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Sample records for prehospital emergency medical

  1. The Danish quality database for prehospital emergency medical services

    DEFF Research Database (Denmark)

    Frischknecht Christensen, Erika; Berlac, Peter Anthony; Nielsen, Henrik;

    2016-01-01

    AIM OF DATABASE: The aim of the Danish quality database for prehospital emergency medical services (QEMS) is to assess, monitor, and improve the quality of prehospital emergency medical service care in the entire prehospital patient pathway. The aim of this review is to describe the design......: Descriptive data included age, region, and Danish Index for Emergency Care including urgency level. CONCLUSION: QEMS is a new database under establishment and is expected to provide the basis for quality improvement in the prehospital setting and in the entire patient care pathway, for example, by providing...

  2. Prehospital emergency medical services in Malaysia.

    Science.gov (United States)

    Hisamuddin, N A R Nik; Hamzah, M Shah; Holliman, C James

    2007-05-01

    Once a very slowly developing country in a Southeast Asia region, Malaysia has undergone considerable change over the last 20 years after the government changed its focus from agriculture to developing more industry and technology. The well-known "Vision 2020," introduced by the late Prime Minister, set a target for the nation to be a developed country in the Asia region by the year 2020. As the economy and standard of living have improved, the demand from the public for a better health care system, in particular, emergency medical services (EMS), has increased. Despite the effort by the government to improve the health care system in Malaysia, EMS within the country are currently limited, best described as being in the "developing" phase. The Ministry of Health, Ministry of Education, Civil Defense, and non-governmental organizations such as Red Crescent and St. John's Ambulance, provide the current ambulance services. At the present time, there are no uniform medical control or treatment protocols, communication systems, system management, training or education, or quality assurance policies. However, the recent development of and interest in an Emergency Medicine training program has gradually led to improved EMS and prehospital care.

  3. Emergency Physician Awareness of Prehospital Procedures and Medications

    Directory of Open Access Journals (Sweden)

    Rachel Waldron

    2014-07-01

    Full Text Available Introduction: Maintaining patient safety during transition from prehospital to emergency department (ED care depends on effective handoff communication between providers. We sought to determine emergency physicians’ (EP knowledge of the care provided by paramedics in terms of both procedures and medications, and whether the use of a verbal report improved physician accuracy. Methods: We conducted a 2-phase observational survey of a convenience sample of EPs in an urban, academic ED. In this large ED paramedics have no direct contact with physicians for non-critical patients, giving their report instead to the triage nurse. In Phase 1, paramedics gave verbal report to the triage nurse only. In Phase 2, a research assistant (RA stationed in triage listened to this report and then repeated it back verbatim to the EPs caring for the patient. The RA then queried the EPs 90 minutes later regarding their patients’ prehospital procedures and medications. We compared the accuracy of these 2 reporting methods. Results: There were 163 surveys completed in Phase 1 and 116 in Phase 2. The oral report had no effect on EP awareness that the patient had been brought in by ambulance (86% in Phase 1 and 85% in Phase 2. The oral report did improve EP awareness of prehospital procedures, from 16% in Phase 1 to 45% in Phase 2, OR=4.28 (2.5-7.5. EPs were able to correctly identify all oral medications in 18% of Phase 1 cases and 47% of Phase 2 cases, and all IV medications in 42% of Phase 1 cases and 50% of Phase 2 cases. The verbal report led to a mild improvement in physician awareness of oral medications given, OR=4.0 (1.09-14.5, and no improvement in physician awareness of IV medications given, OR=1.33 (0.15-11.35. Using a composite score of procedures plus oral plus IV medications, physicians had all three categories correct in 15% of Phase 1 and 39% of Phase 2 cases (p<0.0001. Conclusion: EPs in our ED were unaware of many prehospital procedures and

  4. Prehospital intraosseus access with the bone injection gun by a helicopter-transported emergency medical team.

    NARCIS (Netherlands)

    Gerritse, B.M.; Scheffer, G.J.; Draaisma, J.M.T.

    2009-01-01

    BACKGROUND: To evaluate the use of the bone injection gun to obtain vascular access in the prehospital setting by an Helicopter-Transported Emergency Medical Team. METHODS: Prospective descriptive study to assess the frequency and success rate of the use of the bone injection gun in prehospital care

  5. Pre-hospital emergency medicine.

    Science.gov (United States)

    Wilson, Mark H; Habig, Karel; Wright, Christopher; Hughes, Amy; Davies, Gareth; Imray, Chirstopher H E

    2015-12-19

    Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care.

  6. Effects of physician-based emergency medical service dispatch in severe traumatic brain injury on prehospital run time

    NARCIS (Netherlands)

    Franschman, G.; Verburg, N.; Brens-Heldens, V.; Andriessen, T. M. J. C.; Van der Naalt, J.; Peerdeman, S. M.; Hoogerwerf, N.; Greuters, S.; Schober, P.; Vos, P. E.; Christiaans, H. M. T.; Boer, C.; Valk, J.P.

    2012-01-01

    Introduction: Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch o

  7. Effects of physician-based emergency medical service dispatch in severe traumatic brain injury on prehospital run time

    NARCIS (Netherlands)

    Franschman, G.; Verburg, N.; Brens-Heldens, V.; Andriessen, T.M.J.C.; Naalt, J. van der; Peerdeman, S.M.; Valk, J.P.M. van der; Hoogerwerf, N.; Greuters, S.; Schober, P.; Vos, P.E.; Christiaans, H.M.; Boer, C.

    2012-01-01

    INTRODUCTION: Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch o

  8. Emergency Medical Services Capacity for Prehospital Stroke Care

    Centers for Disease Control (CDC) Podcasts

    2013-09-05

    In this audio podcast, lead author and Preventing Chronic Disease’s 2013 Student Research Contest Winner, Mehul D. Patel, talks about his article on stroke care and emergency medical services.  Created: 9/5/2013 by Preventing Chronic Disease (PCD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 9/5/2013.

  9. Maximizing resource efficiency in rural prehospital emergency medical services through call frequency analysis

    OpenAIRE

    Flynn, Andrew

    2013-01-01

    Rural prehospital emergency medical services are often lacking when compared with their urban counterparts in terms of resources and coordinated resource use: can only employ important resources, such as paramedics, during limited shifts. This project demonstrates a method for determining the most effective use of these limited resources in a rural Red Cross ambulance service in Guápiles, Costa Rica. In this community, paramedic services are only available six days a week for twelve hours. Em...

  10. Prehospital Lactate Measurement by Emergency Medical Services in Patients Meeting Sepsis Criteria

    Directory of Open Access Journals (Sweden)

    Lori L. Boland

    2016-09-01

    Full Text Available Introduction: We aimed to pilot test the delivery of sepsis education to emergency medical services (EMS providers and the feasibility of equipping them with temporal artery thermometers (TATs and handheld lactate meters to aid in the prehospital recognition of sepsis. Methods: This study used a convenience sample of prehospital patients meeting established criteria for sepsis. Paramedics received education on systemic inflammatory response syndrome (SIRS criteria, were trained in the use of TATs and hand-held lactate meters, and enrolled patients who had a recent history of infection, met ≥ 2 SIRS criteria, and were being transported to a participating hospital. Blood lactate was measured by paramedics in the prehospital setting and again in the emergency department (ED via usual care. Paramedics entered data using an online database accessible at the point of care. Results: Prehospital lactate values obtained by paramedics ranged from 0.8 to 9.8 mmol/L, and an elevated lactate (i.e. ≥ 4.0 was documented in 13 of 112 enrolled patients (12%. The unadjusted correlation of prehospital and ED lactate values was 0.57 (p< 0.001. The median interval between paramedic assessment of blood lactate and the electronic posting of the ED-measured lactate value in the hospital record was 111 minutes. Overall, 91 patients (81% were hospitalized after ED evaluation, 27 (24% were ultimately diagnosed with sepsis, and 3 (3% died during hospitalization. Subjects with elevated prehospital lactate were somewhat more likely to have been admitted to the intensive care unit (23% vs 15% and to have been diagnosed with sepsis (38% vs 22% than those with normal lactate levels, but these differences were not statistically significant. Conclusion: In this pilot, EMS use of a combination of objective SIRS criteria, subjective assessment of infection, and blood lactate measurements did not achieve a level of diagnostic accuracy for sepsis that would warrant hospital

  11. Where there are no emergency medical services-prehospital care for the injured in Mumbai, India.

    Science.gov (United States)

    Roy, Nobhojit; Murlidhar, V; Chowdhury, Ritam; Patil, Sandeep B; Supe, Priyanka A; Vaishnav, Poonam D; Vatkar, Arvind

    2010-01-01

    In a populous city like Mumbai, which lacks an organized prehospital emergency medical services (EMS) system, there exists an informal network through which victims arrive at the trauma center. This baseline study describes the prehospital care and transportation that currently is available in Mumbai. A prospective trauma database was created by interviewing 170 randomly selected patients from a total of 454 admitted over a two-month period (July-August 2005) at a Level-I, urban, trauma center. The injured victim in Mumbai usually is rescued by a good Samaritan passer-by (43.5%) and contrary to popular belief, helped by the police (89.7%). Almost immediately after rescue, the victim begins transport to the hospital. No one waits for the EMS ambulance to arrive, as there is none. A taxi cab is the most popular substitute for the ambulance (39.3%). The trauma patient in India usually is a young man in his late-twenties, from a lower socioeconomic class. He mostly finds himself in a government hospital, as private hospitals are reluctant to provide trauma care to the seriously injured. The injured who do receive prehospital care receive inadequate and inappropriate care due to the high cost of consumables in resuscitation, and in part due to the providers' lack of training in emergency care. Those who were more likely to receive prehospital care suffered from road traffic injuries (odds ratio (OR) = 2.3) and those transported by government ambulances (OR = 10.83), as compared to railway accident victims (OR = 0 .41) and those who came by taxi (OR = 0.54). Currently, as a result of not having an EMS system, prehospital care is a citizen responsibility using societal networks. It is easy to eliminate this system and shift the responsibility to the state. The moot point is whether the state-funded EMS system will be robust enough in a resource-poor setting in which public hospitals are poorly funded. Considering the high funding cost of EMS systems in developed countries

  12. Some Ethical Issues in Prehospital Emergency Medicine.

    Science.gov (United States)

    Erbay, Hasan

    2014-12-01

    Prehospital emergency medical care has many challenges including unpredictable patient profiles, emergency conditions, and administration of care in a non-medical area. Many conflicts occur in a prehospital setting that require ethical decisions to be made. An overview of the some of ethical issues in prehospital emergency care settings is given in this article. Ethical aspects of prehospital emergency medicine are classified into four groups: the process before medical interventions, including justice, stigmatization, dangerous situations, and safe driving; the treatment process, including triage, refusal of treatment or transport, and informed consent; the end of life and care, including life-sustaining treatments, prehospital cardiopulmonary resuscitation (CPR), withholding or withdrawal of CPR, and family presence during resuscitation; and some ambulance perception issues, including ambulance misuse, care of minors, and telling of bad news. Prehospital emergency medicine is quite different from emergency medicine in hospitals, and all patients and situations are unique. Consequently, there are no quick formulas for the right action and emotion. It is important to recognize the ethical conflicts that occur in prehospital emergency medicine and then act to provide the appropriate care that is of optimal value.

  13. Does the Norwegian emergency medical dispatch classification as non-urgent predict no need for pre-hospital medical treatment? An observational study.

    Science.gov (United States)

    Grusd, Eystein; Kramer-Johansen, Jo

    2016-05-06

    The number of ambulance call-outs in Norway is increasing owing to societal changes and increased demand from the public. Together with improved but more expensive education of ambulance staff, this leads to increased costs and staffing shortages. We wanted to study whether the current dispatch triage tools could reliably identify patients who only required transport, and not pre-hospital medical care. This could allow selection of such patients for designated transport units, freeing up highly trained ambulance staff to attend patients in greater need. A cross-sectional observational study was used, drawing on all electronic and paper records in our ambulance service from four random days in 2012. The patients were classified into acuity groups, based on Emergency Medical Dispatch codes, and pre-hospital interventions were extracted from the Patient Report Forms. Of the 1489 ambulance call-outs included in this study, 82 PRFs (5 %) were missing. A highly significant association was found between acuity group and recorded pre-hospital intervention (p ≤ 0.001). We found no correlation between gender, distance to hospital, age and pre-hospital interventions. Ambulances staffed by paramedics performed more interventions (234/917, 26 %) than those with emergency medical technicians (42/282, 15 %). The strongest predictor for needing pre-hospital interventions was found to be the emergency medical dispatch acuity descriptor. This study has demonstrated that the Norwegian dispatch system is able to correctly identify patients who do not need pre-hospital interventions. Patients with a low acuity code had a very low level of pre-hospital interventions. Evaluation of adherence to protocol in the Emergency Medical Dispatch is not possible due to the inherent need for medical experience in the triage process. This study validates the Norwegian dispatch tool (Norwegian index) as a predictor of patients who do not need pre-hospital interventions.

  14. Defining Components of Team Leadership and Membership in Prehospital Emergency Medical Services.

    Science.gov (United States)

    Crowe, Remle P; Wagoner, Robert L; Rodriguez, Severo A; Bentley, Melissa A; Page, David

    2017-01-01

    Teamwork is critical for patient and provider safety in high-stakes environments, including the setting of prehospital emergency medical services (EMS). We sought to describe the components of team leadership and team membership on a single patient call where multiple EMS providers are present. We conducted a two-day focus group with nine subject matter experts in crew resource management (CRM) and EMS using a structured nominal group technique (NGT). The specific question posed to the group was, "What are the specific components of team leadership and team membership on a single patient call where multiple EMS providers are present?" After round-robin submission of ideas and in-depth discussion of the meaning of each component, participants voted on the most important components of team leadership and team membership. Through the NGT process, we identified eight components of team leadership: a) creates an action plan; b) communicates; c) receives, processes, verifies, and prioritizes information; d) reconciles incongruent information; e) demonstrates confidence, compassion, maturity, command presence, and trustworthiness; f) takes charge; g) is accountable for team actions and outcomes; and h) assesses the situation and resources and modifies the plan. The eight essential components of team membership identified included: a) demonstrates followership, b) maintains situational awareness, c) demonstrates appreciative inquiry, d) does not freelance, e) is an active listener, f) accurately performs tasks in a timely manner, g) is safety conscious and advocates for safety at all times, and h) leaves ego and rank at the door. This study used a highly structured qualitative technique and subject matter experts to identify components of teamwork essential for prehospital EMS providers. These findings and may be used to help inform the development of future EMS training and assessment initiatives.

  15. Prehospital electronic patient care report systems: early experiences from emergency medical services agency leaders.

    Directory of Open Access Journals (Sweden)

    Adam B Landman

    Full Text Available BACKGROUND: As the United States embraces electronic health records (EHRs, improved emergency medical services (EMS information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies. METHODS: We conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes. RESULTS: Twenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1 identify creative funding sources; 2 leverage regional health information organizations; and 3 build internal information technology capacity. CONCLUSION: EMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and

  16. Emergency medical and health providers' perceptions of key issues in prehospital patient safety.

    Science.gov (United States)

    Atack, Lynda; Maher, Janet

    2010-01-01

    To date, most patient safety studies have been conducted in relation to the hospital rather than the prehospital setting and data regarding emergency medical services (EMS)-related errors are limited. To address this gap, a study was conducted to gain an in-depth understanding of the views of highly experienced EMS practitioners, educators, administrators, and physicians on major issues pertaining to EMS patient safety. The intent of the study was to identify key issues to give direction to the development of best practices in education, policy, and fieldwork. A qualitative study was conducted using processes described by Lincoln and Guba (1985) to enhance the quality and credibility of data and analysis. Purposive sampling was used to identify informants with knowledge and expertise regarding policy, practice, and research who could speak to the issue of patient safety. Sixteen participants, the majority of whom were Canadian, participated in in-depth interviews. Two major themes were identified under the category of key issues: clinical decision making and EMS's focus and relationship with health care. An education gap has developed in EMS, and there is tension between the traditional stabilize-and-transport role and the increasingly complex role that has come about through "scope creep." If, as expected, EMS aligns increasingly with the health sector, then change is needed in the EMS educational structure and process to develop stronger clinical decision-making skills. The results of this study indicate that many individual organizations and health regions are addressing issues related to patient safety in EMS, and there are important lessons to be learned from these groups. The broader issues identified, however, are system-wide and best addressed through policy change from health regions and government.

  17. The impact of a pre-hospital medical response unit on patient care and emergency department attendances.

    LENUS (Irish Health Repository)

    Deasy, C

    2012-02-03

    A rapid response team was instigated in Cork to improve prehospital care and reduce unnecessary Emergency Department (ED) visits. This consisted of a Specialist Registrar (SpR) in Emergency Medicine and a Paramedic who attended all "999" calls in a designated rapid response vehicle on the allotted study days. Two hundred and sixty-three patients were seen on designated days between Jan 2004 and March 2006. Presentations seen included; road traffic accident (23%) collapse (12%), fall (10%) and seizure (8%). The majority of calls were to houses (36%). The most common medical intervention was intravenous cannulation (25%). Intravenous medications were administered in 21% of these patients--morphine sulphate was the most common drug given. It was possible to safely discharge 31% of patients on scene. In our experience skilled Emergency Medicine doctors attending at scene could provide advanced care and reduce ambulance transportation and patient attendance.

  18. Prehospital administered fascia iliaca compartment block by emergency medical service nurses, a feasibility study

    Science.gov (United States)

    2014-01-01

    Introduction Patients with a proximal femur fracture are often difficult to evacuate from the accident scene. Prehospital pain management for this vulnerable group of patients may be challenging. Multiple co-morbidities, polypharmacy and increased age may limit the choice of suitable analgesics. The fascia iliaca compartment (FIC) block may be an alternative to intravenous analgesics. However this peripheral nerve block is mainly applied by physicians. In the Netherlands, prehospital emergency care is mostly provided by EMS-nurses. Therefore we examined whether well-trained EMS-nurses are able to successfully perform a FIC block in order to ensure timely and appropriate effective analgesia. The study was study was registered in the Netherlands Trial Register (NTR-nr 3824). Methods Ten EMS nurses were educated in the performance of a FIC-block. Indications, technique, side-effects and complications were discussed. Hereafter the trained EMS-nurses staffed ambulance teams were dispatched to patients with a suspicion for a proximal femur fracture. After confirmation of the diagnosis, the block was performed and 0.3 ml/kg lidocaine (10 mg/ml) with adrenaline 5 μg/ml was injected. The quality of pain relief, occurrence of complications and patient satisfaction were evaluated. Results In 108 patients a block was performed. One hundred patients could be included. Every EMS nurse performed at least 10 FIC blocks. The block was effective in 96 patients. The initial median (NRS)-pain score decreased after block performance to a score of 6 (after 10 minutes), 4 (after 20 minutes) and 3 (after 30 minutes). At arrival at the Emergency Department the median pain score was 3. Dynamic NRS-pain scores when transferring the patient from the accident scene to the ambulance stretcher, during transportation to the hospital and when transferring the patient to a hospital bed were, 4, 3 and 3.5 respectively. Patient satisfaction was very high. No complications were noted

  19. 院前急救医疗纠纷原因分析与防范对策%Cause analysis and prevention measure of prehospital emergency medical disputes

    Institute of Scientific and Technical Information of China (English)

    姜丽

    2014-01-01

    目的:院前急救是急诊医疗服务体系的首要环节,由于工作的特殊性,如患者病情急、病种复杂、车载急救设备有限、工作环境差等,存在很大医疗风险。因此,研究分析院前急救医疗纠纷多发的各种风险因素,针对性地提出防范对策,有利于提高院前急救成功率,减少或避免医疗纠纷的发生,更好地完成急救任务。%Prehospital emergency is the important link of emergency medical service system.Because of the particularity of the work,such as patients with acute and complex illness,limited in-car equipments,poor working environment,there has a big medical risk.In order to improve the success rate of prehospital first aid,reduce or avoid the occurrence of medical disputes, preferably complete the emergency task,it is necessary to analyze the various risk factors of prehospital emergency medical disputes,and to put forward prevention measure.

  20. The emerging trend in the epidemiology of gunshot injuries in the emergency department of a Nigerian tertiary hospital in a State without formal prehospital emergency medical services

    Directory of Open Access Journals (Sweden)

    Gabriel Uche Pascal Iloh

    2013-01-01

    Full Text Available Background : Gunshot injuries (GSIs though a rarity in Nigeria before the Nigerian civil war have now become rampant with variable epidemiology. It is emerging as a common cause of trauma-related emergency hospitalizations. Aim: The study was aimed at reviewing the epidemiology of gunshot injuries in the emergency department (ED of a Nigerian tertiary hospital over a 5-year period. Materials and Methods: This was a retrospective study of GSIs seen at the ED of Federal Medical Centre, Umuahia, Nigeria using data from medical records, patients′ case notes, ED admission registers, and nurses′ report books. The data collected included age, sex, place of the incidence, time of the incidence, time of presentation to the hospital, anatomic sites, and etiology of the injury. Results : The age ranged from 14 years to 80 years with mean age of 47 ± 8.1 years. There were 95 males and 22 females with a male to female ratio of 4.3:1. The three most common causes were armed robbery (31.6%, kidnapping (21.3%, and police brutality (17.9%. The incident predominantly affected the middle age group (57.3%, occurred mostly during the day time (72.6%, affecting mainly the lower limbs (65.8% and majority (84.6% of the victims presented 1 hour after the injury. None of the victims received prehospital care. Conclusion: There was variability in the epidemiology of GSIs with kidnapping and police brutality emerging among preeminent contributors and downward trend of armed robbery-related GSIs. The incident occurred predominantly during the day time and most victims presented late to the ED. Interventional strategies including the responsible security apparatus system are advocated.

  1. Modelling optimal location for pre-hospital helicopter emergency medical services.

    Science.gov (United States)

    Schuurman, Nadine; Bell, Nathaniel J; L'Heureux, Randy; Hameed, Syed M

    2009-05-09

    Increasing the range and scope of early activation/auto launch helicopter emergency medical services (HEMS) may alleviate unnecessary injury mortality that disproportionately affects rural populations. To date, attempts to develop a quantitative framework for the optimal location of HEMS facilities have been absent. Our analysis used five years of critical care data from tertiary health care facilities, spatial data on origin of transport and accurate road travel time catchments for tertiary centres. A location optimization model was developed to identify where the expansion of HEMS would cover the greatest population among those currently underserved. The protocol was developed using geographic information systems (GIS) to measure populations, distances and accessibility to services. Our model determined Royal Inland Hospital (RIH) was the optimal site for an expanded HEMS - based on denominator population, distance to services and historical usage patterns. GIS based protocols for location of emergency medical resources can provide supportive evidence for allocation decisions - especially when resources are limited. In this study, we were able to demonstrate conclusively that a logical choice exists for location of additional HEMS. This protocol could be extended to location analysis for other emergency and health services.

  2. Modelling optimal location for pre-hospital helicopter emergency medical services

    Directory of Open Access Journals (Sweden)

    L'Heureux Randy

    2009-05-01

    Full Text Available Abstract Background Increasing the range and scope of early activation/auto launch helicopter emergency medical services (HEMS may alleviate unnecessary injury mortality that disproportionately affects rural populations. To date, attempts to develop a quantitative framework for the optimal location of HEMS facilities have been absent. Methods Our analysis used five years of critical care data from tertiary health care facilities, spatial data on origin of transport and accurate road travel time catchments for tertiary centres. A location optimization model was developed to identify where the expansion of HEMS would cover the greatest population among those currently underserved. The protocol was developed using geographic information systems (GIS to measure populations, distances and accessibility to services. Results Our model determined Royal Inland Hospital (RIH was the optimal site for an expanded HEMS – based on denominator population, distance to services and historical usage patterns. Conclusion GIS based protocols for location of emergency medical resources can provide supportive evidence for allocation decisions – especially when resources are limited. In this study, we were able to demonstrate conclusively that a logical choice exists for location of additional HEMS. This protocol could be extended to location analysis for other emergency and health services.

  3. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims

    OpenAIRE

    Gholipour, Changiz; Vahdati, Samad Shams; NOTASH, Mehdi; MIRI, Seyed Hassan; Ghafouri, Rouzbeh Rajaei

    2016-01-01

    SUMMARY Objectives Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a s...

  4. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims

    OpenAIRE

    Gholipour, Changiz; Vahdati, Samad Shams; NOTASH, Mehdi; MIRI, Seyed Hassan; Ghafouri, Rouzbeh Rajaei

    2016-01-01

    SUMMARY Objectives Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a s...

  5. Comparative analysis of three prehospital emergency medical services organizations in India and Pakistan.

    Science.gov (United States)

    Sriram, V; Gururaj, G; Razzak, J A; Naseer, R; Hyder, A A

    2016-08-01

    Strengthened emergency medical services (EMS) are urgently required in South Asia to reduce needless death and disability. Several EMS models have been introduced in India and Pakistan, and research on these models can facilitate improvements to EMS in the region. Our objective was to conduct a cross-case comparative analysis of three EMS organizations in India and Pakistan - GVK EMRI, Aman Foundation and Rescue 1122 - in order to draw out similarities and differences in their models. Case study methodology was used to systematically explore the organizational models of GVK EMRI (Karnataka, India), Aman Foundation (Karachi, Pakistan), and Rescue 1122 (Punjab, Pakistan). Qualitative methods - interviews, document review and non-participant observation - were utilized, and using a process of constant comparison, data were analysed across cases according to the WHO health system 'building blocks'. Emergent themes under each health system 'building block' of service delivery, health workforce, medical products and technology, health information systems, leadership and governance, and financing were described. Cross-cutting issues not applicable to any single building block were further identified. This cross-case comparison, the first of its kind in low- and middle-income countries, highlights key innovations and lessons, and areas of further research across EMS organizations in India, Pakistan and other resource-poor settings. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Staff Trine

    2011-03-01

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

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

    Science.gov (United States)

    Staff, Trine; Søvik, Signe

    2011-03-31

    Few studies have evaluated pre-hospital documentation quality. We retrospectively assessed emergency medical service (EMS) documentation of key logistic, physiologic, and mechanistic variables in motor vehicle accidents (MVAs). Records from police, Emergency Medical Communication Centers (EMCC), ground and air ambulances were retrospectively collected for 189 MVAs involving 392 patients. Documentation of Glasgow Coma Scale (GCS), respiratory rate (RR), and systolic blood pressure (SBP) was classified as exact values, RTS categories, clinical descriptions enabling post-hoc inference of RTS categories, or missing. The distribution of values of exact versus inferred RTS categories were compared (Chi-square test for trend). 25% of ground and 11% of air ambulance records were unretrieveable. Patient name, birth date, and transport destination was documented in >96% of ambulance records and 81% of EMCC reports. Only 54% of patient encounter times were transmitted to the EMCC, but 77% were documented in ground and 96% in air ambulance records. Ground ambulance records documented exact values of GCS in 48% and SBP in 53% of cases, exact RR in 10%, and RR RTS categories in 54%. Clinical descriptions made post-hoc inference of RTS categories possible in another 49% of cases for GCS, 26% for RR, and 20% for SBP. Air ambulance records documented exact values of GCS in 89% and SBP in 84% of cases, exact RR in 7% and RR RTS categories in 80%. Overall, for lower RTS categories of GCS, RR and SBP the proportion of actual documented values to inferred values increased (All: pground and 92% of cases by air ambulance. EMS documentation of logistic and mechanistic variables was adequate. Patient physiology was frequently documented only as descriptive text. Our finding indicates a need for improved procedures, training, and tools for EMS documentation. Documentation is in itself a quality criterion for appropriate care and is crucial to trauma research. © 2011 Staff and S

  8. The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

    Science.gov (United States)

    Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

    2014-01-01

    In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised

  9. 我国院前医疗急救资源调查分析%Investigation and analysis on prehospital emergency medical resources in China

    Institute of Scientific and Technical Information of China (English)

    肖力屏; 徐家相; 孙卉

    2015-01-01

    Objective To explore ways of promoting equalized basic public health services,and provide timely and efficient on-site first aid and safe custody transfer for patients with acute and critical illness.Methods Electronic questionnaire for general survey in whole country-wide emergency center was used to collect data,and the prehospital emergency medical resources of China was analyzed as well.Results The survey for basic information and operating condition of prehospital emergency medical agencies in 2009 throughout our country showed that "120" dialing number to emergency system did not exist for all emergency centers on a national scale,and its adoption rate was 94.16%,but only 24.54% of which has computer dispatch system; Only 71.75% of the total number of employees were authorized personnel;Average gross income of a prehospital emergency medical agency was 1.771 million yuan,and its total expenditure was 1.90 million yuan;There were only 4.86 ambulances,1.52 ventilators,1.79 defibrillators and 2.12 electrocardiograms each prehospital emergency medical agency;Average return rate of ambulances was 14%.Conclusions Prehospital emergency medical resources of China is insufficient,financial input and newly employed emergency personnel must be increased,and prehospital emergency medical resources be allocated and utilized effectively.%目的 探讨促进实现基本公共卫生服务均等化,为急危重症患者提供及时、高效的现场急救和安全的监护转运方案.方法 采用电子问卷普查的调查方法收集资料,对我国院前医疗急救资源进行分析研究.结果 对我国院前医疗急救机构2009年的基本情况及运行状况等方面的调查显示,全国"120"急救电话开通率为94.16%,但计算机调度系统的拥有率仅为24.54%;编制内人员仅占在岗总人数的71.75%;平均每个院前医疗急救机构的总收入177.10万元,总支出190.12万元;每个院前医疗急救机构仅有4.86辆救护车、1.52

  10. [Prehospital emergency care of patients with acute heart failure in Spain: the SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure)].

    Science.gov (United States)

    Miró, Òscar; Llorens, Pere; Escalada, Xavier; Herrero, Pablo; Jacob, Javier; Gil, Víctor; Xipell, Carolina; Sánchez, Carolina; Aguiló, Sira; Martín-Sánchez, Francisco J

    2017-07-01

    To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received. We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Indicators of AHF severity were triage level assigned in the ED, need for admission, need for intensive care, in-hospital mortality, and 30-day mortality. A total of 6106 patients with a mean (SD) age of 80 years were included; 56.5% were women, 47.2% arrived in PVs, 37.8% in NMAs, and 15.0% in MAs. Use of an ambulance was associated with female sex, age over 80 years, chronic obstructive pulmonary disease, a history of AHF, functional dependency, New York Heart Association class III-IV, sphincteral incontinence, labored breathing, orthopnea, cold skin, and sensory depression or restlessness. Assignment of a MA was directly associated with living alone, a history of ischemic heart disease, cold skin, sensory depression or restlessness, and high temperature; it was inversely associated with a history of falls. The rates of receipt of prehospital treatments and AHF severity level increased with use of MAs vs. NMAs vs. PV. Seventy-three percent of patients transported in MAs received oxygen, 29% received a diuretic, 13.5% a vasodilator, and 4.7% noninvasive ventilation. Characteristics of the patient with AHF are associated with the assignment of type of transport to a hospital ED. Assignment appears to be related to severity. Treatment given during MA transport could be increased.

  11. Safety and efficiency of prehospital pain management with fentanyl administered by emergency medical technicians

    DEFF Research Database (Denmark)

    Nielsen, Niels Dalsgaard; Brogaard, Kjeld; Dahl, Michael

    2007-01-01

    minor, and were not treated with naloxone.   Conclusions: Our results suggest that non-medical personnel safely can administer IV fentanyl to selected groups of patients with a satisfactory result in terms of a considerable reduction in pain score and an acceptable rate of negative coincident events....

  12. Safety and efficiency of prehospital pain management with fentanyl administered by emergency medical technicians

    DEFF Research Database (Denmark)

    Nielsen, Niels Dalsgaard; Brogaard, Kjeld; Dahl, Michael

    2007-01-01

    minor, and were not treated with naloxone.   Conclusions: Our results suggest that non-medical personnel safely can administer IV fentanyl to selected groups of patients with a satisfactory result in terms of a considerable reduction in pain score and an acceptable rate of negative coincident events....

  13. Some Thoughts of Pre-hospital Emergency Electronic Medical Record%构建院前急救电子病历的几点思考

    Institute of Scientific and Technical Information of China (English)

    陈志刚; 邹圣强; 赵伟

    2011-01-01

    构建院前急救电子病历应充分考虑院前急救"急、短、快"的工作特点,在其中纳入调度语音信息、急救视频信息、文字与图像信息等数字化信息,并采取有效的实现方式才能满足院前急救电子病历"客观、真实、准确、及时、完整、突出重点"的要求,达到提高急救质量,优化急救资源配置的最终目的.%Construction of pre-hospital emergency electronic medical record should take full account of pre-hospital emergency work characteristics that is urgent, short and fast, incorporating scheduling a voice message, first aid video information., text and image information, and other digital information. It should take effective way to meet the requirements of pre- hospital emergency electronic medical record which are objective, true, accurate,timely, complete, focused, for achieving aid quality improvement and aid resources optimization.

  14. What is dignity in prehospital emergency care?

    Science.gov (United States)

    Abelsson, Anna; Lindwall, Lillemor

    2017-05-01

    Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation. To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care. The study had a qualitative approach. Data were collected by Flanagan's critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis. Ethical considerations: The study followed the ethical principles in accordance with the Declaration of Helsinki. The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient's world and make professional decisions. The ambulance nurse respects the patient's will and protects the patient's body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient. It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human. Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students' ethical obligation results in the courage to see when a patient's dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.

  15. An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU in Brazil

    Directory of Open Access Journals (Sweden)

    Fernando Sabia Tallo

    2014-09-01

    Full Text Available OBJECTIVE: To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU in Brazil and to evaluate their quality of life. METHODS: Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. RESULTS: Of a total of 902 physicians, including 644 (71.4% males, 533 (59.1% were between 30 and 45 years of age and 562 (62.4% worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%, airway surgical access (45.6%, pericardiocentesis (64.4% and thoracentesis (29.9%. Difficulties in using an artificial ventilator (43.3% and in transcutaneous pacing (42.2% were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p48 h per week (12.8 vs 8.6%; p<0.001, and were non-specialists with the shortest length of service (<1 year at SAMU (30.1 vs 18.2%; p<0.001 who were hired without having to pass public service exams* (i.e., for a temporary job (61.8 vs 46.2%; p<0.001. Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU. CONCLUSIONS: The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills

  16. Discussion on the feasibility of Chinese emergency medical technician working at the prehospital emergency care independently%探讨中国医疗救护员独立从事院前急救的可行性

    Institute of Scientific and Technical Information of China (English)

    郑进

    2015-01-01

    Through summarizing the disadvantages of emergency care unit setting in China, this paper expounded the signifi-cance on prehospital emergency care mode of emergency medical technician( EMT)+EMT being the emergency care unit, and then an-alyzed the feasibility of emergency medical technician working at the prehospital emergency care independently from the following per-spectives of disease spectrum, patient assessment and classification, unloaded ambulance return rate, and emergency calling just for transportation.%通过总结中国现行急救单元设置中存在的问题,阐述了建立以医疗救护员( emergency medical technician,EMT)+EMT为主要急救单元的院前急救模式的意义,从中国院前急救疾病谱、检伤分类统计结果、急救车空返率与急诊呼叫仅需转运等多种角度,分析了医疗救护员独立从事院前急救的可行性。

  17. The 2017 International Joint Working Group White Paper by INDUSEM, the Emergency Medicine Association and the Academic College of Emergency Experts on Establishing Standardized Regulations, Operational Mechanisms, and Accreditation Pathways for Education and Care Provided by the Prehospital Emergency Medical Service Systems in India.

    Science.gov (United States)

    Sikka, Veronica; Gautam, V; Galwankar, Sagar; Guleria, Randeep; Stawicki, Stanislaw P; Paladino, Lorenzo; Chauhan, Vivek; Menon, Geetha; Shah, Vijay; Srivastava, R P; Rana, B K; Batra, Bipin; Kalra, O P; Aggarwal, P; Bhoi, Sanjeev; Krishnan, S Vimal

    2017-01-01

    The government of India has done remarkable work on commissioning a government funded prehospital emergency ambulance service in India. This has both public health implications and an economic impact on the nation. With the establishment of these services, there is an acute need for standardization of education and quality assurance regarding prehospital care provided. The International Joint Working Group has been actively involved in designing guidelines and establishing a comprehensive framework for ensuring high-quality education and clinical standards of care for prehospital services in India. This paper provides an independent expert opinion and a proposed framework for general operations and administration of a standardized, national prehospital emergency medical systems program. Program implementation, operational details, and regulations will require close collaboration between key stakeholders, including local, regional, and national governmental agencies of India.

  18. The 2017 International Joint Working Group white paper by INDUSEM, The Emergency Medicine Association and The Academic College of Emergency Experts on establishing standardized regulations, operational mechanisms, and accreditation pathways for education and care provided by the prehospital emergency medical service systems in India

    Directory of Open Access Journals (Sweden)

    Veronica Sikka

    2017-01-01

    Full Text Available The government of India has done remarkable work on commissioning a government funded prehospital emergency ambulance service in India. This has both public health implications and an economic impact on the nation. With the establishment of these services, there is an acute need for standardization of education and quality assurance regarding prehospital care provided. The International Joint Working Group has been actively involved in designing guidelines and establishing a comprehensive framework for ensuring high-quality education and clinical standards of care for prehospital services in India. This paper provides an independent expert opinion and a proposed framework for general operations and administration of a standardized, national prehospital emergency medical systems program. Program implementation, operational details, and regulations will require close collaboration between key stakeholders, including local, regional, and national governmental agencies of India.

  19. Pediatric Airway Management and Prehospital Patient Safety: Results of a National Delphi Survey by the Children's Safety Initiative-Emergency Medical Services for Children.

    Science.gov (United States)

    Hansen, Matthew; Meckler, Garth; OʼBrien, Kerth; Engle, Phillip; Dickinson, Caitlin; Dickinson, Kathryn; Jui, Jonathan; Lambert, William; Cottrell, Erika; Guise, Jeanne-Marie

    2016-09-01

    The objective of this study was to determine what aspects of prehospital pediatric airway management may contribute to patient safety events. We conducted a 3-phase Delphi survey in prehospital professionals across the United States to identify potential contributors to patient safety events. Respondents ranked how likely factors were to contribute on a 9-point Likert-type scale and were allowed to elaborate through open-ended questions. Analysis was conducted using a mixed-methods approach, including Likert-type responses and open-ended questions which were analyzed for specific themes. All 3 phases of the survey were completed by 492 participants; 50.8% of respondents were paramedics, 22% were emergency medical technician-basics/first responders, and 11.4% were physicians. Seventy-five percent identified lack of experience with advanced airway management, and 44% identified medical decision making regarding airway interventions as highly likely to lead to safety events. Within the domain of technical skills, advanced airway management was ranked in the top 3 contributors to safety events by 71% of participants, and bag-mask ventilation by 18%. Qualitative analysis of questions within the domains of equipment and technical skills identified endotracheal intubation as the top contributor to safety events, with bag-mask ventilation second. In the domains of assessment and decision making, respiratory assessment and knowing when to perform an advanced airway were ranked most highly. This national Delphi survey identified lack of experience with pediatric airway management and challenges in decision making in advanced airway management as high risk for safety events, with endotracheal intubation as the most likely of these.

  20. Face Arm Speech Time Test use in the prehospital setting, better in the ambulance than in the emergency medical communication center.

    Science.gov (United States)

    Berglund, Annika; Svensson, Leif; Wahlgren, Nils; von Euler, Mia

    2014-01-01

    Prehospital identification of acute stroke increases the possibility of early treatment and good outcome. To increase identification of stroke, the Face Arm Speech Time (FAST) test was introduced in the Emergency Medical Communication Center (EMCC). This substudy aims to evaluate the implementation of the FAST test in the EMCC and the ambulance service. The study was conducted in the region of Stockholm, Sweden during 6 months. The study population consisted of all calls to the EMCC concerning patients presenting at least one FAST symptom or a history/finding making the EMCC or ambulance personnel to suspect stroke within 6 h. Positive FAST was compared to diagnosis at discharge. Positive predictive values (PPV) for a stroke diagnosis at discharge were calculated. In all, 900 patients with a median age of 71 years were enrolled, 667 (74%) by the EMCC and 233 (26%) by the ambulances. At discharge, 472 patients (52%) were diagnosed with stroke/transient ischemic attack (TIA), 337 identified by the EMCC (71%) and 135 (29%) by the ambulances. The PPV for a discharge diagnosis of stroke/TIA was 51% (CI 47-54%) in EMCC-enrolled and 58% (CI 52-64%) in ambulance-enrolled patients. With a positive FAST the PPV of a correct stroke/TIA diagnosis increased to 56% (CI 52-61%) and 73% (CI 66-80%) in EMCC- and ambulance-enrolled patients, respectively. Positive FAST from EMCC was also found in 44% of patients with a nonstroke diagnosis at discharge. A stroke/TIA diagnosis at discharge but negative FAST was found in 58 and 27 patients enrolled by the EMCC and ambulances, respectively. The PPV of FAST is higher when used on the scene by ambulance than by EMCC. FAST may be a useful prehospital tool to identify stroke/TIA but has limitations as the test can be negative in true strokes, can be positive in nonstrokes, and FAST symptoms may be present but not identified in the emergency call. For the prehospital care situation better identification tools are needed. © 2014 S. Karger AG

  1. Prehospital thoracostomy in patients with traumatic circulatory arrest: results from a physician-staffed Helicopter Emergency Medical Service

    NARCIS (Netherlands)

    Peters, J.H.; Ketelaars, R.; Wageningen, B. van; Biert, J.; Hoogerwerf, N.

    2017-01-01

    OBJECTIVE: Until recently, traumatic cardiac arrest (tCA) was believed to be associated with high mortality and low survival rates. New data suggest better outcomes. The most common error in tCA management is failing to treat a tension pneumothorax (TP). In the prehospital setting, we prefer thoraco

  2. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims.

    Science.gov (United States)

    Gholipour, Changiz; Vahdati, Samad Shams; Notash, Mehdi; Miri, Seyed Hassan; Ghafouri, Rouzbeh Rajaei

    2014-06-01

    Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a study on the success rate of PHEMS personnel in implementing PHTLS guidelines at the scene of trauma. Severe trauma patients who had been transferred to the emergency department were included in the study. Evaluations included transfer time, airway management, spinal immobilization, external bleeding management, intravenous (IV) line access, and fluid therapy. All evaluations were performed by an expert emergency physician in the emergency department. The mean response time was 17.87±9.1 minutes. The PHEMS personnel immobilized cervical spine in 60.4% of patients, out of whom 16.7% were not properly immobilized. Out of 99 (98%) cases of established IV line access by the PHEMS providers, 57% were satisfactory. Fluid therapy, which was carried out in 99 (98%) patients by the PHEMS personnel, was appropriate in 92% of the cases. PHEMS personnel need more education and supervising to provide services according to PHTLS guidelines.

  3. 院前急救病历电子索引开发和应用探讨%Discussion on the Development and Application of Pre-hospital Emergency Medical Records Electronic Index

    Institute of Scientific and Technical Information of China (English)

    陈志刚; 陆素琴; 郭薇; 邹圣强

    2011-01-01

    As the paper pre-hospital emergency medical statistics in the information error-prone, and time-consuming, Zhenjiang City, this has not been achieved in the Emergency Center under the premise of electronic medical records, from starting to save money, to design, development and application of electronic medical records index. After application of the test, pre-hospital emergency epidemiological information to obtain significantly faster and more accurate: Moreover, the pre-hospital emergency medical quality has greatly improved.%由于纸质院前急救病历在信息统计方面容易出错,同时费时费力,为此镇江市急救中心在尚未实现电子病历的前提下,从节约资金出发,自行设计、开发和应用病历电子索引.经过应用测试,院前急救流行病学信息获取明显更加快捷、准确;不仅如此,院前急救病历质量也有了很大的提高.

  4. Man or machine? An experimental study of prehospital emergency amputation.

    Science.gov (United States)

    Leech, Caroline; Porter, Keith

    2016-09-01

    Prehospital emergency amputation is a rare procedure, which may be necessary to free a time-critical patient from entrapment. This study aimed to evaluate four techniques of cadaveric lower limb prehospital emergency amputation. A guillotine amputation of the distal femur was undertaken in fresh frozen self-donated cadavers. A prehospital doctor conducted a surgical amputation with Gigli saw or hacksaw for bone cuts and firefighters carried out the procedure using the reciprocating saw and Holmatro device. The primary outcome measures were time to full amputation and the number of attempts required. The secondary outcomes were observed quality of skin cut, soft tissue cut and CT assessment of the proximal bone. Observers also noted the potential risks to the rescuer or patient during the procedure. All techniques completed amputation within 91 s. The reciprocating saw was the quickest technique (22 s) but there was significant blood spattering and continuation of the cut to the surface under the leg. The Holmatro device took less than a minute. The quality of the proximal femur was acceptable with all methods, but 5 cm more proximal soft tissue damage was made by the Holmatro device. Emergency prehospital guillotine amputation of the distal femur can effectively be performed using scalpel and paramedic shears with bone cuts by the Gigli saw or fire service hacksaw. The reciprocating saw could be used to cut bone if no other equipment was available but carried some risks. The Holmatro cutting device is a viable option for a life-threatening entrapment where only firefighters can safely access the patient, but would not be a recommended primary technique for medical staff. 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/

  5. Organization of prehospital medical care for patients with cerebral stroke

    Directory of Open Access Journals (Sweden)

    Nikolai Anatolyevich Shamalov

    2013-01-01

    Full Text Available The main tasks of prehospital medical care are to make a correct diagnosis of stroke and to minimize patient transportation delays. Stroke is a medical emergency so all patients with suspected stroke must be admitted by a first arrived ambulance team to a specialized neurology unit for stroke patients. Most rapidly transporting the patient to hospital, as well as reducing the time of examination to verify the pattern of stroke are a guarantee of successful thrombolytic therapy that is the most effective treatment for ischemic stroke. Substantially reducing the time of in-hospital transfers (the so-called door-to-needle time allows stroke patients to be directly admitted to the around the clock computed tomography room, without being sent to the admission unit. Prehospital stroke treatment policy (basic therapy is to correct the body’s vital functions and to maintain respiration, hemodynamics, and water-electrolyte balance and it can be performed without neuroimaging verification of the pattern of stroke. The application of current organizational, methodical, and educational approaches is useful in improving the quality of medical care for stroke patients, in enhancing the continuity between prehospital and hospital cares, and in promoting new effective technologies in stroke therapy.

  6. [Prehospital cardiac resuscitation in Queretaro, Mexico. Report of 3 cases. Importance of an integral emergency medical care system].

    Science.gov (United States)

    Fraga-Sastrías, Juan Manuel; Aguilera-Campos, Andrea; Barinagarrementería-Aldatz, Fernando; Ortíz-Mondragón, Claudio; Asensio-Lafuente, Enrique

    2014-01-01

    In Mexico, out-of-hospital cardiac arrest is a health problem that represents 33,000 to 150,000 or more deaths per year. The few existent reports show mortality as high as 100% in contrast to some international reports that show higher survival rates. In Queretaro, during the last 5 years there were no successful resuscitation cases. However, in 2012 some patients were reported to have return of spontaneous circulation. We report in this article 3 cases with return of spontaneous circulation and pulse at arrival to the hospital. Two of the patients were discharged alive, one of them with poor cerebral performance category. Community cardiopulmonary resuscitation, early defibrillation and better emergency medical system response times, are related with survival. This poorly explored health problem in Queretaro could be increased with quality and good public education, bystander assisted cardiopulmonary resuscitation, police involvement in cardiopulmonary resuscitation and defibrillation, public access defibrillation programs and measurement of indicators and feedback for better results.

  7. [Cooperation between emergency and forensic medicine - retrospective evaluation of pre-hospital emergency measures].

    Science.gov (United States)

    Buschmann, Claas T; Kleber, Christian; Tsokos, Michael; Püschel, Klaus; Hess, Thorsten; Kerner, Thoralf; Stuhr, Markus

    2015-06-01

    Emergency medical research is subject to special conditions. Emergency patients e.g. are generally considered to be non-capable of giving consent. This results in sparse emergency medical data when compared to clinical observation studies under controlled conditions. After emergency medical treatment, deceased patients are not rarely subject to forensic investigation. The cooperation between emergency and forensic medicine has not only emergency medical training potential in individual cases, but also scientific innovation potential especially with respect to the retrospective evaluation of pre-hospital emergency measures. Such partnerships (like in Berlin at the Charité - Universitätsmedizin Berlin between the Institute of Legal Medicine and the Center for Musculoskeletal Surgery or in Hamburg between the Institute for Legal Medicine at the University Hospital and the Municipal Fire Brigade with the Emergency Medical Service) are yet exceptional in Germany. © Georg Thieme Verlag Stuttgart · New York.

  8. 云平台和物联网技术在院前急救中的应用%The Application of Cloud Platform and Internet of Things Technology in Pre-hospital Emergency Medical Care

    Institute of Scientific and Technical Information of China (English)

    胡占生; 刘晓辉; 姚惠东; 蔡明珠; 覃森荣

    2014-01-01

    院前急救对时限性要求高,传统方式存在较大的局限性。运用云平台和物联网技术有效解决传统模式下存在的问题,包括远程专家支持、现场明确诊断、区域协同救治等,节省了医疗费用,同时提高了救治效果。介绍了广州军区总医院院前急救系统的软件平台和系统架构。运用院前急救平台使该地区的胸痛患者院前急救达到世界先进水平,取得了显著经济效益和社会效益。%The prehospital emergency medical care has high timing requirement. The traditional way has large limitation. With cloud platform and Internet of Things technology, the problems existing in the traditional mode can be effectively solved, including remote expert support, on-site definite diagnosis, regional coordination treatment, etc. It saves medical cost and improves the effect of the treatment. This paper introduces the composition and system architecture of software platform of prehospital emergency system of Guangzhou General Hospital of Guangzhou Military Command. With the prehospital emergency platform, the region's prehospital emergency level of chest pain patients has reached the world advanced level and significant economic and social benefits have been made.

  9. Protection and disinfection of medical personnel in pre-hospital emergency care of human avian influenza%人禽流感院前急救中医护人员的防护与消毒

    Institute of Scientific and Technical Information of China (English)

    邓明瑞

    2014-01-01

    目的:探讨人禽流感院前急救中医护人员的防护与消毒。方法:2010年2月12-20日转运疑似人禽流感患者14例,在转运过程中遵守工作流程,严格执行防护、消毒隔离制度。结果:院前转运工作结束以后,参加转运工作的司机、医护人员没有发生疑似禽流感感染症状。结论:提高院前急救司机、医护人员的防护意识,加强防护、消毒隔离措施,能有效地避免人禽流感在院前转运中的感染传播。%Objective:To discuss the protection and disinfection of medical personnel in pre-hospital emergency care of human avian influenza.Methods:14 cases of suspected avian influenza were transfered from 12 February to 20 February 2010.In the process of transport,we should follow the work process,and strictly implement protection and disinfection isolation system.Results:After the end of pre-hospital transfer work,the drivers and medical personnel with the transport work had no occurrence of suspected avian influenza infection symptoms.Conclusion:Improving the protection awareness of the drivers and medical personnel in pre-hospital emergency,strengthening the protection,and disinfection isolation measures can effectively prevent the spread of infection of human avian influenza in pre-hospital transfer.

  10. [Prehospital analgesia by emergency physicians and paramedics : Comparison of effectiveness].

    Science.gov (United States)

    Schempf, B; Casu, S; Häske, D

    2017-05-01

    In some German emergency medical service districts, analgesia is performed by paramedics without support of emergency physicians on scene. With regard to safety and effectiveness, paramedics should not be overshadowed by emergency physicians. Is prehospital analgesia performed by paramedics under medical supervision or emergency physicians comparable regarding processes and effectiveness in the case of isolated limb injury? As a retrospective analysis of patients with isolated limb injury, analgesia performed by paramedics and by emergency physicians was analyzed. In addition to pain reduction, prescribed monitoring, and further airway maneuvers, vital parameters (Glasgow coma scale, systolic blood pressure, heartrate and respiratory rate, oxygen saturation) were recorded at the beginning and end of prehospital treatment. Pain was reduced from NRS 8 ± 1 to NRS 2 ± 1 in the paramedic group, and from NRS 8 ± 2 to NRS 2 ± 2 in the physician group, so the mean pain reduction was 6 ± 2 in the paramedic-group and 5 ± 2 in the physician group (p < 0.001). Adequate analgesia was found in 96.9% in the physician group and 91.7% in the paramedic group (p = 0.113). ECG monitoring and oxygen administration according to SOP was significantly more frequent in the paramedic group than in the physician group (p < 0.001). Respiratory frequency was significantly more frequent in the physician group than in the paramedic group (p < 0.001). The study shows, with a given indication, that German paramedics can independently perform safe and successful analgesia under medical supervision.

  11. Prehospital digital photography and automated image transmission in an emergency medical service – an ancillary retrospective analysis of a prospective controlled trial

    Directory of Open Access Journals (Sweden)

    Bergrath Sebastian

    2013-01-01

    Full Text Available Abstract Background Still picture transmission was performed using a telemedicine system in an Emergency Medical Service (EMS during a prospective, controlled trial. In this ancillary, retrospective study the quality and content of the transmitted pictures and the possible influences of this application on prehospital time requirements were investigated. Methods A digital camera was used with a telemedicine system enabling encrypted audio and data transmission between an ambulance and a remotely located physician. By default, images were compressed (jpeg, 640 x 480 pixels. On occasion, this compression was deactivated (3648 x 2736 pixels. Two independent investigators assessed all transmitted pictures according to predefined criteria. In cases of different ratings, a third investigator had final decision competence. Patient characteristics and time intervals were extracted from the EMS protocol sheets and dispatch centre reports. Results Overall 314 pictures (mean 2.77 ± 2.42 pictures/mission were transmitted during 113 missions (group 1. Pictures were not taken for 151 missions (group 2. Regarding picture quality, the content of 240 (76.4% pictures was clearly identifiable; 45 (14.3% pictures were considered “limited quality” and 29 (9.2% pictures were deemed “not useful” due to not/hardly identifiable content. For pictures with file compression (n = 84 missions and without (n = 17 missions, the content was clearly identifiable in 74% and 97% of the pictures, respectively (p = 0.003. Medical reports (n = 98, 32.8%, medication lists (n = 49, 16.4% and 12-lead ECGs (n = 28, 9.4% were most frequently photographed. The patient characteristics of group 1 vs. 2 were as follows: median age – 72.5 vs. 56.5 years, p = 0.001; frequency of acute coronary syndrome – 24/113 vs. 15/151, p = 0.014. The NACA scores and gender distribution were comparable. Median on-scene times were longer with picture

  12. Prehospital digital photography and automated image transmission in an emergency medical service - an ancillary retrospective analysis of a prospective controlled trial.

    Science.gov (United States)

    Bergrath, Sebastian; Rossaint, Rolf; Lenssen, Niklas; Fitzner, Christina; Skorning, Max

    2013-01-16

    Still picture transmission was performed using a telemedicine system in an Emergency Medical Service (EMS) during a prospective, controlled trial. In this ancillary, retrospective study the quality and content of the transmitted pictures and the possible influences of this application on prehospital time requirements were investigated. A digital camera was used with a telemedicine system enabling encrypted audio and data transmission between an ambulance and a remotely located physician. By default, images were compressed (jpeg, 640 x 480 pixels). On occasion, this compression was deactivated (3648 x 2736 pixels). Two independent investigators assessed all transmitted pictures according to predefined criteria. In cases of different ratings, a third investigator had final decision competence. Patient characteristics and time intervals were extracted from the EMS protocol sheets and dispatch centre reports. Overall 314 pictures (mean 2.77 ± 2.42 pictures/mission) were transmitted during 113 missions (group 1). Pictures were not taken for 151 missions (group 2). Regarding picture quality, the content of 240 (76.4%) pictures was clearly identifiable; 45 (14.3%) pictures were considered "limited quality" and 29 (9.2%) pictures were deemed "not useful" due to not/hardly identifiable content. For pictures with file compression (n = 84 missions) and without (n = 17 missions), the content was clearly identifiable in 74% and 97% of the pictures, respectively (p = 0.003). Medical reports (n = 98, 32.8%), medication lists (n = 49, 16.4%) and 12-lead ECGs (n = 28, 9.4%) were most frequently photographed. The patient characteristics of group 1 vs. 2 were as follows: median age - 72.5 vs. 56.5 years, p = 0.001; frequency of acute coronary syndrome - 24/113 vs. 15/151, p = 0.014. The NACA scores and gender distribution were comparable. Median on-scene times were longer with picture transmission (26 vs. 22 min, p = 0.011), but ambulance

  13. Positive Coping: A Unique Characteristic to Pre-Hospital Emergency Personnel

    Science.gov (United States)

    Ebadi, Abbas; Froutan, Razieh

    2017-01-01

    Introduction It is important to gain a thorough understanding of positive coping methods adopted by medical emergency personnel to manage stressful situations associated with accidents and emergencies. Thus, the purpose of this study was to gain a better understanding of positive coping strategies used by emergency medical service providers. Methods This study was conducted using a qualitative content analysis method. The study participants included 28 pre-hospital emergency personnel selected from emergency medical service providers in bases located in different regions of the city of Mashhad, Iran, from April to November 2016. The purposive sampling method also was used in this study, which was continued until data saturation was reached. To collect the data, semistructured open interviews, observations, and field notes were used. Results Four categories and 10 subcategories were extracted from the data on the experiences of pre-hospital emergency personnel related to positive coping strategies. The four categories included work engagement, smart capability, positive feedback, and crisis pioneering. All the obtained categories had their own subcategories, which were determined based on their distinctly integrated properties. Conclusion The results of this study show that positive coping consists of several concepts used by medical emergency personnel, management of stressful situations, and ultimately quality of pre-hospital clinical services. Given the fact that efficient methods such as positive coping can prevent debilitating stress in an individual, pre-hospital emergency authorities should seek to build and strengthen “positive coping” characteristics in pre-hospital medical emergency personnel to deal with accidents, emergencies, and injuries through adopting regular and dynamic policies. PMID:28243409

  14. The difficult medical emergency call

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Kjærulff, Thora Majlund; Viereck, Søren

    2017-01-01

    BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories and the ......BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories...... and the effect of categorization on mortality. METHODS: Register-based study in a 2-year period based on emergency call data from the emergency medical dispatch center in Copenhagen combined with nationwide register data. Logistic regression analysis (N = 78,040 individuals) was used for identification...

