Science.gov

Sample records for air ambulance service

  1. Oregon Air Ambulance Services.

    DTIC Science & Technology

    1986-01-01

    A 85 aboard unpressurized aircraft. These two patients, both of whom suffered from a bowel obstruction , were transported aboard unpressurized...services can safely transport patients with conditions (i.e. bowel obstruction , facial fractures, pneumothorax, intracranial air) which are clearly

  2. Air ambulance medical transport advertising and marketing.

    PubMed

    2011-01-01

    The National Association of EMS Physicians (NAEMSP), the American College of Emergency Physicians (ACEP), the Air Medical Physician Association (AMPA), the Association of Air Medical Services (AAMS), and the National Association of State EMS Officials (NASEMSO) believe that patient care and outcomes are optimized by using air medical transport services that are licensed air ambulance providers with robust physician medical director oversight and ongoing quality assessment and review. Only air ambulance medical transport services with these credentials should advertise/market themselves as air ambulance services.

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

    PubMed

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

    2016-01-01

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

  4. Ambulance times of Ankara emergency aid and rescue services' ambulance system.

    PubMed

    Altintaş, K H; Bilir, N

    2001-03-01

    The aim of this study was to determine various times related to the ambulance activities of Ankara Emergency Aid and Rescue Services (EARS) and if necessary contribute to the improvement of them. A descriptive study was planned to determine various times related to the ambulance activities of Ankara EARS. The data was collected by one of the researchers. The study was conducted between 1 October 1995 and 30 September 1996. The variables of the study were: delay time, response time, time at the scene (scene time), round trip time, transport time and total run time of Ankara EARS ambulance activities. Ankara EARS Emergency Call Registry Forms (5638 forms) were evaluated for the above stated variables. The computer program EPI-INFO 5.0 was used in the study. The median response time of Ankara EARS was found to be 9 minutes. In the research year, the median delay time was 2 minutes. Median arrival to patient contact time of Ankara EARS was 2 minutes. Median time at the scene was 7 minutes. Median round trip time of the system was 44 minutes. The median time to arrive at the scene from the ambulance station was 8 minutes. The median transport time was 10 minutes. The median total run time was 30 minutes. As the median response time was found to be 9 minutes it is concluded that there should be more ambulance vehicles to improve this time of Ankara EARS. Due to financial problems, times were recorded manually by the ambulance crew and dispatchers of Ankara EARS. If digital and electronic recording systems are used, these times might be more precise.

  5. 29 CFR 553.215 - Ambulance and rescue service employees.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... service employees are regularly dispatched to fires, crime scenes, riots, natural disasters and accidents... REGULATIONS APPLICATION OF THE FAIR LABOR STANDARDS ACT TO EMPLOYEES OF STATE AND LOCAL GOVERNMENTS Fire... rescue service employees. (a) Ambulance and rescue service employees of a public agency other than a...

  6. A review of risk analysis and helicopter air ambulance accidents.

    PubMed

    Nix, Sam; Buckner, Steven; Cercone, Richard

    2014-01-01

    The Federal Aviation Administration announced a final rule in February 2014 that includes a requirement for helicopter air ambulance operators to institute preflight risk analysis programs. This qualitative study examined risk factors that were described in 22 preliminary, factual, and probable cause helicopter air ambulance accident and incident reports that were initiated by the National Transportation Safety Board between January 1, 2011, and December 31, 2013. Insights into the effectiveness of existing preflight risk analysis strategies were gained by comparing these risk factors with the preflight risk analysis guidance that is published by the Federal Aviation Administration in the Flight Standards Information Management System. When appropriate, a deeper understanding of the human factors that may have contributed to occurrences was gained through methodologies that are described in the Human Factors Analysis and Classification System. The results of this study suggest that there are some vulnerabilities in existing preflight risk analysis guidelines that may affect safety in the helicopter air ambulance industry. The likelihood that human factors contributed to most of the helicopter air ambulance accidents and incidents that occurred during the study period was also evidenced. The results of this study suggest that effective risk analysis programs should provide pilots with both preflight and in-flight resources.

  7. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., level 2 (ALS2). (4) Paramedic ALS intercept (PI). (5) Specialty care transport (SCT). (6) Fixed wing transport (FW). (7) Rotary wing transport (RW). (c) Paramedic ALS intercept services. Paramedic ALS... necessity requirements—(1) General rule. Medicare covers ambulance services, including fixed wing and...

  8. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., level 2 (ALS2). (4) Paramedic ALS intercept (PI). (5) Specialty care transport (SCT). (6) Fixed wing transport (FW). (7) Rotary wing transport (RW). (c) Paramedic ALS intercept services. Paramedic ALS...—(1) General rule. Medicare covers ambulance services, including fixed wing and rotary wing...

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

    The Nordic Atlantic Cooperation (NORA) is an intergovernmental organization under the auspices of the Nordic Council of Ministers. The NORA region comprises Greenland, Iceland, Faroe Islands and western coastal areas of Norway. Historical, cultural and institutional links bind these nations together in multiple ways, and regional co-operation has in recent years become a focus of interest. This commentary addresses air medical services (AMSs) and available advanced hospital services in the 3 smallest NORA countries challenged sparse populations, hereafter referred to as the region. It seems likely that strengthened regional co-operation can help these countries to address common challenges within health care by exchanging know-how and best practices, pooling resources and improving the efficiency of care delivery. The 4 largest hospitals in the region, Dronning Ingrids Hospital in Nuuk (Greenland), Landspítali in Reykjavík and Sjúkrahúsið á Akureyri, (both in Iceland) and Landssjúkrahúsið Tórshavn on the Faroe Islands, have therefore undertaken the project Network for patient transport in the North-West Atlantic (in Danish: Netværk for patienttransport i Vest-Norden). The goal of the project, and of this article, is to exchange information and provide an overview of current AMSs and access to acute hospital care for severely ill or injured patients in the 3 participating countries. Of equal importance is the intention to highlight the need for increased regional co-operation to optimize use of limited resources in the provision of health care services. PMID:26066019

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

    PubMed

    Bleetman, David

    2012-12-01

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

  12. Medicare program; coverage and payment of ambulance services; inflation update for CY 2004. Final rule with comment period.

    PubMed

    2003-12-05

    This final rule provides the sunset date for the interim bonus payment for rural ambulance mileage of 18 through 50 miles as required by the Medicare, Medicaid and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000 (BIPA) and provides notice of the annual Ambulance Inflation Factor (AIF) for ambulance services for calendar year (CY) 2004. The statute requires that this inflation factor be applied in determining the fee schedule amounts and payment limits for ambulance services.

  13. Exploring optimal air ambulance base locations in Norway using advanced mathematical modelling

    PubMed Central

    Røislien, Jo; van den Berg, Pieter L; Lindner, Thomas; Zakariassen, Erik; Aardal, Karen; van Essen, J Theresia

    2017-01-01

    Background Helicopter emergency medical services are an important part of many healthcare systems. Norway has a nationwide physician staffed air ambulance service with 12 bases servicing a country with large geographical variations in population density. The aim of the study was to estimate optimal air ambulance base locations. Methods We used high resolution population data for Norway from 2015, dividing Norway into >300 000 1 km×1 km cells. Inhabited cells had a median (5–95 percentile) of 13 (1–391) inhabitants. Optimal helicopter base locations were estimated using the maximal covering location problem facility location optimisation model, exploring the number of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, both in green field scenarios and conditioning on the current base structure. We reanalysed on municipality level data to explore the potential information loss using coarser population data. Results For a 45 min threshold, 90% of the population could be covered using four bases, and 100% using nine bases. Given the existing bases, the calculations imply the need for two more bases to achieve full coverage. Decreasing the threshold to 30 min approximately doubles the number of bases needed. Results using municipality level data were remarkably similar to those using fine grid information. Conclusions The whole population could be reached in 45 min or less using nine optimally placed bases. The current base structure could be improved by moving or adding one or two select bases. Municipality level data appears sufficient for proper analysis. PMID:27325670

  14. Air ambulance flights in northern Norway 2002-2008. Increased number of secondary fixed wing (FW) operations and more use of rotor wing (RW) transports

    PubMed Central

    2011-01-01

    Background Air ambulance service in Norway has been upgraded during the last years. European regulations concerning pilots' working time and new treatment guidelines/strategies have called for more resources. Aims The objective was to describe and analyse the two supplementary air ambulance [fixed wing (FW) and rotor wing (RW)] alternatives' activity during the study period (2002-2008). Furthermore we aimed to compare our findings with reports from other north European regions. Methods A retrospective analysis. The air ambulance fleet's activity according to the electronic patient record database of "Luftambulansetjenesten ANS" (LABAS) was analysed. The subject was the fleet's operations in northern Norway, logistics, and patients handled. Type of flight, distances, frequency, and patients served were the main outcome measures. Results A significant increase (45%) in the use of RW and a shift in FW operations (less primary and more secondary) were revealed. The shift in FW operations reflected the centralisation of several health care services [i.e. percutaneous cardiac intervention (PCI), trauma, and cancer surgery] during the study period. Cardiovascular disease (CVD) and injuries were the main diagnoses and constituted half of all operations. CVD was the most common cause of FW operations and injuries of the RW ones. The number of air ambulance operations was 16 per 1,000 inhabitants. This was more frequent than in other north European regions. Conclusions The use of air ambulances and especially RW was significantly increased during the study period. The change in secondary FW operations reflected centralisation of medical care. When health care services are centralised, air ambulance services must be adjusted to the new settings. PMID:21878107

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

    PubMed

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

    2017-02-01

    Introduction This study aimed to document the growth and challenges encountered in the decade since inception of the National Ambulance Service (NAS) in Ghana, West Africa. By doing so, potentially instructive examples for other low- and middle-income countries (LMICs) planning a formal prehospital care system or attempting to identify ways to improve existing emergency services could be identified.

  16. Optimization of Ambulance Services at McDonald Army Community Hospital

    DTIC Science & Technology

    2005-05-31

    Joint Legislative Audit and Review Commission (JLARC) Findings The Joint Legislative Audit and Review Commission (JLARC) of the Virginia General... Legislative Audit and Review Commission (JLARC) of the Virginia General Assembly. (2004). Review of emergency medical services in Virginia. JLARC (house...making process for the provision of ambulance service at Kimbrough Ambulatory Care Center. Fort George Meade, MD (DTIC No. ADA324412)

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

    ERIC Educational Resources Information Center

    Vitzthum, Edward F.; And Others

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

  18. [Simplified schema of action of the ambulance rescue services during mass casualty].

    PubMed

    Guła, Przemysław; Hładki, Waldemar; Górski, Krzysztof; Popławska, Małgorzata

    2008-01-01

    Authors represented problems relating mass - casualty accidents and manner of segregation of victims. Lifesaving activities in mass - casualty usually leads to increased emotional stress. It is the result of event specificity, and also of external threats in the zone of activity. Authors presented schema prepared for needs of Cracow's - Ambulance Rescue Services, being the adaptation of universally accepted in western countries algorithm (SAD CHALETS).

  19. Thrombolysis in the air. Air-ambulance paramedics flying to remote communities treat patients before hospitalization.

    PubMed Central

    Kapasi, H.; Kelly, L.; Morgan, J.

    2000-01-01

    PROBLEM ADDRESSED: First Nations* communities in the North have a high prevalence of coronary artery disease and type 2 diabetes and face an increasing incidence of myocardial infarction (MI). Many conditions delay timely administration of thrombolysis, including long times between when patients first experience symptoms and when they present to community nursing stations, delays in air transfers to treating hospitals, uncertainty about when planes are available, and poor flying conditions. OBJECTIVE OF PROGRAM: To develop a program for administration of thrombolysis on the way to hospital by air ambulance paramedics flying to remote communities to provide more rapid thrombolytic therapy to northern patients experiencing acute MIs. COMPONENTS OF PROGRAM: Critical care flight paramedics fly to northern communities from Sioux Lookout, Ont; assess patients; communicate with base hospital physicians; review an exclusion criteria checklist; and administer thrombolytics according to the Sioux Lookout District Health Centre/Base Hospital Policy and Procedure Manual. Patients are then flown to hospitals in Sioux Lookout; Winnipeg, Man; or Thunder Bay, Ont. CONCLUSION: This thrombolysis program is being pilot tested, and further evaluation and development is anticipated. Images p1316-a p1317-a p1317-b PMID:10907571

  20. Emergency call work-load, deprivation and population density: an investigation into ambulance services across England.

    PubMed

    Peacock, Philip J; Peacock, Janet L

    2006-06-01

    Demand for emergency ambulance services has risen steeply over the recent years. This study examined differences in work-load of ambulance services across England and investigated factors linked to high demand. The number of emergency calls received by each ambulance service in 1997 and 2002 and population and area data were used to calculate call rates and population density for each of 27 service areas. Deprivation score and proportion of the population under age 15 and over age 65 were calculated for each service area. There was wide variation in emergency call rates across England, with London having the highest rate both in 1997 (125.6 calls per 1000 persons) and in 2002 (140.1 per 1000). Statistically significant positive associations were observed between call rates and deprivation (1997, r = 0.49; 2002, r = 0.53) and between call rates and population density (1997, r = 0.70; 2002, r = 0.68). Following multivariable regression, the effect of deprivation score was consistently weaker, but the effect of population density was virtually unchanged. We conclude that areas with higher population density have higher call rates, which is not explained by deprivation. Deprivation is associated with higher usage, but its effect is partly due to population density. There is no evidence that these relationships are confounded by age.

  1. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., level 2 (ALS2). (4) Paramedic ALS intercept (PI). (5) Specialty care transport (SCT). (6) Fixed wing transport (FW). (7) Rotary wing transport (RW). (c) Paramedic ALS intercept services. Paramedic ALS...) Be prohibited by State law from billing for any service. (3) Be furnished by a paramedic...

  2. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., level 2 (ALS2). (4) Paramedic ALS intercept (PI). (5) Specialty care transport (SCT). (6) Fixed wing transport (FW). (7) Rotary wing transport (RW). (c) Paramedic ALS intercept services. Paramedic ALS...) Be prohibited by State law from billing for any service. (3) Be furnished by a paramedic...

  3. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., level 2 (ALS2). (4) Paramedic ALS intercept (PI). (5) Specialty care transport (SCT). (6) Fixed wing transport (FW). (7) Rotary wing transport (RW). (c) Paramedic ALS intercept services. Paramedic ALS...) Be prohibited by State law from billing for any service. (3) Be furnished by a paramedic...

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

    PubMed

    Nilsson, Tomas; Lindström, Veronica

    2017-03-02

    Several previous studies have explored nursing students' perceptions of clinical learning at hospitals and in other health care facilities, but there are few studies exploring nursing students' perceptions of the clinical learning in the ambulance service. Therefore, the aim of this study was to explore nursing students' perceptions of learning nursing skills in the ambulance service. An inductive qualitative study design with two focus group interviews and content analysis was used. Two themes were identified. The first theme, professional skills, included: Assessment, Prioritizing and initiating care, and Medical treatment and evaluation of interventions. The second theme, a holistic approach to the care included: Cultural, social, and ethical aspects of caring, Decision-making in collaboration with patients, and Care provided in the patients' home.

  5. An evaluation of some mechanical resuscitators for use in the ambulance service.

    PubMed Central

    Harber, T.; Lucas, B. G.

    1980-01-01

    The requirements for a mechanical resuscitator intended for use in the ambulance service are set out in detail. Seven resuscitators in current use (4 volume-cycled, 3 pressure-cycled) were subjected to a series of tests of efficiency, reliability, and robustness and their portability and foolproof qualities were evaluated. Although 3 of the machines met the functional requirements for resuscitation, only one, the volume-cycled Pneupac, fulfilled all the criteria laid down. PMID:6930934

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

    PubMed

    Nordby, Halvor

    2015-01-01

    Managers of ambulance stations face many communicative challenges in their interaction with employees working in prehospital first-line services. The article presents an exploratory study of how paramedics experience these challenges in communication with station leaders. On the basis of a dialogue perspective in qualitative method, 24 paramedics were interviewed in one-to-one and focus group settings. Naturalistic and phenomenological approaches were used to analyze the interviews. All the paramedics said that they wished to be more involved in decision processes and that station managers should provide better explanations of information "from above." The paramedics understood that it was difficult for the managers to find time for extensive dialogue, but many thought that the managers should give more priority to communication. The paramedics' views correspond to theoretical assumptions in human resource management. According to this model, employees should be involved in decision processes on management levels, as long as it is realistically possible to do so. Furthermore, expressing emotional support and positive attitudes does not take much time, and the study suggests that many ambulance managers should focus more on interpersonal relations to employees. It has been extensively documented that management communication affects organizational performance. The study indicates that managers of ambulance stations should be more aware of how their leadership style affects professional commitment and motivation in the first-line services.

  7. Automated personnel-assets-consumables-drug tracking in ambulance services for more effective and efficient medical emergency interventions.

    PubMed

    Utku, Semih; Özcanhan, Mehmet Hilal; Unluturk, Mehmet Suleyman

    2016-04-01

    Patient delivery time is no longer considered as the only critical factor, in ambulatory services. Presently, five clinical performance indicators are used to decide patient satisfaction. Unfortunately, the emergency ambulance services in rapidly growing metropolitan areas do not meet current satisfaction expectations; because of human errors in the management of the objects onboard the ambulances. But, human involvement in the information management of emergency interventions can be reduced by electronic tracking of personnel, assets, consumables and drugs (PACD) carried in the ambulances. Electronic tracking needs the support of automation software, which should be integrated to the overall hospital information system. Our work presents a complete solution based on a centralized database supported by radio frequency identification (RFID) and bluetooth low energy (BLE) identification and tracking technologies. Each object in an ambulance is identified and tracked by the best suited technology. The automated identification and tracking reduces manual paper documentation and frees the personnel to better focus on medical activities. The presence and amounts of the PACD are automatically monitored, warning about their depletion, non-presence or maintenance dates. The computerized two way hospital-ambulance communication link provides information sharing and instantaneous feedback for better and faster diagnosis decisions. A fully implemented system is presented, with detailed hardware and software descriptions. The benefits and the clinical outcomes of the proposed system are discussed, which lead to improved personnel efficiency and more effective interventions.

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

    PubMed Central

    Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-01-01

    Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001). EMS productivity (median time from EMS notification to unit back in service) was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median). There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions. PMID:27833678

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

    PubMed

    Vieira, Célia Maria Sales; Mussi, Fernanda Carneiro

    2008-12-01

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

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

    PubMed

    Killens, Jason

    2013-03-01

    LOCOG Medical managed thousands of patient contacts across all the Games venues without our intervention. A polyclinic in the athlete's village had extensive diagnostic options, including X-ray and magnetic resonance imaging for athletes and the Olympic family. These helped limit the number of patients who needed transport to the ED. Although the delivery was seamless, there were "behind the scenes" moments in the final stages of planning that made us think. We received additional requests for ambulance cover at training venues that hadn't been planned for on short notice. In addition, the torch relay attracted bigger crowds than initially planned for. Some of the planning assumptions and agreements changed on short notice for various reasons. This meant we had to adjust our plans while also solving human resource issues that you would expect to see among a workforce of around 500 across a six-week period. As part of the National Health Service (NHS) ambulance service Games cohort, more than 500 staff were deployed across 18 venues and 30 days of sport in London. In doing so, they delivered in excess of 165,000 hours of standby and care, responded to nearly 1,500 Games-related incidents and conveyed 800 patients to emergency departments across the capital. After such an influx, it wasn't easy to return to business as usual. Officials with previous host cities had advised us that there would be a feeling of "what next" once the Games concluded. When I first heard this, I thought the opposite would be the case. I expected feeling relieved of overwhelming emotion as well as from the exhaustion of the long days. I do have to say that although this was the case, it's also true that there is a "post Games" come down. We had just been part of a fantastic summer of sport with a brilliant medal tally from Team Great Britain and Paralympics Great Britain that, of course, helped the euphoria. But we did feel real sense of uncertainty about what to do next. We had spent five

  11. Satellite communications experiment for the Ontario air ambulance service

    NASA Technical Reports Server (NTRS)

    Butterworth, John S.

    1988-01-01

    A satellite communications experiment was conducted to develop a reliable voice communications system between paramedics and doctors at certain larger medical centers. The experiment used INMARSAT's Atlantic Ocean Region satellite which provides coverage to the western border of Ontario. Forward downlink power from the satellite is in great demand, so two highly power-efficient modulation schemes were chosen for evaluation during the experiment. These were amplitude-companded single-sideband (ACSSB) and linear predictive coding in conjunction with DMSK modulation. Good performance with a signal to noise ratio of about 10 dB was demonstrated from many parts of the province with the evevation angle to the satellite ranging from five to twenty degrees and with the aircraft both in-flight and on the runway.

  12. Resource planning for ambulance services in mass casualty incidents: a DES-based policy model.

    PubMed

    Rauner, Marion S; Schaffhauser-Linzatti, Michaela M; Niessner, Helmut

    2012-09-01

    Due to an increasing number of mass casualty incidents, which are generally complex and unique in nature, we suggest that decision makers consider operations research-based policy models to help prepare emergency staff for improved planning and scheduling at the emergency site. We thus develop a discrete-event simulation policy model, which is currently being applied by disaster-responsive ambulance services in Austria. By evaluating realistic scenarios, our policy model is shown to enhance the scheduling and outcomes at operative and online levels. The proposed scenarios range from small, simple, and urban to rather large, complex, remote mass casualty emergencies. Furthermore, the organization of an advanced medical post can be improved on a strategic level to increase rescue quality, including enhanced survival of injured victims. In particular, we consider a realistic mass casualty incident at a brewery relative to other exemplary disasters. Based on a variety of such situations, we derive general policy implications at both the macro (e.g., strategic rescue policy) and micro (e.g., operative and online scheduling strategies at the emergency site) levels.

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

    NASA Astrophysics Data System (ADS)

    Gordin, Vladimir; Bykov, Philipp

    2015-04-01

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

  14. Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

    PubMed Central

    Melton, JTK; Jain, S; Kendrick, B; Deo, SD

    2007-01-01

    INTRODUCTION A retrospective review of all patients transferred by helicopter ambulance to the Great Western Hospital over a 20-month period between January 2003 and September 2004 was undertaken to establish the case-mix of patients (trauma and non-trauma) transferred and the outcome. PATIENTS AND METHODS Details of all Helicopter Emergency Ambulance Service (HEAS) transfers to this unit in the study time period were obtained from the three HEAS providers in the area and case notes were reviewed. RESULTS There were 156 trauma patients transferred (total 193) in the study period with 111 cases identified for analysis with a mean age of 33 years (range, 1–92 years). Average Injury Severity Score on admission was 12 (range, 1–36). Forty-five patients were discharged home from the emergency department, 24 cases had operation, 10 patients required ICU care and 2 were pronounced dead in the emergency department. Average hospital stay following HEAS transfer was 2.97 days (range, 0–18 days). DISCUSSION Helicopter ambulance transfer in the acute setting is of debated value. Triage criteria are at fault if as many as 41% of patients transferred are being discharged home from casualty having incurred the financial cost of helicopter transfer. We suggest that the triage criteria for helicopter emergency transfer should be reviewed. PMID:17688727

  15. Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK

    PubMed Central

    Bevan, Gwyn; Hamblin, Richard

    2009-01-01

    Following devolution, differences developed between UK countries in systems of measuring performance against a common target that ambulance services ought to respond to 75% of calls for what may be immediately life threatening emergencies (category A calls) within 8 minutes. Only in England was this target integral to a ranking system of ‘star rating’, which inflicted reputational damage on services that failed to hit targets, and only in England has this target been met. In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings. The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis. The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries. PMID:19381327

  16. The encounter with the unknown: Nurses lived experiences of their responsibility for the care of the patient in the Swedish ambulance service

    PubMed Central

    Holmberg, Mats; Fagerberg, Ingegerd

    2010-01-01

    Registered nurses (RNs) have, according to the Swedish National Board of Health and Welfare, the overall responsibility for the medical care in the ambulance care setting. Bringing RNs into the ambulance service are judged, according to earlier studies, to lead to a degree of professionalism with a higher quality of medical care. Implicitly in earlier studies, the work in the ambulance service involves interpersonal skills. The aim of this study was to describe RNs' experiences of being responsible for the care of the patient in the Swedish ambulance service. A reflective lifeworld approach within the perspective of caring science was used. Five RNs with at least five years experience from care in the ambulance care setting were interviewed. The findings show that the essence of the phenomenon is to prepare and create conditions for care and to accomplish care close to the patient. Three meaning constituents emerged in the descriptions: prepare and create conditions for the nursing care, to be there for the patient and significant others and create comfort for the patient and significant others. The responsibility is a complex phenomenon, with a caring perspective, emerging from the encounter with the unique human being. PMID:20640018

  17. Superior Ambulance Call Out Rate Forecasting Using Meteorological Data

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  18. Aeronautical Decision Making for Air Ambulance Helicopter Pilots: Learning from Past Mistakes

    DTIC Science & Technology

    1988-07-01

    facility that has jurisdiction over your area of operations. 4. And remember "If you don’t want to get eaten by sharks, stay out of the water". That is...subdural hematoma . The pilot called flight service for weather and received a VMC report. Ŗ,000 broken and higher decks with 7 miles visibility

  19. Ag-Air Service

    NASA Technical Reports Server (NTRS)

    1981-01-01

    Econ, Inc.'s agricultural aerial application, "ag-air," involves more than 10,000 aircraft spreading insecticides, herbicides, fertilizer, seed and other materials over millions of acres of farmland. Difficult for an operator to estimate costs accurately and decide what to charge or which airplane can handle which assignment most efficiently. Computerized service was designed to improve business efficiency in choice of aircraft and determination of charge rates based on realistic operating cost data. Each subscriber fills out a detailed form which pertains to his needs and then receives a custom-tailored computer printout best suited to his particular business mix.

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  1. The role of the payment vehicle in non-market valuations of a health care service: willingness-to-pay for an ambulance helicopter service.

    PubMed

    Gyrd-Hansen, Dorte

    2016-01-01

    This study analyses the role of the payment vehicle when conducting non-market valuations of health care services using stated preference methods. Based on a contingent valuation study conducted in Denmark encompassing more than 3400 respondents three important conclusions are drawn. Firstly, it is found that the valuation of a publicly financed ambulance helicopter service is higher than for an identical privately financed service. Secondly, the results suggest that the public premium is likely to be partly driven by altruistic preferences, and that some citizens value access to this type of service for all. An important driver is also perceptions of quality of services across the private and public sector. Finally, it is shown that exclusion of protest bidders is problematic and may bias welfare estimates. The take home message is that it is difficult to isolate the value of a good per se, and that analysts should take care in applying the payment vehicle that is likely to be applied in real life when valuing non-market goods. There has been little awareness of the importance of choice of payment vehicle in the literature to date.

  2. Elderly and Nonelderly Use of a Dedicated Ambulance Corps' Emergency Medical Services in Taiwan.

    PubMed

    Huang, Chien-Chia; Chen, Wei-Lung; Hsu, Chien-Chin; Lin, Hung-Jung; Su, Shih-Bin; Guo, How-Ran; Huang, Chien-Cheng; Chen, Pi-Ching

    2016-01-01

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

  3. Riding Third: Social Work in Ambulance Work

    ERIC Educational Resources Information Center

    Campbell, Hilary; Rasmussen, Brian

    2012-01-01

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

  4. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... equivalent, where other means of transportation would endanger the beneficiary's health. (b) Emergency and... case of a pregnant woman, the health of the woman or her unborn child; (B) Serious impairment to bodily... enrollee is temporarily absent from the MA plan's service (or, if applicable, continuation) area (or,...

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

    PubMed

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

    2016-07-01

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

  6. Ambulance deployment with the hypercube queuing model.

    PubMed

    Larson, R C

    1982-01-01

    A computer-implemented mathematical model has been developed to assist planners in the spatial deployment and dispatching of ambulances. The model incorporates uncertainties in the arrival times, locations, and service requirements of patients, building on the branch of operations research known as queuing theory. Several system-performance measures are generated by the model, including mean neighborhood-specific response times, mean utilization of each ambulance, and statistical profiles of ambulance response patterns. This model has been implemented by the Department of Health and Hospitals of the City of Boston.

  7. Ambulance Design Survey 2011: A Summary Report.

    PubMed

    Lee, Y Tina; Kibira, Deogratias; Feeney, Allison Barnard; Marshall, Jennifer

    2013-01-01

    Current ambulance designs are ergonomically inefficient and often times unsafe for practical treatment response to medical emergencies. Thus, the patient compartment of a moving ambulance is a hazardous working environment. As a consequence, emergency medical services (EMS) workers suffer fatalities and injuries that far exceed those of the average work place in the United States. To reduce injury and mortality rates in ambulances, the Department of Homeland Security Science and Technology Directorate has teamed with the National Institute of Standards and Technology, the National Institute for Occupational Safety and Health, and BMT Designers & Planners in a joint project to produce science-based ambulance patient compartment design standards. This project will develop new crash-safety design standards and improved user-design interface guidance for patient compartments that are safer for EMS personnel and patients, and facilitate improved patient care. The project team has been working with practitioners, EMS workers' organizations, and manufacturers to solicit needs and requirements to address related issues. This paper presents an analysis of practitioners' concerns, needs, and requirements for improved designs elicited through the web-based survey of ambulance design, held by the National Institute of Standards and Technology. This paper also introduces the survey, analyzes the survey results, and discusses recommendations for future ambulance patient compartments design.

  8. Ambulance Design Survey 2011: A Summary Report

    PubMed Central

    Lee, Y Tina; Kibira, Deogratias; Feeney, Allison Barnard; Marshall, Jennifer

    2013-01-01

    Current ambulance designs are ergonomically inefficient and often times unsafe for practical treatment response to medical emergencies. Thus, the patient compartment of a moving ambulance is a hazardous working environment. As a consequence, emergency medical services (EMS) workers suffer fatalities and injuries that far exceed those of the average work place in the United States. To reduce injury and mortality rates in ambulances, the Department of Homeland Security Science and Technology Directorate has teamed with the National Institute of Standards and Technology, the National Institute for Occupational Safety and Health, and BMT Designers & Planners in a joint project to produce science-based ambulance patient compartment design standards. This project will develop new crash-safety design standards and improved user-design interface guidance for patient compartments that are safer for EMS personnel and patients, and facilitate improved patient care. The project team has been working with practitioners, EMS workers’ organizations, and manufacturers to solicit needs and requirements to address related issues. This paper presents an analysis of practitioners’ concerns, needs, and requirements for improved designs elicited through the web-based survey of ambulance design, held by the National Institute of Standards and Technology. This paper also introduces the survey, analyzes the survey results, and discusses recommendations for future ambulance patient compartments design. PMID:26401439

  9. Medicare program; revisions to payment policies under the physician fee schedule, and other Part B payment policies for CY 2008; revisions to the payment policies of ambulance services under the ambulance fee schedule for CY 2008; and the amendment of the e-prescribing exemption for computer generated facsimile transmissions. Final rule with comment period.

    PubMed

    2007-11-27

    This final rule with comment period addresses certain provisions of the Tax Relief and Health Care Act of 2006, as well as making other proposed changes to Medicare Part B payment policy. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule with comment period also discusses refinements to resource-based practice expense (PE) relative value units (RVUs); geographic practice cost indices (GPCI) changes; malpractice RVUs; requests for additions to the list of telehealth services; several coding issues including additional codes from the 5-Year Review; payment for covered outpatient drugs and biologicals; the competitive acquisition program (CAP); clinical lab fee schedule issues; payment for renal dialysis services; performance standards for independent diagnostic testing facilities; expiration of the physician scarcity area (PSA) bonus payment; conforming and clarifying changes for comprehensive outpatient rehabilitation facilities (CORFs); a process for updating the drug compendia; physician self referral issues; beneficiary signature for ambulance transport services; durable medical equipment (DME) update; the chiropractic services demonstration; a Medicare economic index (MEI) data change; technical corrections; standards and requirements related to therapy services under Medicare Parts A and B; revisions to the ambulance fee schedule; the ambulance inflation factor for CY 2008; and amending the e-prescribing exemption for computer-generated facsimile transmissions. We are also finalizing the calendar year (CY) 2007 interim RVUs and are issuing interim RVUs for new and revised procedure codes for CY 2008. As required by the statute, we are announcing that the physician fee schedule update for CY 2008 is -10.1 percent, the initial estimate for the sustainable growth rate for CY 2008 is -0.1 percent, and the conversion factor (CF) for CY 2008 is $34.0682.

  10. Optimal ambulance location with random delays and travel times.

    PubMed

    Ingolfsson, Armann; Budge, Susan; Erkut, Erhan

    2008-09-01

    We describe an ambulance location optimization model that minimizes the number of ambulances needed to provide a specified service level. The model measures service level as the fraction of calls reached within a given time standard and considers response time to be composed of a random delay (prior to travel to the scene) plus a random travel time. In addition to modeling the uncertainty in the delay and in the travel time, we incorporate uncertainty in the ambulance availability in determining the response time. Models that do not account for the uncertainty in all three of these components may overestimate the possible service level for a given number of ambulances and underestimate the number of ambulances needed to provide a specified service level. By explicitly modeling the randomness in the ambulance availability and in the delays and the travel times, we arrive at a more realistic ambulance location model. Our model is tractable enough to be solved with general-purpose optimization solvers for cities with populations around one Million. We illustrate the use of the model using actual data from Edmonton.

  11. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... vehicle. (2) ALS vehicles. In addition to meeting the vehicle staff requirements of paragraph (b)(1) of... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with...

  12. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... vehicle. (2) ALS vehicles. In addition to meeting the vehicle staff requirements of paragraph (b)(1) of... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with...

  13. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... vehicle. (2) ALS vehicles. In addition to meeting the vehicle staff requirements of paragraph (b)(1) of... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with...

  14. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... vehicle. (2) ALS vehicles. In addition to meeting the vehicle staff requirements of paragraph (b)(1) of... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with...

  15. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... vehicle. (2) ALS vehicles. In addition to meeting the vehicle staff requirements of paragraph (b)(1) of... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with...

  16. Ambulation and multiple sclerosis.

    PubMed

    Motl, Robert W

    2013-05-01

    Walking impairment is a common consequence of multiple sclerosis (MS) that can result in substantial limitations of daily activities and compromised quality of life. Walking impairment is often monitored as an indicator of disease and neurologic disability progression. The worsening of walking performance while undertaking a cognitive task underscores the role of nonmotor impairments in ambulation limitations. Walking impairment has ubiquitous and life-altering consequences, underscoring the importance of continued efforts to identify approaches to prevent and forestall this event, and to restore walking ability in persons with MS.

  17. A study of commuter air service

    NASA Technical Reports Server (NTRS)

    Belina, F. W.; Bush, L. R.

    1977-01-01

    A regionally oriented overview of the commuter air service industry is provided. A framework for an eventual assessment of potential technology directions that may be of benefit to the industry is presented. Data are provided on the industry's market characteristics, service patterns, patronage characteristics, aircraft and airport needs, economic characteristics and institutional issues. Using personal interview and literature survey methods, investigation of a considerable cross-section of the industry was made.

  18. Mathematical model of ambulance resources in Saint-Petersburg

    NASA Astrophysics Data System (ADS)

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

    2016-06-01

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

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

    PubMed

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

    2012-01-01

    In this paper we propose an Emergency Department Information System that will be integrated with the ambulance system to improve the communication, enhance the quality of provided emergency services and facilitate information sharing. The proposed system utilizes new advanced technologies such as mobile web services that overcome the problems of interoperability between different systems, HL7 and GPS. The system is unique in that it allows ambulance officers to locate the nearest specialized hospital and allows access to the patient's electronic health record as well as providing the hospital with required information to prepare for the incoming patient.

  20. The application of a marketing systems planning framework to design a ground-air medical transport service.

    PubMed

    Chasin, S; Schlacter, J; Shirley, C

    1986-01-01

    This article has examined the application of a marketing and community planning process to the development of a regional, complete patient transportation system. The model is designed to interface with a region whose existing Emergency Medical Service System is operating at the advanced Life Support (usually paramedic) level. It is suitable for regions whose existing ambulance (ground and air) services are in need of improvement and/or coordination, and specifically utilizes the concept of ownership and management by a hospital consortium. The model, as described, is sufficiently flexible to be usable in a variety of local and regional environments, where changes in the patient transportation system can enhance the quality and operations of emergency medical services.

  1. [New possibilities in emergency medical transportation and emergency services of Polish Medical Air Rescue].

    PubMed

    Gałazkowski, Robert

    2010-01-01

    In Poland, two types of medical services are accomplished by the Medical Air Rescue (MAR) operating all over the country: emergency transport from the incident scene to hospital and inter-hospital transport. Helicopters or planes are used for this purpose. In 2009, helicopters performed 4359 flights to incidents and 1537 inter-hospital transports whereas planes performed 589 inter-hospital ambulance and 196 rescue flights. MAR operates from 17 bases of the Helicopter Emergency Medical Service (HEMS) and one airbase. Helicopters are mainly used when medical transport is emergent, within the operational region of a given base whereas planes when the distance between the present and target airports exceeds 250 km. In 2008, new modern aircraft were introduced to HEMS-helicopters EC 135. They fulfil all requirements of air transport regulations and are adjusted to visual (VFR) and instrumental (IFR) flights rules, at day and night. The medical cabin of EC 135 is ergonomic and functional considering the majority of rescue activities under life-saving circumstances. It is equipped with ventilator, defibrillator, infusion pumps etc. Defibrillators have 12-lead ECG, E(T)CO2, SpO2, NIBP, and IBP modules. Transport ventilators can work in a variety of ventilation modes including CMV, SIMV, SVV, BILEVEL, PCV, ASB, PPV and CPAP. The purchase of helicopters with modern avionic and medical configuration ensures high quality services of MAR for many years to come.

  2. 14 CFR 71.11 - Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Air Traffic Service (ATS) routes. 71.11... (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.11 Air Traffic Service (ATS) routes. Unless otherwise specified, the following...

  3. 14 CFR 71.11 - Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Air Traffic Service (ATS) routes. 71.11... (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.11 Air Traffic Service (ATS) routes. Unless otherwise specified, the following...

  4. 14 CFR 71.11 - Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false Air Traffic Service (ATS) routes. 71.11... (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.11 Air Traffic Service (ATS) routes. Unless otherwise specified, the following...

  5. 14 CFR 71.11 - Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Air Traffic Service (ATS) routes. 71.11... (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.11 Air Traffic Service (ATS) routes. Unless otherwise specified, the following...

  6. 14 CFR 71.11 - Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Air Traffic Service (ATS) routes. 71.11... (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.11 Air Traffic Service (ATS) routes. Unless otherwise specified, the following...

  7. Physical workload of ambulance assistants.

    PubMed

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

    1995-02-01

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

  8. A framework for the design of ambulance sirens.

    PubMed

    Catchpole, K; McKeown, D

    2007-08-01

    Ambulance sirens are essential for assisting the safe and rapid arrival of an ambulance at the scene of an emergency. In this study, the parameters upon which sirens may be designed were examined and a framework for emergency vehicle siren design was proposed. Validity for the framework was supported through acoustic measurements and the evaluation of ambulance transit times over 240 emergency runs using two different siren systems. Modifying existing siren sounds to add high frequency content would improve vehicle penetration, detectability and sound localization cues, and mounting the siren behind the radiator grill, rather than on the light bar or under the wheel arch, would provide less unwanted noise while maintaining or improving the effective distance in front of the vehicle. Ultimately, these considerations will benefit any new attempt to design auditory warnings for the emergency services.

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

    PubMed

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

    2014-08-01

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

  10. Pilot study on the microbial contamination of conventional vs. silver-impregnated uniforms worn by ambulance personnel during one week of emergency medical service.

    PubMed

    Groß, Raoul; Hübner, Nils; Assadian, Ojan; Jibson, Bethany; Kramer, Axel

    2010-09-21

    The antimicrobial impregnation of products used everyday, such as surfaces, textiles and clothing - including those used in hospitals - is increasing. In view of potential toxic and environmental risks for users and patients, a careful risk-benefit assessment must be conducted for each newly developed product impregnated or coated with antimicrobial agents, prior to marketing and manufacture.It has been proposed that incorporation of silver threads into the clothing of emergency service workers could reduce microbial contamination over time. As clothing in the emergency services is often not adequately changed, and it is plausible that microbial contamination increases with time in use, a study was conducted in the emergency medical setting in order to test this hypothesis. We compared the contamination rates of newly developed silver-hybrid clothing with that of standard textile clothing. Samples were taken from jackets and pants of 10 emergency workers at day 0 (pre-service), day 3 and day 7 after use over a divided 4-week period to examine this hypothesis. No significant difference in the extent of microbial contamination was detected between these two materials. A larger sample size is required to further verify this result.

  11. Assessment of the market for compressed air services

    SciTech Connect

    None, None

    2001-01-01

    The objective of this report is to provide a comprehensive and balanced view of the market for engineering and consulting services to improve the energy efficiency of plant compressed air systems. The report is intended for use by Compressed Air Challenge and other industrial energy efficiency program operators in developing strategies to encourage the growth of the compressed air system efficiency and enhance the quality of the services it offers.

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

    PubMed

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

    2017-01-18

    Introduction The staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model. Hypothesis/Problem The objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]).

  13. Emergency Medical Service

    NASA Technical Reports Server (NTRS)

    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.

  14. Air service to small communities, directions for the future. [conference

    NASA Technical Reports Server (NTRS)

    Vittek, J. F., Jr. (Editor)

    1974-01-01

    The seminar on the problems of providing air service to low and medium density points is reported. National transport policies and programs are discussed along with the technology aspects. Recommendations for ATC, CAB, and FAA are included.

  15. A national census of ambulance response times to emergency calls in Ireland

    PubMed Central

    Breen, N.; Woods, J.; Bury, G.; Murphy, A.; Brazier, H.

