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Sample records for ambulant kontinuerlig registrering

  1. 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

  2. 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…

  3. [Ambulance in emergency medicine].

    PubMed

    Aksoy, Fikret; Ergun, Alper

    2002-07-01

    The ambulance service is very important in emergency medicine. The aim of this study was to investigate the new governing statuate of private ambulance service and to propose some new ideas. We examinated the new governing statuate of private ambulance service, rules of patient transporte between the hospitals and reports written by SSK Goztepe Educational Hospital ambulance drivers. We concluded that SSK Goztepe Educational Hospital ambulance drivers have a iot of problems especially at the rules of patient transport between the hospitals and there are some defiencies at the new governing statuate of private ambulance service. We concluded that it is necesssary to manage all the ambulance services in one center; all the private ambulance services have to have a specialist and all these must be determinated by the special rules. Key words: Regulation ofprivate ambulance, emergency head maintanence, ambulance services

  4. 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.

  5. [Status of Ambulant Geriatrics].

    PubMed

    Kraft, Johannes W

    2017-06-01

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

  6. The carbon footprint of Australian ambulance operations.

    PubMed

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

    2012-12-01

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

  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. 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.

  9. College Student Drinking and Ambulance Utilization

    PubMed Central

    Carey, Kate B.; McClurg, Andrew J.; Bolles, Jamie R.; Hubbell, Suzanne J.; Will, Heather A.; Carey, Michael P.

    2010-01-01

    Objective Alcohol misuse by college students places resource demands on colleges and universities, including the provision of medical services for intoxicated students. We harvested archival data to document the prevalence of alcohol-related ambulance utilization and to explore factors associated with ambulance use. Method We reviewed two years of university ambulance records, and determined which trips were alcohol-related and their demographic, descriptive, and medical correlates. Results Alcohol use was associated with 17% and 16% of all university-based ambulance trips in 2005 and 2006, respectively. When alcohol was involved, patients were more likely to be under 21 years of age, less alert, and more likely to receive advanced life support. Alcohol-related ambulance trips were more likely to occur on weekends, to involve transport from a residence hall, and to a hospital. Conclusion Alcohol misuse is associated with 1 out of every 6 campus-based ambulance runs, a hidden cost of student alcohol misuse. PMID:19823158

  10. Ambulance trends for the '90s.

    PubMed

    1991-01-01

    The changing profile of the EMS professional--with increased access to technology, better education and more experience--has dictated that ambulances, too, evolve along with the profession. How will ambulances change over the next decade? EMS recently asked some of the industry's leading manufacturers for their predictions.

  11. 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…

  12. Hourly associations between heat and ambulance calls.

    PubMed

    Guo, Yuming

    2017-01-01

    The response speed of ambulance calls is very crucial to rescue patients suffering immediately life threatening conditions. The serious health outcomes might be caused by exposing to extreme heat only several hours before. However, limited evidence is available on this topic. This study aims to examine the hourly association between heat and ambulance calls, to improve the ambulance services and to better protect health. Hourly data on ambulance calls for non-accidental causes, temperature and air pollutants (PM10, NO2, and O3) were collected from Brisbane, Australia, during 2001 and 2007. A time-stratified case-crossover design was used to examine the associations between hourly ambulance calls and temperature during warm season (Nov, Dec, Jan, Feb, and Mar), while adjusting for potential confounders. Stratified analyses were performed for sex and age groups. Ambulance calls peaked at 10am for all groups, except those aged <15 years at 19pm, while temperature was hottest at 13pm. The hourly heat-ambulance calls relationships were non-linear for all groups, with thresholds between 27 °C and 31 °C. The associations appeared immediately, and lasted for about 24 h. There were no significant modification effect by sex and age. The findings suggest that hot hourly temperatures (>27 °C) increase the demands of ambulance. This information is helpful to increase the efficiency of ambulance service then save lives, for example, preparing more ambulance before appearance of extremely hot temperature in combination with weather forecast. Also, people should better arrange their time for outdoor activities to avoid exposing to extreme hot temperatures. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Metagenomic characterization of ambulances across the USA.