  15. The difficult medical emergency call

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Kjærulff, Thora Majlund; Viereck, Søren

    2017-01-01

    BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories and the ......BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories...... and the effect of categorization on mortality. METHODS: Register-based study in a 2-year period based on emergency call data from the emergency medical dispatch center in Copenhagen combined with nationwide register data. Logistic regression analysis (N = 78,040 individuals) was used for identification...

  16. Prehospital Emergency Ultrasound: A Review of Current Clinical Applications, Challenges, and Future Implications

    Directory of Open Access Journals (Sweden)

    Mazen J. El Sayed

    2013-01-01

    Full Text Available Imaging modalities in the prehospital setting are helpful in the evaluation and management of time-sensitive emergency conditions. Ultrasound is the main modality that has been applied by emergency medical services (EMS providers in the field. This paper examines the clinical applications of ultrasound in the prehospital setting. Specific focus is on applications that provide essential information to guide triage and management of critical patients. Challenges of this modality are also described in terms of cost impact on EMS agencies, provider training, and skill maintenance in addition to challenges related to the technical aspect of ultrasound.

  17. [Results of a national survey about the use of sedation scales in emergency prehospital medicine].

    Science.gov (United States)

    Belpomme, V; Devaud, M-L; Pariente, D; Ricard-Hibon, A; Mantz, J

    2009-04-01

    The primary goal of sedation in emergency prehospital care is to guarantee the security of the mechanically ventilated patients by optimising their adaptation to the respirator. If the French prehospital guidelines are well codified, their applicability in routine clinical practice seem to be rather empirical. The aim of this national survey was to evaluate the use of the clinical sedation scales by the prehospital physicians. This prospective and clinical practice survey was begun in January 2005. An anonymous questionnaire was sent to the physicians working in the 377 Mobile Intensive Care Unit of the 105 French Emergency Medical Service System. The total response rate from physicians was 28% (n=497). Only 29% of the physicians (n=145) declared to use a sedation scale for a mechanically ventilated patient. The Ramsay score was used in 97% of the cases (n=141).The principal reasons given by the physicians for not using the sedation scales were their ignorance in 57% of the cases (n=200) and the systematic choice of a deep sedation in 42% of the cases (n=147). For 18% of them (n=62), the use of sedation scores was considered too complicated. The final results show that the utilisation ratio of the sedation scores is very low in emergency prehospital medicine and suggest that an effort toward improving the use of sedation in prehospital emergency medicine is necessary.

  18. Knowledge level estimation of medical workers participating in rendering of emergency medical aid to children at a pre-hospital stage

    Directory of Open Access Journals (Sweden)

    V.M. Popkov

    2010-06-01

    Full Text Available Purpose: Estimation of qualifying preparation of the doctors participating in rendering of emergency medical aid to children. Material: On the basis of the developed test cards the analysis of doctors' knowledge level of the first help on the basic questions of emergency medicine is carried out. 120 doctors are interrogated. Results compared depending on age, work experience and presence of a qualifying professional category. Results: As a whole answers of respondents were distributed as follows: unsatisfactorily - 2,6 %; satisfactorily - 7,9 %; well - 18,4 %; perfectly - 71,1 %. Distinctions in a dale of right answers on separate sections of knowledge depending on the experience and a qualifying professional category are established. The conclusion: The weakest places in preparation of experts of the first help on which it is necessary to pay special attention in courses of postdegree preparation are revealed

  19. Designated Medical Directors for Emergency Medical Services: Recruitment and Roles

    Science.gov (United States)

    Slifkin, Rebecca T.; Freeman, Victoria A.; Patterson, P. Daniel

    2009-01-01

    Context: Emergency medical services (EMS) agencies rely on medical oversight to support Emergency Medical Technicians (EMTs) in the provision of prehospital care. Most states require EMS agencies to have a designated medical director (DMD), who typically is responsible for the many activities of medical oversight. Purpose: To assess rural-urban…

  20. 风险管理在防范院前急救医患纠纷中的应用%Application of risk management in preventing medical dispute of prehospital emergency care

    Institute of Scientific and Technical Information of China (English)

    王鑫; 崔晓丽

    2015-01-01

    Objective To discuss the application of risk management in preventing prehospital medical dispute.Methods Since 2014, risk management had been implemented by Beijing emergency medical center for prehospital medical dispute. Risk factors that may result in medical dispute in pre-hospital care process was estimated and recognized. Frequency of medical dispute events, risk factor occurrence and call back satisfaction rates before and after the implementation of risk management were analyzed.Results After implementing the risk management plan, the complaint rate was lower in 2014 than in 2013, and the difference was statistically significant (χ2=7.181,P=0.007); the main causal factor of medical dispute was derived from hospital risk, 61 cases in 2013 (58.10%) and 27 cases in 2014 (44.26%); the secondary was the social risk factor, 28 cases in 2013(26.67%) and 22 cases in 2014 (36.07%); call back satisfaction rate was higher in 2014 than in 2013, and the difference was statistically significant(χ2=5.357,P=0.021). Among them, dissatisfaction events of medical behavior and treatment measure were reduced by 52.63% and 24.00% respectively.Conclusions By utilizing the risk management, prehospital medical dispute events can be decreased, first-aid personnel's risk prevention awareness can be raised, and it's also beneficial to prevent medical dispute event during prehospital emergency care.%目的 探讨风险管理在防范院前急救医患纠纷中的应用.方法 北京急救中心自2014年对院前急救医患纠纷实施风险管理,评估和识别院前急救过程中可能引起医患纠纷的风险因素,并分析实施风险管理前后的医患纠纷事件、风险因素发生次数及电话回访满意率.结果 实施风险管理后,2014年投诉量明显低于2013年,差异有统计学意义(χ2=7.181, P=0.007);造成医患纠纷最主要的风险因素是医方风险因素,2013年61起(58.10%),2014年27起(44.26%);其次为社会风险因素,2013年28起(26

  1. 911 (nueve once): Spanish-speaking parents' perspectives on prehospital emergency care for children.

    Science.gov (United States)

    Watts, Jennifer; Cowden, John D; Cupertino, A Paula; Dowd, M Denise; Kennedy, Chris

    2011-06-01

    Racial, ethnic and language-based disparities occur throughout the US health system. Pediatric prehospital emergency medical services are less likely to be used by Latinos. We identified perceptions of and barriers to prehospital pediatric emergency care (911) access among Spanish-speaking parents. A qualitative study involving six focus groups was conducted. Spanish-speaking parents participated with a bilingual moderator. Topics discussed included experiences, knowledge, beliefs, fears, barriers, and improvement strategies. All groups were audiotaped, transcribed, and reviewed for recurring themes. Forty-nine parents participated. Though parents believed 911 was available to all, many were uncertain how to use it, and what qualified as an emergency. Barriers included language discordance, fear of exposing immigration status, and fear of financial consequences. Parents strongly desired to learn more about 911 through classes, brochures, and media campaigns. Prehospital emergency care should be available to all children. Further quantitative studies may help solidify the identified barriers and uncover areas needing improvement within Emergency Medical Systems. Addressing barriers to 911 use in Spanish-speaking communities could improve the equity of health care delivery, while also decreasing the amount of non-emergency 911 use.

  2. Job Burnout Status among Pre-Hospital Emergency Technicians

    Directory of Open Access Journals (Sweden)

    Zohre Moradi

    2015-02-01

    Full Text Available Introduction: Since pre-hospital emergency staff, who play a vital role in saving peoples’ lives, work under a lot of pressure, determining the rate and dangers of their job burnout is very important. Therefore, this study was carried out to determine the job burnout rate of the pre-hospital emergency staff in Isfahan, Iran. Methods: In this cross-sectional study, all of the pre-hospital emergency staff in all emergency operation centers in Isfahan were included. Using the standard Maslach burnout inventory questionnaire, the job burnout rate of emergency technicians was measured. The studied aspects were frequency and intensity of emotional exhaustion, depersonalization and personal accomplishment feeling, which were then divided into 3 levels (low, average and high according to the intensity and frequency of these feelings. Results: In the end, 68 technicians were involved in this study (Mean age 26.97±7.7; 42.6% single. Regarding intensity, their mean emotional exhaustion score was 25.59±20.39, depersonalization score was 10.57±7.83 and personal accomplishment feeling was 34.6±8.46. Moreover, the mean emotional exhaustion frequency was 21.21±11.95 (low level, depersonalization frequency was 8.94±5.43 (low level and personal accomplishment feeling frequency was 26.82±5.72 (high level. Conclusion: The data obtained in this study shows that the pre-hospital emergency technicians in Isfahan show average levels of emotional exhaustion and depersonalization intensity and frequency and feel highly unaccomplished.

  3. 社区医护人员院前急救知识和技能的培训现状及对策研究%Status of Prehospital Emergency Care Knowledge and Skill among Community Medical Staff and Countermeasures

    Institute of Scientific and Technical Information of China (English)

    温静; 赵渤; 吕书群; 刘辉

    2011-01-01

    目的 了解社区医护人员院前急救知识和技能的培训现状,探讨培训对策.方法 分层抽取宁夏回族自治区五个地级市的社区医护人员174人,采用自制调查表,通过小组问卷法于培训前后收集资料.调查内容包括一般情况、院前急救知识和技能相关情况、培训相关情况等.结果 本次共调查174人,平均年龄(30.99±7.90)岁.参加过院前急救知识和技能培训者62人(35.6%),共92人次;没有参加过任何形式培训者112人(64.4%).采用短期集中式培训,选用"十一五"国家级规划教材为培训教材,三甲医院急诊科高年资医师作为师资,培训形式采用面授讲座、练习、情景教学、考试.培训后社区医护人员的院前急救知识和技能相关问题的正确率与培训前比较,27题间差异有统计学意义(P<0.05),有不同程度提高.对培训方法 满意者148人(85.1%).结论 社区医护人员的院前急救知识和技能水平较低,应采用适宜方式进行培训.%Objective To understand the status of the prehospital medical care knowledge and skills of community doctors and nurses. and approach the training strategy. Methods The stratified random sampling was taken to recruit 174 doctors and nurses from community health services centers of 5 Cities in Ningxia. A self - made questionnaire survey was used to collect the data before and after the short - term training, including general information , prehospital medical care skills and knowledge ,and relevant information of training. Results The average age of them was ( 30. 99 ± 7. 90 ). There among them were 62 ( 35. 6% ) who once attended the training, with a total of 92 times; and 112 ( 64. 4% ) who did not participated in any form of training. A shirt - term centralized mode of training was adopted ; the texthook of emergency medicine in national plan series was taken as the material for training, and senior qualified doctors from emergency departments of the

  4. Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

    Directory of Open Access Journals (Sweden)

    Castrén Maaret

    2011-05-01

    Full Text Available Abstract Background Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. Methods The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. Results The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. Conclusions The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.

  5. Status of pre-hospital emergency medical service in China and abroad%国内外院前急救的现状

    Institute of Scientific and Technical Information of China (English)

    何美娟; 许玲玲; 马明丹; 帅先洁; 刘勇

    2016-01-01

    文章综述了国内外院前急救的模式、人员、物品管理、公众急救知识等方面的现状,分析了国外院前急救优势,为发展我国院前急救事业提供借鉴与参考。%The paper reviewed the status of domestic and overseas pre - hospital emergency medical service(EMS),including the models,staffing,item management,and general knowledge of the public. Then the paper analyzed the advantage of overseas pre - hospital emergency medical service,so as to provide suggestions and references for developing domestic pre - hospital emergency medical services.

  6. Analysis of the epidemiological prehospital emergency medical care in traumas%前急救创伤患者流行病学调查

    Institute of Scientific and Technical Information of China (English)

    袁逊; 余伟桂; 夏根玉

    2012-01-01

      目的研究院前创伤患者的流行病学特征,提高对创伤患者的救治能力.方法通过对2008年1月~2010年12月3年间笔者所在医院院前急救的6216例创伤患者进行回顾性分析,对患者性别、年龄、时间分布和致伤原因进行分析.结果院前创伤患者为6216例次,占同期院前总急救量的50.56%;男女性别比为2.55︰1.00;创伤高峰年龄为20~49岁,占71.64%;创伤的发生高峰时间为18点~第2日凌晨2点.致伤原因中,交通事故占44.03%,斗殴占29.05%,工伤13.48%,跌伤6.76%,坠落伤3.04%.创伤院前死亡占2.22%.结论交通事故与斗殴是院前创伤的主要原因,加强交通法规的宣传教育,加强社会治安的综合管理对预防和减少院前创伤具有重大意义.%  Objective To analyze the epidemiological character of prehospital trauma care, and increase cure ability in trauma. Methods 6216 cases of the prehospital trauma patients include genders, ages, time distributions and vulnerant reasons were collected by Tangxia hospital from Jan 2008 to Dec 2010 and was prospectively analyzed. Results Prehospital trauma were 6216(50.56%), male to femal was 2.55︰1.00,the peak of trauma were 20 to 49(71.64%), the peak of incidences from 18 to 2, among them, traffic accidents(44.03%), fights(29.05%), working and falling injuries(6.76%), crashes(3.04%), prehospital fatality (2.22%), traffic accidents and fights were two main reasons of prehospital. Conclusion Traffic accidents and fights were two main reasons of prehospital Trauma, improve education of traffic laws and public security are key to prevent and reduce prehospital trauma.

  7. Characteristics and prognoses of patients treated by an anaesthesiologist-manned prehospital emergency care unit

    DEFF Research Database (Denmark)

    Mikkelsen, Søren; Lossius, Hans Morten; Toft, Palle

    2017-01-01

    OBJECTIVE: When planning and dimensioning an emergency medical system, knowledge of the population serviced is vital. The amount of literature concerning the prehospital population is sparse. In order to add to the current body of literature regarding prehospital treatment, thus aiding future...... by a MECU operating in a mixed urban/rural area in Denmark from 1 May 2006 to 31 December 2014. Information on missions was extracted from the local MECU registry and linked at the individual level to the Danish population-based databases, the National Patient Registry and the Civil Registration System....... PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures were number of missions and number of patient contacts. Secondary patient variables were mortality and association between mortality and age, sex, comorbidity, prior admission to hospital and response time. RESULTS: The MECU completed 41 513...

  8. Characteristics and prognoses of patients treated by an anaesthesiologist-manned prehospital emergency care unit. A retrospective cohort study

    DEFF Research Database (Denmark)

    Mikkelsen, Søren; Lossius, Hans Morten; Toft, Palle

    2017-01-01

    public health planning, we describe the workload of a prehospital anaesthesiologist-manned mobile emergency care unit (MECU) and the total population it services in terms of factors associated with mortality. PARTICIPANTS: The study is a register-based study investigating all missions carried out......OBJECTIVE: When planning and dimensioning an emergency medical system, knowledge of the population serviced is vital. The amount of literature concerning the prehospital population is sparse. In order to add to the current body of literature regarding prehospital treatment, thus aiding future....... PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures were number of missions and number of patient contacts. Secondary patient variables were mortality and association between mortality and age, sex, comorbidity, prior admission to hospital and response time. RESULTS: The MECU completed 41 513...

  9. Study of Tranexamic Acid during Air Medical Prehospital Transport (STAAMP) Trial

    Science.gov (United States)

    2014-10-01

    during Air Medical Prehospital transport (STAAMP) trial PRINCIPAL INVESTIGATOR: Jason L. Sperry, MD, MPH CONTRACTING ORGANIZATION...Tranexamic acid during Air Medical Prehospital transport (STAAMP) trial 5b. GRANT NUMBER W81XWH-13-2-0080 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S...and explained the purpose of this study to Pittsburgh local and surrounding area. 15. SUBJECT TERMS Prehospital ; Tranexamic acid 16

  10. The value of the pre-hospital learning environment as part of the emergency nursing programme

    Directory of Open Access Journals (Sweden)

    Sonett van Wyk

    2015-06-01

    Conclusion: The research findings support the value and continuation of utilising the pre-hospital clinical learning environment for placing post-basic emergency nursing students when enrolled in the emergency nursing programme.

  11. Establishing a successful pre-hospital emergency service in a developing country: experience from Rescue 1122 service in Pakistan.

    Science.gov (United States)

    Waseem, Hunniya; Naseer, Rizwan; Razzak, Junaid Abdul

    2011-06-01

    As in many other developing countries, emergency medical services, especially pre-hospital emergency care, has long been neglected in Pakistan. Consequently, patients are brought to the emergency departments by relatives or bystanders in private cars, taxis or any other readily available mode of transportation. Ambulances, where they exist, have barely a stretcher and arrangements for oxygen supply. Modern emergency services are considered too costly for many countries. A model of pre-hospital emergency services, called Rescue 1122 and established in Punjab province of Pakistan, is presented. The system is supported by government funding and provides a quality service. The article describes the process of establishment of the service, the organisational structure, the scope of services and the role it is currently playing in the healthcare of the region it serves.

  12. Military Medical Revolution: Prehospital Combat Casualty Care

    Science.gov (United States)

    2012-01-01

    new topical hemostatic agents had received clearance from the US Food and Drug Administration (FDA) and were subjected to comprehensive studies in two...control resusci- tation (DCR), advanced airway maneuvers, and thoracic trau- ma management before arrival at a Role 2 facility led to the development of...this medical doctrine for catastrophic bleeding, airway protection, thoracic trauma management, and other clinical and nonclinical aspects are as follows

  13. Novel wireless electroencephalography system with a minimal preparation time for use in emergencies and prehospital care

    OpenAIRE

    Jakab, Andrei; Kulkas, Antti; Salpavaara, Timo; Kauppinen, Pasi; Verho, Jarmo; Heikkilä, Hannu; Jäntti, Ville

    2014-01-01

    Background Although clinical applications such as emergency medicine and prehospital care could benefit from a fast-mounting electroencephalography (EEG) recording system, the lack of specifically designed equipment restricts the use of EEG in these environments. Methods This paper describes the design and testing of a six-channel emergency EEG (emEEG) system with a rapid preparation time intended for use in emergency medicine and prehospital care. The novel system comprises a quick-applicati...

  14. Prehospital road traffic injuries among the elderly in Beijing, China:data from the Beijing Emergency Medical Center, 2004-2010

    Institute of Scientific and Technical Information of China (English)

    AN Shuai; ZHANG Jin-jun; ZHANG Pei-xun; YIN Xiao-feng; KOU Yu-hui; WANG Yan-hua; WANG Zhen-wei

    2013-01-01

    Background Road traffic injuries (RTIs) are a worldwide issue associated with increasing development and motorization.However,statistical studies do not include any analyses of Beijing's geriatric population.Using data from the Beijing Emergency Medical Center,we present the main characteristics of traffic injuries involving the elderly in Beijing.We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries.Methods In a longitudinal,retrospective study,data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010.Personal information,time of injury event,emergency care response time,road user type,striking vehicle type,injury site,and severity of injury were analyzed using x2 tests and Logistic regression analysis.Results The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing,and the morbidity rate decreased from 2004 to 2010 (P <0.001).The mean age was (72.92±5.67) years,and 911 (53.40%) of the victims were male.The majority of victims sustained head and lower limb injuries and were classified as being of medium severity.Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car (85.64%) and pedestrian victim injuries (79.19%).Our statistical analysis found three factors for injury severity:abdominal injuries (P <0.001),number of injury sites (P=0.027),and head injuries (P=0.034).The decline in traffic injuries is due to a decrease in victims aged 65-74 years and pedestrians; the severity of RTIs also decreased.Conclusions This study highlights the declining trend in traffic injuries among older adults in Beijing.However,traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.

  15. Between professional values and the social valuation of patients: the fluctuating economy of pre-hospital emergency work.

    Science.gov (United States)

    Nurok, Michael; Henckes, Nicolas

    2009-02-01

    A number of authors have shown how medical decisions are influenced by social values; others have minimized the putative influence of values and have argued that medical decisions are predominantly constrained by the organization of medical work. Based on fieldwork in France and the USA observing pre-hospital resuscitations, we seek to resolve these views by showing that while judgments about the social value of a patient do influence professional decisions, so do judgments about the work that must be accomplished to manage a case. Pre-hospital emergency work has many facets that are variably valued by different professionals at different moments of an emergency's trajectory. These values compete with each other in what we call a "fluctuating economy". This article analyses the role of social, technical, medical or surgical, heroic, and competence values in the course of pre-hospital emergency work. We show how these values may conflict or align with each other, forcing professionals to constantly establish priorities during an emergency trajectory.

  16. Taking the Blood Bank to the Field: The Design and Rationale of the Prehospital Air Medical Plasma (PAMPer) Trial.

    Science.gov (United States)

    Brown, Joshua B; Guyette, Francis X; Neal, Matthew D; Claridge, Jeffrey A; Daley, Brian J; Harbrecht, Brian G; Miller, Richard S; Phelan, Herb A; Adams, Peter W; Early, Barbara J; Peitzman, Andrew B; Billiar, Timothy R; Sperry, Jason L

    2015-01-01

    Hemorrhage and trauma induced coagulopathy remain major drivers of early preventable mortality in military and civilian trauma. Interest in the use of prehospital plasma in hemorrhaging patients as a primary resuscitation agent has grown recently. Trauma center-based damage control resuscitation using early and aggressive plasma transfusion has consistently demonstrated improved outcomes in hemorrhaging patients. Additionally, plasma has been shown to have several favorable immunomodulatory effects. Preliminary evidence with prehospital plasma transfusion has demonstrated feasibility and improved short-term outcomes. Applying state-of-the-art resuscitation strategies to the civilian prehospital arena is compelling. We describe here the rationale, design, and challenges of the Prehospital Air Medical Plasma (PAMPer) trial. The primary objective is to determine the effect of prehospital plasma transfusion during air medical transport on 30-day mortality in patients at risk for traumatic hemorrhage. This study is a multicenter cluster randomized clinical trial. The trial will enroll trauma patients with profound hypotension (SBP ≤ 70 mmHg) or hypotension (SBP 71-90 mmHg) and tachycardia (HR ≥ 108 bpm) from six level I trauma center air medical transport programs. The trial will also explore the effects of prehospital plasma transfusion on the coagulation and inflammatory response following injury. The trial will be conducted under exception for informed consent for emergency research with an investigational new drug approval from the U.S. Food and Drug Administration utilizing a multipronged community consultation process. It is one of three ongoing Department of Defense-funded trials aimed at expanding our understanding of the optimal therapeutic approaches to coagulopathy in the hemorrhaging trauma patient.

  17. Evolving prehospital, emergency department, and "inpatient" management models for geriatric emergencies.

    Science.gov (United States)

    Carpenter, Christopher R; Platts-Mills, Timothy F

    2013-02-01

    Alternative management methods are essential to ensure high-quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols to support early condition-specific treatment of older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to address the influence of other factors on the patient's health. This article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care.

  18. Helicopter Emergency Medical Services: effects, costs and benefits

    NARCIS (Netherlands)

    A.N. Ringburg (Akkie)

    2009-01-01

    textabstractAdvanced prehospital medical care with air transport was introduced in the Netherlands in May 1995. The fi rst helicopter Mobile Medical Team, also called Helicopter Emergency Medical Service (HEMS) was a joint venture initiative of the VU Medical Center in Amsterdam and the Algemene Ned

  19. Use of the Airtraq laryngoscope for emergency intubation in the prehospital setting: a randomized control trial.

    Science.gov (United States)

    Trimmel, Helmut; Kreutziger, Janett; Fertsak, Georg; Fitzka, Robert; Dittrich, Markus; Voelckel, Wolfgang G

    2011-03-01

    The optical Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) has been shown to have advantages when compared with direct laryngoscopy in difficult airway patients. Furthermore, it has been suggested that it is easy to use and handle even for inexperienced advanced life support providers. As such, we sought to assess whether the Airtraq may be a reliable alternative to conventional intubation when used in the prehospital setting. Prospective, randomized control trial in emergency patients requiring endotracheal intubation provided by anesthesiologists or emergency physicians responding with an emergency medical service helicopter or ground unit associated with the Department of Anesthesiology, General Hospital, Wiener Neustadt, Austria. During the 18-month study period, 212 patients were enrolled. When the Airtraq was used as first-line airway device (n=106) vs. direct laryngoscopy (n=106), success rate was 47% vs. 99%, respectively (pintubation were related to the fiber-optic characteristic of this device (i.e., impaired sight due to blood and vomitus, n=11) or to assumed handling problems (i.e., cuff damage, tube misplacement, or inappropriate visualization of the glottis, n=24). In 54 of 56 patients where Airtraq intubation failed, direct laryngoscopy was successful on the first attempt; in the remaining two and in one additional case of failed direct laryngoscopy, the airway was finally secured employing the Fastrach laryngeal mask. There was no correlation between success rates and body mass index, age, indication for airway management, emergency medical service unit, or experience of the physicians. Based on these results, the use of the Airtraq laryngoscope as a primary airway device cannot be recommended in the prehospital setting without significant clinical experience obtained in the operation room. We conclude that the clinical learning process of the Airtraq laryngoscope is much longer than reported in the anesthesia literature.

  20. Prehospital emergency care and injury prevention in Sudan

    Directory of Open Access Journals (Sweden)

    Khalid Elbashir

    2014-12-01

    Conclusion: Due to an absence of published literature in Sudan, much of the data have been recorded from paper records and empirical observations. Prehospital care and injury prevention in the Sudan is a recent initiative, but it is developing into a promising model with many opportunities for improvement. This momentum should be nurtured and requires a purposive, collective collaboration to draw a blueprint for a locally relevant, effective and efficient prehospital system in Sudan. It is hoped that this article will highlight and encourage further progress.

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  2. [Prehospital trauma care training course. Integration of emergency physician and rescue services].

    Science.gov (United States)

    Kopschina, C; Stangl, R

    2008-08-01

    With the emergence of a trauma network in the metropolitan area of Nuremberg, Germany, the question arose whether prehospital trauma management and emergency department management could be better integrated. A training scheme was designed for prehospital trauma care by the rescue services of the Workers' Samaritan Federation Germany (ASB), the Bavarian Red Cross, Maltese Ambulance, St. Johns Ambulance, representatives of the emergency physicians, and physicians of Rummelsberg Hospital. A detailed search of the international literature was done for all subjects regarding prehospital trauma management, and the American training systems (ITLS, PHTLS) were studied. The review was followed by a critical evaluation of the reality of on site-care, and the German and American systems were compared. A 2-day course with 6 sessions (accident place and kinetics, trauma investigation, pathologies, resuscitation, practical training, and evaluation) was developed, adapted from the Advanced Trauma Life Support (ATLS) algorithm. Special attention was given to the integration and position of the emergency physician in Germany, as well as to the defined authority of the rescue services. Conversion into practice was facilitated by teamwork. The course is free of charge to all rescue services and members of the concept group. With a qualified prehospital system that works smoothly with the ATLS concepts, improved prehospital care for trauma patients seems possible.

  3. Mobile prehospital emergency care: an analysis of implementation in the State of Rio de Janeiro, Brazil.

    Science.gov (United States)

    O'Dwyer, Gisele; Machado, Cristiani Vieira; Alves, Renan Paes; Salvador, Fernanda Gonçalves

    2016-06-01

    Mobile prehospital care is a key component of emergency care. The aim of this study was to analyze the implementation of the State of Rio de Janeiro's Mobile Emergency Medical Service (SAMU, acronym in Portuguese). The methodology employed included document analysis, visits to six SAMU emergency call centers, and semistructured interviews conducted with 12 local and state emergency care coordinators. The study's conceptual framework was based on Giddens' theory of structuration. Intergovernmental conflicts were observed between the state and municipal governments, and between municipal governments. Despite the shortage of hospital beds, the SAMUs in periphery regions were better integrated with the emergency care network than the metropolitan SAMUs. The steering committees were not very active and weaknesses were observed relating to the limited role played by the state government in funding, management, and monitoring. It was concluded that the SAMU implementation process in the state was marked by political tensions and management and coordination weaknesses. As a result, serious drawbacks remain in the coordination of the SAMU with the other health services and the regionalization of emergency care in the state.

  4. Determining the composition and benefit of the pre-hospital medical response team in the conflict setting.

    Science.gov (United States)

    Davis, P R; Rickards, A C; Ollerton, J E

    2007-12-01

    To determine the optimal composition o f the pre-hospital medical response team (MERT) and the value of pre-hospital critical care interventions in a military setting, and specifically to determine both the benefit of including a doctor in the pre-hospital response team and the relevance of the time and distance to definitive care. A comprehensive review of the literature incorporating a range of electronic search engines and hand searches of key journals. There was no level 1 evidence on which to base conclusions. The 15 most relevant articles were analysed in detail. There was one randomized controlled trial (level 2 evidence) that supports the inclusion of a doctor on MERT. Several cohort studies were identified that analysed the benefits of specific critical care interventions in the pre-hospital setting. A doctor with critical care skills deployed on the MERT is associated with improved survival in victims of major trauma. Specific critical care interventions including emergency endotracheal intubation and ventilation, and intercostal drainage are associated with improved survival and functional recovery in certain patients. These benefits appear to be more easily demonstrated for the rural and remote setting than for the urban setting.

  5. [Prehospital emergency care in Mexico City: the opportunities of the healthcare system].

    Science.gov (United States)

    Pinet, Luis M

    2005-01-01

    Unintentional vehicle traffic injuries cause 1.2 million preventable deaths per year worldwide, mostly affecting the population in their productive years of life. In Mexico, unintentional vehicle traffic injuries are one of the main causes of death; in Mexico City they account for 8% of deaths. Prehospital systems are set up to provide hospital medical care to the population, by means of a complex network that includes transportation, communications, resources (material, financial and human), and public participation. These systems may be designed in a variety of ways, depending on availability, capacity and quality of resources, according to specific community needs, always abiding by laws and regulations. In Mexico, several institutions and organizations offer prehospital services without being overseen in terms of coordination, regulation and performance evaluation, despite the high rates of morbidity and mortality due to injuries and preventable conditions amenable to effective therapy during the prehospital period. Prehospital care may contribute to decrease the morbidity and mortality rates of injuries requiring prompt medical care. Emphasis is made on the importance of assessing the performance of prehospital care, as well as on identification of needs for future development.

  6. Prehospital Medication Administration: A Randomised Study Comparing Intranasal and Intravenous Routes

    Directory of Open Access Journals (Sweden)

    Cian McDermott

    2012-01-01

    Full Text Available Introduction. Opioid overdose is an ever-increasing problem globally. Recent studies have demonstrated that intranasal (IN naloxone is a safe and effective alternative to traditional routes of naloxone administration for reversal of opioid overdose. Aims. This randomised controlled trial aimed to compare the time taken to deliver intranasal medication with that of intravenous (IV medication by advanced paramedic trainees. Methods. 18 advanced paramedic trainees administered either an IN or IV medication to a mannequin model in a classroom-based setting. The time taken for medication delivery was compared. End-user satisfaction was assessed using a 5-point questionnaire regarding ease of use and safety for both routes. Results. The mean time taken for the IN and IV group was 87.1 seconds and 178.2 seconds respectively. The difference in mean time taken was 91.1 seconds (95% confidence interval 55.2 seconds to 126.9 seconds, P≤0.0001. 89% of advanced paramedic trainees reported that the IN route was easier and safer to use than the IV route. Conclusion. This study demonstrates that, amongst advanced paramedic trainees, the IN route of medication administration is significantly faster, better accepted and perceived to be safer than using the IV route. Thus, IN medication administration could be considered more frequently when administering emergency medications in a pre-hospital setting.

  7. Protocol Adherence in Prehospital Medical Care Provided for Patients with Chest Pain and Loss of Consciousness; a Brief Report

    Directory of Open Access Journals (Sweden)

    Mostafa Mehrara

    2017-01-01

    Full Text Available Introduction: Although many protocols are available in the field of the prehospital medical care (PMC, there is still a notable gap between protocol based directions and applied clinical practice. This study measures the rate of protocol adherence in PMC provided for patients with chest pain and loss of consciousness (LOC.Method: In this cross-sectional study, 10 educated research assistants audited the situation of provided PMC for non-traumatic chest pain and LOC patients, presenting to the emergency department of a tertiary level teaching hospital, compare to national recommendations in these regards.Results: 101 cases with the mean age of 56.7 ± 12.3 years (30-78 were audited (55.4% male. 61 (60.3% patients had chest pain and 40 (39.7% cases had LOC. Protocol adherence rates for cardiac monitoring (62.3%, O2 therapy (32.8%, nitroglycerin administration (60.7%, and aspirin administration (52.5% in prehospital care of patients with chest pain were fair to poor. Protocol adherence rates for correct patient positioning (25%, O2 therapy (75%, cardiac monitoring (25%, pupils examination (25%, bedside glucometery (50%, and assessing for naloxone administration (55% in prehospital care of patients with LOC were fair to poor.Conclusion: There were more than 20% protocol violation regarding prehospital care of chest pain patients regarding cardiac monitoring, O2 therapy, and nitroglycerin and aspirin administration. There were same situation regarding O2 therapy, positioning, cardiac monitoring, pupils examination, bedside glucometery, and assessing for naloxone administration of LOC patients in prehospital setting.

  8. Nontraumatic Hypotension and Shock in the Emergency Department and the Prehospital setting, Prevalence, Etiology, and Mortality

    DEFF Research Database (Denmark)

    Holler, Jon Gitz; Bech, Camilla Nørgaard; Henriksen, Daniel Pilsgaard;

    2015-01-01

    studies in Epidemiology (STROBE-statement) to assess the quality. RESULTS: Six observational studies were considered eligible for analysis based on the evaluation of 11,880 identified papers. Prehospital prevalence of hypotension was 19.5/1000 emergency medicine service (EMS) contacts, and the prevalence...

  9. [Emergency medical aid in a paediatrics context].

    Science.gov (United States)

    Branchard, Delphine; Tentillier, Éric; Gillet, Stéphane; Naud, Julien

    2016-01-01

    In France, the organisation of aid involves the intervention of the emergency medical services (Samu), which coordinate the medical regulation platforms for site 15 and the mobile emergency and intensive care services (Smur). Since they were created, the Samu have been tirelessly adapting their response to the various characteristics of pre-hospital assignments. Pre- and inter-hospital paediatrics has seen the development of specialised teams with the aim of providing effective aid which is adapted to the youngest and most vulnerable patients.

  10. (Non-)utilization of pre-hospital emergency care by migrants and non-migrants in Germany.

    Science.gov (United States)

    Kietzmann, Diana; Knuth, Daniela; Schmidt, Silke

    2017-01-01

    This study was designed to explore the utilization and non-utilization of pre-hospital emergency care by migrants and non-migrants, and the factors that influence this behaviour. A cross-sectional representative German survey was conducted in a sample of 2.175 people, 295 of whom had a migration background. An additional sample of 50 people with Turkish migration background was conducted, partially in the Turkish language. Apart from socio-demographics, the utilization of emergency services and the reasons for non-utilization were assessed. Migrants had a higher utilization rate of pre-hospital emergency care (RR = 1.492) than non-migrants. Furthermore, migrants who were not born in Germany had a lower utilization rate (RR = 0.793) than migrants who were born in Germany. Regarding non-utilization, the most frequently stated reasons belonged to the categories initial misjudgment of the emergency situation and acting on one's own behalf, with the latter stated more frequently by migrants than by non-migrants. To prevent over-, under-, and lack of supply, it is necessary to transfer knowledge about the functioning of the medical emergency services, including first aid knowledge.

  11. EMS Attitudes Towards Geriatric Prehospital Care And Continuing Medical Education in Geriatrics

    Science.gov (United States)

    Peterson, Lars-Kristofer N.; Fairbanks, Rollin J.; Hettinger, Aaron Z.; Shah, Manish N.

    2008-01-01

    Objectives To understand the opinions of emergency medical service (EMS) providers regarding their ability to care for older adults, the domains of geriatric medicine in which they need more training, and the modality through which continuing education could be best delivered. Design Qualitative study using key informant interviews. Setting Prehospital EMS system in Rochester, New York. Participants EMS providers, EMS instructors and administrators, emergency physicians, and geriatricians. Outcome Measures Semi-structured interviews were conducted using an interview guide that addressed the following domains: 1)knowledge and skill deficiencies; 2)recommendations for improvement of geriatrics continuing education; 3)delivery methods of education. Results Participant responses were generally congruous despite the diverse backgrounds, and redundancy was achieved rapidly. All participants perceived a deficit in EMS education on the care of older adults, particularly related to communications with patients and skilled nursing facility staff. All desired more geriatric continuing education for EMS providers, especially in communications and psychosocial issues. Education was desired in various modalities. Conclusion Further geriatrics continuing education for EMS providers is needed. Some specific topics relate to medical issues, but a large proportion involve communications and psychosocial issues. Education should be delivered in a variety of modalities to meet the needs of the EMS community. Emerging online video technologies may bridge the gap between learners preferring classroom based modailities and those preferring self-study modules. PMID:19170777

  12. Exploration of key stakeholders' preferences for pre-hospital physiologic monitoring by emergency rescue services.

    Science.gov (United States)

    Mort, Alasdair J; Rushworth, Gordon F

    2013-12-01

    To gather preferences for novel pre-hospital physiologic monitoring technologies from emergency rescue services. Qualitative semi-structured interviews and focus groups were conducted with three groups from UK Search and Rescue (SAR); (1) Extractors (e.g. SAR teams), (2) Transporters (personnel primarily responsible for casualty transport), and (3) Treaters (e.g. Emergency Department doctors). Three themes were defined; SAR casualty management, novel physiologic monitor potential, and physiologic monitor physical properties. Some SAR groups already employed physiologic monitoring but there was no consensus on which monitor(s) to carry or what to monitor and how frequently. Existing monitors also tended to be bulky and heavy and could be unreliable in an unstable environment or if the casualty was cold. Those performing monitoring tended to have only basic first-aid training, and their workload was often high particularly if there was more than one casualty. The potential benefits of employing a novel monitor were strategic and clinical; an opportunity for transmitting data off-scene in order to facilitate monitoring or generate advice (i.e. telemedicine) was also voiced. A range of more intuitive, physical properties was also raised (e.g. small/compact, lightweight). SAR-specific technology should be simple to operate by those with less medical training, which means that clinical data interpretation and presentation should be carefully considered. It would be beneficial if novel monitors carried out a majority of the interpretation, allowing rescuers to proceed with their priority task of removing the casualty to safety.

  13. Large discrepancy between prehospital visitation to mobile emergency care unit and discharge diagnosis

    DEFF Research Database (Denmark)

    Holler, Christine Puck; Wichmann, Sine; Nielsen, Søren Loumann

    2012-01-01

    In Copenhagen, Denmark, patients in need of prehospital emergency assistance dial 112 and may then receive evaluation and treatment by physicians (from the Mobile Emergency Care Unit (MECU)). ST-elevation myocardial infarction (STEMI) is a severe condition leaving only a limited time frame to del...... diagnosis on the scene and, furthermore, to compare these on-scene diagnoses with the primary discharge diagnoses from hospital....

  14. Pediatric emergency medical services and their drawbacks

    Directory of Open Access Journals (Sweden)

    Abdullah Foraih Al-Anazi

    2012-01-01

    Full Text Available Aim: To survey the literature on Pediatric Emergency Medical Services (PEMS with an aim to focus its drawbacks and emphasize the means of improvement. Materials and Methods: Published articles selected for inclusion were based on the significance and understanding of literature search on different aspects of PEMS. To meet this criterion, PubMed, PubMed Central, Science Direct, Uptodate, Med Line, comprehensive databases, Cochrane library and the Internet (Google, Yahoo were thoroughly searched. Results: PEMS provide out-of-hospital medical care and/or transport the patients to definitive care. The task force represents specialties of ambulance transport, first aid, emergency medical care, life saving, trauma, emergency medicine, water rescue, and extrication. Preliminary care is undertaken to save the patients from different medical exigencies. The techniques and procedures of basic and advanced life-support are employed. A large number of weaknesses are recorded in PEMS system, such as ambulance transport irregularities, deficit equipment, lack of expertise, and ignorance of the pre-hospital care providers. These are discussed with special reference to a few examples of medical exigencies. Conclusions: The appointments in PEMS should be regularized with specific qualifications, experience, and expertise in different areas. Responsibility of PEMS should not be left to pre-hospital care providers, who are non clinicians and lack proper education and training. Pediatricians should be adequately trained to play an active role in PEMS. Meetings should be convened to discuss the lapses and means of improvement. Networks of co-operation between pre-hospital providers and experts in the emergency department should be established.

  15. National Apprenticeship and Training Standards for Emergency Medical Technicians.

    Science.gov (United States)

    Employment and Training Administration (DOL), Washington, DC.

    Developed jointly by several professional organizations and government agencies, these national standards depict the essential skills, knowledge, and ability required of certified emergency medical technicians (EMT) to provide optimal prehospital care and transportation to the sick and injured. Topics covered include definitions of terms EMT's…

  16. Effects of Crew Resource Management Training on Medical Errors in a Simulated Prehospital Setting

    Science.gov (United States)

    Carhart, Elliot D.

    2012-01-01

    This applied dissertation investigated the effect of crew resource management (CRM) training on medical errors in a simulated prehospital setting. Specific areas addressed by this program included situational awareness, decision making, task management, teamwork, and communication. This study is believed to be the first investigation of CRM…

  17. [Pre-hospital observation as an alternative to emergency hospitalisation].

    Science.gov (United States)

    Jensvold, Morten; Seim, Arnfinn

    2014-09-30

    Pre-hospital observation beds in community care centres have for many years served as an alternative to hospitalisation in rural districts of Norway. The article presents the use of observation beds associated with the Fosen A&E centre. A retrospective review of records of patients who had contacted Fosen A&E centre during the period 21 August 2006-21 August 2009 was undertaken. Patient characteristics and clinical pathways were registered, including admissions to hospital or to an observation bed, as well as re-admissions. Ever since observation beds were first introduced, clear inclusion and exclusion criteria have been applied with regard to the allocation of patients to observation beds. Altogether 8027 patients had been in direct contact with an A&E doctor, and 2342 were admitted, of whom 77% to hospital and 23% to an observation bed. Of the 530 patients admitted to an observation bed, 55% were 70 years or older. Of these, 68% were discharged to their homes within 36 hours, 17% were transferred to hospital, and the remainder received further treatment in a local rehabilitation unit or nursing home. The rate of readmission to observation beds or hospital amounted to 4% among those who had been discharged after no more than three days, and 18% among those discharged after 3-28 days. A low number of readmissions may indicate that the use of observation beds is an alternative to hospitalisation.

  18. Use of the GlideScope Ranger Video Laryngoscope for Emergency Intubation in the Prehospital Setting: A Randomized Control Trial.

    Science.gov (United States)

    Trimmel, Helmut; Kreutziger, Janett; Fitzka, Robert; Szüts, Stephan; Derdak, Christoph; Koch, Elisabeth; Erwied, Boris; Voelckel, Wolfgang G

    2016-07-01

    We sought to assess whether the GlideScope Ranger video laryngoscope may be a reliable alternative to direct laryngoscopy in the prehospital setting. Multicenter, prospective, randomized, control trial with patient recruitment over 18 months. Four study centers operating physician-staffed rescue helicopters or ground units in Austria and Norway. Adult emergency patients requiring endotracheal intubation. Airway management strictly following a prehospital algorithm. First and second intubation attempt employing GlideScope or direct laryngoscopy as randomized; third attempt crossover. After three failed intubation attempts, immediate use of an extraglottic airway device. A total of 326 patients were enrolled. Success rate with the GlideScope (n = 168) versus direct laryngoscopy (n = 158) group was 61.9% (104/168) versus 96.2% (152/158), respectively (p intubation were failure to advance the tube into the larynx or trachea (26/168 vs 0/158; p intubation failed, direct laryngoscopy was successful in 61 of 64 patients (95.3%), whereas GlideScope enabled intubation in four of six cases (66.7%) where direct laryngoscopy failed (p = 0.055). In addition, GlideScope was prone to impaired visualization of the monitor because of ambient light (29/168; 17.3%). There was no correlation between success rates and body mass index, age, indication for airway management, or experience of the physicians, respectively. Video laryngoscopy is an established tool in difficult airway management, but our results shed light on the specific problems in the emergency medical service setting. Prehospital use of the GlideScope was associated with some major problems, thus resulting in a lower intubation success rate when compared with direct laryngoscopy.

  19. Emergency Medical Services

    Science.gov (United States)

    ... and need help right away, you should use emergency medical services. These services use specially trained people and specially equipped facilities. You may need care in the hospital emergency room (ER). Doctors and nurses there treat emergencies, ...

  20. Can the critically ill consent to participation in commercial television programmes? An Australian prehospital and emergency medicine perspective.

    Science.gov (United States)

    Mackenney, Jonathan N

    2015-08-01

    The fly-on-the-wall medical documentary is a popular television phenomenon. When patients can give appropriate consent to filming, the final product can be both educational for the public and rewarding for its subjects. However, in the dynamic world of emergency and prehospital medicine, consenting critically ill patients before filming is a significant challenge. The main barriers to gaining valid consent in the field and in the ED are limited time to inform the patient and the diminished capacity of the sick patient. Although there is an argument that involvement in a commercial film might be beneficial to several parties, including the patient, these benefits do not amount to therapeutic necessity if prior consent is not obtainable. Despite this, we still see acutely incapacitated patients featured in some television programmes. In these cases, the conventional process of consent might be being sidestepped in order to obtain permission for broadcast retrospectively. This alternative process fails to recognise that incapacitated patients require protection from an invasion of privacy that occurs when a crew is filming their resuscitations. This harm has already occurred by the time consent is sought. Ultimate responsibility for defending the patients' interests during their medical treatment rests with the medical practitioner. We argue that filming a patient without prior consent in both the prehospital and emergency environment is ethically unsound: it threatens trust in the healthcare relationship and might compromise the patient's dignity and privacy. Robust guidelines should be developed for all healthcare professionals who engage with commercial film crews. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  1. Prehospital emergency care training practices regarding lesbian, gay, bisexual, and transgender patients in Maryland (USA).

    Science.gov (United States)

    Jalali, Sara; Levy, Matthew J; Tang, Nelson

    2015-04-01

    Prehospital Emergency Medical Services (EMS) providers are expected to treat all patients the same, regardless of race, gender identity, sexual orientation, or religion. Some EMS personnel who are poorly trained in working with lesbian, gay, bisexual, and transgender (LGBT) patients are at risk for managing such patients incompletely and possibly incorrectly. During emergency situations, such mistreatment has meant the difference between life and death. An anonymous survey was electronically distributed to EMS educational program directors in Maryland (USA). The survey asked participants if their program included training cultural sensitivity, and if so, by what modalities. Specific questions then focused on information about LGBT education, as well as related topics, that they, as program directors, would want included in an online training module. A total of 20 programs met inclusion criteria for the study, and 16 (80%) of these programs completed the survey. All but one program (15, 94%) included cultural sensitivity training. One-third (6, 38%) of the programs reported already teaching LGBT-related issues specifically. Three-quarters of the programs that responded (12, 75%) were willing to include LGBT-related material into their curriculum. All programs (16, 100%) identified specific aspects of LGBT-related emergency health issues they would be interested in having included in an educational module. Most EMS educational program directors in Maryland are receptive to including LGBT-specific education into their curricula. The information gathered in this survey may help guide the development of a short, self-contained, open-access module for EMS educational programs. Further research, on a broader scale and with greater geographic sampling, is needed to assess the practices of EMS educators on a national level.

  2. Evaluation of emergency tourniquets for prehospital use in China

    Institute of Scientific and Technical Information of China (English)

    GUO Jun-yan; LIU Yu; MA Yan-lan; PI Hong-ying; WANG Jian-rong

    2011-01-01

    Objective: Massive hemorrhage is lifethreatening during armed conflicts. Tourniquets are important medical devices used to reduce severe bleeding in trauma. The aim of this study was to empirically evaluate the current tourniquets used in China and provide information to emergency nurses in selecting the appropriate tourniquet.Methods: Five tourniquets were self-applied by 20healthy participants. The blood flow distal to the tourniquet site was assessed using vascular Doppler ultrasound.Application time, pain, numbness, and other parameters were evaluated.Results: The bladder tourniquet and windlass tourniquet effectively occluded arterial blood flow with success rates higher than 75% in both the upper and lower extremities. The Cargo-strap was the fastest to apply, taking (7.22±2.30) s for the upper extremity and (6.48±2.40) s for the lower extremity. The rubber tube was the most painful, and the improvised tourniquet was the least efficient. The success rates were higher in the lower extremity than in the upper extremity (P<0.05, X2=5.714).Conclusions: The bladder tourniquet and the windlass tourniquet are efficient tourniquets, although the windlass is superior with respect to portability and pain. The Cargo-strap and rubber tourniquets have several disadvantages that reduce their suitability for field use. The improvised tourniquet is not recommended because of low efficiency and severe pain during implementation.

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

    Science.gov (United States)

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

    2006-01-01

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

  4. Physician-based emergency medical service deployment characteristics in severe traumatic brain injury : A Dutch multicenter study

    NARCIS (Netherlands)

    Franschman, G.; Andriessen, T. M. J. C.; Boer, C.; Van der Naalt, J.; Horn, J.; Haitsma, I.; Vos, P. E.

    2013-01-01

    Introduction: Prehospital guidelines advise advanced life support in all patients with severe traumatic brain injury (TBI). In the Netherlands, it is recommended that prehospital advanced life support is particularly provided by a physician-based helicopter emergency medical service (P-HEMS) in addi

  5. 提高院前急救调度信息质量探讨%Discussion on improving the quality of dispatching information during prehospital emergency care

    Institute of Scientific and Technical Information of China (English)

    吴敏; 邱晨; 纪学颖; 陈志刚

    2016-01-01

    Prehospital emergency care is the first stage of emergency medical services system while dispatching is the prelude to prehospital emergency care. Therefore, dispatching must be improved in terms of information quality so that rescue efficiency and level can be raised while at the same time the wear and tear of equipment and the energy of paramedics can be reduced. In this way, effective medical resources can be reasonably utilized and the ability of prehospital emergency care and dealing with sudden public event can be enhanced.%院前急救是急诊医疗服务体系中的首要环节。指挥调度工作是院前急救工作的前哨,调度工作必须提高调度信息质量,才能在提高救治效率和水平的同时,减少急救设施的损耗和急救人员的精力损耗,进一步合理利用有效医疗资源,提高院前急救能力和应对突发公共卫生事件能力。

  6. Examining Career Success of Minority and Women Emergency Medical Technicians (EMTs): A LEADS Project

    Science.gov (United States)

    Russ-Eft, Darlene F.; Dickison, Philip D.; Levine, Roger

    2008-01-01

    Emergency medical technicians (EMTs) are a critical segment in prehospital medical care. This study examined EMT-paramedic career success focused on minorities and women, as part of the Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS). The LEADS data come from a representative sampling of EMTs throughout the…

  7. The nurse-patient relationship in pre-hospital emergency care--from the perspective of Swedish specialist ambulance nursing students.

    Science.gov (United States)

    Berntsson, Tommy; Hildingh, Cathrine

    2013-10-01

    The development of the Swedish ambulance service has resulted in three different competence levels in Swedish ambulance teams: specialist ambulance nurses, registered nurses and emergency medical technicians. A nursing scientific model developed by Peplau (Peplau, H., 1991. Interpersonal Relations in Nursing. Springer Publishing Company, New York.) breaks down the nurse-patient relationship into a number of phases: an orientation, an identification, an exploitation and a resolution phase. This model has then been adapted to the pre-hospital emergency care by Suserud (Dahlberg, K., Segesten, K., Nyström, M., Suserud, B.-O., Fagerberg, I., 2003. Att förstå vårdvetenskap [To Understand Caring Science]. Studentlitteratur, Lund.). The purpose of this study was to explore, by direct content analysis, how the phases of the pre-hospital nurse-patient relationship described by Suserud (Dahlberg et al., 2003), emerge in 17 specialist ambulance nursing students descriptions of ambulance missions. The results show that the four phases of the pre-hospital nurse-patient relationship could be identified and each phase includes several different parts. Furthermore, the results show that the parts of each phase can vary depending on the patient's condition and the environmental circumstances of the ambulance mission. This improved understanding of the four phases of the pre-hospital nurse-patient relationship, and their parts, could be used by ambulance team members as a support during the pre-hospital caring process in ambulance missions. This new knowledge could also be used in education. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Facilities and regionalization--emergency medical services systems.

    Science.gov (United States)

    Stewart, R D

    1990-02-01

    Advanced life support and the modern EMS system were born out of the hope that by extending hospital emergency facilities outside the bounds of the hospital, earlier and more intensive care could be provided to those patients requiring it. EMS systems have since left the nest and only recently, following a turbulent adolescence, is prehospital care returning as a partner with the medical facilities and physicians that presided over their modern origins. The next decade will see the continuing trend toward hospitals and practitioners regaining some influence in the design and direction of prehospital care.

  9. Outcome following physician supervised prehospital resuscitation

    DEFF Research Database (Denmark)

    Mikkelsen, Søren; Krüger, Andreas J; Zwisler, Stine T

    2015-01-01

    patient were manually established in each case in a combined audit of the prehospital database, the discharge summary of the MECU and the medical records from the hospital. Outcome parameters were final outcome, the aetiology of the life-threatening condition and the level of competences necessary...... to their own home. CONCLUSIONS: The present study demonstrates that anaesthesiologist administrated prehospital therapy increases the level of treatment modalities leading to an increased survival in relation to a prehospital system consisting of emergency medical technicians and paramedics alone and thus...

  10. Large discrepancy between prehospital visitation to mobile emergency care unit and discharge diagnosis

    DEFF Research Database (Denmark)

    Holler, Christine Puck; Wichmann, Sine; Nielsen, Søren Loumann

    2012-01-01

    In Copenhagen, Denmark, patients in need of prehospital emergency assistance dial 112 and may then receive evaluation and treatment by physicians (from the Mobile Emergency Care Unit (MECU)). ST-elevation myocardial infarction (STEMI) is a severe condition leaving only a limited time frame...... to deliver optimal care in the form of percutaneous transluminal coronary angioplasty. In theory, all patients with chest pain could have STEMI. The aim of this study was to study which of the patients suspected of having acute cardiac disease based on the 112 calls and met by the MECU were given a cardiac...

  11. Incidence of difficult airway situations during prehospital airway management by emergency physicians--a retrospective analysis of 692 consecutive patients.

    Science.gov (United States)

    Thoeni, Nils; Piegeler, Tobias; Brueesch, Martin; Sulser, Simon; Haas, Thorsten; Mueller, Stefan M; Seifert, Burkhardt; Spahn, Donat R; Ruetzler, Kurt

    2015-05-01

    In the prehospital setting, advanced airway management is challenging as it is frequently affected by facial trauma, pharyngeal obstruction or limited access to the patient and/or the patient's airway. Therefore, incidence of prehospital difficult airway management is likely to be higher compared to the in-hospital setting and success rates of advanced airway management range between 80 and 99%. 3961 patients treated by an emergency physician in Zurich, Switzerland were included in this retrospective analysis in order to determine the incidence of a difficult airway along with potential circumstantial risk factors like gender, necessity of CPR, NACA score, GCS, use and type of muscle relaxant and use of hypnotic drugs. 692 patients underwent advanced prehospital airway management. Seven patients were excluded due to incomplete or incongruent documentation, resulting in 685 patients included in the statistical analysis. Difficult intubation was recorded in 22 patients, representing an incidence of a difficult airway of 3.2%. Of these 22 patients, 15 patients were intubated successfully, whereas seven patients (1%) had to be ventilated with a bag valve mask during the whole procedure. In this physician-led service one out of five prehospital patients requires airway management. Incidence of advanced prehospital difficult airway management is 3.2% and eventual success rate is 99%, if performed by trained emergency physicians. A total of 1% of all prehospital intubation attempts failed and alternative airway device was necessary. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Emergency medical services in India: the present and future.

    Science.gov (United States)

    Sharma, Mohit; Brandler, Ethan S

    2014-06-01

    India is the second most populous country in the world. Currently, India does not have a centralized body which provides guidelines for training and operation of Emergency Medical Services (EMS). Emergency Medical Services are fragmented and not accessible throughout the country. Most people do not know the number to call in case of an emergency; services such as Dial 108/102/1298 Ambulances, Centralized Accident and Trauma Service (CATS), and private ambulance models exist with wide variability in their dispatch and transport capabilities. Variability also exists in EMS education standards with the recent establishment of courses like Emergency Medical Technician-Basic/Advanced, Paramedic, Prehospital Trauma Technician, Diploma Trauma Technician, and Postgraduate Diploma in EMS. This report highlights recommendations that have been put forth to help optimize the Indian prehospital emergency care system, including regionalization of EMS, better training opportunities, budgetary provisions, and improving awareness among the general community. The importance of public and private partnerships in implementing an organized prehospital care system in India discussed in the report may be a reasonable solution for improved EMS in other developing countries.

  13. Prehospital identification of stroke - room for improvement

    DEFF Research Database (Denmark)

    Fischer, C.E.; Barnung, S.; Nielsen, S.L.;

    2008-01-01

    INTRODUCTION: Rapid recognition of stroke is important because it allows early brain imaging and management such as thrombolytic therapy. We evaluated the identification of the diagnosis acute cerebrovascular incident in a physician-based prehospital emergency medical system. METHODS: From...... cerebrovascular incident in the prehospital setting with room and need for improvement in order to allow appropriate and expeditious referral for thrombolytic therapy Udgivelsesdato: 2008/8...

  14. The Countermeasures for the Problems Neglected of Pre-hospital Emergency Personal in our Country%我国院前急救人员被忽视的若干问题与对策

    Institute of Scientific and Technical Information of China (English)

    郑进

    2012-01-01

    Pre-hospital emergency care is an weak link of EMSS in China. This paper analyzed some problems which neglected in our country; (1)the nutrition of Prehospital emergency personnel;(2) the psychology of Pre-hospital emergency personnel; (3)the personal protection of Pre-hospital emergency personnel;(4) the occupation? established of emergency medical technician; (5)The success rate of rescue for Pre-hospital emergency care; (6)the time of emergency respond; (7) the international language of Pre-hospital emergency personnel; (8)the confusion of identifying marks on ambulance;(9) the constitution of male and female for Pre-hospital personnel; (10)the lack of philosophy idea of Pre-hospital emergency personnel, and propound the countermeasures for this problems also it may be beneficial to reformation and development for our Pre - hospital emergency care.%院前急救是我国急救医疗服务体系的薄弱环节,目前尚存在一些问题.本文分析了我国院前急救人员被忽视的若干问题:(1)院前急救人员的营养问题;(2)院前急救人员的心理问题;(3)院前急救人员的个人防护问题;(4)医疗救护员职业设置问题;(5)院前急救成功率问题;(6)急救反应时间问题;(7)院前急救人员的语言国际化问题;(8)急救车辆标识问题;(9)院前急救人员性别组成问题;(10)院前急救人员哲学理念缺失问题等,并提出了解决这些问题的相应对策.对我国院前急救事业的改革和发展或有促进作用.