    2000-01-01

    Background—Equity of access to appropriate pre-hospital emergency care is a core principle underlying an effective ambulance service. Care must be provided within a timeframe in which it is likely to be effective. A national census of response times to emergency and urgent calls in statutory ambulance services in Ireland was undertaken to assess current service provision. Methods—A prospective census of response times to all emergency and urgent calls was carried out in the nine ambulance services in the country over a period of one week. The times for call receipt, activation, arrival at and departure from scene and arrival at hospital were analysed. Crew type, location of call and distance from ambulance base were detailed. The type of incident leading to the call was recorded but no further clinical information was gathered. Results—2426 emergency calls were received by the services during the week. Fourteen per cent took five minutes or longer to activate (range 5–33%). Thirty eight per cent of emergencies received a response within nine minutes (range 10–47%). Only 4.5% of emergency calls originating greater than five miles from an ambulance station were responded to within nine minutes (range 0–10%). Median patient care times for "on call" crews were three times longer than "on duty" crews. Conclusion—Without prioritised use of available resources, inappropriately delayed responses to critical incidents will continue. Recommendations are made to improve the effectiveness of emergency medical service utilisation. PMID:11104237

  16. 106. Air defense command "master plan", base map," RCA Service ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    106. Air defense command "master plan", base map," RCA Service Company tab no. F-1, sheet 1 of 2, dated 22 October, 1965. - Clear Air Force Station, Ballistic Missile Early Warning System Site II, One mile west of mile marker 293.5 on Parks Highway, 5 miles southwest of Anderson, Anderson, Denali Borough, AK

  17. 47 CFR 22.881 - Air-Ground Radiotelephone Service subject to competitive bidding.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air... exclusive initial applications for general aviation Air-Ground Radiotelephone Service licenses and mutually exclusive initial applications for commercial Air-Ground Radiotelephone Service licenses are subject...

  18. 47 CFR 22.881 - Air-Ground Radiotelephone Service subject to competitive bidding.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air... exclusive initial applications for general aviation Air-Ground Radiotelephone Service licenses and mutually exclusive initial applications for commercial Air-Ground Radiotelephone Service licenses are subject...

  19. Simultaneous service approach for reducing air passenger queue time

    SciTech Connect

    Chung, C.A.; Sodeinde, T.

    2000-02-01

    Simultaneous service offers service-oriented organizations, such as the air passenger transportation industry, the opportunity to differentiate themselves by providing superior customer service. The concept of simultaneous service is analogous to the concept of simultaneous engineering. However, while simultaneous engineering strives to minimize product development time, simultaneous service strives to minimize customer processing time. Overall customer processing time is reduced by the identification and simultaneous alignment of previously sequentially executed customer service activities. A simultaneous service approach was applied to the international ticketing counter at a major international airport. This involved developing both equipment and operational policy alternatives to the normal sequencing of the ticketing and baggage check-in process. A total of five alternative simultaneous service approaches were investigated. Simulation analysis of these alternatives indicates that a 36% improvement in customer queue and servicing time was possible with this approach.

  20. Heating and Air Conditioning Specialist. Teacher Edition. Automotive Service Series.

    ERIC Educational Resources Information Center

    Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

    This instructor's guide contains materials for teaching the heating and air conditioning specialist component of a competency-based instructional program for students preparing for employment in the automotive service trade. It is based on the National Institute of Automotive Service Excellence task lists. The six instructional units presented…

  1. Post-Service Utilization of Air Force-Gained Skills.

    ERIC Educational Resources Information Center

    Winkler, Anthony J.; Thompson, Paul D.

    More complete information is needed to determine the extent of utilization in the civilian economy of skills developed during military service. Post-service occupation data have been obtained through a questionnaire mailed ten months after separation to each first-term Air Force enlisted man separated between 1 July 1968 and 31 March 1970. As of…

  2. Assessment and Improvement of Related Services (AIRS) Project. Final Report.

    ERIC Educational Resources Information Center

    McClelland, Robert A.; Hirata, Glenn T.

    The document presents the final report of the Assessment and Improvement of Related Services (AIRS) Project, an effort to assess the impact and effectiveness of special education related services in Hawaii. Each of the four project objectives focused on accomplishment of one of the evaluation types specified in the Context-Input-Process-Product…

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

    PubMed Central

    2013-01-01

    Introduction 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. Method 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. Results 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. Conclusion 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. PMID:23938145

  4. Death by a Thousand Cuts: Micro-Air Vehicles (MAV) in the Service of Air Force Missions

    DTIC Science & Technology

    2001-04-01

    exotic approaches as air suction/injection along the wing surface (which might require micro -valves and micro - pumps ), wall heat transfer, or...AU/AWC/___/2001-4 AIR WAR COLLEGE AIR UNIVERSITY DEATH BY A THOUSAND CUTS: MICRO -AIR VEHICLES (MAV) IN THE SERVICE OF AIR FORCE MISSIONS by...Dates Covered (from... to) - Title and Subtitle Death by a thousand Cuts: Micro -Air Vehicles (MAV) in the Service of Air Force Missions Contract

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

    PubMed

    Doyle, Joseph; Graves, John; Gruber, Jonathan; Kleiner, Samuel

    2015-02-01

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

  6. Developing alternative ambulance response schemes: analysis of attitudes, barriers, and change

    PubMed Central

    Squires, J; Mason, S

    2004-01-01

    Methods: South Yorkshire Ambulance Service crews and control room staff were interviewed, using South Yorkshire's paramedic practitioner (PP) scheme as a model of an alternative response scheme. Results: 55 ambulance crew and 17 control staff were interviewed. Most (97%, n = 70) thought that the PP scheme was a good way of dealing with patients who call 999 but may not need urgent transport and hospital treatment. The perceived effect of the PP scheme on traditional ambulance service duties was equally divided between a third who thought there had been no effect, a third who perceived an improvement, and a third a deterioration. Recurrent difficulties with the scheme were found relating to the AMPDS methodology of ambulance dispatch, and ambulance service performance targets. Conclusions: Flexibility of AMPDS and dispatch targets will need to be reviewed to permit the successful implementation of alternative responses to 999 calls. Careful consideration needs to be given to communicating the aims and value of such schemes to all staff and ensuring a common understanding of, and commitment to, a shared vision. The effect of implementation on the remaining service function must be well planned. PMID:15496710

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

    PubMed

    Wong, Ho-Ting; Lai, Poh-Chin

    2014-07-01

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

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

    PubMed

    Lai, Poh-Chin; Wong, Ho-Ting

    2015-03-01

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

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

    PubMed

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

    2014-03-01

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

  10. 47 CFR 22.805 - Channels for general aviation air-ground service.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 2 2011-10-01 2011-10-01 false Channels for general aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service General Aviation Air-Ground Stations § 22.805 Channels for general aviation air-ground service. The following channels are...

  11. 47 CFR 22.805 - Channels for general aviation air-ground service.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Channels for general aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service General Aviation Air-Ground Stations § 22.805 Channels for general aviation air-ground service. The following channels are...

  12. 47 CFR 22.805 - Channels for general aviation air-ground service.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 2 2012-10-01 2012-10-01 false Channels for general aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service General Aviation Air-Ground Stations § 22.805 Channels for general aviation air-ground service. The following channels are...

  13. 47 CFR 22.805 - Channels for general aviation air-ground service.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Channels for general aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service General Aviation Air-Ground Stations § 22.805 Channels for general aviation air-ground service. The following channels are...

  14. 47 CFR 22.805 - Channels for general aviation air-ground service.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 2 2014-10-01 2014-10-01 false Channels for general aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service General Aviation Air-Ground Stations § 22.805 Channels for general aviation air-ground service. The following channels are...

  15. EPA Facility Registry Service (FRS): AIRS_AQS

    EPA Pesticide Factsheets

    This web feature service contains location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of facilities that link to the Air Quality System (AQS). The AQS contains ambient air pollution data collected by EPA, State, Local, and Tribal air pollution control agencies from thousands of monitoring stations. FRS identifies and geospatially locates facilities, sites or places subject to environmental regulations or of environmental interest. Using vigorous verification and data management procedures, FRS integrates facility data from EPA's national program systems, other federal agencies, and State and tribal master facility records and provides EPA with a centrally managed, single source of comprehensive and authoritative information on facilities. This data set contains the subset of FRS integrated facilities that link to monitoring stations once the AQS data has been integrated into the FRS database. Additional information on FRS is available at the EPA website https://www.epa.gov/enviro/facility-registry-service-frs.

  16. Can innovative ambulance transport avert pregnancy–related deaths? One–year operational assessment in Ethiopia

    PubMed Central

    Godefay, Hagos; Kinsman, John; Admasu, Kesetebirhan; Byass, Peter

    2016-01-01

    Background To maximise the potential benefits of maternity care services, pregnant women need to be able to physically get to health facilities in a timely manner. In most of sub–Saharan Africa, transport represents a major practical barrier. Here we evaluate the extent to which an innovative national ambulance service in Ethiopia, together with mobile phones, may have been successful in averting pregnancy–related deaths. Methods An operational assessment of pregnancy–related deaths in relation to utilisation of the new national ambulance service was undertaken in six randomly selected Districts in northern Ethiopia. All 183 286 households in the six randomly selected Districts were visited to identify live–births and deaths among women of reproductive age that occurred over a one–year period. The uptake of the new ambulance transport service for women’s deliveries in the same six randomly selected Districts over the same period was determined retrospectively from ambulance log books. Pregnancy–related deaths as determined by the World Health Organization (WHO 2012) verbal autopsy tool [13] and the InterVA–4 model [14] were analysed against ambulance utilisation by District, month, local area, distance from health facility and mobile network coverage. Findings A total of 51 pregnancy–related deaths and 19 179 live–births were documented. Pregnancy–related mortality for Districts with above average ambulance utilisation was 149 per 100 000 live–births (95% confidence interval CI 77–260), compared with 350 per 100 000 (95% CI 249–479) for below average utilisation (P = 0.01). Distance to a health facility, mobile network availability and ambulance utilisation were all significantly associated with pregnancy–related mortality on a bivariable basis. On a multivariable basis, ambulance non–utilisation uniquely persisted as a significant determinant of mortality (mortality rate ratio 1.97, 95% CI 1.05–3.69; P = 0

  17. The Economics of Air Force Medical Service Readiness

    DTIC Science & Technology

    2010-01-01

    50 Effects of Converting Inpatient Facilities to Stand -Alone Clinics...for Air Force Medical Service Stand -Alone Clinics in CONUS...Force bases were closed after the end of the Cold War) and to the conversion of many hospitals into stand -alone clinics or ASCs. The reasons for

  18. Learning at Air Navigation Services after Initial Training

    ERIC Educational Resources Information Center

    Teperi, Anna-Maria; Leppanen, Anneli

    2010-01-01

    Purpose: This study aims to find out the means used for individual, group and organizational learning at work at one air navigation service provider after the initial training period. The study also aims to find out what practices need to be improved to enhance learning at work. Design/methodology/approach: The data for the study were collected…

  19. Would You Feel Safe in A Driverless Ambulance?

    MedlinePlus

    ... Would You Feel Safe in a Driverless Ambulance? Vehicles would free up an extra person to care ... does have one potential advantage over current emergency vehicles. Right now, a patient in an ambulance gets ...

  20. Environment and air pollution: health services bequeath to grotesque menace.

    PubMed

    Qureshi, Muhammad Imran; Rasli, Amran Md; Awan, Usama; Ma, Jian; Ali, Ghulam; Faridullah; Alam, Arif; Sajjad, Faiza; Zaman, Khalid

    2015-03-01

    The objective of the study is to establish the link between air pollution, fossil fuel energy consumption, industrialization, alternative and nuclear energy, combustible renewable and wastes, urbanization, and resulting impact on health services in Malaysia. The study employed two-stage least square regression technique on the time series data from 1975 to 2012 to possibly minimize the problem of endogeniety in the health services model. The results in general show that air pollution and environmental indicators act as a strong contributor to influence Malaysian health services. Urbanization and nuclear energy consumption both significantly increases the life expectancy in Malaysia, while fertility rate decreases along with the increasing urbanization in a country. Fossil fuel energy consumption and industrialization both have an indirect relationship with the infant mortality rate, whereas, carbon dioxide emissions have a direct relationship with the sanitation facility in a country. The results conclude that balancing the air pollution, environment, and health services needs strong policy vistas on the end of the government officials.

  1. Optimizing the location of ambulances in Tijuana, Mexico.

    PubMed

    Dibene, Juan Carlos; Maldonado, Yazmin; Vera, Carlos; de Oliveira, Mauricio; Trujillo, Leonardo; Schütze, Oliver

    2017-01-01

    In this work we report on modeling the demand for Emergency Medical Services (EMS) in Tijuana, Baja California, Mexico, followed by the optimization of the location of the ambulances for the Red Cross of Tijuana (RCT), which is by far the largest provider of EMS services in the region. We used data from more than 10,000 emergency calls surveyed during the year 2013 to model and classify the demand for EMS in different scenarios that provide different perspectives on the demand throughout the city, considering such factors as the time of day, work and off-days. A modification of the Double Standard Model (DSM) is proposed and solved to determine a common robust solution to the ambulance location problem that simultaneously satisfies all specified constraints in all demand scenarios selecting from a set of almost 1000 possible base locations. The resulting optimization problems are solved using integer linear programming and the solutions are compared with the locations currently used by the Red Cross. Results show that demand coverage and response times can be substantially improved by relocating the current bases without the need for additional resources.

  2. Infection control implications of the laundering of ambulance staff uniforms and reusable mops.

    PubMed

    Mackay, W G; Whitehead, S; Purdue, N; Smith, M; Redhead, N; Williams, C; Wilson, S

    2017-02-22

    There is a lack of published studies on laundering in ambulance services. We performed bacterial culture on soiled and unsoiled uniforms and reusable mop heads artificially contaminated with Escherichia coli, Staphylococcus aureus, and Clostridium difficile spores. Current laundering processes used for routine cleans in the ambulances appears, from our simulations, to be effective at reducing vegetative pathogenic bacteria to undetectable levels, <3.398log10 colony-forming units (S. aureus and E. coli). Reduced levels of C. difficile were still detected after laundering but the risk this poses for infection is unknown, as background levels of these spores in the environment are unknown.

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

    ERIC Educational Resources Information Center

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

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

  4. 14 CFR 71.13 - Classification of Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Classification of Air Traffic Service (ATS... TRANSPORTATION (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.13 Classification of Air Traffic Service (ATS) routes. Unless...

  5. 14 CFR 71.13 - Classification of Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Classification of Air Traffic Service (ATS... TRANSPORTATION (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.13 Classification of Air Traffic Service (ATS) routes. Unless...

  6. 14 CFR 71.13 - Classification of Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Classification of Air Traffic Service (ATS... TRANSPORTATION (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.13 Classification of Air Traffic Service (ATS) routes. Unless...

  7. 14 CFR 71.13 - Classification of Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Classification of Air Traffic Service (ATS... TRANSPORTATION (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.13 Classification of Air Traffic Service (ATS) routes. Unless...

  8. 76 FR 2744 - Disclosure of Code-Share Service by Air Carriers and Sellers of Air Transportation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-14

    ... Office of the Secretary Disclosure of Code-Share Service by Air Carriers and Sellers of Air... Department is publishing the following notice on the enforcement of its rules relating to disclosure of code... Transportation, Office of the Secretary, Washington, DC Guidance on Disclosure of Code-Share Service Under...

  9. Ambulance restocking could violate federal law, despite safe harbor.

    PubMed

    2000-09-01

    A proposed rule to create safe harbors for EDs that restock ambulances was published by the Office of the Inspector General, but EDs are still at risk for violations. Even common practices such as providing free food, waiving education tuition, and restocking ambulance supplies could violate federal anti-kickback laws. Violations of the anti-kickback statute place a hospital at risk of losing its Medicare status. The proposed rule gives EDs seven criteria to qualify for safe harbors for ambulance restocking.

  10. The Economics of Air Force Medical Service Readiness.

    PubMed

    Graser, John C; Blum, Daniel; Brancato, Kevin; Burks, James J; Chan, Edward W; Nicosia, Nancy; Neumann, Michael J; Ritschard, Hans V; Mundell, Benjamin F

    2012-01-01

    The prime mission of the Air Force Medical Service (AFMS), like those of the medical departments of its sister services, is to provide medical care during wartime. AFMS currently runs three successful in-theater hospitals that treat severely injured or wounded U.S. personnel from all four services. But this wartime mission depends on capabilities built at home, as critical-care specialists maintain their technical proficiency, as much as peacetime opportunities allow, by meeting health-care needs of Department of Defense beneficiaries at home. These patients have ranged from young, healthy active-duty personnel to aging retirees, historically presenting a broad range of injuries and illnesses for treatment. However, between the demands of deployments creating gaps in staff at home and changes in care plans, some beneficiaries now seek care in the civilian sector. In addition, several AFMS hospitals stateside have been closed, converted to clinics, or combined with those of other services for various reasons. All is problematic for two reasons: First, inpatient workloads in particular represent the best opportunities for critical care providers to prepare for their wartime missions. AFMS will need to increase these opportunities, perhaps working with other services, the Department of Veterans Affairs, or civilian hospitals. Second, AFMS's funding depends, in part, on the workload performed, but current measurement methods do not necessarily do a good job of accounting for the work AFMS practitioners accomplish outside their home stations. Some imminent changes may help resolve this situation, but AFMS should pursue opportunities to create additional workload for its medical personnel and to increase its budgets.

  11. Shoes versus sneakers in toddler ambulation.

    PubMed

    Gould, N

    1985-10-01

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

  12. Leg spasticity and ambulation in multiple sclerosis.

    PubMed

    Balantrapu, Swathi; Sosnoff, Jacob J; Pula, John H; Sandroff, Brian M; Motl, Robert W

    2014-01-01

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

  13. Leg Spasticity and Ambulation in Multiple Sclerosis

    PubMed Central

    Balantrapu, Swathi; Sosnoff, Jacob J.; Pula, John H.; Sandroff, Brian M.; Motl, Robert W.

    2014-01-01

    Background. Spasticity of the legs is common in multiple sclerosis (MS), but there has been limited research examining its association with ambulatory outcomes. Objective. This study examined spasticity of the legs and its association with multiple measures of ambulation in persons with MS. Methods. The sample included 84 patients with MS. Spasticity of the legs was measured using a 5-point rating scale ranging between 0 (normal) and 4 (contracted). Patients completed the 6-minute walk (6 MW), timed 25 foot walk (T25FW), and timed up-and-go (TUG), and O2 cost of walking was measured during the 6 MW. The patients undertook two walking trials on a GAITRite (CIR systems, Inc.) for measuring spatial and temporal parameters of gait. The patients completed the Multiple Sclerosis Walking Scale-12 (MSWS-12) and wore an accelerometer over a seven-day period. Results. 52% (n = 44) of the sample presented with spasticity of the legs. Those with leg spasticity had significantly worse ambulation as measured by 6 MW (P = 0.0001, d = −0.86), T25FW (P = 0.003, d = 0.72), TUG (P = 0.001, d = 0.84), MSWS-12 (P = 0.0001, d = 1.09), O2 cost of walking (P = 0.001, d = 0.75), average steps/day (P < 0.05, d = −0.45), and walking velocity (P < 0.05, d = −0.53) and cadence (P < 0.05, d = −0.46). Conclusion. Leg spasticity was associated with impairments in ambulation, including alterations in spatiotemporal parameters and free-living walking. PMID:24999434

  14. Ambulation Increases Decompression Sickness in Spacewalk Simulations

    NASA Technical Reports Server (NTRS)

    Pollock, N. W.; Natoli, M. J.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. Understanding the relationships is important to evaluate exercise prebreathe protocols and quantify decompression risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS. METHODS Four experiments will replicate the CEVIS exercise-enhanced oxygen prebreathe protocol, each with a different exception. The first of these is currently underway. Experiment 1 - Subjects complete controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining nonambulatory throughout. Experiment 2 - Subjects remain non-ambulatory during the preflight period and ambulatory at 4.3 psi. Experiment 3 - Subjects ambulate during the preflight period and remain non-ambulatory at 4.3 psi. Experiment 4 - The order of heavy and light exercise employed in the CEVIS protocol is

  15. Resources and Fact Sheets on Servicing Motor Vehicle Air Conditioners (Summary Page)

    EPA Pesticide Factsheets

    Page provides links to resources that can assist motor vehicle air-conditioning system technicians in understanding system servicing requirements and best practices, and learn about alternative refrigerants.

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

    ERIC Educational Resources Information Center

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

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

  17. 78 FR 26103 - Proposed Standard Operating Procedure (SOP) of the Aircraft Certification Service (AIR) Project...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-03

    ... Service (AIR) Project Prioritization and Resource Management ACTION: Notice of availability and request... process used to prioritize certification projects and manage certification project resources when local... Operating Procedure--Aircraft Certification Service Project Prioritization. FOR FURTHER INFORMATION...

  18. 29 CFR 4.130 - Types of covered service contracts illustrated.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

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

    ERIC Educational Resources Information Center

    National Registry of Emergency Medical Technicians, Columbus, OH.

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

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

    PubMed Central

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

    2015-01-01

    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. PMID:26374468

  1. 76 FR 52731 - On-Line Complaint Form for Service-Related Issues in Air Transportation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ... Office of the Secretary On-Line Complaint Form for Service-Related Issues in Air Transportation AGENCY... public to electronically submit aviation service-related complaints against air carriers. DATES: Comments... U.S.C., Subtitle VII, to investigate and enforce consumer protection and civil rights laws...

  2. 14 CFR 375.50 - Transit flights; scheduled international air service operations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Transit flights; scheduled international... WITHIN THE UNITED STATES Transit Flights § 375.50 Transit flights; scheduled international air service... to the International Air Services Transit Agreement in transit across the United States may not...

  3. 14 CFR 375.50 - Transit flights; scheduled international air service operations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Transit flights; scheduled international... WITHIN THE UNITED STATES Transit Flights § 375.50 Transit flights; scheduled international air service... to the International Air Services Transit Agreement in transit across the United States may not...

  4. 14 CFR 375.50 - Transit flights; scheduled international air service operations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Transit flights; scheduled international... WITHIN THE UNITED STATES Transit Flights § 375.50 Transit flights; scheduled international air service... to the International Air Services Transit Agreement in transit across the United States may not...

  5. 14 CFR 375.50 - Transit flights; scheduled international air service operations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Transit flights; scheduled international... WITHIN THE UNITED STATES Transit Flights § 375.50 Transit flights; scheduled international air service... to the International Air Services Transit Agreement in transit across the United States may not...

  6. 14 CFR 375.50 - Transit flights; scheduled international air service operations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Transit flights; scheduled international... WITHIN THE UNITED STATES Transit Flights § 375.50 Transit flights; scheduled international air service... to the International Air Services Transit Agreement in transit across the United States may not...

  7. 76 FR 72836 - Amendment and Establishment of Air Traffic Service Routes; Northeast United States

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-28

    ... Federal Aviation Administration 14 CFR Part 71 RIN 2120-AA66 Amendment and Establishment of Air Traffic Service Routes; Northeast United States AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Final... Register on September 19, 2011, that amends and establishes nine Air Traffic Service Routes (ATS) in...

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

    PubMed

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

    1995-12-01

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

  9. Does telephone triage of emergency (999) calls using advanced medical priority dispatch (AMPDS) with Department of Health (DH) call prioritisation effectively identify patients with an acute coronary syndrome? An audit of 42 657 emergency calls to Hampshire Ambulance Service NHS Trust

    PubMed Central

    Deakin, C D; Sherwood, D M; Smith, A; Cassidy, M

    2006-01-01

    Introduction The National Service Framework for Coronary Heart Disease requires identification of patients with an acute coronary syndrome (ACS) to enable prompt identification of those who may subsequently require pre‐hospital thrombolysis. The Advanced Medical Priority Despatch System (AMPDS) with Department of Health (DH) call prioritisation is now the common triage tool for emergency (‘999') calls in the UK. We retrospectively examined patients with ACS to identify whether this triage tool had been able to allocate an appropriate emergency response. Methods All emergency calls to Hampshire Ambulance Service NHS Trust (HAST) from the Southampton area over an 8 month period (January to August 2004) were analysed. The classification allocated to the patient by AMPDS (version 10.4) was specifically identified. Data from the Myocardial Infarct National Audit Project) were obtained from the receiving hospital in Southampton to identify the actual number of patients with a true ACS. Results In total, 42 657 emergency calls were made to HAST from the Southampton area. Of these, 263 patients were subsequently diagnosed in hospital as having an ACS. Of these 263 patients, 76 presented without chest pain. Sensitivity of AMPDS for detecting ACS in this sample was 71.1% and specificity 92.5%. Positive predictive value was 5.6% (95% confidence interval 4.8 to 6.4%), and 12.5% (33/263) of patients with confirmed ACS were classified as non‐life threatening (category B) incidents. Conclusion Only one of approximately every 18 patients with chest pain has an ACS. AMPDS with DH call prioritisation is not a tool designed for clinical diagnosis, and its extension into this field does not enable accurate identification of patients with ACS. PMID:16498168

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

    PubMed

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

    2016-08-31

    Emergency ambulance calls represent one of the routes of emergency hospital admissions from care homes. We aimed to describe the pattern of ambulance call rates from care homes and identify factors predicting those homes calling for an ambulance most frequently. We obtained data from South Western Ambulance Service NHS Foundation Trust on 3138 ambulance calls relating to people aged 65 and over from care homes in the Torbay region between 1 April 2012 and 31 July 2013. We supplemented this with data from the Care Quality Commission (CQC) website on home characteristics and outcomes of CQC inspections. We used descriptive statistics to identify variation in ambulance call rates for residential and nursing homes and fitted negative binomial regression models to determine if call rates were predicted by home type (nursing versus residential), the five standards in the CQC reports, dementia care status or travel time to hospital. One hundred and forty-six homes (119 residential and 27 nursing) were included in the analysis. The number of calls made ranged from 1 to 99. The median number (IQR; range) of calls per resident per year was 0.51 (0.21-0.89; 0.03-2.45). Nursing homes had a lower call rate than residential homes [adjusted rate ratio (ARR) 0.29; 95% CI: 0.22-0.40; P < 0.001]; care homes failing the quality and suitability of management standard had a lower call rate compared to those who passed (ARR 0.67; 95% CI: 0.50-0.90; P = 0.006); and homes specialising in dementia had a higher call rate compared to those not specialising (ARR 1.56; 95% CI: 1.23-1.96; P < 0.001). These findings require replication in other regions to establish their generalisability and further investigation is required to determine the extent to which call rate variability reflects the different needs of resident populations or differences in care home policies and practice.

  11. Ambulation Increases Decompression Sickness in Altitude Exposure

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny; Pollock, N. W.; Natoli, M. J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    INTRODUCTION - Exercise accelerates inert gas elimination during oxygen breathing prior to decompression (prebreathe), but may also promote bubble formation and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of exercise are likely critical to the net effect. The NASA Prebreathe Reduction Program (PRP) combined oxygen prebreathe and exercise preceding a 4.3 psi exposure in non-ambulatory subjects (a microgravity analog) to produce two protocols now used by astronauts preparing for extravehicular activity (CEVIS and ISLE). Additional work is required to investigate whether exercise normal to 1 G environments increases the risk of DCS over microgravity simulation. METHODS - The CEVIS protocol was replicated with one exception. Our subjects completed controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining non-ambulatory throughout. Decompression stress was graded with aural Doppler (Spencer 0-IV scale). Two-dimensional echocardiographic imaging was used to look for left heart gas emboli (the presence of which prompted test termination). Venous blood was collected at three points to correlate Doppler measures of decompression stress with microparticle (cell fragment) accumulation. Fisher Exact Tests compared test and control groups. Trial suspension would occur when DCS risk >15% or grade IV venous gas emboli (VGE) risk >20% (at 70% confidence). RESULTS - Eleven person-trials were completed (9 male, 2 female) when DCS prompted suspension. DCS was greater than in CEVIS trials (3/11 [27%] vs. 0/45 [0%], respectively, p=0.03). Statistical significance was not reached for peak grade IV VGE (2/11 [18%] vs. 3/45 [7%], p=0.149) or cumulative grade IV VGE observations per subject-trial (8/128 [6%] vs. 26/630 [4%], p=0.151). Microparticle data were collected for 5/11 trials (3 with DCS outcomes), with widely varying patterns that could not be resolved statistically

  12. Glossary of AWS Acrinabs. Acronyms, Initialisms, and Abbreviations Commonly Used in Air Weather Service

    DTIC Science & Technology

    1991-01-01

    National Environmental Data Referral Service NASNET. ... National Airspace System Network NEDS ......... Navy Environmenta! Display Station NASP...Electrical Manufacturers Association NASS ......... National Agricultural Statistics Service NEMS ........ Nimbus-E Microwave Spectrometer NATO...North Atlantic Treaty Organization NEO ........... noncombatant emergency operations NATS ......... Naval Air Transport Service NEPA --------- National

  13. Detection and characterization of surface microbial contamination in emergency ambulances.

    PubMed

    Varona-Barquin, Aketza; Ballesteros-Peña, Sendoa; Lorrio-Palomino, Sergio; Ezpeleta, Guillermo; Zamanillo, Verónica; Eraso, Elena; Quindós, Guillermo

    2017-01-01

    A cross-sectional study was performed in 10 emergency basic life support ambulances operating in Bilbao, Spain, to assess surface bacterial contamination. Presence of clinically relevant bacterial contamination suggests that disinfection of the studied basic life support ambulances was not optimal and represents a potential risk of infection for the patients transferred in them. It is critical to implement existing infection control and prevention protocols to resolve this issue.

  14. Customer Service Analysis of Air Combat Command Vehicle Maintenance Support

    DTIC Science & Technology

    1993-09-01

    the survey, the researchers categorized the services or variables into marketing mix components: product, price, promotion, and customer service...comparing and analyzing the variables identified in the previous three phases to determine a strategic marketing mix (46:9). After analyzing the data...service/physical distribution. Additionally, they found that customer service/physical distribution was an integral component of the marketing mix , and

  15. Pan American Airways/Naval Air Transport Service/destroyer base site showing stone ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Pan American Airways/Naval Air Transport Service/destroyer base site showing stone wall around patio. View facing east-southeast. - U.S. Naval Base, Pearl Harbor, Pearl City Peninsula, Pearl City, Honolulu County, HI

  16. Pan American Airways/Naval Air Transport Service/destroyer base site showing brick ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Pan American Airways/Naval Air Transport Service/destroyer base site showing brick and concrete paving of patio, and circular planters. View facing east. - U.S. Naval Base, Pearl Harbor, Pearl City Peninsula, Pearl City, Honolulu County, HI

  17. 76 FR 54528 - Standard Operating Procedures (SOP) of the Aircraft Certification Service (AIR) Process for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-01

    ... (AIR) Process for the Sequencing of Certification and Validation Projects AGENCY: Federal Aviation...) standard operating procedure (SOP) describing the process used to sequence certification projects that are... Procedure--Aircraft Certification Service Project Sequencing to: Federal Aviation Administration,...

  18. Ambulation after Deep Vein Thrombosis: A Systematic Review

    PubMed Central

    Overend, Tom J.; Godwin, Julie; Sealy, Christina; Sunderji, Aisha

    2009-01-01

    ABSTRACT Purpose: To systematically review the effects of early ambulation on development of pulmonary embolism (PE) and progression or development of a new thrombus in patients with acute deep vein thrombosis (DVT). Methods: Medline, PubMed, CINAHL, EMBASE, PEDro, and Cochrane Library databases were searched from inception to June 2008. Study quality was appraised using the Jadad and PEDro scales. Meta-analyses were reported as relative risks (RR) and 95% confidence intervals (CI). Results: Four randomized trials were accepted. For development of a PE, the pooled relative risks for ambulation and compression versus bed rest and compression (RR = 0.63, 95% CI: 0.34–1.19) and for ambulation and compression versus bed rest alone (RR = 1.36, 95% CI: 0.57–3.29) were not significant. For progression of an existing thrombus or development of a new thrombus, the independent relative risks for ambulation and compression versus bed rest and compression (RR = 0.39, 95% CI: 0.13–1.14) and for ambulation and compression versus bed rest alone (RR = 0.56, 95% CI: 0.20–1.57) were also not significant. Conclusions: Given the clinical benefits of mobility, and because there was no significant difference between ambulation and bed rest for risk of developing a PE or development and progression of a new DVT in any of the studies, clinicians should be confident in prescribing ambulation in this population. PMID:20514175

  19. 5 CFR 9701.232 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Special transition rules for Federal Air... subpart, if DHS transfers Federal Air Marshal Service positions from the Transportation Security Administration (TSA) to another organization within DHS, DHS may cover those positions under a...

  20. 5 CFR 9701.232 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Special transition rules for Federal Air... subpart, if DHS transfers Federal Air Marshal Service positions from the Transportation Security Administration (TSA) to another organization within DHS, DHS may cover those positions under a...

  1. 5 CFR 9701.374 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Special transition rules for Federal Air... in this subpart, if DHS transfers Federal Air Marshal Service positions from the Transportation Security Administration (TSA) to another organization within DHS, DHS may cover those positions under a...

  2. 5 CFR 9701.374 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Special transition rules for Federal Air... in this subpart, if DHS transfers Federal Air Marshal Service positions from the Transportation Security Administration (TSA) to another organization within DHS, DHS may cover those positions under a...

  3. Transition of AIRS Products to the National Weather Service

    NASA Technical Reports Server (NTRS)

    Zavodsky, Bradley

    2012-01-01

    Short-term Prediction Research and Transition Center (SPoRT) is a proven community leader for transitioning satellite products to operational end users and is working hard to bring data from Atmospheric Infrared Sounder (AIRS) to forecasters. SPoRT products using AIRS data are currently or will soon be evaluated at WFOs and National Centers (1) T and q profiles: HWT, Alaska WFOs, HRD/OPC, HMT (2) Ozone profiles: HPC/OPC (3) Carbon Monoxide: Southern and Western Region WFOs SPoRT is actively evaluating differences between V5 and V6 profiles for selected cases and will continue to provide feedback to the AIRS team as V6 development efforts conclude.

  4. Operational factors of air service to small communities

    NASA Technical Reports Server (NTRS)

    1975-01-01

    The feasibility of using 30-passenger jet aircraft to service low density, short haul markets was analyzed. Aircraft characteristics, market potential, and economic factors were among the areas evaluated.

  5. A Consumer Evaluation of Air Force Food Service

    DTIC Science & Technology

    1974-07-01

    unrounded data is indicated in parentheses in this and the following tables. 11 Table 3 presents the Air Force consumers ’ preferences for cuisine or...RECOMMENDATIONS The reader should bear in mind that the following statements are made solely to reflect the consumers ’ preferences . Words like "must

  6. Air Quality Management Using Pollution Prevention: A Joint Service Approach

    DTIC Science & Technology

    1998-03-01

    noncorrosive, nontoxic oil dispersant and cleanser that contains no VOCs, no known carcinogens, and no chemicals regulated by the Occupational Safety and... rinsability , corrosion, hydrogen embrittlement, storage stability, and density. Once this testing is complete, the Air Force will select three stripper

  7. Profile of Ambulance Runs at the Kennedy Space Center

    NASA Technical Reports Server (NTRS)

    Scarpa, Philip J.

    1999-01-01

    The Kennedy Space Center (KSC) has four onsite ambulances staffed with Paramedics at two fire stations that respond to 911 Emergency Medical System (EMS) medical dispatches. These ambulances serve over 22,000 NASA, military, government, and contractor employees in an area of approximately 520 square miles. Included in this coverage are several public areas such as beaches, a wildlife refuge and a popular Visitor Center. Reports are filled out on each patient encountered. However. the only element tracked has been the ambulance response time. Now that reports are filed electronically, it is possible to enter them into an electronic database for analysis. Data analyses reveal trends and assist in better allocation of resources.

  8. Air Force Engineering and Services Laboratory Herbicide Orange Monitoring Program

    DTIC Science & Technology

    1984-04-01

    Air Force leaders with the latest available cata in the continuing environmental monitoring and evaluation studies at these critical sites... monitoring and evaluation studies ot areas on Johnston Island, the Naval Construction Battalion Center, and Eglin APB, previously used for the... and evaluation program by collecting samples from NCBC, JI, and Eglin AFB on a semiannual basis. This report summarizes the data on samples collected

  9. Army Air Force Exchange Service Service (AAFES) Station Tyndall Air Force Base, Florida Final Tiered Environmental Assessment

    DTIC Science & Technology

    2010-04-20

    Management, No ise, Land Use, Air Quali ty, Earth Resources, Biological Resources, Cultural Resources, Water Resources, Hazardous Materials and Wastes ...Resources, Biological Resources, Cultural Resources, Water Resources, Hazardous Materials and Wastes , Safety, Infrastructure and Util ities, Socioeconomic...No impacts to floodpl ai ns. Storm water permit ----:- ---- would be required. _ ____ _ l lazardous Materia ls and Wastes No negative short- or

  10. Application of AirCell Cellular AMPS Network and Iridium Satellite System Dual Mode Service to Air Traffic Management

    NASA Technical Reports Server (NTRS)

    Shamma, Mohammed A.

    2004-01-01

    The AirCell/Iridium dual mode service is evaluated for potential applications to Air Traffic Management (ATM) communication needs. The AirCell system which is largely based on the Advanced Mobile Phone System (AMPS) technology, and the Iridium FDMA/TDMA system largely based on the Global System for Mobile Communications(GSM) technology, can both provide communication relief for existing or future aeronautical communication links. Both have a potential to serve as experimental platforms for future technologies via a cost effective approach. The two systems are well established in the entire CONUS and globally hence making it feasible to utilize in all regions, for all altitudes, and all classes of aircraft. Both systems have been certified for air usage. The paper summarizes the specifications of the AirCell/Iridium system, as well as the ATM current and future links, and application specifications. the paper highlights the scenarios, applications, and conditions under which the AirCell/Iridium technology can be suited for ATM Communication.

  11. Effects of weather conditions on emergency ambulance calls for acute coronary syndromes

    NASA Astrophysics Data System (ADS)

    Vencloviene, Jone; Babarskiene, Ruta; Dobozinskas, Paulius; Siurkaite, Viktorija

    2015-08-01

    The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature ( T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October-April) and warm (May-September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June-September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACS.

  12. Combat Service Support of AirLand Battle Doctrine,

    DTIC Science & Technology

    1986-05-20

    thereby causing him to lose control of the battle. In the offense, it means setting the tarfa of battle and never allowing the enemy to recover from...disorganizes his forces, causes him to lose control and ultimately brings about his defeat. To achieve these conditions on the battlefield requires a...units with a command and control system that allows the coordination and redirection of combat service support assets when and where required. Implied

  13. A Correlational Study of How Airline Customer Service and Consumer Perception of Airline Customer Service Affect the Air Rage Phenomenon

    NASA Technical Reports Server (NTRS)

    Hunter, Joyce A.

    2007-01-01

    Between 1995 and 2000, customer service declined throughout the airline industry, as reported in February 2001 by the U.S. Department of Transportation (2001). One of the biggest problems today within the airline industry is the constant complaining from customers regarding the deterioraton of service (McCollough, Berry, & Yadav, 2000). Since 1995, unfortunately no airline has been immune from service deterioration, as reported by the Airline Quality Rating, an annual report by two airline industry experts who analyzed Department of Transportation statistics (Harrison & Kleinsasser, 1999). The airline' refusal to recognize the issue of customer service has perpetuated an environment that has become dangerous and detrimental to the traveling public as well as to airline employees, which in turn has fueled a new phenomenon, now referred to as "air rage".

  14. A method for the determination of potentially profitable service patterns for commuter air carriers

    NASA Technical Reports Server (NTRS)

    Ransone, R. K.; Kuhlthau, A. R.; Deptula, D. A.

    1975-01-01

    A methodology for estimating market conception was developed as a part of the short-haul air transportation program. It is based upon an analysis of actual documents which provide a record of known travel history. Applying this methodology a forecast was made of the demand for an air feeder service between Charlottesville, Virginia and Dulles International Airport. Local business travel vouchers and local travel agent records were selected to provide the documentation. The market was determined to be profitable for an 8-passenger Cessna 402B aircraft flying a 2-hour daily service pattern designed to mesh to the best extent possible with the connecting schedules at Dulles. The Charlottesville - Dulles air feeder service market conception forecast and its methodology are documented.

  15. 4. OVERALL VIEW TO NORTH SHOWING (LEFT TO RIGHT) AMBULANT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. OVERALL VIEW TO NORTH SHOWING (LEFT TO RIGHT) AMBULANT QUARTERS, STOREHOUSE, BOILER HOUSE (LARGELY OBSCURED), SMOKESTACK, STATION GARAGE, ANIMAL HOUSE, AND WATER SOFTENER BUILDING - VA Medical Center, Aspinwall Division, 5103 Delafield Avenue (O'Hara Township), Aspinwall, Allegheny County, PA

  16. Adaption of the Air Weather Service Fog Model to Forecast Radiation Fog Events in the Southeast United States

    DTIC Science & Technology

    1997-03-01

    ADAPTATION OF THE AIR WEATHER SERVICE FO MODEL TO FORECAST RADIATION FOG EVENT IN THE SOUTHEAST UNITED STATES THESIS Andrew C. Goodnite, Captain...ENP/97M-06 ADAPTATION OF THE AIR WEATHER SERVICE FOG MODEL TO FORECAST RADIATION FOG EVENTS IN THE SOUTHEAST UNITED STATES THESIS Andrew C. Goodnite...AIR WEATHER SERVICE FOG MODEL TO FORECAST RADIATION FOG EVENTS IN THE SOUTHEAST UNITED STATES THESIS Presented to the Faculty of the Graduate School of

  17. Office of Inspector General audit report on aircraft and air service management programs

    SciTech Connect

    1999-01-01

    The Department of Energy`s (DOE) Albuquerque Operations Office (Albuquerque) owns seven aircraft that support defense programs, research and development efforts, emergency response programs, and official travel of Government and contractor employees. An Office of Inspector General (OIG) report, issued in 1994, identified concerns with Albuquerque`s cost for air service. Since that report, there have been reductions in cost and personnel indicating changes in air service requirements. This audit was conducted to determine (1) whether costs to operate Albuquerque`s aircraft were excessive and (2) if individual aircraft in the fleet were justified.

