulsive energy for rendezvous maneuvers. It is suggested that throttleable engines be used when transferring a crew patient whose trauma could be exacerbated by excessive acceleration of the carrier vehicle.

  19. 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.

  20. 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

  1. 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.

  2. 42 CFR 414.620 - Publication of the ambulance fee schedule.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Publication of the ambulance fee schedule. 414.620... Ambulance Services § 414.620 Publication of the ambulance fee schedule. Changes in payment rates resulting... to the fee schedule for ambulance services that result from any factors other than the inflation...

  3. Effect of a mass media campaign on ambulance use for chest pain.

    Science.gov (United States)

    Nehme, Ziad; Cameron, Peter A; Akram, Muhammad; Patsamanis, Harry; Bray, Janet E; Meredith, Ian T; Smith, Karen

    2017-01-16

    To evaluate the impact of comprehensive public awareness campaigns by the National Heart Foundation of Australia on emergency medical service (EMS) use by people with chest pain. A retrospective analysis of 253428 emergency ambulance attendances for non-traumatic chest pain in Melbourne, January 2008 - December 2013. Time series analyses, adjusted for underlying trend and seasonal effects, assessed the impact of mass media campaigns on EMS use. Monthly ambulance attendances. The median number of monthly ambulance attendances for chest pain was 3609 (IQR, 3011-3891), but was higher in campaign months than in non-campaign months (3880 v 3234, Pambulance use for chest pain, and a 15.4% increase (95% CI, 10.1-20.9%; Pambulance increased by 10.0% (95% CI, 6.1-14.2%; P<0.001) during campaign months, the number of patients not transported to hospital also increased, by 13.9% (95% CI, 8.3-19.8%; P<0.001). A public awareness campaign about responding to prodromal acute myocardial infarction symptoms was associated with an increase in EMS use by people with chest pain and suspected acute coronary syndromes. Campaign activity may also lead to increased EMS use in low risk populations.

  4. Guidelines for selecting codes for ground-water transport modeling of low-level waste burial sites. Executive summary

    Energy Technology Data Exchange (ETDEWEB)

    Simmons, C.S.; Cole, C.R.

    1985-05-01

    This document was written to provide guidance to managers and site operators on how ground-water transport codes should be selected for assessing burial site performance. There is a need for a formal approach to selecting appropriate codes from the multitude of potentially useful ground-water transport codes that are currently available. Code selection is a problem that requires more than merely considering mathematical equation-solving methods. These guidelines are very general and flexible and are also meant for developing systems simulation models to be used to assess the environmental safety of low-level waste burial facilities. Code selection is only a single aspect of the overall objective of developing a systems simulation model for a burial site. The guidance given here is mainly directed toward applications-oriented users, but managers and site operators need to be familiar with this information to direct the development of scientifically credible and defensible transport assessment models. Some specific advice for managers and site operators on how to direct a modeling exercise is based on the following five steps: identify specific questions and study objectives; establish costs and schedules for achieving answers; enlist the aid of professional model applications group; decide on approach with applications group and guide code selection; and facilitate the availability of site-specific data. These five steps for managers/site operators are discussed in detail following an explanation of the nine systems model development steps, which are presented first to clarify what code selection entails.

  5. Technical support for GEIS: radioactive waste isolation in geologic formations. Volume 21. Ground water movement and nuclide transport

    Energy Technology Data Exchange (ETDEWEB)

    None

    1978-04-01

    This volume, TM-36/21 Ground Water Movement and Nuclide Transport, is one of a 23-volume series, ''Technical Support for GEIS: Radioactive Waste Isolation in Geologic Formations, Y/OWI/TM-36'' which supplements a ''Contribution to Draft Generic Environmental Impact Statement on Commercial Waste Management: Radioactive Waste Isolation in Geologic Formations, Y/OWI/TM-44.'' The series provides a more complete technical basis for the preconceptual designs, resource requirements, and environmental source terms associated with isolating commercial LWR wastes in underground repositories in salt, granite, shale and basalt. Wastes are considered from three fuel cycles: uranium and plutonium recycling of spent fuel and uranium-only recycling. The studies presented in this volume consider the effect of the construction of the repository and the consequent heat generation on the ground water movement. Additionally, the source concentrations and leach rates of selected radionuclides were studied in relation to the estimated ground water inflow rates. Studies were also performed to evaluate the long term migration of radionuclides as affected by the ground water flow. In all these studies, three geologic environments are considered; granite, shale and basalt.

  6. Ground based measurements of particulate emissions from supersonic transports. Concorde olympus engine

    Energy Technology Data Exchange (ETDEWEB)

    Whitefield, Ph.D.; Hagen, D.E. [Missouri Univ., Rolla, MO (United States). Cloud and Aerosol Sciences Lab.; Lilenfeld, H.V. [McDonnell Douglas Corp., St. Louis, MO (United States)

    1997-12-31

    The application of a mobile aerosol monitoring facility, the Mobile Aerosol Sampling System (MASS) is described to characterize engine aerosol emissions from the Rolls Royce Olympus Engine. The multi-configurational MASS has been employed in both ground and airborne field operations. It has been successfully flown on research aircrafts. In ground tests the MASS has participated in numerous jet engine related ground tests, and has been deployed to resolve aerosol generation problems in a high power chemical laser system. In all cases the measurements were made on samples taken from a harsh physical and chemical environment, with both high and low temperature and pressure, and in the presence of highly reactive gases. (R.P.) 9 refs.

  7. 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...

  8. BALANCING AMBULANCE CREW WORKLOADS VIA A TIERED DISPATCH POLICY

    National Research Council Canada - National Science Library

    Li, Xun; Saydam, Cem

    2016-01-01

    ... relocations to ensure high demand zones are covered adequately. In this paper we propose a tiered dispatch policy to balance the ambulance crew workloads while meeting fast response times for priority 1 calls...

  9. 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 ...

  10. 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.

  11. 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...

  12. 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...

  13. Ambulation in adults with myelomeningocele. Is it possible to predict the level of ambulation in early life?

    DEFF Research Database (Denmark)

    Seitzberg, A.; Lind, M.; Biering-Sørensen, Fin

    2008-01-01

    OBJECTIVE: The objective of this study was to evaluate the prediction of ambulation in adults with myelomeningocele from muscle strength testing and ambulation in early life. MATERIALS AND METHODS: Fifty-two myelomeningocele (MMC) individuals at the age 18-37 years at follow-up were studied...... with muscle strength within the first year of life, 7 achieved the predicted ambulatory function, 6 had a better, and 7 a poorer function. Of 32 individuals with known muscle strength at the age of 5-8 years, 10 had function as predicted, 5 a better ambulatory function, and 17 had a poorer ambulation in adult...... life than predicted. Good strength in quadriceps muscles gave significant better prospect for adult walking. Of the 52 participants, 41 retained their ambulation status from 5-8 years of age. CONCLUSION: For MMC individuals with motor levels L3-L5, adult ambulatory function cannot be determined from...

  14. The effect of an ambulance diversion ban on emergency department length of stay and ambulance turnaround time.

    Science.gov (United States)

    Burke, Laura G; Joyce, Nina; Baker, William E; Biddinger, Paul D; Dyer, K Sophia; Friedman, Franklin D; Imperato, Jason; King, Alice; Maciejko, Thomas M; Pearlmutter, Mark D; Sayah, Assaad; Zane, Richard D; Epstein, Stephen K

    2013-03-01

    Massachusetts became the first state in the nation to ban ambulance diversion in 2009. It was feared that the diversion ban would lead to increased emergency department (ED) crowding and ambulance turnaround time. We seek to characterize the effect of a statewide ambulance diversion ban on ED length of stay and ambulance turnaround time at Boston-area EDs. We conducted a retrospective, pre-post observational analysis of 9 Boston-area hospital EDs before and after the ban. We used ED length of stay as a proxy for ED crowding. We compared hospitals individually and in aggregate to determine any changes in ED length of stay for admitted and discharged patients, ED volume, and turnaround time. No ED experienced an increase in ED length of stay for admitted or discharged patients or ambulance turnaround time despite an increase in volume for several EDs. There was an overall 3.6% increase in ED volume in our sample, a 10.4-minute decrease in length of stay for admitted patients, and a 2.2-minute decrease in turnaround time. When we compared high- and low-diverting EDs separately, neither saw an increase in length of stay, and both saw a decrease in turnaround time. After the first statewide ambulance diversion ban, there was no increase in ED length of stay or ambulance turnaround time at 9 Boston-area EDs. Several hospitals actually experienced improvements in these outcome measures. Our results suggest that the ban did not worsen ED crowding or ambulance availability at Boston-area hospitals. Copyright © 2012. Published by Mosby, Inc.

  15. Factors influencing ambulance nurses' adherence to a national protocol ambulance care: an implementation study in the Netherlands.

    Science.gov (United States)

    Ebben, Remco H A; Vloet, Lilian C M; van Grunsven, Pierre M; Breeman, Wim; Goosselink, Ben; Lichtveld, Rob A; Mintjes-De Groot, Joke A J; van Achterberg, Theo

    2015-06-01

    Adherence to prehospital guidelines and protocols is suboptimal. Insight into influencing factors is necessary to improve adherence. The aim of this study was to identify factors that influence ambulance nurses' adherence to a National Protocol Ambulance Care (NPAC). A questionnaire was developed using the literature, a questionnaire and expert opinion. Ambulance nurses (n=452) from four geographically spread emergency medical services (EMSs) in the Netherlands were invited to fill out the questionnaire. The questionnaire included questions on influencing factors and self-reported adherence. Questionnaires were returned by 248 (55%) of the ambulance nurses. These ambulance nurses' adherence to the NPAC was 83.4% (95% confidence interval 81.9-85.0). Bivariate correlations showed 23 influencing factors that could be related to the individual professional, organization, protocol characteristics and social context. Multilevel regression analysis showed that 21% of the variation in adherence (R=0.208) was explained by protocol characteristics and social influences. Ambulance nurses' self-reported adherence to the NPAC seems high. To improve adherence, protocol characteristics (complexity, the degree of support for diagnosis and treatment, the relationship of the protocol with patient outcomes) and social influences (expectance of colleagues to work with the national protocol) should be addressed.

  16. Factors influencing ambulance nurses’ adherence to a national protocol ambulance care: an implementation study in the Netherlands

    Science.gov (United States)

    Vloet, Lilian C.M.; van Grunsven, Pierre M.; Breeman, Wim; Goosselink, Ben; Lichtveld, Rob A.; Mintjes-De Groot, Joke A.J.; van Achterberg, Theo

    2015-01-01

    Objectives Adherence to prehospital guidelines and protocols is suboptimal. Insight into influencing factors is necessary to improve adherence. The aim of this study was to identify factors that influence ambulance nurses’ adherence to a National Protocol Ambulance Care (NPAC). Methods A questionnaire was developed using the literature, a questionnaire and expert opinion. Ambulance nurses (n=452) from four geographically spread emergency medical services (EMSs) in the Netherlands were invited to fill out the questionnaire. The questionnaire included questions on influencing factors and self-reported adherence. Results Questionnaires were returned by 248 (55%) of the ambulance nurses. These ambulance nurses’ adherence to the NPAC was 83.4% (95% confidence interval 81.9–85.0). Bivariate correlations showed 23 influencing factors that could be related to the individual professional, organization, protocol characteristics and social context. Multilevel regression analysis showed that 21% of the variation in adherence (R2=0.208) was explained by protocol characteristics and social influences. Conclusion Ambulance nurses’ self-reported adherence to the NPAC seems high. To improve adherence, protocol characteristics (complexity, the degree of support for diagnosis and treatment, the relationship of the protocol with patient outcomes) and social influences (expectance of colleagues to work with the national protocol) should be addressed. PMID:24595355

  17. An Analysis of Transport, Dispersion, and Deposition from Two Above-Ground Nuclear Tests in China

    Science.gov (United States)

    1999-04-14

    resulting distribution of radioactive material to the Second-order Closure Integrated PUFF ( SCIPUFF ) model to perform the transport and diffusion of the...Corp, MRC-R-243, Dec 1975 Sykes, R.I., "PC- SCIPUFF Version 0.2 Technical Documentation, Titan Corporation, DNA-TR-96-27, April 1997 Tripoli, G.J

  18. Seasonal associations and atmospheric transport distances of Fusarium collected with unmanned aerial vehicles and ground-based sampling devices

    Science.gov (United States)

    Schmale, David; Ross, Shane; Lin, Binbin

    2014-05-01

    Spores of fungi in the genus Fusarium may be transported through the atmosphere over long distances. Members of this genus are important pathogens and mycotoxin producers. New information is needed to characterize seasonal trends in atmospheric loads of Fusarium and to pinpoint the source(s) of inoculum at both local (farm) and regional (state or country) scales. Spores of Fusarium were collected from the atmosphere in an agricultural ecosystem in Blacksburg, VA, USA using a Burkard volumetric sampler (BVS) 1 m above ground level and autonomous unmanned aerial vehicles (UAVs) 100 m above ground level. More than 2,200 colony forming units (CFUs) of Fusarium were collected during 104 BVS sampling periods and 180 UAV sampling periods over four calendar years (2009-2012). Spore concentrations ranged from 0 to 13 and 0 to 23 spores m-3 for the BVS and the UAVs, respectively. Spore concentrations were generally higher in the fall, spring, and summer, and lower in the winter. Spore concentrations from the BVS were generally higher than those from the UAVs for both seasonal and hourly collections. Some of the species of Fusarium identified from our collections have not been previously reported in the state of Virginia. A Gaussian plume transport model was used to estimate distances to the potential inoculum source(s) by season. This work extends previous studies showing an association between atmospheric transport barriers (Lagrangian coherent structures or LCSs) and the movement of Fusarium in the lower atmosphere. An increased understanding of the aerobiology of Fusarium may contribute to new and improved control strategies for diseases causes by fusaria in the future.

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

    Science.gov (United States)

    Halliday, Megan H; Bouland, Andrew J; Lawner, Benjamin J; Comer, Angela C; Ramos, Daniel C; Fletcher, Mark

    2016-09-01

    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. 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. 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 control, representing a statistically significant decrease

  20. Numerical modeling of ground water flow and contaminant transport in a saturated porous medium

    Science.gov (United States)

    Valipour, Mohammad S.; Sadeghi, Masoomeh; Mahmoudi, Amir H.; Shahi, Mina; Gandaghi, Hadi

    2012-05-01

    In this paper, numerical modeling and experimental testing of the distribution of pollutants along the water flow in a porous medium is discussed. Governing equations including overall continuity, momentum and species continuity equations are derived for porous medium. The governing equations have been solved numerical using the Finite Volume Method based on collocated grids. The SIMPLE algorithm has been adopted for the pressure _ velocity linked equations. In order to validate the numerical results, experimental data from laboratory apparatus are applied and there is a good agreement among numerical results and experimental test. Finally, the main affecting parameters on the distribution and transport of pollutants porous medium were investigated. Results indicate that, the domain of pollution rises with increasing dispersion coefficient and the dispersion phenomenon overcomes on pollutant transfer. Reduction of porosity has decreased the pollutant transfer and increased velocity has result in the increasing pollutant transport phenomenon but has reduced the domain of the pollution.

  1. Simulation of ground-water flow and solute transport in the Glen Canyon aquifer, East-Central Utah

    Science.gov (United States)

    Freethey, Geoffrey W.; Stolp, Bernard J.

    2010-01-01

    The extraction of methane from coal beds in the Ferron coal trend in central Utah started in the mid-1980s. Beginning in 1994, water from the extraction process was pressure injected into the Glen Canyon aquifer. The lateral extent of the aquifer that could be affected by injection is about 7,600 square miles. To address regional-scale effects of injection over a decadal time frame, a conceptual model of ground-water movement and transport of dissolved solids was formulated. A numerical model that incorporates aquifer concepts was then constructed and used to simulate injection. The Glen Canyon aquifer within the study area is conceptualized in two parts-an active area of ground-water flow and solute transport that exists between recharge areas in the San Rafael Swell and Desert, Waterpocket Fold, and Henry Mountains and discharge locations along the Muddy, Dirty Devil, San Rafael, and Green Rivers. An area of little or negligible ground-water flow exists north of Price, Utah, and beneath the Wasatch Plateau. Pressurized injection of coal-bed methane production water occurs in this area where dissolved-solids concentrations can be more than 100,000 milligrams per liter. Injection has the potential to increase hydrologic interaction with the active flow area, where dissolved-solids concentrations are generally less than 3,000 milligrams per liter. Pressurized injection of coal-bed methane production water in 1994 initiated a net addition of flow and mass of solutes into the Glen Canyon aquifer. To better understand the regional scale hydrologic interaction between the two areas of the Glen Canyon aquifer, pressurized injection was numerically simulated. Data constraints precluded development of a fully calibrated simulation; instead, an uncalibrated model was constructed that is a plausible representation of the conceptual flow and solute-transport processes. The amount of injected water over the 36-year simulation period is about 25,000 acre-feet. As a result

  2. High resolution imaging of vadose zone transport using surface and crosswell ground penetrating radar methods

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Kenneth H.; Kowalsky, Mike B.; Peterson, John E.

    2002-11-05

    To effectively clean up many contaminated sites there is a need for information on heterogeneities at scales ranging from one centimeter to tens of meters, as these features can alter contaminant transport significantly. At the Department of Energy's Hanford, Washington site heterogeneities of interest can range from localized phenomena such as silt or gravel lenses, fractures, clastic dikes, to large-scale lithologic discontinuities. In the vadose zone it is critical to understand the parameters controlling flow. These features have been suspected of leading to funneling and fingering, additional physical mechanisms that could alter and possibly accelerate the transport of contaminants to underlying groundwater. For example, it has been observed from the studies to date that over relatively short distances there are heterogeneities in the physical structure of the porous medium and structural differences between repacked soil cores and the field site from which the materials initially came (Raymond and Shdo, 1966). Analysis of cores taken from the vadose zone (i.e., soil surface to water table) has been useful in identifying localized zones of contamination. Unfortunately, these analyses are sparse (limited to a few boreholes) and extremely expensive. The high levels of radioactivity at many of the contaminated sites increase drilling and sample costs and analysis time. Cost of drilling and core analysis for the SX tank farm has exceeded $1M per borehole (50 meter deep) for sampling. The inability to track highly mobile species through the vadose zone highlights an important need: the need for methods to describe the complete vadose zone plume and to determine processes controlling accelerated contamination of groundwater at Hanford. A combination of surface and crosswell (i.e. borehole) geophysical measurements is one means to provide this information. The main questions addressed with the radar methods in this study are: (1) What parts of the vadose zone

  3. 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 ...

  4. Encouraging Sustainable Transport Choices in American Households: Results from an Empirically Grounded Agent-Based Model

    Directory of Open Access Journals (Sweden)

    Davide Natalini

    2013-12-01

    Full Text Available The transport sector needs to go through an extended process of decarbonisation to counter the threat of climate change. Unfortunately, the International Energy Agency forecasts an enormous growth in the number of cars and greenhouse gas emissions by 2050. Two issues can thus be identified: (1 the need for a new methodology that could evaluate the policy performances ex-ante and (2 the need for more effective policies. To help address these issues, we developed an Agent-Based Model called Mobility USA aimed at: (1 testing whether this could be an effective approach in analysing ex-ante policy implementation in the transport sector; and (2 evaluating the effects of alternative policy scenarios on commuting behaviours in the USA. Particularly, we tested the effects of two sets of policies, namely market-based and preference-change ones. The model results suggest that this type of agent-based approach will provide a useful tool for testing policy interventions and their effectiveness.

  5. Sub-seasonal pressure, geometry and sediment transport changes observed in subglacial channels from the analysis of seismic ground motion

    Science.gov (United States)

    Gimbert, F.; Tsai, V. C.; Amundson, J. M.; Bartholomaus, T. C.; Walter, J. I.

    2016-12-01

    Water from ice melt and precipitation that flows to and pressurizes the base of glaciers contributes to glacier and ice sheet acceleration. Predicting acceleration and its impact on ice mass loss and sea-level rise under global climate warming therefore requires knowledge of subglacial channel evolution and water pressurization, which remains limited by a lack of observations. Here we show that ground motion caused by subglacial channel flow at Mendenhall Glacier (Alaska) can be used to recover simultaneously basal water pressure, channel geometry and sediment transport throughout the melt season. We provide observations of the interplay between these physical quantities and discuss the implications for glacier sliding and erosion. By constraining the physics of subglacial hydrology, our framework and its application to outlet glaciers of the Greenland and Antarctic ice sheets may lead to more reliable predictions of ice flow, sea level rise and subglacial erosion rates.

  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. Transport in arrays of submicron Josephson junctions over a ground plane

    Energy Technology Data Exchange (ETDEWEB)

    Ho, Teressa Rae [Univ. of California, Berkeley, CA (United States)

    1997-12-01

    One-dimensional (1D) and two-dimensional (2D) arrays of Al islands linked by submicron Al/AlxOy/Al tunnel junctions were fabricated on an insulating layer grown on a ground plane. The arrays were cooled to temperatures as low as 20 mK where the Josephson coupling energy EJ of each junction and the charging energy EC of each island were much greater than the thermal energy kBT. The capacitance Cg between each island and the ground plane was much greater than the junction capacitance C. Two classes of arrays were studied. In the first class, the normal state tunneling resistance of the junctions was much larger than the resistance quantum for single electrons, RN>> RQe≡ h/e2 ~ 25.8 kΩ, and the islands were driven normal by an applied magnetic field such that EJ = 0 and the array was in the Coulomb blockade regime. The arrays were made on degenerately-doped Si, thermally oxidized to a thickness of approximately 100 nm. The current-voltage (I - V) characteristics of a 1D and a 2D array were measured and found to display a threshold voltage VT below which little current flows. In the second class of arrays, the normal state tunneling resistance of the junctions was close to the resistance quantum for Cooper pairs, RN≈RQ≡h/4e2≈6.45kΩ, such that EJ/EC≈1. The arrays were made on GaAs/Al0.3Ga0.7As heterostructures with a two-dimensional electron gas approximately 100 nm below the surface. One array displayed superconducting behavior at low temperature. Two arrays displayed insulating behavior at low temperature, and the size of the Coulomb gap increased with increasing Rg.

  9. Community-acquired pneumonia; Ambulant erworbene Pneumonien

    Energy Technology Data Exchange (ETDEWEB)

    Poetter-Lang, S.; Herold, C.J. [Medizinische Universitaet Wien, Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Wien (Austria)

    2017-01-15

    The diagnosis of community-acquired pneumonia (CAP) is often not possible based only on the clinical symptoms and biochemical parameters. For every patient with the suspicion of CAP, a chest radiograph in two planes should be carried out. Additionally, a risk stratification for the decision between outpatient therapy or hospitalization is recommended. Based on the evaluation of the different radiological patterns as well as their extent and distribution, a rough allocation to so-called pathogen groups as well as a differentiation between viral and bacterial infections are possible; however, because different pathogens cause different patterns an accurate correlation is not feasible by relying purely on imaging. The radiological findings serve as proof or exclusion of pneumonia and can also be used to evaluate the extent of the disease (e.g. monolobular, multilobular, unilateral or bilateral). In cases of prolonged disease, suspicion of complications (e.g. pleural effusion or empyema, necrotizing pneumonia or abscess) or comorbid conditions (e.g. underlying pulmonary or mediastinal diseases) computed tomography is an important diagnostic tool in addition to chest radiography. Ultrasound is often used to diagnose pleural processes (e.g. parapneumonic effusion or pleural empyema). (orig.) [German] Anhand der klinischen Symptome und laborchemischen Befundkonstellation alleine ist es oft nicht moeglich, die Diagnose einer ambulant erworbenen Pneumonie (''community-acquired pneumonia'', CAP) zu stellen. Bei jedem Patienten mit Verdacht auf CAP sollte eine Roentgenthoraxaufnahme in 2 Ebenen angefertigt werden. Weiter muss eine Risikostratifizierung im Sinne der Entscheidung ambulante Therapie vs. Hospitalisierung erfolgen. Anhand der Analyse radiologischer Muster sowie deren Verteilung und Ausdehnung koennen eine grobe Zuordnung zu sogenannten Erregergruppen sowie eine Differenzierung zwischen viralen und bakteriellen Infektionen gelingen. Da

  10. Ground-level ozone in four Chinese cities: precursors, regional transport and heterogeneous processes

    Directory of Open Access Journals (Sweden)

    L. K. Xue

    2014-08-01

    Full Text Available We analyzed measurements of ozone (O3 and its precursors made at rural/suburban sites downwind of four large Chinese cities – Beijing, Shanghai, Guangzhou and Lanzhou, to elucidate their pollution characteristics, regional transport, in situ production, and impacts of heterogeneous processes. The same measurement techniques and observation-based model were used to minimize uncertainties in comparison of the results due to difference in methodologies. All four cities suffered from serious O3 pollution but showed different precursor distributions. The model-calculated in situ O3 production rates were compared with the observed change rates to infer the relative contributions of on-site photochemistry and transport. At the rural site of Beijing, export of the well-processed urban plumes contributed to the extremely high O3 levels (up to an hourly value of 286 ppbv, while the O3 pollution observed at suburban sites of Shanghai, Guangzhou and Lanzhou was dominated by intense in-situ production. The O3 production was in a VOCs-limited regime in both Shanghai and Guangzhou, and a NOx-controlled regime in Lanzhou. The key VOC precursors are aromatics and alkenes in Shanghai, and aromatics in Guangzhou. The potential impacts on O3 production of several heterogeneous processes, namely, hydrolysis of dinitrogen pentoxide (N2O5, uptake of hydro peroxy radical (HO2 on particles and surface reactions of NO2 forming nitrous acid (HONO, were assessed. The analyses indicate the varying and considerable impacts of these processes in different areas of China depending on the atmospheric abundances of aerosol and NOx, and suggest the urgent need to better understand these processes and represent them in photochemical models.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Patients' experiences of cold exposure during ambulance care.

    Science.gov (United States)

    Aléx, Jonas; Karlsson, Stig; Saveman, Britt-Inger

    2013-06-06

    Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients' experiences of cold exposure and to identify related factors. During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients' finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation. In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from -22.3°C to 8.4°C. Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons.

  13. 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.

  14. 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...

  15. Fate and transport of pesticides in the ground water systems of southwest Georgia, 1993-2005

    Science.gov (United States)

    Dalton, M.S.; Frick, E.A.

    2008-01-01

    Modern agricultural practices in the United States have resulted in nearly unrivaled efficiency and productivity. Unfortunately, there is also the potential for release of these compounds to the environment and consequent adverse affects on wildlife and human populations. Since 1993, the National Water-Quality Assessment (NAWQA) program of the U.S. Geological Survey has evaluated water quality in agricultural areas to address these concerns. The objective of this study is to evaluate trends in pesticide concentrations from 1993-2005 in the surficial and Upper Floridan aquifers of southwest Georgia using pesticide and pesticide degradate data collected for the NAWQA program. There were six compounds - five herbicides and one degradate - that were detected in more than 20% of samples: atrazine, deethylatrazine (DEA), metolachlor, alachlor, floumeturon, and tebuthiuron. Of the 128 wells sampled during the study, only eight wells had pesticide concentrations that either increased (7) or decreased (1) on a decadal time scale. Most of the significant trends were increasing concentrations of pesticides in older water; median pesticide concentrations did not differ between the surficial and Upper Floridan aquifers from 1993 and 2005. Deethylatrazine, in the Upper Floridan aquifer, was the only compound that had a significant change (increase) in concentration during the study. The limited number of wells with increases in pesticide concentrations suggest that ground-water sources of these compounds are not increasing in concentration over the time scale represented in this study. Copyright ?? 2008 by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America. All rights reserved.

  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. 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.

  18. Transport of a nematicide in surface and ground waters in a farmed tropical catchment with volcanic substratum

    Science.gov (United States)

    Charlier, J.-B.; Cattan, P.; Voltz, M.; Moussa, R.

    2009-04-01

    Assessment of water-pollution risks in agricultural regions requires studying pesticide transport processes in soil and water compartments at the catchment scale. In tropical regions, banana (Musa spp.) plantations are located in zones with abundant rainfalls and soils with high infiltration rates, which lead to washout and leaching of soil-applied pesticides, causing severe diffuse pollution of water resources. The aim of this paper is to determine how the nematicide cadusafos [S,S-di-sec-butyl O-ethyl phosphorodithioate], used in banana plantations, contaminates water and soils at the two scales of subcatchment and catchment. The study site was a small banana-growing catchment on the tropical volcanic island of Guadeloupe in the Caribbean (FWI). The catchment is located in pedoclimatic conditions where rainfall is abundant (> 4000 mm/year), and soil permeable (saturated hydraulic conductivity of Andosol Ks > 30 mm/h). Two campaigns of nematicide application were conducted, one in 2003 over 40% of the catchment and one in 2006 over 12%. For 100 days after application, we monitored the surface water and groundwater flows and the cadusafos concentrations in the soil and in surface and ground waters in a 2400 m² subcatchment and a 17.8 ha catchment. The results show that at the subcatchment scale the high retention in the A horizon of the soil limited the transport of cadusafos by runoff, whereas the lower retention of the molecule in the B horizon favoured percolation towards the shallow groundwater. The contamination levels of surface water, as well as shallow and deep groundwaters, reflected the geological structure of the Féfé catchment: i.e. a shallow aquifer in the most recent volcanic deposits that is rapidly exposed to pollution and a deeper aquifer that is relatively protected from the pollution coming from the treated fields. Comparing the losses of cadusafos at the subcatchment and at the catchment scales revealed that the nematicide re-infiltrated in

  19. Managing stress in prehospital care: Strategies used by ambulance nurses.

    Science.gov (United States)

    Bohström, Dan; Carlström, Eric; Sjöström, Nils

    2017-05-01

    Ambulance nurses display stress symptoms, resulting from their work with patients in an emergency service. Certain individuals seem, however, to handle longstanding stress better than others and remain in exposed occupations such as ambulance services for many years. This paper examines stress inducing and stress defusing factors among ambulance nurses. A qualitative descriptive design using critical incident technique was used. A total of 123 critical incidents were identified, and a total of 61 strategies dealing with stress were confirmed. In all, 13 sub-categories (seven stress factors and five stress reducing factors) were merged into four categories (two stress categories and two stress reducing categories). The study shows that ambulance nurses in general experience emergency calls as being stressful. Unclear circumstances increase the stress level, with cases involving children and childbirth being especially stressful. Accurate information and assistance from the dispatch centre reduced the stress. Having discussions with colleagues directly after the assignment were particularly stress reducing. Advanced team collaboration with teammates was viewed as effective means to decrease stress, in addition to simple rituals to defuse stress such as taking short breaks during the workday. The study confirmed earlier studies that suggest the benefits of defusing immediately after stress reactions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. 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

  1. 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

  2. [Emergency ambulance call-outs often provide primary care

    NARCIS (Netherlands)

    Smits, M.; Francissen, O.; Weerts, M.; Janssen, K.; Grunsven, P. van; Giesen, P.