  15. Medical emergencies in Goa

    Directory of Open Access Journals (Sweden)

    Saddichha Sahoo

    2010-01-01

    Full Text Available Background: Most emergencies in Goa arise due to road traffic accidents and drowning, which have been compounded by the rise in number of recorded accidents in 2007 to be above 4000. It is believed that 11 people meet with an accident on Goa′s roads every day and this is expected to rise by 10% by next year. Similar is the case with drownings and other medical emergencies. We therefore aimed to conduct a cross-sectional survey of medical emergencies and identify various types of emergencies presenting to emergency departments. Materials and Methods: Using a stratified random sampling design, all emergencies presenting to the three government hospitals in Goa, which handle 90% of all emergencies currently, were studied on specially designed data sheets in order to collect data. Emergency medical technicians (ETs were placed in the Casualty Ward of the medical colleges and they recorded all emergencies on the data sheet. The collected data were then analyzed for stratification and mapping of emergencies. Results: GMC Hospital attended to majority of emergencies (62%, which were mainly of the nature of accidents or assaults (17% and fever related (17%. Most emergencies were noncritical and about 1% expired. Maximum emergencies also presented from Salcette and Bardez, and occurred among young males in the age group of 19-45 years. Males were also more prone to accidents while females had pregnancies as emergencies. Conclusion: Potential emergency services need to target young males with higher concentrations required in Salcette in South Goa and Bardez in North Goa.

  16. The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI – A case report

    Directory of Open Access Journals (Sweden)

    Robert Gałązkowski

    2014-04-01

    Full Text Available In 2013 a fire broke out in the Nursing Home (NH in the Henryszew village 5 km away from the district hospital in Żyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI. Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary. Med Pr 2014;65(2:289–295

  17. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

    Directory of Open Access Journals (Sweden)

    Rodrigo Assis Neves Dantas

    2015-06-01

    Full Text Available OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K and Content Validity Index (CVI, considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.

  18. Pre-hospital and hospital emergency nursing of cohesion%院前与院内急救护理工作的衔接

    Institute of Scientific and Technical Information of China (English)

    沙丽华

    2015-01-01

    随着我国急诊医疗服务系统、急救网络的逐步形成,急诊急救工作飞速发展,急诊急救护理水平和质量也有了极大的提高,急救护理在急诊医疗服务系统中显现出举足轻重的地位和作用。急救护理是护理学科的一个分支,在其任务、功能和职责方面具有独立性、综合性与协作性,急救医疗服务(emergency medical service,EMS)包括院前急救、院内急救两部分,两者联系紧密、不可分割。%With the emergency medical service system in China, first aid network gradually formed and emergency first-aid work rapid development, emergency first aid levels and quality have greatly improved, emergency care in emergency medical services system shows the important position and role. Emergency care is a branch of nursing discipline, in terms of its task, function and responsibility independence, and the collaborative, comprehensive emergency medical services (emergency medical service, EMS) including pre-hospital first aid, hospital emergency two parts, both closely linked, inseparable.

  19. Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

    Science.gov (United States)

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

    2014-01-01

    Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

  20. Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities

    Directory of Open Access Journals (Sweden)

    Abbasali Ebrahimian

    2014-01-01

    Full Text Available Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: “degree of perceived risk in EMS staffs and their patients.” This theme consisted of two main categories: (1 patient’s condition’ and (2 the context of the EMS mission’. The patent’s condition category emerged from “physical health statuses,” “socioeconomic statuses,” and “cultural background” subcategories. The context of the EMS mission also emerged from two subcategories of “characteristics of the mission” and EMS staffs characteristics’. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients’ needs for transportation in a prehospital situation.

  1. Emergency Medical Service

    Science.gov (United States)

    1980-01-01

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

  2. Systolic blood pressure and short-term mortality in the emergency department and prehospital setting

    DEFF Research Database (Denmark)

    Kristensen, Anders Kasper Bruun; Holler, Jon Gitz; Mikkelsen, Søren;

    2015-01-01

    staffed mobile emergency care unit in Odense between 2007 and 2013. We used the first recorded systolic blood pressure and the main outcome was 7-day mortality. Best performing thresholds were identified with methods based on receiver operating characteristics (ROC) and multivariate regression......INTRODUCTION: Systolic blood pressure is a widely used tool to assess circulatory function in acutely ill patients. The systolic blood pressure limit where a given patient should be considered hypotensive is the subject of debate and recent studies have advocated higher systolic blood pressure...... thresholds than the traditional 90 mmHg. The aim of this study was to identify the best performing systolic blood pressure thresholds with regards to predicting 7-day mortality and to evaluate the applicability of these in the emergency department as well as in the prehospital setting. METHODS...

  3. Novel wireless electroencephalography system with a minimal preparation time for use in emergencies and prehospital care.

    Science.gov (United States)

    Jakab, Andrei; Kulkas, Antti; Salpavaara, Timo; Kauppinen, Pasi; Verho, Jarmo; Heikkilä, Hannu; Jäntti, Ville

    2014-05-08

    Although clinical applications such as emergency medicine and prehospital care could benefit from a fast-mounting electroencephalography (EEG) recording system, the lack of specifically designed equipment restricts the use of EEG in these environments. This paper describes the design and testing of a six-channel emergency EEG (emEEG) system with a rapid preparation time intended for use in emergency medicine and prehospital care. The novel system comprises a quick-application cap, a device for recording and transmitting the EEG wirelessly to a computer, and custom software for displaying and streaming the data in real-time to a hospital. Bench testing was conducted, as well as healthy volunteer and patient measurements in three different environments: a hospital EEG laboratory, an intensive care unit, and an ambulance. The EEG data was evaluated by two experienced clinical neurophysiologists and compared with recordings from a commercial system. The bench tests demonstrated that the emEEG system's performance is comparable to that of a commercial system while the healthy volunteer and patient measurements confirmed that the system can be applied quickly and that it records quality EEG data in a variety of environments. Furthermore, the recorded data was judged to be of diagnostic quality by two experienced clinical neurophysiologists. In the future, the emEEG system may be used to record high-quality EEG data in emergency medicine and during ambulance transportation. Its use could lead to a faster diagnostic, a more accurate treatment, and a shorter recovery time for patients with neurological brain disorders.

  4. [Prehospital management of febrile convulsions by the Mobile Emergency Care Unit in the Capital Region of Denmark

    DEFF Research Database (Denmark)

    Lindekaer, A.L.; Nielsen, S.L.; Pedersen, Ulf Gøttrup

    2008-01-01

    INTRODUCTION: We conducted a quality assurance project of The Mobile Emergency Care Unit (MECU) in the Capital Region of Denmark when dispatched to febrile convulsions. The study focuses on prehospital treatment, comparison between prehospital and in-hospital diagnoses and parents' perceptions...... of their child's febrile convulsions and their satisfaction with the MECU. MATERIAL AND METHODS: The period of investigation was from March 1st 2004 to March 31st 2005. Children with a diagnosis of febrile convulsions or relevant differential diagnoses were eligible for inclusion. Children were excluded...... should still be dispatched primarily to febrile convulsions Udgivelsesdato: 2008/11/24...

  5. Limited evidence for intranasal fentanyl in the emergency department and the prehospital setting--a systematic review

    DEFF Research Database (Denmark)

    Hansen, Morten Sejer; Dahl, Jørgen Berg

    2013-01-01

    The intranasal (IN) mode of application may be a valuable asset in non-invasive pain management. Fentanyl demonstrates pharmacokinetic and pharmacodynamic properties that are desirable in the management of acute pain, and IN fentanyl may be of value in the prehospital setting. The aim of this sys......The intranasal (IN) mode of application may be a valuable asset in non-invasive pain management. Fentanyl demonstrates pharmacokinetic and pharmacodynamic properties that are desirable in the management of acute pain, and IN fentanyl may be of value in the prehospital setting. The aim...... of this systematic review was to evaluate the current evidence for the use of IN fentanyl in the emergency department (ED) and prehospital setting....

  6. Why and when citizens call for emergency help

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Ersbøll, Annette Kjær; Tolstrup, Janne Schurmann

    2015-01-01

    BACKGROUND: A medical emergency call is citizens' access to pre-hospital emergency care and ambulance services. Emergency medical dispatchers are gatekeepers to provision of pre-hospital resources and possibly hospital admissions. We explored causes for access, emergency priority levels, and temp......, and ultimately development of best practice in the area of emergency medicine.......BACKGROUND: A medical emergency call is citizens' access to pre-hospital emergency care and ambulance services. Emergency medical dispatchers are gatekeepers to provision of pre-hospital resources and possibly hospital admissions. We explored causes for access, emergency priority levels...

  7. Does a pre-hospital emergency pathway improve early diagnosis and referral in suspected stroke patients? – Study protocol of a cluster randomised trial [ISRCTN41456865

    Directory of Open Access Journals (Sweden)

    Lori Giuliano

    2005-10-01

    Full Text Available Abstract Background Early interventions proved to be able to improve prognosis in acute stroke patients. Prompt identification of symptoms, organised timely and efficient transportation towards appropriate facilities, become essential part of effective treatment. The implementation of an evidence based pre-hospital stroke care pathway may be a method for achieving the organizational standards required to grant appropriate care. We performed a systematic search for studies evaluating the effect of pre-hospital and emergency interventions for suspected stroke patients and we found that there seems to be only a few studies on the emergency field and none about implementation of clinical pathways. We will test the hypothesis that the adoption of emergency clinical pathway improves early diagnosis and referral in suspected stroke patients. We designed a cluster randomised controlled trial (C-RCT, the most powerful study design to assess the impact of complex interventions. The study was registered in the Current Controlled Trials Register: ISRCTN41456865 – Implementation of pre-hospital emergency pathway for stroke – a cluster randomised trial. Methods/design Two-arm cluster-randomised trial (C-RCT. 16 emergency services and 14 emergency rooms were randomised either to arm 1 (comprising a training module and administration of the guideline, or to arm 2 (no intervention, current practice. Arm 1 participants (152 physicians, 280 nurses, 50 drivers attended an interactive two sessions course with continuous medical education CME credits on the contents of the clinical pathway. We estimated that around 750 patients will be met by the services in the 6 months of observation. This duration allows recruiting a sample of patients sufficient to observe a 30% improvement in the proportion of appropriate diagnoses. Data collection will be performed using current information systems. Process outcomes will be measured at the cluster level six months after the

  8. Barriers professional competence and its relationship with job satisfaction of nurses' moral distress and pre-hospital emergency city of Bam and Jiroft in 1393

    Directory of Open Access Journals (Sweden)

    Mohammadjavad Rahimzadeh

    2016-05-01

    Full Text Available In order to "protect the health of people" Several organizations have been founded and given its role in saving lives when seconds play, is formed Medical Center Emergency Management Whose duty is satisfactory service in the shortest possible time. Because one of the pre-hospital emergency center nurses work centers and first deal with critical diseases carried by nurses, so they are faced with numerous obstacles which could impact on their job satisfaction has less moral distress. In this study, efficient professional barriers and its relation to moral distress and job satisfaction are studied prehospital emergency nurses. This study is a descriptive - correlation of prehospital emergency personnel Bam on 82 Jiroft who were selected by census was conducted. Data gathering questionnaire, including demographic characteristics, barriers to efficient professional, moral distress, job satisfaction after obtaining the appropriate reliability and validity were used. Analysis of the data in this study using SPSS version 18, using measures of central tendency and dispersion, t-test, Pearson correlation coefficient, ANOVA and regression analysis were used. According to the non-normal distribution efficiency and moral distress two variables obstacles relationship between these two variables with Spearman nonparametric Kruskal-Wallis test other variables and for other variables that were normally distributed parametric tests and ANOVA were used Pearson correlation coefficient. A total of 82 patients with mean age (31.54± 5.66 participated in th e study showed. Results are73.4% married, work experience, most people (% 91.5 were under 15 years old. Most people (52% with traffic and pedestrians as factors impeding efficient professional, fully agreed, the average score of moral distress (o.48 ± 2.13, the level of moral distress was most mid-level and job satisfaction 52. 4% of them were average. The results showed that between moral distress and job

  9. A Comparison of Alerting Strategies for Hemorrhage Identification During Prehospital Emergency Transport

    Science.gov (United States)

    2014-01-01

    cumulative sum method. In this report, we applied these strategies to continuously monitored prehospital vital-sign data from trauma patients during...optimized for one use case (e.g., long prehospital transport times) may not necessarily yield performance data that are optimized for another...clinical application (e.g., short prehospital transport times, intensive care units, etc.). I. INTRODUCTION Real-time alerting of life-threatening

  10. [Medical emergency teams

    DEFF Research Database (Denmark)

    Bunkenborg, G.; Lund, C.; Petersen, John Asger

    2008-01-01

    The aim of medical emergency teams (MET) is to identify and treat deteriorating patients on general wards, and to avoid cardiac arrest, unplanned intensive care unit admission and death. The effectiveness of METs has yet to be proven, as the only two randomised, controlled trials on the subject...

  11. A pilot study of quality of life in German prehospital emergency care physicians

    Directory of Open Access Journals (Sweden)

    Michael Sand

    2016-01-01

    Full Text Available Background: Quality of life in patients represents an important area of assessment. However, attention to health professionals should be equally important. The literature on the quality of life (QOL of emergency physicians is scarce. This pilot study investigated QOL in emergency physicians in Germany. Materials and Methods: We conducted a cross-sectional study from January to June in 2015. We approached the German Association of Emergency Medicine Physicians and two of the largest recruitment agencies for emergency physicians in Germany and invited their members to participate. We used the WHO Q-BREF to obtain QOL scores in four domains that included physical, mental, social, and environmental health. Results: The 478 German emergency physicians included in the study held board certifications in general medicine (n = 40; 8.4%, anesthesiology (n = 243; 50.8%, surgery (n = 63; 13.2%, internal medicine (n = 81; 17.0%, or others (n = 51; 10.7%. The women surveyed tended to report a better QOL but worse general health than the men. Regarding specific domains, women scored worse in physical health, particularly energy during everyday work (relative risk ratio [RRR]: 1.98 [1.21–3.24]. Both men and women scored worse in psychological health than general health, particularly young women. Women were also more likely to view their safety (RRR: 1.87 [1.07–3.28] and living place (RRR: 2.51 [1.10–5.73] as being poor than their male counterparts. Conclusion: QOL in German prehospital emergency care physicians is satisfactory for the included participants; however, there were some negative effects in the psychological health domain. This is particularly obvious in young female emergency physicians.

  12. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review.

    Directory of Open Access Journals (Sweden)

    Jon Gitz Holler

    Full Text Available Acute patients presenting with hypotension in the prehospital or emergency department (ED setting are in need of focused management and knowledge of the epidemiology characteristics might help the clinician. The aim of this review was to address prevalence, etiology and mortality of nontraumatic hypotension (SBP ≤ 90 mmHg with or without the presence of shock in the prehospital and ED setting.We performed a systematic literature search up to August 2013, using Medline, Embase, Cinahl, Dare and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines and The Cochrane Collaboration. No restrictions on language, publication date, or status were imposed. We used the Newcastle-Ottawa quality assessment scale (NOS-scale and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE-statement to assess the quality.Six observational studies were considered eligible for analysis based on the evaluation of 11,880 identified papers. Prehospital prevalence of hypotension was 19.5/1000 emergency medicine service (EMS contacts, and the prevalence of hypotensive shock was 9.5-19/1000 EMS contacts with an inhospital mortality of shock between 33 to 52%. ED prevalence of hypotension was 4-13/1000 contacts with a mortality of 12%. Information on mortality, prevalence and etiology of shock in the ED was limited. A meta-analysis was not feasible due to substantial heterogeneity between studies.There is inadequate evidence to establish concise estimates of the characteristics of nontraumatic hypotension and shock in the ED or in the prehospital setting. The available studies suggest that 2% of EMS contacts present with nontraumatic hypotension while 1-2% present with shock. The inhospital mortality of prehospital shock is 33-52%. Prevalence of hypotension in the ED is 1% with an inhospital mortality of 12%. Prevalence

  13. The effects of standardized trauma training on prehospital pain control: have pain medication administration rates increased on the battlefield?

    Science.gov (United States)

    Bowman, W Joseph; Nesbitt, Michael E; Therien, Sean P

    2012-08-01

    The US Military has served in some of the most austere locations in the world. In this ever-changing environment, units are organized into smaller elements operating in very remote areas. This often results in longer evacuation times, which can lead to a delay in pain management if treatment is not initiated in the prehospital setting. Early pain control has become an increasingly crucial military prehospital task and must be controlled from the pain-initiating event. The individual services developed their standardized trauma training based on the recommendations by Frank Butler and the Defense Health Board Committee on Tactical Combat Casualty Care. This training stresses evidence-based treatment modalities, including pain control, derived from casualty injury analysis. Inadequate early pain control may lead to multiple acute and potentially chronic effects. These effects encompass a wide range from changes in blood pressure to delayed wound healing and posttraumatic stress disorder. Therefore, it is essential that pain be addressed in the prehospital environment. Institutional Review Board approval was obtained to conduct a retrospective Joint Theater Trauma Registry comparative study evaluating whether standardized trauma training increased prehospital pain medication administration between 2007 and 2009. These years were selected on the basis of mandatory training initiation dates and available Joint Theater Trauma Registry records. Records were analyzed for all US prehospital trauma cases with documented pain medication administration from Operations Enduring Freedom and Iraqi Freedom for the specified years. Data analysis revealed 232 patients available for review (102 for 2007 and 130 for 2009). A statistically significant prehospital pain treatment increase was noted, from 3.1% in 2007 to 6.7% in 2009 (p importance of early pain control.

  14. Helicopter emergency medical service registrars do not comprehensively document primary surveys.

    Science.gov (United States)

    Ware, Sandra; Reid, Cliff; Burns, Brian J; Habig, Karel

    2013-06-01

    In-hospital primary surveys undertaken on traumatically injured patients can be inaccurate and incomplete. This study examined the documentation of prehospital primary surveys conducted by Greater Sydney Area Helicopter Emergency Medical Service registrars on trauma patients. A retrospective case sheet review of prehospital trauma primary surveys documented by Greater Sydney Area Helicopter Emergency Medical Service registrars was carried out using previously published methodologies. A 13-item prehospital primary survey score was created and analysed by registrar specialty. A linear mixed model was used to determine whether differences in prehospital primary survey score existed between specialties. A one-point difference in the mean scores was considered clinically significant. A total of 75 charts were reviewed. An unadjusted mean of 9.5±1.6 (SD) items, out of a possible 13, was documented. Documentation was found to be less complete for anaesthetic trainees (adjusted mean score=9.10) than for emergency medicine trainees (adjusted mean score=10.34). The difference in the mean scores was 1.24 (95% confidence interval, 0.25-2.23, t53d.f.=2.52, P=0.01). A significant clustering effect was identified for individual registrars (χ1d.f.=6.03, P=0.01). A very good level of agreement was obtained between the PPSS raters (κ=0.93, 95% confidence interval, 0.87-0.99). Helicopter emergency medical service registrars do not comprehensively document prehospital primary surveys on traumatically injured patients. However, emergency medicine trainees document more completely than anaesthetic trainees. Individual registrar variation contributes significantly towards the completeness of prehospital primary survey documentation.

  15. Tactical emergency medical support.

    Science.gov (United States)

    Rinnert, Kathy J; Hall, William L

    2002-11-01

    As increases in criminal activity collide with more aggressive law enforcement postures, there is more contact between police officers and violent felons. Civilian law enforcement special operations teams routinely engage suspects in these violent, dynamic, and complex interdiction activities. Along with these activities comes the substantial and foreseeable risk of death or grievous harm to law officers, bystanders, hostages, or perpetrators. Further, law enforcement agencies who attempt to apprehend dangerous, heavily armed criminals with a special operations team that lacks the expertise to treat the medical consequences that may arise from such a confrontation may be negligent of deliberate indifference. Meanwhile, evidence exists within the military, civilian law enforcement, and medical literature that on-scene TEMS serves to improve mission success and team safety and health, while decreasing morbidity and mortality in the event of an injury or illness suffered during operations. National professional organizations within law enforcement and emergency medicine have identified and support the fundamental need for mission safety and the development of a standard model to train and incorporate TEMS into law enforcement special operations. The overall objective of TEMS is to minimize the potential for injury and illness and to promote optimal medical care from the scene of operations to a definitive care facility. The design, staffing, and implementation of a TEMS program that maximally uses the community resources integrates previously disparate law enforcement, EMS, and emergency medical/trauma center functions to form a new continuum of care [55].

  16. Reporting Helicopter Emergency Medical Services in Major Incidents

    DEFF Research Database (Denmark)

    Fattah, Sabina; Johnsen, Anne Siri; Sollid, Stephen J M

    2016-01-01

    OBJECTIVE: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences...... interacted through e-mail. We asked these experts to define data variables and rank which were most important to report during an immediate prehospital medical response to a major incident. Five rounds were conducted. RESULTS: In the first round, the experts suggested 98 variables. After 5 rounds, 21...

  17. The Prehospital Predictors of Tracheal Intubation for in Patients who Experience Convulsive Seizures in the Emergency Department.

    Science.gov (United States)

    Sato, Kenichiro; Arai, Noritoshi; Omori-Mitsue, Aki; Hida, Ayumi; Kimura, Akio; Takeuchi, Sousuke

    2017-08-15

    Objective To identify the prehospital factors predicting the performance of tracheal intubation (TI) at the emergency department (ED) in patients with convulsive seizure or epilepsy. Methods We performed a retrospective analysis of seizure patients who underwent TI at the ED soon after arrival. The clinical variables obtained in the prehospital setting were reviewed. Patients The study population included consecutive adult patients who were transported to an urban tertiary care ED due to convulsive seizure between August 2010 and September 2015. Results Among the 822 eligible patients, 59 patients (7.2%) underwent TI at the ED. Four independent prehospital predictors were identified using multivariate analysis: age ≥50 years (+1 point), meeting the definition of convulsive status epilepticus (+4 points), and an on-scene heart rate of ≥120 bpm (+1 point) led to a higher likelihood of TI, while a higher on-scene (alert or confused) level of consciousness (-3 points) led to a lower likelihood of TI. The derived prediction rule (the sum of all points) had good predictive performance with an area under the curve of 0.88 (95% confidence interval: 0.79-0.97), a sensitivity of 0.62, a specificity of 0.91, and a positive likelihood ratio of 10.6, when the cut-off value was set to 5 points. Conclusion We constructed a simple prehospital prediction rule to help predict the need for TI in seizure patients, even in the prehospital phase. This may possibly lead to the more effective management of seizure patients in the ED.

  18. Stroke Knowledge among Urban and Frontier First Responders and Emergency Medical Technicians in Montana

    Science.gov (United States)

    McNamara, Michael J.; Oser, Carrie; Gohdes, Dorothy; Fogle, Crystelle C.; Dietrich, Dennis W.; Burnett, Anne; Okon, Nicholas; Russell, Joseph A.; DeTienne, James; Harwell, Todd S.; Helgerson, Steven D.

    2008-01-01

    Purpose: To assess stroke knowledge and practice among frontier and urban emergency medical services (EMS) providers and to evaluate the need for additional prehospital stroke training opportunities in Montana. Methods: In 2006, a telephone survey of a representative sample of EMS providers was conducted in Montana. Respondents were stratified…

  19. Experience in Prehospital Emergency of Acute Abdomen%急腹症的院前急救体会

    Institute of Scientific and Technical Information of China (English)

    杨国成

    2015-01-01

    Objective:To explore the prehospital first-aid and effect of acute abdomen. Methods:78 cases of acute abdomen adopted prehospital emer-gency, and then sent to emergency room of hospital, observing the prognosis of patients. Results:75 patients were successfully rescued and cured, 3 patients died in the intensive care unit because of excessive hemorrhage. Conclusion:Timely and effective prehospital emergency measures can in-crease the successful rescue rate of acute abdomen, and improve the prognosis.%目的:探讨急腹症患者入院前的急救方法和效果。方法:78例急腹症患者进行院前急救后送医院急救室,观察患者预后。结果:75例患者抢救成功并治愈出院,3例患者在重症监护室抢救时因失血过多死亡。结论:及时有效的院前急救措施可提高急腹症患者的抢救成功率,改善其预后。

  20. The evaluation of time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah.

    Science.gov (United States)

    Mohammadi, Mohsen; Nasiripour, Amir Ashkan; Fakhri, Mahmood; Bakhtiari, Ahad; Azari, Samad; Akbarzadeh, Arash; Goli, Ali; Mahboubi, Mohammad

    2014-09-28

    This study evaluated the time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah. This study was a descriptive retrospective cross-sectional study. In this study 500 cases of patients from Shahrivar (September) 2012 to the end of Shahrivar (September) 2013 were selected and studied by the non-probability quota method. The measuring tool included a preset cases record sheet and sampling method was completing the cases record sheet by referring to the patients' cases. Data were analyzed using SPSS version 18 and the concepts of descriptive and inferential statistics (Kruskal-Wallis test, benchmark Eta (Eta), Games-Howell post hoc test). The results showed that the interval mean between receiving the mission to reaching the scene, between reaching the scene to moving from the scene, and between moving from the scene to a health center was 7.28, 16.73 and 7.28 minutes. The overall mean of time performance from the scene to the health center was 11.34 minutes. Any intervention in order to speed up service delivery, reduce response times, ambulance equipment and facilities required for accuracy, validity and reliability of the data recorded in the emergency dispatch department, Continuing Education of ambulance staffs, the use of manpower with higher specialize levels such as nurses, supply the job satisfaction, and increase the coordination with other departments that are somehow involved in this process can provide the ground for reducing the loss and disability resulting from traffic accidents.

  1. Emergency Medical Services Program Guide.

    Science.gov (United States)

    Georgia Univ., Athens. Dept. of Vocational Education.

    This program guide contains the standard emergency medical services curriculum for technical institutes in Georgia. The curriculum encompasses the minimum competencies required for entry-level workers in the emergency medical services field, and includes job skills in six emergency medical services divisions outlined in the national curriculum:…

  2. [Prehospital emergency care injuries from external causes in a region of Venezuela].

    Science.gov (United States)

    Herrera, Rafael; Bastidas, Daniel; Arteaga, Everilda; Bastidas, Gilberto

    2017-01-01

    Worldwide, approximately 3 500 000 people die every year as a result of injuries from external causes, in Venezuela these arte the third leading cause of overall morbidity. Nevertheless, in the country there are no records of the defining aspects of prehospital emergency care as a tool to address this socio-health problem, the aim of this investigation. A descriptive, transversal, field study based on the information recorded daily for a year paramedics was performed. A total 1493 injured by external causes were reported, with a mean age of 29.5 ± 12 years, 84.5% male. Injuries mostly less-moderate (69.4%) were due to severe land transport accidents (70.9%) occurred during the day (75.9%), between monday and friday (72.9%), attended in 20 minutes or less, and transferred in 97.3% of cases. The economically productive young men in areas with higher population density and urbanism are mostly affected by injuries from external causes. In both genres land transport accidents are the most common causes of injury with lower-moderate severity. The care that paramedics provide can be considered adequate.

  3. Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey

    Directory of Open Access Journals (Sweden)

    Cha-Nam Shin

    2017-01-01

    Conclusions: The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.

  4. Expanded access to naloxone among firefighters, police officers, and emergency medical technicians in Massachusetts.

    Science.gov (United States)

    Davis, Corey S; Ruiz, Sarah; Glynn, Patrick; Picariello, Gerald; Walley, Alexander Y

    2014-08-01

    Naloxone is a medication that reverses respiratory depression from opioid overdose if given in time. Paramedics routinely administer naloxone to opioid overdose victims in the prehospital setting, and many states are moving to increase access to the medication. Several jurisdictions have expanded naloxone administration authority to nonparamedic first responders, and others are considering that step. We report here on policy change in Massachusetts, where several communities have equipped emergency medical technicians, law enforcement officers, and firefighters with naloxone.

  5. Prehospital chest ultrasound by a Dutch helicopter emergency medical service

    NARCIS (Netherlands)

    Ketelaars, R.; Hoogerwerf, N.; Scheffer, G.J.

    2013-01-01

    BACKGROUND: Due to advancements in technology, the use of a portable ultrasound (US) machine in the out-of-hospital setting is increasingly feasible. It has diagnostic and therapeutic advantages and may improve the management and treatment of patients. It can be used in-flight and can be easily taug

  6. Physical and digital design of the BlueBio biomonitoring system prototype, to be used in emergency medical response

    DEFF Research Database (Denmark)

    Kramp, Gunnar; Kristensen, M; Pedersen, J.F.

    2006-01-01

    This paper presents the physical and digital design of a wireless biomonitoring system meant to be used especially in the prehospital medical emergency response. Handling of many patients with a minimum of ressources at major incidents is an immense challenge for the emergency personnel on work a...

  7. Physical and Digital Design of the BlueBio Biomonitoring System Prototype, to be used in Emergency Medical Response

    DEFF Research Database (Denmark)

    Kramp, Gunnar; Kristensen, Margit; Pedersen, Jacob Frølund

    2007-01-01

    This paper presents the physical and digital design of a wireless biomonitoring system meant to be used especially in the prehospital medical emergency response. The handling of many patients with a minimum of ressources at major incidents is an immense challenge for the emergency personnel at wo...

  8. Physical and Digital Design of the BlueBio Biomonitoring System Prototype, to be used in Emergency Medical Response

    DEFF Research Database (Denmark)

    Kramp, Gunnar; Kristensen, Margit; Pedersen, Jacob Frølund

    2007-01-01

    This paper presents the physical and digital design of a wireless biomonitoring system meant to be used especially in the prehospital medical emergency response. The handling of many patients with a minimum of ressources at major incidents is an immense challenge for the emergency personnel at work...... of the current prototype....

  9. 加强120急救中心院前急救医疗服务体系的管理%Strengthening administration of pre-hospital care medical service system in 120 first-aid center

    Institute of Scientific and Technical Information of China (English)

    赵明锐

    2012-01-01

    OBJECTIVE To enhance emergency management and establish and further improve pre-hospital emergency medical service center management system,so as to provide better service to patients. METHODS This article summarized the common security risks of the work in 120 emergency centers, and targeted to explore the corresponding emergency medical service management solutions. RESULTS To improve 120 emergency operations and management, it was necessary to establish and improve pre-hospital emergency medical service system, improve the care management system, emergency aid mechanism and regulate treatment. CONCLUSION 120 emergency center pre-hospital emergency medical service system plays an important role in the rescue capabilities of hospitals.%目的 加强急救管理,建立并完善急救中心院前急救医疗服务体系,进一步为患者服务.方法 总结120急救中心园区急救工作中的常见安全隐患,并有针对性急救医疗服务管理对策.结果 主要安全隐患为急救人员急救意识不强、信息提取不清晰、操作技能不熟练等;针对上述问题,应建立并完善院前急救医疗服务体系,健全护理管理体系,加强教育与培训,完善紧急救援机制和规范救治工作.结论 做好120急救中心院前急救医疗服务体系的运行和管理,对提升突发事件医疗救援能力具有重要意义.

  10. Hand Washing Practices Among Emergency Medical Services Providers

    Directory of Open Access Journals (Sweden)

    Joshua Bucher

    2015-10-01

    Full Text Available Introduction: Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS workers, respectively. Methods: We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. Results: There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003. Providers who brought their own sanitizer were more likely to clean their hands. Conclusion: Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

  11. Prehospital cooling of severe burns: Experience of the Emergency Department at Edendale Hospital, KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Fiandeiro, D; Govindsamy, J; Maharaj, R C

    2015-06-01

    Early cooling with 10 - 20 minutes of cool running water up to 3 hours after a burn has a direct impact on the depth of the burn and therefore on the clinical outcome of the injury. An assessment of the early cooling of burns is essential to improve this aspect of burns management. To assess the rates and adequacy of prehospital cooling received by patients with severe burns before presentation to the Emergency Department (ED) at Edendale Hospital, Pietermaritzburg, South Africa. Patients with inadequate prehospital cooling who presented to the ED within 3 hours were also identified. A retrospective reviewof the burns database for all the patients with severe burns admitted from the ED at Edendale Hospital from September 2012 to August 2013 was undertaken. Demographic details, characteristics and timing of the burns, and presentation were correlated with burn cooling. Ninety patients were admitted with severe burns. None received sufficient cooling of their burns, 25.6% received cooling of inadequate duration, and 32.3% arrived at the ED within 3 hours after the burn with either inadequate or no cooling. The median time to presentation to the ED after the burn was 260 minutes. Appropriate cooling of severe burns presenting to Edendale Hospital is inadequate. Education of the community and prehospital healthcare workers about the iiportance of early appropriate cooling of severe burns is required. Many patients would benefit from cooling of their burns in the ED, and facilities should be provided for this vital function.

  12. Advances in prehospital airway management.

    Science.gov (United States)

    Jacobs, Pe; Grabinsky, A

    2014-01-01

    Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts.

  13. [Prehospital stage of medical aid to patients with acute coronary syndrome and elevated ST segment].

    Science.gov (United States)

    Vertkin, A L; Morozov, S N; Fedorov, A I

    2013-01-01

    We studied effect of time on the outcome of acute coronary syndrome and elevated ST segment at the prehospital stage. Logistic regression analysis revealed two time-dependent predictors: "symptom-needle" time and total call service time. In patients undergoing prehospital thrombolysis, these indices (88 and 85 min respectively) reliably predicted the probability of fatal outcome. Their values of 71 and 77 min respectively predicted the risk of unfavourable outcome. The total call service time may serve as an indicator of the quality of work of an ambulance crew at the prehospital stage of management of acute coronary syndrome with elevated ST segment.

  14. [Pediatric emergencies in the emergency medical service].

    Science.gov (United States)

    Silbereisen, C; Hoffmann, F

    2015-01-01

    Out-of-hospital pediatric emergencies occur rarely but are feared among medical personnel. The particular characteristics of pediatric cases, especially the unaccustomed anatomy of the child as well as the necessity to adapt the drug doses to the little patient's body weight, produce high cognitive and emotional pressure. In an emergency standardized algorithms can facilitate a structured diagnostic and therapeutic approach. The aim of this article is to provide standardized procedures for the most common pediatric emergencies. In Germany, respiratory problems, seizures and analgesia due to trauma represent the most common emergency responses. This article provides a practical approach concerning the diagnostics and therapy of emergencies involving children.

  15. Prehospital emergency care for the patients with acute myocardial infarction%急性心肌梗死的院前急诊护理

    Institute of Scientific and Technical Information of China (English)

    蒋彩霞; 张梓童; 周细银; 范学荣; 曹幸平

    2013-01-01

    目的 分析探讨急性心肌梗死患者的院前急诊护理方案.方法 选取本院收治的急性心肌梗死患者60例,其中42例入院前接受急诊护理作为观察组,18例入院前未接受急诊护理作为对照组.对照组18例患者突发急性心肌梗死后马上送医就诊,观察组患者在对照组接受的治疗基础上接受院前急诊护理,比较两组患者抢救成功率、进入重症加强护理病房(ICU)率.结果 观察组42例患者经过院前急诊护理、急诊抢救后38例转入内科普通病房进行治疗,占90.48%,4例转入ICU进行治疗,占9.52%,无死亡,抢救成功率高达100%;对照组18例患者经急诊抢救后,11例转入内科普通病房进行治疗,占61.11%,6例转入ICU继续治疗,占33.33%,1例因抢救无效死亡,占5.55%,两组比较,观察组抢救成功率、进入ICU治疗率均明显低于对照组(P<0.05).结论 对急性心肌梗死患者进行院前急诊护理能有效提高患者接受入院治疗的临床效果,尽可能的保障患者生命安全,值得临床推广使用.%Objective To analyze the plan of prehospital emergency care for the patients with acute myocardial infarction.Methods Sixty patients with acute myocardial infarction were selected and divided into observation group with 42 cases who received prehospital emergency care and control group with 18 cases who did not received it.The patients in control group were sent to be hospitalized immediately,the patients in observation group received prehospital emergency care.Two group were compared with rescue success rate,sending into Intensive Care Unit (ICU) rate.Results In the observation group,after emergency rescue 38 cases were sent to the Medical general ward,accounted for 90.48%,4 cases were transferred to ICU,accounted for 9.52%.No death and rescue success rate was as high as 100% ; In the control group 18 cases of patients with emergency rescue,11 cases were sent into medical general ward

  16. Medical emergencies in dental practice.

    LENUS (Irish Health Repository)

    Wilson, M H

    2009-06-01

    Serious medical emergencies are fortunately a rare occurrence in the dental practice environment; however, if an emergency situation is encountered a delay in treatment may result in potentially avoidable consequences. The risk of mortality or serious morbidity can be reduced by ensuring that basic emergency equipment and medications are in place, and that the dental team is appropriately trained in basic life support measures. This article aims to provide an overview of the basic emergency medications and equipment that should be present in dental practices, and to discuss specific responses to some of the more common adverse medical events that can present while providing dental treatment.

  17. Emergency Medical Technicians and Paramedics

    Science.gov (United States)

    ... Projected Employment, 2024 Change, 2014-24 Employment by Industry Percent Numeric SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program Emergency medical technicians and paramedics ...

  18. The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries : a retrospective observational study

    NARCIS (Netherlands)

    Oosterwold, J. T.; Sagel, D. C.; van Grunsven, P. M.; Holla, M.; de Man-van Ginkel, J.; Berben, S.

    Background Pre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital

  19. [Pre-hospital management of adults with life-threatening emergencies].

    Science.gov (United States)

    Wattel, Francis; Dubois, François

    2012-01-01

    In France, acute life-threatening situations are handled by the French Secours a Personne (assistance to persons) and emergency medical facilities. An unequivocal success, this early management of life-threatening emergency situations relies upon centralized call reception, medical dispatching, and immediate on-site emergency medical care. We describe the different emergency care providers and steps involved in the response to emergency situations. Each call centre (Samu, phone number 15; Sapeurs-Pompiers, 18) provides a response tailored to the nature of incoming calls for assistance. A check-list of grounds for an "automatic response" by the SDIS (Service Départemental d'Incendie et de Secours--the French fire brigade) is in use, ensuring that firefighters are often the first on the spot, while the knowledge and skills of the dispatching physician are essential to ascertain the patient's needs, to preserve life and vital functions, and to ensure the patient is sent to the appropriate emergency healthcare facility. In life-threatening emergency situations, patients must be brought straight to the appropriate reference emergency healthcare facility, as quickly as possible, without prior admittance to an emergency department. This is the procedure for extremely acute emergency situations in the following areas: trauma (multiple trauma and/or uncontrolled bleeding, spinal cord trauma), delivery bleeding, other life-threatening situations such as ischemic heart disease, cardiac arrest (sudden death), cerebrovascular stroke and ensuing brain damage, some acute respiratory situations such as anaphylactic shock, foreign-body inhalation, electrocution, drowning, drug overdose, certain forms of poisoning, and conditions requiring initial hyperbaric oxygen (diving accidents, acute carbon monoxide and smoke poisoning). The reasons for suboptimal emergency care in life-threatening situations are currently a major issue, with medical facilities being reduced in some areas

  20. 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...

  1. Prehospital care and new models of regionalization.

    Science.gov (United States)

    Cone, David C; Brooke Lerner, E; Band, Roger A; Renjilian, Chris; Bobrow, Bentley J; Crawford Mechem, C; Carter, Alix J E; Kupas, Douglas F; Spaite, Daniel W

    2010-12-01

    This article summarizes the discussions of the emergency medical services (EMS) breakout session at the June 2010 Academic Emergency Medicine consensus conference "Beyond Regionalization: Integrated Networks of Emergency Care." The group focused on prehospital issues such as the identification of patients by EMS personnel, protocol-driven destination selection, bypassing closer nondesignated centers to transport patients directly to more distant designated specialty centers, and the modes of transport to be used as they relate to the regionalization of emergency care. It is our hope that the proposed research agenda will be advanced in a way that begins to rigorously approach the unanswered research questions and that these answers, in turn, will lead to an evidence-based, cohesive, comprehensive, and more uniform set of guidelines that govern the delivery and practice of prehospital emergency care.

  2. Emergency patients receiving anaesthesiologist-based pre-hospital treatment and subsequently released at the scene

    DEFF Research Database (Denmark)

    Højfeldt, S G; Sørensen, L P; Mikkelsen, Søren

    2014-01-01

    BACKGROUND: The Mobile Emergency Care Unit in Odense, Denmark consists of a rapid response car, manned with an anaesthesiologist and an emergency medical technician. Eleven per cent of the patients are released at the scene following treatment. The aim of the study was to investigate which...... with the Mobile Emergency Care Unit within 24 h. Of the 143 victims of traffic accidents, 19 (13%) required renewed contact with the emergency department and one required admission to hospital (0.7%). Of all 1609 patients, four died within 24 h of contact (0.2%). CONCLUSION: Patients treated and released...... investigated. In each patient, diagnosis as well as any renewed contact with the Mobile Emergency Care Unit or the hospital within 24 h was registered. RESULTS: ONE THOUSAND SIX HUNDRED NINE: patients were released at the scene. Diagnoses within the category 'examination and investigation' [International...

  3. Out-of-hospital cardiac arrests in an urban/rural area during 1991 and 1996 : have emergency medical service changes improved outcome?

    NARCIS (Netherlands)

    Absalom, AR; Bradley, P; Soar, J

    1999-01-01

    Survival after out-of-hospital cardiac arrest is influenced by pre-hospital emergency medical care. This study compares outcome of cardiac arrest victims presenting to an emergency department serving a mixed urban/rural area (Norfolk, UK) in 1991 with 1996. Between these years the regional emergency

  4. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

    Directory of Open Access Journals (Sweden)

    Lockey David

    2011-10-01

    Full Text Available Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.

  5. Emergency medical services: an overview

    Energy Technology Data Exchange (ETDEWEB)

    Jelenko, C.; Frey, C.F.

    1976-01-01

    The organization and delivery of emergency care are reviewed in a book based on the judgments of 28 national leaders in various fields. It is noted that acute illness has become a major health problem due to the rapid growth of the United States and the increased demands of consumers for improved medical care. Critical needs in the field of emergency care are identified as communications, prompt and proper rescue handling, rapid and careful transportation of victims, and adequate emergency care at hospitals. The long-term solution to the problem of injury is viewed as prevention through efforts made by educators, industrialists, engineers, public health officials, and private citizens. The statement is made that accidents are exceeded only by heart disease, neoplasms, and cerebral vascular disease as a major cause of death in the United States. The dimensions of the accident problem are explored. Other topics addressed are: motor vehicle trauma and emergency medical services; the provision of emergency care to cardiac patients; medicolegal implications of emergency care; and field treatment and transport of emergency victims. The importance of telecommunications, emergency medical technician training, and public education is stressed. Hospital education and training for emergency department personnel are detailed for physicians and nurses. Functional and design aspects of hospital emergency departments are described, and the role of community planning in the provision of emergency health services is considered. A checklist for airport disaster planning and a Michigan law regarding emergency medical services are appended.

  6. Hand hygiene in emergency medical services.

    Science.gov (United States)

    Teter, Jonathan; Millin, Michael G; Bissell, Rick

    2015-01-01

    Hospital-acquired infections (HAIs) affect millions of patients annually (World Health Organization. Guidelines on Hand Hygiene in Healthcare. Geneva: WHO Press; 2009). Hand hygiene compliance of clinical staff has been identified by numerous studies as a major contributing factor to HAIs around the world. Infection control and hand hygiene in the prehospital environment can also contribute to patient harm and spread of infections. Emergency medical services (EMS) practitioners are not monitored as closely as hospital personnel in terms of hand hygiene training and compliance. Their ever-changing work environment is less favorable to traditional hospital-based aseptic techniques and education. This study aimed to determine the current state of hand hygiene practices among EMS providers and to provide recommendations for improving practices in the emergency health services environment. This study was a prospective, observational prevalence study and survey, conducted over a 2-month period. We selected participants from visits to three selected hospital emergency departments in the mid-Atlantic region. There were two data components to the study: a participant survey and hand swabs for pathogenic cultures. This study recruited a total sample of 62 participants. Overall, the study revealed that a significant number of EMS providers (77%) have a heavy bacterial load on their hands after patient care. All levels of providers had a similar distribution of bacterial load. Survey results revealed that few providers perform hand hygiene before (34%) or in between patients (24%), as recommended by the Centers for Disease Control and Prevention guidelines. This study demonstrates that EMS providers are potential vectors of microorganisms if proper hand hygiene is not performed properly. Since EMS providers treat a variety of patients and operate in a variety of environments, providers may be exposed to potentially pathogenic organisms, serving as vectors for the exposure of

  7. Risk assessment of pre-hospital trauma airway management by anaesthesiologists using the predictive Bayesian approach

    Directory of Open Access Journals (Sweden)

    Nakstad Anders R

    2010-04-01

    Full Text Available Abstract Introduction Endotracheal intubation (ETI has been considered an essential part of pre-hospital advanced life support. Pre-hospital ETI, however, is a complex intervention also for airway specialist like anaesthesiologists working as pre-hospital emergency physicians. We therefore wanted to investigate the quality of pre-hospital airway management by anaesthesiologists in severely traumatised patients and identify possible areas for improvement. Method We performed a risk assessment according to the predictive Bayesian approach, in a typical anaesthesiologist-manned Norwegian helicopter emergency medical service (HEMS. The main focus of the risk assessment was the event where a patient arrives in the emergency department without ETI despite a pre-hospital indication for it. Results In the risk assessment, we assigned a high probability (29% for the event assessed, that a patient arrives without ETI despite a pre-hospital indication. However, several uncertainty factors in the risk assessment were identified related to data quality, indications for use of ETI, patient outcome and need for special training of ETI providers. Conclusion Our risk assessment indicated a high probability for trauma patients with an indication for pre-hospital ETI not receiving it in the studied HEMS. The uncertainty factors identified in the assessment should be further investigated to better understand the problem assessed and consequences for the patients. Better quality of pre-hospital airway management data could contribute to a reduction of these uncertainties.

  8. In-flight Medical Emergencies

    Directory of Open Access Journals (Sweden)

    Amit Chandra

    2013-09-01

    Full Text Available Introduction: Research and data regarding in-flight medical emergencies during commercial air travel are lacking. Although volunteer medical professionals are often called upon to assist, there are no guidelines or best practices to guide their actions. This paper reviews the literature quantifying and categorizing in-flight medical incidents, discusses the unique challenges posed by the in-flight environment, evaluates the legal aspects of volunteering to provide care, and suggests an approach to managing specific conditions at 30,000 feet.Methods: We conducted a MEDLINE search using search terms relevant to aviation medical emergencies and flight physiology. The reference lists of selected articles were reviewed to identify additional studies.Results: While incidence studies were limited by data availability, syncope, gastrointestinal upset, and respiratory complaints were among the most common medical events reported. Chest pain and cardiovascular events were commonly associated with flight diversion.Conclusion: When in-flight medical emergencies occur, volunteer physicians should have knowledge about the most common in-flight medical incidents, know what is available in on-board emergency medical kits, coordinate their therapy with the flight crew and remote resources, and provide care within their scope of practice. [West J Emerg Med. 2013;14(5:499–504.

  9. Emergency Medical Service (EMS) Stations

    Data.gov (United States)

    Kansas Data Access and Support Center — EMS Locations in Kansas The EMS stations dataset consists of any location where emergency medical services (EMS) personnel are stationed or based out of, or where...

  10. Use of the GlideScope®-Ranger for pre-hospital intubations by anaesthesia trained emergency physicians – an observational study

    OpenAIRE

    Russo, Sebastian G.; Nickel, Eike A.; Leissner, Kay B; Schwerdtfeger, Katrin; Bauer, Martin; Roessler, Markus S.

    2016-01-01

    Background: Pre-hospital endotracheal intubation is more difficult than in the operating room (OR). Therefore, enhanced airway management devices such as video laryngoscopes may be helpful to improve the success rate of pre-hospital intubation. We describe the use of the Glidescope®-Ranger (GS-R) as an alternative airway tool used at the discretion of the emergency physician (EP) in charge. Methods: During a 3.5 year period, the GS-R was available to be used either as the primary or backup to...

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

    Science.gov (United States)

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

    2003-07-01

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

  12. An Epidemiological Study of Prehospital Cases during the Year of 2009 in Zigong Emergency Rescue Center%2009年度自贡市急救中心院前急救流行病学研究

    Institute of Scientific and Technical Information of China (English)

    徐平; 曹灵红; 章成

    2011-01-01

    Objective To research on the epidemiological characteristics of the prehospital cases in Zigong emergency rescue center. Methods We retrospectively analyzed the database of prehospital cases in Zigong emergency rescue center in 2009. And reviewed the prehospital disease spectrum, gender composition, age structure, the circadian and seasonal distribution, and the outcomes of these cases. Results A total of 4 588 prehospital victims in Zigong emergency rescue center were enrolled. In the study, six leading diseases were injury, poisoning and certain other consequences due to external causes (45. 6%), diseases of the circulatory system (15. 0%), diseases of the respiratory system (6. 3%), diseases of the nervous system (6. 0%), mental and behavioral disorders (5. 6%), and diseases of the digestive system (4. 9%). Male patients were more than female patients (P<0. 05). The proportion of the aged and the middle-aged was significantly larger than that of young population in the same districts (P<0. 05), and the occurrence of prehospital care usually peaked at 15:40 (F<0. 05). Prehospital care had a higher incidence in winter (P<0. 05), and the outcome of prehospital cases was mainly in hospital and in observation ward. The proportion of deaths was 3. 8%. Conclusion We can allocate emergency resources reasonably in prehospital care, and promote the ability of rescuing in order to meet people's medical demands on the basis of the epidemiological study in our city.%目的 研究自贡市急救中心院前急救流行病学特征.方法 回顾性分析2009年度自贡市急救中心出诊的院前急救数据,研究院前急救疾病谱及性别、年龄构成,并分析时刻及季节分布特点,描述院前急救转归.结果 2009年度自贡市急救中心院前急救共4 588例,排前6位疾病依次为损伤、中毒和外因的某些其他后果(45.6%),循环系统疾病(15.0%),呼吸系统疾病(6.3%),神经系统疾病(6.0%),精神和行为障碍(5.6

  13. Prehospital Medical Documentation in the Joint Theater Trauma Registry: A Retrospective Study

    Science.gov (United States)

    2011-07-01

    Nesbitt , DSc, PA-C, Amelia M. Duran-Stanton, PhD, PA-C, and Robert T. Gerhardt, MD, MPH, FACEP Background: Prehospital care of combat casualties is a...5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Therien S. P., Nesbitt M. E., Duran-Stanton A. M., Gerhardt R. T., 5d. PROJECT NUMBER 5e. TASK NUMBER 5f

  14. Why and when citizens call for emergency help: an observational study of 211,193 medical emergency calls.

    Science.gov (United States)

    Møller, Thea Palsgaard; Ersbøll, Annette Kjær; Tolstrup, Janne Schurmann; Østergaard, Doris; Viereck, Søren; Overton, Jerry; Folke, Fredrik; Lippert, Freddy

    2015-11-04

    A medical emergency call is citizens' access to pre-hospital emergency care and ambulance services. Emergency medical dispatchers are gatekeepers to provision of pre-hospital resources and possibly hospital admissions. We explored causes for access, emergency priority levels, and temporal variation within seasons, weekdays, and time of day for emergency calls to the emergency medical dispatch center in Copenhagen in a two-year study period (December 1(st), 2011 to November 30(th), 2013). Descriptive analysis was performed for causes for access and emergency priority levels. A Poisson regression model was used to calculate adjusted ratio estimates for the association between seasons, weekdays, and time of day overall and stratified by emergency priority levels. We analyzed 211,193 emergency calls for temporal variation. Of those, 167,635 calls were eligible for analysis of causes and emergency priority level. "Unclear problem" was the most frequent category (19%). The five most common causes with known origin were categorized as "Wounds, fractures, minor injuries" (13%), "Chest pain/heart disease" (11%), "Accidents" (9%), "Intoxication, poisoning, drug overdose" (8%), and "Breathing difficulties" (7%). The highest emergency priority levels (Emergency priority level A and B) were assigned in 81% of calls. In the analysis of temporal variation, the total number of calls peaked at wintertime (26%), Saturdays (16%), and during daytime (39%). The pattern of citizens' contact causes fell into four overall categories: unclear problems, medical problems, intoxication and accidents. The majority of calls were urgent. The magnitude of unclear problems represents a modifiable factor and highlights the potential for further improvement of supportive dispatch priority tools or educational interventions at dispatch centers. Temporal variation was identified within seasons, weekdays and time of day and reflects both system load and disease occurrence. Data on contact patterns

  15. The emergency department medical director.

    Science.gov (United States)

    Mayer, T A

    1987-02-01

    This article has presented an overview of the duties, responsibilities, and management roles of the emergency department Medical Director, a position that can be among the most challenging, stimulating, and exciting in medicine. However, prior to accepting a position as an Emergency Department medical director, one should have a clear understanding of what the job entails. Careful discussions with the hospital administration, medical staff, nursing personnel, and staff emergency physicians should be undertaken to learn the perceptions of these people and expectations of the position. Once the job has been accepted, using the roles, responsibilities, and duties detailed herein may be of benefit--but should always be applied with good judgment, tactful cooperation, and common sense. Finally, it should not be surprising to a medical director to find, as Spinoza did many years ago, that the excellent thing he aspires to are as difficult as they are rare.

  16. [Lightning strikes and lightning injuries in prehospital emergency medicine. Relevance, results, and practical implications].

    Science.gov (United States)

    Hinkelbein, J; Spelten, O; Wetsch, W A

    2013-01-01

    Up to 32.2% of patients in a burn center suffer from electrical injuries. Of these patients, 2-4% present with lightning injuries. In Germany, approximately 50 people per year are injured by a lightning strike and 3-7 fatally. Typically, people involved in outdoor activities are endangered and affected. A lightning strike usually produces significantly higher energy doses as compared to those in common electrical injuries. Therefore, injury patterns vary significantly. Especially in high voltage injuries and lightning injuries, internal injuries are of special importance. Mortality ranges between 10 and 30% after a lightning strike. Emergency medical treatment is similar to common electrical injuries. Patients with lightning injuries should be transported to a regional or supraregional trauma center. In 15% of all cases multiple people may be injured. Therefore, it is of outstanding importance to create emergency plans and evacuation plans in good time for mass gatherings endangered by possible lightning.

  17. Composition of emergency medical services teams and the problem of specialisation of emergency medical services physicians in the opinions of occupationally active paramedics

    Directory of Open Access Journals (Sweden)

    Dorota Rębak

    2015-01-01

    Full Text Available Introduction: Emergency medicine includes prevention, prehospital care, specialised treatment, rehabilitation, and education. Aim of the research: The objective of the analysis was to determine the opinions of paramedics concerning the problem of the composition of emergency medical services (EMS teams and specialisation of EMS system physicians according to their education level and sense of coherence. Material and methods: The study was conducted among 336 occupationally active paramedics working in EMS teams delivering prehospital care in selected units in Poland. The study was conducted at Ambulance Stations and in Hospital Emergency Departments, which within their structure had an out-of-hospital EMS team. The study was conducted by the method of a diagnostic survey, and the research instrument was the Orientation to Life Questionnaire SOC-29 and a questionnaire designed by the author. Results: The respondents who had licentiate education relatively more frequently indicated paramedics with licentiate education level as persons most suitable to undertake medical actions (26.32% rather than physicians (21.05%. Paramedics with 2-year post-secondary school education relatively more often mentioned physicians (33.07% than those with licentiate education (17.32%. As many as 89.58% of the paramedics reported the need for a physician in the composition of the EMS team delivering prehospital care, while only 10.42% of them expressed an opinion that there should be teams composed of paramedics only. According to 30.65% of respondents, EMS team delivering prehospital care should include a physician with the specialty in emergency medicine, whereas 8.04% of respondents reported the need for a physician, irrespective of specialisation. However, 42.56% of the paramedics expressed an opinion that a physician is needed only in a specialist team with a specialisation in emergency medicine. The opinions of the paramedics concerning the need for a

  18. 加强120急救中心院前急救医疗服务体系的管理%Strengthening Administration of Pre-hospital Care Medical Service System in 120 First-aid Center

    Institute of Scientific and Technical Information of China (English)

    梁鹤峰

    2015-01-01

    目的:为完善120急救中心院前急救医疗服务体系,强化其管理,寻求最佳方式。方法分析当前120急救中心急救医疗服务体系管理中的不足,并提出相应的解决方案与措施。结果120急救中心院前急救医疗服务体系中存在着急救意识淡薄、信息获取模糊、救护人员医疗技术水平较低三个方面的不足,解决当前的现状则需要建立行之有效的急救医疗服务体系。结论加强120急救中西院前急救医疗服务体系的管理,对加强120应对临时事故的应对能力有着重要的现实意义。%Objective To improve the 120 emergency center of pre-hospital emergency medical services system, strengthen its management, seeking the best way. Methods Analyzing the 120 emergency center management of emergency medical services system is insufficient, and put forward corresponding solutions and measures. Results The 120 emergency center in the pre-hospital emergency medical services system there exists a weak consciousness of first aid, access to information fuzzy, rescuers have a relatively low level of medical technology, the shortage of the three aspects, the current situation requires to build a effective emergency medical service system. Conclusion To strengthen 120 ifrst aid of pre-hospital emergency medical service system of Chinese and western management, to strengthen the response capacity in coping with temporary accident have important practical signiifcance.

  19. Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit

    LENUS (Irish Health Repository)

    McGovern, M

    2017-02-01

    Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128\\/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114\\/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child’s illness but on educating and empowering the parent.

  20. Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit.

    Science.gov (United States)

    McGovern, M; Kernan, R; O'Neill, M B

    2017-02-10

    Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child's illness but on educating and empowering the parent.