  18. Quantification of NSW Ambulance Record Linkages with Multiple External Datasets.

    PubMed

    Carroll, Therese; Muecke, Sandy; Simpson, Judy; Irvine, Katie; Jenkins, André

    2015-01-01

    This study has two aims: 1) to describe linkage rates between ambulance data and external datasets for "episodes of care" and "patient only" linkages in New South Wales (NSW), Australia; and 2) to detect and report any systematic issues with linkage that relate to patients, and operational or clinical variables that may introduce bias in subsequent studies if not adequately addressed. During 2010-11, the Centre for Health Record Linkage (CHeReL) in NSW, linked the records for patients attended by NSW Ambulance paramedics for the period July 2006 to June 2009, with four external datasets: Emergency Department Data Collection; Admitted Patient Data Collection; NSW Registry of Births, Deaths and Marriages death registration data; and the Australian Bureau of Statistics mortality data. This study reports linkage rates in terms of those "expected" to link and those who were "not expected" to link with external databases within 24 hours of paramedic attendance. Following thorough data preparation processes, 2,041,728 NSW Ambulance care episodes for 1,116,509 patients fulfilled the inclusion criteria. The overall episode-specific hospital linkage rate was 97.2%. Where a patient was not transported to hospital following paramedic care, 8.6% of these episodes resulted in an emergency department attendance within 24 hours. For all care episodes, 5.2% linked to a death record at some time within the 3-year period, with 2.4% of all death episodes occurring within 7 days of a paramedic encounter. For NSW Ambulance episodes of care that were expected to link to an external dataset but did not, nonlinkage to hospital admission records tended to decrease with age. For all other variables, issues relating to rates of linkage and nonlinkage were more indiscriminate. This quantification of the limitations of this large linked dataset will underpin the interpretation and results of ensuing studies that will inform future clinical and operational policies and practices at NSW Ambulance.

  19. Best Practices in Developing Proactive Supply Strategies for Air Force Low-Demand ServiceParts

    DTIC Science & Technology

    2010-01-01

    avionics and wheels and brakes, had the third-most low-demand requi- sitions, and well as the third-most overall requisitions. Two Air Force bases...overhauls), and airframe and avionics work. Both end-users and manufacturers that we interviewed claimed that about 80 percent of the aftermarket service...example, has publicly reported it has agreements with its avionics suppliers to provide aftermarket services as long as even only one of its products

  20. Pan American Airways/Naval Air Transport Service/destroyer base site at the ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Pan American Airways/Naval Air Transport Service/destroyer base site at the east side showing walkway and building foundation. View facing west-northwest. - U.S. Naval Base, Pearl Harbor, Pearl City Peninsula, Pearl City, Honolulu County, HI

  1. 76 FR 61245 - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ... obtained on reasonable terms and conditions from any company authorized to conduct an insurance business in... October 3, 2011 Part VI The President Memorandum of September 28, 2011--Provision of Aviation Insurance... Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International...

  2. 78 FR 10560 - Proposed Modification and Revocation of Air Traffic Service Routes; Jackson, MS

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-14

    ... Modification and Revocation of Air Traffic Service Routes; Jackson, MS AGENCY: Federal Aviation Administration... jet routes and seven VOR Federal airways; and remove two VOR Federal airways in the vicinity of... amendment to Title 14, Code of Federal Regulations (14 CFR) part 71 to modify two jet routes and seven...

  3. 3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 3 The President 1 2011-01-01 2011-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of September 29, 2010 Provision of Aviation Insurance Coverage for...

  4. 3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 3 The President 1 2013-01-01 2013-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of September 27, 2012 Provision of Aviation Insurance Coverage for...

  5. 3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 3 The President 1 2014-01-01 2014-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of December 27, 2013 Provision of Aviation Insurance Coverage for...

  6. 3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 3 The President 1 2012-01-01 2012-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of September 28, 2011 Provision of Aviation Insurance Coverage for...

  7. 3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 3 The President 1 2010-01-01 2010-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of August 21, 2009 Provision of Aviation Insurance Coverage for...

  8. 77 FR 30437 - Proposed Amendment of Air Traffic Service Routes; Southwestern United States

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-23

    ... Routes; Southwestern United States AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of... Federal Register proposing to amend various Air Traffic Service Routes in the Southwestern United States...; Southwestern United States as published in the Federal Register of April 23, 2010 (77 FR 24156) FR Doc....

  9. Getting Down to Business: Air Conditioning and Heating Service, Module 36. Teacher Guide. Entrepreneurship Training Components.

    ERIC Educational Resources Information Center

    Sanderson, Barbara

    This is the thirty-sixth in a set of 36 teacher guides to the Entrepreneurial Training Modules and accompanies CE 031 100. The purpose of the module is to give students some idea of what it is like to own and operate an air conditioning and heating service. Following an overview are general notes on use of the module. Suggested steps for module…

  10. Environmental Control System Installer/Servicer (Residential Air Conditioning Mechanic). V-TECS Guide.

    ERIC Educational Resources Information Center

    Meyer, Calvin F.; Benson, Robert T.

    This guide provides job relevant tasks, performance objectives, performance guides, resources, learning activitites, evaluation standards, and achievement testing in the occupation of environmental control system installer/servicer (residential air conditioning mechanic). It is designed to be used with any chosen teaching method. The course…

  11. Getting Down to Business: Air Conditioning and Heating Service, Module 36. [Student Guide]. Entrepreneurship Training Components.

    ERIC Educational Resources Information Center

    Sanderson, Barbara

    This module on owning and operating an air conditioning and heating service is one of 36 in a series on entrepreneurship. The introduction tells the student what topics will be covered and suggests other modules to read in related occupations. Each unit includes student goals, a case study, and a discussion of the unit subject matter. Learning…

  12. AIRS Data Subsetting Service at the Goddard Earth Sciences (GES) DISC/DAAC

    NASA Technical Reports Server (NTRS)

    Vicente, Gilberto A.; Qin, Jianchun; Li, Jason; Gerasimov, Irina; Savtchenko, Andrey

    2004-01-01

    The AIRS mission, as a combination of the Atmospheric Infrared Sounder (AIRS), the Advanced Microwave Sounding Unit (AMSU) and the Humidity Sounder for Brazil (HSB), brings climate research and weather prediction into 21st century. From NASA' Aqua spacecraft, the AIRS/AMSU/HSB instruments measure humidity, temperature, cloud properties and the amounts of greenhouse gases. The AIRS also reveals land and sea- surface temperatures. Measurements from these three instruments are analyzed . jointly to filter out the effects of clouds from the IR data in order to derive clear-column air-temperature profiles and surface temperatures with high vertical resolution and accuracy. Together, they constitute an advanced operational sounding data system that have contributed to improve global modeling efforts and numerical weather prediction; enhance studies of the global energy and water cycles, the effects of greenhouse gases, and atmosphere-surface interactions; and facilitate monitoring of climate variations and trends. The high data volume generated by the AIRS/AMSU/HSB instruments and the complexity of its data format (Hierarchical Data Format, HDF) are barriers to AIRS data use. Although many researchers are interested in only a fraction of the data they receive or request, they are forced to run their algorithms on a much larger data set to extract the information of interest. In order to better server its users, the GES DISC/DAAC, provider of long-term archives and distribution services as well science support for the AIRS/AMSU/HSB data products, has developed various tools for performing channels, variables, parameter, spatial and derived products subsetting, resampling and reformatting operations. This presentation mainly describes the web-enabled subsetting services currently available at the GES DISC/DAAC that provide subsetting functions for all the Level 1B and Level 2 data products from the AIRS/AMSU/HSB instruments.

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

    ERIC Educational Resources Information Center

    Krause, James S.

    2010-01-01

    The author compares current employment status after spinal cord injury between participants who were independent in ambulation (required no assistance from others) and those who were dependent in ambulation (required assistance from at least one other person to ambulate). Those who were independent of assistance from others in ambulation were…

  14. Air

    MedlinePlus

    ... do to protect yourself from dirty air . Indoor air pollution and outdoor air pollution Air can be polluted indoors and it can ... this chart to see what things cause indoor air pollution and what things cause outdoor air pollution! Indoor ...

  15. 38 CFR 3.7 - Individuals and groups considered to have performed active military, naval, or air service.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... considered to have performed active military, naval, or air service. 3.7 Section 3.7 Pensions, Bonuses, and... Indemnity Compensation General § 3.7 Individuals and groups considered to have performed active military, naval, or air service. The following individuals and groups are considered to have performed...

  16. 38 CFR 3.7 - Individuals and groups considered to have performed active military, naval, or air service.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... considered to have performed active military, naval, or air service. 3.7 Section 3.7 Pensions, Bonuses, and... Indemnity Compensation General § 3.7 Individuals and groups considered to have performed active military, naval, or air service. The following individuals and groups are considered to have performed...

  17. 38 CFR 3.7 - Individuals and groups considered to have performed active military, naval, or air service.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... considered to have performed active military, naval, or air service. 3.7 Section 3.7 Pensions, Bonuses, and... Indemnity Compensation General § 3.7 Individuals and groups considered to have performed active military, naval, or air service. The following individuals and groups are considered to have performed...

  18. 38 CFR 3.7 - Individuals and groups considered to have performed active military, naval, or air service.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... considered to have performed active military, naval, or air service. 3.7 Section 3.7 Pensions, Bonuses, and... Indemnity Compensation General § 3.7 Individuals and groups considered to have performed active military, naval, or air service. The following individuals and groups are considered to have performed...

  19. 14 CFR 272.9 - Selection of a carrier to provide essential air service and payment of compensation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... provide such essential air service shall be submitted to the President of the United States not less than... President of the Freely Associated State concerned and the Authorities designated by that Government(s) in... THE FREELY ASSOCIATED STATES § 272.9 Selection of a carrier to provide essential air service...

  20. 38 CFR 3.7 - Individuals and groups considered to have performed active military, naval, or air service.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... considered to have performed active military, naval, or air service. 3.7 Section 3.7 Pensions, Bonuses, and... Indemnity Compensation General § 3.7 Individuals and groups considered to have performed active military... military, naval, or air service: (a) Aerial transportation of mail (Pub. L. 140, 73d Congress). Persons...

  1. The Use of Emergency Lights and Sirens by Ambulances and Their Effect on Patient Outcomes and Public Safety: A Comprehensive Review of the Literature.

    PubMed

    Murray, Brett; Kue, Ricky

    2017-04-01

    The benefits of emergency lights and sirens (L&S) use as warning devices by ambulances continue to be a debated topic in Emergency Medical Services (EMS). While the most widely studied aspect of L&S use has been related to their effect on ambulance response and transport times, the literature suggests minimal time savings with more questionable impact on actual patient outcomes. As L&S use has been shown to increase the risk for vehicle crashes, the secondary concern of ambulance design and safety also becomes an important aspect on potential design recommendations that could mitigate the effects of a crash on patients, EMS providers, and the general public. The least studied aspect of L&S use (and probably the most important) is their effect on patient outcomes and quality of medical care during transport. The current evidence suggests no significant improvement on patient outcomes and potential worsening to certain aspects of patient care during transport. The purpose of this review was to examine the current literature regarding ambulance L&S use and the risks they pose to EMS providers, patients, and the general public. In doing so, it will provide sound background for EMS leaders to better develop policies governing the use of L&S by ambulances and promote better research in the patient outcomes effect associated with their use. This review offers some strategies in mitigating the risks associated with L&S use, such as ways to reduce their overall use and modifying other related factors to emergency medical vehicle collisions (EMVCs). Murray B , Kue R . The use of emergency lights and sirens by ambulances and their effect on patient outcomes and public safety: a comprehensive review of the literature. Prehosp Disaster Med. 2017;32(2):209-216.

  2. AIRS Data Mining Service at the Goddard Earth Sciences (GES) DISC DAAC

    NASA Astrophysics Data System (ADS)

    Vicente, G. A.; Qin, J.; Pham, L.; Lynnes, C.; Eng, E.; Li, J.

    2004-05-01

    The Atmospheric Infrared Sounder (AIRS) is a high-resolution infrared (IR) sounder with 2378 spectral channels flying on the EOS Aqua platform with two operational microwave sounders, the Advanced Microwave Sounding Unit (AMSU) and the Humidity Sounder for Brazil (HSB). Measurements from the three instruments are analyzed jointly to filter out the effects of clouds from the IR data in order to derive clear-column air-temperature profiles and surface temperatures with high vertical resolution and accuracy. Together, these three instruments constitute an advanced operational sounding data system that have contributed to improve global modeling efforts and numerical weather prediction; enhance studies of the global energy and water cycles, the effects of greenhouse gases, and atmosphere-surface interactions; and facilitate monitoring of climate variations and trends. The NASA Goddard Earth Sciences Data and Information Services Center/Distributed Active Archive Center (GES DISC DAAC) provides long-term archive and distribution services for AIRS/AMSU/HSB data products as well science support to assist users in understanding, accessing and using the AIRS data products. However, the high data volume generated by the AIRS/AMSU/HSB instruments and the complexity of its data format (Hierarchical Data Format, HDF) are barriers to AIRS data use. Although many researchers are interested in only a fraction of the data they receive or request, they are forced to run their algorithms on a much larger data set to extract the information of interest. In order to address this problem, the GES DAAC is expanding its data mining system to accept AIRS user's algorithms by providing online tools for spectral channels and value added product sub-settings, as well as spatial, temporal and user defined profile sub-settings. This presentation will show details of the AIRS components of the GES DAAC data mining system including technical description, input data and returning products

  3. US EPA 2012 Air Quality Fused Surface for the Conterminous U.S. Map Service

    EPA Pesticide Factsheets

    This web service contains a polygon layer that depicts fused air quality predictions for 2012 for census tracts in the conterminous United States. Fused air quality predictions (for ozone and PM2.5) are modeled using a Bayesian space-time downscaling fusion model approach described in a series of three published journal papers: 1) (Berrocal, V., Gelfand, A. E. and Holland, D. M. (2012). Space-time fusion under error in computer model output: an application to modeling air quality. Biometrics 68, 837-848; 2) Berrocal, V., Gelfand, A. E. and Holland, D. M. (2010). A bivariate space-time downscaler under space and time misalignment. The Annals of Applied Statistics 4, 1942-1975; and 3) Berrocal, V., Gelfand, A. E., and Holland, D. M. (2010). A spatio-temporal downscaler for output from numerical models. J. of Agricultural, Biological,and Environmental Statistics 15, 176-197) is used to provide daily, predictive PM2.5 (daily average) and O3 (daily 8-hr maximum) surfaces for 2012. Summer (O3) and annual (PM2.5) means calculated and published. The downscaling fusion model uses both air quality monitoring data from the National Air Monitoring Stations/State and Local Air Monitoring Stations (NAMS/SLAMS) and numerical output from the Models-3/Community Multiscale Air Quality (CMAQ). Currently, predictions at the US census tract centroid locations within the 12 km CMAQ domain are archived. Predictions at the CMAQ grid cell centroids, or any desired set of locations co

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

    PubMed Central

    Yetisgin, Alparslan

    2017-01-01

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

  5. Acute pain management services: a comparison between Air Force and U.S. hospitals.

    PubMed

    Rayos, C L; McDonough, J P

    1999-12-01

    The purpose of this descriptive study was to assess the prevalence of acute pain management services (APMS) in Air Force medical facilities. There are no published reports on the current status of Air Force pain programs. This study used a telephone survey to all facilities worldwide that house an anesthesia department. Anesthesia providers in charge of pain services or department chiefs were interviewed from December 1996 to May 1997. Respondents were asked questions related to the initiation of a formal APMS, components, and familiarity with the Agency for Health Care Policy and Research guidelines on pain management. Data analysis described current practices and used chi 2 analysis to compare results with a national study of U.S. hospitals. Air Force anesthesia departments (45%) had established as many acute pain services as U.S. hospitals (42%). Formal pain programs are becoming more prevalent in Air Force hospitals. These findings suggest an increased awareness of the need for pain management and future establishment of pain programs.

  6. An Airborne Communications Roadmap for the U.S. Federal Air Marshal Service: Overview and Status

    NASA Technical Reports Server (NTRS)

    Martzaklis, Konstantinos S.

    2007-01-01

    Following the events of September 11, 2001, the responsibilities, operations and numbers of the U.S. Federal Air Marshal Service (FAMS) wer e greatly expanded. With this expansion, new critical research and te chnology needs were identified, including the need for air to ground telecommunications capabilities. To address this need, the FAMS has cr eated a working group to develop, deploy and enhance aviation communi cations with respect to security and law enforcement. This paper presents the working group's progress to date in generating a FAMS air-gro und communications roadmap identifying expected communications servic es, technology maturity, and technology gaps over a timeline. The paper includes a communications preliminary requirements summary and syst em performance characteristics needed to meet identified operational needs. The system engineering process utilized is presented beginning with the identification of users, their operational needs and relevant constraints. The operational needs are translated to desired airbor ne communications services. System technical performance requirements associated with the identified services are summarized. In addition, notional communications architectures addressing the requirements are presented. Finally, future plans to identify and assess potential ca ndidate systems and their associated technical architectures, gaps and barriers to implementation are discussed. The paper addresses the cu rrent, near term (within 5 years) and far term (10 years) timeframes for such an airborne communications system.

  7. Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time–series analysis

    PubMed Central

    Bouttell, Janet; Barnsdale, Lee; Mackay, Daniel; Lewsey, Jim; Hunter, Carole; Robinson, Mark

    2016-01-01

    Abstract Background and Aims It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid‐related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid‐related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call‐outs to opioid‐related overdose incidents and the cumulative number of ‘take‐home naloxone’ (THN) kits in issue; and is there evidence of an association between ambulance call‐outs to opioid‐related overdose incidents in early adopter (pilot) or later adopting (non‐pilot) regions and the cumulative number of THN kits issued in those areas? Design Controlled time–series analysis. Setting Scotland, UK, 2008–15. Participants Pre‐NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post‐implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid‐related overdose were recorded for the pre‐NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post‐implementation period (mean 24.8 attendances per week). Intervention Scotland's NNP; formally implemented on 1 April 2011. Measurements Primary outcome measure was weekly incidence (counts) of call‐outs to opioid‐related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further

  8. Factors on green service industry: Case study at AirAsia

    NASA Astrophysics Data System (ADS)

    Abdullah, Muhammad-Azfar; Chew, Boon-Cheong; Hamid, Syaiful-Rizal

    2017-03-01

    Presently service organizations are challenged by fierce global competition, new technology and changing customer demands. These trends force service sectors to adapt environmental factors and places innovation at the core of their competitive strategy. On the other hand, service sectors challenge to deliver value memorable experiences and complete "service solutions" while lowering costs and keep sustainable. Despite, many studies have attempted to explore the factors that help toward environmental sustainability in the manufacturing sector, the service sector has not yet received a considerable attention in all world countries generally and in developing countries particularly. Thus, this paper aims to explore the factors that help to attain environmental sustainability in the service sector. A qualitative case study through semi-structured interview conducted with twenty managers from AirAsia to explore the factors that are related to environmental sustainability and green services. Besides, secondary data from document analysis was reviewed to gain more comprehensive understanding and triangulate the interview data. The finding of this paper emphasizes to three important factors namely institutional factors, process factors and result factors that each factor contain sustainability and innovations to promote competitive green service in the marketplace.

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

    PubMed Central

    2015-01-01

    Background The utilization of ambulances in low- and middle-income countries is limited. The aim of this study was to ascertain frequency of ambulance use and characteristics of patients brought into emergency departments (EDs) through ambulance and non-ambulance modes of transportation. Methods The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a pilot active surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan between November 2010 and March 2011. Univariate and multivariate logistic regression was performed to investigate the factors associated with ambulance use. Results Out of 274,436 patients enrolled in Pak-NEDS, the mode of arrival to the ED was documented for 94. 9% (n = 260,378) patients, of which 4.1% (n = 10,546) came to EDs via ambulances. The mean age of patients in the ambulance group was significantly higher compared to the mean age of the non-ambulance group (38 ± 18.4 years versus 32.8 ± 14.9 years, p-value < 0.001). The most common presenting complaint in the ambulance group was head injury (12%) while among non-ambulance users it was fever (12%). Patients of all age groups were less likely to use an ambulance compared to those >45 years of age (p-value < 0.001) adjusted for gender, cities, hospital type, presenting complaint group and disposition. The adjusted odds ratio of utilizing ambulances for those with injuries was 3.5 times higher than those with non-injury complaints (p-value < 0.001). Patients brought to the ED by ambulance were 7.2 times more likely to die in the ED than non-ambulance patients after adjustment for other variables in the model. Conclusion Utilization of ambulances is very low in Pakistan. Ambulance use was found to be more among the elderly and those presenting with injuries. Patients presenting via ambulances were more likely to die in the ED. PMID:26689242

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

    PubMed Central

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

    2016-01-01

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

  11. Acute Pain Management Services: What Does the Air Force Have to Offer?

    DTIC Science & Technology

    2013-01-29

    Unrelieved pain due to this nociception , after surgery or trauma is often unhealthy, but it is preventable or controllable in a majority of cases...DC 20503. 1. AGENCY USE ONLY (Leaveblank) 2. REPORT DATE 26-Sep-97 3. REPORT TYPE AND DATES COVERED 4. TITLE AND SUBTITLE ACUTE PAIN MANAGEMENT...Prescribed by ANSI Std. 239.18 Designed using Perform Pro, WHS/DIOR. Oct 94 ACUTE PAIN MANAGEMENT SERVICES: WHAT DOES THE AIR FORCE HAVE TO OFFER

  12. Contribution of ecosystem services to air quality and climate change mitigation policies: the case of urban forests in Barcelona, Spain.

    PubMed

    Baró, Francesc; Chaparro, Lydia; Gómez-Baggethun, Erik; Langemeyer, Johannes; Nowak, David J; Terradas, Jaume

    2014-05-01

    Mounting research highlights the contribution of ecosystem services provided by urban forests to quality of life in cities, yet these services are rarely explicitly considered in environmental policy targets. We quantify regulating services provided by urban forests and evaluate their contribution to comply with policy targets of air quality and climate change mitigation in the municipality of Barcelona, Spain. We apply the i-Tree Eco model to quantify in biophysical and monetary terms the ecosystem services "air purification," "global climate regulation," and the ecosystem disservice "air pollution" associated with biogenic emissions. Our results show that the contribution of urban forests regulating services to abate pollution is substantial in absolute terms, yet modest when compared to overall city levels of air pollution and GHG emissions. We conclude that in order to be effective, green infrastructure-based efforts to offset urban pollution at the municipal level have to be coordinated with territorial policies at broader spatial scales.

  13. Use of the automatic external defibrillator-pacemaker by ambulance personnel: the Stockport experience.

    PubMed Central

    Gray, A J; Redmond, A D; Martin, M A

    1987-01-01

    In an attempt to reduce the number of people who die from a cardiac arrest in the Stockport area ambulances were equipped with automatic external defibrillator-pacemakers, and ambulance personnel were trained in their use. Over an 18 month period ambulance personnel attended 113 patients in cardiac arrest with these devices. One patient subsequently survived, and three patients survived for up to three days. The reasons for these poor initial results include the failure of bystanders to provide cardiopulmonary resuscitation, a delay in calling for the ambulance, and too few defibrillators being available. PMID:3107727

  14. Application of ESE Data and Tools to Air Quality Management: Services for Helping the Air Quality Community use ESE Data (SHAirED)

    NASA Technical Reports Server (NTRS)

    Falke, Stefan; Husar, Rudolf

    2011-01-01

    The goal of this REASoN applications and technology project is to deliver and use Earth Science Enterprise (ESE) data and tools in support of air quality management. Its scope falls within the domain of air quality management and aims to develop a federated air quality information sharing network that includes data from NASA, EPA, US States and others. Project goals were achieved through a access of satellite and ground observation data, web services information technology, interoperability standards, and air quality community collaboration. In contributing to a network of NASA ESE data in support of particulate air quality management, the project will develop access to distributed data, build Web infrastructure, and create tools for data processing and analysis. The key technologies used in the project include emerging web services for developing self describing and modular data access and processing tools, and service oriented architecture for chaining web services together to assemble customized air quality management applications. The technology and tools required for this project were developed within DataFed.net, a shared infrastructure that supports collaborative atmospheric data sharing and processing web services. Much of the collaboration was facilitated through community interactions through the Federation of Earth Science Information Partners (ESIP) Air Quality Workgroup. The main activities during the project that successfully advanced DataFed, enabled air quality applications and established community-oriented infrastructures were: develop access to distributed data (surface and satellite), build Web infrastructure to support data access, processing and analysis create tools for data processing and analysis foster air quality community collaboration and interoperability.

  15. Non-accidental non-fatal poisonings attended by emergency ambulance crews: an observational study of data sources and epidemiology

    PubMed Central

    John, Ann; Porter, Alison; Moore, Chris; Thomas, Gareth; Whitfield, Richard; Oretti, Rossana

    2016-01-01

    Background Non-accidental non-fatal poisoning (NANFP) is associated with high risk of repeat episodes and fatality. This cross-sectional study aims to describe the data sources and epidemiology of non-fatal poisonings (NFPs) presenting to the emergency ambulance service. Methods We assessed incidents of NFP across Wales from electronic ambulance call centre records and paper records completed by attending ambulance crews, December 2007 to February 2008. We descriptively analysed data completed by attending crews. Results 92 331 calls were made to the ambulance call centre, of which 3923 (4.2%) were coded as ‘overdose’ or ‘poisoning’. During the same period, ambulance crews recorded 1827 attended NANFP incidents in those categories, of which 1287 (70.4%) had been identified in the call centre. 76.1% (1356/1782) were aged 15–44 years and 54.2% (991/1827) were female. 75.0% (1302/1753) of incidents occurred in areas from the lower 2 quintiles of deprivation in Wales. Substance taken was reported in 90% of cases (n=1639). Multiple ingestion was common (n=886, 54.1%). Psychotropic was the most frequently taken group of substances (n=585, 32.0%) and paracetamol (n=484, 26.5%) was the most frequently taken substance prehospital. Almost half of patients had taken alcohol alongside other substances (n=844, 46.2%). Naloxone was the most frequently administered treatment (n=137, 7.5%). Only 142/1827 (7.8%) patients were not transported to hospital, of whom 4 were recorded to have been given naloxone. Conclusions We report new data on the epidemiology of NFP across substance types at national level, highlighting deficiencies in information systems and high levels of multiple ingestion. In order to develop policy and practice for this patient group prehospital and further along the care pathway, information systems need to be developed to allow accurate routine monitoring of volume, presentation and outcomes. PMID:27540098

  16. Calcaneus deformity in the ambulant patient with myelomeningocele.

    PubMed

    Fraser, R K; Hoffman, E B

    1991-11-01

    We reviewed our experience of tibialis anterior transfer and anterior release for calcaneus deformity in 46 feet of 26 ambulant patients with myelomeningocele. At an average follow-up of 8.4 years (2 to 17.6) there were 89% who had satisfactory results; 64% of the patients having tibialis anterior transfers were able to stand on their toes. Hip abductor power was a good predictor of a functional transfer. Pre-operative trophic ulceration of the heel increased from 3.2% to 33% if surgery was delayed. Secondary deformities, two-thirds of them into valgus, developed in 76% of feet.

  17. Effects of weather and heliophysical conditions on emergency ambulance calls for elevated arterial blood pressure.

    PubMed

    Vencloviene, Jone; Babarskiene, Ruta M; Dobozinskas, Paulius; Sakalyte, Gintare; Lopatiene, Kristina; Mikelionis, Nerijus

    2015-02-27

    We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009-2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10-I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS>600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR=1.12; 95% confidence interval (CI) 1.04-1.21); and WS≥3.5 knots during days of T<1.5 °C and T≥12.5 °C by 8% (RR=1.08; CI 1.04-1.12). An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T≥17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population's sensitivity to different weather conditions.

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

    PubMed Central

    Vencloviene, Jone; Babarskiene, Ruta M.; Dobozinskas, Paulius; Sakalyte, Gintare; Lopatiene, Kristina; Mikelionis, Nerijus

    2015-01-01

    We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009–2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10–I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS > 600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR = 1.12; 95% confidence interval (CI) 1.04–1.21); and WS ≥ 3.5 knots during days of T < 1.5 °C and T ≥ 12.5 °C by 8% (RR = 1.08; CI 1.04–1.12). An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T ≥ 17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population’s sensitivity to different weather conditions. PMID:25734792

  19. Optimizing Air Transportation Service to Metroplex Airports. Part 1; Analysis of Historical Data

    NASA Technical Reports Server (NTRS)

    Donohue, George; Hoffman, Karla; Sherry, Lance; Ferguson, John; Kara, Abdul Qadar

    2010-01-01

    The air transportation system is a significant driver of the U.S. economy, providing safe, affordable, and rapid transportation. During the past three decades airspace and airport capacity has not grown in step with demand for air transportation (+4% annual growth), resulting in unreliable service and systemic delays. Estimates of the impact of delays and unreliable air transportation service on the economy range from $32B to $41B per year. This report describes the results of an analysis of airline strategic decision-making with regards to: (1) geographic access, (2) economic access, and (3) airline finances. This analysis evaluated markets-served, scheduled flights, aircraft size, airfares, and profit from 2005-2009. During this period, airlines experienced changes in costs of operation (due to fluctuations in hedged fuel prices), changes in travel demand (due to changes in the economy), and changes in infrastructure capacity (due to the capacity limits at EWR, JFK, and LGA). This analysis captures the impact of the implementation of capacity limits at airports, as well as the effect of increased costs of operation (i.e. hedged fuel prices). The increases in costs of operation serve as a proxy for increased costs per flight that might occur if auctions or congestion pricing are imposed.

  20. Using ecosystem services to inform decisions on U.S. air quality standards.

    PubMed

    Rea, Anne W; Davis, Christine; Evans, David A; Heninger, Brian T; Van Houtven, George

    2012-06-19

    The ecosystem services (ES) framework provides a link between changes in a natural system's structure and function and public welfare. This systematic integration of ecology and economics allows for more consistency and transparency in environmental decision making by enabling valuation of nature's goods and services in a manner that is understood by the public. This policy analysis (1) assesses the utility of the ES conceptual framework in the context of setting a secondary National Ambient Air Quality Standard (NAAQS), (2) describes how economic valuation was used to summarize changes in ES affected by NOx and SOx in the review, and (3) uses the secondary NOxSOx NAAQS review as a case study to highlight the advantages and challenges of quantifying air pollutant effects on ES in a decision making context. Using an ES framework can benefit the decision making process by accounting for environmental, ecological, and social elements in a holistic manner. As formal quantitative linkages are developed between ecosystem structure and function and ES, this framework will increasingly allow for a clearer, more transparent link between changes in air quality and public welfare.

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

    NASA Astrophysics Data System (ADS)

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

    2007-12-01

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

  2. On-Premise Alcohol Establishments and Ambulance Calls for Trauma, Assault, and Intoxication

    PubMed Central

    Ray, Joel G.; Turner, Linda; Gozdyra, Piotr; Matheson, Flora I.; Robert, Burgess; Bartsch, Emily; Park, Alison L.

    2016-01-01

    Abstract Alcohol contributes to intentional and unintentional injury. We explored on-premise licensed alcohol establishments (LAEs) and emergency medical service (EMS) ambulance calls. We completed a retrospective population-based study in the Region of Peel, Ontario, 2005 to 2014, where alcohol sales are tightly regulated and healthcare is universally available. We included participants age ≥ 19 years. Longitude–latitude coordinates of all 696 LAEs and all 267,477 EMS ambulance calls were ascertained, and then assigned to 1 of 1568 dissemination areas (DA) in Peel. Relative risks (RRs) described the association between density of on-premise LAEs (by DA deciles) and the rate of EMS calls, adjusted for material deprivation, and density of beer/liquor stores in each DA. There was a curvilinear relation between LAE density and EMS calls for trauma, rising from 45.3 per 1000 in DAs with no LAEs to 381.0 per 1000 in decile-10 (adjusted RR 7.83, 95% confidence interval [CI] 6.15–9.97). This relation was more pronounced for alcohol-focused LAEs, and highest among younger males. Calls for assault (RR 2.67, 95% CI 1.26–5.65) and intoxication (RR 4.00, 95% CI 1.41–11.38) were more likely on the last day of the month and the day thereafter, compared to 1 week prior. At 02:00 hours, when LAEs must stop selling alcohol, there was a considerable rise in assault-related calls in DAs with LAE but not in DAs without LAEs. On-premise LAEs contribute to EMS calls for trauma and assault, especially among young males, around last call, and when monthly pay cheques are cashed. PMID:27175699

  3. Stigma and barriers to accessing mental health services perceived by Air Force nursing personnel.

    PubMed

    Hernandez, Stephen H A; Bedrick, Edward J; Parshall, Mark B

    2014-11-01

    We investigated perceptions of stigma and barriers associated with accessing mental health services among active component U.S. Air Force officer and enlisted nursing personnel (N = 211). The Britt and Hoge et al Stigma scale and Hoge et al Barriers to Care scale were administered via an anonymous, online survey. Stigma items pertained to concerns that might affect decisions to seek mental health treatment. Most of the sample agreed with the items "Members of my unit might have less confidence in me" and "My unit leadership might treat me differently." Approximately 20% to 46% agreed with the other four stigma items. Officer nursing personnel were significantly more likely than enlisted to agree that accessing mental health services would be embarrassing, harm their career, or cause leaders to blame them for the problem (p ≤ 0.03 for each comparison). Getting time off from work for treatment and scheduling appointments were perceived as barriers by 41% and 21% of respondents, respectively. We conclude that proportions of Air Force nursing personnel reporting concerns about potential stigmatizing consequences of seeking mental health care are substantial and similar to ranges previously reported by military service members screening positive for mental health problems after deployment.

  4. 5 CFR 842.811 - Deposits for second-level supervisory air traffic controller service performed before February 10...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Deposits for second-level supervisory air traffic controller service performed before February 10, 2004. 842.811 Section 842.811 Administrative... Regulations Pertaining to Noncodified Statutes § 842.811 Deposits for second-level supervisory air...

  5. 5 CFR 842.811 - Deposits for second-level supervisory air traffic controller service performed before February 10...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Deposits for second-level supervisory air traffic controller service performed before February 10, 2004. 842.811 Section 842.811 Administrative... Regulations Pertaining to Noncodified Statutes § 842.811 Deposits for second-level supervisory air...

  6. 5 CFR 842.811 - Deposits for second-level supervisory air traffic controller service performed before February 10...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Deposits for second-level supervisory air traffic controller service performed before February 10, 2004. 842.811 Section 842.811 Administrative... Regulations Pertaining to Noncodified Statutes § 842.811 Deposits for second-level supervisory air...

  7. 5 CFR 842.811 - Deposits for second-level supervisory air traffic controller service performed before February 10...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Deposits for second-level supervisory air traffic controller service performed before February 10, 2004. 842.811 Section 842.811 Administrative... Regulations Pertaining to Noncodified Statutes § 842.811 Deposits for second-level supervisory air...

  8. 5 CFR 842.811 - Deposits for second-level supervisory air traffic controller service performed before February 10...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Deposits for second-level supervisory air traffic controller service performed before February 10, 2004. 842.811 Section 842.811 Administrative... Regulations Pertaining to Noncodified Statutes § 842.811 Deposits for second-level supervisory air...

  9. Air Force Chaplains' Perceived Effectiveness on Service Member's Resilience and Satisfaction.

    PubMed

    Cafferky, Bryan; Norton, Aaron; Travis, Wendy J

    2017-01-01

    This study examined how 3,777 active duty male United States Air Force service members' (SMs) rank and residence location moderated the associations between perceived chaplain effectiveness, SMs' resilience, family coping, marital satisfaction, and satisfaction with the Air Force (AF). A multiple-sample structural equation model was conducted with four subgroups of SMs who had received chaplain support: enlisted members living on base, enlisted members living off base, officers living on base, and officers living off base. Chaplain effectiveness was significantly related, both directly and indirectly, to SM's spirituality, resilience, family coping, marital satisfaction, and AF satisfaction. Resilience was significantly associated with increased AF satisfaction for all SMs, except for those living on base. However, living on base was found to strengthen the protective factor between family coping and relationship satisfaction. Rank was found to moderate the link between resilience and family coping. Family coping was significantly related to increased relationship satisfaction.

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

    NASA Astrophysics Data System (ADS)

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

    2016-12-01

    Ambulance dispatch is a proxy of acute health outcomes, and growing epidemiological evidence documented its relation to extreme temperature events. Research, however, on short-term temperature change and ambulance dispatches is scarce. We aimed to investigate the effect of short-term temperature change on ambulance dispatches and potential modification by season. Daily data on ambulance dispatch and weather factors were collected in Huainan, a Chinese inland city from December 2011 through December 2013. A Poison generalized linear regression model combined with distributed lag nonlinear model was constructed to examine the association of temperature change between neighboring days (TCN) with ambulance dispatches. The effect modification by season was also examined. There were 48,700 ambulance attendances during the study period. A statistically significant association of TCN with ambulance dispatches was observed. Temperature rise between neighboring days (TCN > 0) was associated with elevated adverse risk of ambulance dispatches, and the effects appeared to be acute (lag0, on the current day) and could last for at least a week, while temperature drop between neighboring days (TCN < 0) had a protective effect. For a 1 °C increase of TCN at lag0 and lag06 (on the 7-day moving average), the risk of ambulance dispatches increased by 2 % (95 % CI 1-3 %) and 7 (95 % CI 1-13 %), respectively. Extreme TCN increase (95th percentile, 3.3 °C vs. 0 °C) at lag0 and lag05 was accompanied by 6 (95 % CI 3-8 %) and 27 % (95 % CI 12-44 %) increase in ambulance dispatches. Ambulance dispatches were more vulnerable to extremely great temperature rise in summer and autumn. TCN was adopted for the first time to quantify the impact of short-term temperature change on ambulance dispatches. Temperature drop between neighboring days (TCN < 0) had a protective effect on ambulance dispatches, while temperature rise between neighboring days (TCN > 0) could acutely trigger the increase in

  11. AIRS/AMSU-A/HSB Data On-demand Subsetting and Visualization Services at NASA GES DISC DAAC

    NASA Astrophysics Data System (ADS)

    Li, J.; Cho, S.; Sun, D.; Qin, J.; Sharma, A. K.

    2002-12-01

    The Atmospheric Infrared Sounder (AIRS) is a high-resolution infrared sounder closely coupled with AMSU-A (Advanced Microwave Sounding Unit-A) and HSB (Humidity Sounder for Brazil) on EOS Aqua spacecraft launched on May 4, 2002. The data products from AIRS/AMSU-A/HSB will be archived and distributed at the Goddard Distributed Active Archive Center (GDAAC) located in the NASA Goddard Earth Sciences Data and Information Services Center (GES DAAC). The ADDST is developing tools to read, visualize, analyze and reformat AIRS/AMSU-A/HSB data. The web-based AIRS on-the-fly/on-demand subsetter will be available to perform channel/variable subsetting and restructuring for Level1B (Calibrated Radiances) and Level2 (Atmospheric Retrievals) data products. One can narrow down criteria to subset data files with desired channels and variables and then download the subsetted file. AIRS QuickLook allows users to view AIRS/HSB/AMSU Level-1B data online for a specific channel prior to ordering or downloading data. Global map is also provided along with image to show geographic coverage of the granule and flight direction of the spacecraft. The Atmospheric Dynamics Data Support Team (ADDST) at the GES DISC/DAAC is providing various services to assist users in understanding, accessing, and using AIRS data product. Information on AIRS data and data analysis tools can be found at AIRS data support informational web site (http://daac.gsfc.nasa.gov/atmodyn/airs/ ) that provides access to various technical online documents, such as, readmes, user's guides, instrument guides, images from AIRS/AMSU-A/HSB data, product search and ordering interfaces, HDF-EOS format information, format conversion software, online data analysis tools, other AIRS related web links and more. Other data support services provided by the ADDST are assist with data mining, helpdesk for user questions on data and information, data ordering, and educational resources.

  12. AIRS Data Service at NASA Goddard Earth Sciences Data and Information Services (GES DISC) and Its Application to Climate Change Study

    NASA Technical Reports Server (NTRS)

    Won, Young-In; Vollimer, Bruce; Theobald, Mike; Hua, Xin-Min

    2008-01-01

    The Atmospheric Infrared Sounder (AIRS) instrument suite is designed to observe and characterize the entire atmospheric column from the surface to the top of the atmosphere in terms of surface emissivity and temperature, atmospheric temperature and humidity profiles, cloud amount and height, and the spectral outgoing infrared radiation on a global scale. The AIRS Data Support Team at the GES DISC provides data support to assist others in understanding, retrieving and extracting information from the AIRS/AMSU/HSB data products. Because a number of years has passed since its operation started, the amount of data has reached a certain level of maturity where we can address the climate change study utilizing AIRS data, In this presentation we will list various service we provide and to demonstrate how to utilize/apply the existing service to long-term and short-term variability study.

  13. Notification: Background Investigation Services EPA’s Efforts to Incorporate Environmental Justice Into Clean Air Act Inspections for Air Toxics

    EPA Pesticide Factsheets

    Project #OPE-FY14-0017, March 7, 2014. The OIG plans to begin the preliminary research phase of an evaluation of the EPA's efforts to incorporate environmental justice into Clean Air Act (CAA) inspections for air toxics.

  14. 42 CFR 414.5 - Hospital services paid under Medicare Part B when a Part A hospital inpatient claim is denied...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... described in § 419.21(a) of this chapter that do not require an outpatient status. (2) Physical therapy services, speech-language pathology services, and occupational therapy services. (3) Ambulance services,...

  15. 42 CFR 414.5 - Hospital services paid under Medicare Part B when a Part A hospital inpatient claim is denied...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... described in § 419.21(a) of this chapter that do not require an outpatient status. (2) Physical therapy services, speech-language pathology services, and occupational therapy services. (3) Ambulance services,...

  16. Development of Training Programs to Optimize Planetary Ambulation

    NASA Technical Reports Server (NTRS)

    Bloomberg, J. J.; Mulavara, A. P.; Peters, B. T.; Cohen, H. S.; Miller, C. A.; Brady, R.; Warren, L. E.; Rutley, T. M.; Kozlovskaya, I. B.