    PubMed

    O'Hara, Niamh B; Reed, Harry J; Afshinnekoo, Ebrahim; Harvin, Donell; Caplan, Nora; Rosen, Gail; Frye, Brook; Woloszynek, Stephen; Ounit, Rachid; Levy, Shawn; Butler, Erin; Mason, Christopher E

    2017-09-22

    Microbial communities in our built environments have great influence on human health and disease. A variety of built environments have been characterized using a metagenomics-based approach, including some healthcare settings. However, there has been no study to date that has used this approach in pre-hospital settings, such as ambulances, an important first point-of-contact between patients and hospitals. We sequenced 398 samples from 137 ambulances across the USA using shotgun sequencing. We analyzed these data to explore the microbial ecology of ambulances including characterizing microbial community composition, nosocomial pathogens, patterns of diversity, presence of functional pathways and antimicrobial resistance, and potential spatial and environmental factors that may contribute to community composition. We found that the top 10 most abundant species are either common built environment microbes, microbes associated with the human microbiome (e.g., skin), or are species associated with nosocomial infections. We also found widespread evidence of antimicrobial resistance markers (hits ~ 90% samples). We identified six factors that may influence the microbial ecology of ambulances including ambulance surfaces, geographical-related factors (including region, longitude, and latitude), and weather-related factors (including temperature and precipitation). While the vast majority of microbial species classified were beneficial, we also found widespread evidence of species associated with nosocomial infections and antimicrobial resistance markers. This study indicates that metagenomics may be useful to characterize the microbial ecology of pre-hospital ambulance settings and that more rigorous testing and cleaning of ambulances may be warranted.

  14. 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.

  15. 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.

  16. 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.

  17. 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

  18. [Customer orientation in ambulant medicine].

    PubMed

    Heinrich, M

    2014-07-01

    Due to developments of the health market, economic aspects of the health system are more relevant. In this upcoming market the patient is regarded as customer and the doctor as provider of medical services. Studies on customer orientation in the ambulant medicine lag behind this dynamic. An aim of the study is to comprehend the attitudes of the doctors referring to the customer orientation. In a second step the findings are discussed according to statements of health-care paticipants. Developments in role comprehension of doctor and patient are focused to gain results in scientific and practical applications. Guideline-supported, partly narrative interviews with n=9 gynaecologists and n=11 general practitioners in Freiburg/Germany are recorded, transcribed and reviewed in a qualitative analysis. The statements of the doctors show patient satisfaction has an incremental meaning sspecially regarding the sequence of patient relationship and economic management of the doctor's workplace. The doctor's role comprehension meets with a refusal of the role of salesman and the patient as customer. The method of interviews is suitable to gather empirical impressions of the doctors. The control sample is adequate, however a bias due to inhomogeneous thematic affinitiy and local social-demographics might be possible. The customer orientation has become an important factor in doctor-patient relationtships. The relevance of the doctor-patient conversation and the risk of misuse of the patient confidence are mentioned by the doctors. The doctor as paternalistic care provider gives way to the customer-focused service provider. The doctor's necessity of autonomyssss and dependency on patient satisfaction have potential for conflict. Intensive mention of customer orientation in medicine in the media emphasises its importance. Rational handling with the possibilities of individual health markets is a prospective challange. Further research could be established in all aspects of

  19. The air-ambulance: Orkney's experience

    PubMed Central

    Collacott, R. A.

    1984-01-01

    The paramount problem for the delivery of the medical services in the Orkneys has been that of effective transport. The development of an efficient air-ambulance service has had a major impact on medical care. The service started in 1934, but was abolished at the outset of the Second World War and did not recommence until 1967. This paper examines the evolution of the air-ambulance service in the Orkney Islands, and describes alternative proposals for the use of aircraft in this region. PMID:6368814

  20. 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 ...

  1. Current challenges in the provision of ambulance services in New Zealand

    PubMed Central

    2010-01-01

    Emergency Medical Services (EMS) in New Zealand has been serving the society since the first ambulance in 1892. Since then it has developed rapidly following national health system reforms and changes in lifestyle that increase demands and expectations from local communities. Today, the system provides high-quality pre-hospital emergency care. This article will briefly introduce some of the issues facing EMS that will impact the future of this crucial system in New Zealand. These issues include demands because of an aging population funding, double crewing, and volunteerism, registration, and unified standards. PMID:21373286

  2. 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.

  3. 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.