  1. Analysis of 10 126 Cases of Pre-hosPital Emergency Care%10126例院前急救病例分析

    Institute of Scientific and Technical Information of China (English)

    付丽琼; 胡远扬; 林建功; 朱龙华

    2013-01-01

    目的:了解泉州市区院前急救疾病的病种及其特点。方法回顾性分析泉州市急救指挥中心2009年1月至2009年12月救治转送的10126例患者及180例死亡病例。结果院前急救病种排序前五位依次为各种创伤6035(59.58%)、脑血管病907(8.95%)、中毒与损伤621(6.13%)、心血管病446(4.6%)、消化系统423(4.2%)此前五位占全部患者的83.46%,创伤中交通伤占一半以上。结论院前急救在医务人员与设备配置方面应与急救疾病谱的变化相适应,要加强针对医务人员及社会公众进行急救创伤知识、心脑血管疾病等培训,提高急救抢救能力。%Objective To explore the disease entity and its clinical characteristics in the pre-hospital emergency cases. Method A retrospective study of 10 126 patients transferred by Quanzhou Emergency Center and 180 deaths among them between January 2009 and December 2009 was performed. Result The five common disease entities in pre-hospital emergency patients which account for 83.46%of the total amount are:6035 cases of trauma(59.58%),half of which are auto accidents,907 cases of cerebrovascular disease(8.95%),621 cases of poisoning (6.13%),446 cases of cardiovascular disease(4.6%),423 cases of gastrointestinal disease(4.2%). Conclusion It is recommended that the emergency resource such as pre-hospital rescuers and devices should be allocated in accordance with the disease spectrum for pre-hospital emergency care. It is essential to improve the quality of the training about the pre-hospital rescue of trauma and cardiac-cerebral vascular disease to ensure the high performance of pre-hospital emergency care.

  2. Pre-hospital emergency and nursing measures of acute carbon monoxide poisoning%急性一氧化碳中毒的院前急救及护理对策

    Institute of Scientific and Technical Information of China (English)

    黎秀英

    2015-01-01

    Objective:To explore the pre-hospital emergency and nursing measures of acute carbon monoxide poisoning.Methods:57 patients with acute carbon monoxide poisoning were given pre-hospital emergency and nursing measures,treatment and nursing measures at the poisoning scene,treatment and nursing measures in the transport process,treatment after admission. Results:In addition to 4 patients were died before the medical personnel arrived at the poisoning scene,other patients were significantly improved and discharged after the treatment,did not appear serious sequelae.Conclusion:Timely taking effective pre-hospital emergency and nursing measures can significantly reduce the disability and mortality of patients with acute carbon monoxide poisoning.%目的:探讨急性一氧化碳(CO)中毒的院前急救及护理对策。方法:对57例急性CO中毒患者采取院外急救及护理措施,中毒现场救治及护理措施,转运过程中救治及护理措施,入院后的治疗。结果:除4例患者在医务人员到达中毒现场前已死亡外,其余患者经治疗,均明显好转出院,未出现严重后遗症。结论:及时采取有效的院前急救及护理对策可明显降低急性CO中毒患者的伤残及死亡率。

  3. Readiness for Radiological and Nuclear Events among Emergency Medical Personnel.

    Science.gov (United States)

    Dallas, Cham E; Klein, Kelly R; Lehman, Thomas; Kodama, Takamitsu; Harris, Curtis Andrew; Swienton, Raymond E

    2017-01-01

    Among medical providers, even though radiological and nuclear events are recognized as credible threats, there is a lack of knowledge and fear about the medical consequences among medical personnel which could significantly affect the treatment of patients injured and/or contaminated in such scenarios. This study was conducted to evaluate the relative knowledge, willingness to respond, and familiarity with nuclear/radiological contamination risks among U.S. and Japanese emergency medical personnel. An institutional review board-approved anonymous paper survey was distributed at various medical and disaster conferences and medicine courses in Japan and in the U.S. The surveys were written in Japanese and English and collected information on the following four categories: generalized demographics, willingness to manage, knowledge of disaster systems, and contamination risks. A total of 418 surveys were completed and collected. Demographics showed that physicians and prehospital responders were the prevalent survey responders. The majority of responders, despite self-professed disaster training, were still very uncomfortable with and unaware how to respond to a radiological/nuclear event. Despite some educational coverage in courses and a limited number of disaster events, it is concluded that there is a lack of comfort and knowledge regarding nuclear and radiological events among the medical community. It is recommended that considerable development and subsequent distribution is needed to better educate and prepare the medical community for inevitable upcoming radiological/nuclear events.

  4. Factors influencing prehospital delay for patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Shujuan CHENG; Lufen GUO; Juyuan LIU; Xiaoling ZHU; Hongbing YAN

    2007-01-01

    Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI).Methods A total of 807 consecutive patients with AMI who presented to the emergency department of Beijing Anzhen Hospital were analyzed. The influence of several potential risk factors on the prehospital delay time (PDT) was evaluated by comparing patients admitted more than 2 hours after onset of chese pain with those admitted within 2 hours after onset. Results Among 807 patients, 402 came to the hospital within 2 hours while the others arrived at the hospital after 2 hours. The median PDT was 130 min. Among the potential variables, advanced age, history of diabetes mellitus, occurrence of symptom at night and use of emergency medical service significantly affected PDT by multivariate analysis. Conclusion Interventions aimed at reducing the prehospital delay in AMI should primarily focus on the awareness of the risk and help-seeking behavior of patients.

  5. Evaluation of prehospital and emergency department systolic blood pressure as a predictor of in-hospital mortality.

    Science.gov (United States)

    Lalezarzadeh, Fariborz; Wisniewski, Paul; Huynh, Katie; Loza, Maria; Gnanadev, Dev

    2009-10-01

    Hypotension is a trauma activation criterion validated by multiple studies. However, field systolic blood pressures (SBP) are still met with skepticism. How significant is the role of prehospital (PH) and emergency department (ED) SBP in the patient's overall condition? A review of the trauma registry over a 5-year period was conducted. PH SBPs were stratified into four categories: severe (SBP 80 mmHg or less), moderate (81-100 mmHg), mild hypotension (101-120 mmHg), and normotension (greater than 120 mmHg). These four groups were further subcategorized into the patients who were hypotensive, SBP 90 mmHg or less in the ED, versus those that were not (SBP greater than 90 mmHg). Data for 6964 patients were analyzed. Patients with PH SBP of 80 mmHg or less compared with patients who had PH SBP of greater than 80 mmHg had higher mortality (OR, 9; 95% CI, 6.45-12.84). Patients with both PH SBP 80 mmHg or less and ED SBP 90 mmHg or less had the highest risk of mortality (50%) and highest need for emergent operative intervention (54%). PH and ED hypotension is a strong predictor of in-hospital mortality and need for emergent surgical intervention in trauma patients. Field or ED blood pressures should serve as a significant marker of the patient's condition.

  6. 新时期院外急救护理工作面临的问题和对策%The problem and strategy of the pre-hospital emergency care in the new period

    Institute of Scientific and Technical Information of China (English)

    刘玲

    2009-01-01

    Objective To explore the new demand and reform of the pre-hospital emergency care under the special medical environment in the new era.Methods The clinical data,including the construction of pre-hospital emergency care and the psychological requirement of patients and their dependents,was analyzed.Results In the market economy, the scope of pre-hospital emergency was widened,and the demands of the patients as well as their families were increased.The disadvantage of the open medical environment,including the participation of the families and the negative psychologic status would do harm to curative activity.Conclusion Raising the integrated ability to deal with the problems,shortening the waiting time of psycology, strengthening the legal education of the on-call doctors,and emphasizing the psychological nursing service of patients and their families could bring benefits to the pre-hospital care.%目的 探讨如何在新时期特殊医疗环境下使院外急救护理工作适应医疗改革发展的需求.方法 分析了院外急救患者的来源构成、院外急救患者和家属心理需求表现等资料.结果 市场经济条件下院外急救范畴拓宽;患者和家属需求增加;开放式急诊医疗环境弊多利少;家属参与存在不利因素;患者和家属负性心理状况影响院外急救.结论 培养护士处理问题的综合能力;缩短心理等候时间;加强对出诊人员的法制教育;重视院前急救患者及家属的心理护理均有助于医护人员应对这些问题.

  7. On the work of the pre-hospital emergency dispatchers%浅论院前急救中调度员的工作

    Institute of Scientific and Technical Information of China (English)

    吴蕙勤; 严莉

    2016-01-01

    Dispatching is a link between patients/witnesses and emergency workers and serves as a hub of pre-hospital care.It is the first and important part of the emergency medical system with attributes as an administrative behavior being both authoritative and public.The author describes norms in the centre's daily alarm dispatching, emergencies, routine duties as well as the specific requirements of the works.The paper takes into account the guidance and supervision to command station in emergency work and extends care and communication to frontlinestaff.Dispatching is a special job, requiring both the operational capacity of the individual and the teamwork spirit. In order to ensure the quality of the work,training and retraining are essential, in addition to the routine training in daily works,attention must be paid to cultivate dispatchers’personality and ability to handle a variety of alarming situation .%120调度员是患者或目击者与急救人员间的联系纽带,是院前急救的中枢,是急诊医学体系的第一环节和重要组成部分,其工作十分重要。该文阐述了120调度中心调度员的日常接警、突发事件应急调度等工作规范和具体要求。认为:调度是一个特殊的岗位,既需要个人的业务能力,又需要团队合作精神。为了保证调度员的工作质量,对其除加强工作常规培训外,更要注重其人格和灵活处理各警情能力的培养。

  8. Privatization and emergency medical services.

    Science.gov (United States)

    Reissman, S G

    1997-01-01

    Osborne and Gaebler's Reinventing Government has sparked discussion amongst elected officials, civil servants, the media, and the general public regarding advantages of privatizing government services. Its support stems from an effort to provide services to municipalities while reducing taxpayer expenditure. Many echo the sentiment of former New York Governor Mario Cuomo, who said, "It is not government's obligation to provide services, but to see that they're provided." Even in the area of public safety, privatization has found a "market." In many localities, privatizing Emergency Medical Services (EMS) is a popular and successful method for providing ambulance services. Privately owned ambulance services staff and respond to medical emergencies in a given community as part of the 9-1-1 emergency response system. Regulations for acceptable response times, equipment, and other essential components of EMS systems are specified by contract. This allows the municipality oversight of the service provided, but it does not provide the service directly. As will be discussed, this "contracting-out" model has many benefits. Privatizing EMS services is a decision based not only on cost-savings, but on accountability. A thorough evaluation must be utilized in the selection process. Issues of efficiency, effectiveness, quality, customer service, responsiveness, and equity must be considered by the government, in addition to cost of service. The uncertain future of health care in the United States has led those in EMS to look beyond the field's internal market to explore additional opportunities for expanding and redefining its roles beyond emergency care. It is important, however, to consider how emergency medical care, the original role of EMS, can be best delivered. Responding to emergencies is not just one of the functions involved in this field, it is the principal function from which public perception of EMS is formed, and from which support for entering other markets can

  9. Emergency motorcycle: has it a place in a medical emergency system?

    Science.gov (United States)

    Soares-Oliveira, Miguel; Egipto, Paula; Costa, Isabel; Cunha-Ribeiro, Luis Manuel

    2007-07-01

    In an emergency medical service system, response time is an important factor in determining the prognosis of a victim. There are well-documented increases in response time in urban areas, mainly during rush hour. Because prehospital emergency care is required to be efficient and swift, alternative measures to achieve this goal should be addressed. We report our experience with a medical emergency motorcycle (MEM) and propose major criteria for dispatching it. This work presents a prospective analysis of the data relating to MEM calls from July 2004 to December 2005. The analyzed parameters were age, sex, reason for call, action, and need for subsequent transport. A comparison was made of the need to activate more means and, if so, whether the MEM was the first to arrive. There were 1972 calls. The average time of arrival at destination was 4.4 +/- 2.5 minutes. The main action consisted of administration of oxygen (n = 626), immobilization (n = 118), and control of hemorrhage (n = 101). In 63% of cases, MEM arrived before other emergency vehicles. In 355 cases (18%), there was no need for transport. The MEM can intervene in a wide variety of clinical situations and a quick response is guaranteed. Moreover, in specific situations, MEM safely and efficiently permits better management of emergency vehicles. We propose that it should be dispatched mainly in the following situations: true life-threatening cases and uncertain need for an ambulance.

  10. Medical Journalism and Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Saeed Safari

    2015-07-01

    Full Text Available Nowadays, many researches in the field of medicine are conducting all around the world and medical journalism is a way to share the results. In fact, dissemination of the related manuscripts can prevent the repetitive research or may even lead to conducting a better survey. Therefore high quality medical journals are considered as up-to-date resources for further investigations. Medical journals are propagating their papers in various media including television programs, newspapers, internet websites and different social media. So they can influence the government policy makers, health-care professionals and even public. Moreover, most researchers hear about medical discoveries for the first time through medical journals and their related social media. So as well a high quality journal can help to improve medical science, a journal of poor quality can be damaging and distorting. Indeed, popular journals have the power of inventing a “communication storm” to draw attention to a certain topic. Thus they have to respect the accepted international principles to prevent spreading inaccurate and misleading data. This paper aims to review the previous and current situation of medical journalism by focus on field of emergency medicine.

  11. Influence of The Education and Training of Prehospital Medical Crews on Measures of Performance and Patient Outcomes

    OpenAIRE

    Blomberg, Hans

    2013-01-01

    Prehospital care has developed dramatically the last decades with the implementation of new devices and educational concepts. Clinical decisions and treatments have moved out from the hospitals to the prehospital setting. In Sweden this has been accompanied by an increase in the level of competence, i.e. by introducing nurses in the ambulances. With some exceptions the scientific support for these changes is poor. This thesis deals with such changes in three different subsets of prehospital c...

  12. Influence of The Education and Training of Prehospital Medical Crews on Measures of Performance and Patient Outcomes

    OpenAIRE

    Blomberg, Hans

    2013-01-01

    Prehospital care has developed dramatically the last decades with the implementation of new devices and educational concepts. Clinical decisions and treatments have moved out from the hospitals to the prehospital setting. In Sweden this has been accompanied by an increase in the level of competence, i.e. by introducing nurses in the ambulances. With some exceptions the scientific support for these changes is poor. This thesis deals with such changes in three different subsets of prehospital c...

  13. Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine.

    Science.gov (United States)

    Olives, Travis D; Nystrom, Paul C; Cole, Jon B; Dodd, Kenneth W; Ho, Jeffrey D

    2016-12-01

    Profound agitation in the prehospital setting confers substantial risk to patients and providers. Optimal chemical sedation in this setting remains unclear. The goal of this study was to describe intubation rates among profoundly agitated patients treated with prehospital ketamine and to characterize clinically significant outcomes of a prehospital ketamine protocol. This was a retrospective cohort study of all patients who received prehospital ketamine, per a predefined protocol, for control of profound agitation and who subsequently were transported to an urban Level 1 trauma center from May 1, 2010 through August 31, 2013. Identified records were reviewed for basic ambulance run information, subject characteristics, ketamine dosing, and rate of intubation. Emergency Medical Services (EMS) ambulance run data were matched to hospital-based electronic medical records. Clinically significant outcomes are characterized, including unadjusted and adjusted rates of intubation. Overall, ketamine was administered 227 times in the prehospital setting with 135 cases meeting study criteria of use of ketamine for treatment of agitation. Endotracheal intubation was undertaken for 63% (85/135) of patients, including attempted prehospital intubation in four cases. Male gender and late night arrival were associated with intubation in univariate analyses (χ2=12.02; P=.001 and χ2=5.34; P=.021, respectively). Neither ketamine dose, co-administration of additional sedating medications, nor evidence of ethanol (ETOH) or sympathomimetic ingestion was associated with intubation. The association between intubation and both male gender and late night emergency department (ED) arrival persisted in multivariate analysis. Neither higher dose (>5mg/kg) ketamine nor co-administration of midazolam or haloperidol was associated with intubation in logistic regression modeling of the 120 subjects with weights recorded. Two deaths were observed. Post-hoc analysis of intubation rates suggested a

  14. Effects of golden hour thrombolysis: a Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy.

    Science.gov (United States)

    Ebinger, Martin; Kunz, Alexander; Wendt, Matthias; Rozanski, Michal; Winter, Benjamin; Waldschmidt, Carolin; Weber, Joachim; Villringer, Kersten; Fiebach, Jochen B; Audebert, Heinrich J

    2015-01-01

    The effectiveness of intravenous thrombolysis in acute ischemic stroke is time dependent. The effects are likely to be highest if the time from symptom onset to treatment is within 60 minutes, termed the golden hour. To determine the achievable rate of golden hour thrombolysis in prehospital care and its effect on outcome. The prospective controlled Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke study was conducted in Berlin, Germany, within an established infrastructure for stroke care. Weeks were randomized according to the availability of a specialized ambulance (stroke emergency mobile unit (STEMO) from May 1, 2011, through January 31, 2013. We included 6182 consecutive adult patients for whom a stroke dispatch (44.1% male; mean [SD] age, 73.9 [15.0] years) or regular care (45.0% male; mean [SD] age, 74.2 [14.9] years) were included. The STEMO was deployed when the dispatchers suspected an acute stroke during emergency calls. If STEMO was not available (during control weeks, when the unit was already in operation, or during maintenance), patients received conventional care. The STEMO is equipped with a computed tomographic scanner plus a point-of-care laboratory and telemedicine connection. The unit is staffed with a neurologist trained in emergency medicine, a paramedic, and a technician. Thrombolysis was started in STEMO if a stroke was confirmed and no contraindication was found. Rates of golden hour thrombolysis, 7- and 90-day mortality, secondary intracerebral hemorrhage, and discharge home. Thrombolysis rates in ischemic stroke were 200 of 614 patients (32.6%) when STEMO was deployed and 330 of 1497 patients (22.0%) when conventional care was administered (P golden hour thrombolysis was 6-fold higher after STEMO deployment (62 of 200 patients [31.0%] vs 16 of 330 [4.9%]; P golden hour thrombolysis had no higher risks for 7- or 90-day mortality (adjusted odds ratios, 0.38 [95% CI, 0.09-1.70]; P = .21 and 0.69 [95% CI

  15. A seamless ubiquitous emergency medical service for crisis situations.

    Science.gov (United States)

    Lin, Bor-Shing

    2016-04-01

    In crisis situations, a seamless ubiquitous communication is necessary to provide emergency medical service to save people's lives. An excellent prehospital emergency medicine provides immediate medical care to increase the survival rate of patients. On their way to the hospital, ambulance personnel must transmit real-time and uninterrupted patient information to the hospital to apprise the physician of the situation and provide options to the ambulance personnel. In emergency and crisis situations, many communication channels can be unserviceable because of damage to equipment or loss of power. Thus, data transmission over wireless communication to achieve uninterrupted network services is a major obstacle. This study proposes a mobile middleware for cognitive radio (CR) for improving the wireless communication link. CRs can sense their operating environment and optimize the spectrum usage so that the mobile middleware can integrate the existing wireless communication systems with a seamless communication service in heterogeneous network environments. Eventually, the proposed seamless mobile communication middleware was ported into an embedded system, which is compatible with the actual network environment without the need for changing the original system architecture.

  16. Emergency intraosseous access in a helicopter emergency medical service: a retrospective study

    Directory of Open Access Journals (Sweden)

    Heradstveit Bård E

    2010-10-01

    Full Text Available Abstract Background Intraosseous access (IO is a method for providing vascular access in out-of-hospital resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseous techniques have been used by our Helicopter Emergency Medical Services (HEMS since 2003. Few articles document IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS. Methods We reviewed all medical records from the period May 2003 to April 2010, and compared three different techniques: Bone Injection Gun (B.I.G® - Waismed, manual bone marrow aspiration needle (Inter V - Medical Device Technologies and EZ-IO® (Vidacare, used on both adults and paediatric patients. Results During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were 50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success on first attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p Conclusions Newer intraosseous techniques may enable faster and more reliable vascular access, and this can lower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believe that all emergency services that handle critically ill or injured paediatric and adult patients should be familiar with intraosseous techniques.

  17. Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces.

    Science.gov (United States)

    Acker, Peter; Newberry, Jennifer A; Hattaway, Leonard Bud F; Socheat, Phan; Raingsey, Prak P; Strehlow, Matthew C

    2016-06-27

    Despite significant improvements in health outcomes nationally, many Cambodians continue to experience morbidity and mortality due to inadequate access to quality emergency medical services. Over recent decades, the Cambodian healthcare system and civil infrastructure have advanced markedly and now possess many of the components required to establish a well functioning emergency medical system. These components include enhanced access to emergency transportation through large scale road development efforts, widspread availability of emergency communication channels via the spread of cellphone and internet technology, and increased access to health services for poor patients through the implementation of health financing schemes. However, the system still lacks a number of key elements, one of which is trained prehospital care providers. Working in partnership with local providers, our team created an innovative, Cambodia-specific prehospital care provider training course to help fill this gap. Participants received training on prehospital care skills and knowledge most applicable to the Cambodian healthcare system, which was divided into four modules: Basic Prehospital Care Skills and Adult Medical Emergencies, Traumatic Emergencies, Obstetric Emergencies, and Neonatal/Pediatric Emergencies. The course was implemented in nine of Cambodia's most populous provinces, concurrent with a number of overarching emergency medical service system improvement efforts. Overall, the course was administered to 1,083 Cambodian providers during a 27-month period, with 947 attending the entire course and passing the course completion exam.

  18. 急性脑卒中的院前急救和护理体会%Acute Stroke Prehospital Emergency and Nursing Experience

    Institute of Scientific and Technical Information of China (English)

    钟旭辉; 贾先翠

    2013-01-01

    Objective:to introduce and investigate stroke prehospital emergency and nursing. Methods: the prehospital emergency and nursing of 1 patients with cerebrovascular diseases. Results:the successful rescue operation, the fol ow-up after treatment, cure. Conclusion:the accurate and rapid prehospital recognition and the fastest speed of the patients to the hospital is one of the key factors to get the best treatment ef ect. To maintain airway patency in patients and avoid turning patients head to ensure patient safety has played an important role in nursing.%目的:介绍并探讨脑卒中的院前急救和护理。方法通过对1例脑血管病患者的急救和护理。结果抢救成功,经后续手术治疗后,治愈。结论准确而快速的院前识别和以最快的速度将患者送往医院是得到最好救治效果的关键因素之一。护理中保持患者的气道通畅和避免转动患者头部在确保患者的安全中起到了重要的作用。

  19. Problems and Countermeasures of Pre-hospital Emergency in the Overcrowded Emergency Room%医院急诊室过度拥挤状况下院前急救存在的问题和对策

    Institute of Scientific and Technical Information of China (English)

    王钱锋; 周海斌; 张军根; 陈淳

    2013-01-01

    目的:通过对医院急诊室过度拥挤状态下院前急救过程中存在的问题进行分析,提出有效的应对策略.方法:对院前急救工作进行回顾性分析,并结合杭州市急救中心实际问题提出对策.结果:院前急救与急诊室作为EMSS的重要组成部分,急诊室的过度拥挤状态下院前急救工作存在的问题包括救护车转向率提高、急救资源滞留及满意度下降等.结论:通过制定相应法律法规,解决急诊室拥挤情况,构建院前院内的资源信息联网平台等,可有效解决院前急救中存在的问题.%Objective:To put forward some effective countermeasures to the problems ledby emergency room overcrowding in the state of pre -hospital emergency process.Methods:To analyze the work of pre-hospital emergency retrospectively,and proposed the countermeasure considering the actual situation of emergency center of Hangzhou.Results:Pre-hospital emergency and emergency room werce importants component of EMSS,emergency room overcrowding problems in the state of pre-hospital emergency work.included ambulances turning rate increase,first aid resources retention and satisfaction levels decrease.Conclusion:probrems will be settled through formulating laws and regulations,ameliorating emergency room crowded situation,constructing network platform relate to the pre-hospital resources information,and effectively solve the problems existing in the pre-hospital emergency.

  20. Comparison of Three Prehospital Cervical Spine Protocols to Missed Injuries

    OpenAIRE

    Hong, Rick; Meenan, Molly; Prince, Erin; Murphy, Ronald; Tambussi, Caitlin; Rohrbach, Rick; Baumann, Brigitte M.

    2014-01-01

    Introduction: We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients wh...

  1. Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries

    OpenAIRE

    Rick Hong; Molly Meenan; Erin Prince; Ronald Murphy; Caitlin Tambussi; Rick Rohrbach; Baumann, Brigitte M.

    2014-01-01

    Introduction: We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients wh...

  2. Comparison of Three Prehospital Cervical Spine Protocols to Missed Injuries

    OpenAIRE

    Hong, Rick; Meenan, Molly; Prince, Erin; Murphy, Ronald; Tambussi, Caitlin; Rohrbach, Rick; Baumann, Brigitte M.

    2014-01-01

    Introduction: We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients wh...

  3. Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries

    OpenAIRE

    Rick Hong; Molly Meenan; Erin Prince; Ronald Murphy; Caitlin Tambussi; Rick Rohrbach; Baumann, Brigitte M.

    2014-01-01

    Introduction: We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients wh...

  4. Comparison of Macintosh, McCoy and C-MAC D-Blade video laryngoscope intubation by prehospital emergency health workers: a simulation study.

    Science.gov (United States)

    Yildirim, Ahmet; Kiraz, Hasan A; Ağaoğlu, İbrahim; Akdur, Okhan

    2017-02-01

    The aim of the this study is to evaluate the intubation success rates of emergency medical technicians using a Macintosh laryngoscope (ML), McCoy laryngoscope (MCL), and C MAC D-Blade (CMDB) video laryngoscope on manikin models with immobilized cervical spines. This randomized crossover study included 40 EMTs with at least 2 years' active service in ambulances. All participating technicians completed intubations in three scenarios-a normal airway model, a rigid cervical collar model, and a manual in-line cervical stabilization model-with three different laryngoscopes. The scenario and laryngoscope model were determined randomly. We recorded the scenario, laryngoscope method, intubation time in seconds, tooth pressure, and intubation on a previously prepared study form. We performed Friedman tests to determine whether there is a significant change in the intubation success rate, duration of tracheal intubation, tooth pressure, and visual analog scale scores due to violations of parametric test assumptions. We performed the Wilcoxon test to determine the significance of pairwise differences for multiple comparisons. An overall 5 % type I error level was used to infer statistical significance. We considered a p value of less than 0.05 statistically significant. The CMDB and MCL success rates were significantly higher than the ML rates in all scenario models (p < 0.05). The CMDB intubation duration was significantly shorter when compared with ML and MCL in all models. CMDB and MCL may provide an easier, faster intubation by prehospital emergency health care workers in patients with immobilized cervical spines.

  5. Pre-hospital midazolam for benzodiazepine-treated seizures before and after the Rapid Anticonvulsant Medication Prior to Arrival Trial: A national observational cohort study.

    Science.gov (United States)

    Shtull-Leber, Eytan; Silbergleit, Robert; Meurer, William J

    2017-01-01

    Implementation of evidence-based treatment for pre-hospital status epilepticus can improve outcomes. We hypothesized that publication of a pivotal pre-hospital clinical trial (RAMPART), demonstrating superiority of intramuscular midazolam over intravenous lorazepam, altered the national utilization rates of midazolam for pre-hospital benzodiazepine-treated seizures, while upholding its safety and efficacy outside the trial setting. This is a retrospective, observational cohort study of pre-hospital patient encounters throughout the United States in the National Emergency Medicine Services Information System database, from January 2010 through December 2014. We compared the rates and odds of midazolam use as first-line treatment among all adult and pediatric benzodiazepine-treated seizures before and after RAMPART publication (February 2012). Secondary analyses were conducted for rates of airway interventions and rescue therapy, as proxies for safety and efficacy of seizure termination. 156,539 benzodiazepine-treated seizures were identified. Midazolam use increased from 26.1% in January 2010 to 61.7% in December 2014 (difference +35.6%, 95% CI, 32.7%-38.4%). The annual rate of midazolam adoption increased significantly from 5.9% per year to 8.9% per year after the publication of RAMPART (difference +3.0% per year; 95%CI, 1.6%-4.5% per year; adjusted OR 1.24; 95%CI, 1.17-1.32). Overall frequency of rescue therapy and airway interventions changed little after the publication of RAMPART. These data are consistent with effective, ongoing, but incomplete clinical translation of the RAMPART results. The effects of the trial, however, cannot be isolated. The study was limited by broad inclusion of all benzodiazepine-treated seizures as well as a lack of information on route of drug of administration. The safety and effectiveness of midazolam for benzodiazepine-treated seizures in prehospital clinical practice appear consistent with trial data, which should encourage

  6. Pre-hospital midazolam for benzodiazepine-treated seizures before and after the Rapid Anticonvulsant Medication Prior to Arrival Trial: A national observational cohort study

    Science.gov (United States)

    Silbergleit, Robert

    2017-01-01

    Background Implementation of evidence-based treatment for pre-hospital status epilepticus can improve outcomes. We hypothesized that publication of a pivotal pre-hospital clinical trial (RAMPART), demonstrating superiority of intramuscular midazolam over intravenous lorazepam, altered the national utilization rates of midazolam for pre-hospital benzodiazepine-treated seizures, while upholding its safety and efficacy outside the trial setting. Methods and findings This is a retrospective, observational cohort study of pre-hospital patient encounters throughout the United States in the National Emergency Medicine Services Information System database, from January 2010 through December 2014. We compared the rates and odds of midazolam use as first-line treatment among all adult and pediatric benzodiazepine-treated seizures before and after RAMPART publication (February 2012). Secondary analyses were conducted for rates of airway interventions and rescue therapy, as proxies for safety and efficacy of seizure termination. 156,539 benzodiazepine-treated seizures were identified. Midazolam use increased from 26.1% in January 2010 to 61.7% in December 2014 (difference +35.6%, 95% CI, 32.7%-38.4%). The annual rate of midazolam adoption increased significantly from 5.9% per year to 8.9% per year after the publication of RAMPART (difference +3.0% per year; 95%CI, 1.6%-4.5% per year; adjusted OR 1.24; 95%CI, 1.17–1.32). Overall frequency of rescue therapy and airway interventions changed little after the publication of RAMPART. Conclusions These data are consistent with effective, ongoing, but incomplete clinical translation of the RAMPART results. The effects of the trial, however, cannot be isolated. The study was limited by broad inclusion of all benzodiazepine-treated seizures as well as a lack of information on route of drug of administration. The safety and effectiveness of midazolam for benzodiazepine-treated seizures in prehospital clinical practice appear consistent

  7. Tranexamic acid as part of remote damage-control resuscitation in the prehospital setting: A critical appraisal of the medical literature and available alternatives.

    Science.gov (United States)

    Ausset, Sylvain; Glassberg, Elon; Nadler, Roy; Sunde, Geir; Cap, Andrew P; Hoffmann, Clément; Plang, Soryapong; Sailliol, Anne

    2015-06-01

    Hemorrhage remains the leading cause of preventable trauma-associated mortality. Interventions that improve prehospital hemorrhage control and resuscitation are needed. Tranexamic acid (TXA) has recently been shown to reduce mortality in trauma patients when administered upon hospital admission, and available data suggest that early dosing confers maximum benefit. Data regarding TXA implementation in prehospital trauma care and analyses of alternatives are lacking. This review examines the available evidence that would inform selection of hemostatic interventions to improve outcomes in prehospital trauma management as part of a broader strategy of "remote damage-control resuscitation" (RDCR). The medical literature available concerning both the safety and the efficacy of TXA and other hemostatic agents was reviewed. TXA use in surgery was studied in 129 randomized controlled trials, and a meta-analysis was identified. More than 800,000 patients were followed up in large cohort study. In trauma, a large randomized controlled trial, the CRASH-2 study, recruited more than 20,000 patients, and two cohort studies studied more than 1,000 war casualties. In the prehospital setting, the US, French, British, and Israeli militaries as well as the British, Norwegian, and Israeli civilian ambulance services have implemented TXA use as part of RDCR policies. Available data support the efficacy and the safety of TXA. High-level evidence supports its use in trauma and strongly suggests that its implementation in the prehospital setting offers a survival advantage to many patients, particularly when evacuation to surgical care may be delayed. TXA plays a central role in the development of RDCR strategies.

  8. Ethical conflicts in the prehospital setting.

    Science.gov (United States)

    Adams, J G; Arnold, R; Siminoff, L; Wolfson, A B

    1992-10-01

    To assess the range of ethical conflicts that confront prehospital care providers. Convenience sample, from October 1989 to January 1990. An urban advanced life support emergency medical service that transports approximately 3,000 patients per month. Six hundred seven paramedic responses were analyzed by a single observer. An ethical conflict was identified when the paramedic faced a dilemma about what "ought to be done" and the paramedic's values conflicted or potentially conflicted with the patient's. Cases with potential ethical consequence were brought to experts in medical ethics and epidemiology for further analysis and classification. Ethical conflicts arose in 14.4% of paramedic responses (88 of 607 cases). Twenty-seven percent of the conflicts involved issues of informed consent, such as refusal of treatment or transport, conflicts of hospital destination, treatment of minors, and consent for research. Difficulties regarding the duty of the paramedics, usually under threatening circumstances, accounted for 19% of the dilemmas encountered. Requests for limitation of resuscitation accounted for 14%. Other circumstances that presented ethical conflicts involved questions of patient competence (17%), resource allocation (10%), confidentiality (8%), truth telling (3%), and training (1%). The data demonstrate a range of ethical conflicts in the prehospital setting and point to areas in which policy needs to be developed. The data also can be used in a prehospital ethics curriculum for paramedics and physicians. Because case sampling was not strictly random, absolute conclusions should not be drawn regarding the frequency of the dilemmas.

  9. Emergency Victim Care. A Textbook for Emergency Medical Personnel.

    Science.gov (United States)

    Ohio State Dept. of Education, Columbus. Trade and Industrial Education Service.

    This textbook for emergency medical personnel should be useful to fire departments, private ambulance companies, industrial emergency and rescue units, police departments, and nurses. The 30 illustrated chapters cover topics such as: (1) Emergency Medical Service Vehicles, (2) Safe Driving Practices, (3) Anatomy and Physiology, (4) Closed Chest…

  10. Prehospital Intubation is Associated with Favorable Outcomes and Lower Mortality in ProTECT III.

    Science.gov (United States)

    Denninghoff, Kurt R; Nuño, Tomas; Pauls, Qi; Yeatts, Sharon D; Silbergleit, Robert; Palesch, Yuko Y; Merck, Lisa H; Manley, Geoff T; Wright, David W

    2017-01-01

    Traumatic brain injury (TBI) causes more than 2.5 million emergency department visits, hospitalizations, or deaths annually. Prehospital endotracheal intubation has been associated with poor outcomes in patients with TBI in several retrospective observational studies. We evaluated the relationship between prehospital intubation, functional outcomes, and mortality using high quality data on clinical practice collected prospectively during a randomized multicenter clinical trial. ProTECT III was a multicenter randomized, double-blind, placebo-controlled trial of early administration of progesterone in 882 patients with acute moderate to severe nonpenetrating TBI. Patients were excluded if they had an index GCS of 3 and nonreactive pupils, those with withdrawal of life support on arrival, and if they had documented prolonged hypotension and/or hypoxia. Prehospital intubation was performed as per local clinical protocol in each participating EMS system. Models for favorable outcome and mortality included prehospital intubation, method of transport, index GCS, age, race, and ethnicity as independent variables. Significance was set at α = 0.05. Favorable outcome was defined by a stratified dichotomy of the GOS-E scores in which the definition of favorable outcome depended on the severity of the initial injury. Favorable outcome was more frequent in the 349 subjects with prehospital intubation (57.3%) than in the other 533 patients (46.0%, p = 0.003). Mortality was also lower in the prehospital intubation group (13.8% v. 19.5%, p = 0.03). Logistic regression analysis of prehospital intubation and mortality, adjusted for index GCS, showed that odds of dying for those with prehospital intubation were 47% lower than for those that were not intubated (OR = 0.53, 95% CI = 0.36-0.78). 279 patients with prehospital intubation were transported by air. Modeling transport method and mortality, adjusted for index GCS, showed increased odds of dying in those transported by ground

  11. Prehospital score for acute disease: a community-based observational study in Japan

    Directory of Open Access Journals (Sweden)

    Fujiwara Hidekazu

    2007-10-01

    Full Text Available Abstract Background Ambulance usage in Japan has increased consistently because it is free under the national health insurance system. The introduction of refusal for ambulance transfer is being debated nationally. The purpose of the present study was to investigate the relationship between prehospital data and hospitalization outcome for acute disease patients, and to develop a simple prehospital evaluation tool using prehospital data for Japan's emergency medical service system. Methods The subjects were 9,160 consecutive acute disease patients aged ≥ 15 years who were transferred to hospital by Kishiwada City Fire Department ambulance between July 2004 and March 2006. The relationship between prehospital data (age, systolic blood pressure, pulse rate, respiration rate, level of consciousness, SpO2 level and ability to walk and outcome (hospitalization or non-hospitalization was analyzed using logistic regression models. The prehospital score component of each item of prehospital data was determined by beta coefficients. Eligible patients were scored retrospectively and the distribution of outcome was examined. For patients transported to the two main hospitals, outcome after hospitalization was also confirmed. Results A total of 8,330 (91% patients were retrospectively evaluated using a prehospital score with a maximum value of 14. The percentage of patients requiring hospitalization rose from 9% with score = 0 to 100% with score = 14. With a cut-off point score ≥ 2, the sensitivity, specificity, positive predictive value and negative predictive value were 97%, 16%, 39% and 89%, respectively. Among the 6,498 patients transported to the two main hospitals, there were no deaths at scores ≤ 1 and the proportion of non-hospitalization was over 90%. The proportion of deaths increased rapidly at scores ≥ 11. Conclusion The prehospital score could be a useful tool for deciding the refusal of ambulance transfer in Japan's emergency medical

  12. Prehospital emergency management of avulsed permanent teeth: Knowledge and attitude of schoolteachers

    OpenAIRE

    Harkiran Kaur; Supreet Kaur; Hargundeep Kaur

    2012-01-01

    Context: Tooth avulsion is one of the most serious dental emergencies in children. Often these injuries occur in school and, therefore, the knowledge of schoolteachers regarding the appropriate measures to be taken immediately after tooth avulsion is crucial to good prognosis. Aims: The purpose of the present study was to evaluate schoolteachers′ knowledge and attitudes regarding immediate management of avulsed teeth in children. Materials and Methods: A total of 177 teachers from sev...

  13. Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals

    Science.gov (United States)

    Dimitrov, Nikolay; Koenig, William; Bosson, Nichole; Song, Sarah; Saver, Jeffrey L.; Mack, William J.; Sanossian, Nerses

    2015-01-01

    Introduction Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Methods Each county’s local emergency medical services agency (LEMSA) was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Results Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45%) had stroke routing protocols, covering 23 counties (40%) and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile). In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. Conclusion California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources. PMID:26587100

  14. Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals

    Directory of Open Access Journals (Sweden)

    Nikolay Dimitrov

    2015-10-01

    Full Text Available Introduction: Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Methods: Each county’s local emergency medical services agency (LEMSA was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Results: Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45% had stroke routing protocols, covering 23 counties (40% and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile. In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. Conclusion: California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources.

  15. Stroke awareness among Dubai emergency medical service staff and impact of an educational intervention.

    Science.gov (United States)

    Shire, Fatima; Kasim, Zahra; Alrukn, Suhail; Khan, Maria

    2017-07-06

    Emergency medical services (EMS) play a vital role in expediting hospital arrival in stroke patients. The objective of our study was to assess the level of awareness regarding pre-hospital identification and management of acute stroke among EMS Staff in Dubai and to evaluate the impact of an educational lecture on their knowledge. Ours was a cross-sectional study with a pre-test and post-test design. The intervention was an educational lecture, based on the updated guidelines in pre-hospital care of acute stroke. Participants were assessed before and after the intervention on various aspects of stroke care. Paired t test were used to compare the impact of the intervention. A total of 274 EMS workers participated in our study. The baseline knowledge of participants regarding stroke types was inadequate with only 68% correctly identifying these. 79% were able to name the cardinal stroke symptoms. Knowledge of stroke mimics was poor with only 6.6% identifying stroke mimics correctly. With respect to management, most participants were unable to correctly identify the points to illicit in the history of an acute stroke patient (25.2%) and also the steps in pre-hospital management (40%). All these aspects showed remarkable improvement post intervention. The baseline awareness of most aspects of acute stroke identification and management was poor in our EMS participants. Our educational lecture proved effective in improving this knowledge when tested immediately post intervention. However, there is a need to re-assess this at periodic intervals to identify the need for refresher courses on pre-hospital stroke management.

  16. Current state and strategy of prehospital emergency treatment, in high altitude regions%高原地区院外急救现状及对策

    Institute of Scientific and Technical Information of China (English)

    公保才旦

    2012-01-01

    阐述高原地区地理特点及高原环境对人体的影响,从急救机构、急救水平、后勤保障以及应急预案的实施等方面概述目前高原地区院外急救现况,并针对这些现况提出对高原地区院外急救工作的建议.%This study explains the geographical features of high altitude regions and the effect on human bodies, summarizes the present situation of prehospital emergency treatment in high altitude regions on emergency facilities, emergency level, logistics and implement of contingency plans, and gives some suggestions about current state of the emergency treatment in plateau regions.

  17. ATTENTION TO THE EMERGENCY ROOM WITH EMPHASIS ON PRE-HOSPITAL CARE: INTEGRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    B. S. Santos

    2017-08-01

    Full Text Available The study aims to identify the factors, which influence positively and negatively the implementation of public policies geared to the needs in scope of mobile, found in the publications of brazilian researchers since the implementation of the National Policy of Attention to the Emergency room in Brazil. This is a study of Integrative Literature Review. Composing the basis of methodology, have been used official documents to guide the findings that comprised the conceptual bases of the study and to guide the Integrative Review were used publications that report on the issue in question respecting all steps of the protocol review. The results show the changes in the organizational structure of the Service Mobile Emergency, given the regionalization as something positive for the growth of this service modality and discuss prematurely early articulation between the sectors that make up the public health system in Brazil. In conclusion, the policies of attention to the urgencies, in particular within mobile, have favored beneficially all of the users who require this type of care, in the meantime, make the necessary reflections about this theme in the attempt of a better understanding of the regionalization process and coordination among the municipalities that will offer the mobile care so as to ensure continuity of care through the mechanisms of reference and counter-reference

  18. Strategically Leapfrogging Education in Prehospital Trauma Management: Four-Tiered Training Protocols

    OpenAIRE

    Abraham, Rohit; Vyas, Dinesh; Narayan, Mayur; Vyas, Arpita

    2015-01-01

    Trauma-related injury in fast developing countries are linked to 90% of international mortality rates, which can be greatly reduced by improvements in often non-existent or non-centralized emergency medical systems (EMS)—particularly in the pre-hospital care phase. Traditional trauma training protocols—such as Advanced Trauma Life Support (ATLS), International Trauma Life Support (ITLS), and Basic Life Support (BLS)—have failed to produce an effective pre-hospital ground force of medical firs...

  19. Benchmarking Prehospital and Emergency Department Care for Argentine Children with Traumatic Brain Injury: For the South American Guideline Adherence Group

    Science.gov (United States)

    Vavilala, Monica S.; Lujan, Silvia B.; Qiu, Qian; Petroni, Gustavo J.; Ballarini, Nicolás M.; Guadagnoli, Nahuel; Depetris, María Alejandra; Faguaga, Gabriela A.; Baggio, Gloria M.; Busso, Leonardo O.; García, Mirta E.; González Carrillo, Osvaldo R.; Medici, Paula L.; Sáenz, Silvia S.; Vanella, Elida E.; Fabio, Anthony; Bell, Michael J.

    2016-01-01

    Objective There is little information on the type of early care provided to children with traumatic brain injury (TBI) in low middle income countries. We benchmarked early prehospital [PH] and emergency department [ED] pediatric TBI care in Argentina. Methods We conducted a secondary analysis of data from patients previously enrolled in a prospective seven center study of children with TBI. Eligible participants were patients 0–18 years, and had diagnosis of TBI (admission Glasgow Coma scale score [GCS] 0). Outcomes were transport type, transport time, PH and ED adherence to best practice, and discharge Pediatric Cerebral Performance Category Scale (PCPC) and Pediatric Overall Performance category Scale (POPC). Results Of the 366 children, mean age was 8.7 (5.0) years, 58% were male, 90% had isolated TBI and 45.4% were transported by private vehicle. 50 (34.7%) of the 144 children with severe TBI (39.3% of all TBI patients) were transported by private vehicle. Most (267; 73%) patients received initial TBI care at an index hospital prior to study center admission, including children with severe (81.9%) TBI. Transport times were shorter for those patients who were directly transported by ambulance to study center than for the whole cohort (1.4 vs.5.5 hours). Ambulance blood pressure data were recorded in 30.9%. ED guideline adherence rate was higher than PH guideline adherence rate (84.8% vs. 26.4%). For patients directly transferred from scene to study trauma centers, longer transport time was associated with worse discharge outcome (PCPC aOR 1.10 [1.04, 1.18] and (POPC aOR 1.10 [1.04, 1.18]). There was no relationship between PH or ED TBI guideline adherence rate and discharge POPC and PCPC. Conclusion This study benchmarks early pediatric TBI care in Argentina and shows that many critically injured children with TBI do not receive timely or best practice PH care, that PH guideline adherence rate is low and that longer transport time was associated with poor

  20. Emergency Medical Service (EMS): Rotorcraft Technology Workshop

    Science.gov (United States)

    Bauchspies, J. S.; Adams, R. J.

    1981-01-01

    A lead organization on the national level should be designated to establish concepts, locations, and the number of shock trauma air medical services. Medical specialists desire a vehicle which incorporates advances in medical technology trends in health care. Key technology needs for the emergency medical services helicopter of the future include the riding quality of fixed wing aircraft (reduced noise and vibration), no tail rotor, small rotor, small rotor diameter, improved visibility, crashworthy vehicle, IFR capability, more affordability high reliability, fuel efficient, and specialized cabins to hold medical/diagnostic and communications equipment. Approaches to a national emergency medical service are discussed.

  1. Termination of prehospital resuscitative efforts

    DEFF Research Database (Denmark)

    Mikkelsen, Søren; Schaffalitzky de Muckadell, Caroline; Binderup, Lars Grassmé

    2017-01-01

    BACKGROUND: Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts...... need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical....... The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not. RESULTS: In total, 1275 patients were either declared dead at the scene...

  2. Advanced airway management--a medical emergency response team perspective.

    Science.gov (United States)

    Haldane, A G

    2010-09-01

    To determine the number of medical emergency response team (MERT) patients undergoing advanced airway management in the peri-evacuation phase and to determine the indications for airway interventions undertaken in flight. This was a retrospective study. Data was collected from patient report and mission debrief forms completed after each MERT mission during Operation HERRICK 10 (April-October 2009). All patients that received advanced airway interventions before or during evacuation were identified. MERTs were involved in the primary transfer of 534 patients during the period studied, 56 (10.5%) underwent advanced airway management, of which 31 (5.8% of total) were initiated by the MERT in the peri-evacuation phase. Twenty five cases (4.7%) underwent advanced airway management by other pre-hospital providers prior to MERT arrival. Of the 31 advanced airway interventions undertaken in-flight, cardiac arrest was the primary indication in only nine cases. The figure of 56 patients requiring advanced airway management is at the higher end of the range expected from the study of historical military data. This may reflect the doctrine of "intelligent tasking", that is sending this physician-led team to the most seriously injured casualties.

  3. Prehospital care in Hong Kong.

    Science.gov (United States)

    Lo, C B; Lai, K K; Mak, K P

    2000-09-01

    A quick and efficient prehospital emergency response depends on immediate ambulance dispatch, patient assessment, triage, and transport to hospital. During 1999, the Ambulance Command of the Hong Kong Fire Services Department responded to 484,923 calls, which corresponds to 1329 calls each day. Cooperation between the Fire Services Department and the Hospital Authority exists at the levels of professional training of emergency medical personnel, quality assurance, and a coordinated disaster response. In response to the incident at the Hong Kong International Airport in the summer of 1999, when an aircraft overturned during landing, the pre-set quota system was implemented to send patients to designated accident and emergency departments. Furthermore, the 'first crew at the scene' model has been adopted, whereby the command is established and triage process started by the first ambulance crew members to reach the scene. The development of emergency protocols should be accompanied by good field-to-hospital and interhospital communication, the upgrading of decision-making skills, a good monitoring and auditing structure, and commitment to training and skills maintenance.

  4. Emergency Medical Rescue in a Radiation Environment

    Energy Technology Data Exchange (ETDEWEB)

    Briesmeister, L.; Ellington, Y.; Hollis, R.; Kunzman, J.; McNaughton, M.; Ramsey, G.; Somers, B.; Turner, A.; Finn, J.

    1999-09-14

    Previous experience with emergency medical rescues in the presence of radiation or contamination indicates that the training provided to emergency responders is not always appropriate. A new course developed at Los Alamos includes specific procedures for emergency response in a variety of radiological conditions.

  5. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment.

    Science.gov (United States)

    Amadi-Obi, Ahjoku; Gilligan, Peadar; Owens, Niall; O'Donnell, Cathal

    2014-01-01

    The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome.

  6. Emergency medical epidemiology in Assam, India

    Directory of Open Access Journals (Sweden)

    Saddichha Sahoo

    2009-01-01

    Full Text Available Background: Assam, with its capital in Dispur has one of the highest rates of infant and maternal mortality in India. Being under both tribal and hilly regions, it has lacked adequate healthcare and emergency services. We therefore aimed to conduct a cross-sectional survey of medical emergencies and identify various types of emergencies presenting to emergency departments, prior to launching emergency services across the state. Materials and Methods: On a prospective basis and using a stratified random sampling design, all emergencies presenting to the three government hospitals in Guwahati, Assam, which handle 90% of all emergencies currently, were studied on specially designed datasheets in order to collect data. Emergency medical technicians (EMTs were placed in the Casualty of the medical colleges and recorded all emergencies on the datasheet. The collected data was then analysed for stratification and mapping of emergencies. In addition, retrospective data for a period of 15 days was collected from the emergency case registers of all three hospitals and the adjoining district civil hospitals, in order to give a wider perspective of the nature of emergencies. Results: A total of 2169 emergencies were recorded over a seven-day prospective and fifteen-day retrospective period. Guwahati Medical College Hospital attended to majority of emergencies (42%, which were mainly of the nature of pregnancies (22.7%, accidents (12.2% or assaults (15.4% and fever related. Maximum emergencies also presented from the border districts, and occurred among young males in the age group of 19-45 years. Males were also more prone to accidents and assaults, while females presented with pregnancies as emergencies. Conclusion: Potential emergency services need to target young pregnant females. Law and order needs to be also tightened in order to curb accidents and assaults among young males.

  7. Advanced communication infrastructure for pre-hospital EMS care.

    Science.gov (United States)

    Orthner, Helmuth; Mazza, Giovanni; Mazza, Giovanni Giorgio; Shenvi, Rohit; Battles, Marcie

    2008-11-06

    The traditional communication infrastructure of the pre-hospital Emergency Medical System (EMS) is limited to voice communication using radio or cell phone technologies. With the emergence of 3rd Generation wireless networks (3G) and enhanced mobile devices capable of data communication (e.g., mobile tablets, PDAs with cell phones, or cell phones with PDA capabilities), the voice communication can be enhanced with interactive data messaging and perhaps even with interactive video communication. However, video requires substantially more bandwidth which 4th Generation (4G) systems are promising. However, their availability is limited. We present an infrastructure that allows dynamic selection of the best data transport mode in the pre-hospital EMS environment.

  8. 2013年北京市急救中心院前急救儿童患者流行病学研究%Epidemiological studies on children patients with pre-hospital emergency in Beijing Emergency ;Center in 2013

    Institute of Scientific and Technical Information of China (English)

    刘杉; 高丁

    2014-01-01

    Objective To summarize the age, gender, and the regularity of disease classification of children patients with pre-hospital emergency in Beijing Emergency Center in 2013, provide the basis for improving children's quality of pre-hospital first aid. Methods Based on the Beijing emergency center scheduling information database, of pre-hospital emergency first aid center in Beijing in 2013 children patients were retrospectively analyzed. Results 2013 emergency center of Beijing children pre-hospital emergency patients, male:female was 1.6∶1. In every age group, 4 to 7 years old preschool children, most patients with a total of 2 492 cases, accounting for 25.31%;Neonatal patients at least within 28 days, a total of 251 cases, accounting for 2.55%. Disease to constitute the top five of the respiratory system disease, trauma, respectively, digestive system disease, neuromuscular disease, airway foreign bodies. Respiratory system disease, trauma, in 4 to 7 years old preschool children group, most patients with digestive system disease, neuromuscular disease, patients with airway foreign bodies in 1 to 3 years old infants group most. Conclusion Pre-hospital emergency according to the emergency center of Beijing children patients with age, sex and characteristics of disease classification, targeted to carry out the related work, can make patients get better pre-hospital emergency services.%目的:总结2013年北京市急救中心院前急救儿童患者的年龄、性别及病种分类规律,为提高儿童的院前急救质量提供依据。方法以北京急救中心调度信息数据库为基础,对2013年北京市急救中心院前急救儿童患者进行回顾性分析。结果2013年北京市急救中心院前急救9845例儿童患者中,男∶女为1.6∶1。各年龄组中,4~7岁的学龄前儿童患者最多,共2492例,占25.31%;28 d以内的新生儿组患者最少,共251例,占2.55%。病种构成前五位分别为呼吸系统疾病、

  9. Prehospital care for multiple trauma patients in Germany

    Institute of Scientific and Technical Information of China (English)

    Marc Maegele

    2015-01-01

    For the German speaking countries,Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid.The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care.The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system.The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept.The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first").If no immediate treatment is necessary,a "Secondary Survey" follows with careful and structured body examination and detailed assessment of the trauma mechanism.Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme.Critical trauma patients should be referred without any delay ("work and go") to TR-DGU(R) certified trauma centers of the local trauma networks.Due to the difficult prehospital environment the number of quality studies in the field is low and,as consequence,the level of evidence for most recommendations is also low.Much information has been obtained from different care systems and the interchangeability of results is limited.The present article provides a synopsis of recommendations for early prehospital care for the severely injured based upon the 2011 updated multidisciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung",the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.

  10. Safety and Efficacy of Prehospital Diltiazem

    Directory of Open Access Journals (Sweden)

    Jeffrey H Luk

    2013-05-01

    Full Text Available Introduction: Very few studies exist on the use of diltiazem in the prehospital setting. Some practitioners believe this medication is prone to causing hypotension in this setting. Our goals were to determine whether the prehospital administration of diltiazem induced hypotension and to evaluate the efficacy of the drug.Methods: Our two-tiered system is located in a suburban region of New Jersey with advanced life support (ALS care provided by fly-car units. The ALS units do not transport patients, and all of them are hospital based. The ALS providers are employed by the hospital system. In New Jersey, all ALS care requires online medical control, including the administration of diltiazem. We retrospectively reviewed patient care records for those who were believed to be in rapid atrial fibrillation and were given diltiazem in a suburban emergeny medical services system over a 22-month period. We examined the differences between heart rate (HR and blood pressure (BP on the initial evaluation and on arrival to the emergency department (ED. A hypotensive response was defined as a final systolic BP (SBP less than 90 mmHg and a drop in SBP of at least 10 mmHg. Diltiazem was considered effective if the ED HR was ,100 beats per minute (bpm or if it decreased [1]20%.Results: During the study period, 26,979 patients were transported. Of these patients, 2,488 had a documented rhythm of atrial fibrillation or atrial flutter. Of the 320 patients who received diltiazem, 42 patient encounters were excluded for incomplete data, yielding 278 patients for analysis. The average initial SBP was 139 mmHg and the average diastolic BP was 84 mmHg. The average diltiazem dosage was 16.7 mg. Two patients became hypotensive. The average initial HR was 154 bpm. On arrival to the ED, 33% of the patients had an HR , 100 bpm and 69% had a drop in HR [1] 20%. The overall efficacy of prehospital diltiazem was 73%.Conclusion: In the prehospital setting, diltiazem is associated

  11. [Helicopter emergency medical service missions at night: 2 years of experience in the Dutch Regional Emergency Healthcare Network East].

    Science.gov (United States)

    Hoogerwerf, Nico; Heijne, Amon; Geeraedts, Leo M G; van Riessen, Christine; Scheffer, Gert-Jan

    2010-01-01

    To study whether there are differences between day and night in the dispatch of helicopter emergency medical services (HEMS) and in their response and travelling times, medical treatment and transport of patients. Retrospective, descriptive study. All data on helicopter emergency medical service (HEMS) missions available 24/7 from Nijmegen, the Netherlands, during 2007 and 2008 were collected. All missions in this period were divided into daytime and night-time missions. Next, the reason for dispatch, the duration of distinct times during the mission, the method of transport of the HEMS team, medical treatments and patient transport were compared. In 2007 and 2008 the HEMS team was dispatched 2891 times. 1107 patients were treated during daytime and 479 during the night. The mean distance to the incident scene was longer for night missions. During night-time the HEMS team was dispatched more often for road traffic accidents and violence-related accidents but less often for falls, drowning, horse riding accidents and people becoming trapped (non-traffic-related). There were no differences in medical treatment given by the HEMS physician between day and night, but fewer patients were transported by helicopter at night. Travelling times and on-scene times were only slightly different. The number of dispatches of the HEMS team at night was higher than expected, but night missions were cancelled more often due to weather conditions than missions by day. Prehospital times and operations of the Netherlands HEMS differed slightly between day and night.

  12. Description of Medication Administration by Emergency Medical Services during Mass-casualty Incidents in the United States.

    Science.gov (United States)

    El Sayed, Mazen; Tamim, Hani; Mann, N Clay

    2016-04-01

    Emergency Medical Services (EMS) preparedness and availability of essential medications are important to reduce morbidity and mortality from mass-casualty incidents (MCIs). This study describes prehospital medication administration during MCIs by different EMS service levels. The US National EMS Public-Release Research Dataset maintained by the National Emergency Medical Services Information System (NEMSIS) was used to carry out the study. Emergency Medical Services activations coded as MCI at dispatch, or by EMS personnel, were included. The Center for Medicare and Medicaid Services (CMS) service level was used for the level of service provided. A descriptive analysis of medication administration by EMS service level was carried out. Among the 19,831,189 EMS activations, 53,334 activations had an MCI code, of which 26,110 activations were included. There were 8,179 (31.3%) Advanced Life Support (ALS), 5,811 (22.3%) Basic Life Support (BLS), 399 (1.5%) Air Medical Transport (AMT; fixed or rotary), and 38 (0.2%) Specialty Care Transport (SCT) activations. More than 80 different medications from 18 groups were reported. Seven thousand twenty-one activations (26.9%) had at least one medication administered. Oxygen was most common (16.3%), followed by crystalloids (6.9%), unknown (5.2%), analgesics (3.2%) mainly narcotics, antiemetics (1.5%), cardiac/vasopressors/inotropes (0.9%), bronchodilators (0.9%), sedatives (0.8%), and vasodilators/antihypertensives (0.7%). Overall, medication administration rates and frequencies of medications groups significantly varied between EMS service levels (Psystems can use the findings of this study to better prepare their stockpiles for MCIs.