    2014-01-01

    OBJECTIVE: To examine patient and care characteristics of emergency ambulance call-outs and to determine how many of them were, in retrospect, effectively providing primary care. DESIGN: Retrospective cross-sectional study. METHOD: We charted patient and care characteristics of 598 emergency

  3. Mathematical model of ambulance resources in Saint-Petersburg

    Science.gov (United States)

    Shavidze, G. G.; Balykina, Y. E.; Lejnina, E. A.; Svirkin, M. V.

    2016-06-01

    Emergency medical system is one of the main elements in city infrastructure. The article contains analysis of existing system of ambulance resource distribution. Paper considers the idea of using multiperiodicity as a tool to increase the efficiency of the Emergency Medical Services. The program developed in programming environment Matlab helps to evaluate the changes in the functioning of the system of emergency medical service.

  4. 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.

  5. Using ambulance data to reduce community violence: critical literature review.

    Science.gov (United States)

    Taylor, Alexander; Boyle, Adrian; Sutherland, Alex; Giacomantonio, Chris

    2016-08-01

    Previous work has demonstrated that much violence requiring medical help is not recorded by the police. Sharing emergency department data on victims of violence is associated with reductions in community violence and is well established throughout the UK. We undertook a critical literature review to determine whether sharing ambulance data was useful to identify violence hotspots and offered unique information for violence prevention. A search of the major medical and criminological databases was undertaken using search terms related to the ambulance service, violence and assault, as well as data collection. The search was conducted within the NICE Evidence, Cochrane Library, Google Scholar, Criminal Justice Abstracts, Scopus and National Criminal Justice Reference Service databases, along with the websites of various relevant institutions. Overall, 36 papers were identified by abstract scanning and bibliography search, of which 10 were considered relevant. A further nine papers were detected in the grey literature, and two were considered to be useful in providing evidence for use of ambulance data in violence surveillance. Two of the identified papers were interventional studies, and the other 10 were observational studies. Although the standard of evidence was generally low, most studies demonstrated that ambulance services detected a substantial proportion of assaults that were not recorded by the police or the emergency departments. We identified only two interventional studies, but they were of low quality. Although the interventional evidence base is currently weak, ambulance data provide a unique source of information about the epidemiology of community violence and have the potential to improve current violent crime surveillance methods.

  6. Stratosphere-to-Troposphere Transport Revealed by Ground-based Lidar and Ozonesonde at a Midlatitude Site

    Science.gov (United States)

    Kuang, Shi; Newchurch, M. J.; Burris, John; Wang, Lihua; Knupp, Kevin; Huang, Guanyu

    2013-01-01

    This paper presents ozone structures measured by a ground-based ozone lidar and ozonesonde at Huntsville, Alabama, on 27-29 April 2010 originating from a stratosphere-to-troposphere transport event associated with a cutoff cyclone and tropopause fold. In this case, the tropopause reached 6 km and the stratospheric intrusion resulted in a 2-km thick elevated ozone layer with values between 70 and 85 ppbv descending from the 306-K to 298-K isentropic surface at a rate of 5 km day1. The potential temperature was provided by a collocated microwave profiling radiometer. We examine the corresponding meteorological fields and potential vorticity (PV) structures derived from the analysis data from the North American Mesoscale model. The 2-PVU (PV unit) surface, defined as the dynamic tropopause, is able to capture the variations of the ozone tropopause estimated from the ozonesonde and lidar measurements. The estimated ozone/PV ratio, from the measured ozone and model derived PV, for the mixing layer between the troposphere and stratosphere is approximately 41 ppbv/PVU with an uncertainty of approximately 33%. Within two days, the estimated mass of ozone irreversibly transported from the stratospheric into the troposphere is between 0.07 Tg (0.9 10(exp33) molecules) and 0.11 Tg (1.3 10(exp33) molecules) with an estimated uncertainty of 59%. Tropospheric ozone exhibited enormous variability due to the complicated mixing processes. Low ozone and large variability were observed in the mid-troposphere after the stratospheric intrusion due to the westerly advection including the transition from a cyclonic system to an anticyclonic system. This study using high temporal and vertical-resolution measurements suggests that, in this case, stratospheric air quickly lost its stratospheric characteristics once it is irreversibly mixed down into the troposphere.

  7. Numerical scheme for non-linear model of supercritical fluid extraction from polydisperse ground plant material: single transport system

    Science.gov (United States)

    Salamatin, A.

    2016-11-01

    Numerical algorithm is developed for modelling non-linear mass transfer process in supercritical fluid extraction (SFE). The ground raw material is considered as polydisperse, characterized by discrete number of effective particle fractions. Two continuous interacting counterparts separated by permeable membrane are distinguished in plant material build-up. The apoplast plays role of transport channels during extraction, and symplast contains extractable oil. The complete SFE model is non-linear as a result of non-linearity of oil dissolution kinetics. The computational scheme is based on the finite-volume approximation method and Thomas elimination procedure. The resulting system of algebraic equations is solved iteratively. Special attention is paid to polydisperse substrates, when particle scale characteristics of all fractions interact with each other through pore phase concentration on the vessel scale. Stability of the developed algorithm is demonstrated in numerical tests. Special iterative procedure guarantees a monotonic decrease of oil content in individual particles of substrate. It is also shown that in the limit of the so-called shrinking core approach the number of mesh nodes on a particle scale should be increased.

  8. Evaluation of the matrix exponential for use in ground-water-flow and solute-transport simulations; theoretical framework

    Science.gov (United States)

    Umari, A.M.; Gorelick, S.M.

    1986-01-01

    It is possible to obtain analytic solutions to the groundwater flow and solute transport equations if space variables are discretized but time is left continuous. From these solutions, hydraulic head and concentration fields for any future time can be obtained without ' marching ' through intermediate time steps. This analytical approach involves matrix exponentiation and is referred to as the Matrix Exponential Time Advancement (META) method. Two algorithms are presented for the META method, one for symmetric and the other for non-symmetric exponent matrices. A numerical accuracy indicator, referred to as the matrix condition number, was defined and used to determine the maximum number of significant figures that may be lost in the META method computations. The relative computational and storage requirements of the META method with respect to the time marching method increase with the number of nodes in the discretized problem. The potential greater accuracy of the META method and the associated greater reliability through use of the matrix condition number have to be weighed against this increased relative computational and storage requirements of this approach as the number of nodes becomes large. For a particular number of nodes, the META method may be computationally more efficient than the time-marching method, depending on the size of time steps used in the latter. A numerical example illustrates application of the META method to a sample ground-water-flow problem. (Author 's abstract)

  9. An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality.

    Science.gov (United States)

    Tayler-Smith, K; Zachariah, R; Manzi, M; Van den Boogaard, W; Nyandwi, G; Reid, T; De Plecker, E; Lambert, V; Nicolai, M; Goetghebuer, S; Christiaens, B; Ndelema, B; Kabangu, A; Manirampa, J; Harries, A D

    2013-08-01

    In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections. Data were collected for the period January to December 2011, using ambulance log books, patient registers and logistics records. In 2011, there were 1478 ambulance call-outs. The median referral time (time from maternity calling for an ambulance to the time the patient arrived at the MSF referral facility) was 78 min (interquartile range, 52-130 min). The total annual cost of the referral system (comprising 1.6 ambulances linked with nine maternity units) was € 85 586 (€ 61/obstetric case transferred or € 0.43/capita/year). Referral times exceeding 3 h were associated with a significantly higher risk of early neonatal deaths (OR, 1.9; 95% CI, 1.1-3.2). MSF coverage of complicated obstetric cases and caesarean sections was estimated to be 80% and 92%, respectively. This study demonstrates that it is possible to implement an effective communication and transport system to ensure access to EmONC and also highlights some of the important operational factors to consider, particularly in relation to minimising referral delays. © 2013 John Wiley & Sons Ltd.

  10. 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…

  11. 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…

  12. Impacts of temperature change on ambulance dispatches and seasonal effect modification

    Science.gov (United States)

    Cheng, Jian; Xu, Zhiwei; Zhao, Desheng; Xie, Mingyu; Yang, Huihui; Wen, Liying; Li, Kesheng; Su, Hong

    2016-12-01

    Ambulance dispatch is a proxy of acute health outcomes, and growing epidemiological evidence documented its relation to extreme temperature events. Research, however, on short-term temperature change and ambulance dispatches is scarce. We aimed to investigate the effect of short-term temperature change on ambulance dispatches and potential modification by season. Daily data on ambulance dispatch and weather factors were collected in Huainan, a Chinese inland city from December 2011 through December 2013. A Poison generalized linear regression model combined with distributed lag nonlinear model was constructed to examine the association of temperature change between neighboring days (TCN) with ambulance dispatches. The effect modification by season was also examined. There were 48,700 ambulance attendances during the study period. A statistically significant association of TCN with ambulance dispatches was observed. Temperature rise between neighboring days (TCN > 0) was associated with elevated adverse risk of ambulance dispatches, and the effects appeared to be acute (lag0, on the current day) and could last for at least a week, while temperature drop between neighboring days (TCN ambulance dispatches increased by 2 % (95 % CI 1-3 %) and 7 (95 % CI 1-13 %), respectively. Extreme TCN increase (95th percentile, 3.3 °C vs. 0 °C) at lag0 and lag05 was accompanied by 6 (95 % CI 3-8 %) and 27 % (95 % CI 12-44 %) increase in ambulance dispatches. Ambulance dispatches were more vulnerable to extremely great temperature rise in summer and autumn. TCN was adopted for the first time to quantify the impact of short-term temperature change on ambulance dispatches. Temperature drop between neighboring days (TCN ambulance dispatches, while temperature rise between neighboring days (TCN > 0) could acutely trigger the increase in ambulance dispatches, and TCN effect differs by season.

  13. Trans-boundary aerosol transport during a winter haze episode in China revealed by ground-based Lidar and CALIPSO satellite

    Science.gov (United States)

    Qin, Kai; Wu, Lixin; Wong, Man Sing; Letu, Husi; Hu, Mingyu; Lang, Hongmei; Sheng, Shijie; Teng, Jiyao; Xiao, Xin; Yuan, Limei

    2016-09-01

    By employing PM2.5 observation data, ground-based lidar measurements, MODIS and CALIPSO satellite images, meteorological data, and back trajectories analysis, we investigate a trans-boundary transport of aerosols during a large-area haze episode in China during 3-5 January 2015. The ground-based lidar observations indicated similar episodes of external aerosols passing through and mixing into three East China cities. A considerable amount of total AOD below 3 km (46% in average) was contributed by the external aerosol layers during passing over and importing. CALIPSO satellite observations of central and eastern China revealed a high altitude pollutant belt on January 3. Although the severest ground pollution was found in central and south-eastern Hebei, the high altitude pollution transport was greater in south-western Shandong, north-western Jiangsu, and north-western Anhui. These observations along with the analysis of air mass trajectories and wind fields indicates pollutants moving from Hebei, Henan and Hubei probably contributed to the haze pollution in Shandong and Jiangsu. This study reveals haze transports from North China Plain to East China could be a common phenomenon influenced by the winter monsoon in northern China. Hence, effective control of air pollution requires collaboration among different cities and provinces throughout China. The long-term measurements of aerosol vertical properties by ground-based lidar and CALIPSO are extremely valuable in quantifying the contributions of external factors and will be helpful in validating and improving various air quality models.

  14. Ground-based and in-flight simulator studies of flight characteristics of a twin-fuselage passenger transport airplane during approach and landing

    Science.gov (United States)

    Grantham, W. D.; Smith, P. M.; Neely, W. R., Jr.; Deal, P. L.; Yenni, K. R.

    1985-01-01

    Six-degree-of-freedom ground-based and in-flight simulator studies were conducted to evaluate the low-speed flight characteristics of a twin-fuselage passenger transport airplane and to compare these characteristics with those of a large, single-fuselage (reference) transport configuration similar to the Lockheed C-5A airplane. The primary piloting task was the approach and landing task. The results of this study indicated that the twin-fuselage transport concept had acceptable but unsatisfactory longitudinal and lateral-directional low-speed flight characteristics, and that stability and control augmentation would be required in order to improve the handling qualities. Through the use of rate-command/attitude-hold augmentation in the pitch and roll axes, and the use of several turn coordination features, the handling qualities of the simulated transport were improved appreciably. The in-flight test results showed excellent agreement with those of the six-degree-of-freedom ground-based simulator handling qualities tests. As a result of the in-flight simulation study, a roll-control-induced normal-acceleration criterion was developed. The handling qualities of the augmented twin-fuselage passenger transport airplane exhibited an improvement over the handling characteristics of the reference (single-fuselage) transport.

  15. Regional-scale transport of air pollutants: impacts of southern California emissions on Phoenix ground-level ozone concentrations

    Directory of Open Access Journals (Sweden)

    J. Li

    2015-03-01

    Full Text Available In this study, WRF-Chem is utilized at high-resolution (1.333 km grid spacing for the innermost domain to investigate impacts of southern California anthropogenic emissions (SoCal on Phoenix ground-level ozone concentrations ([O3] for a pair of recent exceedance episodes. First, WRF-Chem Control simulations are conducted to evaluate model performance. Compared with surface observations of hourly ozone, CO, NOx, and wind fields, the Control simulations reproduce observed variability well. Simulated [O3] are within acceptance ranges recommended by the Environmental Protection Agency (EPA that characterize skillful experiments. Next, the relative contribution of SoCal and Arizona local anthropogenic emissions (AZ to ozone exceedance within the Phoenix metropolitan area is investigated via a trio of sensitivity simulations: (1 SoCal emissions are excluded, with all other emissions as in Control; (2 AZ emissions are excluded with all other emissions as in Control; and (3 SoCal and AZ emissions are excluded (i.e., all anthropogenic emissions are eliminated to account only for biogenic emissions [BEO]. Results for the selected events indicate the impacts of AZ emissions are dominant on daily maximum 8 h average (DMA8 [O3] in Phoenix. SoCal contributions to DMA8 [O3] for the Phoenix metropolitan area range from a few ppbv to over 30 ppbv (10–30% relative to Control experiments. [O3] from SoCal and AZ emissions exhibit the expected diurnal characteristics that are determined by physical and photochemical processes, while BEO contributions to DMA8 [O3] in Phoenix also play a key role. Finally, ozone transport processes and pathways within the lower troposphere are investigated. During daytime, pollutants (mainly ozone near the southern California coasts are pumped into the planetary boundary-layer over the southern California desert through the mountain chimney and pass channel effects, aiding eastward transport along the desert air basins in southern

  16. Determinants of ambulance response time: A study in Sabah, Malaysia

    Science.gov (United States)

    Chin, Su Na; Cheah, Phee Kheng; Arifin, Muhamad Yaakub; Wong, Boh Leng; Omar, Zaturrawiah; Yassin, Fouziah Md; Gabda, Darmesah

    2017-04-01

    Ambulance response time (ART) is one of the standard key performance indicators (KPI) in measuring the emergency medical services (EMS) delivery performances. When the mean time of ART of EMS system reaches the KPI target, it shows that the EMS system performs well. This paper considers the determinants of ART, using data sampled from 967 ambulance runs in a government hospital in Sabah. Multiple regression analysis with backward elimination was proposed for the identification of significant factors. Amongst the underlying factors, travel distance, age of patients, type of treatment and peak hours were identified to be significantly affecting ART. Identifying factors that influence ART helps the development of strategic improvement planning for reducing the ART.

  17. 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...

  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. 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.

  20. Informing clinical policy decision-making practices in ambulance services.

    Science.gov (United States)

    Muecke, Sandy; Curac, Nada; Binks, Darryn

    2013-12-01

    This study aims to identify the processes and frameworks that support an evidence-based approach to clinical policy decision-making practices in ambulance services. This literature review focused on: (i) the setting (pre-hospital); and (ii) the process of evidence translation, for studies published after the year 2000. Searches of Medline, CINAHL and Google were undertaken. Reference lists of eligible publications were searched for relevant articles. A total of 954 articles were identified. Of these, 20 full text articles were assessed for eligibility and seven full text articles met the inclusion criteria. Three provided detailed descriptions of the evidence-based practice processes used to inform ambulance service protocol or guideline development or review. There is little published literature that describes the processes involved, and frameworks required, to inform clinical policy decision making within ambulance services. This review found that processes were iterative and involved collaborations across many internal and external stakeholders. In several jurisdictions, these were coordinated by a dedicated team. Success appears dependent on committed leadership and purposive human and structural resources. Although time consuming, structured processes have been developed in some jurisdictions to assist decision-making processes. Further insight is likely to be obtained from literature published by those from other disciplines. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

  1. Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns

    Science.gov (United States)

    Doyle, Joseph; Graves, John; Gruber, Jonathan

    2014-01-01

    Medicare spending exceeds 4% of GDP in the US each year, and there are concerns that moral hazard problems have led to overspending. This paper considers whether hospitals that treat patients more aggressively and receive higher payments from Medicare improve health outcomes for their patients. An innovation is a new lens to compare hospital performance for emergency patients: plausibly exogenous variation in ambulance-company assignment among patients who live near one another. Using Medicare data from 2002–2010, we show that ambulance company assignment importantly affects hospital choice for patients in the same ZIP code. Using data for New York State from 2000–2006 that matches exact patient addresses to hospital discharge records, we show that patients who live very near each other but on either side of ambulance service area boundaries go to different types of hospitals. Both identification strategies show that higher-cost hospitals achieve better patient outcomes for a variety of emergency conditions. Using our Medicare sample, the estimates imply that a one standard deviation increase in Medicare reimbursement leads to a 4 percentage point reduction in mortality (10% compared to the mean). Taking into account one-year spending after the health shock, the implied cost per at least one year of life saved is approximately $80,000. These results are found across different types of hospitals and patients, as well across both identification strategies. PMID:25750459

  2. 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

  3. Guidelines for selecting codes for ground-water transport modeling of low-level waste burial sites. Volume 2. Special test cases

    Energy Technology Data Exchange (ETDEWEB)

    Simmons, C.S.; Cole, C.R.

    1985-08-01

    This document was written for the National Low-Level Waste Management Program to provide guidance for managers and site operators who need to select ground-water transport codes for assessing shallow-land burial site performance. The guidance given in this report also serves the needs of applications-oriented users who work under the direction of a manager or site operator. The guidelines are published in two volumes designed to support the needs of users having different technical backgrounds. An executive summary, published separately, gives managers and site operators an overview of the main guideline report. Volume 1, titled ''Guideline Approach,'' consists of Chapters 1 through 5 and a glossary. Chapters 2 through 5 provide the more detailed discussions about the code selection approach. This volume, Volume 2, consists of four appendices reporting on the technical evaluation test cases designed to help verify the accuracy of ground-water transport codes. 20 refs.

  4. Ground-water flow, geochemistry, and effects of agricultural practices on nitrogen transport at study sites in the Piedmont and Coastal Plain physiographic provinces, Patuxent River basin, Maryland

    Science.gov (United States)

    McFarland, Randolph E.

    1997-01-01

    In an effort to improve water quality in Chesapeake Bay, agricultural practices are being promoted that are intended to reduce contaminant transport to the Bay. The effects of agricultural practices on nitrogen transport were assessed at two 10-acre study sites in the Patuxent River basin, Maryland, during 1986-92. Nitrogen load was larger in ground water than in surface runoff at both sites. At the study site in the Piedmont Province, nitrogen load in ground water decreased from 12 to 6 (lb/acre)/yr (pound per acre per year) as corn under no-till cultivation was replaced by no-till soybeans, continuous alfalfa, and contoured strip crops alternated among corn, alfalfa, and soybeans. At the study site in the Coastal Plain Province, no-till soybeans resulted in a nitrogen load in ground water of 12.55 (lb/acre)/yr, whereas conventional-till soybeans resulted in a nitrogen load in ground water of 11.51 (lb/acre)/yr.

  5. Critical incident stress intervention after loss of an air ambulance: two-year follow up.

    Science.gov (United States)

    Macnab, A J; Russell, J A; Lowe, J P; Gagnon, F

    1999-01-01

    Following an air ambulance crash with five fatalities, critical incident stress debriefing (CISD) was provided for involved paramedics, physicians, and nurses. A study was conducted to evaluate the long-term effects of a critical incident with critical incident stress debriefing according to the Mitchell model. Six months following the incident, empirically designed questionnaires were mailed to all transport paramedics and directly involved medical staff, and a random sample of both nurses from the dispatch/receiving institution and paramedics from around the province. Twenty-four months post-incident, all members of the transport paramedics completed the Impact of Events Scale and the General Health Questionnaires. There were no differences between groups on any scores, except for disturbed sleep patterns, bad dreams, and the need for personal counseling being greater among transport paramedics at one day. There was no correlation between how well the deceased individuals were known, amount of debriefing, and symptom severity. A trend was seen for those with pre-existing stress management routines to have less severe symptoms at six months (p = 0.07). At two years, 16% of transport paramedics still had significant abnormal behavior. CISD did not appear to affect the severity of stress symptoms, whereas having pre-existing stress management strategies may. These findings give justification for proceeding to a randomized, controlled trial of different levels of critical incident stress intervention.

  6. 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.

  7. Spinal Cord Injury Functional Ambulation Profile: a preliminary look at responsiveness.

    Science.gov (United States)

    Musselman, Kristin E; Yang, Jaynie F

    2014-02-01

    The Spinal Cord Injury Functional Ambulation Profile (SCI-FAP) is a valid, reliable measure of walking skill (eg, walking while negotiating obstacles, doors, and stairs). The responsiveness of the SCI-FAP was assessed at least 7 months after spinal cord injury (SCI) and compared with that of the 10-Meter Walk Test (10MWT) and the Six-Minute Walk Test (6MWT). A secondary analysis of data collected during a randomized, single-blind, crossover trial was performed. Participants had incomplete SCI and could walk at least 5 m without manual assistance. After 3 or 4 baseline assessments, participants completed 2 months of precision training (stepping over obstacles and onto targets on the ground) and 2 months of endurance training (treadmill training with body weight support, if needed). Walking function was assessed with the SCI-FAP, 10MWT, and 6MWT. Internal responsiveness was evaluated through change scores and standardized response means (SRMs). External responsiveness was gauged by correlating change scores on the SCI-FAP, 10MWT, and 6MWT. The minimal detectable change was calculated from the standard error of measurement from the baseline assessments. The SCI-FAP scores improved with both interventions. The magnitude of change was greater for participants whose pretraining self-selected speed was less than 0.5 m/s. The SCI-FAP had moderate SRMs. The 10MWT (fastest speed) and 6MWT had the largest SRMs after precision training and endurance training, respectively. The minimal detectable change in the SCI-FAP was 96 points. The convenience sample was small and all participants could ambulate independently (with devices); therefore, the generalizability of the findings is limited. The SCI-FAP was responsive to changes in walking ability in participants who had incomplete SCI and walked at slow speeds, but overall the 10MWT and 6MWT were more responsive.

  8. Telemedicine-based physician consultation results in more patients treated and released by ambulance personnel

    DEFF Research Database (Denmark)

    Raaber, Nikolaj; Bøtker, Morten T; Riddervold, Ingunn S

    2016-01-01

    . In the intervention period, the EMCC was manned 24/7 with physicians experienced in emergency care. Eligible participants included all patients with nonurgent conditions receiving an ambulance after a medical emergency call. Ambulance personnel assessed patients and subsequently performed a telephone consultation...... a physician at the EMCC and ambulance personnel and noncritically ill 1-1-2 patients results in an increased rate of patients treated and released with high satisfaction. The approach does not seem to compromise patient safety....

  9. Simulations of Ground-Water Flow, Transport, Age, and Particle Tracking near York, Nebraska, for a Study of Transport of Anthropogenic and Natural Contaminants (TANC) to Public-Supply Wells

    Science.gov (United States)

    Clark, Brian R.; Landon, Matthew K.; Kauffman, Leon J.; Hornberger, George Z.

    2008-01-01

    Contamination of public-supply wells has resulted in public-health threats and negative economic effects for communities that must treat contaminated water or find alternative water supplies. To investigate factors controlling vulnerability of public-supply wells to anthropogenic and natural contaminants using consistent and systematic data collected in a variety of principal aquifer settings in the United States, a study of Transport of Anthropogenic and Natural Contaminants to public-supply wells was begun in 2001 as part of the U.S. Geological Survey National Water-Quality Assessment Program. The area simulated by the ground-water flow model described in this report was selected for a study of processes influencing contaminant distribution and transport along the direction of ground-water flow towards a public-supply well in southeastern York, Nebraska. Ground-water flow is simulated for a 60-year period from September 1, 1944, to August 31, 2004. Steady-state conditions are simulated prior to September 1, 1944, and represent conditions prior to use of ground water for irrigation. Irrigation, municipal, and industrial wells were simulated using the Multi-Node Well package of the modular three-dimensional ground-water flow model code, MODFLOW-2000, which allows simulation of flow and solutes through wells that are simulated in multiple nodes or layers. Ground-water flow, age, and transport of selected tracers were simulated using the Ground-Water Transport process of MODFLOW-2000. Simulated ground-water age was compared to interpreted ground-water age in six monitoring wells in the unconfined aquifer. The tracer chlorofluorocarbon-11 was simulated directly using Ground-Water Transport for comparison with concentrations measured in six monitoring wells and one public supply well screened in the upper confined aquifer. Three alternative model simulations indicate that simulation results are highly sensitive to the distribution of multilayer well bores where leakage

  10. Occupational stressors and its organizational and individual correlates: a nationwide study of Norwegian ambulance personnel

    National Research Council Canada - National Science Library

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

    2008-01-01

    .... We compared the severity and frequency level of organizational and ambulance-specific stressors, and studied their relationship to organizational conditions and individual differences A comprehensive...

  11. Interhospital Transport System for Critically Ill Patients: Mobile Extracorporeal Membrane Oxygenation without a Ventilator

    Science.gov (United States)

    Yeo, Hye Ju; Cho, Woo Hyun; Park, Jong Myung; Kim, Dohyung

    2017-01-01

    Background Extracorporeal membrane oxygenation (ECMO) has been successfully used as a method for the interhospital transportation of critically ill patients. In South Korea, a well-established ECMO interhospital transport system is lacking due to limited resources. We developed a simplified ECMO transport system without mechanical ventilation for use by public emergency medical services. Methods Eighteen patients utilized our ECMO transport system from December 2011 to September 2015. We retrospectively analyzed the indications for ECMO, the patient status during transport, and the patient outcomes. Results All transport was conducted on the ground by ambulance. The distances covered ranged from 26 to 408 km (mean, 65.9±88.1 km) and the average transport time was 56.1±57.3 minutes (range, 30 to 280 minutes). All patients were transported without adverse events. After transport, 4 patients (22.2%) underwent lung transplantation because of interstitial lung disease. Eight patients who had severe acute respiratory distress syndrome showed recovery of heart and lung function after ECMO therapy. A total of 13 patients (70.6%) were successfully taken off ECMO, and 11 patients (61.1%) survived. Conclusion Our ECMO transport system without mechanical ventilation can be considered a safe and useful method for interhospital transport and could be a good alternative option for ECMO transport in Korean hospitals with limited resources. PMID:28180097

  12. Temperature adaptation of active sodium-potassium transport and of passive permeability in erythrocytes of ground squirrels.

    Science.gov (United States)

    Kimzey, S. L.; Willis, J. S.

    1971-01-01

    Unidirectional active and passive fluxes of K-42 and Na-24 were measured in red blood cells of ground squirrels (hibernators) and guinea pigs (nonhibernators). As the temperature was lowered, ?active' (ouabain-sensitive) K influx and Na efflux were more considerably diminished in guinea pig cells than in those of ground squirrels. The fraction of total K influx which is ouabain-sensitive in red blood cells of ground squirrels was virtually constant at all temperatures, whereas it decreased abruptly in guinea pig cells as temperature was lowered.

  13. 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.

  14. 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.

  15. Ambulance staging for potentially dangerous scenes: another hidden component of response time.

    Science.gov (United States)

    Gratton, Matthew; Garza, Alex; Salomone, Joseph A; McElroy, James; Shearer, Jason

    2010-01-01

    Emergency medical services (EMS) responses to some scenes are potentially more dangerous than others, requiring EMS systems to develop policies that stage medical responders away from the scene until law enforcement has the area secured. We sought to characterize the calls that are staged and to demonstrate the effect of staging on the response time interval and differences in red lights and sirens (RLS) transport to the hospital between staged calls (SC) and nonstaged calls (NSC). This was a retrospective cohort study of all 9-1-1 calls received during calendar year 2006 in a midwestern, high-performance system. Descriptive statistics, Mann-Whitney U test, and chi-square analysis were used as appropriate; p protocol, dispatchers ordered EMS to stage on five categories: 924 for assault/rape (20.9%), 393 for unknown problem/man down (8.9%), 918 for overdose (20.8%), 734 for psychiatric/suicide attempt (16.6%), and 413 for stab/gunshot wound (9.4%). Dispatchers ordered staging using their own discretion for 1,032 (23.4%) calls. The median response time interval (call received until ambulance arrived at the scene) was 10 minutes 55 seconds (i.e., 10:55 minutes) (interquartile range [IQR]: 8:00-14:27) for SC and 6:16 minutes (IQR: 4:42-8:28) for NSC (p ambulances while police secure potentially dangerous scenes added approximately 4.5 minutes to the response time. We were unable to demonstrate a difference in RLS return to the hospital (our proxy for patient acuity) between SC and NSC.

  16. SUTRA: A model for 2D or 3D saturated-unsaturated, variable-density ground-water flow with solute or energy transport

    Science.gov (United States)

    Voss, Clifford I.; Provost, A.M.