  4. Attributing the responsibility for ambulating patients: a qualitative study.

    PubMed

    Doherty-King, Barbara; Bowers, Barbara J

    2013-09-01

    Functional decline has been identified as a leading negative outcome of hospitalization for older person. Functional decline is defined as a loss in ability to perform activities of daily living including a loss of independent ambulation. In the hospital literature, a patient's loss in ability to independently ambulate during the hospital stay varies between 15 and 59%. Lack of ambulation and deconditioning effects of bed rest are one of the most predictable causes of loss of independent ambulation in hospitalized older persons. Nurses have been identified as the professional most capable of promoting walking independence in the hospital setting. However, nurses do not routinely walk patients. The purpose of this study was to explore the relationship between nurses' attributions of responsibility for ambulating hospitalized patients and their decisions about whether to ambulate. A descriptive, secondary analysis of data gathered for a parent study was conducted. Grounded dimensional analysis was used to analyze the data. Participants consisted of 25 registered nurses employed on medical or surgical units from two urban hospitals in the United States. Nurses fell into two groups: those who claimed ambulation of patients within their responsibility of practice and those who attributed the responsibility to another discipline. Nurses who claimed responsibility for ambulation focused on patient independence and psychosocial well-being. This resulted in actions related to collaborating with physical therapy, determining the appropriateness of activity orders, diminishing the risk and adjusting to resource availability. Nurses who attributed the responsibility deferred decisions about initiating ambulation to either physical therapy or medicine. This resulted in actions related to waiting, which involved, waiting for physical therapy clearance, physician orders, risks to decrease, and resources to improve before ambulating. Nurses who claimed responsibility for

  5. Ambulance Crash in a Rural Area of Thailand.

    PubMed

    Pattanarattanamolee, Ratrawee; Lertsinudom, Somkid; Nakahara, Shinji; Sakamoto, Tetsuya

    2017-10-05

    Ambulance crashes delay patient transfer and endanger patients, ambulance crews, and other road users. In low- and middle-income countries, where motor vehicle crash rates are typically high, ambulances have a high risk of being involved in a crash. This case report describes an ambulance crash in Thailand to elucidate modifiable problems in current protocols and practices of emergency medical services. In November 2016, a 28-year-old male driver of an ambulance died in a crash while transferring a female patient with dizziness to a rural hospital. The driver and another ambulance crew member were sitting in the front seats unrestrained. The other occupants were in the patient compartment unrestrained. The driver was driving the ambulance within the speed limit. He made a sharp turn trying to evade a dog, and the ambulance crashed head-on into a roadside tree. The cabin sustained severe damage, and the occupants in the patient compartment were struck against the compartment wall and were struck by unsecured equipment and the stretcher. The driver sustained a severe brain injury. The other occupants, including the female patient, sustained minor injuries. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case raises safety issues concerning the following aspects of ambulance operations in low- and middle-income countries: speed limit, safety device use, seatbelt use, securing equipment, and vehicle safety standards. Systematic measures to change protocols or even legislation, as well as data collection, are required to address these issues. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. 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.

  7. 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

  8. 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.

  9. 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

  10. 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…

  11. Emergency Department Overcrowding and Ambulance Turnaround Time.

    PubMed

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

    2015-01-01

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

  12. 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.

  13. Gait component changes observed during independent ambulation in young children.

    PubMed

    Sala, Debra A; Cohen, Efrat

    2013-05-01

    The components of gait of the new independent ambulator can differ from that of the more experienced ambulator. The purposes of this review were to describe observable gait components exhibited at the onset of independent ambulation, the progression of changes in these components, and the time when a more mature pattern should be present consistently. Cross-sectional, longitudinal and single-recording studies, which analyzed children's gait at the onset of independent ambulation and followed changes in the components, were reviewed. Only components that can be observed by clinicians were included. The changes were reported as a function of time after independent ambulation onset or chronological age. The gait components evolved from (1) initial contact with toes, footflat or heel to consistent heel strike 1 y after independent ambulation onset or by 2.5 y of age, (2) a wide base of support to a narrower one 11 mo after independent ambulation onset or by 22 mo of age, and (3) upper extremities held in high guard position to reciprocal arm swing 11 mo after independent ambulation onset or by 3.5 y of age. Other components, such as the maintenance of squatted position and trunk flexion, were studied less extensively, but general descriptions are included. This review provides the length of time after independent ambulation onset or chronological age when the more mature form of a gait component should be present. The continued exhibition of a less mature form beyond these times may be indicative of a pathological gait pattern.