  13. Acute myocardial infarction pre-hospital emergency care and emergency analysis%急性心肌梗死的院前急救和急诊急救护理分析

    Institute of Scientific and Technical Information of China (English)

    甘梅

    2015-01-01

    Objective:To analyze patients with acute myocardial infarction and emergency pre-hospital emergency care and first aid measures and effects.Methods:The clinical data of 52 cases admitted to hospital with acute myocardial infarction were retrospectively analyzed, All patients received pre-hospital care and emergency first aid and rescue effect observed in patients.Results:52 patients had 50 cases safely into wards or ICU, Patients with complications are under control, The survival rate was 96.15%.Conclusion:The effective pre-hospital care and emergency first aid care can improve the survival rate of patients with acute myocardial infarction,clinical worth promoting.%目的:分析急性心肌梗死患者的院前急救和急诊急救的护理措施和效果。方法:对本院收治的52例急性心肌梗死患者的临床资料进行回顾性分析,所有患者均接受院前急救和急诊急救护理,观察患者的抢救效果。结果:52例患者有50例安全送入专科病房或ICU,患者并发症均得到控制,抢救成功率为96.15%。结论:及时有效地院前急救和急诊急救护理可以提高急性心肌梗死患者的抢救成功率,值得临床大力推广。

  14. Prevalencia de procesos y patologías atendidos por los servicios de emergencia médica extrahospitalaria en España Prevalence of processes and pathologies dealt with by the pre-hospital emergency medical services in Spain

    Directory of Open Access Journals (Sweden)

    A. Pacheco

    2010-01-01

    Full Text Available Este estudio se ha realizado contactando con 26 Servicios de Emergencia Médica (SEMEx, vía encuesta tabulada, obteniendo datos finales de 22. La población de cobertura atendida: 42.538.730 habitantes. El número total de llamadas: 7.656.768, con 711.228 intervenciones. El número de dispositivos operativos al día: unidad de vigilancia intensiva (UVI-móviles: 329, vehículos de intervención rápida (VIR 20, ambulancias sanitarias 39 y helicópteros medicalizados 39 (5 de ellos 24 horas: Islas Canarias y Baleares, y Castilla-LaMancha y 3 aviones. Intervenciones: UVI-móvil: 94,3%, helicópteros medicalizados: 1,4% y ambulancias sanitarias: 4,3%. El número de médicos de emergencias/día: 388, personal enfermería 427. Las patologías atendidas, agrupadas según clasificación CIE-9-MC: grupo V-psiquiatría: 3,7%, grupo VI-neurológico: 2,7%, grupo VII-cardiovascular: 9,3%, grupo VIII-respiratorio: 3,2%, grupo XVII-lesiones envenenamientos: 23,1%, grupo IX-digestivo: 1,3%, grupos X-XI-genito-urinario y gineco-obstetricia: 1,4%, grupo XVI-otros mal definidos: 40,1%. Los datos de los grupos específicos estudiados (de los SEMEx que los aportaron fueron: dolor torácico-disnea: 3,7%, ictus/accidente cerebrovascular agudo: 0,9%, alteración conciencia: 7,7%, síncope-lipotimia: 2,5%, autolesiones: 2.654 (0,4%. Total grupos patológicos y sindrómicos: 59,9% y total de otros mal definidos: 40,1%. De las patologías consideradas de mayor relevancia en urgencias-emergencias: síndrome coronario agudo: 3,1%, arritmias: 3,2%, paro cardiaco: 1,7%, paro respiratorio: 0,16%, traumatismos totales: 34,9%, politraumatismos: 1,16%, traumatismo cráneo encefálico: 1,77%, intoxicaciones: 5,1%, agresiones: 6,9%, quemados: 0,26%.This study was carried out by contacting 26 Medical Emergency Services (MES, through survey, with final data obtained from 22. Population covered: 42,538,730. Total number of calls: 7,656,768, with 711,228 interventions. Number of

  15. Clinical observation of prehospital emergency treatment of acute myocardial infarction%院前急救抢救急性心肌梗死的临床观察

    Institute of Scientific and Technical Information of China (English)

    马爱华

    2016-01-01

    目的:探讨对急性心肌梗死患者进行院前急救的效果。方法选取郑州大学附属郑州中心医院2013年4月至2014年4月收治的急性心肌梗死患者120例,在患者入院前对其进行院前急救,如加强生命体征检测、吸氧、畅通呼吸道、止痛等措施,并对其疗效进行观察。结果经院前急救措施,患者急救总有效率为98.3%。结论对急性心肌梗死患者进行院前急救能有效的维持患者的生命体征,提高患者心肌细胞存活率,帮助患者改善日后生活质量。院前急救在救治急性心肌梗死中是不可缺少的重要环节之一,值得在临床上推广使用。%Objective TO investiGate tHe effect Of preHOspitaL emerGency treatment On acute myOcardiaL infarctiOn. Methods One Hundred and tWenty patients WitH acute myOcardiaL infarctiOn frOm ApriL 2013 tO ApriL 2014 Were seLected, patients Were Given preHOspitaL emerGency treatment priOr tO admissiOn,sucH as strenGtHeninG tHe vitaL siGns detectiOn,OXyGen,respiratOry fLOW,pain manaGement and OtHer measures,and its efficacy Were Observed. Results After taKen tHe pre-HOspitaL emerGency treatment,tHe pa-tient’s tOtaL effective rate Was 98. 3%. Conclusions PreHOspitaL emerGency treatment Of acute myOcardiaL infarctiOn can effectiveLy maintain tHe patient’s vitaL siGns,imprOve tHe survivaL rate Of myOcardiaL ceLLs,and imprOve tHe patients’quaLi-ty Of Life in tHe future. THerefOre,preHOspitaL emerGency treatment is One Of tHe impOrtant parts in tHe treatment Of acute myOcardiaL infarctiOn,sO it is WOrtH pOpuLarizinG and appLyinG On cLinic.

  16. Asthma Medication Ratio Predicts Emergency Depart...

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in Asthma Medication Ratio Predicts Emergency Department Visits and Hospitalizations in Children with Asthma, published in Volume 3,...

  17. Mobile emergency (surgical) hospital: Development and application in medical relief of "4.20" Lushan earthquake in Sichuan Province, China

    Institute of Scientific and Technical Information of China (English)

    Bin Cheng; Ruofei Shi; Dingyuan Du; Ping Hu; Jun Feng; Guangbin Huang; Anning Cai

    2015-01-01

    In the 21st century,natural disasters and emergencies occur frequently worldwide,which leads to the loss of hundreds of thousands of lives as well as the direct and indirect economic losses.China has a vast territory frequently struck by natural disasters.However,the reality is not optimistic.Poor organization and management during the rescue actions,the lack of large-scale,systematic medical rescue equipment were all great barriers to the outcomes.Mobile hospitals are expected to provide better health care.We were inspired by the concept of mobile hospital.Chongqing Emergency Medical Center,has set up trauma care system since 1988,in which prehospital care,intensive care,and in-hospital treatment is fully integrated.As a major advantage,such a system provided assurance of"golden hour" rescue treatment.Providing mobile intensive care and prehospital surgical service for severe trauma patients could reduce mortality significantly.Based on the civilian experiences in Chongqing Emergency Medical Center,the mobile emergency (surgical) hospital was developed.

  18. National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module X. Medical Emergencies.

    Science.gov (United States)

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

    This instructor's lesson plan guide on medical emergencies is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Ten units of study are presented: (1) diabetic emergencies; (2) anaphylactic reactions; (3) exposure to environmental extremes; (4) alcoholism and drug abuse; (5) poisoning and…

  19. National Prehospital Evidence-Based Guidelines Strategy: A Summary for EMS Stakeholders.

    Science.gov (United States)

    Martin-Gill, Christian; Gaither, Joshua B; Bigham, Blair L; Myers, J Brent; Kupas, Douglas F; Spaite, Daniel W

    2016-01-01

    Multiple national organizations have recommended and supported a national investment to increase the scientific evidence available to guide patient care delivered by Emergency Medical Services (EMS) and incorporate that evidence directly into EMS systems. Ongoing efforts seek to develop, implement, and evaluate prehospital evidence-based guidelines (EBGs) using the National Model Process created by a multidisciplinary panel of experts convened by the Federal Interagency Committee on EMS (FICEMS) and the National EMS Advisory Council (NEMSAC). Yet, these and other EBG efforts have occurred in relative isolation, with limited direct collaboration between national projects, and have experienced challenges in implementation of individual guidelines. There is a need to develop sustainable relationships among stakeholders that facilitate a common vision that facilitates EBG efforts. Herein, we summarize a National Strategy on EBGs developed by the National Association of EMS Physicians (NAEMSP) with involvement of 57 stakeholder organizations, and with the financial support of the National Highway Traffic Safety Administration (NHTSA) and the EMS for Children program. The Strategy proposes seven action items that support collaborative efforts in advancing prehospital EBGs. The first proposed action is creation of a Prehospital Guidelines Consortium (PGC) representing national medical and EMS organizations that have an interest in prehospital EBGs and their benefits to patient outcomes. Other action items include promoting research that supports creation and evaluates the impact of EBGs, promoting the development of new EBGs through improved stakeholder collaboration, and improving education on evidence-based medicine for all prehospital providers. The Strategy intends to facilitate implementation of EBGs by improving guideline dissemination and incorporation into protocols, and seeks to establish standardized evaluation methods for prehospital EBGs. Finally, the Strategy

  20. Emergency Medicine for medical students world wide!

    DEFF Research Database (Denmark)

    Perinpam, Larshan; Thi Huynh, Anh-Nhi

    2015-01-01

    A guest blog from Larshan Perinpam (President of ISAEM) and Anh-Nhi Thi Huynh (Vice president of external affairs, ISAEM) - http://blogs.bmj.com/emj/2015/04/17/emergency-medicine-for-medical-students-world-wide/......A guest blog from Larshan Perinpam (President of ISAEM) and Anh-Nhi Thi Huynh (Vice president of external affairs, ISAEM) - http://blogs.bmj.com/emj/2015/04/17/emergency-medicine-for-medical-students-world-wide/...

  1. The utility of the prehospital electrocardiogram.

    Science.gov (United States)

    Davis, Matthew T; Dukelow, Adam; McLeod, Shelley; Rodriguez, Severo; Lewell, Michael

    2011-11-01

    The 12-lead electrocardiogram (ECG) can capture valuable information in the prehospital setting. By the time patients are assessed by an emergency department (ED) physician, their symptoms and any ECG changes may have resolved. We sought to determine whether the prehospital electrocardiogram (pECG) could influence ED management and how often the pECG was available to and reviewed by the ED physician. A retrospective medical record review was conducted on a random sample of patients ≥ 18 years who had a prehospital 12-lead ECG and were transported to one of two tertiary care centres. Data were recorded onto a standardized data extraction tool. Three investigators independently compared the pECG to the first ECG obtained in the ED after patient arrival at the hospital. Any abnormalities not present on the ED ECG were adjudicated to ascertain whether they had the potential to change ED management. Of 115 ambulance runs selected, 47 had no pECG attached to the ambulance call record (ACR) and another 5 were excluded (one ST elevation myocardial infarction, one cardiac arrest, three ACR missing). Of the 63 pECGs reviewed, 16 (25%) showed changes not apparent on the initial ED ECG (κ  =  0.83; 95% CI 0.74-0.93), of which 12 had differences that might influence ED management (κ  =  0.76; 95% CI 0.72-0.82). Only one hospital record contained a copy of the pECG, despite the current protocol that paramedics print two copies of the pECG on arrival in the ED (one copy for the ACR and one to be handed to the medical personnel). None of 110 ED charts documented that the pECG was reviewed by the ED physician. The pECG has the potential to influence ED management. Improvement in paramedic and physician documentation and a formal pECG handover process appear necessary.

  2. Autonomic dysreflexia: a medical emergency

    Science.gov (United States)

    Bycroft, J; Shergill, I; Choong, E; Arya, N; Shah, P

    2005-01-01

    Autonomic dysreflexia is an important clinical diagnosis that requires prompt treatment to avoid devastating complications. The condition may present itself to all members of medical and surgical specialties, who may not be accustomed to treating it. It is the clinician's responsibility to have a basic understanding of the pathophysiology of the condition and the simple steps required to treat it. PMID:15811886

  3. Emergency medical service, nursing, and physician providers' perspectives on delirium identification and management.

    Science.gov (United States)

    LaMantia, Michael A; Messina, Frank C; Jhanji, Shola; Nazir, Arif; Maina, Mungai; McGuire, Siobhan; Hobgood, Cherri D; Miller, Douglas K

    2017-04-01

    Purpose of the study The study objective was to understand providers' perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. Design and methods The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Results Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults with delirium, emergency nurses identified the need for more training around the management of the condition. Emergency medical services providers identified the need for more support in managing agitated patients when in transport to the hospital and more guidance from emergency physicians on what information to collect from the patient's home environment. Emergency physicians felt that delirium care would be improved if they could have baseline mental status data on their patients and if they had access to a simple, accurate diagnostic tool for the condition. Implications Emergency medical services providers, emergency nurses, and emergency physicians frequently encounter delirious patients, but do not employ clear diagnostic strategies for identifying the condition and have varying levels of comfort in managing the condition. Clear steps should be taken to improve delirium care in the emergency department including the development of mechanisms

  4. Stroke management in northern Lombardy: organization of an emergency-urgency network and development of a connection between prehospital and in-hospital settings.

    Science.gov (United States)

    Vidale, Simone; Verrengia, Elena; Gerardi, Francesca; Arnaboldi, Marco; Bezzi, Giacomo; Bono, Giorgio; Guidotti, Mario; Grampa, Giampiero; Perrone, Patrizia; Zarcone, Davide; Zoli, Alberto; Beghi, Ettore; Agostoni, Elio; Porazzi, Daniele; Landriscina, Mario

    2012-08-01

    Stroke is the leading cause of disability in adulthood, and the principal aim of care in cerebrovascular disease is the reduction of this negative outcome and mortality. Several studies demonstrated the efficacy of thrombolytic therapy in ischemic stroke, but up to 80% of cases could not be treated because the diagnostic workup exceeds the time limit. In this article, we described the design of a study conducted in the northern Lombardy, within the district of Sondrio, Lecco, Como, and Varese. The awaited results of this study are reduction of avoidable delay, organization of an operative stroke emergency network, and identification of highly specialized structures. The study schedules education and data registration with implementation and training of acute stroke management algorithms. The use of standardized protocols during prehospital and in-hospital phase can optimize acute stroke pathways. The results of this study could contribute to the assessment of an effective and homogeneous health system to manage acute stroke.

  5. Medical Emergency Education in Dental Hygiene Programs.

    Science.gov (United States)

    Stach, Donna J.; And Others

    1995-01-01

    A survey of 169 dental hygiene training programs investigated the curriculum content and instruction concerning medical emergency treatment, related clinical practice, and program policy. Several trends are noted: increased curriculum hours devoted to emergency care; shift in course content to more than life-support care; and increased emergency…

  6. Prehospital care of burns: an analysis of 3 years use of the emergency physician system (EPS) Cologne.

    Science.gov (United States)

    Lechleuthner, A; Schmidt-Barbo, A; Bouillon, B; Perbix, W; Holzki, J; Spilker, G

    1993-04-01

    Little information is available about the vital parameters of burns victims shortly after the accident. Therefore cases of burns, electrical and caustic injuries presenting to the Cologne Emergency Physician System over 3 years (n = 262) were prospectively studied and analysed. The average incidence in Cologne, Germany (population 1 million), of burns victims attended by the Emergency Medical System and emergency physicians at the scene was 74 adults and 14 children per year. Children are mainly injured by scalds (41.4 per cent); adults by fire accidents (43 per cent). A classification of the victims at the site of the accident according to their vital signs (Trauma Score (TS) after Champion H. R., Sacco W. J. and Carnazzo A. J. et al. (1981) Trauma Score. Crit. Care Med. 9, 672) showed, that in spite of a major burn injury, the vital signs were usually not or only slightly impaired. Subsequent measurements instituted by the emergency physician at the scene increased with decreasing initial TS. With TS = 14, 50 per cent of the patients were intubated; below 14 points nearly 100 per cent. The fluid administered also increased with a decreasing TS.

  7. Impact of pre-hospital care on the outcome of children arriving with agonal breathing to a pediatric emergency service in South India

    Directory of Open Access Journals (Sweden)

    Debasis Das Adhikari

    2016-01-01

    Full Text Available Background: Data on the prehospital interventions received by critically ill children at arrival to Paediatric Emergency Services (PES is limited in developing countries. This study aims to describe the pre-hospital care scenario, transport and their impact on outcome in non-traumatic, acutely ill children presenting in PES with agonal breathing. Methods: Prospective observational study done on children aged below 15 years arriving in PES with agonal breathing due to non-trauma related causes. Results: Out of 75 children studied, 69% were infants. The duration of illness among 65% of them (75 was less than 3 days. Majority of them (81% had received treatment prior to arrival. Government sector physicians (72%, half of them (51% being pediatricians were the major treating doctors. 37% of the children had arrived to the Emergency in an ambulance. Cardiopulmonary Resuscitation (CPR was given to 27% on arrival in PES. Other interventions included fluid boluses to correct shock (92% and inotrope infusion (56%. Sepsis (24% and pneumonia (24% were the most common diagnoses. Out of 75, 57 (76% children who were stabilized and shifted to PICU and among them 27 (47% survived to discharge. Normal blood pressure (p=0.0410 and non-requirement of CPR (0.0047 and inotropic infusion (0.0459 in PES were associated with a higher chance of survival. Conclusion: 36% (27/75 of children who arrived to our PES with agonal breathing survived to hospital discharge. Survival was significantly better among those who did not need CPR.

  8. 4,871 Emergency Airway Encounters by Air Medical Providers: A Report of the Air Transport Emergency Airway Management (NEAR VI: “A-TEAM” Project

    Directory of Open Access Journals (Sweden)

    Calvin A. Brown III

    2014-03-01

    Full Text Available Introduction: Pre-hospital airway management is a key component of resuscitation although the benefit of pre-hospital intubation has been widely debated. We report a large series of pre-hospital emergency airway encounters performed by air-transport providers in a large, multi-state system. Methods: We retrospectively reviewed electronic intubation flight records from an 89 rotorcraft air medical system from January 01, 2007, through December 31, 2009. We report patient characteristics, intubation methods, success rates, and rescue techniques with descriptive statistics. We report proportions with 95% confidence intervals and binary comparisons using chi square test with p-values <0.05 considered significant. Results: 4,871 patients had active airway management, including 2,186 (44.9% medical and 2,685 (55.1% trauma cases. There were 4,390 (90.1% adult and 256 (5.3% pediatric (age ≤ 14 intubations; 225 (4.6% did not have an age recorded. 4,703 (96.6% had at least one intubation attempt. Intubation was successful on first attempt in 3,710 (78.9% and was ultimately successful in 4,313 (91.7%. Intubation success was higher for medical than trauma patients (93.4% versus 90.3%, p=0.0001 JT test. 168 encounters were managed primarily with an extraglottic device (EGD. Cricothyrotomy was performed 35 times (0.7% and was successful in 33. Patients were successfully oxygenated and ventilated with an endotracheal tube, EGD, or surgical airway in 4809 (98.7% encounters. There were no reported deaths from a failed airway. Conclusion: Airway management, predominantly using rapid sequence intubation protocols, is successful within this high-volume, multi-state air-transport system. [West J Emerg Med. 2014;15(2:188–193.

  9. Evaluation of emergency medical technicians intermediate prediction about their transported patients final disposition in emergency department of Imam Khomeini Hospital.

    Science.gov (United States)

    Afzalimoghadam, Mohammad; Mozafari, Javad; Talebian, Mohammad Taghi; Mohammadnejad, Esmaeil; Kasaeian, Amir

    2013-08-07

    This was a prospective cross-sectional study of consecutive transported patients by emergency medical service (EMS) to a referral hospital. The goal of this study was the evaluation of emergency medical technician intermediate prediction about their transported patients disposition in Emergency Department of Imam Khomeini Hospital. 2950 patients were transported to this hospital, Questionnaires were submitted in 300 of consecutive patient transports and completed data were obtained and available upon arrival at hospital for 267 of these cases. Emergency medical technicians intermediate (EMT-I) were asked to predict whether the transported patient would require admission to the hospital, and if so, what will be their prediction of patient actual disposition. Their predictions were compared with emergency specialist physicians. EMT-I predicted that 208 (78%) transports would lead to admission to the hospital, after actual disposition, 232 (%87) patients became admitted. The sensitivity of predicting any admission was 65%, with positive predictive value (PPV) of 39% and specificity of 86% with negative predictive value (NPV) of 94%. The sensitivity of predicting trauma patients (56.2% of total patients) was 55% with PPV of 38%, specificity of 86% and for Non-trauma patients' sensitivity was 80% with PPV of 40% and specificity of 82%. EMT-I in our emergency medical system have very limited ability in prediction of admission and disposition in transported patients and their prediction were better in Non-trauma patients. So in our EMS, the pre-hospital diversion and necessity of transporting policies should not be based on EMS personnel disposition.

  10. Evaluation of emergency medical technicians intermediate prediction about their transported patients final disposition in emergency department of Imam Khomeini Hospital.

    Directory of Open Access Journals (Sweden)

    Mohammad Afzalimoghadam

    2013-07-01

    Full Text Available This was a prospective cross-sectional study of consecutive transported patients by emergency medical service (EMS to a referral hospital. The goal of this study was the evaluation of emergency medical technician intermediate prediction about their transported patients disposition in Emergency Department of Imam Khomeini Hospital. 2950 patients were transported to this hospital, Questionnaires were submitted in 300 of consecutive patient transports and completed data were obtained and available upon arrival at hospital for 267 of these cases. Emergency medical technicians intermediate (EMT-I were asked to predict whether the transported patient would require admission to the hospital, and if so, what will be their prediction of patient actual disposition. Their predictions were compared with emergency specialist physicians. EMT-I predicted that 208 (78% transports would lead to admission to the hospital, after actual disposition, 232 (%87 patients became admitted. The sensitivity of predicting any admission was 65%, with positive predictive value (PPV of 39% and specificity of 86% with negative predictive value (NPV of 94%. The sensitivity of predicting trauma patients (56.2% of total patients was 55% with PPV of 38%, specificity of 86% and for Non-trauma patients' sensitivity was 80% with PPV of 40% and specificity of 82%. EMT-I in our emergency medical system have very limited ability in prediction of admission and disposition in transported patients and their prediction were better in Non-trauma patients. So in our EMS, the pre-hospital diversion and necessity of transporting policies should not be based on EMS personnel disposition.

  11. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine.

    Science.gov (United States)

    Mebazaa, Alexandre; Yilmaz, M Birhan; Levy, Phillip; Ponikowski, Piotr; Peacock, W Frank; Laribi, Said; Ristic, Arsen D; Lambrinou, Ekaterini; Masip, Josep; Riley, Jillian P; McDonagh, Theresa; Mueller, Christian; deFilippi, Christopher; Harjola, Veli-Pekka; Thiele, Holger; Piepoli, Massimo F; Metra, Marco; Maggioni, Aldo; McMurray, John; Dickstein, Kenneth; Damman, Kevin; Seferovic, Petar M; Ruschitzka, Frank; Leite-Moreira, Adelino F; Bellou, Abdelouahab; Anker, Stefan D; Filippatos, Gerasimos

    2015-06-01

    Acute heart failure is a fatal syndrome. Emergency physicians, cardiologists, intensivists, nurses and other health care providers have to cooperate to provide optimal benefit. However, many treatment decisions are opinion-based and few are evidenced-based. This consensus paper provides guidance to practicing physicians and nurses to manage acute heart failure in the pre-hospital and hospital setting. Criteria of hospitalization and of discharge are described. Gaps in knowledge and perspectives in the management of acute heart failure are also detailed. This consensus paper on acute heart failure might help enable contiguous practice.

  12. Strategies Used by Prehospital Providers to Overcome Language Barriers.

    Science.gov (United States)

    Tate, Ramsey C; Hodkinson, Peter W; Meehan-Coussee, Kelly; Cooperstein, Noah

    2016-01-01

    Language barriers are commonly encountered in the prehospital setting but there is a paucity of research on how prehospital providers address language discordance. We sought to identify the communication strategies, and the limitations of those strategies, used by emergency medical services (EMS) providers when confronted with language barriers in a variety of linguistic and cultural contexts. EMS providers were queried regarding communication strategies to overcome language barriers as part of an international, multi-site, sequential explanatory, qualitative-predominant, mixed methods study of prehospital language barriers. A survey of EMS telecommunicators was administered at dispatch centers in New Mexico (United States) and Western Cape (South Africa). Semi-structured qualitative interviews of EMS field providers were conducted at agencies who respond to calls from participating dispatch centers. Survey data included quantitative data on demographics and communication strategies used to overcome language barriers as well as qualitative free-text responses on the limitations of strategies. Interviews elicited narratives of encounters with language-discordant patients and the strategies used to communicate. Data from the surveys and interviews were integrated at the point of analysis. 125 telecommunicators (overall response rate of 84.5%) and a purposive sample of 27 field providers participated in the study. The characteristics of participants varied between countries and between agencies, consistent with variations in participating agencies' hiring and training practices. Telecommunicators identified 3rd-party telephonic interpreter services as the single most effective strategy when available, but also described time delays and frustration with interpreter communications that leads them to preferentially try other strategies. In the field, all providers reported using similar strategies, relying heavily on bystanders, multilingual coworkers, and non

  13. Emergency medical equipment on board German airliners.

    Science.gov (United States)

    Hinkelbein, Jochen; Neuhaus, Christopher; Wetsch, Wolfgang A; Spelten, Oliver; Picker, Susanne; Böttiger, Bernd W; Gathof, Birgit S

    2014-01-01

    Medical emergencies often occur on commercial airline flights, but valid data on their causes and consequences are rare. Therefore, it is unclear what emergency medical equipment is necessary. Although a minimum standard for medical equipment is defined in regulations, additional material is not standardized and may vary significantly between different airlines. German airlines operating aircrafts with more than 30 seats were selected and interviewed with a 5-page written questionnaire between August 2011 and January 2012. Besides pre-packed and required emergency medical material, drugs, medical devices, and equipment lists were queried. If no reply was received, airlines were contacted another three times by e-mail and/or phone. Descriptive analysis was used for data presentation and interpretation. From a total of 73 German airlines, 58 were excluded from analysis (eg, those not providing passenger transport). Fifteen airlines were contacted and data of 13 airlines were available for analysis (two airlines did not participate). A first aid kit was available on all airlines. Seven airlines reported having a doctor's kit, and another four provided an "emergency medical kit." Four airlines provided an automated external defibrillator (AED)/electrocardiogram (ECG). While six airlines reported providing anesthesia drugs, a laryngoscope, and endotracheal tubes, another four airlines did not provide even a resuscitator bag. One airline did not provide any material for cardiopulmonary resuscitation (CPR). Although the minimal material required according to European aviation regulations is provided by all airlines for medical emergencies, there are significant differences in the provision of additional material. The equipment on most airlines is not sufficient for the treatment of specific emergencies according to published medical guidelines (eg, for CPR or acute myocardial infarction). © 2014 International Society of Travel Medicine.

  14. Analysis of Prehospital Documentation of Injury-Related Pain Assessment and Analgesic Administration on the Contemporary Battlefield.

    Science.gov (United States)

    Gerhardt, Robert T; Reeves, Patrick T; Kotwal, Russ S; Mabry, Robert L; Robinson, John B; Butler, Frank

    2016-01-01

    In addition to life-saving interventions, the assessment of pain and subsequent administration of analgesia are primary benchmarks for quality emergency medical services care which should be documented and analyzed. Analyze US combat casualty data from the Department of Defense Trauma Registry (DoDTR) with a primary focus on prehospital pain assessment, analgesic administration and documentation. Retrospective cohort study of battlefield prehospital and hospital casualty data were abstracted by DoDTR from available records from 1 September 2007 through 30 June 2011. Data included demographics; injury mechanism; prehospital and initial combat hospital pain assessment documented by standard 0-to-10 numeric rating scale; analgesics administered; and survival outcome. Records were available for 8,913 casualties (median ISS of 5 [IQR 2 to 10]; 98.7% survived). Prehospital analgesic administration was documented for 1,313 cases (15%). Prehospital pain assessment was recorded for 581 cases (7%; median pain score 6 [IQR 3 to 8]), hospital pain assessment was recorded for 5,007 cases (56%; median pain score5 [CI95% 3 to 8]), and 409 cases (5%) had both prehospital and hospital pain assessments that could be paired. In this paired group, 49.1% (201/409) had alleviation of pain evidenced by a decrease in pain score (median 4,, IQR 2 to 5); 23.5% (96/409) had worsening of pain evidenced by an increase in pain score (median 3, CI95 2.8 to 3.7, IQR 1 to 5); 27.4% (112/409) had no change; and the overall difference was an average decrease in pain score of 1.1 (median 0, IQR 0 to 3, p prehospital and hospital pain assessment documentation and prehospital analgesic documentation. Our study demonstrates that prehospital pain assessment, management, and documentation remain primary targets for performance improvement on the battlefield. Results of paired prehospital to hospital pain scores and time-series analysis demonstrate both feasibility and benefit of prehospital analgesics

  15. Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.

    Science.gov (United States)

    Beygui, Farzin; Castren, Maaret; Brunetti, Natale Daniele; Rosell-Ortiz, Fernando; Christ, Michael; Zeymer, Uwe; Huber, Kurt; Folke, Fredrik; Svensson, Leif; Bueno, Hector; Van't Hof, Arnoud; Nikolaou, Nikolaos; Nibbe, Lutz; Charpentier, Sandrine; Swahn, Eva; Tubaro, Marco; Goldstein, Patrick

    2015-08-27

    Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts' opinions, for all emergency medical services' health providers involved in the pre-hospital management of acute cardiovascular care. © The European Society of Cardiology 2015.

  16. Patient safety in emergency medical services: executive summary and recommendations from the Niagara Summit.

    Science.gov (United States)

    Bigham, Blair L; Bull, Ellen; Morrison, Merideth; Burgess, Rob; Maher, Janet; Brooks, Steven C; Morrison, Laurie J

    2011-01-01

    Emergency medical services (EMS) personnel care for patients in challenging and dynamic environments that may contribute to an increased risk for adverse events. However, little is known about the risks to patient safety in the EMS setting. To address this knowledge gap, we conducted a systematic review of the literature, including nonrandomized, noncontrolled studies, conducted qualitative interviews of key informants, and, with the assistance of a pan-Canadian advisory board, hosted a 1-day summit of 52 experts in the field of EMS patient safety. The intent of the summit was to review available research, discuss the issues affecting prehospital patient safety, and discuss interventions that might improve the safety of the EMS industry. The primary objective was to define the strategic goals for improving patient safety in EMS. Participants represented all geographic regions of Canada and included administrators, educators, physicians, researchers, and patient safety experts. Data were collected through electronic voting and qualitative analysis of the discussions. The group reached consensus on nine recommendations to increase awareness, reduce adverse events, and suggest research and educational directions in EMS patient safety: increasing awareness of patient safety principles, improving adverse event reporting through creating nonpunitive reporting systems, supporting paramedic clinical decision making through improved research and education, policy changes, using flexible algorithms, adopting patient safety strategies from other disciplines, increasing funding for research in patient safety, salary support for paramedic researchers, and access to graduate training in prehospital research.

  17. Defining and improving the role of emergency medical services in Cape Town, South Africa.

    Science.gov (United States)

    Anest, Trisha; Stewart de Ramirez, Sarah; Balhara, Kamna S; Hodkinson, Peter; Wallis, Lee; Hansoti, Bhakti

    2016-08-01

    Low and middle income countries bear a disproportionate burden of paediatric morbidity and mortality. South Africa, a middle income country, has unacceptably high mortality in children less than 5 years of age. Many factors that contribute to the child mortality rate are time sensitive and require efficient access to emergency care. Delays and barriers within the emergency medical services (EMS) system increase paediatric morbidity and mortality from time sensitive illnesses. This study is a qualitative evaluation of the prehospital care system for paediatric patients in Cape Town, South Africa. A purposive sample of healthcare personnel within and interacting with the EMS system were interviewed. A structured interview form was used to gather data. All interviews were audio recorded and transcribed; two independent reviewers performed blinded content analysis of the transcribed script. 33 structured interviews were conducted over a 4 week period. Eight broad themes were identified during coding, including: access, communication, community education, equipment, infrastructure, staffing, training and triage. Subcategories were used to identify areas for targeted intervention. Overall agreement between the two independent coders was 93.36%, with a κ coefficient of 0.69. The prehospital system is central to delivering time sensitive care for paediatric patients. In a single centre middle income setting, communication barriers between dispatch personnel and medical facilities/EMS personnel were deemed to be a high priority intervention in order to improve care delivery. Other areas for targeted interventions should include broadening the advanced life support provider base and introducing basic medical language in dispatch staff training. 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/

  18. PRE-HOSPITAL THROMBOLYSIS IN KRASNOYARSK: RESULTS OF A RETROSPECTIVE COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    S. A. Skripkin

    2011-01-01

    Full Text Available Aim. To compare the safety and efficacy of pre-hospital thrombolysis with tenecteplase and hospital thrombolysis with alteplase. Material and Methods. Pre-hospital thrombolytic therapy with tenecteplase (n=15 and hospital thrombolysis with alteplaza (n=60 in patients with acute coronary syndrome and acute ST-segment elevation myocardial infarction were analyzed in retrospective comparative study. Time characteristics of thrombolysis and its efficacy and safety were assessed. Results. The mean time from patients emergency medical service call to pre-hospital thrombolysis was 51.8±1.23 min, whereas to hospital thrombolysis 106.5±2.15 min (p<0.05. The effective hospital thrombolysis was observed in 68.3 and 83.3% of patients according to ECG (>50% resolution of ST-segment elevation and coronary angiography criteria, respectively. The effective pre-hospital thrombolysis was registered in 93.3% of patients as demonstrated with ECG and coronary angiography. Conclusion. Pre-hospital thrombolysis in patients with acute coronary syndrome was performed by 54.7 min earlier than hospital thrombolysis was. This can improve the patient prognosis.

  19. The accuracy of prehospital diagnosis of acute cerebrovascular accidents: an observational study

    Science.gov (United States)

    Gluszkiewicz, Marcin; Członkowska, Anna

    2015-01-01

    Introduction Time to treatment is the key factor in stroke care. Although the initial medical assessment is usually made by a non-neurologist or a paramedic, it should ensure correct identification of all acute cerebrovascular accidents (CVAs). Our aim was to evaluate the accuracy of the physician-made prehospital diagnosis of acute CVA in patients referred directly to the neurological emergency department (ED), and to identify conditions mimicking CVAs. Material and methods This observational study included consecutive patients referred to our neurological ED by emergency physicians with a suspicion of CVA (acute stroke, transient ischemic attack (TIA) or a syndrome-based diagnosis) during 12 months. Referrals were considered correct if the prehospital diagnosis of CVA proved to be stroke or TIA. Results The prehospital diagnosis of CVA was correct in 360 of 570 cases. Its positive predictive value ranged from 100% for the syndrome-based diagnosis, through 70% for stroke, to 34% for TIA. Misdiagnoses were less frequent among ambulance physicians compared to primary care and outpatient physicians (33% vs. 52%, p CVA cases were referred with prehospital diagnoses other than CVA. Conclusions Emergency physicians appear to be sensitive in diagnosing CVAs but their overall accuracy does not seem high. They tend to overuse the diagnosis of TIA. Constant education and adoption of stroke screening scales may be beneficial for emergency care systems based both on physicians and on paramedics. PMID:26170845

  20. Chest Pain of Suspected Cardiac Origin: Current Evidence-based Recommendations for Prehospital Care

    Directory of Open Access Journals (Sweden)

    P. Brian Savino

    2015-12-01

    Full Text Available Introduction: In the United States, emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG, ST segment elevation myocardial infarction (STEMI regionalization systems, prehospital fibrinolysis and β-blockers. Results: The protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325mg, 24% recommending 162mg and 15% recommending either, as well as nitroglycerin and opiates (58% choosing morphine. Prehospital 12- Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or β-blocker use. Conclusion: Protocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

  1. Medical Geology : a globally emerging discipline

    OpenAIRE

    Joseph E. Bunnell; Robert B. Finkelman; Centeno, Jose A.; Selinus, O. (Olle)

    2007-01-01

    Medical Geology, the study of the impacts of geologic materials and processes on animal and human health, is a dynamic emerging discipline bringing together the geoscience, biomedical, and public health communities to solve a wide range of environmental health problems. Among the Medical Geology described in this review are examples of both deficiency and toxicity of trace element exposure. Goiter is a widespread and potentially serious health problem caused by deficiency of iodine. In many l...

  2. Risk factors for 48-hours mortality after prehospital treatment of opioid overdose

    DEFF Research Database (Denmark)

    Wichmann, Sine; Nielsen, Søren Loumann; Siersma, Volkert Dirk

    2013-01-01

    INTRODUCTION: Opioid overdose is commonly treated by prehospital emergency services and the majority of the patients are discharged immediately after treatment and a short observation period. There is a minor risk for rebound opioid toxicity and other life-threatening conditions might occur after...... such episodes. The authors describe the short-term outcome and identify risk factors for death within 48 h after prehospital treatment of opioid overdose in Copenhagen, the capital of Denmark. METHODS: Data on all cases of opioid overdose treated by the medical emergency care unit between 1994 and 2003 were...... recorded prospectively. Risk factors for death within 48 h after initial medical emergency care unit contact were analysed in a multivariable logistic regression analysis. RESULTS: The authors recorded 4762 episodes of opioid overdose, covering 1967 unique identified patients. A total of 78 patients (8...

  3. Children's safety initiative: a national assessment of pediatric educational needs among emergency medical services providers.

    Science.gov (United States)

    Hansen, Matthew; Meckler, Garth; Dickinson, Caitlyn; Dickenson, Kathryn; Jui, Jonathan; Lambert, William; Guise, Jeanne-Marie

    2015-01-01

    Emergency medical services (EMS) providers may have critical knowledge gaps in pediatric care due to lack of exposure and training. There is currently little evidence to guide educators to the knowledge gaps that most need to be addressed to improve patient safety. The objective of this study was to identify educational needs of EMS providers related to pediatric care in various domains in order to inform development of curricula. The Children's Safety Initiative-EMS performed a three-phase Delphi survey on patient safety in pediatric emergencies among providers and content experts in pediatric emergency care, including physicians, nurses, and prehospital providers of all levels. Each round included questions related to educational needs of providers or the effect of training on patient safety events. We identified knowledge gaps in the following domains: case exposure, competency and knowledge, assessment and decision making, and critical thinking and proficiency. Individual knowledge gaps were ranked by portion of respondents who ranked them "highly likely" (Likert-type score 7-10 out of 10) to contribute to safety events. There were 737 respondents who were included in analysis of the first phase of the survey. Paramedics were 50.8% of respondents, EMT-basics/first responders were 22%, and physicians 11.4%. The top educational priorities identified in the final round of the survey include pediatric airway management, responder anxiety when working with children, and general pediatric skills among providers. The top three needs in decision-making include knowing when to alter plans mid-course, knowing when to perform an advanced airway, and assessing pain in children. The top 3 technical or procedural skills needs were pediatric advanced airway, neonatal resuscitation, and intravenous/intraosseous access. For neonates, specific educational needs identified included knowing appropriate vital signs and preventing hypothermia. This is the first large-scale Delphi

  4. Factors associated with prehospital death among traffic accident patients in Osaka City, Japan: A population-based study.

    Science.gov (United States)

    Katayama, Yusuke; Kitamura, Tetsuhisa; Kiyohara, Kosuke; Iwami, Taku; Kawamura, Takashi; Hayashida, Sumito; Ogura, Hiroshi; Shimazu, Takeshi

    2017-06-28

    Although it is important to assess the factors associated with traffic accident fatalities to decrease them as a matter of public health, such factors have not been fully identified. Using a large-scale data set of ambulance records in Osaka City, Japan, we retrospectively analyzed all traffic accident patients transported to hospitals by emergency medical service personnel from 2013 to 2014. In this study, prehospital death was defined as that occurring at the scene or in the emergency department immediately after hospital arrival. We assessed prehospital factors associated with prehospital death due to traffic accidents by logistic regression models. This study enrolled 28,903 emergency patients involved in traffic accidents, of whom 68 died prehospital. In a multivariate model, elderly patients aged ≥75 years (adjusted odds ratio [AOR] = 4.34; 95% confidence interval [CI], 2.29-8.23), nighttime (AOR = 2.75; 95% CI, 1.65-4.70), and type of injured person compared to bicyclists such as pedestrians (AOR = 9.58; 95% CI, 5.07-17.99), motorcyclists (AOR = 2.75; 95% CI, 1.21-6.24), and car occupants (AOR = 2.98; 95% CI, 1.39-6.40) were significantly associated with prehospital death due to traffic accidents. In addition, the AOR for automobile versus nonautomobile as the collision opponent was 4.76 (95% CI, 2.30-9.88). In this population, the factors associated with prehospital death due to traffic accidents were elderly people, nighttime, and pedestrian as the type of patient. The proportion of prehospital deaths due to traffic accidents was also high when the collision component was an automobile.

  5. The development of intelligent, triage-based, mass-gathering emergency medical service PDA support systems.

    Science.gov (United States)

    Chang, Polun; Hsu, Yueh-Shuang; Tzeng, Yuann-Meei; Sang, Yiing-Yiing; Hou, I-Ching; Kao, Wei-Fong

    2004-09-01

    The support systems for the Emergency Medical Services (EMS) at mass gatherings, such as the local marathon or large international baseball games, are underdeveloped. The purposes of this study were to extend well-developed, triage-based, EMS Personal Digital Assistant (PDA) support systems to cover pre-hospital emergency medical services and onsite evaluation forms for the mass gatherings, and to evaluate users ' perceived ease of use and usefulness of the systems in terms of Davis ' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. Twenty-three nurses and six physicians in the medical center, who had served at mass gatherings, were invited to examine the new systems and answer the TAM questionnaire. The PDA systems were composed of 450 information items within 42 screens in 6 categories. The results supported the potential for using triage-based PDA systems at mass gatherings. Overall, most of the subjects agreed that the systems were easy to use and useful for mass gatherings, and they were willing to accept the systems.

  6. Analysis of professional prehospital emergency treatment effect on the success rate of cardiopulmonary resuscitation%分析专职化院前急救对心肺复苏成功率的影响

    Institute of Scientific and Technical Information of China (English)

    蒲亚军

    2015-01-01

    目的:研究分析专职化院前急救对心肺复苏成功率的影响。方法回顾分析本院2010年1月至2015年4月期间采取院前急救的184例患者临床资料,按照急救管理模式的不同分为两组,将2010年1月至2012年8月在实行专职化院前急救管理的91例患者作为对照组,将2012年9月至2015年4月期间开始实行专职化院前急救管理的93例患者作为观察组,对比研究分析两组医务人员状况、急救出车耗时、达到现场时效及院前应用高级生命支持技术(ACLS)技术情况,并对比两组抢救成功率。结果实行专职化院前急救的观察组CRI耗时显著短于对照组,差异显著有统计学意义(P<0.05);观察组患者通过及时有效的急救处理,其心肺复苏成功率达到17.2%(16例),而对照组患者心肺复苏成功率仅为3.3%(3例),两组对比差异性明显,有统计学意义(P<0.05)。结论院前急救实行专职化管理,可有效提升院前急救效率,增加了心肺复苏成功率。%Objective To study the effect of professional prehospital emergency treatment on the success rate of cardiopulmonary resuscitation. Methods During a retrospective analysis of our hospital in January 2010 2015 April take pre hospital emergency treatment of 184 cases of patients with clinical data, in accordance with the emergency management model is divided to two groups, will be 2010 January to August 2012 before implementing the professional hospital emergency management of 91 patients as the control group. During the period of April 2012 to September 2015 began practicing full-time Institude of emergency management of 93 patients as the observation group and comparison analysis of two group of medical personnel situation, emergency dispatch time, reached the scene of aging, and the hospital before the application of advanced life support technology (ACLS) technology, the success rate of rescue, and compared the difference between

  7. [PHTLS team course: a pilot project. Structured student education in prehospital care of severely injured patients].

    Science.gov (United States)

    Woelfl, C G; Guehring, T; Moghaddam, A; Gliwitzky, B; Schaedler, T; Gruetzner, P A; Riess, M; Frank, C B

    2012-03-01

    The training of medical school students at the University of Heidelberg seems to be improvable regarding prehospital trauma treatment compared to an established anaesthesiology-based training for medical emergencies. This study addresses the current situation and possibilities for advancing this training. A baseline was set by interviews of the medical school students. Based on this the hypothesis was postulated that there is a deficit in the education of the medical school students concerning the training in prehospital trauma treatment. This was proved by questionnaires given to the students in the 7th and 8th semesters at the University of Heidelberg Medical School. The results were evaluated and a possible approach for improvement was developed. A total of 111 questionnaires could be evaluated. It could be shown that the existing education was not effectual and that there is a need for a praxis-orientated 1-day course in prehospital trauma treatment. Especially the treatment of multiply injured patients is a challenge for young medical professionals. However, there is a high motivation to learn and train in emergency medicine. The students long for a practical trauma course compared to the advanced medical CPR course provided by the Department of Anaesthesiology of the University of Heidelberg. Those algorithm-based trauma courses do exist with PHTLS® and ATLS®. Based on these courses we developed the PHTLS® TEAM course.

  8. The Direction Function of Materialistic Dialectics for Cardiopulmonary Resuscitation in Prehospital Emergency%唯物辩证法在院前心肺复苏实践中的指导作用

    Institute of Scientific and Technical Information of China (English)

    郑进

    2011-01-01

    According to the viewpoint of materialistic dialectics , this paper analyzed some contradictory problem of Cardiopulmonary resuscitation in pre-hospital emergency, and proposed some ideas to resolve this problem too. It benefits for professional and nonprofessional rescuer in pre-hospital emergency care.%在院前心肺复苏实践中,我们会遇到很多矛盾的问题.本文从唯物辩证法的角度出发,分析了院前心肺复苏中一些比较棘手的问题,并为解决这些问题提出建议,对从事院前急救的医学专业人士以及非医学专业人士均具有一定的启发意义.

  9. Issues and Solutions in Introducing Western Systems to the Prehospital Care System in Japan

    Directory of Open Access Journals (Sweden)

    Suzuki, Tetsuji

    2008-08-01

    Full Text Available Objective: This report aims to illustrate the history and current status of Japanese emergency medical services (EMS, including development of the specialty and characteristics adapted from the U.S. and European models. In addition, recommendations are made for improvement of the current systems.Methods: Government reports and academic papers were reviewed, along with the collective experiences of the authors. Literature searches were performed in PubMed (English and Ichushi (Japanese, using keywords such as emergency medicine and pre-hospital care. More recent and peer-reviewed articles were given priority in the selection process.Results: The pre-hospital care system in Japan has developed as a mixture of U.S. and European systems. Other countries undergoing economic and industrial development similar to Japan may benefit from emulating the Japanese EMS model.Discussion: Currently, the Japanese system is in transition, searching for the most suitable and efficient way of providing quality pre-hospital care.Conclusion: Japan has the potential to enhance its current pre-hospital care system, but this will require greater collaboration between physicians and paramedics, increased paramedic scope of medical practice, and greater Japanese societal recognition and support of paramedics.

  10. Prehospital Cricothyrotomy Kits Used in Combat.

    Science.gov (United States)

    Schauer, Steven G; April, Michael D; Cunningham, Cord W; Long, Adrianna N; Carter, Robert

    2017-01-01

    Surgical cricothyrotomy remains the only definitive airway management modality for the tactical setting recommended by Tactical Combat Casualty Care guidelines. Some units have fielded commercial cricothyrotomy kits to assist Combat Medics with surgical cricothyrotomy. To our knowledge, no previous publications report data on the use of these kits in combat settings. This series reports the the use of two kits in four patients in the prehospital combat setting. Using the Department of Defense Trauma Registry and the Prehospital Trauma Registry, we identified four cases of patients who underwent prehospital cricothyrotomy with the use of commercial kits. In the first two cases, a Medic successfully used a North American Rescue CricKit (NARCK) to obtain a surgical airway in a Servicemember with multiple amputations from an improvised explosive device explosion. In case 3, the Medic unsuccessfully used an H&H Medical kit to attempt placement of a surgical airway in a Servicemember shot in the head by small arms fire. A second attempt to place a surgical airway using a NARCK was successful. In case 4, a Soldier sustained a gunshot wound to the chest. A Medic described fluid in the airway precluding bag-valve-mask ventilation; the Medic attempted to place a surgical airway with the H&H kit without success. Four cases of prehospital surgical airway cannulation on the battlefield demonstrated three successful uses of prehospital cricothyrotomy kits. Further research should focus on determining which kits may be most useful in the combat setting. 2017.

  11. Medication errors recovered by emergency department pharmacists.

    Science.gov (United States)

    Rothschild, Jeffrey M; Churchill, William; Erickson, Abbie; Munz, Kristin; Schuur, Jeremiah D; Salzberg, Claudia A; Lewinski, Daniel; Shane, Rita; Aazami, Roshanak; Patka, John; Jaggers, Rondell; Steffenhagen, Aaron; Rough, Steve; Bates, David W

    2010-06-01

    We assess the impact of emergency department (ED) pharmacists on reducing potentially harmful medication errors. We conducted this observational study in 4 academic EDs. Trained pharmacy residents observed a convenience sample of ED pharmacists' activities. The primary outcome was medication errors recovered by pharmacists, including errors intercepted before reaching the patient (near miss or potential adverse drug event), caught after reaching the patient but before causing harm (mitigated adverse drug event), or caught after some harm but before further or worsening harm (ameliorated adverse drug event). Pairs of physician and pharmacist reviewers confirmed recovered medication errors and assessed their potential for harm. Observers were unblinded and clinical outcomes were not evaluated. We conducted 226 observation sessions spanning 787 hours and observed pharmacists reviewing 17,320 medications ordered or administered to 6,471 patients. We identified 504 recovered medication errors, or 7.8 per 100 patients and 2.9 per 100 medications. Most of the recovered medication errors were intercepted potential adverse drug events (90.3%), with fewer mitigated adverse drug events (3.9%) and ameliorated adverse drug events (0.2%). The potential severities of the recovered errors were most often serious (47.8%) or significant (36.2%). The most common medication classes associated with recovered medication errors were antimicrobial agents (32.1%), central nervous system agents (16.2%), and anticoagulant and thrombolytic agents (14.1%). The most common error types were dosing errors, drug omission, and wrong frequency errors. ED pharmacists can identify and prevent potentially harmful medication errors. Controlled trials are necessary to determine the net costs and benefits of ED pharmacist staffing on safety, quality, and costs, especially important considerations for smaller EDs and pharmacy departments. Copyright (c) 2009 American College of Emergency Physicians

  12. 院前急救护理路径在脑卒中患者院前急救中的应用%Application of pre-hospital emergency nursing pathway in the pre-hospital emergency of patients with cerebral stroke

    Institute of Scientific and Technical Information of China (English)

    刘艳

    2015-01-01

    Objective:To explore the application value of pre-hospital emergency nursing pathway in the pre-hospital emergency of patients with cerebral stroke.Methods:96 patients with emergency nursing were selected.They were randomly divided into the observation group and the control group with 48 cases in each group.The control group was given routine emergency nursing.The observation group was given pre-hospital nursing.Results:In the observation group,the arriving patient to implement rescue time was (30.5±9.2) minutes,the hospital stay was (11.2±2.6) days,23 cases were survival,the survival rate was 47.9%,the satisfaction of patients was 96.8%.In the control group,the arriving patient to implement rescue time was (41.3±13.2) minutes,the hospital stay was (18.9±4.5) days,18 cases were survival,the survival rate was 37.5%,the satisfaction of patients was 81.3%.The differ-ence was statistically significant between the two groups(P<0.05).Conclusion:The pre-hospital emergency nursing pathway can significantly reduce the emergency time,improve the survival rate and satisfaction of patients.%目的:探讨院前急救护理路径在脑卒中患者院前急救中的应用价值。方法:急诊护理患者96例,随机分成观察组和对照组各48例,对照组给予常规急救护理。观察组给予院前急救护理。结果:观察组抵达患者实施救护时间(30.5±9.2)min,住院时间(11.2±2.6)d,存活23例,存活率47.9%,患者满意度96.8%,对照组抵达患者实施救护时间(41.3±13.2)min,住院时间(18.9±4.5)d,存活18例,存活率37.5%,患者满意度81.3%,两组比较,差异具有统计学意义(P<0.05)。结论:院前急救护理路径可明显减少急救时间,提高患者的生存率和满意度。

  13. Prehospital use of furosemide for the treatment of heart failure.

    Science.gov (United States)

    Pan, Andy; Stiell, Ian G; Dionne, Richard; Maloney, Justin

    2015-01-01

    The diagnosis and management of acute decompensated heart failure (HF) in the prehospital setting can be challenging. The objectives of this study are to evaluate the appropriateness of furosemide use by Emergency Medical Services (EMS) and its association with adverse outcomes. This study was a multi-centre health records review of EMS patients who received prehospital furosemide or had an emergency department (ED) diagnosis of HF. We included acutely ill patients ≥50 years of age with shortness of breath transported by land EMS. Univariate and logistic regression analyses were performed to determine associations between furosemide use and serious adverse outcomes (acute renal failure, intubation, vasopressors or death). The study population consisted of 330 patients (N=58, furosemide given by EMS but no HF diagnosed in ED; N=110, furosemide given, HF diagnosed; N=162, no furosemide given, HF diagnosed). The median dose of intravenous furosemide was 80 mg (range 20-80 mg). Serious adverse outcomes occurred in 61 patients (19.0%, 23.6% and 14.8% of the three groups, respectively; p=0.18). The adjusted ORs for adverse events with furosemide use was 0.62 (95% CI 0.33 to 1.43) in patients with a diagnosis of HF and 1.14 (95% CI 0.58 to 2.23) in those without. More than a third of patients who received prehospital furosemide did not have an HF diagnosis, suggesting that the prehospital diagnosis of HF can be challenging. Serious adverse outcomes were identified in all patient groups and we found no statistically significant associations between furosemide use and adverse events. 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.

  14. Prehospital care for multiple trauma patients in Germany.

    Science.gov (United States)

    Maegele, Marc

    2015-01-01

    For the German speaking countries, Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first"). If no immediate treatment is necessary, a "Secondary Sur- vey" follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay ("work and go")toTR-DGU® certified trauma centers of the local trauma networks. Due to the difficult pre- hospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of rec- ommendations for early prehospital care for the severely injured based upon the 2011 updated multi- disciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung", the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.

  15. Promoting emergency medical care systems in the developing world: weighing the costs.

    Science.gov (United States)

    Anthony, David R

    2011-01-01

    Despite the global health community's historical focus on providing basic, cost-effective primary health care delivered at the community level, recent trends in the developing world show increasing demand for the implementation of emergency care infrastructures, such as prehospital care systems and emergency departments, as well as specialised training programmes. However, the question remains whether, in a setting of limited global health care resources, it is logical to divert these already-sparse resources into the development of emergency care frameworks. The existing literature overwhelmingly supports the idea that emergency care systems, both community-based and within medical institutions, improve important outcomes, including significant morbidity and mortality. Crucial to the success of any public health or policy intervention, emergency care systems also seem to be strongly desired at the community and governmental levels. Integrating emergency care into existing health care systems will ideally rely on modest, low-cost steps to augment current models of primary health care delivery, focusing on adapting the lessons learned in the developed world to the unique needs and local variability of the rest of the globe.

  16. Prehospital Care of Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    TVSP Murthy

    2008-01-01

    Full Text Available Traumatic brain injury (TBI occurs when a sudden trauma causes brain damage. Depending on the severity, outcome can be anything from complete recovery to permanent disability or death. Emergency medical services play a dominant role in provision of primary care at the site of injury. Since little can be done to reverse the initial brain damage due to trauma, attempts to prevent further brain damage and stabilize the patient before he can be brought to a specialized trauma care centre play a pivotal role in the final outcome. Recognition and early treatment of hypoten-sion, hypoxemia, and hypoglycemia, objective neurological assessment based on GCS and pupils, and safe transport to an optimal care centre are the key elements of prehospital care of a TBI patient.

  17. Optimal training for emergency needle thoracostomy placement by prehospital personnel: didactic teaching versus a cadaver-based training program.

    Science.gov (United States)

    Grabo, Daniel; Inaba, Kenji; Hammer, Peter; Karamanos, Efstathios; Skiada, Dimitra; Martin, Matthew; Sullivan, Maura; Demetriades, Demetrios

    2014-09-01

    Tension pneumothorax can rapidly progress to cardiac arrest and death if not promptly recognized and appropriately treated. We sought to evaluate the effectiveness of traditional didactic slide-based lectures (SBLs) as compared with fresh tissue cadaver-based training (CBT) for placement of needle thoracostomy (NT). Forty randomly selected US Navy corpsmen were recruited to participate from incoming classes of the Navy Trauma Training Center at the LAC + USC Medical Center and were then randomized to one of two NT teaching methods. The following outcomes were compared between the two study arms: (1) time required to perform the procedure, (2) correct placement of the needle, and (3) magnitude of deviation from the correct position. During the study period, a total of 40 corpsmen were enrolled, 20 randomized to SBL and 20 to CBT arms. When outcomes were analyzed, time required to NT placement was not different between the two arms. Examination of the location of needle placement revealed marked differences between the two study groups. Only a minority of the SBL group (35%) placed the NT correctly in the second intercostal space. In comparison, the majority of corpsmen assigned to the CBT group demonstrated accurate placement in the second intercostal space (75%). In a CBT module, US Navy corpsmen were better trained to place NT accurately than their traditional didactic SBL counterparts. Further studies are indicated to identify the optimal components of effective simulation training for NT and other emergent interventions.