    2002-01-01

    SUTRA (Saturated-Unsaturated Transport) is a computer program that simulates fluid movement and the transport of either energy or dissolved substances in a subsurface environment. This upgraded version of SUTRA adds the capability for three-dimensional simulation to the former code (Voss, 1984), which allowed only two-dimensional simulation. The code employs a two- or three-dimensional finite-element and finite-difference method to approximate the governing equations that describe the two interdependent processes that are simulated: 1) fluid density-dependent saturated or unsaturated ground-water flow; and 2) either (a) transport of a solute in the ground water, in which the solute may be subject to: equilibrium adsorption on the porous matrix, and both first-order and zero-order production or decay; or (b) transport of thermal energy in the ground water and solid matrix of the aquifer. SUTRA may also be used to simulate simpler subsets of the above processes. A flow-direction-dependent dispersion process for anisotropic media is also provided by the code and is introduced in this report. As the primary calculated result, SUTRA provides fluid pressures and either solute concentrations or temperatures, as they vary with time, everywhere in the simulated subsurface system. SUTRA flow simulation may be employed for two-dimensional (2D) areal, cross sectional and three-dimensional (3D) modeling of saturated ground-water flow systems, and for cross sectional and 3D modeling of unsaturated zone flow. Solute-transport simulation using SUTRA may be employed to model natural or man-induced chemical-species transport including processes of solute sorption, production, and decay. For example, it may be applied to analyze ground-water contaminant transport problems and aquifer restoration designs. In addition, solute-transport simulation with SUTRA may be used for modeling of variable-density leachate movement, and for cross sectional modeling of saltwater intrusion in

  17. Profile of the horizontal wind variance near the ground in near neutral flow - K-theory and the transport of the turbulent kinetic energy

    Science.gov (United States)

    Yahaya, S.; Frangi, J. P.

    2009-05-01

    This paper deals with the characteristics of the atmospheric turbulent flow in the vicinity of the ground, and particularly with the profile of the horizontal wind variance. The study is based on experimental measurements performed with fast cup anemometers located near the ground at 5 different levels (from 0.25 to 4 m) and sampled at 1 Hz. The experiment was carried over two agricultural plots with various tillage treatments in a fallow semiarid area (Central Aragon, Spain). The results of this study reveal that near the ground surface and under moderate wind, the horizontal wind variance logarithmically increases with height, in direct relationship with the friction velocity and the roughness length scale. A theoretical development has allowed us to link this behaviour to the modeling of the turbulent kinetic energy (TKE) transport through the eddy diffusivity. Thus, the study proposes a formulation of the similarity universal function of the horizontal wind variance. Besides, the formulation offers a new method for the determination of the friction velocity and the roughness length scale and can be used for the evaluation of the TKE transport rate.

  18. Green tree frog (Hyla cinerea) and ground squirrel (Xerospermophilus spilosoma) mortality attributed to inland brevetoxin transportation at Padre Island National Seashore, Texas, 2015

    Science.gov (United States)

    Buttke, Danielle E.; Walker, Alicia; Huang, I-Shuo; Flewelling, Leanne; Lankton, Julia S.; Ballmann, Anne E.; Clapp, Travis; Lindsay, James; Zimba, Paul V.

    2017-01-01

    On 16 September 2015, a red tide (Karenia brevis) bloom impacted coastal areas of Padre Island National Seashore Park. Two days later and about 0.9 km inland, 30–40 adult green tree frogs (Hyla cinerea) were found dead after displaying tremors, weakness, labored breathing, and other signs of neurologic impairment. A rainstorm, accompanied by high winds, rough surf, and high tides, which could have aerosolized brevetoxin, occurred on the morning of the mortality event. Frog carcasses were healthy but contained significant brevetoxin in tissues. Tissue brevetoxin was also found in two dead or dying spotted ground squirrels (Xerospermophilus spilosoma) and a coyote (Canis latrans). Rainwater collected from the location of the mortality event contained brevetoxin. Mortality of green tree frog and ground squirrel mortality has not been previously attributed to brevetoxin exposure and such mortality suggested that inland toxin transport, possibly through aerosols, rainfall, or insects, may have important implications for coastal species.

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

    NARCIS (Netherlands)

    Ebben, R.H.A.; Vloet, L.C.M.; Schalk, D.M.; Mintjes-de Groot, J.; Achterberg, T. van

    2014-01-01

    INTRODUCTION: 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.

  20. Basic life support and automated external defibrillator skills among ambulance personnel

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen

    2012-01-01

    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....

  1. 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.

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

    NARCIS (Netherlands)

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

    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.

  3. Resilience of urban ambulance services under future climate, meteorology and air pollution scenarios

    Science.gov (United States)

    Pope, Francis; Chapman, Lee; Fisher, Paul; Mahmood, Marliyyah; Sangkharat, Kamolrat; Thomas, Neil; Thornes, John

    2017-04-01

    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, other meteorological and air pollution variables on ambulance call out rates for different medical categories will be investigated. We use ambulance call out obtained from various ambulance services worldwide which have significantly different meteorologies, climatologies and pollution conditions. A time-series analysis is utilized to understand the relation between meteorological conditions, air pollutants and different call out categories. We will present findings that support the opinion that ambulance attendance call outs 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 meteorology, climate, air pollution and human health thereby allowing for better prediction of ambulance use through the application of long and short-term weather, climate and pollution forecasts.

  4. [Comparison between alcoholic patients and primary care patients for the use of the ambulance].

    Science.gov (United States)

    Ino, Aro; Yoshimoto, Hisashi; Mizutani, Naomi; Kato, Naohisa; Hirohuji, Hideo; Takemura, Yousuke C

    2013-10-01

    Though heavy drinkers and patients with alcohol dependence make use of the ambulance more frequently as compared with the general population, there are few data on the alcohol-related use of the emergency department (ED) in Japan. A cross sectional study was conducted. 170 patients with alcohol dependence in one clinic and 306 primary care patients across two clinics provided demographic data and answered some questions about the use of emergency ambulance services over the age of 20. The questions asked included whether use of the ambulance caused injuries, as well as AUDIT-C (primary care patients only). In this study, multiple logistic regression analysis was used. The use of emergency ambulance services by patients with alcohol dependence was 4.68 times more than primary care patients, and the occurrence of ambulance-caused injuries was 6.03 times higher, as determined by multiple logistic regression. Among primary care patients, AUDIT-C positive patients (male; 5 points or more, female; 3 points or more) were 37 (12.2%), and the occurrence of ambulance-caused injuries was 3.32 times higher. Like with other countries, in Japan, heavy drinkers and patients with alcohol dependence lead to a significant increase in the use of emergency ambulance services as well as ambulance-caused injuries.

  5. Dynamic ambulance dispatching: is the closest-idle policy always optimal?

    NARCIS (Netherlands)

    C.J. Jagtenberg (Caroline); S. Bhulai (Sandjai); R.D. van der Mei (Rob)

    2016-01-01

    htmlabstractWe address the problem of ambulance dispatching, in which we must decide which ambulance to send to an incident in real time. In practice, it is commonly believed that the ‘closest idle ambulance’ rule is near-optimal and it is used throughout most literature. In this paper, we present

  6. Modern concepts of transport in multiple trauma: a narrative review

    Directory of Open Access Journals (Sweden)

    Zarei Mohammad Reza

    2013-06-01

    Full Text Available 【Abstract】Multiple variables can influence triage decision in multiple trauma. Recognition of priorities and selection of the destination can be successfully achieved by field triage and individualized clinical judgment. This narrative review summarizes the new options and protocols for transport of injured subjects. There are four levels of emergency medical providers including first responders and three levels of emergency medical technicians. Two distinct accepted protocols for transport are known as scoop and run and treat and then transfer. The former provides mini-mum lifesaving treatment at the scene of accident followed by transferring the patient(s as soon as possible, and the latter mainly emphasizes the need for complete stabilization as a prerequisite for safe transport. The destination and mode of transport are selected according to clinical capa-bilities of the receiving hospital, transfer time from the scene to the facility, patient’s medical condition, accessibility of the scene, and weather. Two common methods of transfer are ground transport, including various type of ambulances, and air medical transport, i.e. helicopter and airplane. Key words: Transportation of patients; Multiple trauma; Triage; Emergency medical service communication systems

  7. The Effect of Ambulance Staffing Models in a Metropolitan, Fire-Based EMS System.

    Science.gov (United States)

    Cortez, Eric J; Panchal, Ashish R; Davis, James E; Keseg, David P

    2017-04-01

    Introduction The staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model. Hypothesis/Problem The objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]). This was a retrospective study conducted from September 17, 2013 through December 31, 2013. The PB ambulances were compared to geographically matched ambulances staffed with paramedic-paramedic (PP ambulances). One PP and one PB ambulance were based at Station A; one PP and one PB ambulance were based at Station B. The primary outcome was total on-scene time. Secondary outcomes included time-to-electrocardiogram (EKG), time-to-intravenous (IV) line insertion, IV-line success rate, and percentage of protocol violations. Inclusion criteria were all patients requesting prehospital services that were attended to by these teams. Patients were excluded if they were not attended to by the study ambulance vehicles. Descriptive statistics were reported as medians and interquartile ranges (IQR). Proportions were reported with 95% confidence intervals (CI). The Mann-Whitley U test was used for significance testing (Pambulance were shorter than the PB ambulance team (PP: 10.1 minutes, IQR 6.0-15; PB: 13.0 minutes, IQR 8.1-18; P=.01). This finding also was noted at Station B (PP: 13.5 minutes, IQR 8.5-19; PB: 14.3 minutes, IQR 9.9-20; P=.01). There were no differences between PP and PB ambulance teams at Station A or Station B in time-to-EKG, time-to-IV insertion, IV success rate, and protocol violation rates. In the setting of a well-developed EMS system utilizing an all-Advanced Life Support (ALS) response, this study suggests that PB ambulance teams may function well when compared to PP ambulances. Though longer scene times were observed, differences in

  8. Comparison of different intubation techniques performed inside a moving ambulance: a manikin study.

    Science.gov (United States)

    Wong, K B; Lui, C T; Chan, William Y W; Lau, T L; Tang, Simon Y H; Tsui, K L

    2014-08-01

    OBJECTIVE. Airway management and endotracheal intubation may be required urgently when a patient deteriorates in an ambulance or aircraft during interhospital transfer or in a prehospital setting. The objectives of this study were: (1) to compare the effectiveness of conventional intubation by Macintosh laryngoscope in a moving ambulance versus that in a static ambulance; and (2) to compare the effectiveness of inverse intubation and GlideScope laryngoscopy with conventional intubation inside a moving ambulance. DESIGN. Comparative experimental study. SETTING. The experiment was conducted in an ambulance provided by the Auxiliary Medical Service in Hong Kong. PARTICIPANTS. A group of 22 doctors performed endotracheal intubation on manikins with Macintosh laryngoscope in a static and moving ambulance. In addition, they performed conventional Macintosh intubation, inverse intubation with Macintosh laryngoscope, and GlideScope intubation in a moving ambulance in both normal and simulated difficult airways. MAIN OUTCOME MEASURES. The primary outcome was the rate of successful intubation. The secondary outcomes were time taken for intubation, subjective glottis visualisation grading, and eventful intubation (oesophageal intubation, intubation time >60 seconds, and incisor breakage) with different techniques or devices. RESULTS. In normal airways, conventional Macintosh intubation in a static ambulance (95.5%), conventional intubation in a moving ambulance (95.5%), as well as GlideScope intubation in a moving ambulance (95.5%) were associated with high success rates; the success rate of inverse intubation was comparatively low (54.5%; P=0.004). In difficult airways, conventional Macintosh intubation in a static ambulance (86.4%), conventional intubation in a moving ambulance (90.9%), and GlideScope intubation in a moving ambulance (100%) were associated with high success rates; the success rate of inverse intubation was comparatively lower (40.9%; P=0.034). CONCLUSIONS

  9. Ground-water flow and contaminant transport at a radioactive-materials processing site, Wood River Junction, Rhode Island

    Science.gov (United States)

    Ryan, Barbara J.; Kipp, Kenneth L.

    1997-01-01

    Liquid wastes from an enriched-uranium cold-scrap recovery plant at Wood River Junction, Rhode Island, were discharged to the environment through evaporation ponds and trenches from 1966 through 1980. Leakage from the ponds and trenches resulted in a plume of contaminated ground water extending northwestward to the Pawcatuck River through a highly permeable sand and gravel aquifer of glacial origin.

  10. 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.

  11. Critical care paramedics in England: a national survey of ambulance services.

    Science.gov (United States)

    von Vopelius-Feldt, Johannes; Benger, Jonathan

    2014-08-01

    Critical care paramedics (CCPs) have been introduced by individual ambulance trusts in England, but there is a lack of national coordination of training and practice. We conducted an online survey of NHS ambulance services to provide an overview of the current utilization and role of CCPs in England. The survey found significant variations in training, competencies and the working patterns of the ∼90 CCPs working in five ambulance services. All ambulance trusts currently employing CCPs are planning on increasing CCP numbers, whereas 'insufficient financial means' and 'insufficient scientific evidence' are the two major barriers to CCP utilization. The CCP model established in five ambulance services in England is unique within Europe. With increasing numbers of CCPs, concerns about lack of supportive scientific evidence and clinical need should be addressed. Optimal delivery of prehospital critical care in England remains controversial.

  12. Maglev vehicles and superconductor technology: Integration of high-speed ground transportation into the air travel system

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, L.R.; Rote, D.M.; Hull, J.R.; Coffey, H.T.; Daley, J.G.; Giese, R.F.

    1989-04-01

    This study was undertaken to (1) evaluate the potential contribution of high-temperature superconductors (HTSCs) to the technical and economic feasibility of magnetically levitated (maglev) vehicles, (2) determine the status of maglev transportation research in the United States and abroad, (3) identify the likelihood of a significant transportation market for high-speed maglev vehicles, and (4) provide a preliminary assessment of the potential energy and economic benefits of maglev systems. HTSCs should be considered as an enhancing, rather than an enabling, development for maglev transportation because they should improve reliability and reduce energy and maintenance costs. Superconducting maglev transportation technologies were developed in the United States in the late 1960s and early 1970s. Federal support was withdrawn in 1975, but major maglev transportation programs were continued in Japan and West Germany, where full-scale prototypes now carry passengers at speeds of 250 mi/h in demonstration runs. Maglev systems are generally viewed as very-high-speed train systems, but this study shows that the potential market for maglev technology as a train system, e.g., from one downtown to another, is limited. Rather, aircraft and maglev vehicles should be seen as complementing rather than competing transportation systems. If maglev systems were integrated into major hub airport operations, they could become economical in many relatively high-density US corridors. Air traffic congestion and associated noise and pollutant emissions around airports would also be reduced. 68 refs., 26 figs., 16 tabs.

  13. Fate and transport of petroleum hydrocarbons in soil and ground water at Big South Fork National River and Recreation Area, Tennessee and Kentucky, 2002-2003

    Science.gov (United States)

    Williams, Shannon D.; Ladd, David E.; Farmer, James

    2006-01-01

    In 2002 and 2003, the U.S. Geological Survey (USGS), by agreement with the National Park Service (NPS), investigated the effects of oil and gas production operations on ground-water quality at Big South Fork National River and Recreation Area (BISO) with particular emphasis on the fate and transport of petroleum hydrocarbons in soils and ground water. During a reconnaissance of ground-water-quality conditions, samples were collected from 24 different locations (17 springs, 5 water-supply wells, 1 small stream, and 1 spring-fed pond) in and near BISO. Benzene, toluene, ethylbenzene, and xylene (BTEX) compounds were not detected in any of the water samples, indicating that no widespread contamination of ground-water resources by dissolved petroleum hydrocarbons probably exists at BISO. Additional water-quality samples were collected from three springs and two wells for more detailed analyses to obtain additional information on ambient water-quality conditions at BISO. Soil gas, soil, water, and crude oil samples were collected at three study sites in or near BISO where crude oil had been spilled or released (before 1993). Diesel range organics (DRO) were detected in soil samples from all three of the sites at concentrations greater than 2,000 milligrams per kilogram. Low concentrations (less than 10 micrograms per kilogram) of BTEX compounds were detected in lab-analyzed soil samples from two of the sites. Hydrocarbon-degrading bacteria counts in soil samples from the most contaminated areas of the sites were not greater than counts for soil samples from uncontaminated (background) sites. The elevated DRO concentrations, the presence of BTEX compounds, and the low number of -hydrocarbon-degrading bacteria in contaminated soils indicate that biodegradation of petroleum hydrocarbons in soils at these sites is incomplete. Water samples collected from the three study sites were analyzed for BTEX and DRO. Ground-water samples were collected from three small springs at the

  14. Seasonal associations and atmospheric transport distances of fungi in the genus Fusarium collected with unmanned aerial vehicles and ground-based sampling devices

    Science.gov (United States)

    Lin, Binbin; Ross, Shane D.; Prussin, Aaron J.; Schmale, David G.

    2014-09-01

    Spores of fungi in the genus Fusarium may be transported through the atmosphere over long distances. New information is needed to characterize seasonal trends in atmospheric loads of Fusarium and to pinpoint the source(s) of inoculum at both local (farm) and regional (state or country) scales. We hypothesized that (1) atmospheric concentrations of Fusarium spores in an agricultural ecosystem vary with height and season and (2) transport distances from potential inoculum source(s) vary with season. To test these hypotheses, spores of Fusarium were collected from the atmosphere in an agricultural ecosystem in Blacksburg, VA, USA using a Burkard volumetric sampler (BVS) 1 m above ground level and autonomous unmanned aerial vehicles (UAVs) 100 m above ground level. More than 2200 colony forming units (CFUs) of Fusarium were collected during 104 BVS sampling periods and 180 UAV sampling periods over four calendar years (2009-2012). Spore concentrations ranged from 0 to 13 and 0 to 23 spores m-3 for the BVS and the UAVs, respectively. Spore concentrations were generally higher in the fall, spring, and summer, and lower in the winter. Spore concentrations from the BVS were generally higher than those from the UAVs for both seasonal and hourly collections. A Gaussian plume transport model was used to estimate distances to the potential inoculum source(s) by season, and produced mean transport distances of 1.4 km for the spring, 1.7 km for the summer, 1.2 km for the fall, and 4.1 km for the winter. Environmental signatures that predict atmospheric loads of Fusarium could inform disease spread, air pollution, and climate change.

  15. Characteristics of hospitals diverting ambulances in a California EMS system.

    Science.gov (United States)

    Kahn, Christopher A; Stratton, Samuel J; Anderson, Craig L

    2014-02-01

    While several reports discuss controversies regarding ambulance diversion from acute care hospitals and the mortality, financial, and resource effects, there is scant literature related to the effect of hospital characteristics. The objective of this study was to describe specific paramedic receiving center characteristics that are associated with ambulance diversion rates in an Emergency Medical Services system. A retrospective observational study design was used. The study was performed in a suburban EMS system with 27 paramedic receiving centers studied; one additional hospital present at the beginning of the study period (2000-2008) was excluded due to lack of recent data. Hospital-level and population-level characteristics were gathered, including diversion rate (hours on diversion/total hours open), for-profit status, number of specialty services (including trauma, burn, cardiovascular surgery, renal transplant services, cardiac catheterization capability [both interventional and diagnostic], and burn surgery), average inpatient bed occupancy rate (total patient days/licensed bed days), annual emergency department (ED) volume (patients per year), ED admission rate (percent of ED patients admitted), and percent of patients leaving without being seen. Demographic characteristics included percent of persons in each hospital's immediate census tract below the 100% and 200% poverty lines (each considered separately), and population density within the census tract. Bivariate and regression analyses were performed. Diversion rates for the 27 centers ranged from 0.3%-14.5% (median 4.5%). Average inpatient bed occupancy rate and presence of specialty services were correlated with an increase in diversion rate; occupancy rate showed a 0.08% increase in diversion hours per 1% increase in occupancy rate (95% CI, 0.01%-0.16%), and hospitals with specialty services had, on average, a 4.1% higher diversion rate than other hospitals (95% CI, 1.6%-6.7%). Other characteristics

  16. Dust aerosol characterization and transport features based on combined ground-based, satellite and model-simulated data

    Science.gov (United States)

    Vijayakumar, K.; Devara, P. C. S.; Rao, S. Vijaya Bhaskara; Jayasankar, C. K.

    2016-06-01

    In this paper, we study aerosol characteristics over an urban station in Western India, during a dust event that occurred between 19 and 26 March 2012, with the help of ground-based and satellite measurements and model simulation data. The aerosol parameters are found to change significantly during dust events and they suggest dominance of coarse mode aerosols. The fine mode fraction, size distribution and single scattering albedo reveal that dust (natural) aerosols dominate the anthropogenic aerosols over the study region. Ground-based measurements show drastic reduction in visibility on the dust-laden day (22 March 2012). Additionally, HYSPLIT model and satellite daily data have been used to trace the source, path and spatial extent of dust storm events. Most of the dust aerosols, during the study period, travel from west-to-east pathway from source-to-sink region. Furthermore, aerosol vertical profiles from CALIPSO and synoptic meteorological parameters from ECMWF re-analysis data reveal a layer of thick dust extending from surface to an altitude of about 4 km, and decrease in temperature and increase in specific humidity, respectively. The aerosol radiative forcing calculations indicate more cooling at the surface and warming in the atmosphere during dust event. The results of satellite observations are found to have good consistency with ground-based air quality measurements. Synthesis of satellite data integrated with ground-based observations, supplemented by model analysis, is found to be a promising technique for improved understanding of dust storm phenomenon and its impact on regional climate.

  17. Sensitivity Study of Cross-Atlantic Dust Transport to Dust Emissions, Chemical Aging and Removal Processes and Comparison with Ground and Satellite Data

    Science.gov (United States)

    Abdelkader, Mohamed; Metzger, Swen; Klingmüller, Klaus; Steil, Benedikt; Lelieveld, Jos

    2016-04-01

    -range transport. The comparison of the EMAC results with ground-based observations (AERONET, CASTNET, EMEP), as well as various satellite data (MODIS, MISR and CALIPSO) shows that uncertainties associated with the calculation of the dust transport into the Caribbean reduces by considering the dust aging processes.

  18. Transportability

    Science.gov (United States)

    2013-04-25

    friction ) draft gear and remaining buffer cars (if any) equipped with either standard draft gear or cushioned draft gear, with the draft gear...to flight testing. (b) Once rigged, attach the sling set apex to the cargo hook of a mobile or overhead crane and hoist the item from the ground

  19. 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.

  20. Modern concepts of transport in multiple trauma: a narrative review

    Institute of Scientific and Technical Information of China (English)

    Mohammad Reza Zarei; Kourosh Karimi Yarandi; Mohammad Reza Rasouli; Vafa Rahimi-Movaghar

    2013-01-01

    Multiple variables can influence triage decision in multiple trauma.Recognition of priorities and selection of the destination can be successfully achieved by field triage and individualized clinical judgment.This narrative review summarizes the new options and protocols for transport of injured subjects.There are four levels of emergency medical providers including first responders and three levels of emergency medical technicians.Two distinct accepted protocols for transport are known as scoop and run and treat and then transfer.The former provides minimum lifesaving treatment at the scene of accident followed by transferring the patient(s) as soon as possible,and the latter mainly emphasizes the need for complete stabilization as a prerequisite for safe transport.The destination and mode of transport are selected according to clinical capabilities of the receiving hospital,transfer time from the scene to the facility,patient's medical condition,accessibility of the scene,and weather.Two common methods of transfer are ground transport,including various type of ambulances,and air medical transport,i.e.helicopter and airplane.

  1. Speed and distance requirements for community ambulation: a systematic review.

    Science.gov (United States)

    Salbach, Nancy M; O'Brien, Kelly; Brooks, Dina; Irvin, Emma; Martino, Rosemary; Takhar, Pam; Chan, Sylvia; Howe, Jo-Anne

    2014-01-01

    To provide an overview of the research literature on distance and speed requirements for adults to walk outside the home. We conducted a systematic review and searched PubMed, MEDLINE (Ovid), EMBASE, CINAHL, Scopus, PEDro, and The Cochrane Library from 1948 to May 2012, and other sources. Search terms included communities, walk, ambulation, and neighborhood. Full-text peer-reviewed articles written in English, French, or Spanish reporting distance and/or speed requirements for individuals walking outside the home were considered eligible. Two authors independently screened titles and abstracts. One author reviewed full-text articles to determine inclusion. Of the 3191 titles and abstracts screened, 15 studies (.47%) were selected for detailed review. One author appraised methodological quality. Inadequate description of the reliability of the measurement methods and the population of the town/city assessed was noted. One author extracted data from included studies. A second reviewer independently verified extracted data for accuracy. Seven studies examining 24 community sites and crosswalks in the United States, Australia, and Singapore were included. Three sites with the largest mean distance requirements for adults to walk were club warehouses (677m), superstores (183-607m), and hardware stores (566m). Three sites with the lowest mean distance requirements were walking at the front (16m) and back (19m) of the house, and at cemeteries (18m). The average speed required to cross the street in the time of a walk signal varied from .44 to 1.32m/s. Distance and speed requirements for adults to walk in the community environment vary widely. Findings are relevant to judging capacity for community ambulation to carry out essential activities of daily living, educating patients, and setting rehabilitation goals. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  2. Occupational stressors and its organizational and individual correlates: A nationwide study of Norwegian ambulance personnel

    Directory of Open Access Journals (Sweden)

    Ekeberg Øivind

    2008-12-01

    Full Text Available Abstract Background High levels of stress among ambulance personnel have been attributed to the conditions of ambulance work. However, there is little research to support this notion, and it has been questioned whether ambulance work is inherently stressful. We compared the severity and frequency level of organizational and ambulance-specific stressors, and studied their relationship to organizational conditions and individual differences Methods A comprehensive nationwide questionnaire survey of ambulance personnel (n = 1180 in operational duty. The questionnaire included the Job Stress Survey, the Norwegian Ambulance Stress Survey, the Basic Character Inventory, General Self-Efficacy Scale, and questions addressing organizational conditions. Results Serious operational tasks and physical demands were identified as the two most severe stressors. Lack of support from co-workers was the most severe and frequent organizational stressor. Higher frequency of stressors was most strongly associated with size of service districts (beta ranging between .18 and .30, p p p p p Conclusion Ambulance-specific stressors were reported as both more severe and more frequently occurring stressors than were organizational stressors. Organizational working conditions were more strongly related to frequency of job stressors than were individual differences. In general, the relationship between occupational stressors and individual differences was weak.

  3. Occupational stressors and its organizational and individual correlates: a nationwide study of Norwegian ambulance personnel.

    Science.gov (United States)

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

    2008-12-02

    High levels of stress among ambulance personnel have been attributed to the conditions of ambulance work. However, there is little research to support this notion, and it has been questioned whether ambulance work is inherently stressful. We compared the severity and frequency level of organizational and ambulance-specific stressors, and studied their relationship to organizational conditions and individual differences A comprehensive nationwide questionnaire survey of ambulance personnel (n = 1180) in operational duty. The questionnaire included the Job Stress Survey, the Norwegian Ambulance Stress Survey, the Basic Character Inventory, General Self-Efficacy Scale, and questions addressing organizational conditions. Serious operational tasks and physical demands were identified as the two most severe stressors. Lack of support from co-workers was the most severe and frequent organizational stressor. Higher frequency of stressors was most strongly associated with size of service districts (beta ranging between .18 and .30, p exposure to critical event (beta ranging from .11 to .24, p organizational conditions. Ambulance-specific stressors were reported as both more severe and more frequently occurring stressors than were organizational stressors. Organizational working conditions were more strongly related to frequency of job stressors than were individual differences. In general, the relationship between occupational stressors and individual differences was weak.

  4. The desired competence of the Swedish ambulance nurse according to the professionals - a Delphi study.

    Science.gov (United States)

    Wihlborg, Jonas; Edgren, Gudrun; Johansson, Anders; Sivberg, Bengt

    2014-07-01

    Nursing is evolving into new fields of health care including ambulance care, where a branch of specialist nursing is growing. Various views exist on the desired competence for the ambulance nurse and valid guidelines are lacking in Sweden. To increase knowledge of the field, professionals were asked to describe what competences an ambulance nurse should possess. The aim of this study was therefore to elucidate the desired professional competence of the specialist ambulance nurse, according to the professionals. A modified Delphi technique was used, where a panel of professional experts expressed their views on the desired competence of the ambulance nurse. This study reports, at a high level of agreement among the panel experts, that the desired competence of the specialist ambulance nurse consist of forty-four separate competences creating ten areas of competences: execute leadership, generic abilities, interpersonal communication, institutional collaboration, pedagogic skills, possession of relevant knowledge, professional judgement, professional skills, research activities, and technical skills. The high level of agreement among the professionals as well as the large number of competences reflects the high demands placed on the ambulance nurse by the professionals themselves. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Fatigue and mental health in Australian rural and regional ambulance personnel.

    Science.gov (United States)

    Pyper, Zoe; Paterson, Jessica L

    2016-02-01

    Australian ambulance personnel experience stress, fatigue and exposure to traumatic events. These risks have been extensively researched in metropolitan paramedics. However, there has been limited research in rural and regional personnel. Rural and regional ambulance personnel make up a significant proportion of the Australian ambulance workforce and may be exposed to unique stressors. The aim of the current study was to investigate levels of fatigue, stress, and emotional trauma in rural and regional ambulance personnel. A sample of 134 (103 male, 31 female) rural and regional ambulance personnel completed a mixed methods survey assessing fatigue, stress and emotional trauma. Data were analysed using a combination of descriptive analysis and qualitative, deductive analysis that involved data immersion, coding, and categorisation. Participants reported high levels of fatigue and emotional trauma. Qualitative data revealed stressors including community expectations and 'office politics'. Participants also reported negative effects of fatigue including errors in drug administration and falling asleep while driving. The majority of participants reported normal levels of stress. It may be the case that working with known individuals in a community offers some degree of 'protective' impact for stress in rural and regional ambulance personnel. This is one of the first studies to investigate fatigue, stress, and emotional trauma in a rural and regional ambulance population. Results indicate a complex and unique profile of risks and challenges for this critical and understudied community resource. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  6. Inference of Fractured Rock Transport Properties by Joint Inversion of Push-Pull and Single-Hole Ground Penetrating Radar Data

    Science.gov (United States)

    Shakas, A.; Linde, N.; Bour, O.; Le Borgne, T.