  14. 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.

  15. Geographic-time distribution of ambulance calls in Singapore: utility of geographic information system in ambulance deployment (CARE 3).

    PubMed

    Ong, Marcus E H; Ng, Faith S P; Overton, Jerry; Yap, Susan; Andresen, Derek; Yong, David K L; Lim, Swee Han; Anantharaman, V

    2009-03-01

    Pre-hospital ambulance calls are not random events, but occur in patterns and trends that are related to movement patterns of people, as well as the geographical epidemiology of the population. This study describes the geographic-time epidemiology of ambulance calls in a large urban city and conducts a time demand analysis. This will facilitate a Systems Status Plan for the deployment of ambulances based on the most cost effective deployment strategy. An observational prospective study looking at the geographic-time epidemiology of all ambulance calls in Singapore. Locations of ambulance calls were spot mapped using Geographic Information Systems (GIS) technology. Ambulance response times were mapped and a demand analysis conducted by postal districts. Between 1 January 2006 and 31 May 2006, 31,896 patients were enrolled into the study. Mean age of patients was 51.6 years (S.D. 23.0) with 60.0% male. Race distribution was 62.5% Chinese, 19.4% Malay, 12.9% Indian and 5.2% others. Trauma consisted 31.2% of calls and medical 68.8%. 9.7% of cases were priority 1 (most severe) and 70.1% priority 2 (moderate severity). Mean call receipt to arrival at scene was 8.0 min (S.D. 4.8). Call volumes in the day were almost twice those at night, with the most calls on Mondays. We found a definite geographical distribution pattern with heavier call volumes in the suburban town centres in the Eastern and Southern part of the country. We characterised the top 35 districts with the highest call volumes by time periods, which will form the basis for ambulance deployment plans. We found a definite geographical distribution pattern of ambulance calls. This study demonstrates the utility of GIS with despatch demand analysis and has implications for maximising the effectiveness of ambulance deployment.

  16. 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...

  17. 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...

  18. 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

  19. 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.

  20. The impact of ambulance diversion on heart attack deaths.

    PubMed

    Yankovic, Natalia; Glied, Sherry; Green, Linda V; Grams, Morgan

    2010-01-01

    Hospital ambulance diversions are prevalent and increasing nationwide as emergency departments experience growing congestion. Using negative binomial regressions, this paper links the number of acute myocardial infarction (AMI) deaths to the level and extent of diversion in the five boroughs of New York City. The results indicate that both high levels of ambulance diversion and simultaneous diversion across hospitals are associated with increasing numbers of deaths from AMI.

  1. 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.

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

    PubMed

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

    2016-06-01

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

  3. WHEELCHAIR PROPULSION DEMANDS DURING OUTDOOR COMMUNITY AMBULATION

    PubMed Central

    Hurd, Wendy J.; Morrow, Melissa M. B.; Kaufman, Kenton R.; An, Kai-Nan

    2009-01-01

    Objective Quantify manual wheelchair propulsion effort during outdoor community ambulation. Design Case series Subjects Thirteen individuals (12 with SCI, 1 with spina bifida) who were experienced manual wheelchair users and had no current upper extremity injury or pain complaints. Methods Measurements were obtained from instrumented wheelchair rims during steady-state propulsion as subjects traversed outdoor concrete sidewalk terrain that included smooth level, aggregate level, and a ramp with a smooth surface. Propulsion effort was assessed using the average propulsion moment, average instantaneous power, and work for both upper extremities. Results Propulsion effort, captured by the propulsion moment, work and power, varied across ground conditions (p<0.001). Propulsion effort was greater as the rolling resistance increased (ie., smooth versus aggregate surfaces) and as the inclination angle progressed from level to inclined surfaces. There were no side-to-side differences across ground conditions for the propulsion moment or work. Power generation was significantly greater on the dominant compared to the non-dominant extremity during the more challenging aggregate surface and ramp conditions. Conclusions Propulsion effort varies with demands imposed by different ground conditions. Quantification of wheelchair propulsion demands provides rehabilitations specialists with objective information to guide treatment of patients adapting to manual wheelchair use. PMID:18590967

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-06-01

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

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

    PubMed

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

    1995-11-01

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

  7. 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

  8. Weight Bearing Asymmetry and Functional Ambulation Performance in Stroke Survivors

    PubMed Central

    Adegoke, B. O. A.; Olaniyi, O.; Akosile, C. O.