  18. Emergency medicine in Vietnam.

    Science.gov (United States)

    Richards, J R

    1997-04-01

    The Socialist Republic of Vietnam is one of the poorest countries in the world. Recent economic developments, as the country attempts to start a market economy, have had a profound impact on its health care system. This report describes the state of prehospital and emergency medical care in Vietnam and possibilities for the future.

  19. Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients.

    Science.gov (United States)

    Sunde, Geir Arne; Heltne, Jon-Kenneth; Lockey, David; Burns, Brian; Sandberg, Mårten; Fredriksen, Knut; Hufthammer, Karl Ove; Soti, Akos; Lyon, Richard; Jäntti, Helena; Kämäräinen, Antti; Reid, Bjørn Ole; Silfvast, Tom; Harm, Falko; Sollid, Stephen J M

    2015-08-07

    Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services. We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data. The participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16 %) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92 % of the cases. The rest were managed with supraglottic airway devices (5 %), bag-valve-mask ventilation (2 %) or continuous positive airway pressure (0.2 %). Intubation failure rates were 14.5 % (first-attempt) and 1.2 % (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95 % CI: 1.5-2.6; p airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure. Advanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All failed intubations were handled successfully with a rescue device or surgical airway. www.clinicaltrials.gov NCT01502111 . Registered 22 December 2011.

  20. Emergency Medical Services Public Health Implications and Interim Guidance for the Ebola Virus in the United States

    Directory of Open Access Journals (Sweden)

    Christopher E. McCoy

    2014-11-01

    Full Text Available The 25th known outbreak of the Ebola Virus Disease (EVD is now a global public health emergency and the World Health Organization (WHO has declared the epidemic to be a Public Health Emergency of International Concern (PHEIC. Since the first cases of the West African epidemic were reported in March 2014, there has been an increase in infection rates of over 13,000% over a 6-month period. The Ebola virus has now arrived in the United States and public health professionals, doctors, hospitals, Emergency Medial Services Administrators, Medical Directors, and policy makers have been working with haste to develop strategies to prevent the disease from reaching epidemic proportions. Prehospital care providers (emergency medical technicians and paramedics and medical first responders (including but not limited to firefighters and law enforcement are the healthcare systems front lines when it comes to first medical contact with patients outside of the hospital setting. Risk of contracting Ebola can be particularly high in this population of first responders if the appropriate precautions are not implemented. This article provides a brief clinical overview of the Ebola Virus Disease and provides a comprehensive summary of the Center for Disease Control and Prevention’s Interim Guidance for Emergency Medical Services (EMS Systems and 9-1-1 Public Safety Answering Points (PSAPS for Management of Patients with Known of Suspected Ebola Virus Disease in the United States. [West J Emerg Med. 2014;15(7:-0.

  1. Preventable deaths following emergency medical dispatch--an audit study.

    Science.gov (United States)

    Andersen, Mikkel S; Johnsen, Søren Paaske; Hansen, Andreas Ernst; Skjaerseth, Eivinn; Hansen, Christian Muff; Sørensen, Jan Nørtved; Jepsen, Søren Bruun; Hansen, Jesper Bjerring; Christensen, Erika Frischknecht

    2014-12-19

    Call taker triage of calls to the 112 emergency number, can be error prone because rapid decisions must be made based on limited information. Here we investigated the preventability and common characteristics of same-day deaths among patients who called 112 and were not assigned an ambulance with lights and sirens by the Emergency Medical Communication Centre (EMCC). An audit was performed by an external panel of experienced prehospital consultant anaesthesiologists. The panel focused exclusively on the role of the EMCC, assessing whether same-day deaths among 112 callers could have been prevented if the EMCC had assessed the situations as highly urgent. The panels' assessments were based on review of patient charts and voice-log recordings of 112 calls. All patient related material was reviewed by the audit panel and all cases where then scored as preventable, potentially preventable or non-preventable during a two day meeting. The study setting was three of five regions in Denmark with a combined population of 4,182,613 inhabitants, which equals 75% of the Danish population. The study period was 18 months, from mid-2011 to the end of 2012. Linkage of prospectively collected EMCC data with population-based registries resulted in the identification of 94,488 non-high-acuity 112 callers. Among these callers, 152 (0.16% of all) died on the same day as the corresponding 112 call, and were included in this study. The mean age of included patients was 74.4 years (range, 31-100 years) and 45.4% were female. The audit panel found no definitively preventable deaths; however, 18 (11.8%) of the analysed same-day deaths (0.02% of all non-high-acuity callers) were found to be potentially preventable. In 13 of these 18 cases, the dispatch protocol was either not used or not used correctly. Same-day death rarely occurred among 112 callers whose situations were assessed as not highly urgent. No same-day deaths were found to be definitively preventable by a different EMCC call

  2. Current status of neck collar use in pre-hospital emergency in Hangzhou, Zhejiang Province%杭州地区院外急救颈托使用现状调查与分析

    Institute of Scientific and Technical Information of China (English)

    唐春福

    2013-01-01

    Objective To investigate the current status of neck collar use in pre-hospital emergency in Hangzhou. Methods The clinical data of 1855 prehospital high energy trauma patients in Hangzhou were analyzed so as to survey the neck collar use rate. Results Only 337 patients (19.1%) were given neck collar with a neck collar use rate of 19.1%. Conclusion Most of the high energy trauma patients failed to get neck collar, an effective tool to protect their cervical spinal cord during prehospital emergency treatment. Reasonable use of neck collar during pre-hospital emergency treatment should be promoted.%目的 调查分析杭州地区院外急救颈托使用的现状,为在院外急救中合理规范的使用颈托提供参考依据.方法 对符合标准的1752例高能量创伤患者进行调查,分析颈托不合理使用的现状、原因并提出合理使用的对策.结果 仅19.1%的患者使用了颈托,院外急救中颈托的不合理使用情况较严重.结论 应加强对急救医生创伤知识的培训,提高对高能量创伤的认识,积极推进颈托的合理使用.

  3. Distributed virtual environment for emergency medical training

    Science.gov (United States)

    Stytz, Martin R.; Banks, Sheila B.; Garcia, Brian W.; Godsell-Stytz, Gayl M.

    1997-07-01

    In many professions where individuals must work in a team in a high stress environment to accomplish a time-critical task, individual and team performance can benefit from joint training using distributed virtual environments (DVEs). One professional field that lacks but needs a high-fidelity team training environment is the field of emergency medicine. Currently, emergency department (ED) medical personnel train by using words to create a metal picture of a situation for the physician and staff, who then cooperate to solve the problems portrayed by the word picture. The need in emergency medicine for realistic virtual team training is critical because ED staff typically encounter rarely occurring but life threatening situations only once in their careers and because ED teams currently have no realistic environment in which to practice their team skills. The resulting lack of experience and teamwork makes diagnosis and treatment more difficult. Virtual environment based training has the potential to redress these shortfalls. The objective of our research is to develop a state-of-the-art virtual environment for emergency medicine team training. The virtual emergency room (VER) allows ED physicians and medical staff to realistically prepare for emergency medical situations by performing triage, diagnosis, and treatment on virtual patients within an environment that provides them with the tools they require and the team environment they need to realistically perform these three tasks. There are several issues that must be addressed before this vision is realized. The key issues deal with distribution of computations; the doctor and staff interface to the virtual patient and ED equipment; the accurate simulation of individual patient organs' response to injury, medication, and treatment; and an accurate modeling of the symptoms and appearance of the patient while maintaining a real-time interaction capability. Our ongoing work addresses all of these issues. In this

  4. Prehospital chest tube thoracostomy: effective treatment or additional trauma?

    NARCIS (Netherlands)

    Spanjersberg, W.; Bergs, B.; Krijen, P.; Schipper, I.; Ringburg, A.; Steyerberg, E.W.; Edwards, M.J.R.; Schipper, I.B.; Vugt, A.B. van

    2005-01-01

    BACKGROUND: The use of prehospital chest tube thoracostomy (TT) remains controversial because of presumed increased complication risks. This study analyzed infectious complication rates for physician-performed prehospital and emergency department (ED) TT. METHODS: Over a 40-month period, all consecu

  5. Prehospital chest tube thoracostomy: effective treatment or additional trauma?

    NARCIS (Netherlands)

    Spanjersberg, W.; Bergs, B.; Krijen, P.; Schipper, I.; Ringburg, A.; Steyerberg, E.W.; Edwards, M.J.R.; Schipper, I.B.; Vugt, A.B. van

    2005-01-01

    BACKGROUND: The use of prehospital chest tube thoracostomy (TT) remains controversial because of presumed increased complication risks. This study analyzed infectious complication rates for physician-performed prehospital and emergency department (ED) TT. METHODS: Over a 40-month period, all consecu

  6. Emergency Medical Technicians Are Often Consulted on Termination of Resuscitation, and Will Terminate Resuscitation Based on Controversial Single Factors

    DEFF Research Database (Denmark)

    Mygind-Klausen, Troels; Glerup Lauridsen, Kasper; Bødtker, Henrik

    2016-01-01

    Introduction: Many out-of-hospital cardiopulmonary resuscitation (CPR) attempts have to be terminated. Previous studies have investigated knowledge on abandoning resuscitation among physicians. In the prehospital setting emergency medical technicians (EMTs) may be involved in the decision...... on abandoning CPR but this is sparsely investigated. Aim: To investigate if EMTs are involved in termination of CPR, their self-assessed competence and knowledge of guidelines on termination of CPR according to European Resuscitation Council guidelines 2015. In addition, to evaluate single factors...... that according to an EMT should lead to termination of CPR. Methods: This was a pilot-study including EMTs from a Danish Emergency Medical Service. Data was collected using a structured questionnaire. All responses were collected anonymously. Results: In total, 50 EMTs (male: 88%, median age: 38, response rate...

  7. The effects of interprofessional education - Self-reported professional competence among prehospital emergency care nursing students on the point of graduation - A cross-sectional study.

    Science.gov (United States)

    Castrèn, M; Mäkinen, M; Nilsson, J; Lindström, V

    2017-03-16

    The aim of the study was to investigate whether interprofessional education (IPE) and interprofessional collaboration (IPC) during the educational program had an impact on prehospital emergency care nurses' (PECN) self-reported competence towards the end of the study program. A cross-sectional study using the Nurse Professional Competence (NPC) Scale was conducted. A comparison was made between PECN students from Finland who experienced IPE and IPC in the clinical setting, and PECN students from Sweden with no IPE and a low level of IPC. Forty-one students participated (Finnish n=19, Swedish n=22). The self-reported competence was higher among the Swedish students. A statistically significant difference was found in one competence area; legislation in nursing and safety planning (p<0.01). The Finnish students scored significantly higher on items related to interprofessional teamwork. Both the Swedish and Finnish students' self-reported professional competence was relatively low according to the NPC Scale. Increasing IPC and IPE in combination with offering a higher academic degree may be an option when developing the ambulance service and the study program for PECNs.

  8. Disparities in Feedback Provision to Emergency Medical Services Professionals.

    Science.gov (United States)

    Cash, Rebecca E; Crowe, Remle P; Rodriguez, Severo A; Panchal, Ashish R

    2017-06-16

    Feedback to EMS professionals is a critical component for optimizing patient care and outcomes in the prehospital setting. There is a paucity of data concerning the feedback received by prehospital providers. The objective of this study was to describe the prevalence of feedback received by EMS professionals in the past 30 days including the types, sources, modes, and utility of feedback. The secondary objective was to identify factors associated with receiving any feedback and, specifically, feedback regarding medical care provided. This was a cross-sectional survey examining currently practicing nationally certified EMS patient care providers (EMT or higher) in non-military and non-tribal settings. Data were collected on provider characteristics along with feedback received. Descriptive statistics were calculated, and multivariable logistic regression models were constructed to assess the relationship between EMS provider characteristics and receiving feedback. A non-respondent survey was administered to assess for non-response bias. Responses from 32,314 EMS providers were received (response rate = 10.4%) with 15,766 meeting inclusion criteria. In the 30 days preceding the survey, 69.4% (n = 10,924) of respondents received at least one type of feedback with 54.7% (n = 8,592) reporting receiving medical care feedback. Multivariable logistic regression modeling indicated that higher certification level, fewer years of experience in EMS, working for a hospital-based agency, air medical service, and higher weekly call volumes were significantly associated with increased odds of having received at least one type of feedback, and specifically medical care feedback. Additionally, providing primarily medical/convalescent transport and more years of EMS experience were significantly associated with decreased odds of receiving feedback. Feedback to EMS providers is critical to improving prehospital care. In this study, nearly a third of providers did not receive any

  9. 不稳定型心绞痛院前急救临床观察%Clinical observation of unstable angina pre-hospital emergency intervention

    Institute of Scientific and Technical Information of China (English)

    郭华林

    2008-01-01

    目的 总结不稳定型心绞痛院前急救治疗的经验.方法 对院前胸痛患者,采集病史,体格检查,描记ECG并对其做出低中高危的评估,应用硝酸甘油、阿司匹林、使用β-受体阻滞剂、钙拮抗剂、转换酶抑制剂及肝素治疗,基础生命支持与监护.结果 留观期间:心绞痛症状缓解,有效98例(81.7%),加重21例(17.5%),收住院,其中因心绞痛发生顽固性心肌缺血4例,发展为严重心绞痛心律失常心房颤动6例,心源性休克4例,急性心力衰竭5例,非ST段抬高心肌梗死2例.院前猝死1例(0.8%).结论 不稳定型心绞痛患者院前急救措施的开展具有积极作用,早期识别、干预控制冠心病的危险因素,使心肌缺血症状改善,可减轻劳力性心绞痛的发作及改善患者的生活质量.%Objective To sum up unstable angina pre-hospital treatment interventions,clinical observation and assessment guide for emergency treatment.MethodsFor chest pain patients,collecting history,doing physical examination,checking ECG and making risk assessment,then,treating them with nitroglycerin,aspirin,beta-blocker,calcium antagonists,converting enzyme inhibitors,heparin therapy,and basic life support and monitor.Results During detention,there are 98 cases(81.7%)effective with angina symptoms subsided and discharged,21 cases (17.5%)aggravating and hospitalization,in which there are four cases get myocardial ischemia because of refractory angina,six cases of serious arrhythmia AF,four cases of cardiogenic shock,five cases of acute heart failure,and two cases of non.ST-segment elevation myocardial infarction.Also,there is one case(0.8%)of sudden death before prehospital treatment.Conclusion Pre-hospital treatment of unstable angina played a positive role in early identification,intervention and control of the risks of coronary artery disease,it also helps improving the symptoms of myocardial ischemia,reducing angina attack,and improving the life quality of the

  10. 现代网络院前急救模式对重型颅脑损伤预后影响%Influence of modern network pre-hospital emergency care mode on the prognosis of severe brain trauma

    Institute of Scientific and Technical Information of China (English)

    张守祥; 王诚; 戴利强; 吴涛; 刘胜

    2012-01-01

    目的 探讨现代网络院前急救模式对重型颅脑损伤患者预后的影响.方法 将院前重型颅脑外伤患者分成两组;现代网络院前急救模式(A组,162例)由经过专业培训的急救队伍组成,能够进行基础、高级生命支持,配备先进急救设备和现代交通工具等,利用现代网络连接快捷的特点,在深圳市急救中心调度下开展院前现场急救工作;传统模式组(B组,124例)患者自行到达医院,无医务人员现场抢救及陪同.统计调度时间、到达时间、现场时间、返回时间、总时间,同时对受伤类型、颅内损伤程度、格拉斯哥预后分级( GOS)进行统计学分析.结果 A组和B组的受伤类型、颅内损伤程度差异无显著性(P>0.05).A组预后伤残程度评级:良好72.22%,中残19.14%,重残1.85%,植物状态0.62%,死亡6.17%;B组预后伤残程度评级:良好47.58%,中残24.19%,重残12.10%,植物状态2.23%,死亡14.51%;A组预后优于B组,差异有显著性(P<0.05).结论 现代网络院前急救模式能提升重型颅脑损伤急救速度,降低死亡率和改善预后.%Objective To explore the influence of modern network pre-hospital emergency care mode on the prognosis of the patients with severe brain trauma.Methods Divided the patients with severe brain trauma into 2 groups:modern network pre-hospital emergency care mode group( A group,162 cases ),which had a professional rescue team that equipped with advanced first-aid equipment and had modern transportation and modem fast network,carried pre-hospital emergency rescue work out under the management of the Shenzhen City Emergency Center; Patients in traditional mode group ( B group,124 cases ) went to hospital with no health care and no companionship of medical worker.Then recorded the scheduling time,running time,rescue time,returning time,and total time; statistically analyzed the traumatic type,traumatic degree,and Glasgow Outcome Scale( GOS ) in both

  11. Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care.

    Science.gov (United States)

    Johnson, Maxine; O'Hara, Rachel; Hirst, Enid; Weyman, Andrew; Turner, Janette; Mason, Suzanne; Quinn, Tom; Shewan, Jane; Siriwardena, A Niroshan

    2017-01-24

    Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded 'digital diaries' (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research

  12. Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care

    Directory of Open Access Journals (Sweden)

    Maxine Johnson

    2017-01-01

    Full Text Available Abstract Background Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. Methods The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16 and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded ‘digital diaries’ (155 events. Three staff focus groups (total n = 21 and three service user focus groups (total n = 23 explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. Results The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service

  13. The influence of the workplace-related biological agents on the immune systems of emergency medical personnel.

    Science.gov (United States)

    Brewczyńska, Aleksandra; Depczyńska, Daria; Borecka, Anna; Winnicka, Izabela; Kubiak, Leszek; Skopińska-Różewska, Ewa; Niemcewicz, Marcin; Kocik, Janusz

    2015-01-01

    Emergency medical services workers' (EMSWs) acute exposures to many biological agents are frequent and well recognised in their workplaces, as well as occupational diseases resulting from some of these exposures. At the same time, there is only scant information on the adverse effects of chronic exposure to biological hazard factors on the immune systems of EMSWs. In the Polish legislation system, the Ordinance of the Minister of Health about harmful biological agents in the workplace and ways of protecting workers from exposure to those agents is an implement of Directive 2000/54/EC, which deals thoroughly with those issues in European Union Countries. Emergency medical services workers play an essential role as primary providers of pre-hospital emergency medical care, and they are part of the integral components of disaster response. Traumatic experiences can affect emergency medical staff immune systems negatively, by functioning as a chronic stressor. Conscious use of biological agents in workplaces such as microbial laboratories can be easily controlled and monitored. However, risk assessment is more difficult for workers when they are exposed unintentionally to biological agents. Exposure to bio-aerosols is considered especially harmful. This review summarises available information about biological risk factors for emergency medical services workers, and some information about the influence of these factors on their immune systems.

  14. Improving medical emergency services system by evaluating patient satisfaction: means for health management

    Directory of Open Access Journals (Sweden)

    MR Peyravi

    2014-01-01

    Full Text Available Introduction: One of the important aspects in high quality health care system is delivering health services in an appropriate way which can lead to development of the systems. Patient satisfaction is a quality indicator that has the potential to provide valuable information about the care delivered by an Emergency Medical Services system (EMS. This indicator is considered as an important marker of quality by paramedics. Method: This is a descriptive- analytical study on 1096 patient satisfaction of emergency services suffering from cardiovascular, dyspnea, low level of consciousness and cerebral problems. Variables such as the type of diseases, technicians’ and operators’ behavior, time of response and outcome of the missions were measured with a valid checklist. ANOVA and correlation Pearson were employed as analytical tests. Results: Considering different types of diseases, 4 categories of diseases had positive correlation with satisfaction of the patients and also there was a meaningful correlation between factors which were measured and satisfied patients.( P<0.001 Conclusion: Developing some instructions for technicians and operators focusing on interpersonal skills and enhanced sensitivities and behaviors not only toward patients but also toward bystanders and family members is recommended to improve patient satisfaction and thought quality of delivered care in the prehospital emergency medical systems.

  15. A 'mixed reality' simulator concept for future Medical Emergency Response Team training.

    Science.gov (United States)

    Stone, Robert J; Guest, R; Mahoney, P; Lamb, D; Gibson, C

    2017-08-01

    The UK Defence Medical Service's Pre-Hospital Emergency Care (PHEC) capability includes rapid-deployment Medical Emergency Response Teams (MERTs) comprising tri-service trauma consultants, paramedics and specialised nurses, all of whom are qualified to administer emergency care under extreme conditions to improve the survival prospects of combat casualties. The pre-deployment training of MERT personnel is designed to foster individual knowledge, skills and abilities in PHEC and in small team performance and cohesion in 'mission-specific' contexts. Until now, the provision of airborne pre-deployment MERT training had been dependent on either the availability of an operational aircraft (eg, the CH-47 Chinook helicopter) or access to one of only two ground-based facsimiles of the Chinook's rear cargo/passenger cabin. Although MERT training has high priority, there will always be competition with other military taskings for access to helicopter assets (and for other platforms in other branches of the Armed Forces). This paper describes the development of an inexpensive, reconfigurable and transportable MERT training concept based on 'mixed reality' technologies-in effect the 'blending' of real-world objects of training relevance with virtual reality reconstructions of operational contexts. 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/.

  16. Teammate Familiarity, Teamwork, and Risk of Workplace Injury in Emergency Medical Services Teams.

    Science.gov (United States)

    Hughes, Ashley M; Patterson, P Daniel; Weaver, Matthew D; Gregory, Megan E; Sonesh, Shirley C; Landsittel, Douglas P; Krackhardt, David; Hostler, David; Lazzara, Elizabeth H; Wang, Xiao; Vena, John E; Salas, Eduardo; Yealy, Donald M

    2017-07-01

    Increased teammate familiarity in emergency medical services (EMS) promotes development of positive teamwork and protects against workplace injury. Measures were collected using archival shift records, workplace injury data, and cross-sectional surveys from a nationally representative sample of 14 EMS agencies employing paramedics, prehospital nurses, and other EMS clinicians. One thousand EMS clinicians were selected at random to complete a teamwork survey for each of their recent partnerships and tested the hypothesized role of teamwork as a mediator in the relationship between teammate familiarity and injury with the PROCESS macro. We received 2566 completed surveys from 333 clinicians, of which 297 were retained. Mean participation was 40.5% (standard deviation [SD] = 20.5%) across EMS agencies. Survey respondents were primarily white (93.8%), male (67.3%), and ranged between 21-62 years of age (M = 37.4, SD = 9.7). Seventeen percent were prehospital nurses. Respondents worked a mean of 3 shifts with recent teammates in the 8 weeks preceding the survey (M = 3.06, SD = 4.4). We examined data at the team level, which suggest positive views of teamwork (M = 5.92, SD = 0.69). Our hypothesis that increased teammate familiarity protects against adverse safety outcomes through development of positive teamwork was not supported. Teamwork factor Partner Adaptability and Backup Behavior is a likely mediator (odds ratio = 1.03, P = .05). When dyad familiarity is high and there are high levels of backup behavior, the likelihood of injury is increased. The relationship between teammate familiarity and outcomes is complex. Teammate adaptation and backup behavior is a likely mediator of this relationship in EMS teams with greater familiarity. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  17. APPROACHES TO INCREASE THE AVAILABILITY AND EFFECTIVENESS OF PRE-HOSPITAL THROMBOLYSIS IN REAL CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    L. A. Ostroumova

    2012-01-01

    Full Text Available Aim. To identify the factors of the increasing the availability and effectiveness of pre-hospital thrombolytic therapy of patients with ST segment elevation acute coronary syndrome (STEACS. Material and methods. STEACS patients (n=70 were included in the study and stratified into two groups. Patients of the 1st group (n=30 received emergency medical assistance from the feldsher teams and patients of the 2nd group (n=40 — from the doctor teams. Expert estimation approach was used for the real practice assessment. Results. The hospital-matched diagnose rate was 97.5% in the doctor teams in comparison with 76.7% in feldsher teams (p<0.05. The efficiency of pre-hospital thrombolysis in 90 minutes after its beginning was 60.1% for the doctor teams versus 73.3% for the feldsher teams (p>0.05. The deviation from the standard operating procedure of the medical care for myocardial infarction patients was observed more often in the doctor teams in comparison with this in the feldsher teams. Time for the decision about pre-hospital thrombolysis start, the rate of unreasonable use or unreasonable refusal of thrombolysis did not differ significantly in feldsher and doctor teams. Conclusion. To increase the effectiveness of pre-hospital thrombolysis therapy it is necessary to follow strictly the standard of the medical care for patients with acute coronary syndrome. One of the main approaches to improve the availability of up to date medical care technologies in STEACS treatment is implementation of pre-hospital thrombolysis in practice of feldsher teams.

  18. Prehospital treatment of opioid overdose in Copenhagen--is it safe to discharge on-scene?

    DEFF Research Database (Denmark)

    Rudolph, Søren; Jehu, G; Nielsen, Søren Loumann

    2011-01-01

    In the prehospital setting opioid overdose is often treated with naloxone. In our physician-based medical emergency care unit (MECU) we have adopted a discharge-on-scene policy, where patients are released on scene if no residual signs of opioid intoxication are found after treatment. The aim...... of this study was to describe our experience with the discharge-on-scene policy used during a 10-year-period with focus on the frequency of rebound opioid toxicity....

  19. Comparative study of its pre-hospital emergency exercise among Wuhan, Taibei and Hong Kong%武汉、台北、香港三城市院外急救比较研究

    Institute of Scientific and Technical Information of China (English)

    刘厚俭; 熊悦安; 陈欢; 张欣; 王飞

    2011-01-01

    目的 通过对武汉,台北,香港这三个有着相同语言,相同文化的地区,进行院外急救相关方面的调研和比较,以便加速内地院外急救观念的转变,完善应急机制,提高突发公共事件紧急医疗救援能力.方法 通过查阅文献资料、资料研究及分析对比.结果 香港无论在同等服务人口投入的急救人员数量上,还是在日常当班急救车数量及日常急救任务量上都居第一,台北次之,武汉最低.按每台当班急救车抢救转送相同病例数所配备的急救人员相对数量来看,武汉需要的人员最多,不经济,人力资源消耗最大.台北.香港救护车上急救人员主要为救护员.而武汉必须有医师.结论 内地所确定的院外急救改革发展方向同港台地区目前的做法是一致的,院外急救属于公共卫生服务领域,应由政府负责提供均等化服务.要加强研究.%Objective Sharing with identical language and cultural background, Wuhan,Taipei, and Hong Kong were subject to be comparatively studied on the relevant aspects in prehospital emergency medical exercise. Methods Such a study serves to expedite the process in improving those emergency medical organizations' responding capabilities in any unexpected public events in Mainland. Results The result of study indicated that Hong Kong took first place in providing medical resource, Taipei second and Wuhan the last for same amount of population. It is considered not economical as more than adequate medical staff allocated at each ambulance unit in Wuhan's emergency medical system than that in either Hong Kong or Taipei where only emergency technician is required to be sent with an ambulance rather than a doctor required in Mainland. Conclusion Though the way of reform development of majority of emergency medical centers in the Mainland keeps identical with that in Hong Kong/Taipei which is considered being advanced in the industry, there is still a plenty of room to improve

  20. Application of emergency nursing professional team in the pre-hospital care%院前急救护理专业小组在院前急救护理工作中的应用

    Institute of Scientific and Technical Information of China (English)

    洪小英; 李娜; 周玲; 王根群; 黄超莹

    2013-01-01

      目的探讨成立院前急救护理专业小组在院前急救护理工作中的作用。方法2011年10月~2012年3月收治的患者为成立院前急救护理专业小组前组(设为对照组),2012年4~9月收治的患者为成立院前急救护理专业小组后组(设为研究组),每组各200例。对照组在急救护理工作中按常规急救护理管理,研究组在急救护理工作中成立院前急救护理专业小组进行急救护理管理。比较两组患者满意度、出车时间及护理不良事件发生率。结果成立院前急救护理专业小组后,患者满意度较实施前明显升高,出车时间较实施前明显缩短、护理不良事件发生率较实施前明显减少,两组比较,均P<0.05,差异具有统计学意义。结论在急救护理工作中成立院前急救护理专业小组护理管理模式,能有效提高院前急救护理质量。%Objective To study the role of emergency nursing professional team in the pre-hospital care.Methods Two hundred patients from October 2011 to March 2012 were set as the control group and another 200 patients from April 2012 to September 2012 were selected as the experiment group.The control group was managed by routine emergency mode and the experiment group by the emergency nursing professional team.The two groups were compared in terms of satisfaction degree,the time for the team to start and the rate of adverse nursing events.Results After establishing the emergency nursing professional team,the satisfaction degree was significantly increased,the time for the team to start was significantly shortened and the rate of adverse nursing events was significantly decreased(all P<0.05).Conclusion The management mode of emergency nursing professional team in pre-hospital medical care can effectively improve the quality of nursing care.

  1. EMS Adherence to a Pre-hospital Cervical Spine Clearance Protocol

    Directory of Open Access Journals (Sweden)

    Johnson, David

    2001-10-01

    Full Text Available Purpose: To determine the degree of adherence to a cervical spine (c-spine clearance protocol by pre-hospital Emergency Medical Services (EMS personnel by both self-assessment and receiving hospital assessment, to describe deviations from the protocol, and to determine if the rate of compliance by paramedic self-assessment differed from receiving hospital assessment. Methods: A retrospective sample of pre-hospital (consecutive series and receiving hospital (convenience sample assessments of the compliance with and appropriateness of c-spine immobilization. The c-spine clearance protocol was implemented for Orange County EMS just prior to the April-November 1999 data collection period. Results: We collected 396 pre-hospital and 162 receiving hospital data forms. From the pre-hospital data sheet. the percentage deviation from the protocol was 4.096 (16/396. Only one out of 16 cases that did not comply with the protocol was due to over immobilization (0.2%. The remaining 15 cases were under immobilized, according to protocol. Nine of the under immobilized cases (66% that should have been placed in c-spine precautions met physical assessment criteria in the protocol, while the other five cases met mechanism of injury criteria. The rate of deviations from protocol did not differ over time. The receiving hospital identified 8.0% (13/162; 6/16 over immobilized, 7/16 under immobilized of patients with deviations from the protocol; none was determined to have actual c-spine injury. Conclusion: The implementation of a pre-hospital c-spine clearance protocol in Orange County was associated with a moderate overall adherence rate (96% from the pre-hospital perspective, and 92% from the hospital perspective, p=.08 for the two evaluation methods. Most patients who deviated from protocol were under immobilized, but no c-spine injuries were missed. The rate of over immobilization was better than previously reported, implying a saving of resources.

  2. An application of the MEMbrain training module: Pre-hospital rescue operation

    DEFF Research Database (Denmark)

    Andersen, V.

    1998-01-01

    A system for training in pre-hospital emergency management is being developed and the first version of a prototype has been completed. The training system fulfils the demands from the domain of hospital emergency planning centres and medical attendants concerning increased efficiency of rescue...... efforts. This includes enhanced first aid on site and improved overall co-ordination amongst the organisations involved in coping with emergency situations. The training system is based on the Multi-User System for Training Emergency Response (MUSTER) concept which is used for the training module...... in the decision support system MEMbrain. (C) 1998 Elsevier Science Ltd. All rights reserved....

  3. The expansion and extension of the fire field medical aid to the current pre-hospital first aid in our country%消防部队现场医疗救助应成为我国现行院前急救模式的拓展和延伸

    Institute of Scientific and Technical Information of China (English)

    韩雨; 陈向芳; 林炜栋

    2016-01-01

    To analyze both the deficiency and the existing problems of current prehospital first aid management and the advantage of the fire force medical assistance, to observe the bridging role of the fire field medical aid practice,and put forward prospects of the future of China′s prehospital first aid.By utilizing all the advantages of the fire force, the integration of the fire field medical aid into current prehospital emergency system together with granted corresponding legal rights and responsibility can significantly improve our pre⁃hospital first aid service level, relieve the pressure of hospital first⁃aid, improve the emergency response capability of a city,and increase the public′s sense of security.Applying emergency resources other than current hospitals can effectively increase the prehospital aid capability. As an important comprehensive medical aid force,fire force should be integrated into current medical aid system,and the combination of both can not only benefit the whole society greatly but also can bring China′s prehospital first aid in line with international practice.%分析我国现有院前急救管理办法、院前急救现实中存在的不足以及消防部队现场医疗救助的优势,以观察消防现场医疗救助对于院前急救的弥合作用,并提出未来我国院前急救发展前景。应充分利用消防部队的各种优势,把消防的现场医疗急救有机融合到院前急救体系中,并赋予相应的法律权限和职责,能够显著提高我国院前急救水平,缓解急救矛盾,以提高城市应急能力,增加城市安全感。在我国现有院前急救体制下,应充分利用医疗系统以外的社会急救力量,消防部队作为我国现役的一支社会综合救援力量,二者有机结合才能够突破现有急救瓶颈,适应现实社会发展需要,使我国院前急救逐渐与国际接轨。

  4. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M.; Vaal, de E.T.; Rood, Pleunie P.M.; Hoogerwerf, N.; Doggen, C.J.M.; Schoonhoven, L.

    2015-01-01

    Introduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was devel

  5. Pain management in trauma patients in (pre)hospital based emergency care: Current practice versus new guideline

    NARCIS (Netherlands)

    A.C. Scholten (Annemieke); S.A.A. Berben (Sivera); A.H. Westmaas (Alvin H); P.M. van Grunsven (Pierre); E.T. de Vaal; P.P.M. Rood (Pleunie); N. Hoogerwerf (N.); C.J.M. Doggen (Carine); R. van Schoonhoven (Renee)

    2015-01-01

    textabstractIntroduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideli

  6. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M. van; Vaal, E.T. de; Hoogerwerf, N.; Doggen, C.J.; Schoonhoven, L.

    2015-01-01

    INTRODUCTION: Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was deve

  7. 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.

  8. 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.

  9. [Pediatric emergencies in the Grenoble Medical Center].

    Science.gov (United States)

    Lebrun, E; Bost, M

    1988-01-01

    In the Grenoble Medical Centre, pediatric emergency admissions have been drastically influenced by the opening of an Emergency Unit in May 1983. Our work was carried out one year after the opening in order to study the characteristics of the admitted children. The enquiry was done over 4 months, one month for each season of that year. A total of 1,382 children were included in the study. Thirty-four percent were seen for a medical advice (66% hospitalized). Children seen for medical advice are younger and mostly migrants. They live close to the hospital and are brought most often for fever. Fifty one per cent directly brought to the hospital by their parents for a first pediatric advice (49% were sent by their personal physician). Children directly brought by their parents are in majority infants and migrants. They are mostly admitted at night and morning and during the week-end. They are more frequently followed within the public mother-child health protection system ("Service de Protection Maternelle et Infantile", PMI).

  10. Mobile emergency (surgical hospital: Development and application in medical relief of “4.20” Lushan earthquake in Sichuan Province, China

    Directory of Open Access Journals (Sweden)

    Cheng Bin

    2015-07-01

    Full Text Available In the 21st century, natural disasters and emergencies occur frequently worldwide, which leads to the loss of hundreds of thousands of lives as well as the direct and indirect economic losses. China has a vast territory frequently struck by natural disasters. However, the reality is not optimistic. Poor organization and management during the rescue actions, the lack of large-scale, systematic medical rescue equipment were all great barriers to the outcomes. Mobile hospitals are expected to provide better health care. We were inspired by the concept of mobile hospital. Chongqing Emergency Medical Center, has set up trauma care system since 1988, in which prehospital care, intensive care, and in-hospital treatment is fully integrated. As a major advantage, such a system provided assurance of “golden hour” rescue treatment. Providing mobile intensive care and prehospital surgical service for severe trauma patients could reduce mortality significantly. Based on the civilian experiences in Chongqing Emergency Medical Center, the mobile emergency (surgical hospital was developed.

  11. Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients

    Directory of Open Access Journals (Sweden)

    Kenneth A. Scheppke

    2014-11-01

    Full Text Available Introduction: Violent and agitated patients pose a serious challenge for emergency medical services (EMS personnel. Rapid control of these patients is paramount to successful prehospital evaluation and also for the safety of both the patient and crew. Sedation is often required for these patients, but the ideal choice of medication is not clear. The objective is to demonstrate that ketamine, given as a single intramuscular injection for violent and agitated patients, including those with suspected excited delirium syndrome (ExDS, is both safe and effective during the prehospital phase of care, and allows for the rapid sedation and control of this difficult patient population. Methods: We reviewed paramedic run sheets from five different catchment areas in suburban Florida communities. We identified 52 patients as having been given intramuscular ketamine 4mg/kg IM, following a specific protocol devised by the EMS medical director of these jurisdictions, to treat agitated and violent patients, including a subset of which would be expected to suffer from ExDS. Twenty-six of 52 patients were also given parenteral midazolam after medical control was obtained to prevent emergence reactions associated with ketamine. Results: Review of records demonstrated that almost all patients (50/52 were rapidly sedated and in all but three patients no negative side effects were noted during the prehospital care. All patients were subsequently transported to the hospital before ketamine effects wore off. Conclusion: Ketamine may be safely and effectively used by trained paramedics following a specific protocol. The drug provides excellent efficacy and few clinically significant side effects in the prehospital phase of care, making it an attractive choice in those situations requiring rapid and safe sedation especially without intravenous access. [West J Emerg Med. 2014;15(7:–0.

  12. Emergency Medical Service Personnel Recognize Pediatric Concussions.

    Science.gov (United States)

    Speirs, Joshua N; Lyons, Matthew I; Johansson, Bert E

    2017-01-01

    Concussions are a major cause of morbidity in pediatrics. Many concussions occur during activities with emergency medical service (EMS) providers present to determine if a higher level of care is needed. Data are limited on how capable these providers are. We assessed the ability of EMS providers to recognize pediatric concussions. Fifty-six total responses were included, 38 from EMS and 18 from our MD/RN (medical doctor/registered nurse) group. No statistical differences were found between the 2 groups when adjusted for age, gender, number of years in practice, and number of pediatric concussions managed. This first of its kind pilot study was designed to assess EMS personnel's ability to recognize and triage pediatric concussions. Our findings show EMS providers are statistically identical in their ability to recognize and triage concussions to physicians. The performance of our MD participants was lower than expected. Larger studies are needed to further investigate EMS providers' ability to recognize a concussion.

  13. Mammalian synthetic biology: emerging medical applications.

    Science.gov (United States)

    Kis, Zoltán; Pereira, Hugo Sant'Ana; Homma, Takayuki; Pedrigi, Ryan M; Krams, Rob

    2015-05-06

    In this review, we discuss new emerging medical applications of the rapidly evolving field of mammalian synthetic biology. We start with simple mammalian synthetic biological components and move towards more complex and therapy-oriented gene circuits. A comprehensive list of ON-OFF switches, categorized into transcriptional, post-transcriptional, translational and post-translational, is presented in the first sections. Subsequently, Boolean logic gates, synthetic mammalian oscillators and toggle switches will be described. Several synthetic gene networks are further reviewed in the medical applications section, including cancer therapy gene circuits, immuno-regulatory networks, among others. The final sections focus on the applicability of synthetic gene networks to drug discovery, drug delivery, receptor-activating gene circuits and mammalian biomanufacturing processes. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

  14. Development and Evaluation of Educational Materials for Pre-Hospital and Emergency Department Personnel on the Care of Patients with Autism Spectrum Disorder

    Science.gov (United States)

    McGonigle, John J.; Migyanka, Joann M.; Glor-Scheib, Susan J.; Cramer, Ryan; Fratangeli, Jeffrey J.; Hegde, Gajanan G.; Shang, Jennifer; Venkat, Arvind

    2014-01-01

    With the rising prevalence of patients with autism spectrum disorder (ASD), there has been an increase in the acute presentation of these individuals to the general health care system. Emergency medical services and emergency department personnel commonly address the health care needs of patients with ASD at times of crisis. Unfortunately, there…

  15. Usage of documented pre-hospital observations in secondary care: a questionnaire study and retrospective comparison of records.

    Science.gov (United States)

    Knutsen, Geir O; Fredriksen, Knut

    2013-03-01

    The patient handover is important for the safe transition from the pre-hospital setting to secondary care. The loss of critical information about the pre-hospital phase may impact upon the clinical course of the patient. University Hospital Emergency Care registrars answered a questionnaire about how they perceive clinical documentation from the ambulance services. We also reviewed patient records retrospectively, to investigate to what extent eight selected parameters were transferred correctly to hospital records by clinicians. Only parameters outside the normal range were selected. The registrars preferred a verbal handover with hand-written pre-hospital reports as the combined source of clinical information. Scanned report forms were infrequently used. Information from other doctors was perceived as more important than the information from ambulance crews. Less than half of the selected parameters in pre-hospital notes were transferred to hospital records, even for parameters regarded as important by the registrars. Abnormal vital signs were not transferred as often as mechanism of injury, medication administered and immobilisation of trauma patients. Data on pre-hospital abnormal vital signs are frequently not transferred to the hospital admission notes. This information loss may lead to suboptimal care.

  16. 32 CFR 1656.20 - Expenses for emergency medical care.

    Science.gov (United States)

    2010-07-01

    ... reasonable expenses for emergency medical care, including hospitalization, of ASWs who suffer illness or... date on which the expense was incurred. (f) Cost of emergency medical care including hospitalization... 32 National Defense 6 2010-07-01 2010-07-01 false Expenses for emergency medical care. 1656.20...

  17. 75 FR 27917 - Emergency Medical Services Week, 2010

    Science.gov (United States)

    2010-05-18

    ... medical education, train themselves on the latest life-saving techniques, and maintain vital emergency... Proclamation 8519--Emergency Medical Services Week, 2010 Executive Order 13542--Providing an Order of... President ] Proclamation 8519 of May 13, 2010 Emergency Medical Services Week, 2010 By the President of...

  18. 77 FR 36039 - Federal Interagency Committee on Emergency Medical Services

    Science.gov (United States)

    2012-06-15

    ... National Highway Traffic Safety Administration Federal Interagency Committee on Emergency Medical Services... Interagency Committee on Emergency Medical Services. SUMMARY: NHTSA announces a meeting of the Federal Interagency Committee on Emergency Medical Services (FICEMS) to be held in the Washington, DC area....

  19. 78 FR 30727 - Emergency Medical Services Week, 2013

    Science.gov (United States)

    2013-05-22

    ... Documents#0;#0; ] Proclamation 8982 of May 17, 2013 Emergency Medical Services Week, 2013 By the President... calm under pressure delivers comfort to neighbors in need. During Emergency Medical Services Week, we... proclaim May 19 through May 25, 2013, as Emergency Medical Services Week. I encourage all Americans...

  20. 31 CFR 544.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... Authorization of emergency medical services. The provision of nonscheduled emergency medical services in the... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 544.508 Section 544.508 Money and Finance: Treasury Regulations Relating to Money and...

  1. 77 FR 31143 - Emergency Medical Services Week, 2012

    Science.gov (United States)

    2012-05-24

    ... President Proclamation 8824--Emergency Medical Services Week, 2012 Proclamation 8825--National Safe Boating..., in communities across our country, men and women providing emergency medical services (EMS) stand at... efficiency at a moment's notice. During Emergency Medical Services Week, we honor their...

  2. 48 CFR 1842.7003 - Emergency medical services and evacuation.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Emergency medical services... NASA Contract Clauses 1842.7003 Emergency medical services and evacuation. The contracting officer must insert the clause at 1852.242-78, Emergency Medical Services and Evacuation, in all solicitations...

  3. 31 CFR 593.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... Authorization of emergency medical services. The provision of nonscheduled emergency medical services in the... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 593.508 Section 593.508 Money and Finance: Treasury Regulations Relating to Money and...

  4. 31 CFR 547.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... of emergency medical services. The provision of nonscheduled emergency medical services in the United... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 547.508 Section 547.508 Money and Finance: Treasury Regulations Relating to Money and...

  5. Medical Geology: a globally emerging discipline

    Energy Technology Data Exchange (ETDEWEB)

    Bunnell, J.E.; Finkelman, R.B.; Centeno, J.A.; Selinus, O. [Armed Forces Institute of Pathology, Washington, DC (United States)

    2007-07-01

    Medical Geology, the study of the impacts of geologic materials and processes on animal and human health, is a dynamic emerging discipline bringing together the geoscience, biomedical, and public health communities to solve a wide range of environmental health problems. Among the Medical Geology described in this review are examples of both deficiency and toxicity of trace element exposure. Goiter is a widespread and potentially serious health problem caused by deficiency of iodine. In many locations the deficiency is attributable to low concentrations of iodine in the bedrock. Similarly, deficiency of selenium in the soil has been cited as the principal cause of juvenile cardiomyopathy and muscular abnormalities. Overexposure to arsenic is one of the most widespread Medical Geology problems affecting more than one hundred million people in Bangladesh, India, China, Europe, Africa and North and South America. The arsenic exposure is primarily due to naturally high levels in groundwater but combustion of mineralized coal has also caused arsenic poisoning. Dental and skeletal fluorosis also impacts the health of millions of people around the world and, like arsenic, is due to naturally high concentrations in drinking water and, to a lesser extent, coal combustion. Other Medical Geology issues described include geophagia, the deliberate ingestion of soil, exposure to radon, and ingestion of high concentrations of organic compounds in drinking water. Geoscience and biomedical/public health researchers are teaming to help mitigate these health problems as well as various non-traditional issues for geoscientists such as vector-borne diseases.

  6. Survey Research on Pre-hospital Emergency of Drug-induced Disulfiram-like Reaction%药源性双硫仑样反应院前急救情况分析

    Institute of Scientific and Technical Information of China (English)

    赵云霄; 牟丽

    2016-01-01

    Objective To survey and analyze the rationality and necessity of pre-hospital emergency of drug-induced disul-firam-like reaction. Methods 24 cases of patients with disulfiram-like reaction in the pre-hospital diagnosis in our hospital from January 2010 to May 2012 were selected as the survey objects, and the related data were retrospectively analyzed, and the physiological parameters, heart rate, mean arterial blood pressure and pulse saturation of arterial blood oxygen of pa-tients were counted and analyzed before and after the emergency disposal. Results The general state of patients was obvi-ously improved after the pre-hospital emergency, and various physiological indexes were obviously improved, and the differ-ence had statistical significance. Conclusion The pre-hospital emergency rational intervention can obviously improve the patients with disulfiram-like reaction in limited time, and the emergency physicians should pay great attention to the occur-rence of disulfiram-like reaction when handling the emergency events after drinking.%目的:调查分析药源性双硫仑样反应患者院前急救的合理性及必要性。方法选取2010年1月-2012年5月院前接诊的24例双硫仑反应患者的作为调查对象,对相关资料进行回顾性分析。统计分析病人急救处置前后生理参数情况,心率(HR)、平均动脉压(MABP)、脉搏氧饱和度(SpO2)。结果在经过院前救治后,患者的一般状态明显好转,各项生理指标较前有明显改善,差异有统计学意义。结论双硫仑样反应患者经过院前急救合理干预,能够在有限时间内得到显著明显的改善。急救医师在处理饮酒后发生的急救事件时应特别注意双硫仑样反应的发生。

  7. Emerging medical technologies and emerging conceptions of health.

    Science.gov (United States)

    Stempsey, William E

    2006-01-01

    Using ideas gleaned from the philosophy of technology of Martin Heidegger and Hans Jonas and the philosophy of health of Georges Canguilhem, I argue that one of the characteristics of emerging medical technologies is that these technologies lead to new conceptions of health. When technologies enable the body to respond to more and more challenges of disease, we thus establish new norms of health. Given the continued development of successful technologies, we come to expect more and more that our bodies should be able to respond to ever-new challenges of environment and disease by establishing ever-new norms of health. Technologies may aim at the prevention and treatment of disease, but they also bring about modifications of what we consider normal for the human being. Thus, new norms of health arise from technological innovation.

  8. Emergency medical services and "psych calls": Examining the work of urban EMS providers.

    Science.gov (United States)

    Prener, Christopher; Lincoln, Alisa K

    2015-11-01

    Emergency medical technicians and paramedics form the backbone of the United States' Emergency Medical Service (EMS) system. Despite the frequent involvement of EMS with people with mental health and substance abuse problems, the nature and content of this work, as well as how EMS providers think about this work, have not been fully explored. Using data obtained through observations and interviews with providers at an urban American EMS agency, this paper provides an analysis of the ways in which EMS providers interact with people with mental illness and substance abuse problems, as well as providers' experiences with the mental health care system. Results demonstrate that EMS providers share common beliefs and frustrations about "psych calls" and the types of calls that involve people with behavioral health problems. In addition, providers described their understandings of the ways in which people with mental health and substance use problems "abuse the system" and the consequences of this abuse. Finally, EMS providers discuss the system-level factors that impact their work and specific barriers and challenges to care. These results suggest that additional work is needed to expand our understanding of the role of EMS providers in the care of people with behavioral health problems and that mental health practitioners and policy makers should include consideration of the important role of EMS and prehospital care in providing community-based supports for people with behavioral health needs. (PsycINFO Database Record

  9. Duration of Prehospital Cardiopulmonary Resuscitation and Favorable Neurological Outcomes for Pediatric Out-of-Hospital Cardiac Arrests: A Nationwide, Population-Based Cohort Study.

    Science.gov (United States)

    Goto, Yoshikazu; Funada, Akira; Goto, Yumiko

    2016-12-20

    The appropriate duration of cardiopulmonary resuscitation (CPR) for pediatric out-of-hospital cardiac arrests (OHCAs) remains unclear and may differ based on initial rhythm. We aimed to determine the relationship between the duration of prehospital CPR by emergency medical services (EMS) personnel and post-OHCA outcomes. We analyzed the records of 12 877 pediatric patients who experienced OHCAs (CPR duration was defined as the time from CPR initiation by EMS personnel to prehospital return of spontaneous circulation (ROSC) or to hospital arrival when prehospital ROSC was not achieved during prehospital CPR efforts. The rates of 30-day survival and 30-day CPC 1 to 2 were 9.1% (n=1167) and 2.5% (n=325), respectively. Prehospital EMS-initiated CPR duration was significantly and inversely associated with 30-day outcomes (adjusted odds ratio for 1-minute increments: 0.94, 95% confidence interval: 0.93-0.95 for survival; adjusted odds ratio: 0.90, 95% confidence interval: 0.88-0.92 for CPC 1-2). The duration of prehospital EMS-initiated CPR, beyond which the chance for favorable outcomes diminished to CPR durations beyond which the chance for 30-day survival with CPC 1 to 2 diminished to CPR, the prehospital CPR duration, beyond which the chance for favorable outcome diminished to CPR duration for pediatric OHCAs was independently and inversely associated with 30-day favorable outcomes. The duration of prehospital EMS-initiated CPR, beyond which the chance for 30-day favorable outcomes diminished to CPR duration to achieve this proportion of outcomes differed based on initial rhythm. Further research is required to elucidate appropriate CPR duration for pediatric OHCAs, including in-hospital CPR time. URL: https://clinicaltrials.gov. Unique identifier: NCT02432196. © 2016 American Heart Association, Inc.

  10. The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care.

    Science.gov (United States)

    Goldstein, Judah; McVey, Jennifer; Ackroyd-Stolarz, Stacy

    2016-01-01

    Caring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step.

  11. The development and features of the Spanish prehospital advanced triage method (META) for mass casualty incidents.

    Science.gov (United States)

    Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Garijo Gonzalo, Gracia; Martinez Monzon, Carlos; Pelaez Corres, Nieves; Rodriguez Soler, Alberto; Turegano Fuentes, Fernando

    2016-04-29

    This text describes the process of development of the new Spanish Prehospital Advanced Triage Method (META) and explain its main features and contribution to prehospital triage systems in mass casualty incidents. The triage META is based in the Advanced Trauma Life Support (ATLS) protocols, patient's anatomical injuries and mechanism of injury. It is a triage method with four stages including early identification of patients with severe trauma that would benefit from a rapid evacuation to a surgical facility and introduces a new patient flow by-passing the advanced medical post to improve evacuation. The stages of triage META are: I) Stabilization triage that classifies patients according to severity to set priorities for initial emergency treatment; II) Identifying patients requiring urgent surgical treatment, this is done at the same time than stage I and creates a new flow of patients with high priority for evacuation; III) Implementation of Advanced Trauma Life Support protocols to patients previously classified according to stablished priority; and IV) Evacuation triage, stablishing evacuation priorities in case of lacks of appropriate transport resources. The triage META is to be applied only by prehospital providers with advanced knowledge and training in advanced trauma life support care and has been designed to be implemented as prehospital procedure in mass casualty incidents (MCI).

  12. Equipment to prevent, diagnose, and treat hypothermia: a survey of Norwegian pre-hospital services.

    Science.gov (United States)

    Karlsen, Anders M; Thomassen, Oyvind; Vikenes, Bjarne H; Brattebø, Guttorm

    2013-08-12

    Hypothermia is associated with increased morbidity and mortality in trauma patients and poses a challenge in pre-hospital treatment. The aim of this study was to identify equipment to prevent, diagnose, and treat hypothermia in Norwegian pre-hospital services. In the period of April-August 2011, we conducted a survey of 42 respondents representing a total of 543 pre-hospital units, which included all the national ground ambulance services, the fixed wing and helicopter air ambulance service, and the national search and rescue service. The survey explored available insulation materials, active warming devices, and the presence of protocols describing wrapping methods, temperature monitoring, and the use of warm i.v. fluids. Throughout the services, hospital duvets, cotton blankets and plastic "bubble-wrap" were the most common insulation materials. Active warming devices were to a small degree available in vehicle ambulances (14%) and the fixed wing ambulance service (44%) but were more common in the helicopter services (58-70%). Suitable thermometers for diagnosing hypothermia were lacking in the vehicle ambulance services (12%). Protocols describing how to insulate patients were present for 73% of vehicle ambulances and 70% of Search and Rescue helicopters. The minority of Helicopter Emergency Medical Services (42%) and Fixed Wing (22%) units was reported to have such protocols. The most common equipment types to treat and prevent hypothermia in Norwegian pre-hospital services are duvets, plastic "bubble wrap", and cotton blankets. Active external heating devices and suitable thermometers are not available in most vehicle ambulance units.

  13. Termination of pre-hospital resuscitation by anaesthesiologists - causes and consequences

    DEFF Research Database (Denmark)

    Mikkelsen, S; Lossius, H M; Binderup, L G

    2017-01-01

    extinct in situations where an emergency medical technician (EMT) would have been required to resuscitate. METHODS: All lifeless patients seen pre-hospitally by the anaesthesiologist-manned Mobile Emergency Care Unit in Odense, Denmark, from 2010 to 2014 were retrospectively studied. RESULTS: Of 17 035......, or do-not-resuscitate order. CONCLUSION: In one patient in 30, the MECU refrained from futile resuscitation in cases where legislation required an EMT to initiate resuscitation. This practice reduced unethical attempts of resuscitation, reduced unnecessary emergency ambulance transports, and reduced...

  14. Undergraduate medical education in emergency medical care: a nationwide survey at German medical schools.

    Science.gov (United States)

    Beckers, Stefan K; Timmermann, Arnd; Müller, Michael P; Angstwurm, Matthias; Walcher, Felix

    2009-05-12

    Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21); problem-based learning at 29% (n = 10), e-learning at 3% (n = 1), and internship in ambulance service is mandatory at 11% (n = 4). In terms of assessment methods, multiple-choice exams (15 to 70 questions) are favoured (89%, n = 31), partially supplemented by open questions (31%, n = 11). Some faculties also perform single practical tests (43%, n = 15), objective structured clinical examination (OSCE; 29%, n = 10) or oral examinations (17%, n = 6). Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education in emergency medical care.

  15. Undergraduate medical education in emergency medical care: A nationwide survey at German medical schools

    Directory of Open Access Journals (Sweden)

    Timmermann Arnd

    2009-05-01

    Full Text Available Abstract Background Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Methods Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Results Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21; problem-based learning at 29% (n = 10, e-learning at 3% (n = 1, and internship in ambulance service is mandatory at 11% (n = 4. In terms of assessment methods, multiple-choice exams (15 to 70 questions are favoured (89%, n = 31, partially supplemented by open questions (31%, n = 11. Some faculties also perform single practical tests (43%, n = 15, objective structured clinical examination (OSCE; 29%, n = 10 or oral examinations (17%, n = 6. Conclusion Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard

  16. 院前创伤肋骨骨折急诊处理的临床诊治%An Analysis of Clinical Diagnosis and Treatment for the Emergency Management of Prehospital Rib Fracture

    Institute of Scientific and Technical Information of China (English)

    刘志凯

    2015-01-01

    Objective:To analyze and investigate the clinical treatment methods for the emergency man-agement of prehospital rib fracture.Methods:Retrospectively analyze the clinical treatment methods and effect of 200 patients who were received in our hospital and underwent treatment related to rib fracture.Di-vide those who underwent prehospital emergency management for trauma into observation group and those who did not had prehospital emergency management for trauma into control group.Compare the clinical effect between the 2 groups.Results:After a two-month treatment ,in terms of the clinical effect in the 2 groups,the clinical effect was found to be obviously better than that in control group.Conclusion:Prehospital emergency management for rib fracture is of great significance to patients with rib fracture and it is the key for patients to survive.%目的::分析和探究院前创伤肋骨骨折急诊处理的临床诊治方法。方法:利用回顾性分析的方法,分析来某院进行肋骨骨折治疗的200例患者的临床诊治方法和疗效,其中,对于实施院前创伤急诊处理的患者,分为观察组,未能实施院前创伤急诊处理的患者,分为对照组,对比两组患者的临床疗效。结果:2个月的治疗之后,对比患者的临床疗效发现,观察组患者的临床疗效明显优于对照组。结论:院前创伤肋骨骨折急诊处理,对于肋骨骨折患者的治疗具有十分重要的意义,是患者生存的关键。

  17. The effect of prehospital emergency care in the treatment of patients with severe hypertensive cerebral hemorrhage%院前急救在重症高血压脑出血患者救治中的作用

    Institute of Scientific and Technical Information of China (English)

    毕学志; 王国兴; 黄富

    2015-01-01

    Objective To explore the effect of prehospital emergency care in the treatment of patients with severe hy-pertensive cerebral hemorrhage. Methods Retrospectively analyzed the clinical data and follow-up results of 143 patients , they were divided into two groups (study group and control group) according to whether received prehospital emergency care. Comparatively analyzed the preoperative time, aspiration and pulmonary infection rate, decompressive craniotomy rate, GOS score and mortality rate between the two groups. Results The preoperative time of study group that received prehospital e-mergency care was shorter than control group (P0.05), but the mortality rate of study group was lower than control group (P<0.05). Conclusion The prehospital emergency care has an important role in the treatment of patients with severe hypertensive cerebral hemorrhage , which can give appropriate treatment to patients earlier and reduce mortality effectively.%目的:探讨院前急救在重症高血压脑出血患者救治中的作用。方法回顾性分析143例重症高血压脑出血患者的临床资料及随访结果,根据患者是否进行院前急救分为研究组与对照组,比较分析两组患者的术前时间、误吸及肺部感染发生率、去骨瓣减压率、GOS评分及死亡率。结果行院前急救的研究组患者术前时间较短(P<0.05),误吸及术后肺部感染率、因脑肿胀而行去骨瓣减压率较低(P<0.05),两组患者GOS评分差异无统计学意义(P>0.05),但研究组患者的死亡率低于对照组(P<0.05)。结论院前急救在重症高血压脑出血患者的救治中有重要作用,可使患者更早地得到合适的治疗并降低死亡率。

  18. Nursing Procedure for Patients with Cerebral Vascular Accident Pre-hospital Emergency%浅谈脑血管意外患者院前急救的护理程序

    Institute of Scientific and Technical Information of China (English)

    潘帅平

    2015-01-01

    目的院前急救是抢救的重要环节,探讨运用规范的护理程序后院前急救脑血管意外患者生命支持的时效显著提高,在提高脑血管意外患者院前急救成功率中有重要作用。方法在院前急救中正确规范运用护理程序,迅速了解患者的生命体征,对病情做出及时评估,并进行必要的生命支持及安全转运。结果运用正确规范的护理程序后,院前急救脑血管意外患者生命支持的时效显著提高。结论在运用正确规范的护理程序后,院前急救脑血管意外患者生命支持的时效显著提高,在提高脑血管意外患者院前急救成功率中有重要作用。%Objective Pre-hospital first aid is an important part of the rescue,discussed using the normative nursing program backyard before emergency cerebrovascular accident patients life support aging significantly increased,in improving pre-hospital emergency cerebrovascular accident patients play an important role in the success rate.Methods In pre-hospital first aid cor ect specification using the nursing process,quickly understand the patient's vital signs,to condition assessment in time,and make the necessary life support and safe transport.Results Using the right after the normative nursing program,cerebrovascular accident patients with pre-hospital emergency life support aging significantly increased.Conclusion The ef ect of life support on the life support of patients with cerebral vascular accidents in the pre hospital emergency treatment is significantly improved, and it plays an important role in improving the success rate of cerebrovascular accident patients.