    2007-01-01

    Astronauts experience disturbances in functional mobility following their return to Earth due to adaptive responses that occur during exposure to the microgravity conditions of space flight. Despite significant time spent performing in-flight exercise routines, these training programs have not been able to mitigate postflight alterations in postural and locomotor function. Therefore, the goal of our two inter-related projects (NSBRI-ground based and ISS flight study, "Mobility") is to develop and test gait training programs that will serve to optimize functional mobility during the adaptation period immediately following space flight, thereby improving the safety and efficiency of planetary ambulation. The gait training program entails manipulating the sensory conditions of treadmill exercise to systematically challenge the balance and gait control system. This enhances the overall adaptability of locomotor function enabling rapid reorganization of gait control to respond to ambulation in different gravitational environments. To develop the training program, we are conducting a series of ground-based studies evaluating the training efficacy associated with variation in visual flow, body loading, and support surface stability during treadmill walking. We will also determine the optimal method to present training stimuli within and across training sessions to maximize both the efficacy and efficiency of the training procedure. Results indicate that variations in both visual flow and body unloading during treadmill walking leads to modification in locomotor control and can be used as effective training modalities. Additionally, the composition and timing of sensory challenges experienced during each training session has significant impact on the ability to rapidly reorganize locomotor function when exposed to a novel sensory environment. We have developed the capability of producing support surface variation during gait training by mounting a treadmill on a six

  17. Assessing the ecosystem service of air pollutant removal by urban trees in Guangzhou (China).

    PubMed

    Jim, C Y; Chen, Wendy Y

    2008-09-01

    In Chinese cities, air pollution has become a serious and aggravating environmental problem undermining the sustainability of urban ecosystems and the quality of urban life. Besides technical solutions to abate air pollution, urban vegetation is increasingly recognized as an alternative ameliorative method by removing some pollutants mainly through dry deposition process. This paper assesses the capability and monetary value of this ecosystem service in Guangzhou city in South China. The results indicated an annual removal of SO(2), NO(2) and total suspended particulates at about 312.03 Mg, and the benefits were valued at RMB90.19 thousand (US$1.00=RMB8.26). More removal was realized by recreational land use due to a higher tree cover. Higher concentration of pollutants in the dry winter months induced more removal. The lower cost of pollution abatement in China generated a relatively subdued monetary value of this environmental benefit in comparison with developed countries. Younger districts with more extensive urban trees stripped more pollutants from the air, and this capacity was anticipated to increase further as their trees gradually reach final dimensions and establish a greater tree cover. Tree cover and pollutant concentration constitute the main factors in pollutant removal by urban trees. The efficiency of atmospheric cleansing by trees in congested Chinese cities could be improved by planting more trees other than shrubs or grass, diversifying species composition and biomass structure, and providing sound green space management. The implications for greenery design were discussed with a view to maximizing this ecosystem service in Chinese cities and other developing metropolises.

  18. [The civil ambulances during the Franc-Prussion war (July 19, 1870 to January 28, 1871)].

    PubMed

    Guivarc'h, Marcel

    2007-01-01

    The civil ambulances joined together under the emblem of the Red Cross: the Company of Help to the Wounded Soldiers, directed from the Palate of Industry by Chenu and Le Fort; the Ambulance of the Press, directed by Ricord and Mgr Bailer; and multiple ambulances disseminated in Paris. They brought a decisive help to the French medical military Corps. On the ground, eigtheen civil Ambulances from Countryside formed in Paris looked after the casualties of the two camps: around Sedan, then in the battles of the Loire and the East, where 13 ambulances formed secondarily in province joined them. During the siege of Paris, flying Ambulances went out the ramparts and brought back the wounded to the Palate of Industry or to Longchamp 'street Press ambulancy. They were integrated in November in a great Coordination of 10 hospitals distributors, directed by Hippolyte Larrey. The surgical care, limited to the members, to the head and the neck, were simple, rapids and conservatives, and the number of amputations was limited. But secondary infectious complications were frequent, had a raised mortality, worsened by the associated diseases, infectious (smallpox, typhoid, pneumonia, and by the cold, hunger, denutrition. The war of 1870-1871 brought: a large humane progress due to the neutralization of the casualties, places and actors of care; a better approach of the infection and shown the need for an autonomy of the French Military Corps.

  19. A novel approach for mental health disease management: the Air Force Medical Service's interdisciplinary model.

    PubMed

    Runyan, Christine N; Fonseca, Vincent P; Meyer, John G; Oordt, Mark S; Talcott, G Wayne

    2003-01-01

    Mental health disorders are one of the most substantial public health problems affecting society today, accounting for roughly 15% of the overall burden of disease from all causes in the United States. Although primary care (PC) has the potential to be the frontline for recognition and management of behavioral health conditions, this has been a challenge historically. In order to more effectively address the broad scope of behavioral health needs, the Air Force Medical Service (AFMS) established a new model of behavioral health care. Through a series of coordinated steps, the AFMS ultimately placed trained behavioral health providers into PC clinics to serve as consultants to PC providers (PCPs). Behavioral Health Consultants (BHCs) provide focused assessments, present healthcare options to patients, and deliver brief collaborative interventions in the PC setting. BHCs see patients at the request of the PCP, in 15-30-min appointments. In the pilot study, patients averaged 1.6 visits to the BHC. Over 70% of patients fell into six categories of presenting problems: situational reactions, depressive disorders, adjustment disorders, anxiety disorders, health promotion, and obesity. Patient data (n = 76) suggest 97% of patients seen were either "satisfied" or "very satisfied" with BHC services, and 100% of the PCPs (n = 23, 68% response rate) were highly satisfied and indicated they would "definitely recommend" others use BHC services for their patients. Both the implications and the limitations of this pilot study are discussed.

  20. Cost characteristics of tilt-rotor, conventional air and high speed rail short-haul intercity passenger service

    NASA Technical Reports Server (NTRS)

    Schoendorfer, David L.; Morlok, Edward K.

    1985-01-01

    The cost analysis done to support an assessment of the potential for a small tilt-rotor aircraft to operate in short-haul intercity passenger service is described in detail. Anticipated costs of tilt-rotor air service were compared to the costs of two alternatives: conventional air and high speed rail (HSR). Costs were developed for corridor service, varying key market characteristics including distance, passenger volumes, and minimum frequency standards. The resulting cost vs output information can then be used to compare modal costs for essentially identical service quality and passenger volume or for different service levels and volumes for each mode, as appropriate. Extensive sensitivity analyses are performed. The cost-output features of these technologies are compared. Tilt-rotor is very attractive compared to HSR in terms of costs over the entire range of volume. It also has costs not dramatically different from conventional air, but tilt-rotor costs are generally higher. Thus some of its other advantages, such as the VTOL capability, must offset the cost disadvantage for it to be a preferred or competitive mode in any given market. These issues are addressed in the companion report which considers strategies for tilt-rotor development in commercial air service.

  1. A random blend: the self in Philip Larkin's poems "Ambulances" and "The Building".

    PubMed

    Pickering, Neil

    2014-06-01

    In two of his great poems, "Ambulances" and "The Building," Philip Larkin considers a deep fear about human individuality. The fear is that the human self is contingent and disjunctive, lacking any integrity or unity. The arrival of an ambulance on an urban curb and a visit to the hospital are the occasion of reflection on this form of human fragility. But more significant, the ambulance and the hospital are imagined as contexts in which the contingency of the human individual is brought out and laid before us.

  2. Association of monthly frequencies of diverse diseases in the calls to the public emergency service of the city of Buenos Aires during 1999-2004 with meteorological variables and seasons

    NASA Astrophysics Data System (ADS)

    Alexander, P.

    2013-01-01

    This work aims to study associations between monthly averages of meteorological variables and monthly frequencies of diverse diseases in the calls to the public ambulance emergency service of the city of Buenos Aires during the years 1999-2004. Throughout this time period no changes were made in the classification codes of the illnesses. Heart disease, arrhythmia, heart failure, cardiopulmonary arrest, angina pectoris, psychiatric diseases, stroke, transient ischemic attack, syncope and the total number of calls were analyzed against 11 weather variables and the four seasons. All illnesses exhibited some seasonal behavior, except cardiorespiratory arrest and angina pectoris. The largest frequencies of illnesses that exhibited some association with the meteorological variables used to occur in winter, except the psychiatric cases. Heart failure, stroke, psychiatric diseases and the total number of calls showed significant correlations with the 11 meteorological variables considered, and the largest indices (absolute values above 0.6) were found for the former two pathologies. On the other side, cardiorespiratory arrest and angina pectoris revealed no significant correlations and nearly null indices. Variables associated with temperature were the meteorological proxies with the largest correlations against diseases. Pressure and humidity mostly exhibited positive correlations, which is the opposite of variables related to temperature. Contrary to all other diseases, psychiatric pathologies showed a clear predominance of positive correlations. Finally, the association degree of the medical dataset with recurrent patterns was further evaluated through Fourier analysis, to assess the presence of statistically significant behavior. In the Northern Hemisphere high morbidity and mortality rates in December are usually assigned to diverse factors in relation to the holidays, but such an effect is not observed in the present analysis. There seems to be no clearly preferred

  3. Environmental Assessment for the Hilltop Community Services District, Wright-Patterson Air Force Base, Ohio

    DTIC Science & Technology

    2012-03-01

    characterized by a relatively large range of  seasonal   variability with  cold  winters and warm, humid summers. Climate data from a weather station in Greene...Research Laboratories (USACERL). 1991. Tri‐Services Cultural  Resources  Management  Center. Cultural Resource  Investigation  for Proposed Marker Pylons...88th Air Base Wing Environmental Management Division. we are requesting information on Ohio’s rare plant’S and animals, high quality plant communiUes

  4. Benefit-cost evaluation of an intra-regional air service in the Bay area

    NASA Technical Reports Server (NTRS)

    Haefner, L. E.

    1977-01-01

    Utilization of an iterative statistical model is presented to evaluate combinations of commuter airport sites and surface transportation facilities in confunction with service by a given commuter aircraft type in light of Bay Area regional growth alternatives and peak and off-peak regional travel patterns. The model evaluates such transportation options with respect to criteria of airline profitability, public acceptance, and public and private nonuser costs. It incorporates information modal split, peak and off-peak use of the air commuter fleet, terminal and airport cost, development costs and uses of land in proximity to the airport sites, regional population shifts, and induced zonal shifts in travel demand. The model is multimodal in its analytical capability, and performs exhaustive sensitivity analysis.

  5. 42 CFR 414.605 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... possible to take the steps necessary to respond to the call. Fixed wing air ambulance (FW) means transportation by a fixed wing aircraft that is certified as a fixed wing air ambulance and such services and... (RVUs) means a value assigned to a ground ambulance service. Rotary wing air ambulance (RW)...

  6. The acceptability of an emergency medical dispatch system to people who call 999 to request an ambulance

    PubMed Central

    O'Cathain, A; Turner, J; Nicholl, J

    2002-01-01

    Methods: Postal questionnaires to two systematic random samples of approximately 500 named callers to one ambulance service before, and one year after, the introduction of EMD. Results: The response rate was 72% (355 of 493) before, and 63% (297 of 466) after, EMD. There was a reduction, from 81% (284 of 349) to 70% (200 of 286), in the proportion of callers who found all the questions asked by the call taker relevant, although this did not adversely affect the proportion of callers who were very satisfied with the 999 call, which increased from 78% (268 of 345) to 86% (247 of 287). The proportion of callers who reported receiving first aid advice increased from 7% (23 of 323) to 43% (117 of 272) and general information from 13% (41 of 315) to 58% (157 of 269). Satisfaction levels with the amount of advice given increased, while satisfaction with response times remained stable at 76% (254 of 320) very satisfied before and 78% (217 of 279) after EMD. The proportion of respondents very satisfied with the service in general increased from 71% (238 of 336) to 79% (220 of 277). There was evidence in respondents' written comments of two potential problems with EMD from the caller's viewpoint. Firstly, some callers were advised to take actions that were subsequently not needed; secondly, a small number of callers felt that the ambulance crew did not treat the situation as seriously as they would have liked. Conclusions: Introducing EMD increases the amount of first aid and general advice given to callers, and satisfaction with these aspects of the service, while maintaining satisfaction with response times. Overall satisfaction with the service increased. However, some changes may be needed to prevent a small amount of dissatisfaction directly associated with EMD. PMID:11904272

  7. Improving Pre-service Elementary Teachers' Education via a Laboratory Course on Air Pollution: One University's Experience

    NASA Astrophysics Data System (ADS)

    Mandrikas, Achilleas; Parkosidis, Ioannis; Psomiadis, Ploutarchos; Stoumpa, Artemisia; Chalkidis, Anthimos; Mavrikaki, Evangelia; Skordoulis, Constantine

    2013-04-01

    This paper describes the structure of the `Air Pollution Course', an environmental science laboratory course developed at the Science Education Laboratory of the Faculty of Primary Education, University of Athens, as well as the findings resulting from its implementation by pre-service elementary teachers. The course proposed in this study deals with the problem of air pollution, which has a special local interest in a large and crowded city like Athens, Greece. The design of the `Air Pollution Course' was based on a combination of experimental study and the use of educational software. All the activities were carried out with the aid of contemporary technological equipment according to the Microcomputer Based Laboratory and to Information and Communication Technologies principles. This approach has encouraging results to the understanding of the problem of air pollution. Τhe laboratory course has improved pre-service elementary teachers' correct use of terms and accuracy in scientific descriptions. These facts suppose deeper conceptual understanding on air pollution phenomena. However, there is a need for further improvement of the pre-service elementary teachers' knowledge in air pollution phenomena, as they still hold misconceptions. The teaching implications of these results are discussed.

  8. The U.S. Air Service in World War I. Volume III. The Battle of St. Mihiel

    DTIC Science & Technology

    1979-01-01

    of Col. Edgar S. Gorrell’s "History of the Air Service AEF," the original of which is in the National Archives.3 These sources, unfortu- nately, do...interests of clarity and to meet the requirements imposed by the format of the printed volume. Editorial comments and notes have been kept to the minimum...Graphic, published in Paris by the Institut Geographique National .9 Maps and grids used by the Air Service, AEF are described in Appendix D of this

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

    PubMed

    Lee, Ellen L; Hayes, Wilson C

    2014-04-01

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

  10. 14 CFR 93.219 - Allocation of slots for essential air service operations and applicable limitations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SPECIAL AIR TRAFFIC RULES Allocation of Commuter and Air Carrier IFR Operations at High Density Traffic... or from a High Density Traffic Airport under the Department of Transportation's Essential Air...

  11. 14 CFR 93.219 - Allocation of slots for essential air service operations and applicable limitations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... SPECIAL AIR TRAFFIC RULES Allocation of Commuter and Air Carrier IFR Operations at High Density Traffic... or from a High Density Traffic Airport under the Department of Transportation's Essential Air...

  12. 14 CFR 93.219 - Allocation of slots for essential air service operations and applicable limitations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... SPECIAL AIR TRAFFIC RULES Allocation of Commuter and Air Carrier IFR Operations at High Density Traffic... or from a High Density Traffic Airport under the Department of Transportation's Essential Air...

  13. 14 CFR 93.219 - Allocation of slots for essential air service operations and applicable limitations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... SPECIAL AIR TRAFFIC RULES Allocation of Commuter and Air Carrier IFR Operations at High Density Traffic... or from a High Density Traffic Airport under the Department of Transportation's Essential Air...

  14. 14 CFR 93.219 - Allocation of slots for essential air service operations and applicable limitations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SPECIAL AIR TRAFFIC RULES Allocation of Commuter and Air Carrier IFR Operations at High Density Traffic... or from a High Density Traffic Airport under the Department of Transportation's Essential Air...

  15. An evaluation of the Royal Air Force helicopter search and rescue services in Britain with reference to Royal Air Force Valley 1980-1989.

    PubMed Central

    Liskiewicz, W J

    1992-01-01

    The Royal Air Force (RAF) operates a helicopter Search and Rescue (SAR) service in the United Kingdom and territorial waters; it also provides a similar service in several locations abroad. A 10-year retrospective study of the SAR helicopter service operating from the RAF base at Valley on the island of Anglesey in North Wales is presented, with national SAR statistics over a similar period provided for comparison. Analysis of records kept by SAR aircrew at RAF Valley shows that their assistance had been requested on 1490 occasions during the 10-year period studied; most of these requests were the result of incidents involving holidaymakers, particularly in the mountains or along the coast. The results illustrate the versatility and life-saving potential of a highly skilled and motivated service able to work in adverse weather and dangerous locations. In the light of current debate, the value of aeromedical evacuation of seriously ill patients using helicopters is discussed. PMID:1494160

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

    PubMed

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

    2014-09-01

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

  17. Challenges in recovery and recycling of refrigerants from Indian refrigeration and air-conditioning service sector

    NASA Astrophysics Data System (ADS)

    Devotta, Sukumar; Asthana, Saroja; Joshi, Rahul

    India is a large producer and user of chlorofluorocarbons (CFCs) in the refrigeration and air-conditioning (RAC) sector. Government of India has taken several steps to restrict the production and consumption of CFCs. Refrigerant conservation through recovery, recycling (R&R) and reclamation is one way of reducing emissions and encouraging timely phase out of CFCs in developing countries. CFC recovery, recycling and reclamation have been mandated in many developed countries. However, this practice is yet to make an impact in India although it is practiced in MAC sector to some extent. India is planning for the final phase out of CFCs in the RAC service sector, in which R&R will be one of the components. A model has been developed to assess the economics of R&R for some typical parameters in developing counties like India. The model suggests that the enterprises recycling 1500 kg/a will break even within 1 year for all scenarios. However, R&R may not be cost effective for small workshops and low volume refrigerant vendors until either the price of CFC goes up or the cost of R&R unit is subsidized. A nationwide survey on RAC service sector revealed that in India, there are very few enterprises handling more than 500 kg/a. Therefore, there is a need to provide the RAC service sector with adequate and innovative financial incentives. This paper attempts to study the issues related to R&R for various sub-sectors of RAC in developing countries with an emphasis on cost effectiveness. India is used as a model for this study.

  18. Air Force Posture Statement 2008: Department of Air Force Presentation to the House Armed Services Committee, U.S. House of Representatives, Fiscal Year 2009 Air Force Posture Statement

    DTIC Science & Technology

    2008-02-27

    unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 1 DEPARTMENT OF THE AIR FORCE PRESENTATION TO THE HOUSE ARMED SERVICES...COMMITTEE UNITED STATES HOUSE OF REPRESENTATIVES FISCAL YEAR 2009 AIR FORCE POSTURE STATEMENT STATEMENT OF: THE HONORABLE MICHAEL W. WYNNE SECRETARY OF...Highest Quality of Life Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 4.2.1 Housing and Military Construction

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

    PubMed

    Schmid, Verena

    2012-06-16

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

  20. A SYSTEMATIC REVIEW OF FUNCTIONAL AMBULATION OUTCOME MEASURES IN SPINAL CORD INJURY

    PubMed Central

    Lam, Tania; Noonan, Vanessa K.; Eng, Janice J.

    2011-01-01

    Study Design systematic review Objectives To systematically review the psychometric properties of outcome measures used to assess ambulation in people with spinal cord injury (SCI). Setting Vancouver, Canada Methods A keyword literature search of original articles that evaluated the psychometric properties of ambulation outcome measures in the SCI population was conducted using multiple databases. Multi-dimensional scales of function were included if specific data were available on ambulation-related sub-scales. Reliability, validity, and responsiveness values were extracted and conclusions drawn about the psychometric quality of each measure. Results Seven outcome measures were identified and were broadly categorized into timed and categorical measures of ambulation. Timed measures included timed walking tests that showed excellent reliability, construct validity, and responsiveness to change. The psychometric properties of the categorical scales were more variable, but those that were developed specifically for the SCI population had excellent reliability and validity. Categorical scales also exhibited some floor or ceiling effects. Conclusion Excellent tools are available for measuring functional ambulation capacity. Further work is required to develop and evaluate outcome measures to include environmental factors that contribute to the ability to achieve safe, functional ambulation in everyday settings. Sponsorship Rick Hansen Man-in-Motion Foundation and Ontario Neurotrauma Fund. PMID:17923844

  1. ASME N511-19XX, Standard for periodic in-service testing of nuclear air treatment, heating, ventilating and air conditioning systems

    SciTech Connect

    1997-08-01

    A draft version of the Standard is presented in this document. The Standard covers the requirements for periodic in-service testing of nuclear safety-related air treatment, heating, ventilating, and air conditioning systems in nuclear facilities. The Standard provides a basis for the development of test programs and does not include acceptance criteria, except in cases where the results of one test influence the performance of other tests. The Standard covers general inspection and test requirements, reference values, inspection and test requirements, generic tests, acceptance criteria, in-service test requirements, testing following an abnormal incident, corrective action requirements, and quality assurance. Mandatory appendices provide a visual inspection checklist and four test procedures. Non-mandatory appendices provide additional information and guidance on mounting frame pressure leak test procedure, corrective action, challenge gas substitute selection criteria, and test program development. 8 refs., 10 tabs.

  2. Improving Pre-Service Elementary Teachers' Education via a Laboratory Course on Air Pollution: One University's Experience

    ERIC Educational Resources Information Center

    Mandrikas, Achilleas; Parkosidis, Ioannis; Psomiadis, Ploutarchos; Stoumpa, Artemisia; Chalkidis, Anthimos; Mavrikaki, Evangelia; Skordoulis, Constantine

    2013-01-01

    This paper describes the structure of the "Air Pollution Course", an environmental science laboratory course developed at the Science Education Laboratory of the Faculty of Primary Education, University of Athens, as well as the findings resulting from its implementation by pre-service elementary teachers. The course proposed in this…

  3. 76 FR 57902 - Amendment and Establishment of Air Traffic Service Routes; Northeast United States

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-19

    ... deconflict air traffic. Some communities felt that they are unfairly impacted by low flying aircraft and that... impact is so minimal. Since this is a routine matter that will only affect air traffic procedures and air... Federal Aviation Administration 14 CFR Part 71 RIN 2120-AA66 Amendment and Establishment of Air...

  4. Advances of air pollution science: from forest decline to multiple-stress effects on forest ecosystem services.

    PubMed

    Paoletti, E; Schaub, M; Matyssek, R; Wieser, G; Augustaitis, A; Bastrup-Birk, A M; Bytnerowicz, A; Günthardt-Goerg, M S; Müller-Starck, G; Serengil, Y

    2010-06-01

    Over the past 20 years, the focus of forest science on air pollution has moved from forest decline to a holistic framework of forest health, and from the effects on forest production to the ecosystem services provided by forest ecosystems. Hence, future research should focus on the interacting factorial impacts and resulting antagonistic and synergistic responses of forest trees and ecosystems. The synergistic effects of air pollution and climatic changes, in particular elevated ozone, altered nitrogen, carbon and water availability, must be key issues for research. Present evidence suggests air pollution will become increasingly harmful to forests under climate change, which requires integration amongst various stressors (abiotic and biotic factors, including competition, parasites and fire), effects on forest services (production, biodiversity protection, soil protection, sustained water balance, socio-economical relevance) and assessment approaches (research, monitoring, modeling) to be fostered.

  5. Field investigation source area ST58 old Quartermaster service station, Eielson Air Force Base, Alaska

    SciTech Connect

    Liikala, T.L.; Evans, J.C.

    1995-01-01

    Source area ST58 is the site of the old Quartermaster service station at Eielson Air Force Base, Alaska. The source area is one of several Source Evaluation Report sites being investigated by Pacific Northwest Laboratory for the US Air Force as candidates for no further remedial action, interim removal action, or a remedial investigation/feasibility study under a Federal Facilities Agreement. The purpose of this work was to characterize source area ST58 and excavate the most contaminated soils for use in composting treatability studies. A field investigation was conducted to determine the nature and extent of soil contamination. The field investigation entailed a records search; grid node location, surface geophysical, and soil gas surveys; and test pit soil sampling. Soil excavation followed based on the results of the field investigation. The site was backfilled with clean soil. Results from this work indicate close spatial correlation between screening instruments, used during the field investigation and soil excavation, and laboratory analyses. Gasoline was identified as the main subsurface contaminant based on the soil gas surveys and test pit soil sampling. A center of contamination was located near the northcentral portion of the source area, and a center was located in the northwestern comer. The contamination typically occurred near or below a former soil horizon probably as a result of surface spills and leaks from discontinuities and/or breaks in the underground piping. Piping locations were delineated during the surface geophysical surveys and corresponded very well to unscaled drawings of the site. The high subsurface concentrations of gasoline detected in the northwestern comer of the source area probably reflect ground-water contamination and/or possibly floating product.

  6. The world's air transportation services : data as to passengers, mail, and goods carried by American and European transportation services

    NASA Technical Reports Server (NTRS)

    1922-01-01

    This report presents detailed descriptions, statistics, and graphs on European and American air transport. The European countries listed are Belgium, Czecho-Slovakia, Denmark, France, Germany, Great Britain, Holland, and Italy.

  7. [Long-haul intensive care transports by air].

    PubMed

    Graf, Jürgen; Seiler, Olivier; Pump, Stefan; Günther, Marion; Albrecht, Roland

    2013-03-01

    The need for inter-hospital transports over long distances aboard air ambulances or airlines has increased in recent years, both in the civil as well as the military sector. More often severely ill intensive care patients with multiple organ failure and appropriate supportive care (e.g. mechanical ventilation, catecholamines, dialysis, cardiac assist devices) are transported by air. Despite the fact that long-haul intensive care transports by air ambulance and airlines via Patient Transport Compartment (PTC) are considered established modes of transport they always provide a number of challenges. Both modes of transport have distinct logistical and medical advantages and disadvantages. These-as well as the principal risks of an air-bound long-haul intensive care transport -have to be included in the risk assessment and selection of means of transport. Very often long-haul intensive care transports are a combination of air ambulance and scheduled airlines utilizing the PTC.

  8. Environmental Assessment: Proposed Construction of Army and Air Force Exchange Service Shopping Center Offutt Air Force Base, Nebraska

    DTIC Science & Technology

    2005-05-01

    comprised of dust, ash, soot , smoke, or liquid droplets emitted into the air. Fires, unpaved roads, construction activities, and natural sources (wind...Employer 1(’-,:9 Printed with soy ink on recycled paper ~ DEPARTMENT OF THE ARMY CORPS OF ENGINEERS, OMAHA DISTRICT 106 SOUTH 15TH STREET REPLY

  9. Hearing half the message? A re-audit of the care of patients with acute asthma by emergency ambulance crews in London

    PubMed Central

    Snooks, H; Halter, M; Palmer, Y; Booth, H; Moore, F

    2005-01-01

    

Problem: An initial audit of the care provided to emergency asthma patients by the ambulance service was carried out in 1996. Some under-recognition and under-treatment of severe asthma was found as well as a lack of documentation of patient condition on scene. A re-audit was undertaken in 1999. Design: A multidisciplinary advisory group was reconvened. The same method was adopted as for the first audit. Patients included were those administered nebulised salbutamol by crews in the catchment areas of four hospitals and those diagnosed with asthma at the Accident & Emergency (A&E) departments of those hospitals between January and March 1999. Setting: London Ambulance Service. Key measures for improvement: (1) Accuracy of diagnosis and appropriateness of treatment, and (2) adherence to protocol. Strategies for change: Following the first audit, treatment protocols were widened and brought into line with the British Thoracic Society guidelines for care of acute asthma patients. The results were widely disseminated within the service and training was initiated for all operational staff. Effects of change: The number of patients included in the re-audit more than doubled (audit 1: n = 252, audit 2: n = 532). The increase occurred exclusively in those administered nebulised salbutamol by ambulance crews but diagnosed with conditions other than asthma in A&E (audit 1: n = 15, audit 2: n = 161). The proportion of patients diagnosed with asthma in A&E who were administered nebulised salbutamol by their attending crew rose from 58% to 75%. However, 43 asthma patients were not treated; several of these were not recognised as suffering from asthma and others fell within the changed protocols for treatment. Adherence to protocol for administration of salbutamol remained high. Pre-hospital documentation of key observations did not improve. Lessons learnt: Messages from the first audit seem to have been acted upon selectively. Implementing change is complex, and re

  10. Tools for Schools: Filtration for Improved Air Quality. Technical Services Bulletin.

    ERIC Educational Resources Information Center

    2001

    This product bulletin addresses air pollution control in educational facilities to enhance educational performance, provides air quality recommendations for schools, and examines the filtration needs of various school areas. The types of air particles typically present are highlighted, and the use of proper filtration to control gases and vapors…

  11. Non-Ambulant Duchenne Patients Theoretically Treatable by Exon 53 Skipping have Severe Phenotype

    PubMed Central

    Servais, Laurent; Montus, Marie; Guiner, Caroline Le; Ben Yaou, Rabah; Annoussamy, Mélanie; Moraux, Amélie; Hogrel, Jean-Yves; Seferian, Andreea M.; Zehrouni, Karima; Le Moing, Anne-Gaëlle; Gidaro, Teresa; Vanhulle, Catherine; Laugel, Vincent; Butoianu, Nina; Cuisset, Jean-Marie; Sabouraud, Pascal; Cances, Claude; Klein, Andrea; Leturcq, France; Moullier, Philippe; Voit, Thomas

    2015-01-01

    Abstract Background: Exon skipping therapy is an emerging approach in Duchenne Muscular Dystrophy (DMD). Antisense oligonucleotides that induce skipping of exon 51, 44, 45, or 53 are currently being evaluated in clinical trials. These trials were designed on the basis of data available in general DMD population. Objectives: Our objective was to compare the clinical and functional statuses of non-ambulant DMD patients theoretically treatable by exon 53 skipping and of DMD patients with other mutations. Methods: We first compared fifteen non-ambulant DMD patients carrying deletions theoretically treatable by exon 53 skipping (DMD-53) with fifteen closely age-matched DMD patients with mutations not treatable by exon 53 skipping (DMD-all-non-53) then with fifteen DMD patients carrying deletions not treatable by exon 53 skipping (DMD-del-non-53). Results: We found that DMD-53 patients had a lower left ventricular ejection fraction, more contractures and they tend to have weaker grips and pinch strengths than other DMD patients. DMD-53 patients lost ambulation significantly younger than other DMD patients. This result was confirmed by comparing ages at loss of ambulation in all non-ambulant DMD patients of the DMD cohort identified in a molecular diagnostic lab. Conclusions: These prospective and retrospective data demonstrate that DMD-53 patients have clinically more severe phenotypes than other DMD patients. PMID:27858743

  12. Levels of Community Ambulation Ability in Patients with Stroke Who Live in a Rural Area

    PubMed Central

    Amatachaya, Sugalya; Chuadthong, Janya; Thaweewannaku, Thiwabhorn; Srisim, Kitiyawadee; Phonthee, Sirisuda

    2016-01-01

    Background Community ambulation is essential for patients with stroke. Apart from treatments, an assessment with a quantitative target criterion is also important for patients to clearly demonstrate their functional alteration and determine how close they are to their goal, as well as for therapists to assess the effectiveness of the treatments. The existing quantitative target criteria for community ambulation were all derived from participants in a developed country and ability was assessed using a single-task test. To explore cutoff scores of the single-task and dual-task 10-meter walk test (10MWT) in ambulatory patients with stroke from rural areas of a developing country. Methods Ninety-five participants with chronic stroke were interviewed concerning their community ambulation ability, and assessed for their walking ability using the single- and dual-task 10MWT. Results A walking speed of at least 0.47 m/s assessed using the single-task 10MWT, and at least 0.30 m/s assessed using the dual-task 10MWT, could determine the community ambulation ability of the participants. Conclusion Distinct contexts and anthropometric characteristics required different target criteria for community walking. Thus, when establishing a target value for community ambulation, it needs to be specific to the demographics and geographical locations of the patients. PMID:27540326

  13. Ambulation speed and corresponding mechanics are associated with changes in serum cartilage oligomeric matrix protein.

    PubMed

    Denning, W Matt; Becker Pardo, Michael; Winward, Jason G; Hunter, Iain; Ridge, Sarah; Hopkins, J Ty; Reese, C Shane; Parcell, Allen C; Seeley, Matthew K

    2016-02-01

    Because serum cartilage oligomeric matrix protein (COMP) has been used to reflect articular cartilage condition, we aimed to identify walking and running mechanics that are associated with changes in serum COMP. Eighteen subjects (9 male, 9 female; age=23 ± 2 yrs.; mass=68.3 ± 9.6 kg; height=1.70 ± 0.08 m) completed 4000 steps on an instrumented treadmill on three separate days. Each day corresponded to a different ambulation speed: slow (preferred walking speed), medium (+50% of slow), and fast (+100% of slow). Synchronized ground reaction force and video data were collected to evaluate walking mechanics. Blood samples were collected pre-, post-, 30-minute post-, and 60-minute post-ambulation to determine serum COMP concentration at these times. Serum COMP increased 29%, 18%, and 5% immediately post ambulation for the fast, medium, and slow sessions (p<0.01). When the speeds were pooled, peak ankle inversion, knee extension, knee abduction, hip flexion, hip extension, and hip abduction moment, and knee flexion angle at impact explained 61.4% of total variance in COMP concentration change (p<0.001). These results indicate that (1) certain joint mechanics are associated with acute change in serum COMP due to ambulation, and (2) increased ambulation speed increases serum COMP concentration.

  14. Commercially available accelerometry as an ecologically valid measure of ambulation in individuals with multiple sclerosis.

    PubMed

    Motl, Robert W; Sandroff, Brian M; Sosnoff, Jacob J

    2012-09-01

    Ambulatory impairment is a prevalent consequence of multiple sclerosis (MS) that is often measured in controlled contexts using performance tests that lack ecological validity. This underscores the importance of considering alternative, ecologically valid approaches, such as commercially available accelerometers, for measuring community ambulation in individuals with MS. This consideration is warranted based on problems with existing measures of ambulation in MS (e.g., poor responsiveness and patient-clinician discordance); conceptual associations among MS pathology, impairment and gait function with relevance for the signal detected by accelerometers; assumptions that are empirically supported for the application of commercially available accelerometers as a measure of community ambulation; and evidence supporting the output of commercially available accelerometers as a measure of ambulation. Collectively, the authors believe the time is ripe for the application of commercially available accelerometers as an outcome measure of community ambulation in MS. Such an application has the potential to maximize the understanding of ambulatory impairments in real-world conditions for clinical research and practice involving individuals with MS.

  15. Combat Service Support Enabler Functional Assessment (CEFA). Volume 2: Individual (65) Mini-CEFA Assessments

    DTIC Science & Technology

    1997-12-01

    47E Vibration Management Enhancement DEC 96 Program Cost-Benefit Analysis for U.S. Navy JAN 95 and Marine Corps Helicopter Safety-of-Flight Systems...ASSESSMENTS TABLE OF CONTENTS Mini-Assessment Title Page 1. Advanced Radiographic System (ARS) . 1 2. Air Ambulance (UH-60Q MEDEVAC Helicopter ) 7...Air Ambulance (UH-60Q MEDEVAC Helicopter ) 2. Designation. FXXI CSS Initiative. Provides medical units w/on-board medical technology to

  16. [An ambulance helicopter in Jamtland. A survival necessity in a county of tourism].

    PubMed

    Ek, B; Zetterström, H

    2000-03-22

    The county of Jämtland is a sparsely populated area in which an ambulance-helicopter has been in use since the middle of the 1970's. A prospective study was undertaken during a six month period with the aim of evaluating the benefits of the helicopter as compared with the use of road-ambulance transport alone. Total number of patients involved was n = 249. Both flight nurses and receiving doctors found that in most cases, patients transported by helicopter manned with a flight nurse were given higher quality care. A follow-up study by specialists from the receiving departments confirmed that for 3% (n = 8), transport by ambulance-helicopter resulted in "probably better prognosis", and that for 2% (n = 6) the result was "lifesaving".

  17. Practice guidelines for early ambulation of burn survivors after lower extremity grafts.

    PubMed

    Nedelec, Bernadette; Serghiou, Michael A; Niszczak, Jonathan; McMahon, Margaret; Healey, Tanja

    2012-01-01

    The objective of this review was to systematically evaluate the available clinical evidence for early ambulation of burn survivors after lower extremity skin grafting procedures so that practice guidelines could be proposed. It provides evidence-based recommendations, specifically for the rehabilitation interventions required for early ambulation of burn survivors. These guidelines are designed to assist all healthcare providers who are responsible for initiating and supporting the ambulation and rehabilitation of burn survivors after lower extremity grafting. Summary recommendations were made after the literature, retrieved by systematic review, was critically appraised and the level of evidence determined according to Oxford Centre for Evidence-Based Medicine criteria. A formal consensus exercise was performed to address some of the identified gaps in the literature which were believed to be critical building blocks of clinical practice.

  18. Assessment of broadcast media airings of AIDS-related public service announcements--United States, 1987-1990.

    PubMed

    1991-08-09

    Television and radio public service announcements (PSAs) are an integral part of acquired immunodeficiency syndrome (AIDS) public information campaigns. This report summarizes an assessment of airings of AIDS PSAs in the United States during October 1987-December 1990 that were produced by CDC's "America Responds to AIDS" (ARTA) campaign and other groups.* The assessment used data obtained from Broadcast Advertisers Reports (BAR) of the Arbitron Company.

  19. Risk Factors for Incident Postdeployment Mental Health Conditions Among U.S. Air Force Medical Service Personnel.

    PubMed

    Maupin, Genny M; Tvaryanas, Anthony P; White, Edward D; Lysfjord, Heather J

    2017-03-01

    The prevalence of postdeployment mental health (PDMH) conditions in military health care personnel appears to be on par with that of other military personnel. However, there is no comprehensive analysis of incident PDMH conditions within the overall population of U.S. Air Force Medical Service personnel. This study explored the epidemiology of incident PDMH conditions among Air Force Medical Service personnel returning from deployment. A cohort survival analysis was conducted of 24,409 subjects without preexisting mental health conditions and at least one deployment during 2003-2013. Electronic health record data were used to ascertain the diagnosis of a PDMH condition. The primary outcome measure was an incident PDMH condition defined as a mental health diagnosis on at least two separate clinical encounters. The incidence of PDMH conditions was 59.74 per 1,000 person-years. Adjustment, anxiety, mood, sleep, and post-traumatic stress disorders accounted for 78% diagnoses. Protective factors included officer, surgeon, specific enlisted career fields, Air National Guard or Air Force Reserve, and multiple deployments. Risk factors included nurse, other specific enlisted career fields, female, and unmarried with dependents. Most subjects (73%) were diagnosed within the standard 30-month surveillance time period; median time to diagnosis was 13 months.

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

    PubMed

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

    2008-01-01

    This is the first paper on suicidal ideation and attempts among ambulance personnel. This study aimed to investigate levels of suicidal ideation and suicide attempts among ambulance personnel, and to identify important correlates and the factors to which ambulance personnel attribute their serious suicidal ideation. A comprehensive nationwide questionnaire survey of 1,180 operational ambulance personnel was conducted. Measurements included: Paykel's Suicidal Feelings in the General Population questionnaire, the Hospital Anxiety and Depression scale, the Subjective Health Complaints Questionnaire, the Maslach Burnout Inventory, the Job Satisfaction Scale, the Basic Character Inventory, and the Rosenberg Self-Esteem Scale. Lifetime prevalence ranged from 28% for feelings that life was not worth living to 10.4% for seriously considered suicide and 3.1% for a suicide attempt. Serious suicidal ideation was independently associated with job-related emotional exhaustion (feelings of being overextended and depleted of resources) (OR 1.5, 95% CI 1.1-2.0) and bullying at work (OR 1.7, 95% CI 1.02-2.7), younger age, not married/cohabitant, depression symptoms, low self-esteem and the personality trait reality weakness. In general, suicidal thoughts were hardly attributable to working conditions, since only 1.8% of ambulance personnel attributed suicidal ideation to work problems alone. In conclusion, ambulance personnel reported a moderate level of suicidal ideation and suicide attempts. Although serious suicidal ideation was rarely attributed to working conditions in general, this study suggests that job-related factors like emotional exhaustion and bullying may be of importance.

  1. 24 Month Longitudinal Data in Ambulant Boys with Duchenne Muscular Dystrophy

    PubMed Central

    Sormani, Maria Pia; Scalise, Roberta; Berardinelli, Angela; Messina, Sonia; Torrente, Yvan; D’Amico, Adele; Doglio, Luca; Viggiano, Emanuela; D’Ambrosio, Paola; Cavallaro, Filippo; Frosini, Silvia; Bello, Luca; Bonfiglio, Serena; De Sanctis, Roberto; Rolle, Enrica; Bianco, Flaviana; Magri, Francesca; Rossi, Francesca; Vasco, Gessica; Vita, GianLuca; Motta, Maria Chiara; Donati, Maria Alice; Sacchini, Michele; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Previtali, Stefano; Napolitano, Sara; Bruno, Claudio; Politano, Luisa; Comi, Giacomo Pietro; Bertini, Enrico; Mercuri, Eugenio

    2013-01-01

    Objectives The aim of the study was i) to assess the spectrum of changes over 24 months in ambulant boys affected by Duchenne muscular dystrophy, ii) to establish the difference between the first and the second year results and iii) to identify possible early markers of loss of ambulation. Methods One hundred and thirteen patients (age range 4.1–17, mean 8.2) fulfilled the inclusion criteria, 67 of the 113 were on daily and 40 on intermittent steroids, while 6 were not on steroids. All were assessed using the 6 Minute Walk Test (6MWT), the North Star Ambulatory Assessment (NSAA) and timed test. Results On the 6MWT there was an average overall decline of −22.7 (SD 81.0) in the first year and of −64.7 (SD 123.1) in the second year. On the NSAA the average overall decline was of −1.86 (SD 4.21) in the first year and of −2.98 (SD 5.19) in the second year. Fourteen children lost ambulation, one in the first year and the other 13 in the second year of the study. A distance of at least 330 meters on the 6MWT, or a NSAA score of 18 at baseline reduced significantly the risk of losing ambulation within 2 years. Conclusions These results can be of help at the time of using inclusion criteria for a study in ambulant patients in order to minimize the risk of patients who may lose ambulation within the time of the trial. PMID:23326337

  2. Promoting ambulation and object manipulation in persons with multiple handicaps through the use of a robot.

    PubMed

    Lancioni, G E; Oliva, D; Signorino, M

    1994-10-01

    A robot was used with a man and a woman affected by blindness, motor disabilities, and mental retardation. The robot was to assist these subjects during their ambulation and allow them to reach a couch (on which to sit) and to transport objects. The data showed that both subjects learned to use the robot, succeeded in transporting and putting away objects, and achieved independent ambulation times of over 22 and 20 min. per session. Staff personnel found the situation in which the subjects were busy with the robot preferable to situations in which the robot was not available.