    2012-01-01

    This study evaluated asymmetry of weight bearing on the lower limbs and the association between percentage weight bearing asymmetry (PWBA) and functional ambulation performance in ambulant stroke survivors. Participants were 53 stroke survivors (male = 35, female = 18) aged 40-86 years (mean=58.87; SD=9.21years) with hemiparesis. Weight bearing through the lower limbs in standing was assessed by two juxtaposed bathroom weighing scales while functional ambulation performance was evaluated with the Emory Functional Ambulation Profile (E-FAP). Data were summarized with mean and standard deviation and further analyzed using the Pearson product moment correlation at 0.05 alpha level. Participants bore 60.3% (SD =7.1%) of their body weights on the unaffected legs and had a mean PWBA of 20.8 % (SD=14.7%). There was a significant positive correlation (r = 0.675, p < 0.0001) between PWBA and total E-FAP scores of participants. PWBA could hence be used to monitor functional ambulation recovery in stroke survivors. PMID:22980155

  9. Agreement between ambulance nurses and physicians in assessing stroke patients.

    PubMed

    Blomberg, H; Lundström, E; Toss, H; Gedeborg, R; Johansson, J

    2014-01-01

    If an ambulance nurse could bypass the emergency department (ED) and bring suspected stroke patients directly to a CT scanner, time to thrombolysis could be shortened. This study evaluates the level of agreement between ambulance nurses and emergency physicians in assessing the need for a CT scan, and interventions and monitoring beforehand, in patients with suspected stroke and/or a lowered level of consciousness. From October 2008 to June 2009, we compared the ambulance nurses' and ED physicians' judgement of 200 patients with stroke symptoms. Both groups answered identical questions on patients' need for a CT scan, and interventions and monitoring beforehand. There was poor agreement between ambulance nurses and ED physicians in judging the need for a CT scan: κ = 0.22 (95% confidence interval (CI), 0.06-0.37). The nurses' ability to select the same patients as the physician for a CT scan had a sensitivity of 84% (95% CI, 77-89) and a specificity of 37% (95% CI, 23-53). Agreement concerning the need for interventions and monitoring was also low: κ = 0.32 (95% CI, 0.18-0.47). In 18% of cases, the nurses considered interventions before a CT scan unnecessary when the physicians' deemed them necessary. Additional tools to support ambulance nurses decisions appear to be required before suspected stroke patients can be taken directly to a CT scanner. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Registration Review Process

    EPA Pesticide Factsheets

    EPA will review each registered pesticide at least every 15 years to determine whether it continues to meet the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) standard for registration. There are currently 745 registration review cases.

  11. Pesticide Registration Information System

    EPA Pesticide Factsheets

    PRISM provides an integrated, web portal for all pesticide related data, communications, registrations and transactions for OPP and its stakeholders, partners and customers. PRISM supports Strategic Goal 4 by automating pesticide registration processes.

  12. Initial emergency medical dispatching and prehospital needs assessment: a prospective study of the Swedish ambulance service.

    PubMed

    Hjälte, Lena; Suserud, Björn-Ove; Herlitz, Johan; Karlberg, Ingvar

    2007-06-01

    To evaluate the setting of priorities and patients' need for the ambulance service. A prospective, consecutive study was conducted during a 6-week period. The ambulance staff completed a questionnaire assessing each patient's need for prehospital care. In addition to the questionnaire, data were extracted from the ambulance medical records for each case. The study included 1977 ambulance assignments. The results show that there is a substantial safety margin in the priority assessments made by the emergency medical dispatch operators, where the ambulance staff support the safety margin for initial priorities, despite the lack of at-the-scene confirmation. At-the-scene assessments indicated that 10% of all patients had potentially life-threatening conditions or no signs of life, but the advanced life support units were not systematically involved in these serious cases. The results even showed that one-third of the patients for whom an ambulance was assigned did not need the ambulance service according to the assessment made by the ambulance staff. Using the criteria-based dispatch protocol, the personnel at the emergency medical dispatch centres work with a safety margin in their priority assessments for ambulance response. Generally, this 'overtriage' and safety margin for initial priority settings were supported as appropriate by the ambulance staff. According to the judgement of the ambulance staff, one-third of all the patients who were assigned an ambulance response did not require ambulance transport.