    2015-12-01

    Flow and transport characterization of fractured rock formations is very challenging and important for a multitude of applications that include groundwater extraction, nuclear waste storage and geothermal energy production. One popular hydrogeological method to study fractured rock is a push-pull test, in which injection and retrieval of a tracer is made at the same depth interval in a borehole. In theory, push-pull tests are not sensitive to changes in the heterogeneity of the tracer flow path since the retrieval at the injection location minimizes advective effects and makes the test more sensitive to time-dependent transport processes. This assumption is limiting in the presence of a natural hydraulic gradient or if non-neutrally buoyant tracers are used, but these limitations can be reduced by monitoring push-pull tests with ground penetrating radar (GPR). We present a methodology for combined modeling and inversion of a series of push-pull tests that we monitored with the single hole ground penetrating radar (GPR) method. For the GPR modeling we use a newly developed approach to simulate the GPR response in fractured rock. We coupled the GPR model to a flow-and-transport simulator that we use to define the electrical properties of the fracture filling. The combined model can cope with heterogeneous fractures of any orientation, aperture and size and allows for the effect of density driven flow (that is strong during the saline tracer tests). We use the combined simulator to create synthetic datasets for both the time-series of the GPR traces at different locations and the tracer breakthrough curves. Since the combined problem is highly non-linear and the inverse solution is ill-posed, we use stochastic inversion techniques to obtain probabilistic estimates of the parameters of interest (fracture length, orientation and aperture distribution) and assess the use of different measures to compare the simulated and experimental data.

  7. Audit of oxygen use in emergency ambulances and in a hospital emergency department.

    Science.gov (United States)

    Hale, K E; Gavin, C; O'Driscoll, B R

    2008-11-01

    Oxygen is widely used but poorly studied in emergency medicine, with a limited evidence base for its use in specific conditions. There are safety concerns about the underuse of oxygen in patients with critical illness and its overuse in conditions such as chronic obstructive pulmonary disease (COPD). A baseline audit was required to assess current practice prior to the introduction of new national emergency oxygen guidelines in late 2008. The use of pulse oximetry and oxygen therapy was audited in patients brought by ambulance to the "majors" section of the emergency department (ED) in a university hospital. Oxygen therapy in the ambulance and the ED was subsequently documented. Oxygen use in ambulances was compared with Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidance and with subsequent patient management. The ambulance and ED records of 1022 patients were audited manually. Oxygen saturation (SpO(2)) was recorded for 90% of patients, 17% of whom had SpO(2) ambulance and almost half of these had oxygen discontinued in the ED. Only 62% of ambulance oxygen use was in accordance with JRCALC guidance, but most "undertreated" patients were stable normoxaemic patients for whom guidance recommends high-flow oxygen. Only 58% of patients with COPD were correctly identified in the ambulance and 73% of these patients were treated with flow rates >4 l/min (equivalent to >35% oxygen). Oxygen use in ambulances is very common, equivalent to 2.2 million episodes annually in the UK. The quality of oxygen use is suboptimal, especially for patients with COPD. Emergency oxygen therapy will become simpler when new evidence-based UK emergency oxygen guidelines are published, and it is hoped that future audits will show better protocol adherence.

  8. The new devices of gas-turbine engines of ground transport on the basis cascade pressure exchanger of Krajniuk

    Directory of Open Access Journals (Sweden)

    Aleksander KRAJNIUK

    2011-01-01

    Full Text Available Main trends of perfection of gas-turbine engines (GTE of transport plants by application of principles of the cascade pressure exchange (CPE for air compression in the working cycle of gas-turbine plant have been analyzed. The principle of action and performances of work of heat compressor CPE realizing compression of working body on the whole at the expense straight convert inputting heat in disposing work of torrent with insignificant distraction mechanics work from shaft selection of power has been described. The results of computational investigation of four variants of the GTE working process organization on the basis of the two-staged compression assembly with intermediate cooling and heating of air-gas medium have been adduced. Application of units CPE in the capacity of compressing stage GTE opens the prospect of adaptations GTE performance by conditions of work in the capacity of forcing units of overland transport.

  9. 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.

  10. Multidisciplinary Studies of the Fate and Transport of Contaminants in Ground Water at the U.S. Geological Survey Cape Cod Toxic Substances Hydrology Program Research Site, Massachusetts

    Science.gov (United States)

    Leblanc, D. R.; Smith, R. L.; Kent, D. B.; Barber, L. B.; Harvey, R. W.

    2008-12-01

    The U.S. Geological Survey conducts multidisciplinary research on the physical, chemical, and microbiological processes affecting ground-water contaminants of global concern at its Cape Cod Toxic Substances Hydrology Program site in Massachusetts, USA. The work centers on a 6-kilometer-long plume of treated wastewater in a glacial sand and gravel aquifer. The plume is characterized by distinct geochemical zones caused by the biodegradation of organic materials in treated wastewater that was disposed to the aquifer by rapid infiltration during the period 1936-95. A core group of hydrogeologists, geochemists, microbiologists, and geophysicists has been involved in the research effort for more than two decades. The effort has been enhanced by stable funding, a readily accessible site, a relatively simple hydrologic setting, and logistical support from an adjacent military base. The research team uses a three-part approach to plan and conduct research at the site. First, detailed spatial and temporal monitoring of the plume since the late 1970s provides field evidence of important contaminant-transport processes and provides the basis for multidisciplinary, process-oriented studies. Second, ground-water tracer experiments are conducted in various geochemical zones in the plume to study factors that control the rate and extent of contaminant transport. Several arrays of multilevel sampling devices, including an array with more than 15,000 individual sampling points, are used to conduct these experiments. Plume-scale (kilometers) and tracer-test-scale (1- 100 meters) studies are complemented by laboratory experiments and mathematical modeling of flow and reactive transport. Third, results are applied to the treated-wastewater plume, other contaminant plumes at the military base, and other sites nationally to evaluate the applicability of the findings and to point toward further research. Examples of findings to date include that (1) macrodispersivity can be related to

  11. Inter-hospital transport of critically ill patients; expect surprises

    NARCIS (Netherlands)

    Droogh, Joep M.; Smit, Marije; Hut, Jakob; de Vos, Ronald; Ligtenberg, Jack J. M.; Zijlstra, Jan G.

    2012-01-01

    Introduction: Inter-hospital transport of critically ill patients is increasing. When performed by specialized retrieval teams there are less adverse events compared to transport by ambulance. These transports are performed with technical equipment also used in an Intensive Care Unit (ICU). As a

  12. Analysis of transport and ground deposition of the TCDD emitted on 10 July 1976 from the ICMESA factory (Seveso, Italy)

    Science.gov (United States)

    Cavallaro, A.; Tebaldi, G.; Gualdi, R.

    The areas affected by the contamination of TCDD emitted by the ICMESA factory (Meda-Seveso, Italy) have been identified through soil samples. To determine the course of the paniculate toxic cloud, we have analysed the wind field considering the data obtained by the six meteorological stations placed in the vicinity of the factory. After determining the theoretical path of the release, we have studied the values of the ground concentration of TCDD and we have looked for a deposition equation. We thus demonstrated out that the axial deposition YCA( μgm-2) decreases exponentially accordingly to two different regression lines: YCA = 2900 exp(-2.3 x) forx TCDD deposition should tend to the value of 0.3 μg m -2: at a distance of 10 km from ICMESA and there later sampling showed a maximum value of 0.2μg m -2.

  13. Interactions between surface water and ground water and effects on mercury transport in the north-central Everglades

    Science.gov (United States)

    Harvey, Judson W.; Krupa, Steven L.; Gefvert, Cynthia; Mooney, Robert H.; Choi, Jungyill; King, Susan A.; Giddings, Jefferson B.

    2002-01-01

    The hydrology of the north-central Everglades was altered substantially in the past century by canal dredging, land subsidence, ground-water pumping, and levee construction. Vast areas of seasonal and perennial wetlands were converted to uses for agriculture, light industry, and suburban development. As the catchment area for the Everglades decreased, so did the sources of water from local precipitation and runoff from surrounding uplands. Partly in response to those alterations, water-resources managers compartmentalized the remaining wetlands in the north-central Everglades into large retention basins, called Water Conservation Areas (WCAs). In spite of efforts to improve how water resources are managed, the result has been frequent periods of excessive drying out or flooding of the WCAs because the managed system does not have the same water-storage capacity as the pre-drainage Everglades. Linked to the hydrological modifications are ecological changes including large-scale invasions of cattail, loss of tree islands, and diminishing bird populations in the Everglades. Complex interactions among numerous physical, chemical, and biological factors are responsible for the long-term degradation of the ecological character of the Everglades.Over the past 15 years, a new set of smaller wetland basins, called Stormwater Treatment Areas (STAs), have been designed and constructed by water-resources engineers on the former wetlands adjacent to WCAs. The purpose of STAs is to remove excess nutrients from agricultural drainage water prior to its input to WCAs. STAs tend to be about one-tenth the size of a WCA, and they are located on former wetlands on the northwestern side of WCAs on sites that were managed as farmland for much of the twentieth century in an area referred to as the Everglades Agricultural Area, or EAA. The objective of the present investigation was to quantify interactions between surface water and ground water in the Everglades Nutrient Removal Project

  14. A case study of pollutants transported from HPCL (vishakhapatnam) accidental fire through synergy of flexpart model and ground-based instruments

    Science.gov (United States)

    Wankhede, Tushar

    Tushar Wankhede*, Harish Gadhavi, Amit K. Pandit National Atmospheric Research Laboratory (NARL), Gadanki-517112, Chittoor, A.P. *tushar1771@gmail.com, Mobile: +91-8297152481 A fire at Hindustan Petroleum Corporation Limited (HPCL) in Vishakhapatnam (17.70 ˚N, 83.24˚E) resulted from a gas leak in the salt water cooling tower system. This led to the release of various pollutants like hydrocarbons, black carbon, carbon mono-oxide and carbon dioxide etc(other gases) in just 44 min of fire in system a very huge amount of particles were emitted. The transport of these pollutants has been studied through FLEXPART which is a Lagrangian particle dispersion model having wide range of applications in atmospheric transport modeling. FLEXPART simulation of this accidental fire shows the direction and sensitivity of dispersed pollutants from its source. It was observed that the pollutants reached Gadanki, a rural site located at 13.45 ˚N, 79.18 ˚E in Southern-India. The concentration of pollutant obtained from FLEXPART output we are comparing with ground based instruments data collected at the observation site (Indian Climate Observatory Network-ICON, NARL Gadanki). This case-study provides significant information about the life-time of dispersed pollutants and their long-range transport pattern under the influence of small weather variability en-route from source to receptor. The detailed work of FLEXPART for the Long range transport of the particles will be presented later on in conference.

  15. Organic Wastewater Compounds, Pharmaceuticals, andColiphage in Ground Water Receiving Discharge from OnsiteWastewater Treatment Systems near La Pine, Oregon:Occurrence and Implications for Transport

    Science.gov (United States)

    Hinkle, Stephen J.; Weick, Rodney J.; Johnson, Jill M.; Cahill, Jeffery D.; Smith, Steven G.; Rich, Barbara J.

    2005-01-01

    The occurrence of organic wastewater compounds (components of 'personal care products' and other common household chemicals), pharmaceuticals (human prescription and nonprescription medical drugs), and coliphage (viruses that infect coliform bacteria, and found in high concentrations in municipal wastewater) in onsite wastewater (septic tank effluent) and in a shallow, unconfined, sandy aquifer that serves as the primary source of drinking water for most residents near La Pine, Oregon, was documented. Samples from two types of observation networks provided basic occurrence data for onsite wastewater and downgradient ground water. One observation network was a group of 28 traditional and innovative (advanced treatment) onsite wastewater treatment systems and associated downgradient drainfield monitoring wells, referred to as the 'innovative systems network'. The drainfield monitoring wells were located adjacent to or under onsite wastewater treatment system drainfield lines. Another observation network, termed the 'transect network', consisted of 31 wells distributed among three transects of temporary, stainless-steel-screened, direct-push monitoring wells installed along three plumes of onsite wastewater. The transect network, by virtue of its design, also provided a basis for increased understanding of the transport of analytes in natural systems. Coliphage were frequently detected in onsite wastewater. Coliphage concentrations in onsite wastewater were highly variable, ranging from less than 1 to 3,000,000 plaque forming units per 100 milliliters. Coliphage were occasionally detected (eight occurrences) at low concentrations in samples from wells located downgradient from onsite wastewater treatment system drainfield lines. However, coliphage concentrations were below method detection limits in replicate or repeat samples collected from the eight sites. The consistent absence of coliphage detections in the replicate or repeat samples is interpreted to indicate

  16. Ground level chemical analysis of air transported from the 1998 Mexican-central american fires to the southwestern USA

    Energy Technology Data Exchange (ETDEWEB)

    Villanueva Fierro, Ignacio [Departmento de Ciencias Ambientales, COFAA, CIIDIR-IPN Unidad Durango, Durango, Durango (Mexico)]. E-mail: ifierro62@yahoo.com; Popp, Carl J. [Department of Chemistry, New Mexico Tech, NM (United States); Dixon, Roy W. [Department of Chemistry, California State University at Sacramento, Sacramento, CA (USA); Martin, Randal S. [Department of Civil and Environmental Engineering, Utah State University, Logan, UT (United States); Gaffney, Jeffrey S. [Department of Chemistry, University of Arkansas at Little Rock, Little Rock, AR(United States); Marley, Nancy A. [Graduate Institute of Technology, University of Arkansas at Little Rock, Little Rock, AR (United States); Harris, Joyce M. [Office of Oceanic and Atmospheric Research, ERL/CMDL, NOAA, Boulder, CO (United States)

    2009-02-15

    In May 1998, a large number of forest fires in the region of southern Mexico and Central America, released huge amounts of contaminants that were transported over the Pacific Ocean, then, due to a change in air current direction, the primary contaminants and their secondary pollutant products impacted central New Mexico after 5 to 6 days transport time. The total distance traveled was approximately 3000 km from the fire source. Background measurements of a number of key chemical markers were taken before and during the haze incursion at a site located at Socorro, NM. A number of days before the haze episode in NM, large areas of Texas, Louisiana and the lower Mississippi River valley were also inundated by smoke from the fires. The sum of carbonyl compounds was 5.6 ppbv before and 15.5 ppbv during the smoke event; the sum of carboxylic acids went from 7.2 ppbv to 8.6 ppbv; C1-C2 hydrocarbons went from 270 ppbv to 133 ppbv; particulate NO{sub 3}{sup -} went from 0.1 to 1.3 {mu}g/m{sup 3}; SO{sub 4}{sup -2} went from 1.2 to 3.4 {mu}g/m{sup 3}; and PM10 concentrations remained between the range measured before the episode (15-20 {mu}g/m{sup 3}). The results indicate the significant impact on a rural site from long range transport of primary and secondary smoke pollutants from biomass burning events and the importance of these species being primarily in the gaseous and fine aerosol size range. These fine aerosols are important as climate forcing agents and in reducing air quality and visibility. [Spanish] En mayo de 1998, varios incendios forestales en la region sur de Mexico y en America Central, emitieron enormes cantidades de contaminantes que fueron transportados al Oceano Pacifico; entonces, debido a los cambios de direccion de las corrientes de aire, los contaminantes primarios emitidos, o como contaminantes secundarios, empezaron a llegar al centro de Nuevo Mexico, despues de 5 a 6 dias del episodio. La distancia total del transporte fue de aproximadamente 3000

  17. Guidelines for selecting codes for ground-water transport modeling of low-level waste burial sites. Volume 1. Guideline approach

    Energy Technology Data Exchange (ETDEWEB)

    Simmons, C.S.; Cole, C.R.

    1985-05-01

    This document was written for the National Low-Level Waste Management Program to provide guidance for managers and site operators who need to select ground-water transport codes for assessing shallow-land burial site performance. The guidance given in this report also serves the needs of applications-oriented users who work under the direction of a manager or site operator. The guidelines are published in two volumes designed to support the needs of users having different technical backgrounds. An executive summary, published separately, gives managers and site operators an overview of the main guideline report. This volume includes specific recommendations for decision-making managers and site operators on how to use these guidelines. The more detailed discussions about the code selection approach are provided. 242 refs., 6 figs.

  18. [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.

  19. 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.

  20. Associations between organizational and incident factors and emotional distress in emergency ambulance personnel.

    Science.gov (United States)

    Bennett, Paul; Williams, Yvette; Page, Nicola; Hood, Kerenza; Woollard, Malcolm; Vetter, Norman

    2005-06-01

    This study examined the prevalence and correlates of post-traumatic stress disorder (PTSD), anxiety and depression among emergency ambulance personnel. A questionnaire and reminder were sent anonymously to 1029 emergency ambulance personnel in a large ambulance service. Among the 617 respondents, levels of PTSD symptoms did not differ according to grade, but men had a higher prevalence rate than women. Key predictors of the severity of symptoms were organizational stress, the frequency of experiencing potentially traumatic incidents, length of service, and dissociation in response to an index incident. The degree of organizational, but not incident-related, stress discriminated between 'cases' and 'non-cases'. Nine and 23% of recorded scores indicated clinical levels of depression and anxiety respectively. Several work factors were associated with these emotions, explaining 38% of anxiety and 31% of depression scores. Both organizational and individually based interventions may be necessary to minimize PTSD and other emotional disorders among ambulance personnel.

  1. 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...

  2. 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

  3. Monte Carlo transport simulation for a long counter neutron detector employed as a cosmic rays induced neutron monitor at ground level

    Energy Technology Data Exchange (ETDEWEB)

    Pazianotto, Mauricio Tizziani; Carlson, Brett Vern [Instituto Tecnologico de Aeronautica (ITA), Sao Jose dos Campos, SP (Brazil); Federico, Claudio Antonio; Goncalez, Odair Lelis [Centro Tecnico Aeroespacial (CTA), Sao Jose dos Campos, SP (Brazil). Instituto de Estudos Avancados

    2011-07-01

    Full text: Great effort is required to understand better the cosmic radiation (CR) dose received by sensitive equipment, on-board computers and aircraft crew members at Brazil airspace, because there is a large area of South America and Brazil subject to the South Atlantic Anomaly (SAA). High energy neutrons are produced by interactions between primary cosmic ray and atmospheric atoms, and also undergo moderation resulting in a wider spectrum of energy ranging from thermal energies (0:025eV ) to energies of several hundreds of MeV. Measurements of the cosmic radiation dose on-board aircrafts need to be followed with an integral flow monitor on the ground level in order to register CR intensity variations during the measurements. The Long Counter (LC) neutron detector was designed as a directional neutron flux meter standard because it presents fairly constant response for energy under 10MeV. However we would like to use it as a ground based neutron monitor for cosmic ray induced neutron spectrum (CRINS) that presents an isotropic fluency and a wider spectrum of energy. The LC was modeled and tested using a Monte Carlo transport simulation for irradiations with known neutron sources ({sup 241}Am-Be and {sup 251}Cf) as a benchmark. Using this geometric model its efficiency was calculated to CRINS isotropic flux, introducing high energy neutron interactions models. The objective of this work is to present the model for simulation of the isotropic neutron source employing the MCNPX code (Monte Carlo N-Particle eXtended) and then access the LC efficiency to compare it with experimental results for cosmic ray neutrons measures on ground level. (author)

  4. Ambulance personnel adherence to hygiene routines: still protecting ourselves but not the patient.

    Science.gov (United States)

    Emanuelsson, Lena; Karlsson, Lena; Castrèn, Maaret; Lindström, Veronica

    2013-08-01

    It is well known that adherence to hygiene routines leads to increased quality of care and safety for patients and personnel in hospitals. However, there have been few studies describing hygiene in ambulances, despite the fact that many patients receive advanced medical care and treatment from ambulance services before arriving at an emergency department. Therefore, the purpose of this study was to describe the adherence of ambulance personnel to hygiene routines in the ambulances. A participant observation study in the County of Värmland (Sweden) was conducted over 1 day in November 2010. Seven hygiene-related variables were collected during the observations: disinfection of hands before and after patient contact; correct use of gloves, gowns and short-sleeved uniforms; no rings, watches, or bracelets; and short or tied back hair during patient care. A total of 68 observed ambulance assignments were analyzed in terms of the adherence of personnel to hygiene routines. In 34% of the observed cases, hand rub was used before patient care and, in 72% of the observed cases, the ambulance personnel used hand rub after patient care. Correct adherence to the rule requiring use of a short-sleeved uniform was found in 28% of the observations. Correct adherence to the rule regarding short or tied back hair was found in 91% of the observations. The ambulance personnel were found to have relatively good adherence to some hygiene routines, but not all. The adherence by ambulance personnel to all of the seven observed variables was correct in only 3% of the assignments.

  5. Patient characteristics and patterns of intoxication: one-time and repeated use of emergency ambulance services.

    Science.gov (United States)

    Holzer, Barbara M; Minder, Christoph E; Rosset, Nina; Schaetti, Gabriela; Battegay, Edouard; Mueller, Stefan; Zimmerli, Lukas

    2013-05-01

    The aim of this study was to investigate the utilization of ambulance services that resulted from alcohol and drug intoxication over a period of 1 year in a metropolitan area, with an emphasis on characteristic differences between patients with one-time versus repeated use. All ambulance-service report forms filed in 2010 were systematically screened for utilizations in which alcohol intoxication or intoxication resulting from consumption of illicit or legal drugs other than alcohol was the chief complaint (N = 2,341 patients; 65% male). Repeat users differed from persons with one-time use in their characteristics and patterns of intoxication. On average, patients with repeated ambulance use were almost 8 years older and had a different pattern of ambulance use over the course of the week with no clear peak on any specific day. The mean number of ambulance services in patients with repeated use was 2.8 (SD = 1.517) in the 1-year study period. Repeat users were less likely to be injured than patients with one-time ambulance-service use and more often showed aggression or uncooperative behavior toward paramedics. All cases of death associated with intoxication involved patients with one-time ambulance use. The ambulance-service users' generally slight impairment of consciousness and the high proportion of intoxicated patients without any injuries raise the question of how many of these patients could be adequately cared for in a sobering center. Sobering centers might relieve hospital emergency departments of patients not requiring acute emergency care and, in addition, could provide intervention services to prevent relapses.

  6. Review of measured vibration and noise environments experienced by passengers in aircraft and in ground transportation systems

    Science.gov (United States)

    Stephens, D. G.

    1975-01-01

    Measured vibration and interior noise data are presented for a number of air and surface vehicles. Consideration is given to the importance of direction effects; of vehicle operations such as take-off, cruise, and landing; and of measurement location on the level and frequency of the measurements. Various physical measurement units or descriptors are used to quantify and compare the data. Results suggest the range of vibration and noise associated with a particular mode of transportation and illustrate the comparative levels in terms of each of the descriptors. Collectively, the results form a data base which may be useful in assessing the ride of existing or future systems relative to vehicles in current operation.

  7. 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.

  8. 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.

  9. The relationship between hepatitis serology of ambulance attendants and duration of education.

    Science.gov (United States)

    Güçlü, Ertuğrul; Öğütlü, Aziz; Karabay, Oğuz

    2015-01-01

    Healthcare workers (HCWs) run the risk of hepatitis B virus (HBV) infection. Studies investigating the HBV and hepatitis C virus (HCV) serology of HCWs have been generally conducted in secondary or tertiary hospitals. In this study we aimed to determine the relationships between education level and HBV and HCV serology and HBV vaccination status of ambulance attendants. The data of this study were obtained by retrospective review of ambulance personnel files in Sakarya Province, Turkey. Out of 314 ambulance attendants, 216 (68.7%; 78 males, 138 females) were enrolled in this study. The mean length of employment in the province's ambulance service was 5.22 years. While hepatitis B surface antigen positivity was found in 3 (1.4%) workers, 147 (68%) of them were positive for hepatitis B surface antibodies (anti-HBs). The lowest HBV vaccination rate was 12.5%, in drivers. Naturally acquired immunity against HBV was again the highest in drivers (17.5%; P ambulance service attendants, and positive anti-HBs status related to vaccination is associated with vocational training. Training should be performed to increase HBV awareness of ambulance attendants. Nonvaccinated personnel should be determined on the first day of employment, and regulations should be put in place to ensure their vaccination.

  10. Effect of public awareness campaigns on calls to ambulance across Australia.

    Science.gov (United States)

    Bray, Janet E; Straney, Lahn; Barger, Bill; Finn, Judith

    2015-05-01

    The National Stroke Foundation of Australia has run 12 public awareness campaigns since 2004. Campaign exposure and funding has varied annually and regionally during this time. The aim of this study was to measure the effect of campaigns on calls to ambulance for stroke across Australia in exposed regions (paid or pro bono advertising). All ambulance services in Australia provided monthly ambulance dispatch data between January 2003 and June 2014. We performed multivariable regression to measure the effect of campaign exposure on the volume of stroke-related emergency calls, after controlling for confounders. The final model indicated that 11 of the 12 National Stroke Foundation campaigns were associated with increases in the volume of stroke-related calls (varying between 1% and 9.9%) in regions with exposure to advertising. This increase lasted ≈3 months, with an additional 10.2% relative increase in the volume of the calls in regions with paid advertising. We found no significant additional effect of the campaigns on stroke calls where ambulance services are publicly funded. The National Stroke Foundation stroke awareness campaigns are associated with increases to calls to ambulance for stroke in regions receiving advertising and promotion. Research is now required to examine whether this increased use in ambulance is for appropriate emergencies. © 2015 American Heart Association, Inc.

  11. The lived experiences of patients and ambulance ramping in a regional Australian emergency department: An interpretive phenomenology study.

    Science.gov (United States)

    Kingswell, Chris; Shaban, Ramon Z; Crilly, Julia

    2015-11-01

    Internationally, the workload of emergency departments (ED) has increased, resulting in overcrowding and frequent delays in the offloading of patients arriving via ambulance--referred to in Australia as 'ambulance ramping'. Using interpretive phenomenology, this study sought to understand the experience of ambulance ramping from the perspective of patients. Semi-structured interviews were undertaken with seven patients who presented to a regional Queensland ED via ambulance, and experienced an ambulance offload delay of >30 min. Ambulance ramping in the ED was described as 'Being a patient, patient', and three major themes emerged: Understanding the emergency healthcare system; Making do within the emergency healthcare system; and Being 'in the dark' during ambulance ramping. Most participants did not understand the antecedents to ambulance ramping, but understood some of the consequences. Most were happy to wait with paramedics for a bed and, although without privacy, felt safe. However, most participants felt 'in the dark' during ambulance ramping, due to communication difficulties regarding bed availability, and this led to frustration. In light of the Australian Charter of Healthcare Rights, service improvement opportunities exist for patients arriving to the ED by ambulance to ensure delays are minimised and quality care is delivered. Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  12. Summertime tropospheric ozone enhancement associated with a cold front passage due to stratosphere-to-troposphere transport and biomass burning: Simultaneous ground-based lidar and airborne measurements

    Science.gov (United States)

    Kuang, Shi; Newchurch, Michael J.; Johnson, Matthew S.; Wang, Lihua; Burris, John; Pierce, Robert B.; Eloranta, Edwin W.; Pollack, Ilana B.; Graus, Martin; de Gouw, Joost; Warneke, Carsten; Ryerson, Thomas B.; Markovic, Milos Z.; Holloway, John S.; Pour-Biazar, Arastoo; Huang, Guanyu; Liu, Xiong; Feng, Nan

    2017-01-01

    Stratosphere-to-troposphere transport (STT) and biomass burning (BB) are two important natural sources for tropospheric ozone that can result in elevated ozone and air-quality episode events. High-resolution observations of multiple related species are critical for complex ozone source attribution. In this article, we present an analysis of coinciding ground-based and airborne observations, including ozone lidar, ozonesonde, high spectral resolution lidar (HSRL), and multiple airborne in situ measurements, made on 28 and 29 June 2013 during the Southeast Nexus field campaign. The ozone lidar and HSRL reveal detailed ozone and aerosol structures as well as the temporal evolution associated with a cold front passage. The observations also captured two enhanced (+30 ppbv) ozone layers in the free troposphere (FT), which were determined from this study to be caused by a mixture of BB and stratospheric sources. The mechanism for this STT is tropopause folding associated with a cutoff upper level low-pressure system according to the analysis of its potential vorticity structure. The depth of the tropopause fold appears to be shallow for this case compared to events observed in other seasons; however, the impact on lower tropospheric ozone was clearly observed. This event suggests that strong STT may occur in the southeast United States during the summer and can potentially impact lower troposphere during these times. Statistical analysis of the airborne observations of trace gases suggests a coincident influence of BB transport in the FT impacting the vertical structure of ozone during this case study.

  13. 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.

  14. Transport of Bacteria and Virus-Sized Particles and Bacteriophage from Ground Surface to Depth in a Bedrock Aquifer - A Field Experiment

    Science.gov (United States)

    Novakowski, K. S.; Trimper, S.; Praamsma, T.; Springthorpe, S.

    2010-12-01

    Shallow, unprotected bedrock aquifers are common sources of drinking water supply in eastern North America. The vulnerability of these aquifers to contamination from pathogens is widely recognised, although little is actually known about the transport processes involved, particularly where the source is located near to or on ground surface (i.e. a septic system). In this experiment we explore the transport of fluorescent microspheres having diameters of 1.75 and 0.3 µm and the bacteriophage Φ-X174 in a sparsely-fractured gneissic terrain having minimal overburden cover. The experiment was conducted by ponding water in a 7 m2 area on the edge of an outcrop having observable vertical fractures and measuring the arrival of particles in two nearby monitoring wells. A conservative solute tracer (Lissamine FF) was also used to follow the solute front. In order to encourage transport to the wells and to provide a discharge stream to sample, pumping was conducted at a rate of 7.7 L/min from the lower half of the 15-m deep well farthest from the pond (approximately 7 m away). Sampling was conducted from the pumping stream, the upper 5 m of that well and the upper 5 m of an additional well located about 5 m from the surface pond. The experiment was conducted over a 48 hr period and samples were obtained every 15 min initially declining to once every 2 hrs towards the end of the experiment. Analysis of the bacteriophage was conducted using the Double Agar Layer method and the concentration of microspheres was determined using epi-fluorescent microscopy. As the latter is very time consuming, only preliminary results are available for the microsphere transport. The results show widespread migration of both the microspheres and the bacteriophage, as arrival in all sampling locations was detected. Mass recovery was low but similar for both the bacteriophage and the solute tracer, although the majority of the bacteriophage arrived much earlier than the majority of the solute

  15. 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.