  3. US Army Order of Battle 1919-1941. Volume 3. The Services: Air Service, Engineers, and Special Troops, 1919-41

    DTIC Science & Technology

    2010-01-01

    James A. Meissner 16 Jan 24-ao Feb 24 Maj. W. V. M. Robertson ao Apr 24-15 May 25 Maj. Sumpter Smith 15 May 25-15 Sep 29 Headquarters...Demobilized on 15 February 1929. Commanders, 35th Division Air Service Maj. William M. Robertson 23 Jun 23-16 Sep 24 Capt. William H. Leininger 21 May 25...Refueling Squadron at Seymour -Johnson, A.F.B., NC. Events: 268, 283 Commanders, 21st Reconnaissance Squadron Capt. William V. Andrews 1 Mar 35-1 Jun 35

  4. Manpower Needs in Health Services.

    ERIC Educational Resources Information Center

    Solomon, Herman S.

    All hospitals, nursing homes, clinics, and home nursing and ambulance services in New York State were surveyed to determine projected needs for 39 specific occupations for nursing staff, technicians, and aides. There were 326,000 persons working in the medical care facilities in December 1966, and 182,000 held jobs in the 39 occupations. Hospitals…

  5. Guidelines for evaluating air-pollution impacts on Class I wilderness areas in the Pacific Northwest. Forest Service general technical report

    SciTech Connect

    Peterson, J.; Schmoldt, D.; Peterson, D.; Eilers, J.; Fisher, R.

    1992-05-01

    Forest Service air resource managers in the Pacific Northwest are responsible for protecting class 1 wilderness areas from air pollution. To do this, they need scientifically defensible information to determine critical concentrations of air pollution having the potential to impact class 1 wilderness values. This report documents the results of a workshop where current information on air pollution effects on aquatic and terrestrial resources and visibility was gathered from participating scientists and managers. Critical air pollution concentrations were determined for sulfur dioxide, nitrogen dioxide, and ozone. Critical values for sulfur and nitrogen deposition to forest ecosystems are listed.

  6. A critical review of studies of the association between demands for hospital services and air pollution.

    PubMed Central

    Lipfert, F W

    1993-01-01

    Studies of the associations between air pollution and hospital admissions and emergency room use are reviewed, including studies of air pollution episodes, time-series analyses, and cross-sectional analyses. These studies encompass a variety of methods of analysis and levels of air quality. Findings from all three types of studies were generally consistent in that almost all of the studies reviewed found statistically significant associations between hospital use and air pollution; this unanimity may have resulted in part from publication bias. These associations were characterized by elasticities of the order of 0.20; i.e., a 100% change in air pollution was associated with a change in hospital use of about 20%, for specific diagnoses. Respiratory diagnoses were emphasized by most studies; cardiac diagnoses were included in five of them. The air pollutants most often associated with changes in hospital use were particulate matter, sulfur oxides, and oxidants. Apart from the major air pollution episodes, there was no obvious link between air pollution level and the significance or magnitudes of the associations. Long-term indicators of hospitalization appeared to also be influenced by medical care supply factors, including the numbers of beds and physicians per capita. These nonpathological causal factors could also have influenced the findings of the time-series studies by introducing extraneous factors in the patterns of admissions. Although consistent associations have been shown between hospital use and air pollution, further research is required to distinguish among potentially responsible pollutants and to deduce specific dose-response relationships of general utility. PMID:8243395

  7. Requirements for regional short-haul air service and the definition of a flight program to determine neighborhood reactions to small transport aircraft

    NASA Technical Reports Server (NTRS)

    Feher, K.; Bollinger, L.; Bowles, J. V.; Waters, M. H.

    1978-01-01

    An evaluation of the current status and future requirements of an intraregional short haul air service is given. A brief definition of the different types of short haul air service is given. This is followed by a historical review of previous attempts to develop short haul air service in high density urban areas and an assessment of the current status. The requirements for intraregional air service, the need for economic and environmental viability and the need for a flight research program are defined. A detailed outline of a research program that would determine urban community reaction to frequent operations of small transport aircraft is also given. Both the operation of such an experiment in a specific region (San Francisco Bay area) and the necessary design modifications of an existing fixed wing aircraft which could be used in the experiment are established. An estimate is made of overall program costs.

  8. A PAIR OF 10TH CAVALRY AMBULANCES, PARKED NEXT TO ONE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    A PAIR OF 10TH CAVALRY AMBULANCES, PARKED NEXT TO ONE OF THE STABLE LABELED "M.D. 10." PHOTOGRAPH TAKEN CIRCA 1918 (FORT HUACHUCA HISTORICAL MUSEUM, PHOTOGRAPH 1918.00.00.135, PHOTOGRAPHER UNIDENTIFIED, CREATED BY AND PROPERTY OF THE UNITED STATES ARMY) - Fort Huachuca, Cavalry Stables, Clarkson Road, Sierra Vista, Cochise County, AZ

  9. Desirable attributes of the ambulance technician, paramedic, and clinical supervisor: findings from a Delphi study

    PubMed Central

    Kilner, T

    2004-01-01

    Methods: The Delphi technique was used to gain a consensus view from a panel of experts. The first round of the study asked the experts to list the attributes they believed were desirable for the ambulance technician, the ambulance paramedic, and the clinical supervisor. The first round of the study generated 3403 individual statements that were collapsed into 25 broad categories, which were returned to the experts, who were required to rate each of the attributes along a visual analogue scale in respect of each of the identified occupational groups. Results: On completion of the second round the data were analysed to demonstrate rank ordering of desirable attributes by occupational group. The level of agreement within each group was determined by analysis using the Kendall coefficient of concordance. This showed high levels of agreement within the technician group but less agreement within the paramedic and clinical supervisor group. All were highly significant p<0.0001. Conclusions: There was significant agreement among the experts as to the desirable attributes of ambulance staff, many of which do not feature in existing ambulance training curriculums. The findings of this study may therefore be of value in informing future curriculum development and in providing guidance for the selection of staff for each of the occupational groups. PMID:15107388

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

    PubMed

    Kim, Sun Hoon; Lee, Young Hoon

    2016-12-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  12. The 6 minute walk test and performance of upper limb in ambulant duchenne muscular dystrophy boys.

    PubMed

    Pane, Marika; Mazzone, Elena Stacy; Sivo, Serena; Fanelli, Lavinia; De Sanctis, Roberto; D'Amico, Adele; Messina, Sonia; Battini, Roberta; Bianco, Flaviana; Scutifero, Marianna; Petillo, Roberta; Frosini, Silvia; Scalise, Roberta; Vita, Gian Luca; Bruno, Claudio; Pedemonte, Marina; Mongini, Tiziana; Pegoraro, Elena; Brustia, Francesca; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Busato, Fabio; Bonfiglio, Serena; Rolle, Enrica; Colia, Giulia; Bonetti, Annamaria; Palermo, Concetta; Graziano, Alessandra; D'Angelo, Grazia; Pini, Antonella; Corlatti, Alice; Gorni, Ksenija; Baranello, Giovanni; Antonaci, Laura; Bertini, Enrico; Politano, Luisa; Mercuri, Eugenio

    2014-10-07

    The Performance of Upper Limb (PUL) test was specifically developed for the assessment of upper limbs in Duchenne muscular dystrophy (DMD). The first published data have shown that early signs of involvement can also be found in ambulant DMD boys. The aim of this longitudinal Italian multicentric study was to evaluate the correlation between the 6 Minute Walk Test (6MWT) and the PUL in ambulant DMD boys. Both 6MWT and PUL were administered to 164 ambulant DMD boys of age between 5.0 and 16.17 years (mean 8.82). The 6 minute walk distance (6MWD) ranged between 118 and 557 (mean: 376.38, SD: 90.59). The PUL total scores ranged between 52 and 74 (mean: 70.74, SD: 4.66). The correlation between the two measures was 0.499. The scores on the PUL largely reflect the overall impairment observed on the 6MWT but the correlation was not linear. The use of the PUL appeared to be less relevant in the very strong patients with 6MWD above 400 meters, who, with few exceptions had near full scores. In patients with lower 6MWD the severity of upper limb involvement was more variable and could not always be predicted by the 6MWD value or by the use of steroids. Our results confirm that upper limb involvement can already be found in DMD boys even in the ambulant phase.

  13. The 6 Minute Walk Test and Performance of Upper Limb in Ambulant Duchenne Muscular Dystrophy Boys

    PubMed Central

    Pane, Marika; Mazzone, Elena Stacy; Sivo, Serena; Fanelli, Lavinia; De Sanctis, Roberto; D’Amico, Adele; Messina, Sonia; Battini, Roberta; Bianco, Flaviana; Scutifero, Marianna; Petillo, Roberta; Frosini, Silvia; Scalise, Roberta; Vita, Gian Luca; Bruno, Claudio; Pedemonte, Marina; Mongini, Tiziana; Pegoraro, Elena; Brustia, Francesca; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Busato, Fabio; Bonfiglio, Serena; Rolle, Enrica; Colia, Giulia; Bonetti, Annamaria; Palermo, Concetta; Graziano, Alessandra; D’Angelo, Grazia; Pini, Antonella; Corlatti, Alice; Gorni, Ksenija; Baranello, Giovanni; Antonaci, Laura; Bertini, Enrico; Politano, Luisa; Mercuri, Eugenio

    2014-01-01

    The Performance of Upper Limb (PUL) test was specifically developed for the assessment of upper limbs in Duchenne muscular dystrophy (DMD). The first published data have shown that early signs of involvement can also be found in ambulant DMD boys. The aim of this longitudinal Italian multicentric study was to evaluate the correlation between the 6 Minute Walk Test (6MWT) and the PUL in ambulant DMD boys. Both 6MWT and PUL were administered to 164 ambulant DMD boys of age between 5.0 and 16.17 years (mean 8.82). The 6 minute walk distance (6MWD) ranged between 118 and 557 (mean: 376.38, SD: 90.59). The PUL total scores ranged between 52 and 74 (mean: 70.74, SD: 4.66). The correlation between the two measures was 0.499. The scores on the PUL largely reflect the overall impairment observed on the 6MWT but the correlation was not linear. The use of the PUL appeared to be less relevant in the very strong patients with 6MWD above 400 meters, who, with few exceptions had near full scores. In patients with lower 6MWD the severity of upper limb involvement was more variable and could not always be predicted by the 6MWD value or by the use of steroids. Our results confirm that upper limb involvement can already be found in DMD boys even in the ambulant phase. PMID:25642376

  14. Modeling the Emergency Ambulance Pass-By of Small Rural Hospitals in Victoria, Australia

    ERIC Educational Resources Information Center

    Gleeson, Patrick; Duckett, Stephen

    2005-01-01

    Context: Many small rural hospitals struggle to attract sufficient numbers of suitable patients. Inadequate patient throughput threatens the viability of these hospitals and, consequently, the financial, physical, and social well-being of the whole community. Anecdotal evidence suggests that many emergency ambulance patients are routinely taken…

  15. Effect of fee-for-service air-conditioning management in balancing thermal comfort and energy usage.

    PubMed

    Chen, Chen-Peng; Hwang, Ruey-Lung; Shih, Wen-Mei

    2014-11-01

    Balancing thermal comfort with the requirement of energy conservation presents a challenge in hot and humid areas where air-conditioning (AC) is frequently used in cooling indoor air. A field survey was conducted in Taiwan to demonstrate the adaptive behaviors of occupants in relation to the use of fans and AC in a school building employing mixed-mode ventilation where AC use was managed under a fee-for-service mechanism. The patterns of using windows, fans, and AC as well as the perceptions of students toward the thermal environment were examined. The results of thermal perception evaluation in relation to the indoor thermal conditions were compared to the levels of thermal comfort predicted by the adaptive models described in the American Society of Heating, Refrigerating, and Air-Conditioning Engineers Standard 55 and EN 15251 and to that of a local model for evaluating thermal adaption in naturally ventilated buildings. A thermal comfort-driven adaptive behavior model was established to illustrate the probability of fans/AC use at specific temperature and compared to the temperature threshold approach to illustrate the potential energy saving the fee-for-service mechanism provided. The findings of this study may be applied as a reference for regulating the operation of AC in school buildings of subtropical regions.

  16. TECHNOLOGY EVALUATION REPORT CEREX ENVIRONMENTAL SERVICES UV HOUND POINT SAMPLE AIR MONITOR

    EPA Science Inventory

    The USEPA's National Homeland Security Research Center (NHSRC) Technology Testing and Evaluation Program (TTEP) is carrying out performance tests on homeland security technologies. Under TTEP, Battelle evaluated the performance of the Cerex UV Hound point sample air monitor in de...

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

    PubMed

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

    2016-01-01

    Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (<16 years) who had pain as a symptom (regardless of cause) at any stage during the prehospital phase of care were included in this study. Over the study period, 6,371 children attended the four EDs by emergency ambulance, of which 2,635 (41.4%, 95% confidence interval 40.2-42.3%) had pain as a documented symptom on the ambulance patient care report (PCR) form. Overall 32% (n = 856) of children who complained of pain were subject to a formal pain assessment during the prehospital phase of care. Younger age, short transfer time to the ED, and emergency calls between midnight and 6 am were independently associated with decreased likelihood of having a documented assessment of pain intensity during the prehospital phase of care. Of the 2,635 children who had documented pain on the ambulance PCR, 26% (n = 689) received some form of analgesic agent prior to ED arrival. Upon ED arrival 54% (n = 1,422) of children had a documented pain assessment and some form of analgesic agent was administered to 50% (n = 1,324). Approximately 41% of children who attend EDs in Ireland by ambulance have pain documented as their primary symptom. This study suggests that the management of acute pain in children transferred by

  18. Air Weather Service Master Station Catalog: USAFETAC Climatic Database Users Handbook No. 6

    DTIC Science & Technology

    1993-03-01

    Federal Aviation Administration (FAA) G = Air Force Global Weather Central (AFGWC) K = Carswell Automated Weather Network (Det 7, AFGWC) 0...Carswell Automated Weather Network (Det 7, AFGWC) M = Located by meteorological analysis B-6 P" 0 0 S 5 0 0 • 0 •, 0 N = Hydrology office...Airways Facilities Sector AMOS - Automated Meteorological Observing System ANG - Air National Guard weather facility AUT - Automated reporting

  19. Air quality climate in the Columbia River Basin. Forest Service general technical report

    SciTech Connect

    Ferguson, S.A.

    1998-08-01

    Aspects of climate that influence air quality in the Columbia River Basin of the Northwestern United States are described. A few, relatively simple, analytical tools were developed to show the spatial and temporal patterns of mean-monthly mixing heights, precipitation scavenging, upper level and surface trajectory winds, and drought that inhibit pollution uptake. Also, potential changes in air quality from the effects of increasing greenhouse gases are discussed.

  20. Ambulance smartphone tool for field triage of ruptured aortic aneurysms (FILTR): study protocol for a prospective observational validation of diagnostic accuracy

    PubMed Central

    Lewis, Thomas L; Fothergill, Rachael T; Karthikesalingam, Alan

    2016-01-01

    Introduction Rupture of an abdominal aortic aneurysm (rAAA) carries a considerable mortality rate and is often fatal. rAAA can be treated through open or endovascular surgical intervention and it is possible that more rapid access to definitive intervention might be a key aspect of improving mortality for rAAA. Diagnosis is not always straightforward with up to 42% of rAAA initially misdiagnosed, introducing potentially harmful delay. There is a need for an effective clinical decision support tool for accurate prehospital diagnosis and triage to enable transfer to an appropriate centre. Methods and analysis Prospective multicentre observational study assessing the diagnostic accuracy of a prehospital smartphone triage tool for detection of rAAA. The study will be conducted across London in conjunction with London Ambulance Service (LAS). A logistic score predicting the risk of rAAA by assessing ten key parameters was developed and retrospectively validated through logistic regression analysis of ambulance records and Hospital Episode Statistics data for 2200 patients from 2005 to 2010. The triage tool is integrated into a secure mobile app for major smartphone platforms. Key parameters collected from the app will be retrospectively matched with final hospital discharge diagnosis for each patient encounter. The primary outcome is to assess the sensitivity, specificity and positive predictive value of the rAAA triage tool logistic score in prospective use as a mob app for prehospital ambulance clinicians. Data collection started in November 2014 and the study will recruit a minimum of 1150 non-consecutive patients over a time period of 2 years. Ethics and dissemination Full ethical approval has been gained for this study. The results of this study will be disseminated in peer-reviewed publications, and international/national presentations. Trial registration number CPMS 16459; pre-results. PMID:27797986

  1. 39 CFR 927.2 - Noncontractual air service for international and military mail.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... military mail. 927.2 Section 927.2 Postal Service UNITED STATES POSTAL SERVICE PROCEDURES RULES OF... and military mail. (a) Report of infraction. Each mail handling irregularity will be reported in the... adapted to the respective modes of transportation, see International Mail Operations, Handbook...

  2. 39 CFR 927.2 - Noncontractual air service for international and military mail.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... military mail. 927.2 Section 927.2 Postal Service UNITED STATES POSTAL SERVICE PROCEDURES RULES OF... and military mail. (a) Report of infraction. Each mail handling irregularity will be reported in the... adapted to the respective modes of transportation, see International Mail Operations, Handbook...

  3. 39 CFR 927.2 - Noncontractual air service for international and military mail.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... military mail. 927.2 Section 927.2 Postal Service UNITED STATES POSTAL SERVICE PROCEDURES RULES OF... and military mail. (a) Report of infraction. Each mail handling irregularity will be reported in the... adapted to the respective modes of transportation, see International Mail Operations, Handbook...

  4. 39 CFR 927.2 - Noncontractual air service for international and military mail.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... military mail. 927.2 Section 927.2 Postal Service UNITED STATES POSTAL SERVICE PROCEDURES RULES OF... and military mail. (a) Report of infraction. Each mail handling irregularity will be reported in the... adapted to the respective modes of transportation, see International Mail Operations, Handbook...

  5. Planning and Implementing total Quality Management in an Air Force Service Organization: A Case Study

    DTIC Science & Technology

    1988-09-01

    48 IV. Conclusions and Recommendations ...... 52 Lessons Learned ..... .............. 52 Practical Implications ........... 55 Recommendations...traditional quality control methods practically useless in a service-oriented environment (8:9-10). Common threads among the literature indicate these...disseminating known and tried practices , techniques and tools (1:9). Scope This case concerns a single service organization, AFALC, as the unit of

  6. 29 CFR 4.130 - Types of covered service contracts illustrated.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) Aerial reconnaissance for fire detection. (3) Ambulance service. (4) Barber and beauty shop services. (5... construction equipment (See § 4.123(e).). (34) Mess attendant services. (35) Mortuary services. (36) Motor pool... facility. (39) Packing and crating. (40) Parking services. (41) Pest control. (42) Property management....

  7. 29 CFR 4.130 - Types of covered service contracts illustrated.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) Aerial reconnaissance for fire detection. (3) Ambulance service. (4) Barber and beauty shop services. (5... construction equipment (See § 4.123(e).). (34) Mess attendant services. (35) Mortuary services. (36) Motor pool... facility. (39) Packing and crating. (40) Parking services. (41) Pest control. (42) Property management....

  8. 29 CFR 4.130 - Types of covered service contracts illustrated.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) Aerial reconnaissance for fire detection. (3) Ambulance service. (4) Barber and beauty shop services. (5... construction equipment (See § 4.123(e).). (34) Mess attendant services. (35) Mortuary services. (36) Motor pool... facility. (39) Packing and crating. (40) Parking services. (41) Pest control. (42) Property management....

  9. 29 CFR 4.130 - Types of covered service contracts illustrated.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) Aerial reconnaissance for fire detection. (3) Ambulance service. (4) Barber and beauty shop services. (5... construction equipment (See § 4.123(e).). (34) Mess attendant services. (35) Mortuary services. (36) Motor pool... facility. (39) Packing and crating. (40) Parking services. (41) Pest control. (42) Property management....

  10. A Monetary Repayment Model for Recoupment of the Educational Costs of Air Force Sponsored Graduate Education in Lieu of Completion of an Active Duty Service Commitment.

    ERIC Educational Resources Information Center

    Mangold, Sanford Dangler

    The study develops a model which enables the Air Force to initiate recoupment action against any officer, who is separating from active service prior to the completion of a graduate education Active Duty Service Commitment (ADSC). It is set up to determine the amount of money owed by the early existing officer, at any point in the ADSC. The…

  11. Idling Reduction for Emergency and Other Service Vehicles

    SciTech Connect

    2015-05-07

    This is a fact sheet about reducing idling for emergency and service vehicles. Emergency vehicles, such as police cars, ambulances, and fire trucks, along with other service vehicles such as armored cars, are often exempt from laws that limit engine idling. However, these vehicles can save fuel and reduce emissions with technologies that allow them to perform vital services without idling.

  12. 5 CFR 9701.232 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Marshal Service. 9701.232 Section 9701.232 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Transitional Provisions §...

  13. 5 CFR 9701.232 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Marshal Service. 9701.232 Section 9701.232 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Transitional Provisions §...

  14. 5 CFR 9701.232 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Marshal Service. 9701.232 Section 9701.232 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Transitional Provisions §...

  15. Leveraging Air Force Medical Service (AFMS) Senior Leadership Corps Diversity to Improve Efficiency

    DTIC Science & Technology

    2013-04-01

    commanders and AFMS senior leadership; • Set a single PME standard for AFMS officers; • Shift provider billets to patient care roles and establish...single PME standard, and by realigning human resources to increase clinical currency, medical readiness and resource efficiency. Some structural...organizational entity. Like running a surgical service or a medical service. . . . It’s much bigger than that, because you’re dealing with finance and

  16. Air Weather Service Master Station Catalog USAFETAC Climatic Database Users Handbook No. 6

    DTIC Science & Technology

    1993-03-01

    Federal Aviation Administration (FAA) G = Air Force Global Weather Central (AFGWC) K = Carswell Automated Weather Network (Det 7, AFGWC) 0...AFGWC) J = Jepsen (JEPS) K = Carswell Automated Weather Network (Det 7, AFGWC) M = Located by meteorological analysis B-6 N = Hydrology office...Airfield ACC - Area control center AERO - Aerodrome AHP - U.S. Army Heliport AUX - Auxiliary AFS - Airways Facilities Sector AMOS - Automated

  17. Aeronautical Decision Making for Air Ambulance Helicopter Pilots: Situational Awareness Exercises

    DTIC Science & Technology

    1988-07-01

    provided: PITFALL DEFINITION ANSWER 1. Peer Pressure a. Unjustified reliance on the aircraft’s high performance capabilities. 2. Mental Set b...psychological pitfall does the statement in sentence 8 represent? a. Responding to Peer Pressure b. Mental Set (or expectancy) c. Scud Running d. Get...without adequate fuel reserves. b. Inadvertant 1HC. c. Responding to peer pressure . d. Neglect of flight planninS, preflight inspection, check lists

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

    DTIC Science & Technology

    2014-11-01

    Medical Evacuation (medevac) helicopters in Afghanistan. This represents the initial experience for pre- hospital blood product transfusion by U.S...adverse reaction or local blood product wastage . Shock index (heart rate/systolic blood pressure) improved significantly en-route, with a median shock...adherence to protocol, and diversion and/or wastage of limited resources were important considerations in the development of the pilot program. Aviation

  19. 75 FR 62639 - Air Ambulance and Commercial Helicopter Operations, Part 91 Helicopter Operations, and Part 135...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-12

    ... between the snow and the cloud eliminating all shadows. The result is a loss of depth perception.'' \\5\\ Brownout conditions occur when sand or other particles restrict visibility and depth perception. Prior to... light greatly impairs a pilot's ability to perceive depth, distance, altitude, or topographical...

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

    PubMed

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

    2016-10-01

    Short-term exposure to air pollution may be linked to negative health outcomes that require an emergency medical response. However, few studies have been undertaken on this phenomenon to date. The aim of this study therefore was to examine the association between short-term exposure to ambient suspended particulate matter (SPM) and emergency ambulance dispatches (EADs) for acute illness in Japan. Daily EAD data, daily mean SPM and meteorological data were obtained for four prefectures in the Kanto region of Japan for the period from 2007 to 2011. The area-specific association between daily EAD for acute illness and SPM was explored using generalized linear models while controlling for ambient temperature, relative humidity, seasonality, long-term trends, day of the week and public holidays. Stratified analyses were conducted to evaluate the modifying effects of age, sex and medical conditions. Area-specific estimates were combined using meta-analyses. For the total study period the mean level of SPM was 23.7μg/m(3). In general, higher SPM was associated with a significant increase in EAD for acute illness [estimated pooled relative risk (RR): 1.008, 95% CI: 1.007 to 1.010 per 10μg/m(3) increase in SPM at lag 0-1]. The effects of SPM on EAD for acute illness were significantly greater for moderate/mild medical conditions (e.g. cases that resulted in <3weeks hospitalization or no hospitalization) when compared to severe medical conditions (e.g. critical cases, and cases that led to >3weeks hospitalization or which resulted in death). Using EAD data, this study has shown the adverse health effects of ambient air pollution. This highlights the importance of reducing the level of air pollution in order to maintain population health and well-being.

  1. Cross-Cultural Perspectives of Service Quality and Risk in Air Transportation

    NASA Technical Reports Server (NTRS)

    Cunningham, Lawrence F.; Young, Clifford E.; Lee, Moonkyu

    2002-01-01

    This study compares US and Korean customers in terms of their perceptions of airline service quality based on SERVPERF and industry-based measures, as well as their perceptions of risks involved in the airline choice. SERVPERF is a set of multi-dimensional measures of customer evaluations of service quality. The results indicate that: (1) US passengers are generally more satisfied with their airline service than Korean customers on most of the SERVPERF dimensions; (2) Koreans are generally more satisfied with the bumping procedures whereas US participants feel more satisfied with the airline's baggage handling, operations/safety, and connections; and (3) US participants perceive higher levels of performance and financial risks whereas Koreans feel greater social risk in choosing an airline. This study also examines the SERVPERF, industry-based measure, and perceived risk in predicting customer satisfaction with, and intention to repatronize the airline. The results suggest that US customers consider service reliability, in-flight comfort, and connections as the key factors determining satisfaction with airline service whereas Korean passengers generally regard reliability, assurance, and risk factors as predictors of satisfaction. The determining factors of customer intention to repatronize the airline are reliability and empathy for US, and reliability and overall risk for Korean customers. The study demonstrates the applicability of SERVPERF as a cross-cultural tool and indicates the importance of perceived risk in cross-cultural studies.

  2. Optimizing Air Transportation Service to Metroplex Airports. Par 2; Analysis Using the Airline Schedule Optimization Model (ASOM)

    NASA Technical Reports Server (NTRS)

    Donoue, George; Hoffman, Karla; Sherry, Lance; Ferguson, John; Kara, Abdul Qadar

    2010-01-01

    The air transportation system is a significant driver of the U.S. economy, providing safe, affordable, and rapid transportation. During the past three decades airspace and airport capacity has not grown in step with demand for air transportation; the failure to increase capacity at the same rate as the growth in demand results in unreliable service and systemic delay. This report describes the results of an analysis of airline strategic decision-making that affects geographic access, economic access, and airline finances, extending the analysis of these factors using historic data (from Part 1 of the report). The Airline Schedule Optimization Model (ASOM) was used to evaluate how exogenous factors (passenger demand, airline operating costs, and airport capacity limits) affect geographic access (markets-served, scheduled flights, aircraft size), economic access (airfares), airline finances (profit), and air transportation efficiency (aircraft size). This analysis captures the impact of the implementation of airport capacity limits, as well as the effect of increased hedged fuel prices, which serve as a proxy for increased costs per flight that might occur if auctions or congestion pricing are imposed; also incorporated are demand elasticity curves based on historical data that provide information about how passenger demand is affected by airfare changes.

  3. Delinquent Medical Service Accounts at David Grant Air Force Medical Center Need Additional Management Oversight

    DTIC Science & Technology

    2015-09-24

    facilities. DGMC provides a full spectrum of care to a prime service area of more than 106,000 Tricare-eligible patients in the San Francisco-Sacramento...area and 370,000 patients from the Department of Veterans Affairs Northern California Health Care System that covers more than 40,000 square miles and...members of the Military Services and others entitled to or eligible for DoD medical care and benefits. U.S. Treasury FedDebt FedDebt is an online

  4. Environmental Assessment: Proposed Construction of Army and Air Force Exchange Service New Day Street Shoppette

    DTIC Science & Technology

    2003-10-01

    Table 3-5 Dominant Tree Species at MAFB Common Name Scientific Name Slash pine Pinus elliotti Live oak Quercus virginiana Pecan Carya illinoensis ...of Federal Regulations CO carbon monoxide CRMP Cultural Resource Management Plan CWA Clean Water Act dB decibel dBA A-weighted decibel DoD...consequences: air quality, noise, land use, geological resources, water resources, biological resources, transportation and circulation, cultural

  5. In Service to the Nation: Air Force Research Institute Strategic Concept for 2018-2023

    DTIC Science & Technology

    2009-01-01

    Cacadia Subduction Zone off the Oregon/Washington coast places McChord AFB at risk. To the East, Hill AFB lies in the Wasatch Fault Zone . Further east...by a century’s long preoccupation with protecting itself via a regional zone of influence. However, the demographic concerns of a low birth rate will... zones . Access to theater airspace and airfields throughout the world presents a major limiting factor to air-mobility operations. Through- out the

  6. Energy consumption in children with myelomeningocele: a comparison between reciprocating gait orthosis and hip-knee-ankle-foot orthosis ambulators.

    PubMed

    Cuddeford, T J; Freeling, R P; Thomas, S S; Aiona, M D; Rex, D; Sirolli, H; Elliott, J; Magnusson, M

    1997-04-01

    This study compared the differences in energy efficiency (energy cost) in children with myelomeningocele ambulating with either reciprocating gait orthoses (RGOs) or hip-knee-ankle-foot orthoses (HKAFOs). There were 15 children who ambulated with RGOs and 11 children braced and ambulating in HKAFOs. Velocity was measured in m/s, energy consumption was measured in mL/kg/min, and energy cost (energy consumption/velocity) was measured in mL/kg/m. Children in HKAFOs had a significantly higher energy consumption rate than children in RGOs. However, children who swing through in a HKAFO have a significantly faster velocity than children who ambulate with the RGO using a reciprocating pattern. The increased energy cost in the RGO group is influenced by their slower velocity, just as the decreased energy cost in the HKAFO group is influenced by their increased velocity. Therefore it appears that children in HKAFOs are more energy efficient than children in RGOs.

  7. 10-year experience of CO2-laser application in ambulance gynecology

    NASA Astrophysics Data System (ADS)

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

    2000-10-01

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

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

    PubMed

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

    2000-08-01

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

  9. Commercial Note-Taking Services: Effects on Attendance and Performance. AIR 1998 Annual Forum Paper.

    ERIC Educational Resources Information Center

    Putten, Jim Vander; Coppola, Brian

    This study investigated student use of commercial note-taking services as a predictor of class attendance and examined the effects of their use on academic performance in science courses. The study draws upon results of a survey distributed to 1,874 undergraduate students (response rate 58.2 percent) enrolled in two large-lecture chemistry courses…

  10. 5 CFR 9701.374 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Marshal Service. 9701.374 Section 9701.374 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional...

  11. 5 CFR 9701.374 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Marshal Service. 9701.374 Section 9701.374 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional...

  12. Member’s Perception of Service Quality At the Nellis Air Force Base Officers Open Mess

    DTIC Science & Technology

    1993-05-01

    parsimonious 22-item SERVQUAL instrument. Perceptions were compared to expectations to achieve a SERVQUAL score for the five dimensions of service quality...90 Table 7. SERVQUAL Scores: Unweighted and Weighted ......... 95 Table 8. Relative Importance of SERVQUAL Dimensions when Club Members...Expectation/ Perception Scores ......................................... 106 Table 11. Problem Resolution: Relative Importance of SERVQUAL Dimensions when

  13. Armstrong Laboratory (AL) Analytical Services Process Improvement Team (PIT) - Air Force Team Quality Award Application

    DTIC Science & Technology

    1994-01-01

    describe this process in detail 6. Identify key parameters for measuring customer satisfaction ; establish targets for improvement whenever possible...parameters for measuring customer satisfaction ; establish targets for improvement whenever possible. .Hints !Example wich parameers are most important POSSIBLE... measuring customer satisfaction : Dec 92 Need/Purpose: To find customer’s key desires on our services provided. How: Team discussed customer feedback and

  14. Using Ecosystem Services to Inform Decisions on U.S. Air Quality Standards

    EPA Science Inventory

    The ecosystem services (ES) framework provides a link between changes in a natural system’s structure and function and public welfare. This systematic integration of ecology and economics allows for more consistency and transparency in environmental decision making by enab...

  15. 5 CFR 9701.374 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Marshal Service. 9701.374 Section 9701.374 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional...

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

    PubMed Central

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

    2017-01-01

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

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

    PubMed Central

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

    2012-01-01

    Purposes To compare daily ambulatory measures in children, adolescents, and young adults with and without metabolic syndrome, and to assess which metabolic syndrome components, demographic measures, and body composition measures are associated with daily ambulatory measures. Methods Two-hundred fifty subjects between the ages of 10 and 30 years were assessed on metabolic syndrome components, demographic and clinical measures, body fat percentage, and daily ambulatory strides, durations, and cadences during seven consecutive days. Forty-five of the 250 subjects had metabolic syndrome, as defined by the International Diabetes Federation. Results Subjects with metabolic syndrome ambulated at a slower daily average cadence than those without metabolic syndrome (13.6 ± 2.2 strides/min vs. 14.9 ± 3.2 strides/min; p=0.012), and they had slower cadences for continuous durations of 60 minutes (p=0.006), 30 minutes (p=0.005), 20 minutes (p=0.003), 5 minutes (p=0.002), and 1 minute (p=0.001). However, the total amount of time spent ambulating each day was not different (p=0.077). After adjustment for metabolic syndrome status, average cadence is linearly associated with body fat percentage (p<0.001) and fat mass (p<0.01). Group difference in average cadence was no longer significant after adjusting for body fat percentage (p=0.683) and fat mass (p=0.973). Conclusion Children, adolescents, and young adults with metabolic syndrome ambulate more slowly and take fewer strides throughout the day than those without metabolic syndrome, even though the total amount of time spent ambulating is not different. Furthermore, the detrimental influence of metabolic syndrome on ambulatory cadence is primarily a function of body fatness. PMID:22811038

  18. Regional intensive care transports: a prospective analysis of distance, time and cost for road, helicopter and fixed-wing ambulances

    PubMed Central

    2014-01-01

    Background There are three different types of ambulance systems, all of which can manage the same secondary intensive care patient transport mission: road ambulance, rotor-wing ambulance, and fixed-wing ambulance. We hypothesized that costs for specific transport distances would differ between systems. We aimed to analyze distances and observed times for ambulance intensive care secondary transport missions together with system costs to assess this. Methods We prospectively collected data for consecutive urgent intensive care transports into the regional tertiary care hospital in the northern region of Sweden. Distances and transport times were gathered, and a cost model was generated based on these together with fixed and operating costs from the three different ambulance systems. Distance-cost and time–cost estimations were then generated for each transport system. Results Road ambulance cost relatively less for shorter distances (within 250 kilometers/155 miles) but were relatively time ineffective. The rotor-wing systems were most expensive regardless of distance; but were most time-effective up to 400–500 km (248–310 miles). Fixed-wing systems were more cost-effective for longer distance (300 km/186 miles), and time effective for transports over 500 km (310 miles). Conclusions In summary, based on an economic model developed from observed regional ICU patient transports, and cost estimations, different ambulance system cost-distances could be compared. Distance-cost and time results show that helicopters can be effective up to moderate ICU transport distances (400–500), though are expensive to operate. For longer ICU patient transports, fixed-wing transport systems are both cost and time effective compared to helicopter-based systems. PMID:24902480

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

    PubMed

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

    2011-01-01

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

  20. Energy cost of ambulation with different methods of foot and ankle immobilization

    SciTech Connect

    Fowler, P.T.; Botte, M.J.; Byrne, T.P.; Sutherland, D.H. ); Mathewson, J.W.; Speth, R.S. )

    1993-05-01

    In order to measure the energy cost of immobilization of the foot and ankle during ambulation, 14 healthy male volunteers exercised while wearing various immobilization devices. Oxygen consumption, oxygen cost, cardiac output, minute ventilation, heart rate, stroke volume, stride length, and stride frequency were determined at a steady state of exercise as the subjects walked on a treadmill at 80 m/min (equivalent to the comfortable walking speed of approximately 3 mi/h). Each subject was tested with three different types of immobilization devices: a short leg walking cast, a prefabricated lower leg orthosis, and a rigid-soled surgical shoe. The results were compared with those for the same men ambulating without an immobilization device. Ambulation with the short leg walking cast and the prefabricated lower leg orthosis required significantly more energy in comparison with control values (all p values <0.006) in terms of oxygen cost, cardiac index, oxygen consumption, and minute ventilation. 15 refs., 1 fig., 2 tabs.

  1. Upper limb module in non-ambulant patients with spinal muscular atrophy: 12 month changes.

    PubMed

    Sivo, Serena; Mazzone, Elena; Antonaci, Laura; De Sanctis, Roberto; Fanelli, Lavinia; Palermo, Concetta; Montes, Jacqueline; Pane, Marika; Mercuri, Eugenio

    2015-03-01

    Recent studies have suggested that in non-ambulant patients affected by spinal muscular atrophy the Upper Limb Module can increase the range of activities assessed by the Hammersmith Functional Motor Scale Expanded. The aim of this study was to establish 12-month changes in the Upper Limb Module in a cohort of non-ambulant spinal muscular atrophy patients and their correlation with changes on the Hammersmith Functional Motor Scale Expanded. The Upper Limb Module scores ranged between 0 and 17 (mean 10.23, SD 4.81) at baseline and between 1 and 17 at 12 months (mean 10.27, SD 4.74). The Hammersmith Functional Motor Scale Expanded scores ranged between 0 and 34 (mean 12.43, SD 9.13) at baseline and between 0 and 34 at 12 months (mean 12.08, SD 9.21). The correlation betweeen the two scales was 0.65 at baseline and 0.72 on the 12 month changes. Our results confirm that the Upper Limb Module can capture functional changes in non-ambulant spinal muscular atrophy patients not otherwise captured by the other scale and that the combination of the two measures allows to capture changes in different subgroups of patients in whom baseline scores and functional changes may be influenced by several variables such as age.

  2. The Prehospital assessment of severe trauma patients` performed by the specialist ambulance nurse in Sweden – a phenomenographic study

    PubMed Central

    2012-01-01

    Background A common feature of prehospital emergency care is the short and fragmentary patient encounters with increased demands for efficient and rapid treatment. Crucial decisions are often made and the premise is the specialist ambulance nurse’s ability to capture the situation instantaneously. The assessment is therefore a pre-requisite for decisions about appropriate actions. However, the low exposure to severe trauma cases in Sweden leads to vulnerability for the specialist ambulance nurse, which makes the assessment more difficult. Our objective was to describe specialist ambulance nurses’ perceptions of assessing patients exposed to severe trauma. Methods This study had a phenomenographic approach and was performed in 2011 as an interview study. 15 specialist ambulance nurses with a minimum of 2.5 years of experience from praxis were included. The analysis of data was performed using phenomenography according to Marton. Results The perceptions of assessing patients exposed to severe trauma were divided into: To be prepared for emergency situations, Confidence in one’s own leadership and Developing professional knowledge. Conclusions This study reveals that the specialist ambulance nurse, on the scene of accident, finds the task of assessment of severe trauma patients difficult and complicated. In some cases, even exceeding what they feel competent to accomplish. The specialist ambulance nurses feel that no trauma scenarios are alike and that more practical skills, more training, exercise and feedback are needed. PMID:22985478

  3. Microbiological Evaluation of the Food Service System at Travis Air Force Base

    DTIC Science & Technology

    1975-04-01

    tables in the kitchen area were almost always improperly sanitized. This was most likely due to the use of sponges and dirty cloths for wiping (see...safety of the entire food service system with emphasis on new production procedures in the In-Flight Kitchen (IFK) and S—13 operation. 4. To...study III Sanitary evaluation of the in-flight kitchen and bakery by RODAC 39 plates in the first study IV Distribution of RODAC plate counts

  4. A Strategic Decision Matrix for Analyzing Food Service Operations at Air Force Bases

    DTIC Science & Technology

    2006-12-01

    comment addressing this area on the returned questionnaire stated “Since our wartime mission is food and we earn a large portion of our go-to-war...looking to satisfy a craving for fast food . The menu also changes from day to day to add additional variety. But, their strategy is not based solely on...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT A Strategic Decision Matrix for Analyzing Food Service

  5. Customer Service Analysis of Tactical Air Command Base Level Supply Support

    DTIC Science & Technology

    1990-09-01

    other components of the marketing mix , i.e. price, product, and promotion, and identifying the contribution of each of these components to the overall...identify a customer service and marketing strategy (28:6). They set out to test the hypothesis that the " marketing mix components of product, price...relevant criteria identified during the first three phases of the study to determine a strategic marketing mix for the industry (28:9). The variables used

  6. Very-High-Cycle-Fatigue of in-service air-engine blades, compressor and turbine

    NASA Astrophysics Data System (ADS)

    Shanyavskiy, A. A.