  13. 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.

  14. 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.

  15. 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.

  16. Recovery of ambulation in motor-incomplete tetraplegia.

    PubMed

    Burns, S P; Golding, D G; Rolle, W A; Graziani, V; Ditunno, J F

    1997-11-01

    To determine the effect of age and initial neurologic status on recovery of ambulation in patients with motor-incomplete tetraplegia. Inception cohort study. Urban, tertiary care hospital with Regional Spinal Cord Injury Center. One hundred five patients with American Spinal Injury Association (ASIA) C or D tetraplegia at admission or within 72 hours of injury. Ambulatory status at time of discharge from inpatient rehabilitation. Ninety-one percent (30/33) of ASIA C patients younger than 50 years of age became ambulatory by discharge, versus 42% (13/31) ASIA C patients age 50 or older (p < .0001). All (41/41) patients initially classified as ASIA D became ambulatory by discharge. For patients with ASIA D tetraplegia, prognosis for recovery of independent ambulation is excellent. For patients with ASIA C tetraplegia, recovery of ambulation is significantly less likely if age is 50 years or older.

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

    PubMed

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

    2013-06-06

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

  18. Undergraduate Cross Registration.

    ERIC Educational Resources Information Center

    Grupe, Fritz H.

    This report discusses various aspects of undergraduate cross-registration procedures, including the dimensions, values, roles and functions, basic assumptions, and facilitating and encouragment of cross-registration. Dimensions of cross-registration encompass financial exchange, eligibility, program limitations, type of grade and credit; extent of…

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... inflation factor for ambulance services. (b) 2003 Payment. For services furnished in CY 2003, payment is... inflation factor for ambulance services. (c) 2004 Payment. For services furnished in CY 2004, payment is... inflation factor for ambulance services. (d) 2005 Payment. For services furnished in CY 2005, payment...

  1. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... physician, a signed certification statement must be obtained from either the physician assistant (PA), nurse... one or more volunteer ambulance services that meet the following conditions: (i) Are certified to... intercept supplier that meets the following conditions: (i) Is certified to furnish ALS services as required...

  2. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... statement must be obtained from either the physician assistant (PA), nurse practitioner (NP), clinical nurse... one or more volunteer ambulance services that meet the following conditions: (i) Are certified to... intercept supplier that meets the following conditions: (i) Is certified to furnish ALS services as required...

  3. 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. Copyright © 2014 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

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

    PubMed

    Bohström, Dan; Carlström, Eric; Sjöström, Nils

    2017-05-01

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

  5. 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...

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

    PubMed

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

    2015-01-01

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

  7. 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

  8. 29 CFR 553.215 - Ambulance and rescue service employees.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 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 fire protection or law enforcement agency may be treated as employees engaged in fire protection or law...

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

    PubMed

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

    2013-01-01

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

  10. 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.

  11. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Requirements for ambulance suppliers. 410.41 Section 410.41 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services...

  12. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Requirements for ambulance suppliers. 410.41 Section 410.41 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services...