  16. Emergency nursing workload and patient dependency in the ambulance bay: A prospective study.

    Science.gov (United States)

    Varndell, Wayne; Ryan, Elizabeth; Jeffers, Alison; Marquez-Hunt, Nadya

    2016-11-01

    The purpose of this prospective observational study was to characterise patients occupying the ambulance bay and to determine the ensuing nursing workload. The number of patients presenting to ED by ambulance is increasing. During periods of peak demand and access block in the ED, patients with ongoing care needs, requiring continual assessment and symptom management by emergency nurses can remain in the ambulance bay for extended periods of time. The profile of these patients and on the related nursing workload is not well known. A prospective observational study design based upon a convenience sample of patients was conducted over a randomly selected four-week period. Nursing workload was assessing using the Jones Dependency Tool. A modified Work Observation Method By Activity Timing technique was used to estimate direct nursing care time. Of 4068 presentations to ED, 640 (16%) occupied the ambulance bay following triage, of which the majority (n=408; 64%) had arrived by ambulance. Of those occupying the ambulance bay 205 (32%) were evaluated using the JDT. The majority of patients had potentially life-threatening symptoms (ATS 3, n=424; 66%), were moderately dependent (n=134; 65%), and consumed approximately 152.1h of direct nursing care time. A large proportion of direct nursing care time was spent on patient reassessment (60.4h) and pain management (29.6h). Patients occupying the ambulance bay had an average ED length of stay of 5.6h (4.6h), of which 1.8h (SD 1.8h) was spent delayed in the ambulance bay. Early detailed assessment and symptom management of patients occupying the ambulance bay is extensively undertaken by emergency nurses. The frequency and number of patients off-loaded into non-clinical areas is not currently monitored or reported upon. This study has demonstrated that patients managed in the ambulance bay consume large amounts of nursing resources, commonly require acute level care and hospital admission. Copyright © 2016 College of Emergency

  17. A Testing Ground for Polarized Maser Transport: Multi-Epoch Analysis of a π/2 Electric Vector Rotation

    Science.gov (United States)

    Tobin, Taylor; Kemball, Athol J.

    2017-01-01

    The near circumstellar environment (NCSE) around Asymptotic Giant Branch (AGB) stars is chaotic, exhibiting shocks, turbulence, velocity gradients, and a potentially dynamically significant magnetic field (Vlemmings et al. 2005). Very Long Baseline Interferometry (VLBI) of masers emanating from these environments can provide sub-milliarcsecond angular resolution of the NCSE (Kemball 2002). Solidifying the origin of the polarization in these masers may be the key to understanding the magnitude and behavior of these stars' magnetic fields (eg. Goldreich et al. 1973; Elitzur 1996). However, other theories of polarized maser transport do not rely heavily on the magnetic field; some are more dependent on anisotropic pumping (Elitzur 1996; Watson 2009) or anisotropic resonant scattering (Asensio Ramos et al. 2005; Houde 2014). One optimal test of these theories is their ability to account for a π/2 rotation of the Electric Vector Position Angle (EVPA) observed in some maser features. The profile of linear polarization across such a feature varies with the generating mechanism. In this study, we utilize multi-epoch observations of ν=1, J=1-0 SiO maser emission around TX Cam (Diamond & Kemball 2003; Kemball et al. 2009; Gonidakis et al. 2010) to analyze a single feature with a π/2 rotation that persisted for five epochs and compare it to the behavior expected according to various theories of maser polarization. In addition, we analyze the low levels of circular polarization - now achievable due to recent improvements in millimeter-wavelength circular polarization reduction (Kemball & Richter 2011) - and compare their correlation with other parameters to further test these polarization generation theories.

  18. LES investigation of the transport and decay of various-strengths wake vortices in ground effect and subjected to a turbulent crosswind

    Science.gov (United States)

    Bricteux, L.; Duponcheel, M.; De Visscher, I.; Winckelmans, G.

    2016-06-01

    This study is concerned with the investigation of two-vortex systems (2VS) of various strengths that are released near the ground and evolve in the presence of a turbulent crosswind. We analyze the physics of the vortices interactions with the turbulent wind and with the ground during the rebound phase, and that lead to the fully developed turbulent flow and interactions. The transport and decay of the vortices are also analyzed. The turbulent wind itself is obtained by direct numerical simulation using a half channel flow. The flow is then supplemented with the 2VS, using vortices with a circulation distribution that is representative of vortices after roll-up of a near wake. The vortex strengths, Γ0, are such that ReΓ = Γ0/ν = 2.0 × 104 for the baseline; there is then a case with twice weaker vortices, and a case with twice stronger vortices. The simulations are run in wall-resolved Large Eddy Simulation (LES) mode. The baseline is in line with the wall-resolved LES study of a similar case [A. Stephan et al., "Aircraft wake-vortex decay in ground proximity - Physical mechanisms and artificial enhancement," J. Aircr. 50(4), 1250-1260 (2013)]. They highlighted the significant effect that the near-wall streaks of the wind have on the development of instabilities in the secondary vortices, and the ensuing turbulence. Our analysis complements theirs by also showing the significant effect that the wind turbulent structures, away from the ground and that are stretched by the primary vortices, also have on the destabilization of the secondary vortices. Comparisons are also made with the most recent study [F. N. Holzäpfel et al., "Wind impact on single vortices and counter-rotating vortex pairs in ground proximity," in 7th AIAA Atmospheric and Space Environments Conference, AIAA Aviation (American Institute of Aeronautics and Astronautics, 2015)], where ReΓ = 2.0 × 104 for all cases and where it is the wind intensity that is varied. Diagnostics on the vortex

  19. EFFECTIVENESS OF SCHEDULED AMBULATION ON EARLY POSTOPERATIVE OUTCOME AMONG PATIENTS WHO HAVE UNDERGONE ABDOMINAL HYSTERECTOMY

    Directory of Open Access Journals (Sweden)

    Rinku Girija

    2017-01-01

    Full Text Available BACKGROUND Abdominal hysterectomy is one of the most frequently performed surgical procedures in women. The non-ambulatory postoperative period is a high risk period for the development of various complications like wound infection, venous stasis, lower respiratory infection, secondary haemorrhage, deep vein thrombosis, pulmonary embolism, paralytic ileus etc. Prolonged surgery, delayed ambulation and not feeding the patient within 48 hours of surgery are often associated with post-operative morbidity and mortality. This study aims to assess the effectiveness of Scheduled Ambulation on early post-operative outcome among patients undergone abdominal hysterectomy by introduction of Scheduled Ambulation from second day of surgery. MATERIALS AND METHODS Method used is quantitative and quasi experimental post-test control method. Scheduled ambulation technique and pattern were taught pre operatively to 35 patients consecutively selected from general and post-operative ward who formed the experimental group. They were given scheduled ambulation from second to fifth post-operative days and results analysed. Another 35 patients taken as control were given the routine post-operative care. Data Analysis- was performed using SPSS version 17.0. Between group comparisons, quantitative variables analysed by Chisquare test p value >0, 05 considered significant. RESULTS The indication of hysterectomy was fibroid uterus in 80% of the control group and 88, 6% of the experimental group. 51.4% of the hysterectomies were encountered in the age group 40-49 years. There was a statistically significant reduction in the severity of pain, fatigue, postural hypotension and risk for developing Deep vein thrombosis in the experimental group on practicing Scheduled Ambulation from second to fifth post-operative days. CONCLUSION Scheduled ambulation helped the abdominal hysterectomy patients to recover from fatigue, pain, postural hypotension and risk for Deep vein thrombosis

  20. Circumstances surrounding non-fatal opioid overdoses attended by ambulance services.

    Science.gov (United States)

    Madah-Amiri, Desiree; Clausen, Thomas; Myrmel, Lars; Brattebø, Guttorm; Lobmaier, Philipp

    2017-05-01

    Opioid overdose fatalities are a significant concern globally. Non-fatal overdoses have been described as a strong predictor for future overdoses, and are often attended by the ambulance services. This paper explores characteristics associated with non-fatal overdoses and aims to identify possible trends among these events in an urban area in Norway. This is a retrospective analysis of non-fatal overdoses from Bergen ambulance services from 2012 to 2013. Demographic, temporal and geographic data were explored. During the two years, 463 non-fatal opioid overdoses were attended by ambulance services. Ambulance call-outs occurred primarily during the late afternoon and evening hours of weekdays. Summer months had more overdoses than other seasons, with a peak in August. Overdoses were nearly twice as likely to occur in a public location in August (risk ratio 1.92, P = 0.042). Ambulance response times were more likely to be longer to private locations, and these victims were more likely to be treated and left at the scene. There was no difference in arrival time for drug-related and non-drug related dispatch. The temporal patterns suggest that non-fatal overdoses occur during non-recreational time periods. The longer ambulance response time and disposition for private addresses indicate potential opportunities for peer interventions. Our analysis describes circumstances surrounding non-fatal overdoses and can be useful in guiding relevant, targeted prevention interventions. [Madah-Amiri D, Clausen T, Myrmel L, Brattebø G, Lobmaier P. Circumstances surrounding non-fatal opioid overdoses attended by ambulance services. Drug Alcohol Rev 2017;36:288-294]. © 2016 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.

  1. Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed.

    Science.gov (United States)

    Crilly, Julia; Keijzers, Gerben; Tippett, Vivienne; O'Dwyer, John; Lind, James; Bost, Nerolie; O'Dwyer, Marilla; Shiels, Sue; Wallis, Marianne

    2015-06-01

    To describe and compare characteristics and outcomes of patients who arrive by ambulance to the ED. We aimed to (i) compare patients with a delayed ambulance offload time (AOT) >30 min with those who were not delayed; and (ii) identify predictors of an ED length of stay (LOS) of >4 h for ambulance-arriving patients. A retrospective, multi-site cohort study was undertaken in Australia using 12 months of linked health data (September 2007-2008). Outcomes of AOT delayed and non-delayed presentations were compared. Logistic regression analysis was undertaken to identify predictors of an ED LOS of >4 h. Of the 40 783 linked, analysable ambulance presentations, AOT delay of >30 min was experienced by 15%, and 63% had an ED LOS of >4 h. Patients with an AOT ambulance time at hospital; time to see healthcare professional; proportion seen within recommended triage time frame; and ED LOS for both admitted and non-admitted patients. In-hospital mortality did not differ. Strong predictors of an ED LOS >4 h included: hospital admission, older age, triage category, and offload delay >30 min. Patients arriving to the ED via ambulance and offloaded within 30 min experience better outcomes than those delayed. Given that offload delay is a modifiable predictor of an ED LOS of >4 h, targeted improvements in the ED arrival process for ambulance patients might be useful. © 2015 The Authors. Emergency Medicine Australasia published by Wiley Publishing Asia Pty Ltd on behalf of Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  2. Ambulance telephone triage using 'NHS Pathways' to identify adult cardiac arrest.

    Science.gov (United States)

    Deakin, Charles D; England, Simon; Diffey, Debbie

    2017-05-01

    UK ambulance services are called to 30 000 cardiac arrests (CAs) annually where resuscitation is attempted. Correct identification by the ambulance service trebles survival by facilitating bystander-cardiopulmonary resuscitation (CPR) and immediate ambulance dispatch. Identification of CA by telephone is challenging and involves algorithms to identify key features. 'NHS Pathways' is now used for triage by six of 12 UK ambulance services, covering a population of 20 million. With the significant improvements in survival when CA is accurately identified, it is vital that 'NHS Pathways' is able to identify CA correctly. All '999' emergency calls to South Central Ambulance Service (SCAS) over a 12-month period screened by NHS Pathways v9.04 were identified. All actual or presumed CAs identified by the emergency call taker were cross-referenced with the ambulance crew's Patient Report Form to identify all confirmed CAs. A total of 469 400 emergency (999) calls were received by SCAS. Of the 3119 CA identified by ambulance crew, 753 were not initially classified as CA by NHS Pathways (24.1%). Overall, sensitivity=0.759 (95% CI 0.743 to 0.773); specificity=0.986 (95% CI 0.9858 to 0.98647); and positive predictive value=26.80% (95% CI 25.88 to 27.73%). NHS Pathways accurately identifies 75.9% of adult CAs. The remainder represents approximately 7500 treatable CAs in the UK annually where the diagnosis is missed, with significant implications for patient outcome. Further work is required to improve this first link in the chain of survival. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. Using genetic algorithms to optimise current and future health planning - the example of ambulance locations

    Science.gov (United States)

    2010-01-01

    Background Ambulance response time is a crucial factor in patient survival. The number of emergency cases (EMS cases) requiring an ambulance is increasing due to changes in population demographics. This is decreasing ambulance response times to the emergency scene. This paper predicts EMS cases for 5-year intervals from 2020, to 2050 by correlating current EMS cases with demographic factors at the level of the census area and predicted population changes. It then applies a modified grouping genetic algorithm to compare current and future optimal locations and numbers of ambulances. Sets of potential locations were evaluated in terms of the (current and predicted) EMS case distances to those locations. Results Future EMS demands were predicted to increase by 2030 using the model (R2 = 0.71). The optimal locations of ambulances based on future EMS cases were compared with current locations and with optimal locations modelled on current EMS case data. Optimising the location of ambulance stations locations reduced the average response times by 57 seconds. Current and predicted future EMS demand at modelled locations were calculated and compared. Conclusions The reallocation of ambulances to optimal locations improved response times and could contribute to higher survival rates from life-threatening medical events. Modelling EMS case 'demand' over census areas allows the data to be correlated to population characteristics and optimal 'supply' locations to be identified. Comparing current and future optimal scenarios allows more nuanced planning decisions to be made. This is a generic methodology that could be used to provide evidence in support of public health planning and decision making. PMID:20109172

  4. Modeling Water and Nutrient Transport through the Soil-Root-Canopy Continuum: Explicitly Linking the Below- and Above-Ground Processes

    Science.gov (United States)

    Kumar, P.; Quijano, J. C.; Drewry, D.

    2010-12-01

    Vegetation roots provide a fundamental link between the below ground water and nutrient dynamics and above ground canopy processes such as photosynthesis, evapotranspiration and energy balance. The “hydraulic architecture” of roots, consisting of the structural organization of the root system and the flow properties of the conduits (xylem) as well as interfaces with the soil and the above ground canopy, affect stomatal conductance thereby directly linking them to the transpiration. Roots serve as preferential pathways for the movement of moisture from wet to dry soil layers during the night, both from upper soil layer to deeper layers during the wet season (‘hydraulic descent’) and vice-versa (‘hydraulic lift’) as determined by the moisture gradients. The conductivities of transport through the root system are significantly, often orders of magnitude, larger than that of the surrounding soil resulting in movement of soil-moisture at rates that are substantially larger than that through the soil. This phenomenon is called hydraulic redistribution (HR). The ability of the deep-rooted vegetation to “bank” the water through hydraulic descent during wet periods for utilization during dry periods provides them with a competitive advantage. However, during periods of hydraulic lift these deep-rooted trees may facilitate the growth of understory vegetation where the understory scavenges the hydraulically lifted soil water. In other words, understory vegetation with relatively shallow root systems have access to the banked deep-water reservoir. These inter-dependent root systems have a significant influence on water cycle and ecosystem productivity. HR induced available moisture may support rhizosphere microbial and mycorrhizal fungi activities and enable utilization of heterogeneously distributed water and nutrient resources To capture this complex inter-dependent nutrient and water transport through the soil-root-canopy continuum we present modeling

  5. Evaluating a 3-D transport model of atmospheric CO2 using ground-based, aircraft, and space-borne data

    Directory of Open Access Journals (Sweden)

    J.-D. Paris

    2010-07-01

    Full Text Available We evaluate the GEOS-Chem atmospheric transport model (v8-02-01 of CO2 over 2003–2006, driven by GEOS-4 and GEOS-5 meteorology from the NASA Goddard Global Modelling and Assimilation Office, using surface, aircraft and space-borne concentration measurements of CO2. We use an established ensemble Kalman filter to estimate a posteriori biospheric+biomass burning (BS+BB and oceanic (OC CO2 fluxes from 22 geographical regions, following the TransCom 3 protocol, using boundary layer CO2 data from a subset of GLOBALVIEW surface sites. Global annual net BS+BB+OC CO2 fluxes over 2004–2006 for GEOS-4 (GEOS-5 meteorology are −4.4±0.9 (−4.2±0.9, −3.9±0.9 (−4.5±0.9, and −5.2±0.9 (−4.9±0.9 Pg C yr−1 , respectively. The regional a posteriori fluxes are broadly consistent in the sign and magnitude of the TransCom-3 study for 1992–1996, but we find larger net sinks over northern and southern continents. We find large departures from our a priori over Europe during summer 2003, over temperate Eurasia during 2004, and over North America during 2005, reflecting an incomplete description of terrestrial carbon dynamics. We find GEOS-4 (GEOS-5 a posteriori CO2 concentrations reproduce the observed surface trend of 1.91–2.43 ppm yr−1, depending on latitude, within 0.15 ppm yr−1 (0.2 ppm yr−1 and the seasonal cycle within 0.2 ppm (0.2 ppm at all latitudes. We find the a posteriori model reproduces the aircraft vertical profile measurements of CO2 over North America and Siberia generally within 1.5 ppm in the free and upper troposphere but can be biased by up to 4–5 ppm in the boundary layer at the start and end of the growing season. The model has a small negative bias in the free troposphere CO2 trend (1.95–2.19 ppm yr−1 compared to AIRS data which has a trend of 2.21–2.63 ppm yr−1 during 2004–2006, consistent with surface data. Model CO2 concentrations in the upper troposphere, evaluated using CONTRAIL (Comprehensive

  6. Evaluating a 3-D transport model of atmospheric CO2 using ground-based, aircraft, and space-borne data

    Directory of Open Access Journals (Sweden)

    J.-D. Paris

    2011-03-01

    Full Text Available We evaluate the GEOS-Chem atmospheric transport model (v8-02-01 of CO2 over 2003–2006, driven by GEOS-4 and GEOS-5 meteorology from the NASA Goddard Global Modeling and Assimilation Office, using surface, aircraft and space-borne concentration measurements of CO2. We use an established ensemble Kalman Filter to estimate a posteriori biospheric+biomass burning (BS + BB and oceanic (OC CO2 fluxes from 22 geographical regions, following the TransCom-3 protocol, using boundary layer CO2 data from a subset of GLOBALVIEW surface sites. Global annual net BS + BB + OC CO2 fluxes over 2004–2006 for GEOS-4 (GEOS-5 meteorology are −4.4 ± 0.9 (−4.2 ± 0.9, −3.9 ± 0.9 (−4.5 ± 0.9, and −5.2 ± 0.9 (−4.9 ± 0.9 PgC yr−1, respectively. After taking into account anthropogenic fossil fuel and bio-fuel emissions, the global annual net CO2 emissions for 2004–2006 are estimated to be 4.0 ± 0.9 (4.2 ± 0.9, 4.8 ± 0.9 (4.2 ± 0.9, and 3.8 ± 0.9 (4.1 ± 0.9 PgC yr−1, respectively. The estimated 3-yr total net emission for GEOS-4 (GEOS-5 meteorology is equal to 12.5 (12.4 PgC, agreeing with other recent top-down estimates (12–13 PgC. The regional a posteriori fluxes are broadly consistent in the sign and magnitude of the TransCom-3 study for 1992–1996, but we find larger net sinks over northern and southern continents. We find large departures from our a priori over Europe during summer 2003, over temperate Eurasia during 2004, and over North America during 2005, reflecting an incomplete description of terrestrial carbon dynamics. We find GEOS-4 (GEOS-5 a posteriori CO2 concentrations reproduce the observed surface trend of 1.91–2.43 ppm yr−1 (parts per million per year, depending on latitude, within 0.15 ppm yr−1 (0.2 ppm yr−1 and the seasonal cycle within 0.2 ppm (0.2 ppm at all latitudes. We find the a posteriori model reproduces the aircraft vertical profile measurements of CO2 over North America and Siberia generally within 1

  7. 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.

  8. Bringing humanity into view: action research with Qatar's ambulance service.

    Science.gov (United States)

    Coleman, Gill; Wiggins, Liz

    2017-08-21

    Purpose The purpose of this paper is to argue for the widening of attention in healthcare improvement efforts, to include an awareness of the humanity of people who work in the sector and an appreciation of the part human connection plays in engagement around good quality work. Theoretical frameworks and research approaches which draw on action-based, interpretive and systemic thinking are proposed, as a complement to current practices. Design/methodology/approach The paper describes the early stages of an action research (AR) project, which used the appreciative inquiry "4D" framework to conduct participative inquiry in Hamad Medical Corporation's ambulance service in Qatar, in which staff became co-researchers. Findings The co-researchers were highly motivated to work with improvement goals as a result of their participation in the AR. They, and their managers, saw each other and the work in new ways and discovered that they had much to offer. Research limitations/implications This was a small-scale pilot project, from which findings must be considered tentative. The challenges of establishing good collaboration across language, culture and organisational divides are considerable. Practical implications Appreciative and action-oriented inquiry methods can serve not only to find things out, but also to highlight and give value to aspects of humanity in the workplace that are routinely left invisible in formal processes. This, in turn, can help with quality improvement. Originality/value This paper is a challenge to the orthodox way of viewing healthcare organisations, and improvement processes within them, as reliant on control rather than empowerment. An alternative is to actively include the agency, sense-making capacity and humanity of those involved.

  9. Ambulance diversion and emergency department offload delay: resource document for the National Association of EMS Physicians position statement.

    Science.gov (United States)

    Cooney, Derek R; Millin, Michael G; Carter, Alix; Lawner, Benjamin J; Nable, Jose Victor; Wallus, Harry J

    2011-01-01

    The emergency medical services (EMS) system is a component of a larger health care safety net and a key component of an integrated emergency health care system. EMS systems, and their patients, are significantly impacted by emergency department (ED) crowding. While protocols designed to limit ambulance diversion may be effective at limiting time on divert status, without correcting overall hospital throughput these protocols may have a negative effect on ED crowding and the EMS system. Ambulance offload delay, the time it takes to transfer a patient to an ED stretcher and for the ED staff to assume the responsibility of the care of the patient, may have more impact on ambulance turnaround time than ambulance diversion. EMS administrators and medical directors should work with hospital administrators, ED staff, and ED administrators to improve the overall efficiency of the system, focusing on the time it takes to get ambulances back into service, and therefore must monitor and address both ambulance diversions and ambulance offload delay. This paper is the resource document for the National Association of EMS Physicians position statement on ambulance diversion and ED offload time. Key words: ambulance; EMS; diversion; bypass; offload; delay.

  10. Reducing inappropriate emergency department attendances--a review of ambulance service attendances at a regional teaching hospital in Scotland.

    Science.gov (United States)

    Patton, Gareth Gordon; Thakore, Shobhan

    2013-06-01

    Emergency Departments (ED) in the UK have seen increasing attendance rates in recent years. Departments are now seeking strategies to reduce their attendances. A review of all ambulance attendances to the ED at Ninewells Hospital was conducted to identify if patients presenting by ambulance could be seen and treated more appropriately in other parts of the health service. A retrospective review of ambulance attendances to the ED at Ninewells Hospital over 7 non-consecutive days. The ambulance patient report form and the ED notes were reviewed by the duty consultant to deem whether it was appropriate for the patient to be presented to the ED. If inappropriate, an alternative destination was suggested. Additional data was collected on the source of the ambulance call. There were 910 attendances in the 7 days. 295 (32%) presented by ambulance. 32 had incomplete data and were excluded. 185 (70%) and 179 (68%) of the 263 were deemed appropriate from review of the patient report form and notes respectively. Of the inappropriate, 74.4% and 79.7% had primary care suggested as an alternative. Patients who call for their own ambulance and NHS24 had higher rates of inappropriate attendances. The ambulance services present one-third of the patients to the ED at Ninewells Hospital. 30%-32% were found to be attending inappropriately and 74%-80% of these could have been managed in primary care. Reducing inappropriate ambulance attendances could reduce the departmental patient load by 11%.

  11. Factors influencing the use of ambulance among patients with acute coronary syndrome: results of two centers in Turkey.

    Science.gov (United States)

    Demirkan, Burcu; Ege, Meltem Refiker; Doğan, Pınar; İpek, Esra Gücük; Güray, Umit; Güray, Yeşim

    2013-09-01

    In this study, we aimed to identify the factors influencing the use of ambulance among patients admitted to two Turkish hospitals with acute coronary syndrome (ACS). Overall, 330 with a mean age of 55±13 years, hospitalized patients with ACS at 2 different hospitals were included in this prospective cohort study. The factors influencing the use of ambulance hospital were investigated through a questionnaire. The comparisons were made between two groups regarding use of ambulance. The predictors of the use of ambulance were determined using multiple logistic regression analysis. Despite the high rate of knowing the emergency service number of "112", of the 330 patents, only 96 (29%) used ambulance. Ambulance users had shorter arrival duration with median of 60 min vs 120 min (p=0.03). Presenting with ST elevation myocardial infarction (OR=3.127, 95% CI: 1.555-6.2877, pambulance (OR= 4.184, 95% CI: 2.528-6.926, pambulance use. Using ambulance was in a very low rate among our study patients with ACS. Severity of symptoms, type of ACS and knowledge are seemed to be related with increased ambulance use. Informative health educational programs can be organized to achieve a behavioral change in using of ambulance.

  12. The Application of Ground-Penetrating Radar to Transportation Engineering: Recent Advances and New Perspectives (GI Division Outstanding ECS Award Lecture)

    Science.gov (United States)

    Tosti, Fabio; Benedetto, Andrea; Pajewski, Lara; Alani, Amir M.

    2017-04-01

    Ground-penetrating radar (GPR) is one of the most acknowledged and established non-destructive testing (NDT) techniques within the context of the health monitoring and assessment of transportation infrastructures. GPR is being increasingly used for the effective management of infrastructural assets as it weakens the case for using other destructive monitoring methods, such as digging holes, and allows for rapid and reliable detection of many causes of the subsurface damage. Thereby, its usage favours the optimisation of the economical expenditure for the effective maintenance of great infrastructures as well as it improves the public safety by preventing or not raising the risk of accidents. GPR has been used in highway, railway and airfield engineering as well as for the monitoring of critical infrastructures, such as bridges and tunnels. It has found established use in the assessment of the geometric properties of the subsurface, such as in the case of the evaluation of the pavement layer thicknesses, or the size of the rebars in concrete-made structural components. Major physical-based investigations have been focused on the evaluation of the moisture ingress in flexible road pavements and in concrete structures, as well as on the detection of the rebars corrosion caused by the ingress of chloride. The majority of these parameters are evaluated using methods of signal analysis and data processing based on the signal in the time domain. The sophistication of the hardware and software of the GPR systems over the last few years as well as the recent advances achieved in the research have contributed to raise the high potential of this non-destructive technique and paved the way towards new application areas in transportation engineering. In particular, GPR is nowadays finding major application when used with complementary non-destructive testing techniques, although it has still proved to provide reliable results in various self-standing applications. This work

  13. 49 CFR 234.249 - Ground tests.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Ground tests. 234.249 Section 234.249 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION..., Inspection, and Testing Inspections and Tests § 234.249 Ground tests. A test for grounds on each energy...

  14. 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.

  15. Assessing the Impacts of Chinese Sustainable Ground Transportation on the Dynamics of Urban Growth: A Case Study of the Hangzhou Bay Bridge

    Directory of Open Access Journals (Sweden)

    Qing Zheng

    2016-07-01

    Full Text Available Although China has promoted the construction of Chinese Sustainable Ground Transportation (CSGT to guide sustainable development, it may create substantial challenges, such as rapid urban growth and land limitations. This research assessed the effects of the Hangzhou Bay Bridge on impervious surface growth in Cixi County, Ningbo, Zhejiang Province, China. Changes in impervious surfaces were mapped based on Landsat images from 1995, 2002, and 2009 using a combination of multiple endmember spectral mixture analysis (MESMA and landscape metrics. The results indicated that the area and density of impervious surfaces increased significantly during construction of the Hangzhou Bay Bridge (2002–2009. Additionally, the bridge and connected road networks promoted urban development along major roads, resulting in compact growth patterns of impervious surfaces in urbanized regions. Moreover, the Hangzhou Bay Bridge promoted the expansion and densification of impervious surfaces in Hangzhou Bay District, which surrounds the bridge. The bridge also accelerated socioeconomic growth in the area, promoting rapid urban growth in Cixi County between 2002 and 2009. Overall, the Hangzhou Bay Bridge is an important driver of urban growth in Cixi County, and policy suggestions for sustainable urban growth should be adopted in the future.

  16. Effectiveness of media awareness campaigns on the proportion of vehicles that give space to ambulances on roads: An observational study.

    Science.gov (United States)

    Shaikh, Shiraz; Baig, Lubna A; Polkowski, Maciej

    2017-01-01

    The findings of the Health Care in Danger project in Karachi suggests that there is presence of behavioral negligence among vehicle operators on roads in regards to giving way to ambulances. A mass media campaign was conducted to raise people's awareness on the importance of giving way to ambulances. The main objective of this study was to determine the effectiveness of the campaign on increasing the proportion of vehicles that give way to ambulances. This was a quasi-experimental study that was based on before and after design. Three observation surveys were carried out in different areas of the city in Karachi, Pakistan before, during and after the campaign by trained observers who recorded their findings on a checklist. Each observation was carried out at three different times of the day for at least two days on each road. The relationship of the media campaign with regards to a vehicle giving space to an ambulance was calculated by means of odds ratios and 95% confidence intervals using multivariate logistic regression. Overall, 245 observations were included in the analysis. Traffic congestion and negligence/resistance, by vehicles operators who were in front of the ambulance, were the two main reasons why ambulances were not given way. Other reasons include: sudden stops by minibuses and in the process causing obstruction, ambulances not rushing through to alert vehicle operators to give way and traffic interruption by VIP movement. After adjustment for site, time of day, type of ambulance and number of cars in front of the ambulance, vehicles during (OR=2.13, 95% CI=1.22-3.71, p=0.007) and after the campaign (OR=1.73, 95% CI=1.02-2.95, p=0.042) were significantly more likely give space to ambulances. Mass media campaigns can play a significant role in changing the negligent behavior of people, especially when the campaign conveys a humanitarian message such as: giving way to ambulances can save lives.