    2014-01-01

    In-service Very-High-Cycle-Fatigue (VHCF) regime of compressor vane and turbine rotor blades of the Al-based alloy VD-17 and superalloy GS6K, respectively, was considered. Surface crack origination occurred at the lifetime more than 1500 hours for vanes and after 550 hours for turbine blades. Performed fractographic investigations have shown that subsurface crack origination in vanes took place inspite of corrosion pittings on the blade surface. This material behavior reflected lifetime limit that was reached by the criterion VHCF. In superalloy GS6K subsurface fatigue cracking took place with the appearance of flat facet. This phenomenon was discussed and compared with specimens cracking of the same superalloy but prepared by the powder technology. In turbine blades VHCF regime appeared because of resonance of blades under the influenced gas stream. Both cases of compressor-vanes and turbine blades in-service cracking were discussed with crack growth period and stress equivalent estimations. Recommendations to continue aircrafts airworthiness were made for in-service blades.

  7. Gaps between policy, protocols and practice: a qualitative study of the views and practice of emergency ambulance staff concerning the care of patients with non-urgent needs

    PubMed Central

    Snooks, H; Kearsley, N; Dale, J; Halter, M; Redhead, J; Foster, J

    2005-01-01

    Aim: To describe emergency ambulance crews' views about (1) how they make decisions on whether to convey patients to hospital; (2) an intervention enabling them to triage patients to non-conveyance; and (3) their experience of using new protocols for undertaking such triage. Methods: Two focus groups were held at the outset of an evaluation of Treat and Refer (T&R) protocols: one with staff based at an ambulance station who were to implement the new service (intervention station), and the other with staff from a neighbouring station who would be continuing their normal practice during the study (control station). A third session was held with staff from the intervention station following training and 3 months' experience of protocol usage. Results: Before the introduction of the T&R protocols, crews reported experience, intuition, training, time of call during shift, patient preference, and home situation as influencing their decisions concerning conveyance. Crews were positive about changing practice but foresaw difficulties with advising patients who wanted to go to hospital, and with referral to other agencies. Following experience of T&R protocol use, crews felt they had needed more training than had been provided. Some felt their practice and job satisfaction had improved. Problems with referral and with persuading some patients that they did not need to go to hospital were discussed. There was consensus that the initiative should be introduced across the service. Conclusions: With crews generally positive about this intervention, an opportunity to tackle this difficult area of emergency care now exists. This study has, however, highlighted the complexity of the change in practice and service delivery, and professional and organisational constraints that need to be considered. PMID:16076788

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

    PubMed Central

    van Hooff, Robbert-Jan; De Smedt, Ann; Nagels, Guy; Hubloue, Ives; De Keyser, Jacques; Brouns, Raf

    2016-01-01

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

  9. NASA Turbulence Technologies In-Service Evaluation: Delta Air Lines Report-Out

    NASA Technical Reports Server (NTRS)

    Amaral, Christian; Dickson, Steve; Watts, Bill

    2007-01-01

    Concluding an in-service evaluation of two new turbulence detection technologies developed in the Turbulence Prediction and Warning Systems (TPAWS) element of the NASA Aviation Safety and Security Program's Weather Accident Prevention Project (WxAP), this report documents Delta's experience working with the technologies, feedback gained from pilots and dispatchers concerning current turbulence techniques and procedures, and Delta's recommendations regarding directions for further efforts by the research community. Technologies evaluated included an automatic airborne turbulence encounter reporting technology called the Turbulence Auto PIREP System (TAPS), and a significant enhancement to the ability of modern airborne weather radars to predict and display turbulence of operational significance, called E-Turb radar.

  10. [Prevention of cervical and breast cancer in health services and non-governmental organizations in the city of Buenos Aires].

    PubMed

    Ponce, Marisa

    2013-08-01

    The article analyzes actions for the prevention of cervical and breast cancer in public, private, and employment-based health services and in non-governmental organizations in the city of Buenos Aires. The article seeks to reflect on the reach and limitations of the approaches implemented in the three subsectors of the health care system and the community to prevent women from suffering or eventually dying as a consequence of these diseases, in the fragmented context of a health system with great heterogeneity in access and deep social inequalities in the use of preventive actions. The study utilizes a broad definition of prevention which integrates education, awareness-building and early detection of pre-carcinogenic and carcinogenic lesions, among other medical and non-medical components. The results were obtained using semi-structured interviews with subjects from public hospitals, employment-based health care services, private medical companies and non-governmental organizations with work in cancer prevention. These results show that contrary to a comprehensive approach, each institution limits its actions to only one aspect of prevention, implementing predominately isolated or disconnected actions inadequate to generate an autonomous and well-informed demand for treatment and health care among women.

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

    PubMed Central

    Drachev, Sergei N.; Unguryanu, Tatiana N.; Grjibovski, Andrej M.

    2012-01-01

    Objective To assess daily variations in ambulance calls for cardiovascular diseases (CVDs), mental and behavioral disorders, and external causes in Arkhangelsk, Northwest Russia, in 2000–2008. Study design A population-based study. Methods Data about all ambulance calls during the years 2000–2008 were obtained from the Arkhangelsk ambulance station. Information about patient's gender, age, doctor's diagnosis according to International Classification of Diseases, 10th revision, and the date of call were recorded. Pearson's Chi-squared tests were used for comparing proportions of ambulance calls across the week for CVDs (I00-99), mental and behavioral disorders (F00-F99), and external causes (S00-T98, V01-Y98). The ratio of incidence of ambulance calls on Saturday, Sunday, and Monday versus the rest of week was also calculated. Results There is a significant daily variation (p < 0.001) in calls for CVDs in men and women aged 18–59 and women aged 60 years and older, with increased numbers of calls on weekends and Mondays varying between 2 and 3% excess calls. For mental and behavioral disorders, a similar pattern was found in the age group of 18–59 year-olds. Ratios for the number of calls during weekends and Mondays vs. the rest of the week were 1.05 (95% CI: 1.02–1.08) among women and 1.02 (95% CI: 1.00–1.05) among men. For external causes, a significant variation and an increase in ambulance calls during Saturdays, Sundays, and Mondays from 4 to 17% excess calls was observed for both age and gender groups. Conclusions The observed daily variations in ambulance calls with an increased number of calls on weekends and Mondays for CVDs, mental and behavioral disorders, and external causes may be associated with excessive alcohol consumption on the weekends. Further research using data on individual levels of alcohol consumption are warranted. PMID:23130353

  12. Tractor-Maintenance: Operation & Daily Care [and] Servicing Air Cleaner & Lubrication. Student Materials. V. A. III. [V-C-1 through V-C-4].

    ERIC Educational Resources Information Center

    Texas A and M Univ., College Station. Vocational Instructional Services.

    Designed for use by students in vocational agricultural classes, this manual deals with tractor maintenance. Operation and daily care are the topics of the first section. Safety is also covered. In the final part of the manual, servicing the air cleaner and lubricating the engine are discussed. Both sections conclude with a quiz. (PLB)

  13. The Correlation between Sex, Age, Educational Background, and Hours of Service on Vigilance Level of ATC Officers in Air Nav Surabaya, Indonesia

    ERIC Educational Resources Information Center

    Saleh, Lalu Muhammad; Suwandi, Tjipto; Hamidah

    2016-01-01

    The vigilance of an Air Traffic Control (ATC) officer determines aviation safety. The number of aviation accidents tends to be increasing in recent years. Aviation accidents may be caused by human errors (i.e. errors made by pilot or ATC officer) or unsafe work condition. Sex, age, educational background, and hours of service might affect…

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

    PubMed

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

    2016-06-16

    Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment.

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

    PubMed Central

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

    2016-01-01

    Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment. PMID:27340808

  16. Configuring a Powered Knee and Ankle Prosthesis for Transfemoral Amputees within Five Specific Ambulation Modes

    PubMed Central

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

    2014-01-01

    Lower limb prostheses that can generate net positive mechanical work may restore more ambulation modes to amputees. However, configuration of these devices imposes an additional burden on clinicians relative to conventional prostheses; devices for transfemoral amputees that require configuration of both a knee and an ankle joint are especially challenging. In this paper, we present an approach to configuring such powered devices. We developed modified intrinsic control strategies—which mimic the behavior of biological joints, depend on instantaneous loads within the prosthesis, or set impedance based on values from previous states, as well as a set of starting configuration parameters. We developed tables that include a list of desired clinical gait kinematics and the parameter modifications necessary to alter them. Our approach was implemented for a powered knee and ankle prosthesis in five ambulation modes (level-ground walking, ramp ascent/descent, and stair ascent/descent). The strategies and set of starting configuration parameters were developed using data from three individuals with unilateral transfemoral amputations who had previous experience using the device; this approach was then tested on three novice unilateral transfemoral amputees. Only 17% of the total number of parameters (i.e., 24 of the 140) had to be independently adjusted for each novice user to achieve all five ambulation modes and the initial accommodation period (i.e., time to configure the device for all modes) was reduced by 56%, to 5 hours or less. This approach and subsequent reduction in configuration time may help translate powered prostheses into a viable clinical option where amputees can more quickly appreciate the benefits such devices can provide. PMID:24914674

  17. Clinical effectiveness of grip strength in predicting ambulation of elderly inpatients

    PubMed Central

    Beseler, MR; Rubio, C; Duarte, E; Hervás, D; Guevara, MC; Giner-Pascual, M; Viosca, E

    2014-01-01

    Background Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients. Methods A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old). Manual muscle test was used for checking strength of hip flexor muscles, hip abductor muscles and knee extensor muscles. Grip strength was assessed by hydraulic dynamometer. Walking ability was assessed by functional ambulation categories and Functional Classification of Sagunto Hospital Ambulation. Existence of cognitive impairment (Short Portable Mental Status of Pfeiffer) and comorbidity (abbreviated Charlson index) were considered to be confounding variables. Statistical analysis Simple comparisons and mixed models of multiple ordinal regression. Results The sample presented generalized weakness in scapular (mean 4.22) and pelvic (mean 3.82) muscle. Mean hand grip values were similar: 11.98 kg right hand; 11.70 kg left hand. The patients had lost walking ability. After treatment, there was a statistically significant for scapular waist strength (P=0.001), pelvic waist strength (P=0.005) and walking ability (P=0.001). A statistically significant relationship in the regression analysis was found between the grip (right and left hands) and walking ability post-treatment (P=0.009; odds ratio 1.14 and P=0.0014 odds ratio 1.113 for each walking scale). The confounding variables showed no statistical significance in the results. Conclusion Grip strength is associated with walking ability in hospitalized frail elderly. Grip strength assessment by hydraulic dynamometry is useful in patients with poor collaboration. Walking ability training in frail elderly inpatients is useful. PMID:25395842

  18. Taking services to the streets over the party season.

    PubMed

    Brace, Samantha; Farmer, Christopher; Calow, Phil

    2009-12-01

    Christmas and New Year festivities notoriously result in increased attendance at emergency departments (EDs). The knock-on effect of this in Solihull, in the West Midlands, is that, when ambulance staff and police accompany patients to hospital, the locality is temporarily under-resourced by these services. To address this problem, a collaborative project was implemented to enable advanced clinical practitioners, with consultant support, to assess, treat and potentially discharge patients from a specially constructed emergency facility situated in Solihull town centre. This has reduced the number of ED admissions and transfers, and resulted in significant cost and time savings for the ambulance service.

  19. [Study of the quality of interhospital transport of sick neonates by selected ambulances in the Witwatersrand area].

    PubMed

    Roux, J C; Nolte, A G; Muller, M E

    1989-12-01

    The quality of the inter hospital transport of ill neonates, by selected ambulances in the Witwatersrand area, was investigated by means of the case study method. Of the fifteen case studies investigated, eleven neonates were transported by a private ambulance and four by provincial ambulances. Data regarding the maternal- and neonatal history, the optimal maintenance of the neonate's condition, the communication system, as well as aspects relating to the transport personnel, were collected by means of a structured instrument. Retrospective auditing of records, structured interviewing and direct observation/inspection were utilised as the research techniques. The quality of the inter hospital transport of ill neonates, especially by the private ambulance, is not up to standard. Deterioration of the neonate's body temperature, heart and respiration rates, as well as the serum glucose values after transport, were of the more important findings. The lack of equipment, especially in the private ambulance, increases the risk of transport. Staff development and formal control by a local committee, as well as a national control body, are recommended.

  20. Effect of maternal ambulation on labour with low-dose combined spinal-epidural analgesia.

    PubMed

    Collis, R E; Harding, S A; Morgan, B M

    1999-06-01

    Two hundred and twenty-nine nulliparous women who requested regional analgesia during labour were given a combined spinal-epidural block. They were randomly allocated to stay in bed or spend at least 20 min of every hour out of bed. There was no significant difference in duration of labour, analgesia requirements, mode of delivery or condition of the baby between the groups. Ambulation appeared to be safe for the mother and baby. Maternal satisfaction with the low-dose combined spinal-epidural was high in both groups.

  1. Should we be giving high concentration oxygen to all patients treated in an ambulance?

    PubMed

    Lavery, G G; Corris, P A

    2012-03-01

    Oxygen is one of the most widely used drugs. It is important to recognise that oxygen administration carries risks as well as benefits. While adequate oxygen saturation of arterial blood is an important factor in tissue oxygen delivery, oxygen administration to patients with chronic obstructive pulmonary disease can lead to decompensated type II respiratory failure. In this debate, Dr Lavery makes the case that high concentration oxygen should be given to all patients treated in an ambulance, while Professor Corris argues against this position.

  2. 42 CFR 414.610 - Basis of payment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... computed according to the following provisions: (1) Ground ambulance service levels. The CF is multiplied... payment. Air ambulance services have no CF or RVUs. This amount is compared to the actual charge. The... RAF may be applied, as appropriate. (f) Updates. The CF, the air ambulance base rates, and the...

  3. 42 CFR 414.610 - Basis of payment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... computed according to the following provisions: (1) Ground ambulance service levels. The CF is multiplied... amount of payment. Air ambulance services have no CF or RVUs. This amount is compared to the actual... RAF may be applied, as appropriate. (f) Updates. The CF, the air ambulance base rates, and the...

  4. Ambulance Handbook

    NASA Technical Reports Server (NTRS)

    1976-01-01

    Johnson Space Center has devised a checklist for the skylab inflight medical support system that has been transferred for public emergencies. The checklist illustrates a procedure for diagnosis, treatment, and stabilization of a wide variety of emergencies. Handbook presents comprehensive ordered description of emergency medical equipment and its use in treating victims. Paramedics assigned to the Houston Fire Department are now using the checklist.

  5. Notification: Background Investigation Services New Assignment Notification: EPA’s Efforts to Incorporate Environmental Justice Into Clean Air Act Inspections for Air Toxics

    EPA Pesticide Factsheets

    The purpose of this memorandum is to notify you that the EPA OIG plans to begin the preliminary research phase of an evaluation of the U.S. EPA's efforts to incorporate environmental justice into Clean Air Act inspections for air toxics.

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

    PubMed

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

    2012-11-01

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

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

    PubMed Central

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

    2017-01-01

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

  8. Knee disarticulation: survival, wound healing and ambulation. A historic cohort study.

    PubMed

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

    2009-03-01

    The aim of this study was to analyze survival, wound healing and ambulation after knee disarticulation (KD). A historic cohort study using medical records and nursing home records was performed. Data included demographics, reason for amputation, concomitant diseases, survival, wound healing, re-amputation and ambulation. Data of 80 patients (71 unilateral and nine bilateral amputees) were available for evaluation. Median follow-up was 9.9 years (IQR: 4.1; 14.3 years). Mean age of amputation was 76.9 (+/- 9.6) years. Reason for amputation was gangrene in 72 patients. Most common concomitant (96%) disease was peripheral arterial disease (PAD). Survival after 1, 6 and 12 months was 87%, 65% and 52%, respectively. Delayed wound healing occurred in 42% (n = 16) of the patients with two or three concomitant diseases and in 15% (n = 6) of the patients with no or one concomitant disease. Trans-femoral re-amputation was performed in nine (12%) patients. Of the 61 discharged KD amputees, 36 (59%) were provided with a prosthesis. Eventually 21 (34%) patients became household walkers.

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

    PubMed Central

    Delgado, M. Kit; Meng, Lesley J.; Mercer, Mary P.; Pines, Jesse M.; Owens, Douglas K.; Zaric, Gregory S.

    2013-01-01

    Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion. Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields. Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion. Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals are promising avenues for reducing diversion. PMID:24106548

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

    PubMed

    Kannenberg, Andreas; Zacharias, Britta; Pröbsting, Eva

    2014-01-01

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

  11. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    PubMed

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

    2015-04-01

    In Sweden, ambulances must be staffed by at least one registered nurse. Twelve universities offer education in ambulance nursing. There is no national curriculum for detailed course content and there is a lack of knowledge about the educational content that deals with the ambulance nurse practical professional work. The aim of this study was to describe the content in course curricula for ambulance nurses. A descriptive qualitative research design with summative content analysis was used. Data were generated from 49 courses in nursing and medical science. The result shows that the course content can be described as medical, nursing and contextual knowledge with a certain imbalance with largest focus on medical knowledge. There is least focus on nursing, the registered nurses' main profession. This study clarifies how the content in the education for ambulance nurses in Sweden looks today but there are reasons to discuss the content distribution.

  13. Overview of the Shenzhen Emergency Medical Service Call Pattern

    PubMed Central

    Man Lo, Shuk; Min Yu, Yi; Larry Lee, Lap Yip; Eliza Wong, Mi Ling; Ying Chair, Sek; J Kalinowski, Edward; Jimmy Chan, Tak Shing

    2012-01-01

    BACKGROUND: In Shenzhen, the Emergency Medical Service (EMS) system has been in service since 1997. This study aims to examine the operation of Shenzhen 120 EMS center and to identify the reasons of calling EMS. METHODS: In this retrospective quantitative descriptive study, the data from the Shenzhen 120 EMS registry in 2011 were analyzed. RESULTS: Shenzhen 120 EMS center is a communication command center. When the number of 120 are dialed, it is forwarded to the closest appropriate hospital for ambulance dispatch. In 2011, the Shenzhen 120 EMS center received 153 160 ambulance calls, with an average of 420 calls per day. Calling emergency services was mainly due to traffic accidents. Trauma and other acute diseases constituted a majority of ambulance transports. The adult patients aged 15–60 years are the principal users of EMS. There are no recognized ‘paramedic’ doctors and nurses. The pre-hospital emergency service is under the operation of emergency departments of hospitals. Shenzhen at present does not have specialized pre-hospital training for doctors and nurses in post-trauma management. Moreover, specialized pre-hospital training, financial support, and public health education on proper use of EMS should be emphasized. CONCLUSION: The Shenzhen 120 EMS center has its own epidemiology characteristics. Traumatic injury and traffic accident are the main reasons for calling ambulance service. In-depth study emphasizing the distribution and characteristics of trauma patients is crucial to the future development of EMS. PMID:25215072

  14. Development of Key-Pecking, Pause, and Ambulation during Extended Exposure to a Fixed-Interval Schedule of Reinforcement

    ERIC Educational Resources Information Center

    Berry, Meredith S.; Kangas, Brian D.; Branch, Marc N.

    2012-01-01

    Six pigeons key-pecked under a fixed-interval (FI) 3-min schedule of food presentation. Each pigeon was studied for 200 daily sessions with 15 intervals per session (3,000 total food presentations). Analyses included the examination of latency to first peck (pause), mean rate of key pecking, and ambulation. Characterizations of stable performance…

  15. Development of key-pecking, pause, and ambulation during extended exposure to a fixed-interval schedule of reinforcement.

    PubMed

    Berry, Meredith S; Kangas, Brian D; Branch, Marc N

    2012-05-01

    Six pigeons key-pecked under a fixed-interval (FI) 3-min schedule of food presentation. Each pigeon was studied for 200 daily sessions with 15 intervals per session (3,000 total food presentations). Analyses included the examination of latency to first peck (pause), mean rate of key pecking, and ambulation. Characterizations of stable performance were assessed across measures of behavior and evaluated using commonly employed stability criteria. Stability of response rate and pause was identified better by assessments that evaluated variability and trend, rather than just variability. Between-subject differences in rate of acquisition and terminal values of steady-state performance of pause were observed, and stable pause durations took longer to develop than did stable key-pecking rates. Relative variability in response rate and pause duration decreased as the means increased. A temporally organized pattern of key-pecking (the so-called FI scallop) developed within 50 sessions of exposure to the schedule. Overall ambulation decreased during the early sessions of exposure and further analyses showed greater rates of ambulation during the pause than after it for 4 of the 6 pigeons. Performance under the FI 3-min schedule developed relatively slowly, and key-pecking, pause, and ambulation developed at different rates.

  16. A Delphi Study Executive Skills 2010: A Toolbox of Competencies for Air Force Medical Service Corps Officers of the 21st Century

    DTIC Science & Technology

    2006-05-31

    Executive Skills 2010 1 A Delphi Study Executive Skills 2010: A Toolbox of Competencies for Air Force Medical Service Corps Officers of the 21st...Century A Graduate Management Project Submitted for the Degree of Master in Health Administration 3 June 2003 Douglas E. E. Stevens, Capt, USAF, MSC...Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to

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

    PubMed

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

    2016-12-01

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

  18. Fasten their seatbelts: legal restraint of children in car seats and road ambulances.

    PubMed

    Wilson, Phil

    2007-09-01

    Registered nurses transport sick children in ambulances and other road vehicles every day in the United Kingdom (U.K.). Safely restraining the child, the equipment and the accompanying adults is a matter which should be addressed by all departments who transport children. A motor vehicle collision may cause an unrestrained child to be seriously injured. An unrestrained child is likely to inflict serious injury on the accompanying nurse or parent. Recent changes in child seat law require that appropriate measures must be put in place to ensure sick children receive the safest possible care. The use of a Regulation 44 compliant child-seat or an appropriately sized five-point stretcher harness should be the default standard when transporting a child in a road vehicle under any circumstances. Recent research also indicates that young infants must never be allowed to sleep in car seats on the ward because of the increased risk of obstructive sleep apnoea.

  19. Development and tests of a paediatric and neonatal immobilizer for ambulance transfers.

    PubMed

    Ballesteros, Tomás; Arana, Ignacio; Pérez Ezcurdia, Amaya; Alfaro, José Ramón

    2014-05-01

    There are many stretcher models able to adequately achieve the spinal immobilization of adult patients during emergency transports but do not work well with children. A paediatric and neonatal immobilizer has been designed, constructed and tested. It is simple, radio-transparent, able to be adequately fastened to an ambulance, adaptable to a wide range of paediatric patient's size, providing a correct spinal immobilization without an excessive immobilization of the rest of the body, without impairing the aperture of an aerial way or the cardiopulmonary resuscitation (CPR) and without reducing the accessibility of the medical personnel to the paediatric patient. It is able to be adapted to the size and injuries of the patient instead of adapting the position of the patient to the characteristics of the immobilizer. It can also be effectively fastened to the bed of an emergency helicopter, allowing the aerial transport of the paediatric patients.

  20. Air transport

    NASA Technical Reports Server (NTRS)

    Page, F Handley

    1924-01-01

    I purpose (sic) in this paper to deal with the development in air transport which has taken place since civil aviation between England and the Continent first started at the end of August 1919. A great deal of attention has been paid in the press to air services of the future, to the detriment of the consideration of results obtained up to the present.

  1. The effect of claudication pain on temporal and spatial gait measures during self-paced ambulation.

    PubMed

    Gardner, Andrew W; Montgomery, Polly S; Ritti-Dias, Raphael M; Forrester, Larry

    2010-02-01

    We determined the effect of claudication pain on temporal and spatial gait characteristics, and on ambulatory symmetry at preferred and rapid self-selected walking paces in patients with unilateral peripheral arterial disease (PAD). Twenty-eight patients with PAD limited by intermittent claudication were studied. Patients ambulated at their preferred and rapid paces over a 7.3-meter portable gait mat system while they were pain-free and after experiencing claudication pain. The order of the pain-free and painful walking trials was randomized, and the following gait parameters were obtained: velocity, cadence, stride length, swing time, stance time, single-support time, and double-support time. During the self-selected rapid pace, patients walked 3% slower (p = 0.020) while in pain due to a 3% shorter stride length (p < 0.001), and they were in double-stance longer (p = 0.024). Claudication pain in the symptomatic leg resulted in an increase in single-stance (p = 0.007). Furthermore, gait became asymmetrical with pain, as the symptomatic leg spent a higher percentage of the gait cycle in the swing phase (p < 0.01) and lower percentages in stance (p < 0.01) and single-stance (p < 0.01) than the asymptomatic leg. Ambulation was symmetrical for all measures during the pain-free trial. In conclusion, claudication pain slows ambulatory velocity at preferred and rapid paces, and increases asymmetry when ambulatory function is challenged with rapid walking. The reduced ambulatory speed with the development of claudication pain may be an adaptation to elicit a safer and less destabilizing gait pattern.

  2. Control of neuromuscular stimulation for ambulation by complete paraplegics via artificial neural networks.

    PubMed

    Kordylewski, H; Graupe, D

    2001-07-01

    The paper describes the application of a neural network (ANN) for controlling a functional neuromuscular stimulation (FNS) system to facilitate patient-responsive ambulation by paralyzed patients with traumatic, thoracic-level spinal cord injuries. The particular ANN that is employed is a modified Adaptive-Resonance-Theory (ART-1) network. It serves as a controller in an FNS system (the Parastep system) that is presently in use by approximately 500 patients worldwide (but still without ANN control) and which was the first and only FNS system approved by FDA. The proposed neural network discriminates above-lesion upper-trunk electromyographic (EMG) time series to activate standing and walking functions under FNS and controls FNS stimuli levels using response-EMG signals. For this particular application, several modifications are introduced into the standard ART-1 ANN. First, a modified on-line learning rule is proposed. The new rule assures bi-directional modification of the stored patterns and prevents noise interference. Second, a new reset rule is proposed, which prevents 'exact matching' when the input is a subset of the chosen pattern. A single ART-1-based structure is being applied to solving two problems, namely (1) signal pattern recognition and limb function determination, and (2) control of stimulation levels. This also facilitates ambulation of paraplegics under FNS, with adequate patient interaction in initial system training, retraining the network when needed, and in allowing patient's manual over-ride in the case of error, where any manual over-ride serves as a re-training input to the neural network. The ANN control facilitates continuous update of control settings during normal use, without formal retraining.

  3. Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome.

    PubMed

    Kellow, J E; Gill, R C; Wingate, D L

    1990-05-01

    Continuous 72-h recordings of duodenojejunal contractile activity were obtained from 20 freely ambulant subjects; pressure was detected by two strain-gauge sensors incorporated in a transnasal catheter attached to an encoder and a miniature tape recorder. The subjects were 12 patients with irritable bowel syndrome, 6 of whom were constipation predominant and 6 of whom were diarrhea predominant, and 8 healthy controls. The procedure was well tolerated by all subjects and did not interfere with sleep or normal activity. In all subjects, the diurnal migrating motor complex cycle was characterized by a brief phase 1 and a prolonged phase 2; this was reversed during sleep when phase 2 was virtually absent. All subjects showed a circadian variation in migrating motor complex propagation velocity, and there was no difference in the patterns of motor activity during sleep between any of the groups. During the day, the duration of postprandial motor activity was shorter in irritable bowel syndrome patients than in controls, and diurnal migrating motor complex intervals were shorter in diarrhea-predominant than in constipation-predominant irritable bowel syndrome. In 11 of 12 inflammatory bowel syndrome patients, episodes of clustered contractions recurring at 0.9-min intervals were noted; these episodes had a mean duration of 46 min and were often associated with transient abdominal pain and discomfort. In both groups of irritable bowel syndrome patients, defecation was significantly (p less than 0.01) prolonged with a greater number of voluntary abdominal contractions (p less than 0.01) than in controls. Prolonged ambulant monitoring of proximal bowel motor activity in subjects who are free to move, eat, and sleep as they choose has, for the first time, clearly defined the striking difference in motility between the sleeping and waking state and shown that abnormalities associated with irritable bowel syndrome are confined to the latter.

  4. Ambulant 24-h glucose rhythms mark calendar and biological age in apparently healthy individuals.

    PubMed

    Wijsman, Carolien A; van Heemst, Diana; Hoogeveen, Evelien S; Slagboom, P Eline; Maier, Andrea B; de Craen, Anton J M; van der Ouderaa, Frans; Pijl, Hanno; Westendorp, Rudi G J; Mooijaart, Simon P

    2013-04-01

    Glucose metabolism marks health and disease and is causally inferred in the aging process. Ambulant continuous glucose monitoring provides 24-h glucose rhythms under daily life conditions. We aimed to describe ambulant 24-h glucose rhythms measured under daily life condition in relation to calendar and biological age in apparently healthy individuals. In the general population and families with propensity for longevity, we studied parameters from 24-h glucose rhythms; glucose levels; and its variability, obtained by continuous glucose monitoring. Participants were 21 young (aged 22-37 years), 37 middle-aged (aged 44-72 years) individuals from the general population, and 26 middle-aged (aged 52-74 years) individuals with propensity for longevity. All were free of diabetes. Compared with young individuals, middle-aged individuals from the general population had higher mean glucose levels (5.3 vs. 4.7 mmol L(-1) , P < 0.001), both diurnally (P < 0.001) and nocturnally (P = 0.002). Glucose variability was higher in the middle-aged compared with the young (standard deviation 0.70 vs. 0.57 mmol L(-1) , P = 0.025). Compared with middle-aged individuals from the general population, middle-aged individuals with propensity for longevity had lower overall mean glucose levels (5.2 vs. 5.4 mmol L(-1) , P = 0.047), which were more different nocturnally (4.8 vs. 5.2 mmol L(-1) , P = 0.003) than diurnally (5.3 vs. 5.5 mmol L(-1) , P = 0.14). There were no differences in glucose variability between these groups. Results were independent of body mass index. Among individuals without diabetes, we observed significantly different 24-h glucose rhythms depending on calendar and biological age.

  5. Longitudinal effect of eteplirsen versus historical control on ambulation in Duchenne muscular dystrophy

    PubMed Central

    Goemans, Nathalie; Lowes, Linda P.; Alfano, Lindsay N.; Berry, Katherine; Shao, James; Kaye, Edward M.; Mercuri, Eugenio; Hamid, Hoda Abdel; Byrne, Barry J.; Connolly, Anne M.; Dracker, Robert A.; Matthew Frank, L.; Heydemann, Peter T.; O'Brien, Kevin C.; Sparks, Susan E.; Specht, Linda A.; Rodino‐Klapac, Louise; Sahenk, Zarife; Al‐Zaidy, Samiah; Cripe, Linda H.; Lewis, Sarah; M, Pane; E, Mazzone; S, Messina; GL, Vita; Bertini, D Amico A; Casimiro, Berardinelli A; Y, Torrente; F, Magri; GP, Comi; G, Baranello; T, Mongini; A, Pini; R, Battini; E, Pegoraro; C, Bruno; L, Politano; S, Previtali

    2016-01-01

    Objective To continue evaluation of the long‐term efficacy and safety of eteplirsen, a phosphorodiamidate morpholino oligomer designed to skip DMD exon 51 in patients with Duchenne muscular dystrophy (DMD). Three‐year progression of eteplirsen‐treated patients was compared to matched historical controls (HC). Methods Ambulatory DMD patients who were ≥7 years old and amenable to exon 51 skipping were randomized to eteplirsen (30/50mg/kg) or placebo for 24 weeks. Thereafter, all received eteplirsen on an open‐label basis. The primary functional assessment in this study was the 6‐Minute Walk Test (6MWT). Respiratory muscle function was assessed by pulmonary function testing (PFT). Longitudinal natural history data were used for comparative analysis of 6MWT performance at baseline and months 12, 24, and 36. Patients were matched to the eteplirsen group based on age, corticosteroid use, and genotype. Results At 36 months, eteplirsen‐treated patients (n = 12) demonstrated a statistically significant advantage of 151m (p < 0.01) on 6MWT and experienced a lower incidence of loss of ambulation in comparison to matched HC (n = 13) amenable to exon 51 skipping. PFT results remained relatively stable in eteplirsen‐treated patients. Eteplirsen was well tolerated. Analysis of HC confirmed the previously observed change in disease trajectory at age 7 years, and more severe progression was observed in patients with mutations amenable to exon skipping than in those not amenable. The subset of patients amenable to exon 51 skipping showed a more severe disease course than those amenable to any exon skipping. Interpretation Over 3 years of follow‐up, eteplirsen‐treated patients showed a slower rate of decline in ambulation assessed by 6MWT compared to untreated matched HC. Ann Neurol 2016;79:257–271 PMID:26573217

  6. Medical emergency motorcycle – is it useful in a Scandinavian Emergency Medical Service?

    PubMed Central

    Nakstad, Anders Rostrup; Bjelland, Bjørn; Sandberg, Mårten

    2009-01-01

    Background Medical emergency motorcycles (MEM) can be used in time-critical conditions like cardiac arrest and multi-traumatized patients in an attempt to reduce the response time. Other potential benefits with MEM are more efficient patient evaluation, reduction of unnecessary EMS car ambulance missions and reduced cost. The potential benefits have been evaluated in this study. The incidence of accidents when operating the vehicle was also of interest. Methods A prospective study was performed when MEM was introduced as a trial in an urban ambulance service in Norway. Results A total of 703 MEM missions were registered in the period. The mean emergency driving time was significantly shorter for the MEM than for the ambulance car located at the same station (6 min 24 seconds vs. 6 min 54 seconds). In addition to time-critical conditions, the MEM was used to evaluate patients when the need for emergency medical assistance was uncertain, and this practice lead to a reduced number of unnecessary car ambulance missions. No accidents involving the MEM were registered in the study period. The hourly cost of running the MEM was € 29 vs. € 75 for a car ambulance. However, the actual cost benefit is smaller since the weather conditions make it impossible to run a MEM in wintertime. Conclusion The small reduction in driving time when using a MEM instead of a car ambulance was statistically significant but probably of little clinical importance. The number of unnecessary car ambulance missions was reduced. It was cheaper to operate a MEM than a car ambulance, but the cost-effectiveness was reduced since the MEM could not operate 12 months a year. The lack of accidents may be contributed to the extensive training of the drivers and the fact that the vehicle was operated in daylight only. PMID:19239681

  7. 42 CFR 483.480 - Condition of participation: Dietetic services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... must designate a person to serve as the director of food services. (4) The client's interdisciplinary... persons with ambulation deficits, in dining areas, unless otherwise specified by the interdisciplinary... client eats in an upright position, unless otherwise specified by the interdisciplinary team or...

  8. 42 CFR 422.112 - Access to services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... services are available 24 hours a day, 7 days a week, when medically necessary. (8) Cultural considerations... limited English proficiency or reading skills, and diverse cultural and ethnic backgrounds. (9) Ambulance... the network is being offered. Factors making up community patterns of health care delivery that...

  9. 42 CFR 422.112 - Access to services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... services are available 24 hours a day, 7 days a week, when medically necessary. (8) Cultural considerations... limited English proficiency or reading skills, and diverse cultural and ethnic backgrounds. (9) Ambulance... the network is being offered. Factors making up community patterns of health care delivery that...

  10. 42 CFR 422.112 - Access to services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... services are available 24 hours a day, 7 days a week, when medically necessary. (8) Cultural considerations... limited English proficiency or reading skills, and diverse cultural and ethnic backgrounds. (9) Ambulance... the network is being offered. Factors making up community patterns of health care delivery that...

  11. 42 CFR 422.112 - Access to services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... services are available 24 hours a day, 7 days a week, when medically necessary. (8) Cultural considerations... limited English proficiency or reading skills, and diverse cultural and ethnic backgrounds. (9) Ambulance... delivery in the areas where the network is being offered. Factors making up community patterns of...

  12. 42 CFR 422.112 - Access to services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... services are available 24 hours a day, 7 days a week, when medically necessary. (8) Cultural considerations... limited English proficiency or reading skills, and diverse cultural and ethnic backgrounds. (9) Ambulance... the network is being offered. Factors making up community patterns of health care delivery that...

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

    SciTech Connect

    Laughlin, Michael; Owens, Russell J.

    2016-01-01

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

  14. Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test.

    PubMed

    Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

    2015-10-01

    The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between -20 and 4 (mean -4.4). The mean changes were -3.79 in the glucocorticoid group, -5.52 in those who stopped at loss of ambulation and -4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function.

  15. Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test

    PubMed Central

    Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

    2015-01-01

    The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between −20 and 4 (mean −4.4). The mean changes were −3.79 in the glucocorticoid group, −5.52 in those who stopped at loss of ambulation and −4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. PMID:26248957

  16. Bed Rest versus Early Ambulation with Standard Anticoagulation in The Management of Deep Vein Thrombosis: A Meta-Analysis

    PubMed Central

    Chen, Yuexin; Fan, Zhongjie; Li, Yongjun

    2015-01-01

    Introduction Bed rest has been considered as the cornerstone of management of deep vein thrombosis (DVT) for a long time, though it is not evidence-base, and there is growing evidence favoring early ambulation. Methods Electronic databases including Medline, PubMed, Cochrane Library and three Chinese databases were searched with key words of “deep vein thrombosis”, “pulmonary embolism”, “venous thrombosis”, “bed rest”, “immobilization”, “mobilization” and “ambulation”. We considered randomized controlled trials, prospective or retrospective cohort studies that compared the outcomes of acute DVT patients managed with early ambulation versus bed rest, in addition to standard anticoagulation. Meta-analysis pertaining to the incidence of new pulmonary embolism (PE), progression of DVT, and DVT related deaths were conducted, as well as the extent of remission of pain and edema. Results 13 studies were included with a total of 3269 patients. Compared to bed rest, early ambulation was not associated with a higher incidence of new PE, progression of DVT, or DVT related deaths (RD −0.03, 95% CI −0.05∼ −0.02; Z = 1.24, p = 0.22; random effect model, Tau2 = 0.01). Moreover, if the patients suffered moderate or severe pain initially, early ambulation was related to a better outcome, with respect to remission of acute pain in the affected limb (SMD 0.42, 95%CI 0.09∼0.74; Z = 2.52, p = 0.01; random effect model, Tau2 = 0.04). Meta-analysis of alleviation of edema cannot elicit a solid conclusion because of significant heterogeneity among the few studies. Conclusions Compared to bed rest, early ambulation of acute DVT patients with anticoagulation was not associated with a higher incidence of new PE, progression of DVT, and DVT related deaths. Furthermore, for the patients suffered moderate or severe pain initially, a better outcome can be seen in early ambulation group, regarding to the remission of acute pain in the affected limb. PMID

  17. Genetic modifiers of ambulation in the cooperative international Neuromuscular research group Duchenne natural history study

    PubMed Central

    Bello, Luca; Kesari, Akanchha; Gordish-Dressman, Heather; Cnaan, Avital; Morgenroth, Lauren P; Punetha, Jaya; Duong, Tina; Henricson, Erik K; Pegoraro, Elena; McDonald, Craig M; Hoffman, Eric P

    2015-01-01

    Objective We studied the effects of LTBP4 and SPP1 polymorphisms on age at loss of ambulation (LoA) in a multiethnic Duchenne muscular dystrophy (DMD) cohort. Methods We genotyped SPP1 rs28357094 and LTBP4 haplotype in 283 of 340 participants in the Cooperative International Neuromuscular Research Group Duchenne Natural History Study (CINRG-DNHS). Median ages at LoA were compared by Kaplan–Meier analysis and log-rank test. We controlled polymorphism analyses for concurrent effects of glucocorticoid corticosteroid (GC) treatment (time-varying Cox regression) and for population stratification (multidimensional scaling of genome-wide markers). Results Hispanic and South Asian participants (n = 18, 41) lost ambulation 2.7 and 2 years earlier than Caucasian subjects (p = 0.003, <0.001). The TG/GG genotype at SPP1 rs28357094 was associated to 1.2-year-earlier median LoA (p = 0.048). This difference was greater (1.9 years, p = 0.038) in GC-treated participants, whereas no difference was observed in untreated subjects. Cox regression confirmed a significant effect of SPP1 genotype in GC-treated participants (hazard ratio = 1.61, p = 0.016). LTBP4 genotype showed a direction of association with age at LoA as previously reported, but it was not statistically significant. After controlling for population stratification, we confirmed a strong effect of LTBP4 genotype in Caucasians (2.4 years, p = 0.024). Median age at LoA with the protective LTBP4 genotype in this cohort was 15.0 years, 16.0 for those who were treated with GC. Interpretation SPP1 rs28357094 acts as a pharmacodynamic biomarker of GC response, and LTBP4 haplotype modifies age at LoA in the CINRG-DNHS cohort. Adjustment for GC treatment and population stratification appears crucial in assessing genetic modifiers in DMD. PMID:25641372

  18. An Analysis of the Efficiency of Sourcing Knowledge-based Services in the United States Air Force

    DTIC Science & Technology

    2013-06-01

    purchases, as well as where things are located in the supply chain. Using the Internet can help organizations to streamline manual processes, track...often classified as heterogeneous (Fitzsimmons & Fitzsimmons, 2008). Because services differ by such things as complexity, duration, location, and...they are purchasing. These behind-the-scene processes, internet - based transactions, and service personnel attitudes and expertise make it difficult

  19. Opinions and Beliefs About Telemedicine for Emergency Treatment During Ambulance Transportation and for Chronic Care at Home

    PubMed Central

    Guldolf, Kaat; Vandervorst, Fenne; Van Hooff, Robbert-Jan; Fernandez Tellez, Helio; Desmaele, Sara; Cambron, Melissa; Hubloue, Ives

    2016-01-01

    Background Telemedicine is a valid alternative to face-to-face patient care in many areas. However, the opinion of all stakeholders is decisive for successful adoption of this technique, especially as telemedicine expands into novel domains such as emergency teleconsultations during ambulance transportation and chronic care at home. Objective We evaluate the viewpoints of the broad public, patients, and professional caregivers in these situations. Methods A 10-question survey was developed and obtained via face-to-face interviews of visitors at the Universitair Ziekenhuis Brussel (UZB). The online questionnaire was also distributed among professional caregivers via the intranet of the UZB and among the broad public using social media. Results In total, 607 individuals responded to the questionnaire, expressing a positive opinion regarding telemedicine for in-ambulance emergency treatment and for chronic care at home. Privacy issues were not perceived as relevant, and most respondents were ready to participate in future teleconsultations. Lack of telecommunication knowledge (213/566, 37.6%) was the only independent factor associated with rejection of telemedicine at home and respondents via social media (250/607, 41.2%) were less concerned about privacy issues than respondents via face-to-face interviews (visitors, 234/607, 38.6%). The visitors were more positive towards in-ambulance telemedicine and more likely to agree with future participation in teleconsultations than respondents via social media. Conclusions The broad public, professional caregivers, and patients reported a positive attitude towards telemedicine for emergency treatment during ambulance transportation and for chronic care at home. These results support further improvement of telemedicine solutions in these domains. PMID:27029999

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

    PubMed Central

    2012-01-01

    Background Reviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance personnel and the core work force in Denmark. In addition, to examine the association between physical and psychosocial work environment factors and different measures of health among ambulance personnel. Methods Data were taken from a nationwide sample of ambulance personnel and fire fighters (n = 1,691) and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality. Results Ambulance personnel have half the prevalence of poor self-rated health compared to the core work force (5% vs. 10%). Levels of mental health were the same across the two samples whereas a substantially higher proportion of the ambulance personnel reported musculoskeletal pain (42% vs. 29%). The ambulance personnel had higher levels of emotional demands and meaningfulness of and commitment to work, and substantially lower levels of quantitative demands and influence at work. Only one out of ten aspects of physical work environment was consistently associated with higher levels of musculoskeletal pain. Emotional demands was the only psychosocial work factor that was associated with both poorer mental health and worse sleep quality. Conclusions Ambulance personnel have similar levels of mental health but substantially higher levels of musculoskeletal pain than the work force in general. They are more exposed to emotional demands and these demands are associated with higher levels of poor mental health and poor sleep quality. To improve work environment, attention should be paid to musculoskeletal problems and the presence

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

    PubMed

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

    2013-06-01

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

  2. Reliability and validity of the modified functional ambulation category scale in patients with hemiparalysis

    PubMed Central

    Park, Chang Sik; An, Seung Heon

    2016-01-01

    [Purpose] This study aimed to examine the inter- and intra-rater reliability and validity of the modified functional ambulation category (mFAC) scale. [Subjects and Methods] The participants were 66 stroke patients with hemiparalysis. The inter- and intra-rater validity of the mFAC was calculated using the Spearman correlation coefficient. A score comparison of the stable or maximum gait speed with regard to mFAC and modified Rivermead Mobility Index (mRMI) performances was performed as a univariate linear regression analysis to determine how the Kruskal-Wallis test affects the mRMI and stable/maximum gait speed with regard to mFAC. [Results] The inter-rater reliability of the mFAC (intraclass coefficient [ICC]) was 0.982 (0.971–0.989), with a kappa coefficient of 0.923 and a consistency ratio of 94%. In contrast, the intra-rater reliability of the mFAC (ICC) was 0.991 (0.986–0.995), with a kappa coefficient of 0.961 and a consistency ratio of 96%, showing higher reliability. Moreover, there was a significant difference in stable/maximum gait speed between the mFAC and the mRMI. [Conclusion] Since the mFAC has sufficient inter- and intra-reliability and high validity, it can be used as an assessment tool that reflects the gait performance and mobility of stroke patients. PMID:27630410

  3. Ambulance 12-lead electrocardiography transmission via cell phone technology to cardiologists.

    PubMed

    Hsieh, Jui-Chien; Lin, Bo-Xuan; Wu, Feng-Ren; Chang, Pei-Chann; Tsuei, Yi-Wei; Yang, Chung-Chi

    2010-10-01

    This study demonstrates transmission of 12-lead electrocardiography (ECG) in an ambulance to the cell phone of the attendant emergency medical technician and then to the hospital and to cell phones of off-site cardiologists. The emergency medical technician cell phone receives Extensible Markup Language files generated by a Phillips Extensible Markup Language ECG instrument via Wi-Fi-based wireless network and then sends them to an ECG-processing server at the hospital over the mobile telephone network. After reducing ECG noises and artifacts, the server converts files to Digital Imaging and Communications in Medicine-based ECG reports stored in Picture Archiving and Communication System. These reports are sent to the cell phones of off-site cardiologists. Consequently, on-site Emergency Department physicians and off-site cardiologists can discuss ECG reports via Picture Archiving and Communication System on their computers or cell phones to prepare for the most appropriate treatment while the patient is on the way to the hospital. In conclusion, this 12-lead ECG transmission e-technology expands the functions of a 12-lead ECG instrument and facilitates more efficient prehospital cardiac care.