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

    PubMed

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

    2016-08-01

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

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

    PubMed

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

    2016-04-01

    Management of pain in the pre-hospital setting is often inadequate. In 2011, ambulance personnel were authorized to administer intravenous fentanyl in the Central Denmark Region. The aim of this study was to evaluate the efficacy and safety of intravenous fentanyl administered by ambulance personnel. Pre-hospital medical charts from 2348 adults treated with intravenous fentanyl by ambulance personnel during a 6-month period were reviewed. The primary outcome was the change in pain intensity on a numeric rating scale (NRS) from before fentanyl treatment to hospital arrival. Secondary outcomes included the number of patients with reduction in pain intensity during transport (NRS ≥ 2), the number of patients with NRS > 3 at hospital arrival, and potential fentanyl-related side effects. Fentanyl reduced pain from before treatment (8, IQR 7-9) to hospital arrival (4, IQR 3-6) (NRS reduction: 3, IQR 2-5; P = 0.001), 79.3% of all patients had a reduction in > 2 on the NRS during transport, and 58.4% of patients experienced pain at hospital arrival (NRS > 3). Twenty-one patients (0.9%) had oxygen saturation < 90%. A decrease in Glasgow Coma Scale was seen in 31 patients (1.3%) and hypotension observed in 71 patients (3.0%). Intravenous fentanyl caused clinically meaningful pain reduction in most patients and was safe in the hands of ambulance personnel. Many patients had moderate to severe pain at hospital arrival. As the protocol allowed higher doses of fentanyl, feedback on effect and safety should be part of continuous education of ambulance personnel. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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

    PubMed Central

    Yperzeele, Laetitia; Van Hooff, Robbert-Jan; De Smedt, Ann; Valenzuela Espinoza, Alexis; Van Dyck, Rita; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; Lauwaert, Door; De Keyser, Jacques; Brouns, Raf

    2014-01-01

    Background Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third generation. Methods A routine ambulance was equipped with a system for real-time bidirectional audio-video communication, automated transmission of vital parameters, glycemia and electronic patient identification. All patients ( ≥18 years) transported during emergency missions by a Prehospital Intervention Team of the Universitair Ziekenhuis Brussel were eligible for inclusion. To guarantee mobility and to facilitate 24/7 availability, the teleconsultants used lightweight laptop computers to access a dedicated telemedicine platform, which also provided functionalities for neurological assessment, electronic reporting and prehospital notification of the in-hospital team. Key registrations included any safety issue, mobile connectivity, communication of patient information, audiovisual quality, user-friendliness and accuracy of the prehospital diagnosis. Results Prehospital teleconsultation was obtained in 41 out of 43 cases (95.3%). The success rates for communication of blood pressure, heart rate, blood oxygen saturation, glycemia, and electronic patient identification were 78.7%, 84.8%, 80.6%, 64.0%, and 84.2%. A preliminary prehospital diagnosis was formulated in 90.2%, with satisfactory agreement with final in-hospital diagnoses. Communication of a prehospital report to the in-hospital team was successful in 94.7% and prenotification of the in-hospital team via SMS in 90.2%. Failures resulted mainly from limited mobile connectivity and to a lesser extent from software, hardware or human error. The user acceptance was high. Conclusions Ambulance-based telemedicine of the third generation is safe, feasible and reliable but further research and development, especially

  16. Feasibility of AmbulanCe-Based Telemedicine (FACT) study: safety, feasibility and reliability of third generation in-ambulance telemedicine.

    PubMed

    Yperzeele, Laetitia; Van Hooff, Robbert-Jan; De Smedt, Ann; Valenzuela Espinoza, Alexis; Van Dyck, Rita; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; Lauwaert, Door; De Keyser, Jacques; Brouns, Raf

    2014-01-01

    Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third generation. A routine ambulance was equipped with a system for real-time bidirectional audio-video communication, automated transmission of vital parameters, glycemia and electronic patient identification. All patients ( ≥ 18 years) transported during emergency missions by a Prehospital Intervention Team of the Universitair Ziekenhuis Brussel were eligible for inclusion. To guarantee mobility and to facilitate 24/7 availability, the teleconsultants used lightweight laptop computers to access a dedicated telemedicine platform, which also provided functionalities for neurological assessment, electronic reporting and prehospital notification of the in-hospital team. Key registrations included any safety issue, mobile connectivity, communication of patient information, audiovisual quality, user-friendliness and accuracy of the prehospital diagnosis. Prehospital teleconsultation was obtained in 41 out of 43 cases (95.3%). The success rates for communication of blood pressure, heart rate, blood oxygen saturation, glycemia, and electronic patient identification were 78.7%, 84.8%, 80.6%, 64.0%, and 84.2%. A preliminary prehospital diagnosis was formulated in 90.2%, with satisfactory agreement with final in-hospital diagnoses. Communication of a prehospital report to the in-hospital team was successful in 94.7% and prenotification of the in-hospital team via SMS in 90.2%. Failures resulted mainly from limited mobile connectivity and to a lesser extent from software, hardware or human error. The user acceptance was high. Ambulance-based telemedicine of the third generation is safe, feasible and reliable but further research and development, especially with regard to high speed broadband