  17. Emergency ambulance service involvement with residential care homes in the support of older people with dementia: an observational study.

    Science.gov (United States)

    Amador, Sarah; Goodman, Claire; King, Derek; Machen, Ina; Elmore, Natasha; Mathie, Elspeth; Iliffe, Steve

    2014-08-28

    Older people resident in care homes have a limited life expectancy and approximately two-thirds have limited mental capacity. Despite initiatives to reduce unplanned hospital admissions for this population, little is known about the involvement of emergency services in supporting residents in these settings. This paper reports on a longitudinal study that tracked the involvement of emergency ambulance personnel in the support of older people with dementia, resident in care homes with no on-site nursing providing personal care only. 133 residents with dementia across 6 care homes in the East of England were tracked for a year. The paper examines the frequency and reasons for emergency ambulance call-outs, outcomes and factors associated with emergency ambulance service use. 56% of residents used ambulance services. Less than half (43%) of all call-outs resulted in an unscheduled admission to hospital. In addition to trauma following a following a fall in the home, results suggest that at least a reasonable proportion of ambulance contacts are for ambulatory care sensitive conditions. An emergency ambulance is not likely to be called for older rather than younger residents or for women more than men. Length of residence does not influence use of emergency ambulance services among older people with dementia. Contact with primary care services and admission route into the care home were both significantly associated with emergency ambulance service use. The odds of using emergency ambulance services for residents admitted from a relative's home were 90% lower than the odds of using emergency ambulance services for residents admitted from their own home. Emergency service involvement with this vulnerable population merits further examination. Future research on emergency ambulance service use by older people with dementia in care homes, should account for important contextual factors, namely, presence or absence of on-site nursing, GP involvement, and access to

  18. 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

    2017-05-01

    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 homes failing the quality and suitability of management standard had a lower 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 home policies and practice. © 2016 John Wiley & Sons Ltd.

  19. 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.

  20. 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

    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...... score for cognitive dysfunction were performed. On the first three postoperative days patients were assessed with the cumulated ambulation score consisting of a cumulated assessment of simple ambulation characteristics with a score from 0 to 18 (fully mobile). The three assessments were correlated...

  1. Factors affecting ambulance utilization for asthma attack treatment: understanding where to target interventions.

    Science.gov (United States)

    Raun, L H; Ensor, K B; Campos, L A; Persse, D

    2015-05-01

    Asthma is a serious, sometimes fatal condition, in which attacks vary in severity, potentially requiring emergency medical services (EMS) ambulance treatment. A portion of asthma attacks requiring EMS ambulance treatment may be prevented with improved education and access to care. The aim of this study was to identify areas of the city with high rates of utilization of EMS ambulance for treatment, and the demographics, socio-economic status, and time of day associated with these rates, to better target future interventions to prevent emergencies and reduce cost. A cross-sectional study was conducted on individuals in Houston, TX (USA) requiring ambulance treatment for asthma attacks from 2004 to 2011. 12,155 EMS ambulance-treated asthma attack cases were linked to census tracts. High rate treatment areas were identified with geospatial mapping. Census tract demographic characteristics of these high rate areas were compared with the remainder of the city using logistic regression. The association between case level demographics and the time of day of asthma attack within the high rate area was also assessed with logistic regression. EMS ambulance-treated high rate areas were identified and found to have a utilization incidence rate over six times higher per 100,000 people than the remainder of the city. There is an increased risk of location in this high rate area with a census tract level increase of percent of population: earning less than $10,000 yearly income (RR 1.21, 1.16-1.26), which is black (RR 1.08, 1.07-1.10), which is female (RR 1.34, 1.20-1.49) and have obtained less than a high school degree (RR 1.02, 1.01-1.03). Within the high rate area, case level data indicates an increased risk of requiring an ambulance after normal doctor office hours for men compared with women (RR 1.13, 1.03-1.22), for black compared with Hispanic ethnicity (RR 1.31, 1.08-1.59), or for adults (less than 41 and greater than 60) compared with children. Interventions to prevent

  2. Impact of short-term exposure to fine particulate matter on emergency ambulance dispatches in Japan.

    Science.gov (United States)

    Michikawa, Takehiro; Ueda, Kayo; Takeuchi, Ayano; Kinoshita, Makoto; Hayashi, Hiromi; Ichinose, Takamichi; Nitta, Hiroshi

    2015-01-01

    Evidence of an association between fine particulate matter (PM2.5) and morbidity is limited in Asia. We used a case-crossover design to evaluate the association between short-term exposure to PM2.5 and emergency ambulance dispatches (as a proxy of acute health outcomes), and to calculate the extent to which a 10 μg/m(3) decrease in PM2.5 concentrations would reduce the number of ambulance dispatches. We used data on emergency ambulance dispatches in Fukuoka City, Japan between 2005 and 2010. Emergency ambulance services are publicly funded and cover the entire city. After excluding ambulance dispatches related to external injuries and pregnancy/childbirth, we analysed data on the remaining 176 123 dispatches. We also collected records of daily concentrations of PM2.5 from one ambient air pollution monitoring station. ORs per 10 μg/m(3) increase in PM2.5 were estimated using conditional logistic regression controlled for ambient temperature and relative humidity. During the study period, the average daily concentration of PM2.5 was 20.3 μg/m(3). Exposure to PM2.5 was associated with emergency ambulance dispatches in general (lag0-1; OR=1.008 (95% CI 1.002 to 1.014)) and with dispatches due to respiratory diseases (lag0-1; OR=1.027 (1.007 to 1.048)). No association was observed for dispatches due to cardiovascular diseases. We estimated that a 10 μg/m(3) decrease in PM2.5 concentrations would have led to approximately 260 (estimated range=70-460) fewer ambulance dispatches in Fukuoka for 2012. Providing further evidence on the short-term health effects of PM2.5 exposure, we found that exposure was associated with an increased number of emergency ambulance dispatches. The effect was, however, relatively small. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. 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.

  4. Assessing Pesticide Impact on Human Health in Nebraska: A Survey of Ambulance Services and Rescue Squads. Department Report No. 7.

    Science.gov (United States)

    Vitzthum, Edward F.; And Others

    A study examined the employment qualifications, job content, training, and training needs of ambulance service and rescue squad workers in Nebraska. Based on the 268 mail questionnaires that were completed and returned out of a total of 338 sent out, it was concluded that the strengths of the various ambulance and rescue services vary widely. The…

  5. 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.

  6. Treatment of presumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure

    NARCIS (Netherlands)

    Dieperink, Willem; Weelink, E. E. M.; van der Horst, I. C. C.; de Vos, R.; Jaarsma, T.; Aarts, L. P. H. J.; Zijlstra, F.; Nijsten, M. W. N.

    Background: Early initiation of continuous positive airway pressure (CPAP) applied by face mask benefits patients with acute cardiogenic pulmonary oedema (ACPE). The simple disposable Boussignac CPAP (BCPAP) has been used in ambulances by physicians. In the Netherlands, ambulances are manned by

  7. Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: a pilot study

    National Research Council Canada - National Science Library

    Zeilig, Gabi; Weingarden, Harold; Zwecker, Manuel; Dudkiewicz, Israel; Bloch, Ayala; Esquenazi, Alberto

    2012-01-01

    ...™ exoskeleton ambulation system in people with spinal cord injury. Measures of functional ambulation were also assessed and correlated to neurological spinal cord level, age, and duration since injury...

  8. Cost-efficient evaluation of ambulance services for community ...

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH. AFRICAN ... The annual operational cost was Kshs. 70,328,627 (USD 717,639.05). ... The supply barriers were transport costs, operational costs and in-efficient signage on roads for direction.

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

    Science.gov (United States)

    Chen, Yuqiang; Lai, Yucheng; Ke, Jiajie; Chen, Yuefeng; Xu, Yuling; Ma, Yuqin; Yuan, Jiayin; Liang, Tian; Mai, Pengzhan; Lin, Changmin; Xie, Yang; Huang, Keng

    2015-01-01

    To explore the impact of subtropical maritime monsoon climate on the frequency of ambulance use for trauma patients in a coastal region in China. 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. The daily ambulance use for trauma patients differed between spring and summer or autumn (pambulance use for trauma patients (R² =0.103, pambulance use between good and bad weather (pambulance 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.

  10. HCOOH distributions from IASI for 2008-2014: comparison with ground-based FTIR measurements and a global chemistry-transport model

    Science.gov (United States)

    Pommier, Matthieu; Clerbaux, Cathy; Coheur, Pierre-François; Mahieu, Emmanuel; Müller, Jean-François; Paton-Walsh, Clare; Stavrakou, Trissevgeni; Vigouroux, Corinne

    2016-07-01

    Formic acid (HCOOH) is one of the most abundant volatile organic compounds in the atmosphere. It is a major contributor to rain acidity in remote areas. There are, however, large uncertainties on the sources and sinks of HCOOH and therefore HCOOH is misrepresented by global chemistry-transport models. This work presents global distributions from 2008 to 2014 as derived from the measurements of the Infrared Atmospheric Sounding Interferometer (IASI), based on conversion factors between brightness temperature differences and representative retrieved total columns over seven regions: Northern Africa, southern Africa, Amazonia, Atlantic, Australia, Pacific, and Russia. The dependence of the measured HCOOH signal on the thermal contrast is taken into account in the conversion method. This conversion presents errors lower than 20 % for total columns ranging between 0.5 and 1 × 1016 molec cm-2 but reaches higher values, up to 78 %, for columns that are lower than 0.3 × 1016 molec cm-2. Signatures from biomass burning events are highlighted, such as in the Southern Hemisphere and in Russia, as well as biogenic emission sources, e.g., over the eastern USA. A comparison between 2008 and 2014 with ground-based Fourier transform infrared spectroscopy (FTIR) measurements obtained at four locations (Maido and Saint-Denis at La Réunion, Jungfraujoch, and Wollongong) is shown. Although IASI columns are found to correlate well with FTIR data, a large bias (> 100 %) is found over the two sites at La Réunion. A better agreement is found at Wollongong with a negligible bias. The comparison also highlights the difficulty of retrieving total columns from IASI measurements over mountainous regions such as Jungfraujoch. A comparison of the retrieved columns with the global chemistry-transport model IMAGESv2 is also presented, showing good representation of the seasonal and interannual cycles over America, Australia, Asia, and Siberia. A global model underestimation of the distribution

  11. A comparison between evacuation from the scene and interhospital transportation using a helicopter for subarachnoid hemorrhage.

    Science.gov (United States)

    Ishikawa, Kouhei; Omori, Kazuhiko; Takeuchi, Ikuto; Jitsuiki, Kei; Yoshizawa, Toshihiko; Ohsaka, Hiromichi; Nakao, Yasuaki; Yamamoto, Takuji; Yanagawa, Youichi

    2017-04-01

    We investigated the changes in the vital signs and the final outcomes subarachnoid hemorrhage (SAH) patients who were evacuated from the scene using the doctor-helicopter (Dr. Heli) service and those who only underwent interhospital transportation using the doctor-helicopter Dr. Heli service to investigate safety of this system. We retrospectively investigated all of the patients with non-traumatic SAH who were transported by a Dr. Heli between January 2010 and March 2016. The subjects were divided into two groups: the Scene group included subjects who were evacuated from the scene by a Dr. Heli, while the Interhospital group included subjects who were transported by a ground ambulance to a nearby medical facility and then transported by a Dr. Heli to a single tertiary center. The systolic blood pressure, ratio of cardiac arrest, and Fisher classification values of the patients in the Scene group were significantly greater than those in the Interhospital group. The Glasgow Coma Scale in the Scene group was significantly lower than that in the Interhospital group. After excluding the patients with cardiac arrest, the Glasgow Coma Scale scores of the patients in the two groups did not differ to a statistically significant extent during, before or after transportation. There were no significant differences in Glasgow Outcome Scores or the survival ratio of the two groups, even when cardiac arrest patients were included. The present study indirectly suggests the safety of using a Dr. Heli to evacuate SAH patients from the scene. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. 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...

  13. Symbolic and systemic violence in media representations of aggression towards ambulance personnel in the Netherlands

    NARCIS (Netherlands)

    Cuijpers, N.; Brown, P.R.

    2016-01-01

    Violence towards public sector employees is perceived as a growing problem in a number of societies, attracting the attention of mass media, politicians and social scientists alike. In this article we discuss how national newspapers have reported aggression towards ambulance workers in the Netherlan

  14. Symbolic and systemic violence in media representations of aggression towards ambulance personnel in the Netherlands

    NARCIS (Netherlands)

    Cuijpers, N.; Brown, P.R.

    2016-01-01

    Violence towards public sector employees is perceived as a growing problem in a number of societies, attracting the attention of mass media, politicians and social scientists alike. In this article we discuss how national newspapers have reported aggression towards ambulance workers in the

  15. Nursing students' perceptions of learning nursing skills in the ambulance service.

    Science.gov (United States)

    Nilsson, Tomas; Lindström, Veronica

    2017-05-01

    Several previous studies have explored nursing students' perceptions of clinical learning at hospitals and in other health care facilities, but there are few studies exploring nursing students' perceptions of the clinical learning in the ambulance service. Therefore, the aim of this study was to explore nursing students' perceptions of learning nursing skills in the ambulance service. An inductive qualitative study design with two focus group interviews and content analysis was used. Two themes were identified. The first theme, professional skills, included: Assessment, Prioritizing and initiating care, and Medical treatment and evaluation of interventions. The second theme, a holistic approach to the care included: Cultural, social, and ethical aspects of caring, Decision-making in collaboration with patients, and Care provided in the patients' home. The ambulance service provides a learning environment where the students face a multifaceted picture of health and illness. This learning environment helps nursing students to learn independently how to use professional nursing skills and how to care by employing a holistic approach. However, further research is needed to explore if and how this knowledge about nursing and caring in the ambulance service is useful when working as a Registered Nurse in other health care settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. 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

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

    Science.gov (United States)

    Bergmueller, A; Zavgorodnii, I; Zavgorodnia, N; Kapustnik, W; Boeckelmann, I

    The work in Emergency Medical Ambulance Service is one of the professions, which is accompanied by high psychological and emotional stress. The aim was to determine the risk of professional burnout syndrome of Emergency Medical Ambulance Service staff and the relationship between burnout syndrome and personality. Ninety-seven doctors (57 women and 40 men, aged 37.0±12.21) of Emergency Medical Ambulance Service were interviewed using the MBI-GS questionnaire and the Freiburg personality questionnaire (FPI). Correlation and regression analysis were used. Nine (11.5%) of respondents had a risk of burnout syndrome and 28 (35.9%) had some symptoms. In the group, aged 45 years and older, the risk of burnout syndrome was not identified. The staff of Emergency Medical Ambulance Service is characterized by stable personality features. It is necessary to identify the prevalence of burnout syndrome and also to identity the causes for its prevention and development of measures on the increase of personal stress resilience.

  18. Nurses and advanced airway management: the experience of the Piacenza ambulance service

    Directory of Open Access Journals (Sweden)

    Fabio Mozzarelli

    2015-10-01

    Full Text Available The study examined the intubation manoeuvres performed by Piacenza local health authority ambulance service nurses in patients with sudden cardiac arrest of nontraumatic origin. The study has a retrospective observational design and analyzes all the intubation manoeuvres performed by ambulance service nurses in patients with non-traumatic cardiac arrest between January 2010 and December 2013. The success of the procedure with subglottic tubes was 97.7% (P>0.60, while it was 100% (P>0.50 with supraglottic devices. The success rate of the procedures is encouraging and the statistical analysis showed that there are no significant differences between literature data and the experience of Piacenza ambulance system crews. An increase in the use of supraglottic devices was also observed. The results show that the Piacenza ambulance service nursing staff has a good level of skills and competence in advanced airway management. A future development of this ability could involve intubation also in situations other than cardiac arrest using specific medication.

  19. 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

  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

    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

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

    Science.gov (United States)

    Ebben, Remco H A; Vloet, Lilian C M; Schalk, Donna M J; Mintjes-de Groot, Joke A J; van Achterberg, Theo

    2014-03-01

    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. Semi-structured interviews were held with ambulance nurses, emergency nurses, and physicians (N = 20) with medical end responsibility in the Netherlands to explore influencing factors. Content analysis was used to identify influencing factors. The main influencing factors for adherence were individual factors, including individual (clinical) experience, awareness, and the preference of following local protocols instead of national protocols. Organizational or external factors were involvement in protocol development, training and education, control mechanisms for adherence, and physicians' interest. Also of influence were protocol characteristics including integration of the advanced trauma life support approach, being in accordance with daily practice, and the generality of the content. Influencing factors could be a barrier as well as a facilitator for adherence. Factors influencing ambulance and emergency nurses' protocol adherence could be assigned to individual, organizational, and external categories, as well as to protocol characteristics. To improve adherence, implementation strategies should be tailored to identified factors. Multifaceted implementation strategies will be needed to improve adherence. Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

  3. 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

  4. Promoting Ambulation Responses among Children with Multiple Disabilities through Walkers and Microswitches with Contingent Stimuli

    Science.gov (United States)

    Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Oliva, Doretta; Smaldone, Angela; La Martire, Maria L.; Stasolla, Fabrizio; Castagnaro, Francesca; Groeneweg, Jop

    2010-01-01

    Children with severe or profound intellectual and motor disabilities often present problems of balance and ambulation and spend much of their time sitting or lying, with negative consequences for their development and social status. Recent research has shown the possibility of using a walker (support) device and microswitches with preferred…

  5. 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

  6. 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

  7. 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

  8. Iterative optimization algorithm with parameter estimation for the ambulance location problem.

    Science.gov (United States)

    Kim, Sun Hoon; Lee, Young Hoon

    2016-12-01

    The emergency vehicle location problem to determine the number of ambulance vehicles and their locations satisfying a required reliability level is investigated in this study. This is a complex nonlinear issue involving critical decision making that has inherent stochastic characteristics. This paper studies an iterative optimization algorithm with parameter estimation to solve the emergency vehicle location problem. In the suggested algorithm, a linear model determines the locations of ambulances, while a hypercube simulation is used to estimate and provide parameters regarding ambulance locations. First, we suggest an iterative hypercube optimization algorithm in which interaction parameters and rules for the hypercube and optimization are identified. The interaction rules employed in this study enable our algorithm to always find the locations of ambulances satisfying the reliability requirement. We also propose an iterative simulation optimization algorithm in which the hypercube method is replaced by a simulation, to achieve computational efficiency. The computational experiments show that the iterative simulation optimization algorithm performs equivalently to the iterative hypercube optimization. The suggested algorithms are found to outperform existing algorithms suggested in the literature.

  9. Time-dependent ambulance allocation considering data-driven empirically required coverage.

    Science.gov (United States)

    Degel, Dirk; Wiesche, Lara; Rachuba, Sebastian; Werners, Brigitte

    2015-12-01

    Empirical studies considering the location and relocation of emergency medical service (EMS) vehicles in an urban region provide important insight into dynamic changes during the day. Within a 24-hour cycle, the demand, travel time, speed of ambulances and areas of coverage change. Nevertheless, most existing approaches in literature ignore these variations and require a (temporally and spatially) fixed (double) coverage of the planning area. Neglecting these variations and fixation of the coverage could lead to an inaccurate estimation of the time-dependent fleet size and individual positioning of ambulances. Through extensive data collection, now it is possible to precisely determine the required coverage of demand areas. Based on data-driven optimization, a new approach is presented, maximizing the flexible, empirically determined required coverage, which has been adjusted for variations due to day-time and site. This coverage prevents the EMS system from unavailability of ambulances due to parallel operations to ensure an improved coverage of the planning area closer to realistic demand. An integer linear programming model is formulated in order to locate and relocate ambulances. The use of such a programming model is supported by a comprehensive case study, which strongly suggests that through such a model, these objectives can be achieved and lead to greater cost-effectiveness and quality of emergency care.

  10. Basic Training Program for Emergency Medical Technician: Ambulance Concepts and Recommendations.

    Science.gov (United States)

    Fucigna, Joseph T.; And Others

    The main objective was to develop and pilot test a basic course for ambulance personnel with emphasis on the medical aspect of training. This included the identification of a medically acceptable text or manual, and determining the prerequisites for selecting students and instructors. Secondary objectives were to outline the requirements for…

  11. Emergency Medical Technician-Ambulance: National Standard Curriculum. Course Guide (Third Edition).

    Science.gov (United States)

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This course guide is intended to assist course coordinators in planning and managing a course to train emergency medical technicians to work with ambulance or other specialized rescue services. Materials are presented to enable students to perform the following functions: recognize the nature and seriousness of the patient's condition or extent of…

  12. An Action Learning Approach to the Question: Are Ambulance Response Time Targets Achievable?

    Science.gov (United States)

    Slater, Alan

    2017-01-01

    In recent years, NHS Ambulance Trusts throughout the UK have consistently failed to achieve their response time targets for both actual and potential life-threatening calls. To avoid a media and public outcry, the NHS response has been to change the basic parameters upon which the response time targets are calculated. An action learning study,…

  13. 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.

  14. 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 ...

  15. METABOLIC SYNDROME AND DAILY AMBULATION IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS

    Science.gov (United States)

    Gardner, Andrew W.; Parker, Donald E.; Krishnan, Sowmya; Chalmers, Laura J.

    2012-01-01

    Purposes To compare daily ambulatory measures in children, adolescents, and young adults with and without metabolic syndrome, and to assess which metabolic syndrome components, demographic measures, and body composition measures are associated with daily ambulatory measures. Methods Two-hundred fifty subjects between the ages of 10 and 30 years were assessed on metabolic syndrome components, demographic and clinical measures, body fat percentage, and daily ambulatory strides, durations, and cadences during seven consecutive days. Forty-five of the 250 subjects had metabolic syndrome, as defined by the International Diabetes Federation. Results Subjects with metabolic syndrome ambulated at a slower daily average cadence than those without metabolic syndrome (13.6 ± 2.2 strides/min vs. 14.9 ± 3.2 strides/min; p=0.012), and they had slower cadences for continuous durations of 60 minutes (p=0.006), 30 minutes (p=0.005), 20 minutes (p=0.003), 5 minutes (p=0.002), and 1 minute (p=0.001). However, the total amount of time spent ambulating each day was not different (p=0.077). After adjustment for metabolic syndrome status, average cadence is linearly associated with body fat percentage (pmetabolic syndrome ambulate more slowly and take fewer strides throughout the day than those without metabolic syndrome, even though the total amount of time spent ambulating is not different. Furthermore, the detrimental influence of metabolic syndrome on ambulatory cadence is primarily a function of body fatness. PMID:22811038

  16. Prehospital advanced airway management by ambulance technicians and paramedics: is clinical practice sufficient to maintain skills?

    Science.gov (United States)

    Deakin, C D; King, P; Thompson, F

    2009-12-01

    Ambulance paramedics are now trained routinely in advanced airway skills, including tracheal intubation. Initial training in this skill requires the insertion of 25 tracheal tubes, and further ongoing training is attained through clinical practice and manikin-based practice. In contrast, training standards for hospital-based practitioners are considerably greater, requiring approximately 200 tracheal intubations before practice is unsupervised. With debate growing regarding the efficacy of paramedic intubation, there is a need to assess current paramedic airway practice in order to review whether initial training and maintenance of skills provide an acceptable level of competence with which to practice advanced airway skills. All ambulance patient report forms (anonymised) for the period 1 January 2007 to 31 December 2007 were reviewed, and data relating to airway management were collected. Paramedic and technician identification codes were used to determine the number of airway procedures undertaken on an individual basis. Of the 269 paramedics, 128 (47.6%) had undertaken no intubation and 204 (75.8%) had undertaken one or less intubation in the 12-month study period. The median number of intubations per paramedic during the 12-month period was 1.0 (range 0-11). A total of 76 laryngeal mask insertion attempts were recorded by 41 technicians and 30 paramedics. The median number of laryngeal mask insertions per paramedic/technician during the 12-month period was 0 (range 0-2). A survey of ongoing continuing professional development across all ambulance trusts demonstrated no provision for adequate training to compensate for the lack of clinical exposure to advanced airway skills. Paramedics use advanced airway skills infrequently. Continuing professional development programmes within ambulance trusts do not provide the necessary additional practice to maintain tracheal intubation skills at an acceptable level. Advanced airway management delivered by ambulance crews

  17. 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.

  18. Design and trial of a new ambulance-to-emergency department handover protocol: 'IMIST-AMBO'.

    Science.gov (United States)

    Iedema, Rick; Ball, Chris; Daly, Barbara; Young, Jacinta; Green, Tim; Middleton, Paul M; Foster-Curry, Catherine; Jones, Marea; Hoy, Sarah; Comerford, Daniel

    2012-08-01

    Information communicated by ambulance paramedics to Emergency Department (ED) staff during handover of patients has been found to be inconsistent and incomplete, and yet has major implications for patients' subsequent hospital treatment and trajectory of care. The study's aims were to: (1) identify the existing structure of paramedic-to-emergency staff handovers by video recording and analysing them; (2) involve practitioners in reflecting on practice using the footage; (3) combine those reflections with formal analyses of these filmed handovers to design a handover protocol; (4) trial-run the protocol; and (5) assess the protocol's enactment. The study was a 'video-reflexive ethnography' involving: structured analysis of videoed handovers (informed by ED clinicians' and ambulance paramedics' comments); ED clinicians and ambulance paramedics viewing their own practices; and rapid at-work training and feedback for paramedics. A five-question pre- and post-survey measured ED triage nurses' perceptions of the new protocol's impact. In total, 137 pre- and post-handovers were filmed involving 291 staff, and 368 staff were educated in the use of the new protocol. There was agreement that Identification of the patient, Mechanism/medical complaint, Injuries/information relative to the complaint, Signs, vitals and GCS, Treatment and trends/response to treatment, Allergies, Medications, Background history and Other (social) information (IMIST-AMBO) was the preferred protocol for non-trauma and trauma handovers. Uptake of IMIST-AMBO showed improvements: a greater volume of information per handover that was more consistently ordered; fewer questions from ED staff; a reduction in handover duration; and fewer repetitions by both paramedics and ED clinicians that may suggest improved recipient comprehension and retention. IMIST-AMBO shows promise for improving the ambulance-ED handover communication interface. Involving paramedics and ED clinicians in its development enhanced the

  19. Treadmill-based locomotor training with leg weights to enhance functional ambulation in people with chronic stroke: a pilot study.

    Science.gov (United States)

    Lam, Tania; Luttmann, Kathryn; Houldin, Adina; Chan, Catherine

    2009-09-01

    Novel locomotor training strategies for individuals with disorders of the central nervous system have been associated with improved locomotor function. The purpose of this study was to investigate the effects of treadmill-based locomotor training combined with leg weights on functional ambulation in individuals with chronic stroke. We assessed functional ambulation and muscle activity in ambulatory individuals with chronic stroke. We used a pre/posttest design. Six individuals with chronic stroke who were community ambulators were recruited. Participants underwent a 30-minute treadmill-based locomotor training sessions three times per week for four to 12 weeks. The training program involved treadmill walking for 30 minutes with partial body weight support as needed. Leg weights, equivalent to 5% of body weight, were affixed around the paretic leg. Outcome measures consisted of the 10-m walk test, the modified Emory Functional Ambulation Profile, and temporal gait parameters. Improvements were observed in functional ambulation measures, particularly the stairs subscore of the modified Emory Functional Ambulation Profile. Participants also exhibited an increase in the proportion of time the paretic leg spent in swing. No significant improvements were observed in the 10-m walk test. This pilot study demonstrates that the combination of leg weights and treadmill training is a feasible approach, that is well tolerated by participants. This approach may have the potential to improve some aspects of functional ambulation and the performance of activities requiring hip and knee flexion.

  20. Weather and age-gender effects on the projection of future emergency ambulance demand in Hong Kong.

    Science.gov (United States)

    Lai, Poh-Chin; Wong, Ho-Ting

    2015-03-01

    An accurate projection for ambulance demand is essential to enable better resource planning for the future that strives to either maintain current levels of services or reconsider future standards and expectations. More than 2 million cases of emergency room attendance in 2008 were obtained from the Hong Kong Hospital Authority to project the demand for its ambulance services in 2036. The projection of ambulance demand in 2036 was computed in consideration of changes in the age-gender structure between 2008 and 2036. The quadratic relation between average daily temperature and daily ambulance demand in 2036 was further explored by including and excluding age-gender demographic changes. Without accounting for changes in the age-gender structure, the 2036 ambulance demand for age groups of 65 and above were consistently underestimated (by 38%-65%), whereas those of younger age groups were overestimated (by 6%-37%). Moreover, changes in the 2008 to 2036 age-gender structure also shift upward and emphasize relationships between average daily temperature and daily ambulance demand at both ends of the quadratic U-shaped curve. Our study reveals a potential societal implication of ageing population on the demand for ambulance services. © 2012 APJPH.

  1. Ambulance call-outs and response times in Birmingham and the impact of extreme weather and climate change.

    Science.gov (United States)

    Thornes, John Edward; Fisher, Paul Anthony; Rayment-Bishop, Tracy; Smith, Christopher

    2014-03-01

    Although there has been some research on the impact of extreme weather on the number of ambulance call-out incidents, especially heat waves, there has been very little research on the impact of cold weather on ambulance call-outs and response times. In the UK, there is a target response rate of 75% of life threatening incidents (Category A) that must be responded to within 8 min. This paper compares daily air temperature data with ambulance call-out data for Birmingham over a 5-year period (2007-2011). A significant relationship between extreme weather and increased ambulance call-out and response times can clearly be shown. Both hot and cold weather have a negative impact on response times. During the heat wave of August 2003, the number of ambulance call-outs increased by up to a third. In December 2010 (the coldest December for more than 100 years), the response rate fell below 50% for 3 days in a row (18 December-20 December 2010) with a mean response time of 15 min. For every reduction of air temperature by 1°C there was a reduction of 1.3% in performance. Improved weather forecasting and the take up of adaptation measures, such as the use of winter tyres, are suggested for consideration as management tools to improve ambulance response resilience during extreme weather. Also it is suggested that ambulance response times could be used as part of the syndromic surveillance system at the Health Protection Agency.

  2. Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

    Science.gov (United States)

    Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick

    2013-11-01

    U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.