  19. Hazard perception in emergency medical service responders.

    Science.gov (United States)

    Johnston, K A; Scialfa, C T

    2016-10-01

    The perception of on-road hazards is critically important to emergency medical services (EMS) professionals, the patients they transport and the general public. This study compared hazard perception in EMS and civilian drivers of similar age and personal driving experience. Twenty-nine EMS professionals and 24 non-professional drivers were given a dynamic hazard perception test (HPT). The EMS group demonstrated an advantage in HPT that was independent of simple reaction time, another indication of the validity of the test. These results are also consistent with the view that professional driving experience results in changes in the ability to identify and respond to on-road hazards. Directions for future research include the development of a profession-specific hazard perception tool for both assessment and training purposes.

  20. Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review.

    Science.gov (United States)

    Johnsen, Anne Siri; Fattah, Sabina; Sollid, Stephen J M; Rehn, Marius

    2016-02-09

    This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. Early prehospital phase of a major incident. Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and 'major incidents' to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed. CRD42013004473. 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/

  1. Work stress in emergency medical technicians.

    Science.gov (United States)

    Neale, A V

    1991-09-01

    To better understand the dynamics underlying their high turnover rate, emergency medical technicians (EMTs) were asked to participate in a union-sponsored study. Fifty-two percent of 200 EMT union members returned the three mailed questionnaires: the Occupational Stress Index, which assesses stress, strain, and coping; the Staff Burnout Scale for Health Professionals; and a survey that probed areas of job satisfaction. The sample had high stress, strain, and burnout scores. Coping skills were within the normal range. Burnout, stress, strain, and coping (BSS&C) were significantly related to job satisfaction, worry about infectious diseases, and perceptions of being poorly treated by emergency room personnel and fire fighters. BSS&C also were related to being upset by "runs" related to injuries from violence, drug overdoses, and exposure. Job dissatisfaction was related to attitudes that the job adversely affects one's family, that the EMT quarters are uncomfortable, and that administrators are not knowledgeable of the job demands and skills of EMTs. Areas of great discontent were the low salary of the profession and the inadequacy of the equipment.

  2. 31 CFR 587.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... Licensing Policy § 587.508 Authorization of emergency medical services. The provision of nonscheduled emergency medical services in the United States to persons designated in or pursuant to § 587.201(a) is... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency...

  3. 31 CFR 588.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... medical services. The provision of nonscheduled emergency medical services in the United States to persons... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 588.508 Section 588.508 Money and Finance: Treasury Regulations Relating to Money and...

  4. 31 CFR 594.507 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... medical services. The provision of nonscheduled emergency medical services in the United States to persons... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 594.507 Section 594.507 Money and Finance: Treasury Regulations Relating to Money and...

  5. 31 CFR 545.517 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... medical services. The provision of nonscheduled emergency medical services in the United States to persons... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 545.517 Section 545.517 Money and Finance: Treasury Regulations Relating to Money and...

  6. 31 CFR 536.507 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... medical services. The provision of nonscheduled emergency medical services to a specially designated... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 536.507 Section 536.507 Money and Finance: Treasury Regulations Relating to Money and...

  7. An effective support system of emergency medical services with tablet computers.

    Science.gov (United States)

    Yamada, Kosuke C; Inoue, Satoshi; Sakamoto, Yuichiro

    2015-02-27

    There were over 5,000,000 ambulance dispatches during 2010 in Japan, and the time for transportation has been increasing, it took over 37 minutes from dispatch to the hospitals. A way to reduce transportation time by ambulance is to shorten the time of searching for an appropriate facility/hospital during the prehospital phase. Although the information system of medical institutions and emergency medical service (EMS) was established in 2003 in Saga Prefecture, Japan, it has not been utilized efficiently. The Saga Prefectural Government renewed the previous system in an effort to make it the real-time support system that can efficiently manage emergency demand and acceptance for the first time in Japan in April 2011. The objective of this study was to evaluate if the new system promotes efficient emergency transportation for critically ill patients and provides valuable epidemiological data. The new system has provided both emergency personnel in the ambulance, or at the scene, and the medical staff in each hospital to be able to share up-to-date information about available hospitals by means of cloud computing. All 55 ambulances in Saga are equipped with tablet computers through third generation/long term evolution networks. When the emergency personnel arrive on the scene and discern the type of patient's illness, they can search for an appropriate facility/hospital with their tablet computer based on the patient's symptoms and available medical specialists. Data were collected prospectively over a three-year period from April 1, 2011 to March 31, 2013. The transportation time by ambulance in Saga was shortened for the first time since the statistics were first kept in 1999; the mean time was 34.3 minutes in 2010 (based on administrative statistics) and 33.9 minutes (95% CI 33.6-34.1) in 2011. The ratio of transportation to the tertiary care facilities in Saga has decreased by 3.12% from the year before, 32.7% in 2010 (regional average) and 29.58% (9085

  8. [Practice report: Structured training to improve quality of care in emergency medical service. On-scene supervision: A new approach to emergency medical service training in Wiesbaden and Rheingau-Taunus-Kreis?].

    Science.gov (United States)

    Häske, David; Kreinest, Michael; Wölfl, Christoph G; Frank, Christian; Brodermann, Götz; Horter, Johannes; Suda, Arnold J; Gliwitzky, Bernhard; Beckers, Stefan K; Stöckle, Ulrich; Münzberg, Matthias

    2013-01-01

    In recent years, the emergency medical services in Wiesbaden and the Rheingau-Taunus district made great efforts to standardise structures. Since there are only few established procedures in the annual examinations for paramedics, there is reason to assume that treatment procedures for patients have not been standardised either. Materials and equipment are not handled uniformly, and employee satisfaction has significantly decreased over the last few years. To solve these problems, all paramedics undergo standardised and structured trainings. These training courses make use of the internationally accepted PHTLS (Pre-Hospital Trauma Life Support) and AMLS (Advanced Life Support Medial) programmes. In addition, practising skills and handling the equipment as well as on-scene supervision is to be established in practical training sessions.

  9. 荆州市院前急救人员手卫生状况调查%Investigation of hand hygiene status among pre-hospital emergency care staff in Jingzhou City

    Institute of Scientific and Technical Information of China (English)

    刘克英; 李培玲; 张枭霄; 陈春霞

    2012-01-01

    目的 了解荆州市院前急救医护人员手卫生状况及其影响因素.方法 采用问卷调查方法,调查85名院前急救人员手卫生执行状况;采用手部菌落采样法调查试验组45人(加强六步洗手法教育和使用手消毒剂)、对照组40人的手部污染状况.并调查救护车上的洗手设备情况.结果 院前急救人员手卫生执行率低.两组院前急救人员出诊中、洗手后的平均菌落数与手合格率差异均有统计学意义(P<0.01).14辆救护车上有洗手设备的仅6辆,但均不能正常使用.结论 院前急救人员自我保护意识强于保护患者的意识.救护车上手卫生设施缺失严重,院前急救人员手部污染严重,出诊前按常规的六步洗手法洗手不现实,但在救护车上用快速手消毒剂擦手是切实可行的,是减少手部细菌污染的好办法.%[Objective] To understand the hand hygiene status and its influencing factors among pre-hospital emergency care staff in Jingzhou City. [ Methods] The practice status of hand hygiene was investigated in 85 pre-hospital emergency care workers by questionnaire survey. By using hand bacterial colonies sampling, the hand contamination status of the study group (45 people) which was given education of six-step hand-washing method and using hand disinfectant, and the control group (40 people) was investigated. The status of hand-washing equipment in the ambulances was investigated. [Results]The practice rate of hand hygiene among pre-hospital emergency care staff was low. There were significant differences in average colony counts during treatment and after hand-washing, and qualified rate of hand hygiene between two groups (P <0.01). Among 14 ambulances, only 6 had hand-washing equipment, but all of them cannot work normally. [Conclusion] The self-protection consciousness of pre-hospital emergency care staff is higher than the consciousness of protecting patients. The deficiency of hand-washing equipment is

  10. Can public health registry data improve Emergency Medical Dispatch?

    DEFF Research Database (Denmark)

    Andersen, M S; Christensen, E F; Jepsen, S B

    2016-01-01

    BACKGROUND: Emergency Medical Dispatchers make decisions based on limited information. We aimed to investigate if adding demographic and hospitalization history information to the dispatch process improved precision. METHODS: This 30-day follow-up study evaluated time-critical emergencies...

  11. 3. Medical emergencies in primary schools and school ownership of ...

    African Journals Online (AJOL)

    RICHY

    Key words:Schools, First Aid Boxes, Medical Emergencies. ABSTRACT ... average school-aged child spends 28% of the day and. 1 ... exercise sessions, break time interaction with friends which on the ... Part of such emergency preparedness by school ought to ... emergency, staff should take emergency action without. 5.

  12. Efficacy of a sedo-analgesia protocol in pre-hospital trauma treatment

    Directory of Open Access Journals (Sweden)

    Savino Occhionorelli

    2013-06-01

    Full Text Available Pre-hospital trauma treatment is an important situation in which pain should be appropriately assessed and treated, but there is a great lack of studies about it. Literature has widely pointed out that the underanalgesia problem is spread to all groups of patients. The objective of the study is to verify the efficacy of a sedation-analgesia protocol based on the use of NSAIDs, Fentanyl and Midazolam, for prehospital treatment of trauma patients. The protocol was tested in three Emergency Medical Services for a four month period, in which 30 patients were included in the study. Results evidenced a good management of both pain and anxiety in the majority of patients treated, with the achievement of analgesia target in 80% of the patients and sedation target in 100% of the patients.

  13. The United States Army Medical Department Journal, April - June 2011. Prehospital combat casualty care; The starting point of battlefield survival

    Science.gov (United States)

    2011-04-01

    advanced since 1831. Highlighting the technologic advances in combat arms to the individual medic level, one only need look at the medic’s semiautomatic ...splenic laceration) in normal and coagulopathic pigs,31,32 but was ineffective against severe arterial (aortotomy injury22), venous ( grade V liver...swine model with a grade V liver injury. The results demonstrated the superior efficacy of this dressing over regular gauze for controlling venous

  14. Customer satisfaction measurement in emergency medical services.

    Science.gov (United States)

    Kuisma, Markku; Määttä, Teuvo; Hakala, Taisto; Sivula, Tommi; Nousila-Wiik, Maria

    2003-07-01

    The annual patient volume in emergency medical services (EMS) systems is high worldwide. However, there are no comprehensive studies on customer satisfaction for EMS. The authors report how a customer satisfaction survey on EMS patients was conducted, the results, and the possible causes for dissatisfaction. Two prospective customer satisfactions surveys were conducted in an urban EMS system. Consecutive patients treated by EMS received a postal questionnaire approximately two weeks after service. Satisfaction was measured in a scale from 1 (very poor) to 5 (excellent). Neither EMS personnel nor patients were made aware prospectively that patient satisfaction would be measured. Response rates to the surveys were 36.8% (432/1,175) in 2000 and 40.0% (464/1,150) in 2002. The mean general grades for the service were 4.6 and 4.5, respectively. Patients reported the highest degree of dissatisfaction when they were not taken to their hospital of choice, when they perceived that the paramedics were not able to meet their needs, and when paramedics did not introduce themselves or communicate directly with the patient's relatives. In high-volume calls (i.e., frequent chief complaints), the general satisfaction was highest in patients with arrhythmias, breathing difficulties, and hypoglycemia. Patients with drug overdose included the highest proportion of unsatisfied patients. None of the background variables (e.g., gender, transport decision, working shift) was statistically related to general patient satisfaction. This study shows that customer satisfaction surveys can be successfully conducted for EMS. EMS systems should consider routinely using customer satisfaction surveys as a tool for quality measurement and improvement.

  15. [Geriatric emergencies versus adult emergencies: retrospective analysis of medical emergencies at a general hospital].

    Science.gov (United States)

    Rodríguez Artalejo, F; González Montalvo, J I; Sanz Segovia, F; Jaramillo Gómez, E; Banegas Banegas, J R; Rodríguez Mañas, L; Carbonell Collar, A

    1989-10-14

    The aim of the study was to evaluate the process of the attention to emergencies in patients older than 65 years and to compare it with the same process in adult patients. To this end, 965 clinical records of medical emergencies from the Hospital Central de la Cruz Roja in Madrid were retrospectively evaluated, and data were obtained regarding age, the cause for consultation, the investigations performed and their yield, the administration of drug therapy, the major diagnosis at the time of discharge from the service and the clinical course. It was found that all evaluated diagnostic investigations were carried out with equal or higher frequency in patients older than 65 years and that their mean clinical effectiveness was also higher. In addition, it was found that the patients older than 65 years were more commonly admitted to the hospital through the emergency service than the rest of the population. It was concluded, therefore, that the process of attention to emergencies has differential characteristics in the elderly population, and that if the number and proportion of old people increase as it will presumably happen during the two next decades, the cost of attention to emergencies and the number of emergency hospital admissions will also increase.

  16. Expanding the Role of Emergency Medical Services in Homeland Security

    Science.gov (United States)

    2013-03-01

    Medical Services FEMA Federal Emergency Management Agency FBI Federal Bureau of Investigation H1N1 Influenza a Virus HIPAA Health Information...Smyth, William G. Manley, Daniel E. Summers, Nels D. Sanddal, Teri L. Sanddal, et al. “Realities of Rural Emergency Medical Services Disaster

  17. 31 CFR 595.507 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... services. The provision of nonscheduled emergency medical services to a specially designated terrorist... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 595.507 Section 595.507 Money and Finance: Treasury Regulations Relating to Money and...

  18. 31 CFR 548.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... services. The provision of nonscheduled emergency medical services in the United States to persons whose... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 548.508 Section 548.508 Money and Finance: Treasury Regulations Relating to Money and...

  19. 31 CFR 542.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... services. The provision of nonscheduled emergency medical services in the United States to persons whose... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 542.508 Section 542.508 Money and Finance: Treasury Regulations Relating to Money and...

  20. 31 CFR 543.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... services. The provision of nonscheduled emergency medical services in the United States to persons whose... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 543.508 Section 543.508 Money and Finance: Treasury Regulations Relating to Money and...

  1. 31 CFR 551.507 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... services. The provision of nonscheduled emergency medical services in the United States to persons whose... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 551.507 Section 551.507 Money and Finance: Treasury Regulations Relating to Money and...

  2. 31 CFR 541.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... services. The provision of nonscheduled emergency medical services in the United States to persons whose... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 541.508 Section 541.508 Money and Finance: Treasury Regulations Relating to Money and...

  3. 31 CFR 546.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... services. The provision of nonscheduled emergency medical services in the United States to persons whose... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 546.508 Section 546.508 Money and Finance: Treasury Regulations Relating to Money and...

  4. 31 CFR 537.508 - Authorization of emergency medical services.

    Science.gov (United States)

    2010-07-01

    ... services. The provision of nonscheduled emergency medical services in the United States to persons whose... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Authorization of emergency medical services. 537.508 Section 537.508 Money and Finance: Treasury Regulations Relating to Money and...

  5. Basic Training Program for Emergency Medical Technician Ambulance: Course Guide.

    Science.gov (United States)

    Fucigna, Joseph T.; And Others

    In an effort to upgrade or further develop the skills levels of all individuals involved in the emergency medical care service, this training program was developed for the National Highway Safety Bureau. This specific course is an attempt to organize, conduct, and standardize a basic training course for emergency medical technicians (EMTs). The…

  6. Employability Competencies for Entry Level Emergency Medical Aides.

    Science.gov (United States)

    Werner, Claire

    This document describes competencies needed by persons who complete the Los Angeles Schools' emergency medical aide competency-based program, which is designed to enhance their ability to obtain certification as an Emergency Medical Technician (EMT). The overall competency statement ("goal") of the program heads each page and is defined by one or…

  7. Emerging research trends in medical textiles

    CERN Document Server

    Gokarneshan, N; Rajendran, V; Lavanya, B; Ghoshal, Arundhathi

    2015-01-01

    This book provides a comprehensive review of the significant researches reported during the recent years in the field of medical textiles. It also highlights the use of new types of fibres in developing medical textile products and their promising role in the respective areas of application. Considerable developments have taken place in the development of medical textiles for varied applications.

  8. 38 CFR 1.485 - Medical emergencies.

    Science.gov (United States)

    2010-07-01

    ... §§ 1.460 through 1.499 of this part may be disclosed to medical personnel who have a need for... identifying information may be disclosed to medical personnel of the Food and Drug Administration (FDA) who... name and address of the medical personnel to whom disclosure was made and their affiliation with...

  9. 42 CFR 2.51 - Medical emergencies.

    Science.gov (United States)

    2010-10-01

    ... identifying information may be disclosed to medical personnel who have a need for information about a patient... information may be disclosed to medical personnel of the Food and Drug Administration (FDA) who assert a... forth in writing: (1) The name of the medical personnel to whom disclosure was made and...

  10. Simulation in Medical School Education: Review for Emergency Medicine

    OpenAIRE

    Shahram Lotfipour; T. Kent Denmark; Christopher Erik McCoy; Srinidhi Subraya Bhat; Elizabeth ter Haar; Bharath Chakravarthy

    2011-01-01

    Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM). The use of medical simulation in graduate medical education is well documente...

  11. Workplace Violence: A Survey of Nationally Registered Emergency Medical Services Professionals

    Directory of Open Access Journals (Sweden)

    Anthony Oliver

    2015-01-01

    Full Text Available Previous studies on violence against prehospital personnel have mainly reported on “verbal” and “physical” violence. This study explored how provider demographic and work-related characteristics were associated with five different forms of workplace violence (being cursed or threatened; being punched, slapped, or scratched; being spat upon; being stabbed/stabbing attempt; and being shot/shooting attempt. A cohort of nationally registered United States Emergency Medical Services professionals was surveyed to determine the experience of each of these types of patient initiated violence by these providers and their partners. Multivariable logistic regression analyses indicated gender was significantly associated with both being cursed/threatened and being stabbed or experiencing a stabbing attempt (odds ratio (OR = 0.65, CI = 0.44–0.96; OR = 0.27, CI = 0.09–0.75, resp.. Level of EMT practice was significantly associated with being cursed/threatened, being spat upon, and being punched, slapped, or scratched (OR = 0.17, CI = 0.11–0.27; OR = 0.30, CI = 0.21–0.43; OR = 0.31, CI = 0.22–0.44, resp.. Both community size and experience were significantly associated with all the types of violence investigated. EMS workplace violence research is at its infancy; thus this study adds to a limited but growing body of knowledge.

  12. Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China.

    Science.gov (United States)

    Yin, Xiaoxv; Yang, Tingting; Gong, Yanhong; Zhou, Yanfeng; Li, Wenzhen; Song, Xingyue; Wang, Mengdie; Hu, Bo; Lu, Zuxun

    2016-03-01

    Emergency medical services (EMS) can effectively shorten the prehospital delay for patients with acute ischemic stroke. This study aimed to investigate EMS utilization and its associated factors in patients with acute ischemic stroke in China. A cross-sectional study was conducted from October 1, 2014, to January 31, 2015, which included 2096 patients admitted for acute ischemic stroke from 66 hospitals in Hubei province in China. A multivariable stepwise logistic regression model was undertaken to identify the factors associated with EMS utilization. Of the 2096 participants, only 323 cases (15.4%) used EMS. Those acute ischemic stroke patients who previously used EMS (odds ratio [OR] =9.8), whose National Institutes of Health Stroke Scale score was ≥10 (OR=3.7), who lived in urban communities (OR=2.5), who had sudden onset of symptoms (OR=2.4), who experienced their first stroke (OR=1.8), and who recognized initial symptom as stroke (OR=1.4) were more likely to use EMS. Additionally, when acute ischemic stroke patients' stroke symptom were noticed first by others (OR=2.1), rather than by the patients, EMS was more likely to be used. A very low proportion of patients with acute ischemic stroke used the EMS in Hubei province in China. Considerable education programs are required regarding knowledge of potential symptoms and the importance of EMS for stroke. © 2016 American Heart Association, Inc.

  13. The Extent, Nature and Contributing Factors of Violence Against Iranian Emergency Medical Technicians

    Directory of Open Access Journals (Sweden)

    Soheili

    2016-06-01

    Full Text Available Background Workplace Violence (WPV is one of the most complex and dangerous occupational hazards faced by pre-hospital emergency medical technicians (EMTs. Objectives This study aimed to assess the extent, nature and contributing factors of WPV against EMTs in Urmia, Iran. Materials and Methods A cross-sectional study was conducted on 120 EMTs from April to October 2014. A questionnaire was used for collecting the data. Descriptive statistics were applied to the data. Results Most of the participants (79% experienced WPV during the past six months. Accident scene was the most important place of violence and the patients’ companions were the main perpetrators of violence. Overall, 76% of violence victims reported “lack of awareness of the EMTs’ duties” as the most important contributing factor for WPV. Conclusions This study highlighted the high frequency of WPV against EMTs. Evidently, the health care systems’ officials would benefit from taking proper actions in this area, particularly by “staff and public education”.

  14. Case study and case-based research in emergency nursing and care: Theoretical foundations and practical application in paramedic pre-hospital clinical judgment and decision-making of patients with mental illness.

    Science.gov (United States)

    Shaban, Ramon Z; Considine, Julie; Fry, Margaret; Curtis, Kate

    2017-02-01

    Generating knowledge through quality research is fundamental to the advancement of professional practice in emergency nursing and care. There are multiple paradigms, designs and methods available to researchers to respond to challenges in clinical practice. Systematic reviews, randomised control trials and other forms of experimental research are deemed the gold standard of evidence, but there are comparatively few such trials in emergency care. In some instances it is not possible or appropriate to undertake experimental research. When exploring new or emerging problems where there is limited evidence available, non-experimental methods are required and appropriate. This paper provides the theoretical foundations and an exemplar of the use of case study and case-based research to explore a new and emerging problem in the context of emergency care. It examines pre-hospital clinical judgement and decision-making of mental illness by paramedics. Using an exemplar the paper explores the theoretical foundations and conceptual frameworks of case study, it explains how cases are defined and the role researcher in this form of inquiry, it details important principles and the procedures for data gathering and analysis, and it demonstrates techniques to enhance trustworthiness and credibility of the research. Moreover, it provides theoretically and practical insights into using case study in emergency care. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  15. Development and Implementation of a Novel Prehospital Care System in the State of Kerala, India.

    Science.gov (United States)

    Brown, Heather A; Douglass, Katherine A; Ejas, Shafi; Poovathumparambil, Venugopalan

    2016-12-01

    Most low- and middle-income countries (LMICs) have struggled to find a system for prehospital care that can provide adequate patient care and geographical coverage while maintaining a feasible price tag. The emergency medical systems of the Western world are not necessarily relevant in developing economic systems, given the lack of strict legislation, the scarcity of resources, and the limited number of trained personnel. Meanwhile, most efforts to provide prehospital care in India have taken the form of adapting Western models to the Indian context with limited success. Described here is a novel approach to prehospital care designed for and implemented in the State of Kerala, India. The Active Network Group of Emergency Life Savers (ANGELS) was launched in 2011 in Calicut City, the third largest city in the Indian State of Kerala. The ANGELS integrated an existing fleet of private and state-owned ambulances into a single network utilizing Global Positioning System (GPS) technology and a single statewide call number. A total of 85 volunteer emergency medical certified technicians (EMCTs) were trained in basic first aid and trauma care principles. Public awareness campaigns accompanied all activities to raise awareness amongst community members. Funding was provided via public-private partnership, aimed to minimize costs to patients for service utilization. Over a two-year period from March 2011 to April 2013, 8,336 calls were recorded, of which 54.8% (4,569) were converted into actual ambulance run sheets. The majority of calls were for medical emergencies and most patients were transported to Medical College Hospital in Calicut. This unique public-private partnership has been responsive to the needs of the population while sustaining low operational costs. This system may provide a relevant template for Emergency Medical Services (EMS) development in other resource-limited settings. Brown HA , Douglass KA , Ejas S , Poovathumparambil V . Development and

  16. Effects of Different Prehospital Emergency Rescuing Training Programs for Community Service Personal%不同院前急救培训方案对社区服务人员的培训效果

    Institute of Scientific and Technical Information of China (English)

    蒲晓煜; 席淑华

    2011-01-01

    Objective To probe into the optimal method for popularizing prehospital emergency rescuing training program for community service personal. Methods The convenience sampling method was used to select 91 community service providers from two communities of Laoximen and the Bound. All the participants were randomized into three groups for prehospital emergency rescuing training. The training effects were evaluated using the Red Cross's theory and skills assessment tools before the training,immediately after the training,one month after the training and three months after the training seperately. Results No significant difference was observed on the general condition among the three groups before the training (P>0.05). After the training, significant differences were observed on all the rest items(P<0.05). Conclusion The prehospital emergency rescuing training is popularized using the optimal training method and the pragmatic concept. The training effects can be enhanced by re-establishing the training time.%目的 探讨普及社区服务人员院前急救培训的最佳方法.方法 采用方便抽样的方法 选取了上海市老西门、外滩两个社区的91名社区服务人员,按随机数字表法将其分配到3个培训模式组中进行院前急救培训.采用红十字会的理论和技能评估工具在培训前、培训后即刻、培训后1个月、培训后3个月对3组学员的培训效果进行评估.结果 3组社区服务人员在培训前的一般情况没有统计学差异(P>0.05).培训后,3组人员在各评估项目上的差异均有统计学意义(均P<0.05).结论 利用最佳培训方式,注重实效,普及院前急救培训;确立再培训时间,可增强培训效果.

  17. Atención prehospitalaria de urgencias en el Distrito Federal: las oportunidades del sistema de salud Prehospital emergency care in Mexico City: the opportunities of the healthcare system

    Directory of Open Access Journals (Sweden)

    Luis M Pinet

    2005-02-01

    Full Text Available Las lesiones de tráfico no-intencionales a escala global causan 1.2 millones de muertes cada año, afectan a personas en edad productiva y son eventos potencialmente prevenibles. En México es una de las causas principales de mortalidad nacional y el Distrito Federal registra más de 8% en este rubro. Los sistemas prehospitalarios han sido diseñados para extender los servicios médicos hospitalarios a la población, a través de la interacción de una compleja red de transportación, comunicación, recursos materiales y humanos, recursos económicos y participación pública. Estos sistemas pueden ser diseñados de distintas maneras, dependiendo de la disponibilidad, capacidad y calidad de recursos, y con base en las necesidades de la comunidad, de acuerdo con leyes y reglamentos establecidos. En México varias instituciones y organizaciones ofrecen servicios prehospitalarios sin que exista coordinación, regulación y evaluación de su desempeño, a pesar de las elevadas tasas de morbilidad y mortalidad ocasionadas por lesiones y enfermedades prevenibles o para las cuales existen tratamientos efectivos aplicados durante la fase prehospitalaria. La medicina prehospitalaria puede colaborar hacia la reducción de morbilidad y mortalidad por lesiones que requieren pronta atención médica, por lo que es de gran importancia evaluar el desempeño del sistema y determinar las oportunidades para su futuro desarrollo.Unintentional vehicle traffic injuries cause 1.2 million preventable deaths per year worldwide, mostly affecting the population in their productive years of life. In Mexico, unintentional vehicle traffic injuries are one of the main causes of death; in Mexico City they account for 8% of deaths. Prehospital systems are set up to provide hospital medical care to the population, by means of a complex network that includes transportation, communications, resources (material, financial and human, and public participation. These systems may be

  18. Effect Observation on Prehospital Emergency Measures for the Prognosis of Patients With Cerebral Hemorrhage%院前急救措施对脑出血患者预后的影响观察

    Institute of Scientific and Technical Information of China (English)

    郑嘉

    2015-01-01

    Objective To observe the effect of prehospital emergency treatment on the prognosis of patients with cerebral hemorrhage.Methods 44 patients with cerebral hemorrhage which used prehospital emergency treatment were selected as the observation group,44 cases of cerebral hemorrhage patients treated by the patients' family members were selected as the control group. The neurological function defect score, complication rate and mortality rate were compared between the two groups. Results The neurological function defect score, the incidence of complications and mortality of the the observation group were significantly lower than that of the control group(P<0.05).Conclusion Emergency treatment for patients with cerebral hemorrhage can significantly improve the prognosis of patients,reduce the mortality and the incidence of complications.%目的 观察院前急救措施对脑出血患者预后的影响.方法 选择我院收治的采取院前急救措施的44例脑出血患者为观察组,同期由患者家属自行送院的脑出血患者44例作为对照组,对所有患者随访20 d,比较两组患者出院时的神经功能缺损评分、并发症发生率以及病死率.结果 观察组出院时神经功能缺损评分、并发症发生率以及病死率均低于对照组,差异有统计学意义(P<0.05).结论 对脑出血患者实施院前急救措施可以改善患者的预后,降低病死率和并发症发生率.

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

    Directory of Open Access Journals (Sweden)

    Patel Alka B

    2012-10-01

    Full Text Available Abstract Background Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS using geographic information systems (GIS. The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. Methods The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval. The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. Results There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7–8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. Conclusions The widespread use of generalized EMS pre-hospital

  20. 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

  1. 试论我国急救医疗调度员的分级制与实施%Discussion of classification system of emergency medical dispatchers and its implementation in China

    Institute of Scientific and Technical Information of China (English)

    陈志刚; 吴敏

    2016-01-01

    Commanding and dispatching plays a leading role in the process of prehospital emergency. Through definition and assessment of emergency medical dispatchers’abilities, such as ability of guidance, command, communication, direction, language, and psychological assistance, etc., all the abilities has been linked up with different levels of emergency medical dispatchers, which will be beneficial to standardized implementation of dispatching and scientific development of prehospital emergency work.%指挥调度在院前急救过程中起主导作用,通过对急救医疗调度员(emergency medical dispatchers,EMDs)引导、指挥、沟通、指导、语言、心理辅导等能力的界定和考核,使其与急救医疗调度员分级挂钩,有利于调度工作科学规范的实施和院前急救工作的科学发展。

  2. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

    Directory of Open Access Journals (Sweden)

    Tan-Hsu Tan

    2017-01-01

    Full Text Available This study presents a new ubiquitous emergency medical service system (UEMS that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients’ biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient’s biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.

  3. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

    Science.gov (United States)

    Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y.; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

    2017-01-01

    This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients’ biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient’s biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios. PMID:28117724

  4. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation.

    Science.gov (United States)

    Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

    2017-01-21

    This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients' biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient's biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.

  5. Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model

    Directory of Open Access Journals (Sweden)

    Grier Gareth

    2010-03-01

    Full Text Available Abstract Introduction We describe a system of scenario-based training using simple mannequins under realistic circumstances for the training of pre-hospital care providers. Methods A simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic. Training is conducted outdoors at the base location all year round. The scenarios are led by scenario facilitators who are predominantly senior physicians. Their role is to brief the training team and guide the scenario, results of patient assessment and the simulated responses to interventions and treatment. Pilots, fire-fighters and medical students are utilised in scenarios to enhance realism by taking up roles as bystanders, additional ambulance staff and police. These scenario participants are briefed and introduced to the scene in a realistic manner. After completion of the scenario, the training team would usually be invited to prepare and deliver a hospital handover as they would in a real mission. A formal structured debrief then takes place. Results This training method technique has been used for the training of all London Helicopter Emergency Medical Service (London HEMS doctors and paramedics over the last 24 months. Informal participant feedback suggests that this is a very useful teaching method, both for improving motor skills, critical decision-making, scene management and team interaction. Although formal assessment of this technique has not yet taken place we describe how this type of training is conducted in a busy operational pre-hospital trauma service. Discussion The teaching and maintenance of pre-hospital care skills is essential to an effective pre-hospital trauma care system. Simple mannequin based scenario training is feasible on a day-to-day basis and has the advantages of low cost, rapid set up and turn around. The scope of scenarios is limited only by

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

    Institute of Scientific and Technical Information of China (English)

    李丽梅; 刘菁; 胡远扬

    2015-01-01

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

  7. Toward Ubiquitous Communication Platform for Emergency Medical Care

    Science.gov (United States)

    Ishibashi, Kenichi; Morishima, Naoto; Kanbara, Masayuki; Sunahara, Hideki; Imanishi, Masami

    Interaction between emergency medical technicians (EMTs) and doctors is essential in emergency medical care. Doctors require diverse information related to a patient to provide efficient aid. In 2005, we started the Ikoma119 project and have developed a ubiquitous communication platform for emergency medical care called Mobile ER. Our platform, which is based on wireless internet technology, has such desirable properties as low-cost, location-independent service, and ease of service introduction. We provide an overview of our platform and describe the services that we have developed. We also discuss the remaining issues to realize our platform's actual operation.

  8. The Ausralian emergency medical system%澳大利亚急救医疗体系的发展

    Institute of Scientific and Technical Information of China (English)

    Gerard Joseph FitzGerald; Xiang-Yu Hou; 黄航

    2008-01-01

    The Australian emergency medical system has transformed over the last thirty years with the development of pre-hospital care services, hospital Emergency Departments and the development of new professional roles of Emergen-cy Physician and Paramedic. This transformation which has reflected those in many other countries has occurredbecause of increasing accountability by health services for the quality of emergency health care and increased pro-fessional commitment.%澳大利亚的急救医疗体系在过去的30年经历了本质性的转变,包括院前急救的发展,院内急诊科的发展,以及急诊专科医师和急救师作为新的职业的发展.这一本质性的转变在其他很多国家也同时存在,并缘于卫生体系提供高质量的急救医疗服务的义务和不断增加的职业责任.

  9. 模拟出车现场对提高急诊护士院前急救能力的效果观察%Observation on effect of simulating the site of vehicle set-out to enhance pre-hospital first-aid ability of nurses in emergency

    Institute of Scientific and Technical Information of China (English)

    刘小红; 俆小文; 沙银娟; 梁小燕

    2011-01-01

    Objective : To probe into application effect of mimic road accident locus in quo on enhancing prehospital first - aid ability of nurses in emergency department. Through establishing prehospital first - aid ability training group, to give theoretical lessons,first - aid skills demonstration, and mimic road accident locus in quo training for emergency nurses. In combination of clinic,operation flowsheet of prehospital first - aid was worked out. After adopting mimic road accident locus in quo undergoing operation training, first - aid knowledge, emergency skills manipulation,prehospital first - aid ability and degree of satisfaction on cooperating with doctor of emergency nurses had been enhanced obviously. It has enhanced prehospital first - aid level. And it can win the precious time to save the life of patients.%探讨模拟出车现场对提高急诊护士院前急救能力的应用效果.通过成立院前急救能力培训小组,对急诊护士进行理论授课、急救技能示教、模拟出车现场操作培训,结合临床制订院前急救操作流程,采用模拟出车现场进行操作培训,急诊护士的急救知识、急救技能操作、院前急救能力和医生的配合满意度明显提高.

  10. Emergency Medical Service Providers' Perspectives towards Management of the Morbidly Obese.

    Science.gov (United States)

    Cienki, John J

    2016-10-01

    Obesity is a growing epidemic in the United States with increasing burden to the health care system. Management and transport of the morbidly obese (MO) pose challenges for Emergency Medical Services (EMS) providers. Though equipment and resources are being directed to the transport of the obese, little research exists to guide these efforts. To address this, the author of this study sought to assess EMS providers' perspectives on the challenges of caring for MO patients. An anonymous, web-based survey was distributed to all active providers of prehospital transport of a large, urban, fire-based EMS system to evaluate the challenges of MO patients. The definition of MO was left up to the provider. This survey looked at various components of transport: lifting, transport time, airway management, establishing intravenous access, drug administration, as well as demographics, equipment, and education needs. The survey contained yes/no, rank-order, and Likert scale questions. Data were analyzed using descriptive statistics. The study was approved by the University of Miami (Miami, Florida USA) Institutional Review Board. Of survey participants, 71.9% felt the average weight of their patients had increased, and 100% reported to have transported a MO patient. Of calls made to EMS, 25% were only for assistance in the house and another 25% were for non-emergent transport to a health care facility; shortness of breath was the most common emergent complaint. Of specific challenges to properly care for MO patients, 94.4 % ranked lifting and/or moving the patient highest, followed by airway management, intravenous access, and measuring vital signs. A total of 43.8% of respondents felt that MO patients require at least six to eight EMS personnel to transport patients while 31.8% felt more than eight providers were necessary. Greater than 81.3% felt it would be beneficial to receive more training and 90.4% felt more equipment was needed. Of participants, 68.8 % felt that MO

  11. Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

    Science.gov (United States)

    Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

    2015-01-01

    Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  12. REMINDER: In a medical emergency call 74444

    CERN Multimedia

    2005-01-01

    What happened? A CERN colleague, complaining of pains that might indicate serious heart problem, went to the ?infirmary' on the Prévessin site for medical aid. He was unaware that the ?infirmary' was in fact no such thing, but the office of the French contractors' medical practitioner, and, on top of that, it was closed. He therefore took his own car and went to the CERN Fire Station on the Meyrin Site (Building 65). The firemen and the CERN medical team took care of him and requested helicopter transport to the Geneva cantonal hospital, where he responded well to medical treatment. What do we learn from this event? You must call the CERN internal number 74444 in the event of serious and acute illness, and do not have to present yourself in person or get somebody to go with you. This number is not reserved exclusively for accident, pollution, fire etc. The Firemen can prodice professional assistance at all times as required: first aid on the spot, amulance transport and medical assistance as necessary. ...

  13. Hand Washing Practices Among Emergency Medical Services Providers

    National Research Council Canada - National Science Library

    Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

    2015-01-01

    Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS...

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

    Data.gov (United States)

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

  15. Use of Morphine Sulphate by South African Paramedics for Prehospital Pain Management

    Directory of Open Access Journals (Sweden)

    Craig Vincent-Lambert

    2015-01-01

    Full Text Available BACKGROUND: Evidence in the literature highlights the fact that acute pain in the prehospital setting remains poorly managed. Morphine remains the most commonly used analgesic agent in the South African prehospital emergency care setting. Although guidelines and protocols relating to the dosage and administration of morphine exist, little data are available describing its use by South African paramedics.

  16. Strategies for reducing medication errors in the emergency department

    Directory of Open Access Journals (Sweden)

    Weant KA

    2014-07-01

    Full Text Available Kyle A Weant,1 Abby M Bailey,2 Stephanie N Baker2 1North Carolina Public Health Preparedness and Response, North Carolina Department of Health and Human Services, Raleigh, NC, 2University of Kentucky HealthCare, Department of Pharmacy Services, Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA Abstract: Medication errors are an all-too-common occurrence in emergency departments across the nation. This is largely secondary to a multitude of factors that create an almost ideal environment for medication errors to thrive. To limit and mitigate these errors, it is necessary to have a thorough knowledge of the medication-use process in the emergency department and develop strategies targeted at each individual step. Some of these strategies include medication-error analysis, computerized provider-order entry systems, automated dispensing cabinets, bar-coding systems, medication reconciliation, standardizing medication-use processes, education, and emergency-medicine clinical pharmacists. Special consideration also needs to be given to the development of strategies for the pediatric population, as they can be at an elevated risk of harm. Regardless of the strategies implemented, the prevention of medication errors begins and ends with the development of a culture that promotes the reporting of medication errors, and a systematic, nonpunitive approach to their elimination. Keywords: emergency medicine, pharmacy, medication errors, pharmacists, pediatrics

  17. Does increased prehospital replacement volume lead to a poor clinical course and an increased mortality? A matched-pair analysis of 1896 patients of the Trauma Registry of the German Society for Trauma Surgery who were managed by an emergency doctor at the accident site.

    Science.gov (United States)

    Hussmann, Bjoern; Lefering, Rolf; Waydhas, Christian; Touma, Alexander; Kauther, Max D; Ruchholtz, Steffen; Lendemans, Sven

    2013-05-01

    Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is regarded as an important primary treatment option. Our study aimed to assess the influence of prehospital fluid replacement therapy on the post-traumatic course of severely injured patients in a retrospective analysis of matched pairs. The data of 51,425 patients of the Trauma Registry of the German Society for Trauma Surgery were analysed. The following patients were included: Injury Severity Score ≥ 16 points, primary admission, age ≥ 16 years, no isolated brain injury, transfusion of at least one unit of packed red blood cells (pRBC), systolic blood pressure ≥ 60 mmHg at the accident site. The patients were divided into two groups according to the following matched-pair criteria (low-volume: 0-1500 ml prehospital volume replaced; high-volume: ≥ 1501 ml prehospital volume): intubation at the accident site (yes/no), time from injury to hospital ± 10 min., means of rescue (emergency helicopter, MICU), Abbreviated Injury Scale (body regions), injury year, systolic blood pressure and age (years). All patients were managed by an emergency doctor at the accident site. A total of 948 patients in each group met the inclusion criteria. Increasing replacement volume was associated with an increased need for transfusion (pRBCs: low-volume: 7 units, high-volume: 8.3 units; ptrauma. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Preparing for medical emergencies in the dental office.

    Science.gov (United States)

    Morrison, A D; Goodday, R H

    1999-05-01

    If you discover an unconscious patient in your office, attend to the ABCs while you evaluate the patient's medical history and piece together the events leading up to the emergency. These actions will help you arrive at a diagnosis. Then as the emergency cart and team arrive, you will be able to provide good, safe care to stabilize the patient and get him or her to a medical facility.

  19. A Telematic Support System for Emergency Medical Services

    Directory of Open Access Journals (Sweden)

    Michael Protogerakis

    2013-08-01

    Full Text Available The presented system is part of the research project Medon-@ ix for the safe application of information technology in preclinical emergency health care. It aims at supporting members of the emergency medical services (EMS at the incident location from a remote Competence Centre. In this paper cases in which a telematic support system can be used will be outlined. This includes the assistance of medical and non-medical staff in emergency incidents. The functional and non-functional requirements for the on site medical devices, the documentation system and the medical decision support system in the Competence Centre will be outlined. This paper also presents a possible hardware and software system architecture approach to a telematic support system.

  20. Pre-hospital advanced airway management by anaesthesiologists: is there still room for improvement?

    Science.gov (United States)

    Sollid, Stephen J M; Heltne, Jon Kenneth; Søreide, Eldar; Lossius, Hans Morten

    2008-07-21

    Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  1. Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement?

    Directory of Open Access Journals (Sweden)

    Søreide Eldar

    2008-07-01

    Full Text Available Abstract Background Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Method Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Results Of the 17 available respondents, most (88% felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. Conclusion The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  2. Survey of WBSNs for Pre-Hospital Assistance: Trends to Maximize the Network Lifetime and Video Transmission Techniques

    Directory of Open Access Journals (Sweden)

    Enrique Gonzalez

    2015-05-01

    Full Text Available This survey aims to encourage the multidisciplinary communities to join forces for innovation in the mobile health monitoring area. Specifically, multidisciplinary innovations in medical emergency scenarios can have a significant impact on the effectiveness and quality of the procedures and practices in the delivery of medical care. Wireless body sensor networks (WBSNs are a promising technology capable of improving the existing practices in condition assessment and care delivery for a patient in a medical emergency. This technology can also facilitate the early interventions of a specialist physician during the pre-hospital period. WBSNs make possible these early interventions by establishing remote communication links with video/audio support and by providing medical information such as vital signs, electrocardiograms, etc. in real time. This survey focuses on relevant issues needed to understand how to setup a WBSN for medical emergencies. These issues are: monitoring vital signs and video transmission, energy efficient protocols, scheduling, optimization and energy consumption on a WBSN.

  3. Prehospital first aid and emergency nursing in patients with acute myocardial infarction%急性心肌梗塞患者的院前急救与急诊护理

    Institute of Scientific and Technical Information of China (English)

    张绍丽

    2015-01-01

    目的:分析急性心肌梗塞患者的院前急救方法和急诊护理措施。方法将2014年1月至2015年1月期间来我院急诊科接受治疗,予以院前急救和急诊护理的51例急性心肌梗塞患者设为研究组,将同一时间段内未接受院前急救和急诊护理,直接来我院急诊科就诊,给予常规护理的50例急性心肌梗塞患者设为常规组。结果研究组患者急救反应时间(发病至接受治疗)和住院时间均短于常规组(P﹤0.05)。常规组患者中,8例患者死亡,相关并发症发生率为28.0%,研究组中无死亡病例,相关并发症发生率为11.9%,研究组患者的预后状况明显优于常规组患者(P﹤0.05)。结论正确评估急性心肌梗塞患者的病情,对患者实施有效的院前急救和急诊护理,可有效提高患者急诊救治成功率,改善患者预后状况。%Objective To analyze the prehospital first aid methods and emergency nursing measures in patients with acute myocardial infarction (AMI). Methods This study included 51 AMI patients (observation group) given prehospital first aid and emergency nursing before being admitted to the Emergence Department of our hospital from January 2014 to January 2015, as well as another 50 AMI patients (conventional group) given conventional nursing in the Emergency Department of our hospital during the same period. Results The observation group had significantly shorter emergency response time and length of hospital stay than the conventional group (P﹤0.05). The number of deaths and incidence rate of AMI-related complications in the conventional group and observation group were 8 vs 0 and 28.0% vs 11.9%, respectively; the observation group had significantly better prognosis than the conventional group (P﹤0.05). Conclusion Correctly assessing the AMI conditions and implementing appropriate prehospital first aid and emergency nursing can effectively increase the success rate of AMI

  4. Designing emergency-medical-service helicopter interiors using virtual manikins.

    Science.gov (United States)

    Michalski, Rafal; Grobelny, Jerzy

    2014-01-01

    Researchers employed digital manikins to determine the space necessary in an emergency-medical-service helicopter to effectively and efficiently conduct life-saving medical procedures. To simulate resuscitation with appropriate digital human models, they used Anthropos ErgoMAX modeling software in the 3D Studio Max environment.

  5. [Longer waiting time and higher mortality in older people with traumatic brain injuries. Mapping of emergency prehospital management and hospital management in Västerbotten].

    Science.gov (United States)

    Holzmann, Martin; Bylund, Per O; Degerfält, Lisa; Carlsson, Axel C; Wändell, Per; Ruge, Toralph

    2015-10-06

    The main purpose was to study the prehospital and early intrahospital treatment of patients with traumatic brain injury (TBI) in the county of Västerbotten 2011-2012. In total, 162 patients were included. The main finding was that a large proportion of TBI patients were older men who fell in the same or from a different level. Older patients had higher mortality and had to wait longer for diagnostic imaging compared to younger patients. Furthermore, most patients were initially relatively unaffected by the injury and around 1/5 of the patients were transported to hospital by private transport. Finally, we observed that most patients were admitted to hospital and computer tomography scan of the head was performed within 4 hours.

  6. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service.

    NARCIS (Netherlands)

    Gerritse, B.M.; Schalkwijk, A.; Pelzer, B.J.; Scheffer, G.J.; Draaisma, J.M.T.

    2010-01-01

    BACKGROUND: To determine the advanced life support procedures provided by an Emergency Medical Service (EMS) and a Helicopter Emergency Medical Service (HEMS) for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures

  7. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service.

    NARCIS (Netherlands)

    Gerritse, B.M.; Schalkwijk, A.; Pelzer, B.J.; Scheffer, G.J.; Draaisma, J.M.T.

    2010-01-01

    BACKGROUND: To determine the advanced life support procedures provided by an Emergency Medical Service (EMS) and a Helicopter Emergency Medical Service (HEMS) for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures r

  8. Relief for maritime medical emergencies through telematics.

    Science.gov (United States)

    Anogianakis, G; Maglavera, S; Pomportsis, A

    1998-12-01

    MERMAID is a European Union (EU)-financed maritime telemedicine project with global reach and 24-h multilingual capability, so as to serve multinational crews working in the isolation of the world's oceans. It provides a model for the provision of healthcare services based on the electronic transmission of medical information via ISDN-based video conferencing. This model is not limited to medical diagnostics, but it encompasses all cases in which the actual delivery of healthcare services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an extensive telecommunications infrastructure that includes both satellite transmission for ship to shore communication and an extensive ground-based network for summoning expert medical help from around the world so as to meet the project's multilinguality requirements and, therefore, the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low-, medium-, and high-bandwidth data requirements) are considered, while the full range of network choices (digital land lines, cellular/wireless, satellite, and broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their lifecycle. Finally, out of that, MERMAID utilizes advanced land-based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

  9. Physiological-Social Scores in Predicting Outcomes of Prehospital Internal Patients

    Directory of Open Access Journals (Sweden)

    Abbasali Ebrahimian

    2014-01-01

    Full Text Available The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708–0.767. Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients’ wards in EMS situations.

  10. Physiological-social scores in predicting outcomes of prehospital internal patients.

    Science.gov (United States)

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

    2014-01-01

    The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708-0.767). Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients' wards in EMS situations.

  11. The Need for More Prehospital Research on Language Barriers: A Narrative Review.

    Science.gov (United States)

    Tate, Ramsey C

    2015-12-01

    Despite evidence from other healthcare settings that language barriers negatively impact patient outcomes, the literature on language barriers in emergency medical services (EMS) has not been previously summarized. The objective of this study is to systematically review existing studies of the impact of language barriers on prehospital emergency care and identify opportunities for future research. A systematic review with narrative synthesis of publications with populations specific to the prehospital setting and outcome measures specific to language barriers was conducted. A four-prong search strategy of academic databases (PubMed, Academic Search Complete, and Clinical Key) through March 2015, web-based search for gray literature, search of citation lists, and review of key conference proceedings using pre-defined eligibility criteria was used. Language-related outcomes were categorized and reported as community-specific outcomes, EMS provider-specific outcomes, patient-specific outcomes, or health system-specific outcomes. Twenty-two studies met eligibility criteria for review. Ten publications (45%) focused on community-specific outcomes. Language barriers are perceived as a barrier by minority language speaking communities to activating EMS. Eleven publications (50%) reported outcomes specific to EMS providers, with six of these studies focused on EMS dispatch. EMS dispatchers describe less accurate and delayed dispatch of resources when confronted with language discordant callers, as well as limitations in the ability to provide medical direction to callers. There is a paucity of research on EMS treatment and transport decisions, and no studies provided patient-specific or health system-specific outcomes. Key research gaps include identifying the mechanisms by which language barriers impact care, the effect of language barriers on EMS utilization and clinically significant outcomes, and the cost implications of addressing language barriers. The existing

  12. The Need for More Prehospital Research on Language Barriers: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Ramsey C. Tate

    2015-12-01

    Full Text Available Introduction: Despite evidence from other healthcare settings that language barriers negatively impact patient outcomes, the literature on language barriers in emergency medical services (EMS has not been previously summarized. The objective of this study is to systematically review existing studies of the impact of language barriers on prehospital emergency care and identify opportunities for future research. Methods: A systematic review with narrative synthesis of publications with populations specific to the prehospital setting and outcome measures specific to language barriers was conducted. A fourprong search strategy of academic databases (PubMed, Academic Search Complete, and Clinical Key through March 2015, web-based search for gray literature, search of citation lists, and review of key conference proceedings using pre-defined eligibility criteria was used. Language-related outcomes were categorized and reported as community-specific outcomes, EMS provider-specific outcomes, patient-specific outcomes, or health system-specific outcomes. Results: Twenty-two studies met eligibility criteria for review. Ten publications (45% focused on community-specific outcomes. Language barriers are perceived as a barrier by minority language speaking communities to activating EMS. Eleven publications (50% reported outcomes specific to EMS providers, with six of these studies focused on EMS dispatch. EMS dispatchers describe less accurate and delayed dispatch of resources when confronted with language discordant callers, as well as limitations in the ability to provide medical direction to callers. There is a paucity of research on EMS treatment and transport decisions, and no studies provided patient-specific or health system-specific outcomes. Key research gaps include identifying the mechanisms by which language barriers impact care, the effect of language barriers on EMS utilization and clinically significant outcomes, and the cost implications of

  13. 76 FR 4151 - National Emergency Medical Services Advisory Council Teleconference Meeting

    Science.gov (United States)

    2011-01-24

    ... National Highway Traffic Safety Administration National Emergency Medical Services Advisory Council... Transportation (DOT). Title: National Emergency Medical Services Advisory Council Teleconference Meeting. ACTION: National Emergency Medical Services Advisory Council (NEMSAC); notice of Teleconference Meeting....

  14. 76 FR 15043 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

    Science.gov (United States)

    2011-03-18

    ... National Highway Traffic Safety Administration National Emergency Medical Services Advisory Council (NEMSAC... (NHTSA), Department of Transportation (DOT). ACTION: Meeting Notice--National Emergency Medical Services... public. The purpose of NEMSAC is to provide a nationally recognized council of emergency medical...

  15. 76 FR 15044 - Federal Interagency Committee on Emergency Medical Service (FICEMS) Teleconference Meeting

    Science.gov (United States)

    2011-03-18

    ... National Highway Traffic Safety Administration Federal Interagency Committee on Emergency Medical Service.... ACTION: Meeting Notice--Federal Interagency Committee on Emergency Medical Services. SUMMARY: NHTSA announces a teleconference meeting of the Federal Interagency Committee on Emergency Medical...

  16. 77 FR 46802 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

    Science.gov (United States)

    2012-08-06

    ... National Highway Traffic Safety Administration National Emergency Medical Services Advisory Council (NEMSAC... medical services representatives and consumers to provide advice and recommendations regarding Emergency... of Emergency Medical Services, 1200 New Jersey Avenue SE., NTI-140, Washington, DC 20590,...

  17. 77 FR 27278 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

    Science.gov (United States)

    2012-05-09

    ... National Highway Traffic Safety Administration National Emergency Medical Services Advisory Council (NEMSAC... services representatives and consumers to provide advice and recommendations regarding Emergency Medical... Transportation, Office of Emergency Medical Services, 1200 New Jersey Avenue SE., NTI-140, Washington, DC...

  18. 75 FR 71791 - National Emergency Medical Services Advisory Council Meeting Notice

    Science.gov (United States)

    2010-11-24

    ... National Highway Traffic Safety Administration National Emergency Medical Services Advisory Council Meeting...). ACTION: National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory... public. The purpose of NEMSAC is to provide a nationally recognized council of emergency medical...

  19. 78 FR 67463 - National Emergency Medical Services Advisory Council (NEMSAC) and Federal Interagency Committee...

    Science.gov (United States)

    2013-11-12

    ... National Highway Traffic Safety Administration National Emergency Medical Services Advisory Council (NEMSAC) and Federal Interagency Committee on Emergency Medical Services (FICEMS); Notice of Federal Advisory... Transportation (DOT). ACTION: Meeting Notice--National Emergency Medical Services Advisory Council and...

  20. 78 FR 801 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

    Science.gov (United States)

    2013-01-04

    ... National Highway Traffic Safety Administration National Emergency Medical Services Advisory Council (NEMSAC... to the public. The purpose of NEMSAC, a nationally recognized council of emergency medical services representatives and consumers, is to provide advice and recommendations regarding Emergency Medical Services...

  1. 77 FR 9297 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

    Science.gov (United States)

    2012-02-16

    ... National Highway Traffic Safety Administration National Emergency Medical Services Advisory Council (NEMSAC... council of emergency medical services (EMS) representatives and consumers to provide advice and..., Director, U.S. Department of Transportation, Office of Emergency Medical Services, 1200 New Jersey...

  2. 76 FR 64174 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

    Science.gov (United States)

    2011-10-17

    ... TRANSPORTATION National Highway Traffic Safety Administration National Emergency Medical Services Advisory... emergency medical services representatives and consumers to provide advice and recommendations regarding Emergency Medical Services (EMS) to DOT's NHTSA. DATES: The meeting will be held on December 13, 2011,...

  3. 77 FR 12908 - Appointment/Reappointment to the National Emergency Medical Services Advisory Council (NEMSAC)

    Science.gov (United States)

    2012-03-02

    ... the National Emergency Medical Services Advisory Council (NEMSAC). SUMMARY: NHTSA is soliciting... nationally recognized council of emergency medical services (EMS) representatives and consumers to provide..., Office of Emergency Medical Services, Attn: NEMSAC, 1200 New Jersey Avenue SE., NTI-140, Washington,...