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

    PubMed

    Kannape, Oliver A; Herr, Hugh M

    2014-01-01

    Although great advances have been made in the design and control of lower extremity prostheses, walking on different terrains, such as ramps or stairs, and transitioning between these terrains remains a major challenge for the field. In order to generalize biomimetic behaviour of active lower-limb prostheses top-down volitional control is required but has until recently been deemed unfeasible due to the difficulties involved in acquiring an adequate electromyographic (EMG) signal. In this study, we hypothesize that a transtibial amputee can extend the functionality of a hybrid controller, designed for level ground walking, to stair ascent and descent by volitionally modulating powered plantar-flexion of the prosthesis. We here present data illustrating that the participant is able to reproduce ankle push-off behaviour of the intrinsic controller during stair ascent as well as prevent inadvertent push-off during stair descent. Our findings suggest that EMG signal from the residual limb muscles can be used to transition between level-ground walking and stair ascent/descent within a single step and significantly improve prosthesis performance during stair-ambulation.

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

    PubMed

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

    2007-01-01

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

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

    PubMed

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

    2016-02-01

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

  7. Ambulation During Periods of Supersaturation Increase Decompression Stress in Spacewalk Simulations

    NASA Technical Reports Server (NTRS)

    Pollock, N. W.; Natoli, M. J.; Martina, S. D.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.

    2016-01-01

    Musculoskeletal activity accelerates inert gas elimination during oxygen breathing prior to decompression (prebreathe), but may also promote bubble formation (nucleation) and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation are likely critical to the net effect. Understanding the relationships is important to evaluate exercise prebreathe protocols and quantify decompression risk in gravity and microgravity environments. The NASA Prebreathe Reduction Program (PRP) combined oxygen prebreathe and exercise preceding a low pressure (4.3 psia; altitude equivalent of 30,300 ft [9,235 m]) simulation exposure of non-ambulatory subjects (a microgravity analog) to produce two protocols now used by astronauts preparing for extravehicular activity. One protocol included both upright cycling and non-cycling exercise (CEVIS: 'cycle ergometer vibration isolation system') and one protocol relied on non-cycling exercise only (ISLE: 'in-suit light exercise'). CEVIS trial data serve as control data for the current study to investigate the influence of ambulation exercise in 1G environments on bubble formation and the subsequent risk of DCS.

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

    PubMed Central

    Okazaki, Hiroshi; Goto, Takahiro

    2016-01-01

    Reconstructive surgery following an internal hemipelvectomy for a malignant pelvic tumor is difficult due to the structural complexity of the pelvis and the massive extension of the tumor. While high complication rates have been encountered in various types of reconstructive surgery, resection without reconstruction reportedly involved fewer complications. However, this method often results in limb shortening with resultant instability during walking. We reported herein leg lengthening performed to correct lower limb shortening after an internal hemipelvectomy, which improved ambulatory stability and overall QOL. An 18-year-old male patient came to our hospital to correct a lower limb discrepancy resulting from a left internal hemipelvectomy. His left pelvis and proximal femur had been resected, and the femur remained without an acetabular roof. His left lower limb was about 8 centimeters shorter. The left tibia was lengthened 8 centimeters with an external fixator. After the lengthening, the patient was able to walk without support and his gait remarkably improved. Additionally he no longer required placing a wallet in his back pocket as a pad as a means of raising the left side of his torso while sitting. Leg lengthening was a useful method of improving ambulation after an internal hemipelvectomy. PMID:27800202

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

    PubMed Central

    2015-01-01

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

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

    PubMed

    Meyer, Jessica

    2015-05-01

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

  11. Attitudinal and Perceptual Barriers to Accessing Mental Health Services Among Members of the U.S. Air Force.

    DTIC Science & Technology

    1998-07-02

    Psychological Help (ATSPPH) scale , which is a part of the survey, indicated that USAF members have more negative views of help seeking than their...examined two large- scale studies of mental health services in each country. The results showed that Americans were consistently more likely to use...to utilization of those services (Snowden et al., 1982). Some evidence dismisses this factor. Two large- scale studies, however, support the

  12. An Analysis of the Efficiency of Sourcing Knowledge-Based Services in the United States Air Force

    DTIC Science & Technology

    2013-05-30

    leaders at all levels informed of purchases, as well as where things are located in the supply chain. Using the Internet can help organizations to...often classified as heterogeneous (Fitzsimmons & Fitzsimmons, 2008). Because services differ by such things as complexity, duration, location, and price...scene processes, Internet - based transactions, and service personnel attitudes and expertise make it difficult for customers to see where the greatest

  13. The 1980 Guide to the Evaluation of Educational Experiences in the Armed Services. [Volume] 1: Air Force.

    ERIC Educational Resources Information Center

    Sullivan, Eugene J.; And Others

    For more than 35 years, this Guide has been the standard reference work for recognizing learning acquired in military life. All the courses offered by the Air Force are listed and briefly described. Each course description includes the course title and number: the length of the course, and where and when it was offered; the course objectives; the…

  14. 48 CFR 47.403-1 - Availability and unavailability of U.S.-flag air carrier service.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the time in a travel status, including delay at origin and accelerated arrival at destination, by at... gateway airport in the United States would extend time in a travel status by at least 6 hours more than... the time in a travel status by at least 6 hours more than travel by a foreign-flag air...

  15. 41 CFR 301-10.135 - When must I travel using U.S. flag air carrier service?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... use of the U.S. flag air carrier would at least double your en route travel time; or (g) When the... 41 Public Contracts and Property Management 4 2012-07-01 2012-07-01 false When must I travel using... Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES ALLOWABLE TRAVEL...

  16. 48 CFR 47.403-1 - Availability and unavailability of U.S.-flag air carrier service.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the time in a travel status, including delay at origin and accelerated arrival at destination, by at... gateway airport in the United States would extend time in a travel status by at least 6 hours more than... the time in a travel status by at least 6 hours more than travel by a foreign-flag air...

  17. 78 FR 78302 - Proposed Modification and Establishment of Air Traffic Service (ATS) Routes in the Vicinity of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-26

    ..., except Federal holidays. An informal docket may also be examined during normal business hours at the... file V-243 are being vectored between the Bowling Green, KY (BWG), VOR Tactical Air Navigation (VORTAC... Bowling Green, KY. * * * * * Paragraph 6011 United States Area Navigation Routes * * * * * T-325...

  18. Air Force Academy: Gender and Racial Disparities. Report to the Chairman, Committee on Armed Services, U.S. Senate.

    ERIC Educational Resources Information Center

    Gebicke, Mark E.

    This study evaluated the situation of women and minorities at the Air Force Academy addressing differences in performance indicators, cadets' perceptions, and Academy actions to enhance the success of women and minorities. Performance indicators for male and female cadets showed mixed results. Minority cadets had comparable physical fitness…

  19. Monitoring firefighter exposure to air toxins at prescribed burns of forest and range biomass. Forest Service research paper

    SciTech Connect

    Reinhardt, T.E.

    1991-10-01

    A variety of potent air toxins are in the smoke produced by burning forest and range biomass. Preliminary data on firefighter exposures to carbon monoxide and formaldehyde at four prescribed burns of Western United States natural fuels are presented. Formaldehyde may be correlated to carbon monoxide emissions. The firefighters' exposures to these compounds relative to workplace standards are discussed.

  20. Ash pests: A guide to major insects, diseases, air pollution injury, and chemical injury. Forest Service general technical report

    SciTech Connect

    Solomon, J.D.; Leininger, T.D.; Wilson, A.D.; Anderson, R.L.; Thompson, L.C.

    1993-09-01

    The ashes (Fraxinus spp.) are one of the authors' more valuable hardwood resources--some 275 million board feet of ash lumber are sawn annually in the United States. Insects, diseases, and pollutants are continuing problems for the ashes, but few actually threaten their widespread use. Disease, simply stated, is a condition of abnormal growth resulting from infection by a biotic agent (fungus, bacterium, or virus), or induced by an abiotic stress such as drought or air pollution.

  1. Long Term Natural History Data in Ambulant Boys with Duchenne Muscular Dystrophy: 36-Month Changes

    PubMed Central

    Sormani, Maria Pia; Messina, Sonia; D′Amico, Adele; Carlesi, Adelina; Vita, Gianluca; Fanelli, Lavinia; Berardinelli, Angela; Torrente, Yvan; Lanzillotta, Valentina; Viggiano, Emanuela; D′Ambrosio, Paola; Cavallaro, Filippo; Frosini, Silvia; Barp, Andrea; Bonfiglio, Serena; Scalise, Roberta; De Sanctis, Roberto; Rolle, Enrica; Graziano, Alessandra; Magri, Francesca; Palermo, Concetta; Rossi, Francesca; Donati, Maria Alice; Sacchini, Michele; Arnoldi, Maria Teresa; Baranello, Giovanni; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Previtali, Stefano; Bruno, Claudio; Politano, Luisa; Comi, Giacomo P.; Bertini, Enrico; Mercuri, Eugenio

    2014-01-01

    The 6 minute walk test has been recently chosen as the primary outcome measure in international multicenter clinical trials in Duchenne muscular dystrophy ambulant patients. The aim of the study was to assess the spectrum of changes at 3 years in the individual measures, their correlation with steroid treatment, age and 6 minute walk test values at baseline. Ninety-six patients from 11 centers were assessed at baseline and 12, 24 and 36 months after baseline using the 6 minute walk test and the North Star Ambulatory Assessment. Three boys (3%) lost the ability to perform the 6 minute walk test within 12 months, another 13 between 12 and 24 months (14%) and 11 between 24 and 36 months (12%). The 6 minute walk test showed an average overall decline of −15.8 (SD 77.3) m at 12 months, of −58.9 (SD 125.7) m at 24 months and −104.22 (SD 146.2) m at 36 months. The changes were significantly different in the two baseline age groups and according to the baseline 6 minute walk test values (below and above 350 m) (p<0.001). The changes were also significantly different according to steroid treatment (p = 0.01). Similar findings were found for the North Star Ambulatory Assessment. These are the first 36 month longitudinal data using the 6 minute walk test and North Star Ambulatory Assessment in Duchenne muscular dystrophy. Our findings will help not only to have a better idea of the progression of the disorder but also provide reference data that can be used to compare with the results of the long term extension studies that are becoming available. PMID:25271887

  2. Utilization of the walking oximetry test to allow safe ambulation after pulmonary resection.

    PubMed

    Kageyama, Y; Urabe, N; Chiba, A

    2001-01-01

    Supplemental oxygen therapy after pulmonary resection can generally be tapered according to arterial blood gases at rest or pulse oximetry (SpO2). However, detecting exercise-induced oxygen desaturation can be difficult. We developed the walking oximetry test (WOT) so that thoracotomy patients could be rehabilitated without the risk of undetected ambulatory hypoxemia. The subjects were 58 patients who had undergone pulmonary resection and could walk at the bedside, with oxygen at 3 l/min via a nasal cannula. Patients with a value of more than 100 torr were allowed to walk with assistance for 6 min in the corridor. The oxygen flow rate was kept at 3 l/min and the walking pace was less than 50 m/min. SpO2 was determined using a wristwatch pulse oximeter. The test was stopped if the SpO2 fell below 90% or there was a score of 5 or more on the Borg scale (range 1-10). Oxygen desaturation occurred in six patients (10%) during the WOT. These patients underwent ambulatory training with sufficient oxygen supplementation and were then tested again. Patients whose SpO2 values remained higher than 90% and who showed no more than 5% desaturation were permitted to walk in the corridor with oxygen at 3 l/min via a nasal cannula. All these patients had a Borg score of 4 or lower. The WOT is a reliable, nonvasive method for detecting exercise-induced oxygen desaturation during ambulation after pulmonary resection.

  3. Health risk assessment of ambient air concentrations of benzene, toluene and xylene (BTX) in service station environments.

    PubMed

    Edokpolo, Benjamin; Yu, Qiming Jimmy; Connell, Des

    2014-06-18

    A comprehensive evaluation of the adverse health effects of human exposures to BTX from service station emissions was carried out using BTX exposure data from the scientific literature. The data was grouped into different scenarios based on activity, location and occupation and plotted as Cumulative Probability Distributions (CPD) plots. Health risk was evaluated for each scenario using the Hazard Quotient (HQ) at 50% (CEXP50) and 95% (CEXP95) exposure levels. HQ50 and HQ95 > 1 were obtained with benzene in the scenario for service station attendants and mechanics repairing petrol dispensing pumps indicating a possible health risk. The risk was minimized for service stations using vapour recovery systems which greatly reduced the benzene exposure levels. HQ50 and HQ95 < 1 were obtained for all other scenarios with benzene suggesting minimal risk for most of the exposed population. However, HQ50 and HQ95 < 1 was also found with toluene and xylene for all scenarios, suggesting minimal health risk. The lifetime excess Cancer Risk (CR) and Overall Risk Probability for cancer on exposure to benzene was calculated for all Scenarios and this was higher amongst service station attendants than any other scenario.

  4. The Public-Service Tax Credit: A Proposed Solution to the Problems of Off-Air Videotaping.

    ERIC Educational Resources Information Center

    Troost, F. William

    1982-01-01

    Proposes a public-service tax credit that would allow copyright owners of any television program broadcast on the public airwaves to claim a limited tax credit in exchange for school rights to copy programs and retain them indefinitely for face-to-face, nonprofit, instructional purposes. (Author/MLF)

  5. An Analysis of Factors Related to Retirement Intentions of Upper Level Civil Service Employees in the Air Force.

    DTIC Science & Technology

    1986-09-01

    first study obtained data from 175 male executives aged 63-69 that were still working in the Paris, France region during 1978 (Poitrenaud, Vallery...socioeconomic status Op *’. (Palmore et al., 1982; Schmitt, White, Coyle, Rauschenberger, a.. 1979; McPherson and Guppy , 1979). Research that focuses on...typical respondent was male (n=768), between 52 and 60 years old and averaged 27.5 years of creditable service toward retirement. Over 48% of the

  6. Structured communication for patient safety in emergency medical services: a legal case report.

    PubMed

    Greenwood, Mark J; Heninger, Jacob R

    2010-01-01

    Providers of emergency medical services (EMS) must communicate vital information during critical phases of operations. Errors in communications, for example, the failure to hear a directive, will compromise safe and effective patient care. This article presents a case that resulted in litigation because of communication failures during the interfacility transfer of a trauma patient who subsequently died in the ambulance. The communication failure involved members of a ground ambulance crew, their dispatcher, and a supervisor. The failure of the emergency medical technician (EMT) who was driving to hear from the treating EMT and her dispatcher vital information pertaining to changes in their destination and of plans to intercept another ambulance, or alternatively, the driver's ignoring this information, led to a delay in care and may have contributed to the patient's death. Factors contributing to the cause of this communication failure may have been related to the nature of the EMS setting: the physical separation between crew members (the driver, and the care provider in the back of the ambulance); the noise of the ground ambulance transport environment, most notably, the siren; and the stress of treating a patient in critical condition. The case highlights the importance of using structured forms of communication, specifically the read-back tool and the critical assertion strategy, to limit failures in communication during EMS operations and in operations in other high-risk medical settings.

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

    PubMed

    2016-08-03

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

  8. The effects of prosthesis mass on metabolic cost of ambulation in non-vascular trans-tibial amputees.

    PubMed

    Gailey, R S; Nash, M S; Atchley, T A; Zilmer, R M; Moline-Little, G R; Morris-Cresswell, N; Siebert, L I

    1997-04-01

    The effect of prosthesis mass on the metabolic cost of steady-state walking was studied in ten male non-vascular trans-tibial amputees (TTAs) and ten non-amputee controls. The subjects underwent four trials of treadmill ambulation, with each trial performed for nine minutes at level grade and 76 m/min. Twenty minutes of seated rest followed each trial. During trials numbers one and two, TTAs ambulated without mass added to their prosthesis. During the third and fourth trials, either 454 or 907 grammes mass (1 or 2lbs mass respectively) were randomly assigned and added to either the prosthesis or the leg of the non-amputee control. Subjects were blinded to the amount of mass added to their limb. Within-group comparisons across the four trials showed significant differences in oxygen consumption (VO2) and heart rate (HR) between the two non "mass added" trials, but no effect for addition of mass. The VO2 of TTAs was only 0.6 ml/kg/min (4.7 percent) greater during walking following the addition of 907 grammes to the prosthesis than without mass addition at all, while HR averaged only 1.4 beats/min. higher under the same testing condition. Pearson-product moment correlations echoed these findings, as moderate, but in all cases, negative correlations were observed for associations among the factors of subject age, stump length, and prosthesis-shoe weight, and both VO2 and HR. It was concluded that adding up to 907 grammes mass to a non-vascular TTA's prosthesis will not significantly increase the energy expenditure or HR at a normal walking speed, and that elevated energy cost of ambulation in repeated measures testing without mass added may reflect task familiarization and not an added burden of prosthesis mass.

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

    PubMed

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

    2015-10-01

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

  10. Characterization of Artifacts Produced by Gel Displacement on Non-invasive Brain-Machine Interfaces during Ambulation.

    PubMed

    Costa, Álvaro; Salazar-Varas, Rocio; Úbeda, Andrés; Azorín, José M

    2016-01-01

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

  11. Characterization of Artifacts Produced by Gel Displacement on Non-invasive Brain-Machine Interfaces during Ambulation

    PubMed Central

    Costa, Álvaro; Salazar-Varas, Rocio; Úbeda, Andrés; Azorín, José M.

    2016-01-01

    So far, Brain-Machine Interfaces (BMIs) have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals). To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training) and one movement-free condition (BMI motor imagery task) are compared to perform this study. Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD) of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions. PMID:26941601

  12. Motor Imagery Training on Muscle Strength and Gait Performance in Ambulant Stroke Subjects-A Randomized Clinical Trial

    PubMed Central

    Chakrapani, M.; Kedambadi, Rakshith

    2016-01-01

    Introduction The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living (ADLs). Motor imagery (MI) is an active process during which a specific action is reproduced within working memory without any actual movements. MI training enhances motor learning, neural reorganization and cortical activation in stroke. The efficacy of MI training involving lower extremity mobility tasks need to be assessed. Aim To evaluate the effects of combining motor imagery with physical practice in paretic Lower Extremity Muscles Strength and Gait Performance in Ambulant Stroke subjects. Materials and Methods A Randomized Clinical Trial was conducted in Department of Physical Therapy, Tertiary Care Hospitals, Mangalore, India which includes 40 hemi paretic subjects (>3 months post-stroke) who were ambulant with good imagery ability in both KVIQ-20 ≥ 60 and Time dependent MI screening test were recruited and randomly allocated into task-oriented training group (n=20) and task-oriented training group plus MI group (n=20). Subjects in both groups underwent task orientated training for lower extremity 45-60 minutes, 4 days per week for 3 weeks. In addition, the experimental group received 30 minutes of audio-based lower extremity mobility tasks for MI practice. Isometric muscle strength of Hip, Knee and Ankle using a hand-held dynamometer and self-selected 10 m gait speed were assessed before and after 3 weeks of intervention. Results Both the groups had found a significant change for all the outcome measures following 3 weeks of interventions with p <.05. The experimental group had shown a significant improvement in paretic hip muscles (both flexors and extensors), knee extensors and ankle dorsiflexors and gait speed compare to control group with p < .05 between group analyses. Conclusion Additional task specific MI training improves paretic muscle strength and gait

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

    PubMed Central

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

    2015-01-01

    [Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training. PMID:26644642

  14. Emergency Medical Services; Recommendations For An Approach To An Urgent National Problem.

    ERIC Educational Resources Information Center

    American Coll. of Surgeons, Chicago, IL.

    Medical technicians such as ambulance attendants must be trained to administer life-saving measures to the acutely ill and injured and transport them safely to a medical facility. Thus, the purpose of this conference was to bring together, for a discussion of all aspects of emergency medical services, representatives of all those groups which are…

  15. A Kernel Approach to the Estimation of Performance Measures in a Helicopter Ambulance Service with Missing Data

    DTIC Science & Technology

    2005-06-01

    radius 100 miles centered in Gilroy and Salinas , respectively; with a large part of their coverage areas reachable from either base. The base in Salinas ...extending the operation of one helicopter to 24/7 for its Salinas base. In this study we analyze the operational impacts of that extension, and...Northern California. Two of these bases serve the land areas encompassed roughly in a circular area of radius 100 miles centered in Gilroy and Salinas

  16. Model application for rapid detection of the exact location when calling an ambulance using OGC Open GeoSMS Standards

    NASA Astrophysics Data System (ADS)

    Sukic, Enes; Stoimenov, Leonid

    2016-02-01

    The web has penetrated just about every sphere of human interest and using information from the web has become ubiquitous among different categories of users. Medicine has long being using the benefits of modern technologies and without them it cannot function. This paper offers a proposal of use and mutual collaboration of several modern technologies within facilitating the location and communication between persons in need of emergency medical assistance and the emergency head offices, i.e., the ambulance. The main advantage of the proposed model is the technical possibility of implementation and use of these technologies in developing countries and low implementation cost.

  17. Aging and service wear of air-operated valves used in safety-related systems at nuclear power plants

    SciTech Connect

    Cox, D.F.; McElhaney, K.L.; Staunton, R.H.

    1995-05-01

    Air-operated valves (AOVs) are used in a variety of safety-related applications at nuclear power plants. They are often used where rapid stroke times are required or precise control of the valve obturator is required. They can be designed to operate automatically upon loss of power, which is often desirable when selecting components for response to design basis conditions. The purpose of this report is to examine the reported failures of AOVs and determine whether there are identifiable trends in the failures related to predictable causes. This report examines the specific components that comprise a typical AOV, how those components fail, when they fail, and how such failures are discovered. It also examines whether current testing frequencies and methods are effective in predicting such failures.

  18. Characteristics of the ambulation-increasing effect of GBR-12909, a selective dopamine uptake inhibitor, in mice.

    PubMed

    Hirate, K; Kuribara, H

    1991-04-01

    Behavioral effects of a dopamine uptake inhibitor, GBR-12909 (GBR), were evaluated by ambulatory activity in mice. The single administration of over 10 mg/kg of GBR, i.p. and p.o., significantly increased the ambulatory activity. The repeated administration of GBR, at only 10 mg/kg, produced a reverse tolerance to its ambulation-increasing effect. However, a cross-reverse tolerance was induced between GBR (10 and 20 mg/kg) and methamphetamine (2 mg/kg) in both directions. Furthermore, 5 mg/kg of GBR significantly enhanced the effects of methamphetamine, cocaine, imipramine, morphine, scopolamine and caffeine. R-THBP, a coenzyme of tyrosine hydroxylase, also enhanced the effect of GBR. In contrast, the ambulation-increasing effect of 10 mg/kg of GBR was markedly reduced by haloperidol, chlorpromazine, tetrabenazine, oxypertine, reserpine and alpha-methyl-p-tyrosine. On the other hand, the effect of GBR was only slightly and/or scarcely modified by apomorphine, caerulein, physostigmine, pilocarpine, N6-(L-2-phenylisopropyl)-adenosine and naloxone. The neurochemical experiment in rats, not in mice, revealed that GBR possessed more dominant action on dopaminergic systems than noradrenergic or serotonergic systems. However, the behavioral characteristics of GBR are similar to those of methamphetamine and cocaine, which possess less selective action than GBR on dopaminergic and noradrenergic systems.

  19. [A statistical analysis of factors influencing standing balance, activity of daily living and ambulation in hemiplegic patients].

    PubMed

    Nogaki, H

    1992-04-01

    This study was undertaken to investigate several factors influencing standing balance, activity of daily living and ambulation in hemiplegic patients after cerebro-vascular diseases. A statistical analysis of 121 hemiplegic patients with unilateral supratentorial lesions showed that age, severity of muscle weakness of involved or uninvolved extremities, unilateral spatial neglect and the sense of toe position had influence on standing balance, activity of daily living or ambulation. The patients were divided into five groups based on the degree of unilateral spatial neglect, evaluated by their copies of two daisies who omitted more than three quarters, three quarters, half, one quarter and none of the figures were defined as the USN-4, USN-3, USN-2, USN-1 and no involvement groups, respectively. Those who belonged to the USN-2 group had significantly lower scores for activity of daily living than those who belonged to the no involvement group. In the USN-2 group, 7 of the 8 patients could not keep standing for 50 seconds, while in the no involvement group, this was the case in only 1 of the 15 patients. Activity of daily living scores or sway area during standing showed no statistically significant differences between the USN-1 and no involvement groups. These results suggested that severe or moderate unilateral spatial neglect is one of the most important factors influencing standing balance and activity of daily living.

  20. Does a waist-worn ActiGraph accelerometer quantify community ambulation in persons with multiple sclerosis?

    PubMed

    Sosnoff, Jacob J; Socie, Michael J; Boes, Morgan K; Sandroff, Brian M; Motl, Robert W

    2012-01-01

    Accelerometry has been recognized as a method of objectively measuring community ambulation in persons with multiple sclerosis (MS). However, the assumption that walking itself serves as a major contributor to the accelerometer signal has yet to be tested. This study examined the assumption that community-based walking is a primary contributor to accelerometer output in MS. Ambulatory persons (5 males/17 females; 13 without aid/9 with aid) with MS wore a triaxial accelerometer (ActiGraph GT3X, Health One Technologies; Fort Walton Beach, Florida) as well as an IDEEA system (MiniSun, Inc; Fresno, Florida) over the course of a single day. Outcome measures for the accelerometer included movement counts/hour for the vertical, anterior-posterior, and mediolateral axes. Outcomes for the IDEEA system included percent time walking, sitting, and standing, as well as walking speed. Pearson product correlations (r) were used to examine the associations between outcomes from the accelerometer and IDEEA system. Significant correlations were observed between percent walking time and movement counts/hour along the vertical (r = 0.84) and anterior-posterior (r = 0.69) axes. Significant correlations were further noted between movement counts/hour along the vertical axis and walking speed (r = 0.45) and self-report walking impairment (r = -0.50) and disability (r = -0.46). Such observations further support accelerometry as an objective marker of community ambulation in persons with MS.

  1. Retirement Policies and Support for Emergency Service Personnel: The Transition to Retirement.

    PubMed

    Bracken-Scally, Mairéad; McGilloway, Sinéad; Mitchell, Jeffrey T

    2016-06-01

    The aim of this study was to explore policies and procedures to support employees who retire from the emergency services. Interviews were conducted with participants who were familiar with existing policies and procedures in a large ambulance (n = 8) and fire (n = 6) service in Ireland. Four key themes were identified: (1) "I don't think it's a job at 65 to be running out on an emergency ambulance"; (2) "They do genuinely feel a wee bit isolated"; (3) improving the "cultural shock"; and (4) "I just keep going and hope for the best". Findings point towards retirement as a major life change and highlight a need for more structured, effective pre-retirement preparation. Factors unique to emergency service personnel include the physical and emotional stress involved in emergency service; a strong identification with the service; and a lack of clarity about rules and entitlements, requiring better information and preparation.

  2. Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana

    PubMed Central

    Mould-Millman, Nee-Kofi; Rominski, Sarah D; Bogus, Joshua; Ginde, Adit A; Zakariah, Ahmed N; Boatemaah, Christiana A; Yancey, Arthur H; Akoriyea, Samuel Kaba; Campbell, Thomas B

    2015-01-01

    Background: Emergency medical services (EMS) systems provide professional prehospital emergency medical care and transportation to help improve outcomes from emergency conditions. Ghana’s national ambulance service has relatively low public utilization in comparison with the large burden of acute disease. Methods: A survey instrument was developed using Pechansky and Thomas’s model of access covering 5 dimensions of availability, accessibility, accommodation, affordability, and acceptability. The instrument was used in a cross-sectional survey in 2013 in Accra, Ghana; eligible participants were those 18 years and older who spoke English, French, or Twi. Although the analysis was mainly descriptive, logistic regression was used to identify factors associated with reported intention to call for an ambulance in the case of a medical emergency. Results: 468 participants completed surveys, with a response rate of 78.4%. Few (4.5%) respondents had ever used an ambulance in prior emergency situations. A substantial proportion (43.8%) knew about the public access medical emergency telephone number, but of those only 37.1% knew it was a toll-free call. Most (54.7%) respondents believed EMTs offered high-quality care, but 78.0% believed taxis were faster than ambulances and 69.2% thought the number of ambulances in Accra insufficient. Many (23.4%) thought using ambulances to transport corpses would be appropriate. In two hypothetical emergency scenarios, respondents most commonly reported taxis as the preferred transportation (63.6% if a family member were burned in a house fire, 64.7% if a pedestrian were struck by a vehicle). About 1 in 5 respondents said they would call an ambulance in either scenario (20.7% if a family member were burned in a house fire, 23.3% if a pedestrian were struck by a vehicle) while 15.5% and 10.2%, respectively, would use any available vehicle. Those aged 18–35 years were more likely than older respondents to prefer an ambulance (odds

  3. Wearable seismocardiography: towards a beat-by-beat assessment of cardiac mechanics in ambulant subjects.

    PubMed

    Di Rienzo, M; Vaini, E; Castiglioni, P; Merati, G; Meriggi, P; Parati, G; Faini, A; Rizzo, F

    2013-11-01

    Seismocardiogram (SCG) is the measure of the micro-vibrations produced by the heart contraction and blood ejection into the vascular tree. Over time, a large body of evidence has been collected on the ability of SCG to reflect cardiac mechanical events such as opening and closure of mitral and aortic valves, atrial filling and point of maximal aortic blood ejection. We recently developed a smart garment, named MagIC-SCG, that allows the monitoring of SCG, electrocardiogram (ECG) and respiration out of the laboratory setting in ambulant subjects. The present pilot study illustrates the results of two different experiments performed to obtain a first evaluation on whether a dynamical assessment of indexes of cardiac mechanics can be obtained from SCG recordings obtained by MagIC-SCG. In the first experiment, we evaluated the consistency of the estimates of two indexes of cardiac contractility, the pre-ejection period, PEP, and the left ventricular ejection time, LVET. This was done in the lab, by reproducing an experimental protocol well known in literature, so that our measures derived from SCG could have been compared with PEP and LVET reference values obtained by traditional techniques. Six healthy subjects worn MagIC-SCG while assuming two different postures (supine and standing); PEP was estimated as the time interval between the Q wave in ECG and the SCG wave corresponding to the opening of aortic valve; LVET was the time interval between the SCG waves corresponding to the opening and closure of the aortic valve. The shift from supine to standing posture produced a significant increase in PEP and PEP/LVET ratio, a reduction in LVET and a concomitant rise in the LF/HF ratio in the RR interval (RRI) power spectrum. These results are in line with data available in literature thus providing a first support to the validity of our estimates. In the second experiment, we evaluated in one subject the feasibility of the beat-by-beat assessment of LVET during spontaneous

  4. Cost & efficiency evaluation of a publicly financed & publicly delivered referral transport service model in three districts of Haryana State, India

    PubMed Central

    Prinja, Shankar; Manchanda, Neha; Aggarwal, Arun Kumar; Kaur, Manmeet; Jeet, Gursimer; Kumar, Rajesh

    2013-01-01

    Background & objectives: Various models of referral transport services have been introduced in different States in India with an aim to reduce maternal and infant mortality. Most of the research on referral transport has focussed on coverage, quality and timeliness of the service with not much information on cost and efficiency. This study was undertaken to analyze the cost of a publicly financed and managed referral transport service model in three districts of Haryana State, and to assess its cost and technical efficiency. Methods: Data on all resources spent for delivering referral transport service, during 2010, were collected from three districts of Haryana State. Costs incurred at State level were apportioned using appropriate methods. Data Envelopment Analysis (DEA) technique was used to assess the technical efficiency of ambulances. To estimate the efficient scale of operation for ambulance service, the average cost was regressed on kilometres travelled for each ambulance station using a quadratic regression equation. Results: The cost of referral transport per year varied from ₹5.2 million in Narnaul to ₹9.8 million in Ambala. Salaries (36-50%) constituted the major cost. Referral transport was found to be operating at an average efficiency level of 76.8 per cent. Operating an ambulance with a patient load of 137 per month was found to reduce unit costs from an average ₹ 15.5 per km to ₹ 9.57 per km. Interpretation & conclusions: Our results showed that the publicly delivered referral transport services in Haryana were operating at an efficient level. Increasing the demand for referral transport services among the target population represents an opportunity for further improving the efficiency of the underutilized ambulances. PMID:24521648

  5. Potential Use of the Australian Satellite Communications System for School of the Air and Enhanced Educational Services. Report Prepared for the Commonwealth/State Advisory Committee on the Educational Use of Communications Technology.

    ERIC Educational Resources Information Center

    Davies, N. G.; Gillam, J. A.

    This report considers the potential for the use of the Australian Communications Satellite System (ACSS) for the Australian Schools of the Air (SOTAs) and the delivery of enhanced educational services, and develops the concept of all SOTAs operating through one transponder in a national beam. An evolutionary introduction of satellite transmission…

  6. Factors Associated with Incidence of "Inappropriate" Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children

    ERIC Educational Resources Information Center

    Poltavski, Dmitri; Muus, Kyle

    2005-01-01

    Context: Ambulance transport of pediatric trauma patients to designated trauma centers in cases of moderate and severe injury is not always performed, which has been shown to result in poor treatment outcomes. Determination of factors involved in inappropriate patient transport, especially in rural areas, remains an important avenue of research.…

  7. Factors Associated With Incidence of "?Inappropriate"? Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children

    ERIC Educational Resources Information Center

    Poltavski, Dmitri; Muus, Kyle

    2005-01-01

    Context: Ambulance transport of pediatric trauma patients to designated trauma centers in cases of moderate and severe injury is not always performed, which has been shown to result in poor treatment outcomes. Determination of factors involved in inappropriate patient transport, especially in rural areas, remains an important avenue of research.…

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

    PubMed

    Kim, Soonyoung

    2016-12-01

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

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

    PubMed Central

    Kim, Soonyoung

    2016-01-01

    [Purpose] The aim of this study was to evaluate the differences in the ambulation patterns and knee joint performance between people with and without patellofemoral pain. The present study also aimed to utilize these results as a basis for the development of pain-alleviating and performance-improving treatment programs. [Subjects and Methods] Subjects consisted of 32 adult females diagnosed with patellofemoral pain syndrome and 25 adult females without patellofemoral pain (controls). Contact ratio patterns during ambulation and isokinetic muscle strength around the knee joint were measured in both groups and then compared. [Results] Ambulation patterns, specifically the contact ratios of the left forefoot and right forefoot, differed significantly between patients with patellofemoral pain syndrome and controls. An isokinetic muscle strength test demonstrated that left and right knee extensor and flexor torques also significantly differed between these two groups. [Conclusion] Basic analysis based on ambulation patterns and muscle strength can be used to indicate functional recovery from patellofemoral pain syndrome and provide insight into improving the rehabilitation of patients. PMID:28174434

  10. Real-Time Human Ambulation, Activity, and Physiological Monitoring: Taxonomy of Issues, Techniques, Applications, Challenges and Limitations

    PubMed Central

    Khusainov, Rinat; Azzi, Djamel; Achumba, Ifeyinwa E.; Bersch, Sebastian D.

    2013-01-01

    Automated methods of real-time, unobtrusive, human ambulation, activity, and wellness monitoring and data analysis using various algorithmic techniques have been subjects of intense research. The general aim is to devise effective means of addressing the demands of assisted living, rehabilitation, and clinical observation and assessment through sensor-based monitoring. The research studies have resulted in a large amount of literature. This paper presents a holistic articulation of the research studies and offers comprehensive insights along four main axes: distribution of existing studies; monitoring device framework and sensor types; data collection, processing and analysis; and applications, limitations and challenges. The aim is to present a systematic and most complete study of literature in the area in order to identify research gaps and prioritize future research directions. PMID:24072027

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

    PubMed

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

    2008-06-01

    We report the testing of a mobile Robotic Tele-echo system that was placed in an ambulance and successfully transmitted clear real time echo imaging of a patient's abdomen to the destination hospital from where this device was being remotely operated. Two-way communication between the paramedics in this vehicle and a doctor standing by at the hospital was undertaken. The robot was equipped with an ultrasound probe which was remotely controlled by the clinician at the hospital and ultrasound images of the patient were transmitted wirelessly. The quality of the ultrasound images that were transmitted over the public mobile telephone networks and those transmitted over the Multimedia Wireless Access Network (a private networks) were compared. The transmission rate over the public networks and the private networks was approximately 256 Kbps, 3 Mbps respectively. Our results indicate that ultrasound images of far higher definition could be obtained through the private networks.

  12. The Effect of a Shock Absorber on Spatiotemporal Parameters and Ground Reaction Forces of Forearm Crutch Ambulation.

    PubMed

    Dooley, Adam; Ma, Ye; Zhang, Yanxin

    2015-01-01

    Forearm crutches are a commonly used assistive device to aid the ambulation of people with lower limb impairment. Due to the structure of the joints of the upper limb, the loading patterns during crutch-walking can be detrimental to the user. Shock-absorbed or compliant crutches may reduce ground contact impact, potentially benefitting the user. In this study, the authors performed a biomechanical evaluation of a shock absorber crutch, which uses an elastomeric system to absorb impact. Ground reaction forces (GRFs) and spatiotemporal parameters were compared between shock absorbed and standard crutches. Results indicate no significant differences to spatiotemporal parameters and peak ground reaction forces between the crutches. There is an initial impact spike during crutch strike when using shock absorbed crutches, after which the rate of force development is moderately decreased when compared with a standard crutch. The practical benefit of a small reduction in force is questionable and more work must be undertaken to further optimise shock absorber design.