  3. Ambulance Transfer in Case of Postpartum Hemorrhage after Birth in Primary Midwifery Care in The Netherlands: A Prospective Cohort Study.

    Science.gov (United States)

    Stolp, Ineke; Smit, Marrit; Luxemburg, Sanne; van den Akker, Thomas; de Waard, Jan; van Roosmalen, Jos; de Vos, Rien

    2015-09-01

    The objective of this prospective cohort study was to assess whether the 45-minute prehospital limit for ambulance transfer is met in case of postpartum hemorrhage (PPH) after midwifery-supervised home birth in The Netherlands and evaluate the process of ambulance transfer, maternal condition during transfer, and outcomes in relation to whether this limit was met. Using ambulance report forms and medical charts, ambulance intervals, urgency coding, clinical condition (using the lowest Revised Trauma Score, [RTS]), and maternal outcomes were collected. From April 2008 to April 2010, midwives reported 72 cases of PPH. Associations between duration of the ambulance transfer, maternal condition during ambulance transfer and outcomes were analyzed. The main outcome measures were duration of ambulance transfer, RTS, blood loss, surgical procedures, and blood transfusions. Seventy-two cases were reported, 18 (25%) were excluded: 54 cases were analyzed. In 63 percent, the 45-minute prehospital limit was met, 75.9 percent received a RTS of 12, indicating optimal Glasgow Coma Scale, systolic blood pressure, and respiratory frequency. In 24.1 percent a decrease in systolic blood pressure was found (RTS 10 or 11). We found no difference in outcomes between women with different RTS or in whom the 45-minute prehospital limit was or was not met. We found no relation between the duration of ambulance transfer and maternal condition or outcomes. All women fully recovered. The low-risk profile of women in primary care, well-organized midwifery, and ambulance care in The Netherlands are likely to contribute to these findings. © 2015 Wiley Periodicals, Inc.

  4. Documentation of a computer program to simulate lake-aquifer interaction using the MODFLOW ground water flow model and the MOC3D solute-transport model

    Science.gov (United States)

    Merritt, Michael L.; Konikow, Leonard F.

    2000-01-01

    Heads and flow patterns in surficial aquifers can be strongly influenced by the presence of stationary surface-water bodies (lakes) that are in direct contact, vertically and laterally, with the aquifer. Conversely, lake stages can be significantly affected by the volume of water that seeps through the lakebed that separates the lake from the aquifer. For these reasons, a set of computer subroutines called the Lake Package (LAK3) was developed to represent lake/aquifer interaction in numerical simulations using the U.S. Geological Survey three-dimensional, finite-difference, modular ground-water flow model MODFLOW and the U.S. Geological Survey three-dimensional method-of-characteristics solute-transport model MOC3D. In the Lake Package described in this report, a lake is represented as a volume of space within the model grid which consists of inactive cells extending downward from the upper surface of the grid. Active model grid cells bordering this space, representing the adjacent aquifer, exchange water with the lake at a rate determined by the relative heads and by conductances that are based on grid cell dimensions, hydraulic conductivities of the aquifer material, and user-specified leakance distributions that represent the resistance to flow through the material of the lakebed. Parts of the lake may become ?dry? as upper layers of the model are dewatered, with a concomitant reduction in lake surface area, and may subsequently rewet when aquifer heads rise. An empirical approximation has been encoded to simulate the rewetting of a lake that becomes completely dry. The variations of lake stages are determined by independent water budgets computed for each lake in the model grid. This lake budget process makes the package a simulator of the response of lake stage to hydraulic stresses applied to the aquifer. Implementation of a lake water budget requires input of parameters including those representing the rate of lake atmospheric recharge and evaporation

  5. 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.

  6. 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

  7. Guidance for ambulance personnel on decisions and situations related to out-of-hospital CPR.

    Science.gov (United States)

    Ågård, Anders; Herlitz, Johan; Castrén, Maaret; Jonsson, Lars; Sandman, Lars

    2012-01-01

    Ethical guidelines on out-of-hospital cardio-pulmonary resuscitation (CPR) are designed to provide substantial guidance for the people who have to make decisions and deal with situations in the real world. The crucial question is whether it is possible to formulate practical guidelines that will make things somewhat easier for ambulance personnel. The aims of this article are to address the ethical aspects related to out-of-hospital CPR, primarily to decisions on not starting or terminating resuscitation attempts, using the views and experience of ambulance personnel as a starting point, and to summarise the key points in a practice guideline on the subject. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  8. 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.

  9. Aspects of neutrality: two Dutch ambulances at the eastern front in the First World War.

    Science.gov (United States)

    van Bergen, Leo

    2010-01-01

    The paper looks at two First World War ambulance teams which distinctly differed from each other, both in the way they perceived the war and the places at the front where they worked. The first was working on the Serbian side and the second on the Austrian-Hungarian. The questions raised are: how was medical neutrality defined (was it defined at all)? Was neutrality maintained, and if so how? The writings of several protagonists are closely examined, and placed in context, to show that total neutrality was not adhered to by the physicians and nurses of these ambulances. Apparently neutrality in wartime is difficult, even for men and women coming from a neutral country with an occupation seen as essentially neutral.

  10. 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

  11. 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...

  12. 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.

  13. 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.

  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. 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.

  16. Proposal for periodic verifications of electromedical devices integrated to terrestrial Technical Ambulance Inspection (TAI)

    Science.gov (United States)

    Del Aguila Heidenreich, R.; Vanella, O.; Bruni, R.; Taborda, R.

    2011-12-01

    In Argentina, electromedical devices may only be commercialized if they meet safety and performance requirements established by current regulations, ensuring their safety and intended performance when leaving the Factory. However, during usage, natural wearing and overloading may change this condition, especially if used in extra hospital services performed by ambulances, which are likely to be subjected to rough handling conditions and hitting. This proposal explains the chosen methodology to address the periodic verification activities of electro medical devices within the process of terrestrial Technical Ambulance Inspection (TAI). Among the results stand out the set of methods for verification and the lists used to record the outcome of this evaluation. Outstanding conclusions include that the operations meet the conditions of an analogous mechanism to that of a Technical Vehicle Inspection (existing for other vehicles), and that the same working structure can be used as a basis for making a manual of procedures for a TAI.

  17. Grounded theory.

    Science.gov (United States)

    Harris, Tina

    2015-04-29

    Grounded theory is a popular research approach in health care and the social sciences. This article provides a description of grounded theory methodology and its key components, using examples from published studies to demonstrate practical application. It aims to demystify grounded theory for novice nurse researchers, by explaining what it is, when to use it, why they would want to use it and how to use it. It should enable nurse researchers to decide if grounded theory is an appropriate approach for their research, and to determine the quality of any grounded theory research they read.

  18. 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....

  19. A Statistical Analysis of Santa Barbara Ambulance Response in 2006: Performance Under Load

    Directory of Open Access Journals (Sweden)

    Chang, Joshua C

    2009-02-01

    Full Text Available Ambulance response times in Santa Barbara County for 2006 are analyzed using point process techniques, including kernel intensity estimates and K-functions. Clusters of calls result in significantly higher response times, and this effect is quantified. In particular, calls preceded by other calls within 20 km and within the previous hour are significantly more likely to result in violations. This effect appears to be especially pronounced within semi-rural neighborhoods.[WestJEM. 2009;10:42-47.

  20. Are overdoses treated by ambulance services an opportunity for additional interventions? A prospective cohort study.

    Science.gov (United States)

    Gjersing, Linn; Bretteville-Jensen, Anne Line

    2015-11-01

    To assess whether people who inject drugs (PWID) and who are treated for overdose by ambulance services have a greater mortality risk compared with other PWID, and to compare mortality risk within potentially critical time-periods (1 week, 1 month, 3 months, 6 months, 1 year, 5 years) after an overdose attendance with the mortality risk within potentially non-critical time-periods (time before and/or after critical periods). A prospective cohort study. Oslo, Norway. A total of 172 PWID street-recruited in 1997 and followed-up until the end of 2004. Interview data linked to data from ambulance records, Norwegian Correctional Services, Opioid Substitution Treatment records and National Cause of Death Registry. Separate Cox regression models (one for each critical time-period) were estimated. Ambulance services treated 54% of the participants for an overdose during follow-up. The mortality rate was 2.8 per 100 person-years for those with an overdose and 3.3 for those without; the adjusted hazard ratio (HR) was 1.3 (95% CI = 0.6, 2.6, P = 0.482). Mortality risk was greater in all but the shortest critical time-period following ambulance attendance than in the non-critical periods. The mortality risk remained significantly elevated during critical periods, even when adjusted for total time spent in prison and substitution treatment. The HR ranged from 9.4 (95% CI = 3.5, 25.4) in the month after an overdose to 13.9 (95% CI = 6.4, 30.2) in the 5-year period. Mortality risk among people who inject drugs is significantly greater in time-periods after an overdose attendance than outside these time-periods. © 2015 Society for the Study of Addiction.

  1. 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...

  2. Ambulance Dispatches From Unaffected Areas After the Great East Japan Earthquake: Impact on Emergency Care in the Unaffected Areas.

    Science.gov (United States)

    Hagihara, Akihito; Onozuka, Daisuke; Nagata, Takashi; Abe, Takeru; Hasegawa, Manabu; Nabeshima, Yoshihiro

    2015-12-01

    Although dispatching ambulance crews from unaffected areas to a disaster zone is inevitable when a major disaster occurs, the effect on emergency care in the unaffected areas has not been studied. We evaluated whether dispatching ambulance crews from unaffected prefectures to those damaged by the Great East Japan Earthquake was associated with reduced resuscitation outcomes in out-of-hospital cardiac arrest (OHCA) cases in the unaffected areas. We used the Box-Jenkins transfer function model to assess the relationship between ambulance crew dispatches and return of spontaneous circulation (ROSC) before hospital arrival or 1-month survival after the cardiac event. In a model whose output was the rate of ROSC before hospital arrival, dispatching 1000 ambulance crews was associated with a 0.474% decrease in the rate of ROSC after the dispatch in the prefectures (p=0.023). In a model whose output was the rate of 1-month survival, dispatching 1000 ambulance crews was associated with a 0.502% decrease in the rate of 1-month survival after the dispatch in the prefectures (p=0.011). The dispatch of ambulances from unaffected prefectures to earthquake-stricken areas was associated with a subsequent decrease in the ROSC and 1-month survival rates in OHCA cases in the unaffected prefectures.

  3. An association between fine particulate matter (PM2.5) levels and emergency ambulance dispatches for cardiovascular diseases in Japan.

    Science.gov (United States)

    Ichiki, Toshihiro; Onozuka, Daisuke; Kamouchi, Masahiro; Hagihara, Akihito

    2016-11-01

    The aim of this study is to determine whether short-term exposure to fine particulate matter (PM2.5) is associated with emergency ambulance dispatches for cardiovascular diseases in Japan. The nationwide data on emergency dispatches of ambulance for cardiovascular diseases classified as I00-I99 by International Classification of Diseases-10th revision in 30 Japanese prefectures between April 1 and December 31, in 2010 were analyzed. Data on weather variability including PM2.5, temperature and relative humidity were acquired from ambient air pollution monitoring stations. Conditional Poisson regression models were used to estimate the prefecture-specific effects of PM2.5 on morbidity, and adjust for confounding factors. A meta-analysis was then applied to pool estimates at the 30-prefecture level. A total of 160,566 emergency ambulance dispatches for cardiovascular diseases were reported during the study period. The risk of emergency ambulance dispatch for cardiovascular diseases significantly increased with an increase in the exposure to PM2.5 in Fukuoka and Iwate Prefectures. However, we found no statistically significant associations between PM2.5 and emergency ambulance dispatches in the pooled analysis (odds ratio 1.00, 95 % confidence interval 0.99-1.00). Heterogeneity was not observed between prefectures (Cochran Q test, p = 0.187, I (2) = 18.4 %). Exposure to PM2.5 is not associated with overall emergency ambulance dispatches for cardiovascular diseases in Japan.

  4. A coproduced patient and public event: An approach to developing and prioritizing ambulance performance measures.

    Science.gov (United States)

    Irving, Andy; Turner, Janette; Marsh, Maggie; Broadway-Parkinson, Andrea; Fall, Dan; Coster, Joanne; Siriwardena, A Niroshan

    2017-08-25

    Patient and public involvement (PPI) is recognized as an important component of high-quality health services research. PPI is integral to the Pre-hospital Outcomes for Evidence Based Evaluation (PhOEBE) programme. The PPI event described in detail in this article focusses on the process of involving patients and public representatives in identifying, prioritizing and refining a set of outcome measures that can be used to support ambulance service performance measurement. To obtain public feedback on little known, complex aspects of ambulance service performance measurement. The event was codesigned and coproduced with the PhOEBE PPI reference group and PhOEBE research team. The event consisted of brief researcher-led presentations, group discussions facilitated by the PPI reference group members and electronic voting. Data were collected from eighteen patient and public representatives who attended an event venue in Yorkshire. The results of the PPI event showed that this interactive format and mode of delivery was an effective method to obtain public feedback and produced a clear indication of which ambulance performance measures were most highly favoured by event participants. The event highlighted valuable contributions the PPI reference group made to the design process, supporting participant recruitment and facilitation of group discussions. In addition, the positive team working experience of the event proved a catalyst for further improvements in PPI within the PhOEBE project. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  5. Lightweight physiologic sensor performance during pre-hospital care delivered by ambulance clinicians.

    Science.gov (United States)

    Mort, Alasdair J; Fitzpatrick, David; Wilson, Philip M J; Mellish, Chris; Schneider, Anne

    2016-02-01

    The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (SpO2). The second was the RESpeck respiratory rate (RR) sensor, which was wireless-enabled with a Bluetooth(®) Low Energy protocol. Sensor data were recorded from 16 pre-hospital patients, who were monitored for 21.2 ± 9.8 min, on average. Some form of error was identified on almost every HR and SpO2 trace. However, the mean proportion of each trace exhibiting error was ambulance transit on the incidence of HR or SpO2 error. The RESpeck RR sensor delivered an average of 4.2 (±2.2) validated breaths per minute, but did not produce any validated breaths during the gross motion of ambulance transit as its pre-defined motion threshold was exceeded. However, this was many more data points than could be achieved using traditional manual assessment of RR. Error was identified on a majority of pre-hospital physiologic signals, which emphasised the need to ensure consistent sensor attachment in this unstable and unpredictable environment, and in developing intelligent methods of screening out such error.

  6. Ambulation monitoring of transtibial amputation subjects with patient activity monitor versus pedometer.

    Science.gov (United States)

    Dudek, Nancy L; Khan, Omar D; Lemaire, Edward D; Marks, Meridith B; Saville, Leyana

    2008-01-01

    Our study aimed to compare the accuracy of step count and ambulation distance determined with the Yamax Digi-Walker SW-700 pedometer (DW) and the Ossur patient activity monitor (PAM) in 20 transtibial amputation subjects who were functioning at the K3 Medicare Functional Classification Level. Subjects completed four simulated household tasks in an apartment setup and a gymnasium walking course designed to simulate outdoor walking without the presence of environmental barriers or varied terrain. The mean step count accuracy of the DW and the PAM was equivalent for both the household activity (75.3% vs 70.6%) and the walking course (93.8% vs 94.0%). The mean distance measurement accuracy was better with the DW than with the PAM (household activity: 72.8% vs 0%, walking course: 92.5% vs 86.3%; p < 0.05). With acceptable step count accuracy, both devices are appropriate for assessing relatively continuous ambulation. The DW may be preferred for its more accurate distance measurements. Neither device is ideal for monitoring in-home ambulation.

  7. 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.

  8. Telemedicin - en mulighed til kvinder der føder ambulant?

    DEFF Research Database (Denmark)

    Danbjørg, Dorthe Boe; Clemensen, Jane; Wagner, Lis

    Formål og baggrund: Længden af hospitalsophold efter fødsel er afkortet i løbet af de sidste 10-20 år. Udfordringen bliver at sikre ’at den observation og understøttelse af mor og barn, der tidligere fandt sted under indlæggelse, fortsat sikres efter ambulant fødsel eller tidlig udskrivelse’ (SST...... 2009, s.36). Det overordnede formål er at udforske om telemedicin kan være en mulig løsning, når kvinder udskrives ambulant. Design og metoder: Projektet er et aktionsforskningsprojekt, nærmere bestemt arbejdes der ud fra Participartory Design. Metodologien er baseret på deltagelse af brugerne, og det......-løsningen med fokus på hvordan sygeplejerskerne og de nybagte familier oplever brug af en app efter ambulant fødsel. Foreløbige resultater: Den første fase af undersøgelsen understreger behovet for et individuelt barselsforløb, hvor der er opfølgende støtte efter udskrivelsen og hvor familierne oplever, at de...

  9. Reducing Time to First on Scene: An Ambulance-Community First Responder Scheme

    Directory of Open Access Journals (Sweden)

    Alan Campbell

    2016-01-01

    Full Text Available The importance of early access to prehospital care has been demonstrated in many medical emergencies. This work aims to describe the potential time benefit of implementing a student Community First Responder scheme to support ambulance services in an inner-city setting in the United Kingdom. Twenty final and penultimate year medical students in the UK were trained in the “First Person on Scene” Business and Technology Education Council (BTEC qualification. Over 12 months, they attended 89 emergency calls in an inner-city setting as Community First Responders (CFRs, alongside the West Midlands Ambulance Service, UK. At the end of this period, a qualitative survey investigated the perceived educational value of the scheme. The mean CFR response time across all calls was an average of 3 minutes and 8 seconds less than ambulance crew response times. The largest difference was to calls relating to falls (12 min. The difference varied throughout the day, peaking between 16:00 and 18:00. All questionnaire respondents stated that they felt more prepared in assessing and treating acutely unwell patients. In this paper, the authors present a symbiotic solution which has both reduced time to first on scene and provided training and experience in medical emergencies for senior medical students.

  10. Reducing Time to First on Scene: An Ambulance-Community First Responder Scheme.

    Science.gov (United States)

    Campbell, Alan; Ellington, Matt

    2016-01-01

    The importance of early access to prehospital care has been demonstrated in many medical emergencies. This work aims to describe the potential time benefit of implementing a student Community First Responder scheme to support ambulance services in an inner-city setting in the United Kingdom. Twenty final and penultimate year medical students in the UK were trained in the "First Person on Scene" Business and Technology Education Council (BTEC) qualification. Over 12 months, they attended 89 emergency calls in an inner-city setting as Community First Responders (CFRs), alongside the West Midlands Ambulance Service, UK. At the end of this period, a qualitative survey investigated the perceived educational value of the scheme. The mean CFR response time across all calls was an average of 3 minutes and 8 seconds less than ambulance crew response times. The largest difference was to calls relating to falls (12 min). The difference varied throughout the day, peaking between 16:00 and 18:00. All questionnaire respondents stated that they felt more prepared in assessing and treating acutely unwell patients. In this paper, the authors present a symbiotic solution which has both reduced time to first on scene and provided training and experience in medical emergencies for senior medical students.

  11. The Birth and Growth of the National Ambulance Service in Ghana.

    Science.gov (United States)

    Zakariah, Ahmed; Stewart, Barclay T; Boateng, Edmund; Achena, Christiana; Tansley, Gavin; Mock, Charles

    2017-02-01

    Introduction This study aimed to document the growth and challenges encountered in the decade since inception of the National Ambulance Service (NAS) in Ghana, West Africa. By doing so, potentially instructive examples for other low- and middle-income countries (LMICs) planning a formal prehospital care system or attempting to identify ways to improve existing emergency services could be identified. Data routinely collected by the Ghana NAS from 2004-2014 were described, including: patient demographics, reason for the call, response location, target destination, and ti1mes of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported. In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%-80% and 10%-57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described. The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving public awareness of NAS services

  12. Improving the coding and classification of ambulance data through the application of International Classification of Disease 10th revision.

    Science.gov (United States)

    Cantwell, Kate; Morgans, Amee; Smith, Karen; Livingston, Michael; Dietze, Paul

    2014-02-01

    This paper aims to examine whether an adaptation of the International Classification of Disease (ICD) coding system can be applied retrospectively to final paramedic assessment data in an ambulance dataset with a view to developing more fine-grained, clinically relevant case definitions than are available through point-of-call data. Over 1.2 million case records were extracted from the Ambulance Victoria data warehouse. Data fields included dispatch code, cause (CN) and final primary assessment (FPA). Each FPA was converted to an ICD-10-AM code using word matching or best fit. ICD-10-AM codes were then converted into Major Diagnostic Categories (MDC). CN was aligned with the ICD-10-AM codes for external cause of morbidity and mortality. The most accurate results were obtained when ICD-10-AM codes were assigned using information from both FPA and CN. Comparison of cases coded as unconscious at point-of-call with the associated paramedic assessment highlighted the extra clinical detail obtained when paramedic assessment data are used. Ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Coding of ambulance data using ICD-10-AM allows for comparison of not only ambulance service users but also with other population groups. WHAT IS KNOWN ABOUT THE TOPIC? There is no reliable and standard coding and categorising system for paramedic assessment data contained in ambulance service databases. WHAT DOES THIS PAPER ADD? This study demonstrates that ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Representation of ambulance case types using ICD-10-AM-coded information obtained after paramedic assessment is more fine grained and clinically relevant than point-of-call data, which uses caller information before ambulance attendance. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? This paper describes

  13. Does helicopter transport improve outcomes independently of emergency medical system time?

    Science.gov (United States)

    Ryb, Gabriel E; Dischinger, Patricia; Cooper, Carnell; Kufera, Joseph A

    2013-01-01

    Helicopter emergency medical systems (HEMS) have been reported to improve trauma survival. This study seeks to determine HEMS effect on survival across different subpopulations in relation to injury severity, degree of physiologic derangement, and transportation time (TT). The 2007 National Trauma Data Bank adult patients transported directly to hospitals by ground ambulance or HEMS were compared in relation to their survival with discharge and other possible confounders. Multivariate models were constructed to determine the adjusted odds ratios (OR) of survival for the entire cohort and across subpopulations stratified by different Injury Severity Score (ISS), hospital Revised Trauma Score (RTS), and TT. A total of 192,422 patients with complete data were analyzed. HEMS patients (15.3%) experienced lower survival rates than those transported by ground (93.8% vs. 96.1%, p < 0.001). Multivariate analysis revealed a survival advantage for HEMS in the entire cohort (OR, 1.78 [1.65-1.92]). Adding TT to the model did not affect HEMS effect on survival. HEMS effect was present across all ISS levels but was limited to those with RTS of less than 6 (n = 15,427; OR, 2.28 [2.10-2.49]). In contrast, those with RTS of 6 or greater experienced lower adjusted survival when transported by HEMS (n = 176,995; OR, 0.83 [0.74-0.94]). Stratification by RTS and ISS did not affect the results. Substratification by TT revealed no effect of HEMS on survival among patients with RTS of less than 6, ISS of less than 16, and TT of 60 minutes or greater. Remaining associations were not affected by TT substratification. HEMS beneficial effect on survival seems to be limited to patients with physiologic instability. Physiologically stable patients seem to have a worse outcome when transported by air. Epidemiologic/prognostic study, level III.

  14. Grounded cognition.

    Science.gov (United States)

    Barsalou, Lawrence W

    2008-01-01

    Grounded cognition rejects traditional views that cognition is computation on amodal symbols in a modular system, independent of the brain's modal systems for perception, action, and introspection. Instead, grounded cognition proposes that modal simulations, bodily states, and situated action underlie cognition. Accumulating behavioral and neural evidence supporting this view is reviewed from research on perception, memory, knowledge, language, thought, social cognition, and development. Theories of grounded cognition are also reviewed, as are origins of the area and common misperceptions of it. Theoretical, empirical, and methodological issues are raised whose future treatment is likely to affect the growth and impact of grounded cognition.

  15. 49 CFR 229.97 - Grounding fuel tanks.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Grounding fuel tanks. 229.97 Section 229.97 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Equipment § 229.97 Grounding fuel tanks. Fuel tanks and related piping shall be electrically grounded....

  16. 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.

  17. 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.

  18. MODFLOW-2000, the U.S. Geological Survey Modular Ground-Water Model--Documentation of the SEAWAT-2000 Version with the Variable-Density Flow Process (VDF) and the Integrated MT3DMS Transport Process (IMT)

    Science.gov (United States)

    Langevin, Christian D.; Shoemaker, W. Barclay; Guo, Weixing

    2003-01-01

    SEAWAT-2000 is the latest release of the SEAWAT computer program for simulation of three-dimensional, variable-density, transient ground-water flow in porous media. SEAWAT-2000 was designed by combining a modified version of MODFLOW-2000 and MT3DMS into a single computer program. The code was developed using the MODFLOW-2000 concept of a process, which is defined as ?part of the code that solves a fundamental equation by a specified numerical method.? SEAWAT-2000 contains all of the processes distributed with MODFLOW-2000 and also includes the Variable-Density Flow Process (as an alternative to the constant-density Ground-Water Flow Process) and the Integrated MT3DMS Transport Process. Processes may be active or inactive, depending on simulation objectives; however, not all processes are compatible. For example, the Sensitivity and Parameter Estimation Processes are not compatible with the Variable-Density Flow and Integrated MT3DMS Transport Processes. The SEAWAT-2000 computer code was tested with the common variable-density benchmark problems and also with problems representing evaporation from a salt lake and rotation of immiscible fluids.

  19. 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.

  20. Striving for balance - A qualitative study to explore the experiences of nurses new to the ambulance service in Sweden.

    Science.gov (United States)

    Hörberg, Anna; Lindström, Veronica; Kalén, Susanne; Scheja, Max; Vicente, Veronica

    2017-08-19

    New nurses and nurses new to a professional practice go through a transition where they adopt a new professional identity. This has been described as a challenging time where peer support and limited responsibility are considered necessary. Little is known about the experience of nurses being new to the ambulance service where support is limited and the nurse holds full responsibility of patient care. The aim of this study has therefore been to explore nurses' experiences during their first year of employment in the Swedish ambulance service. Data was generated from semi-structured interviews with 13 nurses having less than 12 months of experience of work in the ambulance service. The nurses represented nine different districts in Sweden. Analysis was a latent inductive qualitative content analysis. The analysis resulted in the main category, "Striving for balance during the transition process in the ambulance context". Transition in the ambulance service was experienced as a balance act between emotions, expectations and a strive for professional development. The balance was negatively affected by harsh, condescending attitudes among colleagues and the lack of structured support and feedback. In striving for balance in their new professional practice, the nurses described personal, unsupervised strategies for professional development. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study

    Science.gov (United States)

    2014-01-01

    Background Acute asthma is a common reason for patients to seek care from ambulance services. Although better care of acute asthma can prevent avoidable morbidity and deaths, there has been little research into ambulance clinicians’ adherence to national guidelines for asthma assessment and management and how this might be improved. Our research aim was to explore paramedics’ attitudes, perceptions and beliefs about prehospital management of asthma, to identify barriers and facilitators to guideline adherence. Methods We conducted three focus group interviews of paramedics in a regional UK ambulance trust. We used framework analysis supported by NVivo 8 to code and analyse the data. Results Seventeen participants, including paramedics, advanced paramedics or paramedic operational managers at three geographical sites, contributed to the interviews. Analysis led to five themes: (1) guidelines should be made more relevant to ambulance service care; (2) there were barriers to assessment; (3) the approach needed to address conflicts between clinicians’ and patients’ expectations; (4) the complexity of ambulance service processes and equipment needed to be taken into account; (5) and finally there were opportunities for improved prehospital education, information, communication, support and care pathways for asthma. Conclusions This qualitative study provides insight into paramedics’ perceptions of the assessment and management of asthma, including why paramedics may not always follow guidelines for assessment or management of asthma. These findings provide opportunities to strengthen clinical support, patient communication, information transfer between professionals and pathways for prehospital care of patients with asthma. PMID:25086749

  2. The association between the first locating emergency ambulance being single crewed and cardiac arrest outcomes in New Zealand.

    Science.gov (United States)

    Dicker, Bridget; Davey, Paul; Smith, Tony

    2017-09-01

    This study investigated the association between the first locating emergency ambulance being single crewed on outcomes following out-of-hospital cardiac arrest in New Zealand. Using data from the St John cardiac arrest registry for the period of 1 October 2013 to 30 June 2015, cases were included if a resuscitation attempt was made and the patient was an adult. Logistic regression modelling was used to account for confounding factors. The primary outcome was survival to hospital discharge. A total of 2,347 cases were included. There was no difference in the rate of return of spontaneous circulation sustained to hospital handover in patients attended by either single-crewed (27%) or double-crewed ambulances (32%); p=0.059. However, patients were significantly less likely to survive to hospital discharge when attended by single-crewed (12%) compared to double-crewed ambulances (17%) with an OR of 0.533, 95% confidence interval 0.320-0.888 and p=0.016. Patients had lower survival to hospital discharge outcomes when the first locating ambulance was single crewed than those where the first locating ambulance was double crewed.

  3. MODFLOW-2000, the U.S. Geological Survey modular ground-water model : user guide to the LMT6 package, the linkage with MT3DMS for multi-species mass transport modeling

    Science.gov (United States)

    Zheng, Chunmiao; Hill, Mary Catherine; Hsieh, Paul A.

    2001-01-01

    MODFLOW-2000, the newest version of MODFLOW, is a computer program that numerically solves the three-dimensional ground-water flow equation for a porous medium using a finite-difference method. MT3DMS, the successor to MT3D, is a computer program for modeling multi-species solute transport in three-dimensional ground-water systems using multiple solution techniques, including the finite-difference method, the method of characteristics (MOC), and the total-variation-diminishing (TVD) method. This report documents a new version of the Link-MT3DMS Package, which enables MODFLOW-2000 to produce the information needed by MT3DMS, and also discusses new visualization software for MT3DMS. Unlike the Link-MT3D Packages that coordinated previous versions of MODFLOW and MT3D, the new Link-MT3DMS Package requires an input file that, among other things, provides enhanced support for additional MODFLOW sink/source packages and allows list-directed (free) format for the flow model produced flow-transport link file. The report contains four parts: (a) documentation of the Link-MT3DMS Package Version 6 for MODFLOW-2000; (b) discussion of several issues related to simulation setup and input data preparation for running MT3DMS with MODFLOW-2000; (c) description of two test example problems, with comparison to results obtained using another MODFLOW-based transport program; and (d) overview of post-simulation visualization and animation using the U.S. Geological Survey?s Model Viewer.