  4. A systematic review of stroke recognition instruments in hospital and prehospital settings.

    Science.gov (United States)

    Rudd, Matthew; Buck, Deborah; Ford, Gary A; Price, Christopher I

    2016-11-01

    We undertook a systematic review of all published stroke identification instruments to describe their performance characteristics when used prospectively in any clinical setting. A search strategy was applied to Medline and Embase for material published prior to 10 August 2015. Two authors independently screened titles, and abstracts as necessary. Data including clinical setting, reported sensitivity, specificity, positive predictive value, negative predictive value were extracted independently by two reviewers. 5622 references were screened by title and or abstract. 18 papers and 3 conference abstracts were included after full text review. 7 instruments were identified; Face Arm Speech Test (FAST), Recognition of Stroke in the Emergency Room (ROSIER), Los Angeles Prehospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Scale (MASS), Ontario Prehospital Stroke Screening tool (OPSS), Medic Prehospital Assessment for Code Stroke (MedPACS) and Cincinnati Prehospital Stroke Scale (CPSS). Cohorts varied between 50 and 1225 individuals, with 17.5% to 92% subsequently receiving a stroke diagnosis. Sensitivity and specificity for the same instrument varied across clinical settings. Studies varied in terms of quality, scoring 13-31/36 points using modified Standards for the Reporting of Diagnostic accuracy studies checklist. There was considerable variation in the detail reported about patient demographics, characteristics of false-negative patients and service context. Prevalence of instrument detectable stroke varied between cohorts and over time. CPSS and the similar FAST test generally report the highest level of sensitivity, with more complex instruments such as LAPSS reporting higher specificity at the cost of lower detection rates. Available data do not allow a strong recommendation to be made about the superiority of a stroke recognition instrument. Choice of instrument depends on intended purpose, and the consequences of a false-negative or false

  5. Availability and utilisation of physician-based pre-hospital critical care support to the NHS ambulance service in England, Wales and Northern Ireland

    Science.gov (United States)

    Mackenzie, Rod; Ng, Gail; Reid, Cliff; Pearson, Gale

    2011-01-01

    Background Every day throughout the UK, ambulance services seek medical assistance in providing critically ill or injured patients with pre-hospital care. Objective To identify the current availability and utilisation of physician-based pre-hospital critical care capability across England, Wales and Northern Ireland. Design A postal and telephone survey was undertaken between April and December 2009 of all 13 regional NHS ambulance services, 17 air ambulance charities, 34 organisations affiliated to the British Association for Immediate Care and 215 type 1 emergency departments in England, Wales and Northern Ireland. The survey focused on the availability and use of physician-based pre-hospital critical care support. Results The response rate was 100%. Although nine NHS ambulance services recorded physician attendance at 6155 incidents, few could quantify doctor availability and utilisation. All but one of the British Association for Immediate Care organisations deployed ‘only when available’ and only 45% of active doctors could provide critical care support. Eleven air ambulance services (65%) operated with a doctor but only 5 (29%) operated 7 days a week. Fifty-nine EDs (27%) had a pre-hospital team but only 5 (2%) had 24 h deployable critical care capability and none were used regularly. Conclusion There is wide geographical and diurnal variability in availability and utilisation of physician-based pre-hospital critical care support. Only London ambulance service has access to NHS-commissioned 24 h physician-based pre-hospital critical care support. Throughout the rest of the UK, extensive use is made of volunteer doctors and charity sector providers of varying availability and capability. PMID:21427108

  6. 56例急性心肌梗死心脏骤停患者的院前急救分析%Analysis of Emergency Treatment of 56 Cases of Patients with Acute Myocardial Infarction in Prehospital Cardiac Arrest

    Institute of Scientific and Technical Information of China (English)

    吕吉

    2013-01-01

    Objective To investigate the acute myocardial infarction heart sudden pain in patients with pre-hospital emergency measures, the success rate of rescue analysis various factors influence, improve pre-hospital rescue success rate. Methods a retrospective analysis of 120 emergency center of our hospital in the past 5 years were 56 cases of acute myocardial infarction and cardiac arrest patients pre-hospital data, analysis of the emergency procedure, first aid success rate and influence factors. Results among the 56 cases, 36 cases had died on the scene, but died in the hospital 8 cases of persistent rescue specialist treatment, 12 cases after successful rescue, rescue success rate was 21.4%;the death group and the successful group, no significant dif erence in gender and previous history of heart disease, but in the age, electric hammer time to defibril ation, the implementation of CPR time and there are no significant dif erences in terms of tracheal intubation. Conclusion perfect emergency network, ef icient salvage process, standardized emergency measures can ef ectively improve the acute myocardial infarction cardiac arrest patients rescue success rate.%目的探讨急性心肌梗死心脏骤疼患者的院前急救措施,分析影响抢救成功率的各种因素,提高院前抢救成功率。方法回顾性分析我院120急救中心于过去5年内接诊的56例急性心肌梗死并心脏骤停患者的院前急救资料,分析急救流程,急救成功率和影响因素。结果本组共56例,现场死亡36例,有8例持续抢救但于院内死亡,12例抢救成功后转专科治疗,抢救成功率为21.4%;死亡组与成功组相比,在性别和既往心脏病史等方面无明显差异,但在年龄、电击除颤时间、实施CPR时间和有无气管插管方面有明显差异。结论完善的急救网络、高效的抢救流程、规范化的急救措施能有效提高急性心肌梗死心脏骤停患者的急救成功率。

  7. System of acute medical support to emergency during dental treatment.

    Science.gov (United States)

    Kawahara, M; Takeshita, T; Akita, S

    1986-01-01

    The Resuscitation Committee of Hiroshima City Dental Association was established in 1983 in order to provide acute medical support in case of emergency during dental treatment at private dental clinics. This Committee is composed of representatives from the Hiroshima City Dental Association, Hiroshima University School of Dentistry, Hiroshima University School of Medicine, Hiroshima City Health Bureau, and Hiroshima City Fire and Ambulance Department. A portable ECG monitor with defibrillator and a resuscitation kit are held in readiness at the Hiroshima University Hospital. In case of emergency during dental treatment at a private dental clinic, we hurry to the clinic with the resuscitation set and give emergency treatment. We have been involved in two cases of emergency since this system started. Both of them recovered without any sequelae. Besides these activities, we give lectures annually to dentists and dental hygienists on the treatment of medical emergencies.

  8. 3 CFR 8383 - Proclamation 8383 of May 20, 2009. Emergency Medical Services Week, 2009

    Science.gov (United States)

    2010-01-01

    ... responders, emergency medical technicians, paramedics, nurses, physicians, and many others. These highly... skills. All share a common aspiration to help those in need, and during Emergency Medical Services...

  9. Protocol for a prospective observational study to improve prehospital notification of injured patients presenting to trauma centres in India.

    Science.gov (United States)

    Mitra, Biswadev; Mathew, Joseph; Gupta, Amit; Cameron, Peter; O'Reilly, Gerard; Soni, Kapil Dev; Kaushik, Gaurav; Howard, Teresa; Fahey, Madonna; Stephenson, Michael; Kumar, Vineet; Vyas, Sharad; Dharap, Satish; Patel, Pankaj; Thakor, Advait; Sharma, Naveen; Walker, Tony; Misra, Mahesh Chandra; Gruen, Russell; Fitzgerald, Mark

    2017-07-17

    Prehospital notification of injured patients enables prompt and timely care in hospital through adequate preparation of trauma teams, space, equipment and consumables necessary for resuscitation, and may improve outcomes. In India, anecdotal reports suggest that prehospital notification, in those few places where it occurs, is unstructured and not linked to a well-defined hospital response. The aim of this manuscript is to describe, in detail, a study protocol for the evaluation of a formalised approach to prehospital notification. This is a longitudinal prospective cohort study of injured patients being transported by ambulance to major trauma centres in India. In the preintervention phase, prospective data on patients will be collected on prehospital assessment, notification, inhospital assessment, management and outcomes and recorded in a new tailored multihospital trauma registry. All injured patients arriving by ambulance and allocated to a red or yellow priority category will be eligible for inclusion. The intervention will be a prehospital notification application to be used by ambulance clinicians to notify emergency departments of the impending arrival of a patient. The proportion of eligible patients arriving to hospital after notification will be the primary outcome measure. Secondary outcomes evaluated will be availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray and inhospital mortality. Ethical approval has been obtained from the All India Institute of Medical Sciences, New Delhi and site-specific approval granted by relevant trauma services. The trial has also been registered with the Monash University Human Research and Ethics Committee; Project number: CF16/1814 - 2016000929. Results will be fed back to prehospital and hospital clinicians via a series of reports and presentations. These will be used to facilitate discussions about service redesign and implementation. It is expected that evidence

  10. Simulation in Medical School Education: Review for Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Shahram Lotfipour

    2011-05-01

    Full Text Available Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM. The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.

  11. Simulation in medical school education: review for emergency medicine.

    Science.gov (United States)

    Chakravarthy, Bharath; Ter Haar, Elizabeth; Bhat, Srinidhi Subraya; McCoy, Christopher Eric; Denmark, T Kent; Lotfipour, Shahram

    2011-11-01

    Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM). The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.

  12. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study.

    Science.gov (United States)

    Rognås, Leif; Hansen, Troels Martin; Kirkegaard, Hans; Tønnesen, Else

    2013-07-25

    We report data from the first Utstein-style study of physician-provided pre-hospital advanced airway management. Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) prospectively registered data according to the template for reporting data from pre-hospital advanced airway management. Data collection took place from February 1st 2011 to October 31st 2012. Included were patients of all ages on whom pre-hospital advanced airway management was performed. The objective was to estimate the incidences of failed and difficult pre-hospital endotracheal intubation, and complications related to pre-hospital advanced airway management. The overall incidence of successful pre-hospital endotracheal intubation among 636 intubation attempts was 99.7%, even though 22.4% of pre-hospital endotracheal intubations required more than one intubation attempt. The overall incidence of complications related to pre-hospital advanced airway management was 7.9%. Following rapid sequence intubation, the incidence of first pass success was 85.8%, the overall incidence of complications was 22.0%, the incidence of hypotension 7.3% and that of hypoxia 5.3%. Multiple endotracheal intubation attempts were associated with an increased overall incidence of complications. No airway management related deaths occurred. The overall incidence of successful pre-hospital endotracheal intubations compares to those found in other physician-staffed pre-hospital systems. The incidence of pre-hospital endotracheal intubations requiring more than one attempt is higher than suspected. The incidence of hypotension or hypoxia after pre-hospital rapid sequence intubation compares to those found in UK emergency departments. Pre-hospital advanced airway management including pre-hospital endotracheal intubation performed by experienced anaesthesiologists is associated with high success rates and relatively low

  13. Medical emergencies on board commercial airlines: is documentation as expected?

    Science.gov (United States)

    Sand, Michael; Morrosch, Stephan; Sand, Daniel; Altmeyer, Peter; Bechara, Falk G

    2012-12-12

    The purpose of this study was to perform a descriptive, content-based analysis on the different forms of documentation for in-flight medical emergencies that are currently provided in the emergency medical kits on board commercial airlines. Passenger airlines in the World Airline Directory were contacted between March and May 2011. For each participating airline, sample in-flight medical emergency documentation forms were obtained. All items in the sample documentation forms were subjected to a descriptive analysis and compared to a sample "medical incident report" form published by the International Air Transport Association (IATA). A total of 1,318 airlines were contacted. Ten airlines agreed to participate in the study and provided a copy of their documentation forms. A descriptive analysis revealed a total of 199 different items, which were summarized into five sub-categories: non-medical data (63), signs and symptoms (68), diagnosis (26), treatment (22) and outcome (20). The data in this study illustrate a large variation in the documentation of in-flight medical emergencies by different airlines. A higher degree of standardization is preferable to increase the data quality in epidemiologic aeromedical research in the future.

  14. Prehospital Pediatric Care: Opportunities for Training, Treatment, and Research.

    Science.gov (United States)

    Drayna, Patrick C; Browne, Lorin R; Guse, Clare E; Brousseau, David C; Lerner, E Brooke

    2015-01-01

    Pediatric transports comprise approximately 10% of emergency medical services (EMS) requests for aid, but little is known about the clinical characteristics of pediatric EMS patients and the interventions they receive. Our objective was to describe the pediatric prehospital patient cohort in a large metropolitan EMS system. This retrospective analysis of all pediatric (age Pox), and respiratory effort. We defined abnormal vital signs using previously reported age-specific standards. We identified the working assessments most frequently associated with abnormal vital signs and the working assessments associated with the most commonly performed interventions. Data were analyzed using descriptive statistics. There were 9,956 pediatric transports, 8.7% of the total call volume. The most common working assessments were "other" (16.1%), respiratory distress (13.7%), seizure (12.4%), and blunt trauma (12.0%). Vital signs were documented at variable rates: RR (91.1%), GCS (82.9%), SBP (71.3%), pulse (69.4%), respiratory effort (49.7%), and Pox (33.5%). Of all transported patients, 61.5% had a documented abnormal initial vital sign. Patients with an abnormal vital sign had the same most common working assessments as those with normal vital signs. Glucometry (16.9%), medication delivery (13.6%), and IV placement (11.5%) were the most common interventions and were most often provided to patients with working assessments of seizure, asthma, trauma, altered consciousness, or "other." Cardiopulmonary resuscitation (0.4%), bag mask ventilation (0.4%), and advanced airway (0.4%) occurred rarely and were most often performed for cardiac arrest and trauma. Children made up a small part of EMS providers' clinical practice; those encountered most frequently had respiratory distress, seizures, trauma, or an undefined assessment (i.e., "other"). EMS providers frequently encounter children with physiologic evidence of acute illness, although vital sign documentation was incomplete

  15. National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module XI. Obstetric/Gynecologic Emergencies.

    Science.gov (United States)

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

    This instructor's lesson plan guide on obstetric/gynecologic emergencies is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Six units of study are presented: (1) anatomy and physiology of the female reproductive system; (2) patient assessment; (3) pathophysiology and management of gynecologic…

  16. Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments.

    Science.gov (United States)

    Wijesekera, Olindi; Reed, Amanda; Chastain, Parker S; Biggs, Shauna; Clark, Elizabeth G; Kole, Tamorish; Chakrapani, Anoop T; Ashish, Nandy; Rajhans, Prasad; Breaud, Alan H; Jacquet, Gabrielle A

    2016-12-01

    Introduction Without a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.

  17. Medical Transport of Children with Complex Chronic Conditions

    Directory of Open Access Journals (Sweden)

    Carlos F. Lerner

    2012-01-01

    Full Text Available One of the most notable trends in child health has been the increase in the number of children with special health care needs, including those with complex chronic conditions. Care of these children accounts for a growing fraction of health care resources. We examine recent developments in health care, especially with regard to medical transport and prehospital care, that have emerged to adapt to this remarkable demographic trend. One such development is the focus on care coordination, including the dissemination of the patient-centered medical home concept. In the prehospital setting, the need for greater coordination has catalyzed the development of the emergency information form. Training programs for prehospital providers now incorporate specific modules for children with complex conditions. Another notable trend is the shift to a family-centered model of care. We explore efforts toward regionalization of care, including the development of specialized pediatric transport teams, and conclude with recommendations for a research agenda.

  18. Prehospital evaluation and economic analysis of different coronary syndrome treatment strategies - PREDICT - Rationale, Development and Implementation

    Directory of Open Access Journals (Sweden)

    Craig Alan

    2011-03-01

    Full Text Available Abstract Background A standard of prehospital care for patients presenting with ST-segment elevation myocardial infarction (STEMI includes prehospital 12-lead and advance Emergency Department notification or prehospital bypass to percutaneous coronary intervention centres. Implementation of either care strategies is variable across communities and neither may exist in some communities. The main objective is to compare prehospital care strategies for time to treatment and survival outcomes as well as cost effectiveness. Methods/Design PREDICT is a multicentre, prospective population-based cohort study of all chest pain patients 18 years or older presenting within 30 mins to 6 hours of symptom onset and treated with nitroglycerin, transported by paramedics in a number of different urban and rural regions in Ontario. The primary objective of this study is to compare the proportion of study subjects who receive reperfusion within the target door-to-reperfusion times in subjects obtained after four prehospital strategies: 12-lead ECG and advance emergency department (ED notification or 3-lead ECG monitoring and alert to dispatch prior to hospital arrival; either with or without the opportunity to bypass to a PCI centre. Discussion We anticipate four challenges to successful study implementation and have developed strategies for each: 1 diversity in the interpretation of the ethical and privacy issues across 47 research ethics boards/commiittees covering 71 hospitals, 2 remote oversight of data guardian abstraction, 3 timeliness of implementation, and 4 potential interference in the study by concurrent technological advances. Research ethics approvals from academic centres were obtained initially and submitted to non academic centre applications. Data guardians were trained by a single investigator and data entry is informed by a detailed data dictionary including variable definitions and abstraction instrucations and subjected to error and logic

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

  1. 874例院外猝死临床分析与急救干预%Clinical analysis and emergency interference on 874 cases of prehospital sudden death patients

    Institute of Scientific and Technical Information of China (English)

    瞿惠春; 徐绍春

    2001-01-01

    目的 分析探讨院外猝死及现场复苏成败的原因,以进一步提高现场复苏成功率,强化院外猝死的急救干预。方法 收集1999年1~12月经本中心院外急救的874例猝死病历,参照Utstein模式进行资料报告方法统计,进行回顾性研究。结果 猝死前有心血管病史者占70.44%;猝死高发年龄为60~84岁,占64.48%,且男性多于女性;发病地点以家庭为主,占93.8%;先由目击者进行心肺复苏(CPR)的24例中16例复苏有效,有效率66.67%,而后再由医生进行CPR的815例中43例复苏有效,有效率仅为5.28%,二者差别有显著意义(P<0.01);呼叫~到达现场平均间期在复苏有效组与无效组中分别为8.16分钟和9.90分钟;经除颤、气管插管后复苏有效率分别为12.59%和28.22%,面未用除颤、气管插管的有效率仅为5.89%和1.92%,二者差别有显著意义(P<0.01);现场复苏有效58例(6.91%),复苏成功1例(0.12%)。院外猝死率在12个月中的高峰期为冬季。在平均一昼夜中的高峰点为早晨7点。结论 降低院外猝死发生率的急救干预:①要识别、防治猝死的高危因素;②在人群中普及以CPR为主的初级救护知识;③努力缩短急救反应时间即呼叫~到达现场间期;④要针对不同季节和时间,及时调整急救力量。%Objective Analyze and approach sudden death and the reasons for the success and failure in on-the-spot resuscitation,in order to improve success rate in on-the-spot resuscitation.Methods Colle cted consecutive 874 records of sudden death patients who received prehospitale mergency medical care provided by Shanghai medical Emergency Center during Jan.1999 through Dec.1999 and retrospec tive study was performed by referencing Utstein mode statistics.Results 70.44% of the patients had history of cardiovascular diseases before sudden death.High sudden death incidence happened in the age group of 60

  2. Medical Identity Theft in the Emergency Department: Awareness is Crucial

    Directory of Open Access Journals (Sweden)

    Michelino Mancini

    2014-11-01

    Full Text Available Medical Identity theft in the emergency department (ED can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient’s identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior. [West J Emerg Med. 2014;15(7:–0.

  3. Radiation dose from medical imaging: a primer for emergency physicians.

    Science.gov (United States)

    Jones, Jesse G A; Mills, Christopher N; Mogensen, Monique A; Lee, Christoph I

    2012-05-01

    Medical imaging now accounts for most of the US population's exposure to ionizing radiation. A substantial proportion of this medical imaging is ordered in the emergency setting. We aim to provide a general overview of radiation dose from medical imaging with a focus on computed tomography, as well as a literature review of recent efforts to decrease unnecessary radiation exposure to patients in the emergency department setting. We conducted a literature review through calendar year 2010 for all published articles pertaining to the emergency department and radiation exposure. The benefits of imaging usually outweigh the risks of eventual radiation-induced cancer in most clinical scenarios encountered by emergency physicians. However, our literature review identified 3 specific clinical situations in the general adult population in which the lifetime risks of cancer may outweigh the benefits to the patient: rule out pulmonary embolism, flank pain, and recurrent abdominal pain in inflammatory bowel disease. For these specific clinical scenarios, a physician-patient discussion about such risks and benefits may be warranted. Emergency physicians, now at the front line of patients' exposure to ionizing radiation, should have a general understanding of the magnitude of radiation dose from advanced medical imaging procedures and their associated risks. Future areas of research should include the development of protocols and guidelines that limit unnecessary patient radiation exposure.

  4. Review on emergency medical response against terrorist attack.

    Science.gov (United States)

    Wang, De-Wen; Liu, Yao; Jiang, Ming-Min

    2014-01-01

    Terrorism is a global issue and a constant international threat. As a result, anti-terrorism and emergency response strategies are tasks of critical importance that have a direct impact on the national security of every country in the world. This paper reviews new characteristics of international anti-terrorism measures and offers an in-depth reflection on emergency medical response countermeasures; additionally, this paper presents the goals of related research, which include: 1) to present a model of a highly efficient medical response command; 2) to introduce the pre-planning phases of the emergency medical response; 3) to establish a response system capable of handling various types of terror attacks; 4) to promote anti-terrorism awareness to the general public and emphasize its prevention; and 5) to continue basic investigations into emergency medical responses for various types of terrorist attacks (for example, the classifications and characteristics of new injuries, pathophysiology, prevention and treatment of the resultant stress disorders, improved high-efficiency medical response measures and equipment, etc.).

  5. Prehospital use of hemostatic dressings in emergency medical services in the Netherlands: A prospective study of 66 cases

    NARCIS (Netherlands)

    Grotenhuis, R. te; Grunsven, P.M. van; Heutz, W.M.; Tan, E.C.T.H.

    2016-01-01

    BACKGROUND: Uncontrolled haemorrhage is the leading cause of potentially preventable death in both civilian and military trauma patients. Animal studies and several case series have shown that hemostatic dressings reduce haemorrhage and might improve survival. One of these products is HemCon

  6. Barriers to utilization of pre-hospital emergency medical services among residents in Libreville, Gabon: A qualitative study

    Directory of Open Access Journals (Sweden)

    Nichole Bosson

    2013-12-01

    Conclusion: We identified remediable barriers to EMS (SAMU access in Libreville, Gabon: lack of awareness, misperceptions, established alternatives, and cost. Interventions and future investigations designed to increase EMS utilization in Gabon should target these four areas.

  7. Medical identity theft in the emergency department: awareness is crucial.

    Science.gov (United States)

    Mancini, Michelino

    2014-11-01

    Medical identity theft in the emergency department (ED) can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient's identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior.

  8. Medication errors of nurses in the emergency department.

    Science.gov (United States)

    Ehsani, Seyyedeh Roghayeh; Cheraghi, Mohammad Ali; Nejati, Amir; Salari, Amir; Esmaeilpoor, Ayeshe Haji; Nejad, Esmaeil Mohammad

    2013-01-01

    Patient safety is one of the main concepts in the field of healthcare provision and a major component of health services quality. One of the important stages in promotion of the safety level of patients is identification of medication errors and their causes. Medical errors such as medication errors are the most prevalent errors that threaten health and are a global problem. Execution of medication orders is an important part of the treatment and care process and is regarded as the main part of the nurses' performance. The purpose of this study was to explore the medication error reporting rate, error types and their causes among nurses in the emergency department. In this descriptive study, 94 nurses of the emergency department of Imam Khomeini Hospital Complex were selected based on census in 2010-2011. Data collection tool was a researcher-made questionnaire consisting of two parts: demographic information, and types and causes of medication errors. After confirming content-face validity, reliability of the questionnaire was determined to be 0.91 using Cronbach's alpha test. Data analyses were performed by descriptive statistics and inferential statistics. SPSS-16 software was used in this study and P values less than 0.05 were considered significant. The mean age of the nurses was 27.7 ± 3.4 years, and their working experience was 7.3 ± 3.4 years. Of participants 46.8% had committed medication errors in the past year, and the majority (69.04%) had committed the errors only once. Thirty two nurses (72.7%) had not reported medication errors to head nurses or the nursing office. The most prevalent types of medication errors were related to infusion rates (33.3%) and administering two doses of medicine instead of one (23.8%). The most important causes of medication errors were shortage of nurses (47.6%) and lack of sufficient pharmacological information (30.9%). This study showed that the risk of medication errors among nurses is high and medication errors are a

  9. Impact of Helicopter Emergency Medical Service in Traumatized Patients: Which Patient Benefits Most?

    Directory of Open Access Journals (Sweden)

    Hagen Andruszkow

    Full Text Available The Helicopter Emergency Medical Service (HEMS was established for the prehospital trauma care of patients. Improved rescue times and increased coverage areas are discussed as specific advantages of HEMS. We recently found evidence that HEMS exerts beneficial effects on outcomes for severely injured patients. However, it still remains unknown which group of trauma patients might benefit most from HEMS rescue. Consequently, the unique aim of this study was to reveal which patients might benefit most from HEMS rescue.Trauma patients (ISS ≥9 primarily treated by HEMS or ground emergency medical services (GEMS between 2002 and 2012 were analysed using the TraumaRegister DGU. A multivariate regression analysis was used to reveal the survival benefit between different trauma populations.The study included 52 281 trauma patients. Of these, 68.8% (35 974 were rescued by GEMS and 31.2% (16 307 by HEMS. HEMS patients were more severely injured compared to GEMS patients (ISS: HEMS 24.8±13.5 vs. GEMS 21.7±18.0 and more frequently suffered traumatic shock (SBP sys <90mmHg: HEMS 18.3% vs. GEMS 14.8%. However, logistic regression analysis revealed that HEMS rescues resulted in an overall survival benefit compared to GEMS (OR 0.81, 95% CI [0.75-0.87], p<0.001, Nagelkerke's R squared 0.526, area under the ROC curve 0.922, 95% CI [0.919-0.925]. Analysis of specific subgroups demonstrated that patients aged older than 55 years (OR 0.62, 95% CI [0.50-0.77] had the highest survival benefit after HEMS treatment. Furthermore, HEMS rescue had the most significant impact after 'low falls' (OR 0.68, 95% CI [0.55-0.84] and in the case of minor severity injuries (ISS 9-15 (OR 0.66, 95% CI [0.49-0.88].In general, trauma patients benefit from HEMS rescue with in-hospital survival as the main outcome parameter. Focusing on special subgroups, middle aged and older patients, low-energy trauma, and minor severity injuries had the highest survival benefit when rescued

  10. Outcomes of patients calling emergency medical services for suspected acute cardiovascular disease

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Sejersten, Maria Sejersten; Baber, Usman

    2015-01-01

    and registries are subject to selection biases. We aimed to describe the prevalence and prognosis of acute CV disease and the effect of invasive treatment, in an unselected and consecutive prehospital cohort of 3,410 patients calling the national emergency telephone number from 2005 to 2008 with follow.......4%, respectively. Stroke, acute heart failure, and ST-segment elevation myocardial infarction (STEMI) carried a 25- to 50-fold adjusted mortality hazard during the first 4 days. In patients with suspected STEMI, 90.5% had an acute angiography performed. Nontransferred, nonreperfused patients with STEMI (9...

  11. A Pilot Project Demonstrating that Combat Medics Can Safely Administer Parenteral Medications in the Emergency Department.

    Science.gov (United States)

    Schauer, Steven G; Cunningham, Cord W; Fisher, Andrew D; DeLorenzo, Robert A

    2017-08-15

    Introduction Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration. Project Design This was a quality assurance project that monitored training of combat medics to administer parenteral medications and to ensure patient safety. Combat medics were provided training that included direct supervision during medication administration. Once proficiency was demonstrated, combat medics would prepare the medications under direct supervision, followed by indirect supervision during administration. As part of the quality assurance and safety processes, combat medics were required to document all medication administrations, supervising provider, and unexpected adverse events. Additional quality assurance follow-up occurred via complete chart review by the project lead. Data During the project period, the combat medics administered the following medications: ketamine (n=13), morphine (n=8), ketorolac (n=7), fentanyl (n=5), ondansetron (n=4), and other (n=6). No adverse events or patient safety events were reported by the combat medics or discovered during the quality assurance process. In this limited case series, combat medics safely administered parenteral medications under indirect provider supervision. Future research is needed to further develop this training model for both the military and civilian setting. Schauer SG , Cunningham C W, Fisher AD , DeLorenzo RA . A pilot project demonstrating that combat medics can safely administer parenteral medications in the emergency department.

  12. Critical incidents during prehospital cardiopulmonary resuscitation: what are the problems nobody wants to talk about?

    Science.gov (United States)

    Hohenstein, Christian; Rupp, Peter; Fleischmann, Thomas

    2011-02-01

    We wanted to identify incidents that led or could have led to patient harm during prehospital cardiopulmonary resuscitation. A nationwide anonymous and Internet-based critical incident reporting system gave the data. During a 4-year period we received 548 reports of which 74 occurred during cardiopulmonary resuscitation. Human error was responsible for 85% of the incidents, whereas equipment failure contributed to 15% of the reports. Equipment failure was considered to be preventable in 61% of all the cases, whereas incidents because of human error could have been prevented in almost all the cases. In most cases, prevention can be accomplished by simple strategies with the Poka-Yoke technique. Insufficient training of emergency medical service physicians in Germany requires special attention. The critical incident reports raise concerns regarding the level of expertize provided by emergency medical service doctors.

  13. Emerging programmed aging mechanisms and their medical implications.

    Science.gov (United States)

    Goldsmith, Theodore C

    2016-01-01

    For many generations programmed aging in humans was considered theoretically impossible and medical attempts to treat or delay age-related diseases were based on non-programmed aging theories. However, there is now an extensive theoretical basis for programmed mammal aging and substantially funded medical research efforts based on programmed aging theories are underway. This article describes the very different disease mechanism concepts that logically result from the theories and the impacts emerging programmed aging mechanisms will have on funding and performing medical research on age-related conditions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Development of Emergency Medical Services (EMS in Iran: Components of Access

    Directory of Open Access Journals (Sweden)

    Mohammadkarim Bahadori

    2012-04-01

    Full Text Available Introduction: One of the most important components of emergency medical services (EMS which plays a major role in reducing mortality and disability of victims is access to healthcare services. Equitable access to healthcare services requires providing essential andaccessible services for all people without imposing any financial burden on them. The aim of this study was to determine and prioritize the components of access to EMS in Iran.Methods: This study is a descriptive and cross-sectional study that has done in the first half of 2010 in Iran using DEMATEL method. The data about the access components of EMS in different systems was collected using researcher-made questionnaire. Afterwards, a sample of30 Iranian experts in EMS who were selected using purposive sampling method were asked to evaluate the suggestions and revise the collected components using their scientific, practical and visionary experience. Then, the components were identified using Delphi method. The priority of components was depicted using MATLAB and Edraw Max 5 softwares.Results: Capitation, third party insurance, insurance for non-traffics cases, the budget of some especial organizations such as the tobacco companies, etc., distribution of facilities based on the characteristics of each region and distribution of facilities in urban areas based on the population density were determined as access components. Also, The components of third party insurance and capitation were determined as the most affecting and affected access components with the coordinates (1.44 and 1.44 and (0.09 and -0.09 respectively, on the pre-hospital emergency access components graph.Conclusion: Given the limited resources to access EMS, alternatives should be taken into consideration. Considering the high number of deaths from traffic accidents in Iran, part of car insurance premiums should be allocated to provide emergency services for people injured. Some Iranian organizations such as tobacco

  15. Personal networks enabling remote assistance for medical emergency team

    NARCIS (Netherlands)

    Hartog, F.T.H. den; Schmidt, J.R.; Vries, A. de

    2005-01-01

    Personal Networks provide the technology that is needed to interconnect the various private networks of a single user (home network, office network, Personal Area Network, and others) seamlessly, at any time and in any place. This can be useful in healthcare. In case of medical emergencies, it can

  16. Personal networks enabling remote assistance for medical emergency team

    NARCIS (Netherlands)

    Hartog, F.T.H. den; Schmidt, J.R.; Vries, A. de

    2005-01-01

    Personal Networks provide the technology that is needed to interconnect the various private networks of a single user (home network, office network, Personal Area Network, and others) seamlessly, at any time and in any place. This can be useful in healthcare. In case of medical emergencies, it can p

  17. Knowledge and use of emergency contraception by medical doctors ...

    African Journals Online (AJOL)

    Knowledge and use of emergency contraception by medical doctors on internship in ... while about a quarter (26.9%) routinely counsel women about ECP use. ... We recommend that in.service training should focus more on EC to improve the ...

  18. Three Types of Memory in Emergency Medical Services Communication

    Science.gov (United States)

    Angeli, Elizabeth L.

    2015-01-01

    This article examines memory and distributed cognition involved in the writing practices of emergency medical services (EMS) professionals. Results from a 16-month study indicate that EMS professionals rely on distributed cognition and three kinds of memory: individual, collaborative, and professional. Distributed cognition and the three types of…

  19. On the Alert: Preparing for Medical Emergencies in Schools

    Science.gov (United States)

    Mahoney, Dan

    2012-01-01

    Medical emergencies can happen in any school at any time. They can be the result of preexisting health problems, accidents, violence, unintentional actions, natural disasters, and toxins. Premature deaths in schools from sudden cardiac arrest, blunt trauma to the chest, firearm injuries, asthma, head injuries, drug overdose, allergic reactions,…

  20. [The nurse within emergency medical-psychological units].

    Science.gov (United States)

    Darbon, Rémy; Dalphin, Catherine; Prieto, Nathalie; Cheucle, Éric

    2017-04-01

    The growing recognition of post-traumatic stress disorders and the need to intervene early justifies the creation of emergency medical-psychological units. The nurse has a major role to play within these teams. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  1. Constructing Common Information Space across Distributed Emergency Medical Teams

    DEFF Research Database (Denmark)

    Zhang, Zhan; Sarcevic, Aleksandra; Bossen, Claus

    2017-01-01

    This paper examines coordination and real-time information sharing across four emergency medical teams in a high-risk and distributed setting as they provide care to critically injured patients within the first hour after injury. Through multiple field studies we explored how common understanding...

  2. Three Types of Memory in Emergency Medical Services Communication

    Science.gov (United States)

    Angeli, Elizabeth L.

    2015-01-01

    This article examines memory and distributed cognition involved in the writing practices of emergency medical services (EMS) professionals. Results from a 16-month study indicate that EMS professionals rely on distributed cognition and three kinds of memory: individual, collaborative, and professional. Distributed cognition and the three types of…

  3. Emergency Medical Technician. Competency Based Education Curriculum. Student Material.

    Science.gov (United States)

    Spotts, Sue Ann

    Beginning with an introductory handbook, this competency-based curriculum contains 13 modules for an 81-hour secondary- or postsecondary-level course for Emergency Medical Technician (EMT). Introductory materials include module component descriptions and information for administering an EMT training program, such as an instructor's schedule, list…

  4. Training Program for Emergency Medical Technician: Dispatcher. 1--Course Guide.

    Science.gov (United States)

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

    The material presented in this course guide is designed to aid administrators in setting up and administering the emergency medical technician (EMT) dispatcher course. Descriptions of the overall objectives and scope of the course are presented, including behavioral objectives for eleven units of instruction covering the following emergency…

  5. Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Robert S. Green

    2016-01-01

    Full Text Available Background. Patients with sepsis benefit from early diagnosis and treatment. Accurate paramedic recognition of sepsis is important to initiate care promptly for patients who arrive by Emergency Medical Services. Methods. Prospective observational study of adult patients (age ≥ 16 years transported by paramedics to the emergency department (ED of a Canadian tertiary hospital. Paramedic identification of sepsis was assessed using a novel prehospital sepsis screening tool developed by the study team and compared to blind, independent documentation of ED diagnoses by attending emergency physicians (EPs. Specificity, sensitivity, accuracy, positive and negative predictive value, and likelihood ratios were calculated with 95% confidence intervals. Results. Overall, 629 patients were included in the analysis. Sepsis was identified by paramedics in 170 (27.0% patients and by EPs in 71 (11.3% patients. Sensitivity of paramedic sepsis identification compared to EP diagnosis was 73.2% (95% CI 61.4–83.0, while specificity was 78.8% (95% CI 75.2–82.2. The accuracy of paramedic identification of sepsis was 78.2% (492/629, 52 true positive, 440 true negative. Positive and negative predictive values were 30.6% (95% CI 23.8–38.1 and 95.9% (95% CI 93.6–97.5, respectively. Conclusion. Using a novel prehospital sepsis screening tool, paramedic recognition of sepsis had greater specificity than sensitivity with reasonable accuracy.

  6. Prehospital lung ultrasound for the diagnosis of cardiogenic pulmonary oedema

    DEFF Research Database (Denmark)

    Laursen, Christian B; Hänselmann, Anja; Posth, Stefan

    2016-01-01

    : The sensitivity of PLUS is high, making it a potential tool for ruling-out cardiogenic pulmonary. The observed specificity was lower than what has been described in previous studies. CONCLUSIONS: Performed, as part of a physician based prehospital emergency service, PLUS seems fast and highly feasible in patients...

  7. Smartphones and Medical Applications in the Emergency Department Daily Practice.

    Science.gov (United States)

    Jahanshir, Amirhosein; Karimialavijeh, Ehsan; Sheikh, Hojjat; Vahedi, Motahar; Momeni, Mehdi

    2017-01-01

    Medical applications help physicians to make more rapid and evidence based decisions that may provide better patient care. This study aimed to determine the extent to which smart phones and medical applications are integrated in the emergency department daily practice. In a cross sectional study, a modified standard questionnaire (Payne et al.) consisting of demographic data and information regarding quality and quantity of smartphone and medical app utilization was sent to emergency-medicine residents and interns twice (two weeks apart), in January 2015. The questionnaire was put online using open access "Web-form Module" and the address of the web page was e-mailed along with a cover letter explaining the survey. Finally, responses were analyzed using descriptive statistics and SPSS 22 software. 65 cases participated (response rate 86%). The mean age of interns and residents were 25.03 ± 1.13 and 30.27 ± 4.68 years, respectively (p UpToDate, respectively. 38 (61.3%) of the respondents were using their apps more than once a day and mostly for drug information. English (83.9%), Persian (12.9%), and other languages (3.2%) were preferred languages for designing a medical software among the participants, respectively. The findings of present study showed that smartphones are very popular among Iranian interns and residents in emergency department and a substantial number of them own a smartphone and are using medical apps regularly in their clinical practice.

  8. 78 FR 24802 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

    Science.gov (United States)

    2013-04-26

    ... National Highway Traffic Safety Administration National Emergency Medical Services Advisory Council (NEMSAC... nationally recognized council of emergency medical services representatives and consumers, is to advise and... (NHTSA), U.S. Department of Transportation (DOT). ACTION: Meeting Notice--National Emergency...

  9. 76 FR 22166 - Renewal of Charter for the National Emergency Medical Services Advisory Council (NEMSAC)

    Science.gov (United States)

    2011-04-20

    ... of the National Emergency Medical Services Advisory Council to provide advice and recommendations regarding emergency medical services (EMS) matters to the U.S. Department of Transportation, National... National Highway Traffic Safety Administration Renewal of Charter for the National Emergency...

  10. 76 FR 39977 - National Emergency Medical Services Advisory Council Teleconference Meeting

    Science.gov (United States)

    2011-07-07

    ... National Highway Traffic Safety Administration National Emergency Medical Services Advisory Council... nationally recognized council of Emergency Medical Services (EMS) representatives and consumers to provide... proper arrangements. FOR FURTHER INFORMATION CONTACT: Drew Dawson, Director, Office of Emergency...

  11. Management of pain in pre-hospital settings.

    Science.gov (United States)

    Parker, Michael; Rodgers, Antony

    2015-06-01

    Assessment and management of pain in pre-hospital care settings are important aspects of paramedic and clinical team roles. As emergency department waiting times and delays in paramedic-to-nurse handover increase, it becomes more and more vital that patients receive adequate pre-hospital pain relief. However, administration of analgesia can be inadequate and can result in patients experiencing oligoanalgesia, or under-treated pain. This article examines these issues along with the aetiology of trauma and the related socioeconomic background of traumatic injury. It reviews validated pain-assessment tools, outlines physiological responses to traumatic pain and discusses some of the misconceptions about the provision of effective analgesia in pre-hospital settings.

  12. Do emergency physicians attribute drug-related emergency department visits to medication-related problems?

    Science.gov (United States)

    Hohl, Corinne M; Zed, Peter J; Brubacher, Jeffrey R; Abu-Laban, Riyad B; Loewen, Peter S; Purssell, Roy A

    2010-06-01

    Adverse drug events represent the most common cause of preventable nonsurgical adverse events in medicine but may remain undetected. Our objective is to determine the proportion of drug-related visits emergency physicians attribute to medication-related problems. This prospective observational study enrolled adults presenting to a tertiary care emergency department (ED) during 12 weeks. Drug-related visits were defined as ED visits caused by adverse drug events. The definition of adverse drug event was varied to examine both narrow and broad adverse drug event classification systems. Clinical pharmacists evaluated all patients for drug-related visits, using standardized assessment algorithms, and then followed patients until hospital discharge. Interrater agreement for the clinical pharmacist diagnosis of drug-related visit was assessed. Emergency physicians, blinded to the clinical pharmacist opinion, were interviewed at the end of each shift to determine whether they attributed the visit to a medication-related problem. An independent committee reviewed and adjudicated all cases in which the emergency physicians' and clinical pharmacists' assessments were discordant, or either the emergency physician or clinical pharmacist was uncertain. The primary outcome was the proportion of drug-related visits attributed to a medication-related problem by emergency physicians. Nine hundred forty-four patients were enrolled, of whom 44 patients received a diagnosis of the narrowest definition of an adverse drug event, an adverse drug reaction (4.7%; 95% confidence interval [CI] 3.5% to 6.2%). Twenty-seven of these were categorized as medication-related by emergency physicians (61.4%; 95% CI 46.5% to 74.3%), 10 were categorized as uncertain (22.7%; 95% CI 12.9% to 37.1%), and 7 categorized as a non-medication-related problem (15.9%; 95% CI 8.0% to 29.5%). Seventy-eight patients (8.3%; 95% CI 6.7% to 10.2%) received a diagnosis of an adverse drug event caused by an adverse drug

  13. Social Media: Portrait of an Emerging Tool in Medical Education.

    Science.gov (United States)

    Roy, Durga; Taylor, Jacob; Cheston, Christine C; Flickinger, Tabor E; Chisolm, Margaret S

    2016-02-01

    The authors compare the prevalence of challenges and opportunities in commentaries and descriptive accounts versus evaluative studies of social media use in medical education. A previously published report of social media use in medical education provided an in-depth discussion of 14 evaluative studies, a small subset of the total number of 99 articles on this topic. This study used the full set of articles identified by that review, including the 58 commentaries and 27 descriptive accounts which had not been previously reported, to provide a glimpse into how emerging tools in medical education are initially perceived. Each commentary, descriptive account, and evaluative study was identified and compared on various characteristics, including discussion themes regarding the challenges and opportunities of social media use in medical education. Themes related to the challenges of social media use in medical education were more prevalent in commentaries and descriptive accounts than in evaluative studies. The potential of social media to affect medical professionalism adversely was the most commonly discussed challenge in the commentaries (53%) and descriptive accounts (63%) in comparison to technical issues related to implementation in the evaluative studies (50%). Results suggest that the early body of literature on social media use in medical education-like that of previous innovative education tools-comprises primarily commentaries and descriptive accounts that focus more on the challenges of social media than on potential opportunities. These results place social media tools in historical context and lay the groundwork for expanding on this novel approach to medical education.

  14. Administration Medication Errors in Emergency Department in Level III Hospital

    Directory of Open Access Journals (Sweden)

    Silvia González Gómez

    2012-09-01

    Full Text Available • Objective: To determine the prevalence of medication errors associated with the administration in the emergency room of University Hospital Marques de Valdecilla. • Introduction: Adverse events related to health care, are increasingly common, it is estimated that between 44000 and 98000 people served in U.S. hospitals die from adverse events related to health care. In 7000 these deaths are caused by medication errors. In Spain the studies speak of similar figures. The emergency services are excluded usually in these studies because of its particular characteristics, but also are well known that these are characteristics (speed of decision-making, not having systems in unit dose dispensing ... what is expected that mistakes can be produced in larger numbers in emergency services in the areas of Spain hospitalization. • Method: This is a descriptive study in which cross-examine a sample of 627 administrations made in different areas of attention of the Emergency Department Valdecilla Hospital, in different time slots, months of the year and days a week. Between the months of January and December 2009.• Results: Have detected 119 errors in 627 observations, the most common error is log.• Conclusions: We have found a lower incidence of error 2.7%, comparing with other work (10%. While most of the studies reviewed speak of medication errors in general, including prescription, transcription, and administration.

  15. 院前病情评估表对急诊患者分诊的指导意义%Guiding Significance of Pre-hospital Condition Assessment for Emergency Triage

    Institute of Scientific and Technical Information of China (English)

    胡登科; 刘利生; 刘晓海; 朱勇

    2014-01-01

    Objective To discuss the values and guiding significance of pre-hospital condition assessment for emer-gency triage. Methods A total of 1 810 patients who visited Department of Emergency,the Fourth People's Hospital of Li-anyungang from August 2012 to January 2014 were enrolled in this study. The experienced nurses observed and scored the pa-tients' age,temperature,heart rate respiration frequency,blood pressure,blood oxygen saturation,state of consciousness, and divided the patients,according to score standards,into mild,moderate,severe,critical conditions,and followed physi-cians' disposals for the patients. Results The emergency physicians( doctor group) and triage nurses( nurse group) evalua-ted the 1 810 patients' condition. There was no significant difference in condition evaluation between 2 groups(P>0. 05). In 21 patients who were assessed as severe condition by nurse group,18 were assessed as severe,3 as moderate by doctor group;in 10 patients who were assessed as critical condition by nurse group,9 assessed as critical,1 as severe by doctor group. Conclu-sion Pre-hospital condition assessment which can score emergency patients' condition and help triage,is of a certain role in i-dentifying potential critical patients and has them treated first. It is an emergency triage method worthy of generalization.%目的:探讨院前病情评估表对急诊患者分诊的价值与指导意义。方法选取2012年8月—2014年1月于连云港市第四人民医院急诊科就诊的患者共1810例,由有经验的分诊护师按照院前病情评估表对患者进行年龄、体温、心率、呼吸、血压、血糖、血氧饱和度、意识状态的评估并评分,按评分标准将患者病情分为轻、中、重、危(护师组);同时追踪急诊医师对患者的评估结果(医师组)。结果医师组和护师组对急诊患者病情的评估比较,差异无统计学意义( P>0.05)。其中被护师组评估为重的21例中18

  16. [Cirurgia Taurina--emergency medical treatment of bullfighters in Spain].

    Science.gov (United States)

    Lehmann, V; Lehmann, J

    2003-08-01

    A considerable risk of life-threatening injury is inherent to bullfighting. Thus, a unique form of emergency treatment has evolved over recent decades of organized bull-fighting. Today bullfight arenas in larger cities are equipped with emergency facilities including fully furnished operating rooms. During a fiesta these facilities are run by a medical team consisting of three surgeons, one intensive care specialist, and one anesthesiologist with their supporting medical personnel. In smaller arenas or villages immediate care units consist of emergency vehicles, and a mobile container equipped with a fully functional operating room. Of all toreros the matadores including the novilleros are most often injured in 56 % of cases. This rate decreases for banderillos (30 %), and for picadores (14 %). Parts of the body that are most frequently affected are thighs, and the inguinal region (54 %). Head and neck injuries are seen in 19 %, and 12 % of cases present with open abdominal wounds including liver or gastrointestinal tract traumas. 10 % of injuries affect the thorax, and 4 % the pelvic floor. The particular form of organised medical treatment for bullfighters in Spain has only developed since the nineteen-thirties. In 1972 a scientific society for bullfight surgery was founded in Spain by specialized surgeons, and immediate care specialists holding a first convention that year. The society is continuously striving to improve technical and logistical aspects of immediate medical care for injured bullfighters.

  17. Recruitment and retention of emergency medical technicians: a qualitative study.

    Science.gov (United States)

    Patterson, P Daniel; Probst, Janice C; Leith, Katherine H; Corwin, Sara J; Powell, M Paige

    2005-01-01

    Emergency medical technicians (EMTs) are critical to out-of-hospital care, but maintaining staff can be difficult. The study objective was to identify factors that contribute to recruitment and retention of EMTs and paramedics. Information was drawn from three focus groups of EMT-Basic, EMT-Intermediate, and EMT-Paramedic personnel recruited from participants at an annual conference. Thoughts and feelings of EMTs and paramedics were investigated using eight questions designed to explore entry into emergency medical services, what it is like to be an EMT or paramedic, and the EMT educational process. Data were analyzed at the group level for common themes using NVivo. For a majority of respondents, emergency medical services was not a primary career path. Most respondents entered the industry as an alternate or replacement for a nursing career or as a second career following military medic service. The majority of respondents believed the job was stressful yet rewarding, and although it negatively affected their personal lives, the occupation gave them a sense of accomplishment and belonging. Respondents expressed a preference for EMT education resulting in college credit or licensure versus professional certification. Job-related stress produced by numerous factors appears to be a likely contributor to low employee retention. Recruitment and retention efforts should address study findings, incorporating key findings into educational, evaluation, and job enhancement programs.

  18. Prehospital management of gunshot patients at major trauma care centers: exploring the gaps in patient care.

    Science.gov (United States)

    Norouzpour, Amir; Khoshdel, Ali Reza; Modaghegh, Mohammad-Hadi; Kazemzadeh, Gholam-Hossein

    2013-09-01

    Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality. To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers. This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome. There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis. GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed.

  19. 医疗救护员培训与执业体系的国际化发展对我国的启示%Enlightenment of worldwide development of training and practicing system of emergency medical technician on China

    Institute of Scientific and Technical Information of China (English)

    彭碧波; 郑静晨; 刘海峰

    2016-01-01

    医疗救护员(emergency medical technician, EMT)是率先在美国出现的新型职业,属于急救医疗服务体系的一部分,并已建立起良好的 EMT 培训与职业考试制度。笔者深度述评美国 EMT 培训与执业体系的历史与运行现状,并与我国现行院前急救体系比较,旨在为我国院前急救体系的改革带来新的启示。%Emergency medical technician (EMT) is a new occupation that first emerged in United States, and it is a part of the emergency medical service, and it has established a well training and certification test system. The author deeply reviewed the history and current development of EMT training and practicing system in United States, and compared it with current prehospital emergency system in China, in order to bring new enlightenment to the reform of prehospital emergency system in China.

  20. Paramedic use of needle thoracostomy in the prehospital environment.

    Science.gov (United States)

    Warner, Keir J; Copass, Michael K; Bulger, Eileen M

    2008-01-01

    The use of prehospital needle thoracostomy (NT) is controversial as it is not without risk. Issues such as inappropriate patient selection, misplacement causing iatrogenic injury, treatment failures in obese patients, and delaying definitive tube thoracostomy in the emergency department contribute to this controversy. The purpose of this study is to evaluate a cohort of patients undergoing NT by paramedics for tension pneumothorax and review the indications for use, complications, and emergency department outcomes of NT. We conducted a retrospective review of patients undergoing NT in the prehospital setting and transported directly to a Level 1 trauma center over a one-year period. Patients were transported by a single ground transport agency staffed by paramedics. All paramedics were trained to follow uniform protocols for treatment procedures. Variables included indications for NT, patient demographics, prehospital vital signs, injury mechanism, chest X-ray, and Emergency Department outcomes. Paramedics responded to 20,330 advanced life support calls, and 39 (0.2%) patients had a NT placed for treatment of tension pneumothorax. Twenty-two (56.4%) patients were in circulatory arrest, with 12 suffering traumatic arrest and 10 patients in nontraumatic PEA arrest. The remaining 17 (43.6%) patients were treated for nonarrest causes. The use of NT appears to be a safe procedure when preformed by paramedics in an urban EMS system. Prehospital NT resulted in four cases of unexpected survival.

  1. Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care

    Directory of Open Access Journals (Sweden)

    G.S. Youssef

    2017-09-01

    Conclusion: Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.

  2. Emergency Department Management of Trauma

    DEFF Research Database (Denmark)

    MacKenzie, Colin; Lippert, Freddy

    1999-01-01

    Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... strongly influences patient morbidity and mortality. Prolonged transport times or inadequate prehospital care increases the requirement for early rapid restoration of tissue perfusion and reversal of physiologic disturbances on patient arrival. On the other hand, in urban areas, rapid emergency medical...... services (EMS) response times and advanced prehospital care increase the number of critically injured patients surviving sufficiently long to reach a hospital “in extremis.” Both scenarios provide challenges in the management of traumatized patients. This article addresses the management of severely...

  3. Participatory Design in Emergency Medical Service: Designing for Future Practice

    DEFF Research Database (Denmark)

    Kristensen, Margit; Kyng, Morten; Palen, Leysia Ann

    2006-01-01

    address challenges identified by disaster sociologists when designing for major incidents. Through qualitative research and participatory design, we have ex-amined the features of EMS work and technology use in different emergency situations from the perspective of mul-tiple actors. We conceptualize......We describe our research—its approach, results and prod-ucts—on Danish emergency medical service (EMS) field or “pre-hospital” work in minor and major incidents. We dis-cuss how commitments to participatory design and attention to the qualitative differences between minor and major incidents...

  4. International Federation for Emergency Medicine Model curriculum for medical student education in emergency medicine

    Directory of Open Access Journals (Sweden)

    Cherri Hobgood

    2011-09-01

    The curriculum is designed with a focus on the basic minimum emergency medicine educational content that any medical school should be delivering to its students during their undergraduate years of training. It is designed, not to be prescriptive, but to assist educators and emergency medicine leadership in advancing physician education in basic emergency medicine content. The content would be relevant, not just for communities with mature emergency medicine systems, but also for developing nations or for nations seeking to expand emergency medicine within current educational structures. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational milieu, the resources available, and the goals of the institutions’ educational leadership.

  5. 院前急救护士多元文化护理认知状况调查%Survey on Cognitive Situation of Multicultural Nursing of Prehospital E-mergency Nurses

    Institute of Scientific and Technical Information of China (English)

    袁丽秀

    2016-01-01

    Objective To survey the cognitive situation of multicultural nursing of prehospital emergency nurses. Methods 32 cases of nursing personnel in the department of emergency in our hospital from April 2014 to April 2015 were selected, and the relevant emergency knowledge and nursing culture coverage degree and level were comprehensively evaluated, and the cognitive situation was observed and the corresponding nursing learning strategies were made. Results The multicultural relevant scores of nursing personnel in the department of emergency in our hospital showed that each indicator score was not high and the cognitive situation was not ideal. Conclusion The survey discovers that the understanding of multicultural nursing concept of the nursing personnel in the department of emergency in our hospital is worse, faced with the situation, the hospital should organize nursing personnel in the emergency department to regularly learn the concept of multicultural nursing mode and enhance practice exercise, strength their professional knowledge study, improve the practical operation a-bility and make efforts to improve the weak situation of present clinical multicultural nursing concept.%目的:对院前急救护理人员多元文化护理认知状况进行调查。方法选取该院急诊科在2014年4月-2015年4月期间工作的32例护理人员,全面评估其相关急救知识及护理文化涵盖度及层次,观察其认知现状并制定相应护理学习对策。结果对该院急诊科护理人员进行多元文化相关评分得出,各指标评分均不高,认知现状不理想。结论该院经调查发现该院急诊科护理人员对于多元文化护理概念理解力较差,面对此种情况,医院应组织急诊科护理人员定期学习多元文化护理模式的概念并加强实践锻炼,加强自身专业知识学习及提高实际操作能力,努力改善目前临床多元文化护理概念薄弱现状。

  6. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service

    Directory of Open Access Journals (Sweden)

    Scheffer Gert J

    2010-03-01

    Full Text Available Abstract Background To determine the advanced life support procedures provided by an Emergency Medical Service (EMS and a Helicopter Emergency Medical Service (HEMS for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures restricted to the HEMS-physician and procedures for which the HEMS is more experienced than the EMS. Methods Prospective study of a consecutive group of children examined and treated by the HEMS of the eastern region of the Netherlands. Data regarding type of emergency, physiological parameters, NACA scores, treatment, and 24-hour survival were collected and subsequently analysed. Results Of the 558 children examined and treated by the HEMS on scene, 79% had a NACA score of IV-VII. 65% of the children had one or more advanced life support procedures restricted to the HEMS and 78% of the children had one or more procedures for which the HEMS is more experienced than the EMS. The HEMS intubated 38% of all children, and 23% of the children intubated and ventilated by the EMS needed emergency correction because of potentially lethal complications. The HEMS provided the greater part of intraosseous access, as the EMS paramedics almost exclusively reserved this procedure for children in cardiopulmonary resuscitation. The EMS provided pain management only to children older than four years of age, but a larger group was in need of analgesia upon arrival of the HEMS, and was subsequently treated by the HEMS. Conclusions The Helicopter Emergency Medical Service of the eastern region of the Netherlands brings essential medical expertise in the field not provided by the emergency medical service. The Emergency Medical Service does not provide a significant quantity of procedures obviously needed by the paediatric patient.

  7. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 3--Anatomy and Physiology. Revised.

    Science.gov (United States)

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the third in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains one section covering the following topics: general anatomical terms, the body cavities and contents, the integumentary system, the skeletal system, the muscular system, the nervous system, the respiratory…

  8. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 5. CPR, Oxygen Therapy. Revised.

    Science.gov (United States)

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the fifth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains two sections covering the following course content; cardiopulmonary resuscitation (CPR) (including artificial ventilation, foreign body obstructions, adjunctive equipment and special techniques, artificial…

  9. Analysis of 78 cases of prehospital death due to traffic accident injury

    Institute of Scientific and Technical Information of China (English)

    胡孝菽; 洪勇; 等

    1999-01-01

    Objective The cause and time of prehospital death for the injured patients caused by traffic accidents were studied in order to improve traffic management and clinical treatment,and reduce mortality.Methods The characteristics of the injury,the rescue procedure,the status of the injury leading to death were analyzed based on the retrospective data of 78 cases died before admission.Results The main causes of prehospital death in the traffic accidents included:1.head injury,2.bleeding,3.chest and heart wound,4.spinal cord injury at upper cervix.Death happened immediately after injury was in 17 cases.Death happened from the accident site to our hospital was in 47 cases.Death happened within half an hour after reaching emergency room was in 14 cases.In all of the cases,the death on the transfer took up 62.5%.Conclusions Findings from analysis of the data will be presented on a wide range of traffic safety issues.These include enhancing education of traffic safety and administration of drivers and motor vehicles,establishing a perfect emergency medical service system and a well-trained team of first aid,and popularizing first aid