  13. Effect evaluation of a heated ambulance mattress-prototype on body temperatures and thermal comfort - an experimental study

    PubMed Central

    2014-01-01

    Background Exposure to cold temperatures is, often, a neglected problem in prehospital care. One of the leading influences of the overall sensation of cold discomfort is the cooling of the back. The aim of this study was to evaluate the effect of a heated ambulance mattress-prototype on body temperatures and thermal comfort in an experimental study. Method Data were collected during four days in November, 2011 inside and outside of a cold chamber. All participants (n = 23) participated in two trials each. In one trial, they were lying on a stretcher with a supplied heated mattress and in the other trial without a heated mattress. Outcomes were back temperature, finger temperature, core body temperature, Cold Discomfort Scale (CDS), four statements from the state-trait anxiety – inventory (STAI), and short notes of their experiences of the two mattresses. Data were analysed both quantitatively and qualitatively. A repeated measure design was used to evaluate the effect of the two mattresses. Results A statistical difference between the regular mattress and the heated mattress was found in the back temperature. In the heated mattress trial, the statement “I am tense” was fewer whereas the statements “I feel comfortable”, “I am relaxed” and “I feel content” were higher in the heated mattress trial. The qualitative analyses of the short notes showed that the heated mattress, when compared to the unheated mattress, was experienced as warm, comfortable, providing security and was easier to relax on. Conclusions Heat supply from underneath the body results in increased comfort and may prevent hypothermia which is important for injured and sick patients in ambulance care. PMID:25103366

  14. 78 FR 46405 - Agency Information Collection Activities: Requests for Comments; Clearance of a New Approval of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-31

    ... request the Office of Management and Budget (OMB) approval for a new information collection. The FAA Modernization and Reform Act of 2012 included a mandate to begin collection of operational data from Air... air ambulance services. The helicopter air ambulance operational data provided to the FAA will be...

  15. Headquarters Air Weather Service Reorganization.

    DTIC Science & Technology

    1986-05-01

    Cambridge, Massachusetts: Winthrop Publishers, Inc., 1981), p. 72. 2. J. W. Lorsch , "Organization Design: A Situational Perspective," Organizational...William B. Public Organization Behavior and Development. Cambridge, Massachusetts: Winthrop Publishers, Inc., 1981. Galbraith, Jay .R. Designing...Complex Organizations. Reading, Ma.: Addison-Wesley, 1973. Galbraith, Jay R. Organization Design. Reading, Ma.: Addison-Wesley, 1977. Gardner, John W. "How

  16. Executive summary: Benefit-cost evaluation of an intra-regional air service in the Bay Area and a technology assessment of transportation system investments. [regional planning for the San Francisco Bay area of California

    NASA Technical Reports Server (NTRS)

    Haefner, L. E.

    1978-01-01

    The benefits and costs that would result from an intra-regional air service operation in the San Francisco Bay area were determined by utilizing an iterative statistical decision model to evaluate combinations of commuter airport sites and surface transportation facilities in conjunction with service by a given commuter aircraft type in light of area regional growth alternatives and peak and off-peak regional travel patterns. The model evaluates such transportation option with respect to criteria of airline profitability, public acceptance, and public and private non-user costs. In so doing, it incorporates information on modal split, peak and off-peak use of the air commuter fleet, terminal and airport costs, development costs and uses of land in proximity to the airport sites, regional population shifts, and induced zonal shifts in travel demand. The model is multimodal in its analytic capability, and performs exhaustive sensitivity analysis.

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

    ERIC Educational Resources Information Center

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

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

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

    PubMed

    Higgs, E; Melling, J

    1997-04-01

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

  19. Air Research

    EPA Pesticide Factsheets

    EPA's air research provides the critical science to develop and implement outdoor air regulations under the Clean Air Act and puts new tools and information in the hands of air quality managers and regulators to protect the air we breathe.

  20. Air Cargo Marketing Development

    NASA Technical Reports Server (NTRS)

    Kersey, J. W.

    1972-01-01

    The factors involved in developing a market for air cargo services are discussed. A comparison is made between the passenger traffic problems and those of cargo traffic. Emphasis is placed on distribution analyses which isolates total distribution cost, including logistical costs such as transportation, inventory, materials handling, packaging, and processing. Specific examples of methods for reducing air cargo costs are presented.

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

    PubMed

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

    2016-03-20

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

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

    NASA Technical Reports Server (NTRS)

    Carl, J. G.; Furukawa, S.

    1975-01-01

    A manual is presented that provides basic technical documentation to support the operation and utilization of the Portable Ambulance Module (PAM) in the field. The PAM is designed to be used for emergency resuscitation and victim monitoring. The functions of all the controls, displays, and stowed equipment of the unit are defined. Supportive medical and physiological data in those areas directly related to the uses of the PAM unit are presented.

  3. Effects of a Static Bicycling Programme on the Functional Ability of Young People with Cerebral Palsy Who Are Non-Ambulant

    ERIC Educational Resources Information Center

    Williams, Heather; Pountney, Teresa

    2007-01-01

    This study investigated the effects of exercise on the motor function of 11 young people (10 females, one male; age range 11-15y; mean age 12y 7mo [SD 1y 4mo]) with cerebral palsy (CP) who were non-ambulant (Gross Motor Function Classification System Levels IV or V), using an adapted static bicycle. Three participants had dyskinetic quadriplegia,…

  4. Degree of ambulation and factors associated with the median distance moved per day in Alzheimer's disease patients.

    PubMed

    Nishikata, Shiori; Yamakawa, Miyae; Shigenobu, Kazue; Suto, Shunji; Makimoto, Kiyoko

    2013-09-01

    The Integrated Circuit tag monitoring system became available to measure wandering in terms of the distance moved by dementia patients. The purposes of the study were to describe degree of ambulation in patients with Alzheimer's disease (AD) and to examine factors associated with the distance moved. AD patients were recruited at a dementia care unit in Asakayama Hospital, Osaka, Japan. The monitoring system generated the distance moved per day. Demographic and clinical data were abstracted from medical records. Mini-Mental State Examination was used to measure cognitive function. A multiple linear regression was used to predict the distance moved per day. The research was approved by the ethics committee of the university and the hospital, and written informed consent was obtained from the patients' proxies. Majority of the AD subjects monitored had moderate to advance stage of dementia. Patients' age and cognitive function were predictors of the median distance moved/day, and these two variables explained almost half of the variance. Older age and lower cognitive function were associated with reduced median distance moved per day in AD patients.

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

    PubMed

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

    2013-05-01

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

  6. 78 FR 48925 - Agency Information Collection Activities: Requests for Comments; Clearance of a New Approval of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-12

    ... request the Office of Management and Budget (OMB) approval for a new information collection. This notice... Reform Act of 2012 included a mandate to begin collection of operational data from Air Ambulance... services. See 49 U.S.C. 44731. The helicopter air ambulance operational data provided to the FAA will...

  7. Prehospital emergency medical services in Malaysia.

    PubMed

    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.

  8. Predictors of Ambulance Transport in Patients with ST-Elevation Myocardial Infarction

    PubMed Central

    Scherer, Tara M.; Russ, Stephan; Jenkins, Cathy A.; Jones, Ian D.; Slovis, Corey M.; Cunningham, Brittany L.; Barrett, Tyler W.

    2012-01-01

    Introduction Despite intense public awareness campaigns, many patients with ST-elevation myocardial infarction (STEMI) do not utilize Emergency Medical Services (EMS) transportation to the Emergency Department (ED). Predictors for mode of transport by EMS versus private vehicle in patients with an acute STEMI were investigated. Hypothesis It was hypothesized that patient characteristics, specifically older age, male sex, and a history of a prior cardiac intervention, would be associated with a higher likelihood of EMS utilization. Methods A retrospective, observational cohort study was performed for all STEMI patients treated from April 1, 2007 through June 30, 2010 at an urban, academic ED with 24-hour cardiac catheterization available. Multivariable analyses with predetermined predictors (age, sex, prior cardiac intervention, weekend/evening arrival) were performed to investigate associations with mode of transport. Door-to-balloon (D2B) times were calculated. Results Of the 209 STEMI patients, 11 were excluded, leaving 198 for analysis. Median age was 60 years (IQR: 53-70), 138 (70%) arrived by private vehicle, and 60 (30%) by EMS. The primary analysis did not identify significant predictors for EMS, but a post-hoc model found that private insurance (OR 0.18; 95% CI, 0.07-0.45) was associated with fewer EMS transports. Although not statistically significant due to the great variability in time of arrival for STEMI patients transported by private vehicle, EMS transports had shorter D2B times. During business hours and weekend/evenings, EMS had D2B times of 50 (IQR: 42-61) and 58 minutes (IQR: 47-63), respectively, while private vehicle transports had median D2B times of 62 (IQR: 50-74) and 78 minutes (IQR: 66-106). Conclusion No associations between mode of transport and patient age, sex, weekend/ evening presentation and history of a prior cardiac intervention were identified. Privately insured patients were less likely to use EMS when experiencing a STEMI. More

  9. Services Supply Chain in the Department of Defense: A Comparison of Acquisition Management Practices in the Army, Navy, and Air Force

    DTIC Science & Technology

    2010-08-23

    k^s^i=mlpqdo^ar^qb=p`elli= models; and Schiele and McCue (2006) studied the acquisition of consulting services in the public sector. Although these...Aeronautics and Astronautics. Schiele , J. J., & McCue, C. P. (2006). Professional service acquisition in public sector procurement. International

  10. Air Pollution

    MedlinePlus

    Air pollution is a mixture of solid particles and gases in the air. Car emissions, chemicals from factories, ... Ozone, a gas, is a major part of air pollution in cities. When ozone forms air pollution, it's ...

  11. Characterizing the effect of summer temperature on heatstroke-related emergency ambulance dispatches in the Kanto area of Japan.

    PubMed

    Ng, Chris Fook Sheng; Ueda, Kayo; Ono, Masaji; Nitta, Hiroshi; Takami, Akinori

    2014-07-01

    Despite rising concern on the impact of heat on human health, the risk of high summer temperature on heatstroke-related emergency dispatches is not well understood in Japan. A time-series study was conducted to examine the association between apparent temperature and daily heatstroke-related ambulance dispatches (HSAD) within the Kanto area of Japan. A total of 12,907 HSAD occurring from 2000 to 2009 in five major cities-Saitama, Chiba, Tokyo, Kawasaki, and Yokohama-were analyzed. Generalized additive models and zero-inflated Poisson regressions were used to estimate the effects of daily maximum three-hour apparent temperature (AT) on dispatch frequency from May to September, with adjustment for seasonality, long-term trend, weekends, and public holidays. Linear and non-linear exposure effects were considered. Effects on days when AT first exceeded its summer median were also investigated. City-specific estimates were combined using random effects meta-analyses. Exposure-response relationship was found to be fairly linear. Significant risk increase began from 21 °C with a combined relative risk (RR) of 1.22 (95% confidence interval, 1.03-1.44), increasing to 1.49 (1.42-1.57) at peak AT. When linear exposure was assumed, combined RR was 1.43 (1.37-1.50) per degree Celsius increment. Overall association was significant the first few times when median AT was initially exceeded in a particular warm season. More than two-thirds of these initial hot days were in June, implying the harmful effect of initial warming as the season changed. Risk increase that began early at the fairly mild perceived temperature implies the need for early precaution.

  12. EFFECTS OF THE GENIUM KNEE SYSTEM ON FUNCTIONAL LEVEL, STAIR AMBULATION, PERCEPTIVE AND ECONOMIC OUTCOMES IN TRANSFEMORAL AMPUTEES

    PubMed Central

    Highsmith, M. Jason; Kahle, Jason T.; Wernke, Matthew M.; Carey, Stephanie L.; Miro, Rebecca M.; Lura, Derek J.; Sutton, Bryce S.

    2016-01-01

    Compared to non-microprocessor knees, the C-Leg microprocessor knee (MPK) is bioenergentically and economically more efficient and safer for transfemoral amputation (TFA) patients. The Genium MPK has demonstrated improvements in perceived function, knee kinematics, and physical functional performance compared to C-Leg. Clinical and health economic analyses have not been conducted with the Genium knee system. The purpose of this study was to determine if laboratory determined benefits of Genium are detectable using common clinical assessments and if there are economic benefits associated with its use. This study utilized a randomized AB crossover study with 60 d follow-up including cost-effectiveness analysis. Twenty TFA patients tested with both knees in mobility and preference measures. Incremental cost-effectiveness ratios (ICER) were calculated based on performance measures. Stair Assessment Index scores improved with Genium. Mean stair completion times and descent stepping rate were not different between knees. Stair ascent stepping rate for C-Leg was greater compared with Genium (p = 0.04). Genium use decreased Four square step test completion time and increased functional level and step activity (p ≤ 0.05). Further, Genium use improved (p ≤ 0.05) function and safety in three out of five Activities of Daily Living (ADL) survey domains. Finally, more subjects preferred Genium following testing. Functional measures were used to calculate ICERs. ICER values for Genium fall within established likely-to-accept value ranges. Compared with C-Leg, Genium use improved stair walking performance, multi-directional stepping, functional level, and perceived function. In this group of community ambulators with TFA, Genium was preferred, and, while more costly, it may be worth funding due to significant improvements in functional performance with ADLs. PMID:27917268

  13. Study of low density air transportation concepts

    NASA Technical Reports Server (NTRS)

    Webb, H. M.

    1972-01-01

    Low density air transport refers to air service to sparsely populated regions. There are two major objectives. The first is to examine those characteristics of sparsely populated areas which pertain to air transportation. This involves determination of geographical, commercial and population trends, as well as those traveler characteristics which affect the viability of air transport in the region. The second objective is to analyze the technical, economic and operational characteristics of low density air service. Two representative, but diverse arenas, West Virginia and Arizona, were selected for analysis: The results indicate that Arizona can support air service under certain assumptions whereas West Virginia cannot.

  14. A Conceptual Model of the Severe-Storm Environment for Inclusion into Air Weather Service Severe-Storm Analysis and Forecast Procedures.

    DTIC Science & Technology

    2014-09-26

    Severe-Storm Environment of the Great Plains 9 2. Median of 230 Soundings Representing Type I Air Structure Where Tornadoes Have Formed 10 3a. Skew T-Log...the Southern Great Plains of the United States and Mexico 13 5. Total Number of Tornadoes per 50-Mile Square Reported From 1920 to 1949, by Months 16 6...Mean Sounding of Type IV Tornado Air Mass 20 7. Major Lid Features at 700 mb 21 8. Relevant Lid Features at 850 mb 23 9. Surface Chart Showing

  15. Air Force Construction Contract Disputes: An Analysis of Armed Services Board of Contract Appeals Cases to Identify Dispute Types and Causes

    DTIC Science & Technology

    1982-09-01

    k 4. TITLir (wE i. AIR FORCE CONSTRUCTION CONTRAC" TYP, O, RPORT A PERoo CovEREo T Y E o r R E P R a COMPO EC•N O VR E D DISPUTES: AN ANALYSIS OF...UNCUASSIFIED SECURITY CLASSIFICATION OF THIS PAGE (When Dole EntereO ............. SMCURITT CLASWF14ATION OF THIS PApUrwn P ,11177907.g _ * Construction...management. 4 4 I p UNCLASSIFIED SIMUghTY CLASSIFICATION OF TWO PA69(IWh.f. Dle". . t-. .- • I LSSR 88-82 i AIR FORCE CONSTRUCTION CONTRACT DISPUTES: AN

  16. Articulated, Performance-Based Instruction Objectives Guide for Air Conditioning, Refrigeration, and Heating (Environmental Control System Installer/Servicer). Edition I.

    ERIC Educational Resources Information Center

    Henderson, William Edward, Jr., Ed.

    This articulation guide contains 17 units of instruction for the first year of a two-year vocational program designed to prepare the high school graduate to install, maintain, and repair various types of residential and commercial heating, air conditioning, and refrigeration equipment. The units are to introduce the student to fundamental theories…

  17. A SYSTEM DESIGN FOR THE PROVISION OF A SAFER, MORE ECONOMIC, AND MORE EFFICIENT AIR TRAFFIC SERVICE FOR THE ICAO NORTH ATLANTIC REGION.

    DTIC Science & Technology

    The ICAO Fourth North Atlantic Regional Air Navigation Meeting adopted a recommendation which called for the introduction of a systems planning...concept to the ICAO North Atlantic Region. Following acceptance of this recommendation by the ICAO Council, the Federal Aviation Agency (FAA) established

  18. The 1998 Guide to the Evaluation of Educational Experiences in the Armed Services. 3: Air Force, Coast Guard, Department of Defense, Marine Corps.

    ERIC Educational Resources Information Center

    American Council on Education, Washington, DC.

    This guide is the standard reference work for recognizing learning acquired by military personnel for conversion to academic credit in degree work at colleges and universities. This volume contains recommendations for formal courses offered by the Air Force, the Coast Guard, the Marine Corps, and the Department of Defense in 1990 and later years.…

  19. 32 CFR Appendix B to Part 68 - Addendum for Education Services Between [Name of Educational Institution] and the U.S. Air Force

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... U.S. Air Force B Appendix B to Part 68 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN VOLUNTARY EDUCATION PROGRAMS Pt. 68, App. B Appendix B..., invoices, degree completions, and search tools pre-built into the USAF online Voluntary Education System....

  20. 14 CFR 19-4 - Service classes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... (Service Class F) is a composite of first class, coach, and mixed passenger/cargo service. The following... applicable to the performance of nonscheduled aircraft charters, and other air transportation services...

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

    PubMed

    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.

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

    PubMed Central

    Moraux, Amélie; Annoussamy, Mélanie; Dorveaux, Eric; Gasnier, Erwan; Hogrel, Jean-Yves; Voit, Thomas; Vissière, David; Servais, Laurent

    2016-01-01

    Measurement of muscle strength and activity of upper limbs of non-ambulant patients with neuromuscular diseases is a major challenge. ActiMyo® is an innovative device that uses magneto-inertial sensors to record angular velocities and linear accelerations that can be used over long periods of time in the home environment. The device was designed to insure long-term stability and good signal to noise ratio, even for very weak movements. In order to determine relevant and pertinent clinical variables with potential for use as outcome measures in clinical trials or to guide therapy decisions, we performed a pilot study in non-ambulant neuromuscular patients. We report here data from seven Duchenne Muscular Dystrophy (DMD) patients (mean age 18.5 ± 5.5 years) collected in a clinical setting. Patients were assessed while wearing the device during performance of validated tasks (MoviPlate, Box and Block test and Minnesota test) and tasks mimicking daily living. The ActiMyo® sensors were placed on the wrists during all the tests. Software designed for use with the device computed several variables to qualify and quantify muscular activity in the non-ambulant subjects. Four variables representative of upper limb activity were studied: the rotation rate, the ratio of the vertical component in the overall acceleration, the hand elevation rate, and an estimate of the power of the upper limb. The correlations between clinical data and physical activity and the ActiMyo® movement parameters were analyzed. The mean of the rotation rate and mean of the elevation rate appeared promising since these variables had the best reliability scores and correlations with task scores. Parameters could be computed even in a patient with a Brooke functional score of 6. The variables chosen are good candidates as potential outcome measures in non-ambulant patients with Duchenne Muscular Dystrophy and use of the ActiMyo® is currently being explored in home environment. Trial Registration

  3. Physician Presence in an Ambulance Car Is Associated with Increased Survival in Out-of-Hospital Cardiac Arrest: A Prospective Cohort Analysis

    PubMed Central

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

    2014-01-01

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

  4. Air pollution.

    PubMed

    Le, Nhu D; Sun, Li; Zidek, James V

    2010-01-01

    Toxic air pollutants are continuously released into the air supply. Various pollutants come from chemical facilities and small businesses, such as automobile service stations and dry cleaning establishments. Others, such as nitrogen oxides, carbon monoxide and other volatile organic chemicals, arise primarily from the incomplete combustion of fossil fuels (coal and petroleum) and are emitted from sources that include car exhausts, home heating and industrial power plants. Pollutants in the atmosphere also result from photochemical transformations; for example, ozone is formed when molecular oxygen or nitrogen interacts with ultraviolet radiation. An association between air pollution exposure and lung cancer has been observed in several studies. The evidence for other cancers is far less conclusive. Estimates of the population attributable risk of cancer has varied substantially over the last 40 years, reflecting the limitations of studies; these include insufficient information on confounders, difficulties in characterizing associations due to a likely lengthy latency interval, and exposure misclassification. Although earlier estimates were less than one percent, recent cohort studies that have taken into account some confounding factors, such as smoking and education amongst others, suggest that approximately 3.6% of lung cancer in the European Union could be due to air pollution exposure, particularly to sulphate and fine particulates. A separate cohort study estimated 5-7% of lung cancers in European never smokers and ex-smokers could be due to air pollution exposure. Therefore, while cigarette smoking remains the predominant risk factor, the proportion of lung cancers attributable to air pollution may be higher than previously thought. Overall, major weaknesses in all air-pollution-and-cancer studies to date have been inadequate characterization of long-term air pollution exposure and imprecise or no measurements of covariates. It has only been in the last

  5. Evaluating Cellular Instrumentation on Rural Handpumps to Improve Service Delivery-A Longitudinal Study in Rural Rwanda.

    PubMed

    Nagel, Corey; Beach, Jack; Iribagiza, Chantal; Thomas, Evan A

    2015-12-15

    In rural sub-Saharan Africa, where handpumps are common, 10-67% are nonfunctional at any one time, and many never get repaired. Increased reliability requires improved monitoring and responsiveness of maintenance providers. In 2014, 181 cellular enabled water pump use sensors were installed in three provinces of Rwanda. In three arms, the nominal maintenance model was compared against a "best practice" circuit rider model, and an "ambulance" service model. In only the ambulance model was the sensor data available to the implementer, and used to dispatch technicians. The study ran for seven months in 2014-2015. In the study period, the nominal maintenance group had a median time to successful repair of approximately 152 days, with a mean per-pump functionality of about 68%. In the circuit rider group, the median time to successful repair was nearly 57 days, with a per-pump functionality mean of nearly 73%. In the ambulance service group, the successful repair interval was nearly 21 days with a functionality mean of nearly 91%. An indicative cost analysis suggests that the cost per functional pump per year is approximately similar between the three models. However, the benefits of reliable water service may justify greater focus on servicing models over installation models.

  6. Ambulation and Parkinson disease.

    PubMed

    Amano, Shinichi; Roemmich, Ryan T; Skinner, Jared W; Hass, Chris J

    2013-05-01

    Parkinson disease is a progressive neurodegenerative disorder characterized by a variety of motor and nonmotor features. This article reviews the problems of postural instability and gait disturbance in persons with Parkinson disease through the discussion of (1) the neuropathology of parkinsonian motor deficits, (2) behavioral manifestations of gait and postural abnormalities observed in persons with Parkinson disease, and (3) pharmacologic, surgical, and physical therapy-based interventions to combat postural instability and gait disturbance. This article advances the treatment of postural instability and gait disturbance by condensing up-to-date knowledge and making it available to clinicians and rehabilitation professionals.

  7. Validity and timeliness of syndromic influenza surveillance during the autumn/winter wave of A (H1N1) influenza 2009: results of emergency medical dispatch, ambulance and emergency department data from three European regions

    PubMed Central

    2013-01-01

    Background Emergency medical service (EMS) data, particularly from the emergency department (ED), is a common source of information for syndromic surveillance. However, the entire EMS chain, consists of both out-of-hospital and in-hospital services. Differences in validity and timeliness across these data sources so far have not been studied. Neither have the differences in validity and timeliness of this data from different European countries. In this paper we examine the validity and timeliness of the entire chain of EMS data sources from three European regions for common syndromic influenza surveillance during the A(H1N1) influenza pandemic in 2009. Methods We gathered local, regional, or national information on influenza-like illness (ILI) or respiratory syndrome from an Austrian Emergency Medical Dispatch Service (EMD-AT), an Austrian and Belgian ambulance services (EP-AT, EP-BE) and from a Belgian and Spanish emergency department (ED-BE, ED-ES). We examined the timeliness of the EMS data in identifying the beginning of the autumn/winter wave of pandemic A(H1N1) influenza as compared to the reference data. Additionally, we determined the sensitivity and specificity of an aberration detection algorithm (Poisson CUSUM) in EMS data sources for detecting the autumn/winter wave of the A(H1N1) influenza pandemic. Results The ED-ES data demonstrated the most favourable validity, followed by the ED-BE data. The beginning of the autumn/winter wave of pandemic A(H1N1) influenza was identified eight days in advance in ED-BE data. The EP data performed stronger in data sets for large catchment areas (EP-BE) and identified the beginning of the autumn/winter wave almost at the same time as the reference data (time lag +2 days). EMD data exhibited timely identification of the autumn/winter wave of A(H1N1) but demonstrated weak validity measures. Conclusions In this study ED data exhibited the most favourable performance in terms of validity and timeliness for syndromic

  8. DEMONSTRATION BULLETIN: SITE CHARACTERIZATION ANALYSIS PENETROMETER SYSTEM (SCAPS) LIF SENSOR - U.S. ARMY, NAVY, AND AIR FORCE (TRI-SERVICES)

    EPA Science Inventory

    The Tri-Services Site Characterization Analysis Penetrometer System (SCAPS) was developed by the U.S. Army (U.S. Army Corps of Engineers, Waterways Experiment Station [WES] and the Army Environmental Center [AEC]), Navy (Naval Command, Control and Ocean Surveillance Center), and ...

  9. Services Supply Chain in the Department of Defense: Comparison and Analysis of Acquisition Management in the Army, Navy, and Air Force

    DTIC Science & Technology

    2010-05-01

    product-based manufacturing models; and Schiele and McCue (2006) studied the acquisition of consulting services in public sector. Although these and...2008). Management of defense acquisition projects. Reston, VA: American Institute of Aeronautics and Astronautics. Schiele , J.J., & McCue, C.P

  10. Air/Water Purification

    NASA Technical Reports Server (NTRS)

    1992-01-01

    After 18 years of research into air/water pollution at Stennis Space Center, Dr. B. C. Wolverton formed his own company, Wolverton Environmental Services, Inc., to provide technology and consultation in air and water treatment. Common houseplants are used to absorb potentially harmful materials from bathrooms and kitchens. The plants are fertilized, air is purified, and wastewater is converted to clean water. More than 100 U.S. communities have adopted Wolverton's earlier water hyacinth and artificial marsh applications. Catfish farmers are currently evaluating the artificial marsh technology as a purification system.

  11. Adaptation and promotion of emergency medical service transportation for climate change.

    PubMed

    Pan, Chih-Long; Chiu, Chun-Wen; Wen, Jet-Chau

    2014-12-01

    The purpose of this study is to find a proper prehospital transportation scenario planning of an emergency medical service (EMS) system for possible burdensome casualties resulting from extreme climate events. This project focuses on one of the worst natural catastrophic events in Taiwan, the 88 Wind-caused Disasters, caused by the Typhoon Morakot; the case of the EMS transportation in the Xiaolin village is reviewed and analyzed. The sequential-conveyance method is designed to promote the efficiency of all the ambulance services related to transportation time and distance. Initially, a proposed mobile emergency medical center (MEMC) is constructed in a safe location near the area of the disaster. The ambulances are classified into 2 categories: the first-line ambulances, which reciprocate between the MEMC and the disaster area to save time and shorten the working distances and the second-line ambulances, which transfer patients in critical condition from the MEMC to the requested hospitals for further treatment. According to the results, the sequential-conveyance method is more efficient than the conventional method for EMS transportation in a mass-casualty incident (MCI). This method improves the time efficiency by 52.15% and the distance efficiency by 56.02%. This case study concentrates on Xiaolin, a mountain village, which was heavily destroyed by a devastating mudslide during the Typhoon Morakot. The sequential-conveyance method for the EMS transportation in this research is not only more advantageous but also more rational in adaptation to climate change. Therefore, the findings are also important to all the decision-making with respect to a promoted EMS transportation, especially in an MCI.

  12. Adaptation and Promotion of Emergency Medical Service Transportation for Climate Change

    PubMed Central

    Pan, Chih-Long; Chiu, Chun-Wen; Wen, Jet-Chau

    2014-01-01

    Abstract The purpose of this study is to find a proper prehospital transportation scenario planning of an emergency medical service (EMS) system for possible burdensome casualties resulting from extreme climate events. This project focuses on one of the worst natural catastrophic events in Taiwan, the 88 Wind-caused Disasters, caused by the Typhoon Morakot; the case of the EMS transportation in the Xiaolin village is reviewed and analyzed. The sequential-conveyance method is designed to promote the efficiency of all the ambulance services related to transportation time and distance. Initially, a proposed mobile emergency medical center (MEMC) is constructed in a safe location near the area of the disaster. The ambulances are classified into 2 categories: the first-line ambulances, which reciprocate between the MEMC and the disaster area to save time and shorten the working distances and the second-line ambulances, which transfer patients in critical condition from the MEMC to the requested hospitals for further treatment. According to the results, the sequential-conveyance method is more efficient than the conventional method for EMS transportation in a mass-casualty incident (MCI). This method improves the time efficiency by 52.15% and the distance efficiency by 56.02%. This case study concentrates on Xiaolin, a mountain village, which was heavily destroyed by a devastating mudslide during the Typhoon Morakot. The sequential-conveyance method for the EMS transportation in this research is not only more advantageous but also more rational in adaptation to climate change. Therefore, the findings are also important to all the decision-making with respect to a promoted EMS transportation, especially in an MCI. PMID:25501065

  13. Effects of London helicopter emergency medical service on survival after trauma.

    PubMed Central

    Nicholl, J. P.; Brazier, J. E.; Snooks, H. A.

    1995-01-01

    OBJECTIVE--To assess the effect of the London helicopter emergency medical service on survival after trauma. DESIGN--Prospective comparison of outcomes in cohorts of seriously injured patients attended by the helicopter and attended by London ambulance service land ambulances crewed by paramedics. SETTING--Greater London. SUBJECTS--337 patients attended by helicopter and 466 patients attended by ambulance who sustained traumatic injuries and died, stayed in hospital three or more nights, or had other evidence of severe injury and who were taken to any one of 20 primary receiving hospitals. MAIN OUTCOME MEASURE--Survival at six months after the incident. RESULTS--After differences in the nature and severity of the injuries in the two cohorts were accounted for the estimated survival rates were the same (relative risk of death with helicopter = 1.0; 95% confidence interval 0.7 to 1.4). An analysis with trauma and injury severity scores (TRISS) found 16% more deaths than predicted in the helicopter cohort but only 2% more in the ambulance cohort. There was no evidence of a difference in survival for patients with head injury but a little evidence that patients with major trauma (injury severity score > or = 16) were more likely to survive if attended by the helicopter. An estimated 13 (-5 to 39) extra patients with major trauma could survive each year if attended by the helicopter. CONCLUSION--Any benefit in survival is restricted to patients with very severe injuries and amounts to an estimated one additional survivor of major trauma each month. Over all the helicopter caseload, however, there is no evidence that it improves the chance of survival in trauma. PMID:7627033

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

    PubMed

    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.

  15. An Agent-Based Model for Analyzing Control Policies and the Dynamic Service-Time Performance of a Capacity-Constrained Air Traffic Management Facility

    NASA Technical Reports Server (NTRS)

    Conway, Sheila R.

    2006-01-01

    Simple agent-based models may be useful for investigating air traffic control strategies as a precursory screening for more costly, higher fidelity simulation. Of concern is the ability of the models to capture the essence of the system and provide insight into system behavior in a timely manner and without breaking the bank. The method is put to the test with the development of a model to address situations where capacity is overburdened and potential for propagation of the resultant delay though later flights is possible via flight dependencies. The resultant model includes primitive representations of principal air traffic system attributes, namely system capacity, demand, airline schedules and strategy, and aircraft capability. It affords a venue to explore their interdependence in a time-dependent, dynamic system simulation. The scope of the research question and the carefully-chosen modeling fidelity did allow for the development of an agent-based model in short order. The model predicted non-linear behavior given certain initial conditions and system control strategies. Additionally, a combination of the model and dimensionless techniques borrowed from fluid systems was demonstrated that can predict the system s dynamic behavior across a wide range of parametric settings.

  16. An Overview of Shiraz Emergency Medical Services, Dispatch to Treatment

    PubMed Central

    Peyravi, Mahmoudreza; Örtenwal, Per; Djalali, Ahmadreza; Khorram-Manesh, Amir

    2013-01-01

    Background Advanced ambulance service (Emergency Medical Services/EMS) is considered to be an integral part of emergency medical care as the first assets responding to emergencies and disasters in the prehospital setting in most developed countries. Objectives The aim of this study was to evaluate the current situation of Shiraz’s EMS by comparing data obtained during two different time periods. Materials and Methods This is a retrospective analytic and comparative study in which data obtained from Shiraz EMS during two one-year periods (21st of March 2011 to 20th of March 2012 and 22nd of September 1999 to 21st of September 2000) were compared. Furthermore, these data were also compared with available data from Gothenburg’s EMS (2010). Results Of 84084 missions performed by Shiraz EMS during one year trauma cases were the most common [39282 (46.7%)]. The most common cause of trauma was road traffic accidents (RTA) (27257; 76.5%). Near 56% of all patients were transported to hospitals; some 47% by ambulances and 8.8% by private cars. Around 36.2% of patients received definitive medical treatment at the scene. While there was an increase in response and evacuation times, the number of deaths at scene before ambulance arrival decreased. Conclusions Although Shiraz’s EMS has expanded during last decade and the mortality rate at scene has decreased, the number of RTA-related trauma cases, along with the response and evacuation time, has increased. More than one third of the patients received definitive treatment and could be dismissed directly from the scene. Standardized triage and treatment protocols are needed to improve the EMS activity. PMID:24616794

  17. 78 FR 50138 - Applications for Certificates of Public Convenience and Necessity and Foreign Air Carrier Permits

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-16

    ... PanAir requesting a foreign air carrier permit to operate charter air transportation of property..., whether or not it constitutes part of a continuous operation that includes service to Panama. PanAir...

  18. 14 CFR Sec. 19-4 - Service classes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... a composite of first class, coach, and mixed passenger/cargo service. The following classifications... performance of nonscheduled aircraft charters, and other air transportation services not constituting...

  19. 14 CFR Sec. 19-4 - Service classes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... a composite of first class, coach, and mixed passenger/cargo service. The following classifications... performance of nonscheduled aircraft charters, and other air transportation services not constituting...

  20. 14 CFR Sec. 19-4 - Service classes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... a composite of first class, coach, and mixed passenger/cargo service. The following classifications... performance of nonscheduled aircraft charters, and other air transportation services not constituting...

  1. 14 CFR Sec. 19-4 - Service classes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... a composite of first class, coach, and mixed passenger/cargo service. The following classifications... performance of nonscheduled aircraft charters, and other air transportation services not constituting...

  2. 32 CFR 1602.17 - Military service.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Military service. 1602.17 Section 1602.17 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.17 Military service. The term military service includes service in the Army, the Navy, the Air...

  3. 32 CFR 1602.17 - Military service.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Military service. 1602.17 Section 1602.17 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.17 Military service. The term military service includes service in the Army, the Navy, the Air...

  4. 32 CFR 1602.17 - Military service.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Military service. 1602.17 Section 1602.17 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.17 Military service. The term military service includes service in the Army, the Navy, the Air...

  5. 32 CFR 1602.17 - Military service.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Military service. 1602.17 Section 1602.17 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.17 Military service. The term military service includes service in the Army, the Navy, the Air...

  6. 32 CFR 1602.17 - Military service.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Military service. 1602.17 Section 1602.17 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.17 Military service. The term military service includes service in the Army, the Navy, the Air...

  7. Apprentice Food Service Specialist (AFSC 62230).

    ERIC Educational Resources Information Center

    Air Univ., Gunter AFS, Ala. Extension Course Inst.

    This two-volume student text is designed for use by Air Force personnel enrolled in a self-study extension course for apprentice food service specialists. Covered in the first volume are fundamentals of food preparation and service (careers in food service, food service sanitation, principles of food preparation and service, and baking…

  8. Section 609 of the Clean Air Act: Motor Vehicle Air Conditioning

    EPA Pesticide Factsheets

    Fact sheet provides a general overview of EPA regulations under Section 609 of the Clean Air Act, which is focused on preventing the release of refrigerants during the servicing of motor vehicle air-conditioning systems and similar appliances.

  9. Medicare, Medicaid, and Children's Health Insurance Programs: announcement of the extended temporary moratoria on enrollment of ambulance suppliers and home health agencies in designated geographic locations. Extension of temporary moratoria.

    PubMed

    2014-08-01

    This document announces the extension of temporary moratoria on the enrollment of new ambulance suppliers and home health agencies (HHAs) in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse.

  10. America's Service Academies, Your Service Academies

    ERIC Educational Resources Information Center

    Born, Dana H.; Phillips, Andrew T.; Trainor, Timothy E.

    2012-01-01

    The United States Air Force Academy, United States Naval Academy, and United States Military Academy are America's three largest service academies. They are "the" primary undergraduate institutions and commissioning sources that educate and develop the officers who are expected to lead this nation's armed forces. They are special places that have…

  11. Southern Nevadas Club Ride Commuter Service Wins EPA Honor

    EPA Pesticide Factsheets

    · Clean Air Partners Program - CLEAN AIR Force of Central Texas · Club Ride Commuter Services - Regional Transportation Commission of Southern Nevada · Air Quality Partnership of the Delaware Valley - Delaware Valley Regional Planning

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

    PubMed Central

    Bloch, Scott A.; Akhavan, Mahsa; Avarello, Jahn

    2013-01-01

    Guillain-Barre syndrome (GBS) is an acquired disease of the peripheral nervous system which causes demyelination and leads to weakness, ataxia, and areflexia. There are a variety of forms of the syndrome, and although it is found in all age groups, it is rare in children less than two years of age. The present complaint of weakness, ataxia, or lower extremity pain in the pediatric population should cause the practitioner to consider GBS in the differential. We describe a case of a 14-month-old girl presenting with weakness and the inability to ambulate who was diagnosed with GBS. The purpose of this paper is to review the emergency medicine diagnosis and management of Guillain-Barre syndrome in children. PMID:23431480

  13. Effects of Ambulant Myofeedback Training and Ergonomic Counselling in Female Computer Workers with Work-Related Neck-Shoulder Complaints: A Randomized Controlled Trial

    PubMed Central

    Sandsjö, Leif; Vollenbroek-Hutten, Miriam M. R.; Larsman, Pernilla; Kadefors, Roland; Hermens, Hermie J.

    2007-01-01

    Objective: To investigate the effects of ambulant myofeedback training including ergonomic counselling (Mfb) and ergonomic counselling alone (EC), on work-related neck-shoulder pain and disability. Methods: Seventy-nine female computer workers reporting neck-shoulder complaints were randomly assigned to Mfb or EC and received four weeks of intervention. Pain intensity in neck, shoulders, and upper back, and pain disability, were measured at baseline, immediately after intervention, and at three and six months follow-up. Results: Pain intensity and disability had significantly decreased immediately after four weeks Mfb or EC, and the effects remained at follow up. No differences were observed between the Mfb and EC group for outcome and subjects in both intervention groups showed comparable chances for improvement in pain intensity and disability. Conclusions: Pain intensity and disability significantly reduced after both interventions and this effect remained at follow-up. No differences were observed between the two intervention groups. PMID:17260162

  14. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

    PubMed Central

    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

  15. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation.

    PubMed

    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.

  16. Effect of the number of request calls on the time from call to hospital arrival: a cross-sectional study of an ambulance record database in Nara prefecture, Japan

    PubMed Central

    Hanaki, Nao; Yamashita, Kazuto; Kunisawa, Susumu; Imanaka, Yuichi

    2016-01-01

    Objectives In Japan, ambulance staff sometimes must make request calls to find hospitals that can accept patients because of an inadequate information sharing system. This study aimed to quantify effects of the number of request calls on the time interval between an emergency call and hospital arrival. Design and setting A cross-sectional study of an ambulance records database in Nara prefecture, Japan. Cases A total of 43 663 patients (50% women; 31.2% aged 80 years and over): (1) transported by ambulance from April 2013 to March 2014, (2) aged 15 years and over, and (3) with suspected major illness. Primary outcome measures The time from call to hospital arrival, defined as the time interval from receipt of an emergency call to ambulance arrival at a hospital. Results The mean time interval from emergency call to hospital arrival was 44.5 min, and the mean number of requests was 1.8. Multilevel linear regression analysis showed that ∼43.8% of variations in transportation times were explained by patient age, sex, season, day of the week, time, category of suspected illness, person calling for the ambulance, emergency status at request call, area and number of request calls. A higher number of request calls was associated with longer time intervals to hospital arrival (addition of 6.3 min per request call; p<0.001). In an analysis dividing areas into three groups, there were differences in transportation time for diseases needing cardiologists, neurologists, neurosurgeons and orthopaedists. Conclusions The study revealed 6.3 additional minutes needed in transportation time for every refusal of a request call, and also revealed disease-specific delays among specific areas. An effective system should be collaboratively established by policymakers and physicians to ensure the rapid identification of an available hospital for patient transportation in order to reduce the time from the initial emergency call to hospital arrival. PMID:27940625

  17. National Air and Space Museum Library.

    ERIC Educational Resources Information Center

    Pietropaoli, Frank A.

    1986-01-01

    A branch of Smithsonian Institution Libraries, the National Air and Space Museum Library provides materials and services to support research programs of National Air and Space Museum. Brief histories of museum and its library and summary of museum programs provide background for overview of current library users, resources, and services.…

  18. 47 CFR 22.807 - General aviation air-ground application requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false General aviation air-ground application... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service General Aviation Air-Ground Stations § 22.807 General aviation air-ground application requirements. In addition to the...

  19. 47 CFR 22.857 - Channel plan for commercial aviation air-ground systems.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 2 2014-10-01 2014-10-01 false Channel plan for commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.857 Channel plan for commercial aviation air-ground systems. The 849-851 MHz and 894-896...

  20. 47 CFR 22.857 - Channel plan for commercial aviation air-ground systems.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Channel plan for commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.857 Channel plan for commercial aviation air-ground systems. The 849-851 MHz and 894-896...