  4. Transport and fate of nitrate in a glacial outwash aquifer in relation to ground water age, land use practices, and redox processes

    Science.gov (United States)

    Puckett, L.J.; Cowdery, T.K.

    2002-01-01

    A combination of ground water modeling, chemical and dissolved gas analyses, and chlorofluorocarbon age dating of water was used to determine the relation between changes in agricultural practices, and NO3- concentrations in ground water of a glacial outwash aquifer in west-central Minnesota. The results revealed a redox zonation throughout the saturated zone with oxygen reduction occurring near the water table, NO3- reduction immediately below it, and then a large zone of ferric iron reduction, with a small area of sulfate (SO42-) reduction and methanogenesis (CH4) near the end of the transect. Analytical and NETPATH modeling results supported the hypothesis that organic carbon served as the electron donor for the redox reactions. Denitrification rates were quite small, 0.005 to 0.047 mmol NO3- yr-1, and were limited by the small amounts of organic carbon, 0.01 to 1.45%. In spite of the organic carbon limitation, denitrification was virtually complete because residence time is sufficient to allow even slow processes to reach completion. Ground water sample ages showed that maximum residence times were on the order of 50 to 70 yr. Reconstructed NO3- concentrations, estimated from measured NO3- and dissolved N gas showed that NO3- concentrations have been increasing in the aquifer since the 1940s, and have been above the 714 ??mol L-1 maximum contaminant level at most sites since the mid- to late-1960s. This increase in NO3- has been accompanied by a corresponding increase in agricultural use of fertilizer, identified as the major source of NO3- to the aquifer.

  5. 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.

  6. Prehospital Trauma Life Support (PHTLS) training of ambulance caregivers and impact on survival of trauma victims.

    Science.gov (United States)

    Johansson, Jakob; Blomberg, Hans; Svennblad, Bodil; Wernroth, Lisa; Melhus, Håkan; Byberg, Liisa; Michaëlsson, Karl; Karlsten, Rolf; Gedeborg, Rolf

    2012-10-01

    The Prehospital Trauma Life Support (PHTLS) course has been widely implemented and approximately half a million prehospital caregivers in over 50 countries have taken this course. Still, the effect on injury outcome remains to be established. The objective of this study was to investigate the association between PHTLS training of ambulance crew members and the mortality in trauma patients. A population-based observational study of 2830 injured patients, who either died or were hospitalized for more than 24 h, was performed during gradual implementation of PHTLS in Uppsala County in Sweden between 1998 and 2004. Prehospital patient records were linked to hospital-discharge records, cause-of-death records, and information on PHTLS training and the educational level of ambulance crews. The main outcome measure was death, on scene or in hospital. Adjusting for multiple potential confounders, PHTLS training appeared to be associated with a reduction in mortality, but the precision of this estimate was poor (odds ratio, 0.71; 95% confidence interval, 0.42-1.19). The mortality risk was 4.7% (36/763) without PHTLS training and 4.5% (94/2067) with PHTLS training. The predicted absolute risk reduction is estimated to correspond to 0.5 lives saved annually per 100,000 population with PHTLS fully implemented. PHTLS training of ambulance crew members may be associated with reduced mortality in trauma patients, but the precision in this estimate was low due to the overall low mortality. While there may be a relative risk reduction, the predicted absolute risk reduction in this population was low. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  7. Ambulance diversion reduction and elimination: the 3-2-1 plan.

    Science.gov (United States)

    Patel, Pankaj B; Vinson, David R

    2012-11-01

    The diversion of ambulances from their intended emergency departments (EDs) occurs frequently, compromising patient care. Previously, we reduced ambulance diversion (AD) by 74% in a large urban area with 17 EDs. In this follow-up program, we sought to further reduce and eliminate AD by progressively reducing the duration of each AD event. Using tight diversion criteria, AD at each ED was limited by protocol to 3h at a stretch, after which incoming ambulances had to be accepted at that ED for at least 1h. After 6 months, AD was limited to 2h per diversion event; after another 6 months, AD was limited to 1h. The monitoring for AD was programmed into a region-wide, Internet-based Emergency Medical Services (EMS) program. Total annual AD decreased from 8469 h in 2006 (pre-implementation) to 4592 h in 2007 (during implementation), and finally to 2439 h and 2306 h in 2008 and 2009 (post-implementation), respectively, an 87.4% (95% confidence interval 64.6-95.5%) reduction, and one county within the region eliminated AD altogether. From 2006 to 2009, overall increases were noted in EMS arrivals (7.8%), ED census (13.0%), hospital admissions (6.6%), Intensive Care Unit admissions (17.1%), and overall Sacramento population (1.9%). By limiting the duration of AD events to progressively shorter periods of time using a region-wide, Internet-based EMS program, we reduced AD hours in 17 EDs by 87.4% and eliminated AD in one entire county. This original, collaborative 3-2-1 Plan may be readily reproduced across the country to progressively reduce and eliminate AD. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. 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.

    2016-01-01

    Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment. PMID:27340808

  9. Effects of weather conditions on emergency ambulance calls for acute coronary syndromes

    Science.gov (United States)

    Vencloviene, Jone; Babarskiene, Ruta; Dobozinskas, Paulius; Siurkaite, Viktorija

    2015-08-01

    The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature ( T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October-April) and warm (May-September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June-September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACS.

  10. 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.

  11. Appraisal of work ability in relation to job-specific health requirements in ambulance workers.

    Science.gov (United States)

    van Schaaijk, A; Boschman, J S; Frings-Dresen, M H W; Sluiter, J K

    2017-01-01

    To gain insight into which job-specific health requirements relate to work ability, the following two research questions were formulated: Which job-specific health requirements are associated with the appraisal of work ability in ambulance drivers and paramedics? How are appraisals of physical and mental work ability associated with the appraisal of overall work ability in ambulance drivers and paramedics? Workers Health Surveillance cross-sectional data of 506 ambulance workers (236 drivers and 270 paramedics) were used. The tests for specific job requirements were divided into six categories. Work ability was appraised as overall, physical and mental/emotional. Multiple linear stepwise regression analyses were used to model the associations. Outcomes in 'raised alertness and judgment ability' (R (2) = 0.09), 'job-specific physical abilities' (R (2) = 0.10) and 'emotional peak load' (R (2) = 0.07) significantly explained appraised overall, physical and mental/emotional work ability. Physical and mental/emotional work ability together explained 48.3% of the variance of overall work ability. The explained variance by physical and mental/emotional work ability was almost 4% higher in drivers than in paramedics. Overall work ability was significantly explained by outcomes in 'raised alertness and judgment ability' and 'emotional peak load.' Physical work ability was significantly explained by 'job-specific physical abilities' and 'raised alertness and judgment ability' outcomes, while 'emotional peak load' and 'raised alertness and judgment ability' outcomes significantly explained mental/emotional work ability. Physical and mental/emotional work ability explains the same proportion of variance in overall work ability.

  12. Trends in cannabis-related ambulance presentations from 2000 to 2013 in Melbourne, Australia.

    Science.gov (United States)

    Kaar, Stephen J; Gao, Caroline X; Lloyd, Belinda; Smith, Karen; Lubman, Dan I

    2015-10-01

    The current burden of cannabis-related presentations to emergency health services is largely unknown. This paper presents data collected over a 13-year period in metropolitan Melbourne, Australia as part of the Ambo Project, a unique surveillance system that analyses and codes paramedic records for drug-related trends and harms. Cannabis-related ambulance attendances involving 15-59 year olds in metropolitan Melbourne were analysed retrospectively from 2000 to 2013 (n=10,531). Trends and attendance characteristics were compared among cannabis only (CO)-, cannabis and alcohol (CA)- and cannabis with polydrug use (CP)-related attendances. Changes in alcohol and drug involvements in cannabis-related attendances were explored. Rates of cannabis-related ambulance attendances increased significantly over the study period. Increasing rate of attendances per 100,000 population per year changed from 0.6 (2000-2010) to 5.5 (2010-2013). This sharp change was driven by CO- and CP-related attendances (rate of CA-related attendance increased steadily). The highest increasing rate (15.6) was for CO-related attendances among 15-29 years old males (2010-2013). Crystal methamphetamine became the most common illicit co-intoxicant amongst cannabis presentations in 2013. Relative to the total drug-related burden on ambulance services, cannabis-related presentations appear to be a small but significant and increasing problem. Significant changes in trends across other drug involvement and demographic subgroups suggest a possible shift in the cannabis using population and/or a change in using behaviours. Public health strategies should raise awareness of the increased risk posed by cannabis polydrug use and high attendance subpopulations should be determined. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. 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.

  14. Prosthetic fitting and ambulation in a paraplegic patient with an above-knee amputation.

    Science.gov (United States)

    Herman, T; David, Y; Ohry, A

    1995-03-01

    The combination of paraplegia with an above-knee amputation is a complex injury that makes the rehabilitation process difficult. This article describes a case of T12 paraplegia and an above-knee amputation. After the rehabilitation course, the patient achieved full ambulatory independence with an ischial containment, contoured adducted trochanteric controlled alignment method (CATCAM) prosthesis and a knee ankle foot orthosis (KAFO). Difficulties in fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed.

  15. 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

  16. An improved video median noise reduction algorithm for ambulance vehicle terminal monitoring system

    Science.gov (United States)

    Ma, Xian-Min; Zhang, Hang

    2012-04-01

    An improved video median noise reduction algorithm is presented for 120 vehicle terminal monitoring system in this paper. The noise causes of the video images in many 120 ambulance vehicle video terminal monitor equipments are analyzed, and the space rigid body model of self-adaptive median noise reduction filter is established to decrease the noises of the video image transmission process. The noise reduction experiment of video images shows that the proposed video median noise reduction algorithm is superior to the traditional adaptive filtering method, because the new method has the superiority of space-time joint noise reduction.

  17. Ground Wars

    DEFF Research Database (Denmark)

    Nielsen, Rasmus Kleis

    Political campaigns today are won or lost in the so-called ground war--the strategic deployment of teams of staffers, volunteers, and paid part-timers who work the phones and canvass block by block, house by house, voter by voter. Ground Wars provides an in-depth ethnographic portrait of two...... infrastructures that utilize large databases with detailed individual-level information for targeting voters, and armies of dedicated volunteers and paid part-timers. Nielsen challenges the notion that political communication in America must be tightly scripted, controlled, and conducted by a select coterie...... of professionals. Yet he also quashes the romantic idea that canvassing is a purer form of grassroots politics. In today's political ground wars, Nielsen demonstrates, even the most ordinary-seeming volunteer knocking at your door is backed up by high-tech targeting technologies and party expertise. Ground Wars...

  18. 49 CFR 236.107 - Ground tests.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Ground tests. 236.107 Section 236.107...: All Systems Inspections and Tests; All Systems § 236.107 Ground tests. (a) Except as provided in paragraph (b) of this section, a test for grounds on each energy bus furnishing power to circuits,...

  19. 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.

  20. Ambulance Handbook

    Science.gov (United States)

    1976-01-01

    Johnson Space Center has devised a checklist for the skylab inflight medical support system that has been transferred for public emergencies. The checklist illustrates a procedure for diagnosis, treatment, and stabilization of a wide variety of emergencies. Handbook presents comprehensive ordered description of emergency medical equipment and its use in treating victims. Paramedics assigned to the Houston Fire Department are now using the checklist.

  1. Paraplegia and transtibial amputation: successful ambulation after dual disability: a retrospective case report.

    Science.gov (United States)

    Senthilvelkumar, Thangavelu; Chandy, Bobeena R

    2017-01-01

    This is a single-subject case report. The objective is to describe the unique rehabilitation outcome of an individual with motor complete T12 paraplegia and a right transtibial amputation. This study was conducted at the Department of Physical Medicine and Rehabilitation of Christian Medical College in India. A 42-year-old policeman presented to our rehabilitation centre with motor complete T12 paraplegia and right transtibial amputation, 3 months following a road traffic accident. As the patient's goal was to walk, he was given a trial of independent ambulation with a customized prosthesis on the right side and a regular knee ankle foot orthosis (KAFO) on the left side. At the end of 12 weeks of rehabilitation, the patient was able to walk independently with the prosthesis/orthosis and bilateral elbow crutches. His Walking Index for Spinal Cord Injury (WISCI) score improved from 0/20 to 12/20 points. The scope of functional ambulation should not get restricted for a person with low thoracic spinal cord injury even when there is concurrent transtibial amputation.

  2. 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.

  3. 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.)

  4. [An approach to ambulant cancer chemotherapy by the pharmaceutical department system].

    Science.gov (United States)

    Atsumi, Sachie; Iwasa, Masahiro; Konomi, Ginko; Watanabe, Masayuki

    2007-12-01

    In recent years, cancer chemotherapy has been switching from hospital treatment to ambulant treatment. In such a situation, pharmacists are required to carry out their work unfailingly and smoothly in checking chemotherapy regimens, admixtures of drugs and providing information, for example. At Tokai University Hachioji Hospital, we have been trying to computerize a regimen-check, quantitative calculations for admixtures of anticancer drugs and the comment-input function of the pharmaceutical department so that our work will be more efficient and precise. The regimen-check system receives automatically, the patients' own data and the information of injection prescriptions and of the clinical laboratory from the Hospital Information System. Then pharmacists put the information to the regimen master file for recording in order to manage dosages, the accumulated dose and dose schedule. Also by registering the amount of dissolution of each anticancer drug beforehand, the quantitative calculation system makes it possible to automatically convert dosages on electronic medical charts to a liquid measure needed for the admixtures of drugs and to print the information on the prescription of injections. Additionally, the comment-input function makes it possible to print information on injections such as chemical information needed for regimen-checks and doctors' answers to questions about prescriptions. The pharmaceutical department system enables pharmacists to check regimens accurately and quickly to calculate the precise quantity for admixtures of drugs and to share information among pharmacists. The system has also contributed to the efficiency and medical safety of the ambulant cancer chemotherapy.

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. Ambulance response time and emergency medical dispatcher program: a study in Kelantan, Malaysia.

    Science.gov (United States)

    Shah, C H Mohd Shaharudin; Ismail, I Mohd; Mohsin, S S J Syed

    2008-11-01

    This study provided data by a simple method of acquiring information related to ambulance response time (ART) and determined whether it met the international standards of ART. Additionally, this paper also compared the duration of ART at this hospital before and after the implementation of an Emergency Medical Dispatcher (EMD) program. The ART, which started when details like phone number of the caller, exact location of the incident and the nature of the main complaint were received and ended when the emergency team arrived at the scene of the incident. The parameters recorded include call processing time, time taken to prepare the team and time taken to travel to the scene. The results of the study revealed that the ART for the university hospital (HUSM) was at 913.2 +/- 276.5 seconds (mean +/- SD) and it was far below the international standard of ART as a benchmark of a good ambulance service. However, the study suggested that the EMD program that was recently implemented at the HUSM gave a significantly improvement to the ART score.

  10. Development and Pilot Testing of 24/7 In-Ambulance Telemedicine for Acute Stroke : Prehospital Stroke Study at the Universitair Ziekenhuis Brussel-Project

    NARCIS (Netherlands)

    Espinoza, Alexis Valenzuela; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Tellez, Helio Fernandez; Dupont, Alain; Putman, Koen; Brouns, Raf

    2016-01-01

    Background: In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study

  11. 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. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. A Survey on the Choice of Transportation to come to Emergency Department among Patients with Acute Coronary Syndrome of A Community in Malaysia.

    Science.gov (United States)

    Chew, K S; Wan Masliza, W M A; Nik Hisamuddin, N A R; Mohd Hashairi, F; Shaik Farid, A W; Tuan Hairulnizam, T K; Zikri, A M; Zurkurnai, Y

    2015-02-01

    Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain. This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices. This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012. Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (peducation as well as past history of ischemic heart disease did not significantly influence the patients' choice of transportation. The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultural and logistic factors may need to be addressed.

  13. 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

  14. 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

  15. 可调地隙采摘式菠萝运输车底盘的设计与研究%Design and Research of Chassis of Pineapple Transporter with Plucking and Adjustable Ground Clearance

    Institute of Scientific and Technical Information of China (English)

    吴伟斌; 冯运琳; 罗阔; 詹潇智; 曾伟鹏; 廖劲威; 卢迪豪; 黄涛; 洪添胜

    2016-01-01

    At present, the harvest and transportation of pineapple in China are mainly depengding on artificial labor, which lacks mechanization, leading to the low production efficiency and the high labor cost.In order to promote the de-velopment of Chinese pineapple industry, realize the mechanization of the pineapple planting industry, improve the effi-ciency of pineapple transportation as well as reduce the orchardist ' s laboring intensity, our team designed a type of pine-apple transporter with plucking and adjustable to gap.Based on the field investigation data, we designed a kind of new frame and new carriage structure to make the transporter meet the need of pineapple planting industry.With SolidWorks 3 d modeling and motion simulation, using SolidWorks Simulation software to study the car beam, frame and lifting mech-anism by finite element stress method,we check the rationality of the design and optimize organization structure of the de-sign.The pivotal technology is using hydraulic scissor lift structure to meet the need of adjustable ground clearance of pin -eapple transporter, and using gasoline-electric hybrid provides driving force in order to simplify the transmission and re-duce the fuel consumption.%目前,我国的菠萝的采收与运输主要以人工为主,缺乏机械化,生产效率低,人工成本较高.为此,研制了一款可调地隙采摘式菠萝运输车,并基于实地调研资料,设计了新式的车架与车厢结构,使运输车适应于菠萝种植业作业需求.采用SolidWorks进行三维建模,并进行运动仿真,利用SolidWorks Simulation软件对车横梁、车架、升降机构等进行有限元受力分析,校核设计机构的合理性,优化设计结构.本产品关键技术为采用了剪叉式液压升降结构,可满足离地间隙可调的性能要求,并采用汽油发电机混合动力提供行驶动力,简化了传动机构且降低了油耗.

  16. 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

  17. 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....

  18. Ambulance Attendant. D.O.T. No. 355.374-010. Individualized Study Guide [with Teachers' Packet]. First Edition.

    Science.gov (United States)

    East Texas State Univ., Commerce. Occupational Curriculum Lab.

    Developed for students in a cooperative training program in health occupations education, this study guide is designed for individualized study of competencies for ambulance attendants. It follows the general responsibilities outlined in the Dictionary of Occupational Titles. The occupational outlook and job description are first presented.…

  19. 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

  20. Simulation of solute transport of tetrachloroethylene in ground water of the glacial-drift aquifer at the Savage Municipal Well Superfund Site, Milford, New Hampshire, 1960-2000

    Science.gov (United States)

    Harte, Philip T.

    2004-01-01

    The Savage Municipal Well Superfund site, named after the former municipal water-supply well for the town of Milford, is underlain by a 0.5-square mile plume of volatile organic compounds (VOCs), primarily tetrachloroethylene (PCE). The plume occurs mostly within a highly transmissive sand-and-gravel unit, but also extends to an underlying till and bedrock unit. The plume logistically is divided into two areas termed Operable Unit No. 1 (OU1), which contains the primary source area, and Operable Unit No. 2 (OU2), which is the extended plume area. PCE concentrations in excess of 100,000 parts per billion (ppb) had been detected in the OU1 area in 1995, indicating a likely Dense Non-Aqueous Phase Liquid (DNAPL) source. In the fall of 1998, the New Hampshire Department of Environmental Services (NHDES) and the U.S. Environmental Protection Agency (USEPA) installed a remedial system in OU1. The OU1 remedial system includes a low-permeability barrier that encircles the highest detected concentrations of PCE, and a series of injection and extraction wells. The barrier primarily sits atop bedrock and penetrates the full thickness of the sand and gravel; and in some places, the full thickness of the underlying basal till. The sand and gravel unit and the till comprise the aquifer termed the Milford-Souhegan glacial-drift aquifer (MSGD). Two-dimensional and three-dimensional finite-difference solute-transport models of the unconsolidated sediments (MSGD aquifer) were constructed to help evaluate solute-transport processes, assess the effectiveness of remedial activities in OU1, and to help design remedial strategies in OU2. The solute-transport models simulate PCE concentrations, and model results were compared to observed concentrations of PCE. Simulations were grouped into the following three time periods: an historical calibration of the distribution of PCE from the initial input (circa 1960) of PCE into the subsurface to the 1990s, a pre-remedial calibration from 1995

  1. Features of the Transportation Capsules with the Ground by Means of the Inflatable Shell in the Suction Head of the SPACECRAFT "PhobosGrunt"

    Directory of Open Access Journals (Sweden)

    J. A. Petrov

    2016-01-01

    Full Text Available One of the most interesting trends of space research is a delivery of the soil samples of the investigated object to the Earth. In delivering the soil samples the most important stage is a stage to pick-and-place it in the transportation (returned capsule.The aim of this work is to develop a reloading device of the suction head to provide picking up the soil of Mars’ satellite “Phobos”. This device is designed for use as a part of the spacecraft "Phobos-Grunt".The presented device belongs to a manipulating type of devices and consists of a manipulator and a handling device. The manipulator provides picking up the Phobos surface soil samples and their placing into a capsule, which is in the block of the handling device. Upon the capsule has been filled it is reloaded from the soil intake area to the area of capsule transfer, which is provided by means of a compactly piled gas-filled shell.In operation there is a number of restrictions. The tolerable capsule opening size to take-in the soil samples can be up to 10 mm with 1003 cm free soil capsule volume. When picking up the soil the magnitude of the axial force of the manipulator is restricted.The paper considers the operating principle of the reloading device and describes the handling device design and method to calculate its characteristics. It also presents the designing results of the handling device and its basic characteristics. The issues of the suction head reliability are also discussed.There is the Russian Federation patent for the invention №2413660 of the developed device.

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

    Directory of Open Access Journals (Sweden)

    D Orwig

    2017-01-01

    Analysis: Analyses for all aims will be performed according to the intention-to-treat paradigm. Except for testing of the primary hypothesis, all statistical tests will be two-sided and not adjusted for multiple comparisons. The test of the primary hypothesis (comparing groups on the proportion who are community ambulators at 16 weeks after randomisation will be based on a one-sided 0.025-level hypothesis test using a procedure consisting of four interim analyses and one final analysis with critical values chosen by a Hwang-Shih-Decani alpha-spending function. Analyses will be performed to test group differences on other outcome measures and to examine the differential impac

  3. 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.

  4. 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.

  5. [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.

  6. 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.

  7. Evaluation of Bacterial Contamination on Pre Hospital Ambulances in Qom University of Medical Sciences of Iran in 2015

    Directory of Open Access Journals (Sweden)

    Roohollah Farhadloo

    2016-07-01

    Full Text Available Abstract Background & Aims of the Study: When the issue of the quality of the patient's care is addressed, determination of infection degrees in reference to the quality of such cares has gained a high priority. Therefore, infections in ambulance equipment might play a significant role in reduction of the quality of the hospital cares. This study was conducted wishing to determine bacterial infection degrees in ambulances servicing in pre-hospital emergency medical services of Qom University of Medical Sciences, Iran. Materials and Methods: In this analytical cross-sectional study, 132 sampling of the equipments of 12 ambulances were done. Samples were stored on BHI broth as an amplifier for 24 hours. Then, they were introduced to blood agar and Eosin Methylene Blue (EMB agar culture environments. After 24 hours, negative staphylococcus coagulase and bacillus were specified by different environments, solutions, diagnostic discs, gram staining, catalase test, oxidase test and coagulase test. Then data were analyzed by SPSS16. Results: The results showed that the highest infection prevalence rate was observed in stretchers (12 samples, 100% and the lowest in oxygenation moisturizers (1 sample, 8.4%. From infected equipments, in addition, four instruments (37% were mobile and eight of them (63% were immobile. Conclusion: Results indicated that an infection degree of the utensils and instruments which were used in ambulances employed servicing in the Qom Province Medical Emergency Response Center of Iran is high, that might have their roots in non-application of disinfectants for disinfecting ambulance surfaces and equipment. This is a mandatory for healthcare agents to utilize the protective covers, especially medical gloves.

  8. Why do patients with ‘primary care sensitive’ problems access ambulance services? A systematic mapping review of the literature

    Science.gov (United States)

    Booker, Matthew J; Shaw, Ali R G; Purdy, Sarah

    2015-01-01

    Objective Emergency ambulance use for problems that could be managed in primary care continues to rise owing to complex reasons that are poorly understood. The objective of this systematic review is to draw together published evidence across a variety of study methodologies and settings to gain a better understanding of why patients seek help from ambulance services for these problems. Design Systematic searches were undertaken across the MEDLINE, EMBASE, PsychINFO, CINAHL, Health Management Information Consortium and Health Management Information Service publication databases. Google Scholar, Web of Science, OpenSigle, EThOS and DART databases were also systematically searched for reports, proceedings, book chapters and theses, along with hand-searching of grey literature sources. Studies were included if they reported on findings examining patient, carer, health professional or service management interactions with ambulance services for primary care problems. All study methodologies and perspectives were of interest. Data were extracted, quality assessed and systematically mapped according to key findings through generation of an iterative framework. Results A total of 31 studies met inclusion criteria. Findings were summarised across 5 broad categories: factors associated with individual patients; actions of care-givers and bystanders; population-level factors; health infrastructure factors; challenges faced by health professionals. A number of subcategories were developed to explore these factors in more detail. Conclusions This review reports important factors that may impact on ambulance use for primary care problems across a global setting, including demographic measures associated with deprivation, minority status and individual social circumstances. Categorising ambulance calls for primary care problems as ‘inappropriate’ is context dependant and may be unhelpful. Potential implications for triage and risk management strategies are discussed. PMID

  9. Why do patients with 'primary care sensitive' problems access ambulance services? A systematic mapping review of the literature.

    Science.gov (United States)

    Booker, Matthew J; Shaw, Ali R G; Purdy, Sarah

    2015-05-19

    Emergency ambulance use for problems that could be managed in primary care continues to rise owing to complex reasons that are poorly understood. The objective of this systematic review is to draw together published evidence across a variety of study methodologies and settings to gain a better understanding of why patients seek help from ambulance services for these problems. Systematic searches were undertaken across the MEDLINE, EMBASE, PsychINFO, CINAHL, Health Management Information Consortium and Health Management Information Service publication databases. Google Scholar, Web of Science, OpenSigle, EThOS and DART databases were also systematically searched for reports, proceedings, book chapters and theses, along with hand-searching of grey literature sources. Studies were included if they reported on findings examining patient, carer, health professional or service management interactions with ambulance services for primary care problems. All study methodologies and perspectives were of interest. Data were extracted, quality assessed and systematically mapped according to key findings through generation of an iterative framework. A total of 31 studies met inclusion criteria. Findings were summarised across 5 broad categories: factors associated with individual patients; actions of care-givers and bystanders; population-level factors; health infrastructure factors; challenges faced by health professionals. A number of subcategories were developed to explore these factors in more detail. This review reports important factors that may impact on ambulance use for primary care problems across a global setting, including demographic measures associated with deprivation, minority status and individual social circumstances. Categorising ambulance calls for primary care problems as 'inappropriate' is context dependant and may be unhelpful. Potential implications for triage and risk management strategies are discussed. Published by the BMJ Publishing Group Limited. For

  10. [Índice de Saturación Modificado y Ambulancias (ISMA): Ambulance assignment and remote Emergency Room Bed Reservation].

    Science.gov (United States)

    Polanco-González, Carlos; Castañón-González, Jorge Alberto; Villanueva-Martínez, Sebastián; Samaniego-Mendoza, José Lino; Buhse, Thomas

    2015-01-01

    In most places all over the world–including our country–services in emergency rooms are oversaturated. This situation frequently forces the continuously arriving ambulances to be redirected to other medical units, delaying the admission of patients moved and thus adversely affecting their physical condition. To introduce an improvement to the Índicede Saturación Modificado computational system, which monitors the degree of saturation of a network of emergency medical services, to include a network of ambulances, enabling in the system: (i) the effective allocation of ambulances to the site of the accident, or severe clinical event, and (ii) the remote booking of beds in the nearest and least saturated emergency room available. The evaluation and connectivity of the computational improvement to the Índicede Saturación Modificado system was carried out with a computational test verifying these two aspects, using only differences in postal codes, for time measuring. The verification of its sustainability online showed the new Índice de Saturación Modificado y Ambulancias system (ISMA) has a robust structure capable of being adapted to mobile phones, laptops or tablets, and can efficiently administrate: (i) the quantification of excessive demand in the emergency room services of a hospital network, (ii) the allocation of ambulances attending the site of the event or contingency, and (iii) the allocation of ambulances and patients, in the best distance-time conditions, from the site of the accident or clinical event to the nearest and least saturated emergency room service. This administrative management tool is efficient and simple to use, and it optimally relates independent service networks.

  11. A Survey of the Competency of Ambulance Service Personnel in the Diagnosis and Management of Sepsis.

    Science.gov (United States)

    Shime, Nobuaki

    2015-08-01

    Few studies have evaluated the current status of knowledge of sepsis in ambulance service personnel. Our aim was to ascertain the levels of competency and proficiency of ambulance service personnel in the diagnosis and management of severe sepsis. A questionnaire was submitted to a sample of 208 participants in a professional ambulance service conference, and was recovered on site. The study probed eight areas of sepsis diagnosis and management based on modifications of a questionnaire used in a previous study. The term sepsis in Japanese, Haiketsushou, was familiar to 99% of Japanese certified emergency life-saving technicians (ELST) (Group I) and to 92% of noncertified ambulance service personnel (Group II), although 15% of participants in Group I and 44% in Group II ignored the meaning of sepsis. The definition of sepsis as "body's response to infection," "blood poisoning," or "shock due to bacteria in blood" were selected by 17%, 16%, and 37%, respectively, in Group I, and 4%, 6%, and 22%, respectively, in Group II. The mortality associated with sepsis was underestimated by 57% in Group I and 78% in Group II. Vital signs raising a suspicion for sepsis and their pertinent ranges were correctly chosen by only 50% of certified ELST. Hypothermia was prominently undervalued as a sign raising the suspicion of sepsis. Insufficient knowledge and perception for sepsis in Japanese ambulance services is revealed. A higher level of onsite or formal postgraduate education needs to be provided with a view to improve the prehospital management of sepsis. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. 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.

  13. 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

  14. 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.

  15. 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 t