  17. Image Registration Workshop Proceedings

    NASA Technical Reports Server (NTRS)

    LeMoigne, Jacqueline (Editor)

    1997-01-01

    Automatic image registration has often been considered as a preliminary step for higher-level processing, such as object recognition or data fusion. But with the unprecedented amounts of data which are being and will continue to be generated by newly developed sensors, the very topic of automatic image registration has become and important research topic. This workshop presents a collection of very high quality work which has been grouped in four main areas: (1) theoretical aspects of image registration; (2) applications to satellite imagery; (3) applications to medical imagery; and (4) image registration for computer vision research.

  18. 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…

  19. 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…

  20. Decompression sickness during simulated extravehicular activity: ambulation vs. non-ambulation.

    PubMed

    Webb, James T; Beckstrand, Devin P; Pilmanis, Andrew A; Balldin, Ulf I

    2005-08-01

    Extravehicular activity (EVA) is required from the International Space Station on a regular basis. Because of the weightless environment during EVA, physical activity is performed using mostly upper-body movements since the lower body is anchored for stability. The adynamic model (restricted lower-body activity; non-ambulation) was designed to simulate this environment during earthbound studies of decompression sickness (DCS) risk. DCS symptoms during ambulatory (walking) and non-ambulatory high altitude exposure activity were compared. The objective was to determine if symptom incidences during ambulatory and non-ambulatory exposures are comparable and provide analogous estimates of risk under otherwise identical conditions. A retrospective analysis was accomplished on DCS symptoms from 2010 ambulatory and 330 non-ambulatory exposures. There was no significant difference between the overall incidence of DCS or joint-pain DCS in the ambulatory (49% and 40%) vs. the non-ambulatory exposures (53% and 36%; p > 0.1). DCS involving joint pain only in the lower body was higher during ambulatory exposures (28%) than non-ambulatory exposures (18%; p < 0.01). Non-ambulatory exposures terminated more frequently with non-joint-pain DCS (17%) or upper-body-only joint pain (18%) as compared with ambulatory exposures, 9% and 11% (p < 0.01), respectively. These findings show that lower-body, weight-bearing activity shifts the incidence of joint-pain DCS from the upper body to the lower body without altering the total incidence of DCS or joint-pain DCS. Use of data from previous and future subject exposures involving ambulatory activity while decompressed appears to be a valid analogue of non-ambulatory activity in determining DCS risk during simulated EVA studies.

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

    NASA Astrophysics Data System (ADS)

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

    2017-04-01

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

  2. Accuracy of cancer registration.

    PubMed Central

    West, R R

    1976-01-01

    In South Wales cancer registration is done principally by means of the Hospital Activity Analysis. Altogether 1460 hospital records of cancer patients (19% of the 1972 registrations received by May 1973) were studied and the principal items of information required for cancer registrations by the Office of Population Censuses and Surveys were copied and subsequently compared with the corresponding registrations at the Welsh Hospital Board's cancer bureau. Differences between these 're-registrations' and the original registrations were analysed item by item. There were 234 registrations with errors in the diagnostic summary (although 110 of these would cause misclassification only under the fourth digit of the ICD code), 164 with errors in date of birth (36 of which would cause classification in the wrong WHO age group) and 198 with errors in the date of registration (112 of which were wrongly ascribed to the year 1972). Error and omission rates were particularly high for NHS number, occupation, place of birth, and histology. PMID:974439

  3. Weather inference and daily demand for emergency ambulance services.

    PubMed

    Wong, H T; Lai, P C

    2012-01-01

    To examine weather effects on the daily demand for ambulance services in Hong Kong. Over 6 million cases of emergency attendance from May 2006 through April 2009 (3 years) were obtained from the Hospital Authority in Hong Kong. These cases were further stratified by age, triage levels, hospital admission status, comprehensive social security assistance (CSSA) recipients and gender. The stratification was used to correlate against weather factors to assess the dependency of these variables and their effects on the daily number of ambulance calls. Adjusted-R(2) values obtained from the regression analysis were used as a measure for evaluating predictability. The adjusted-R(2) of emergency cases by age groups showed proportional correlation with weather factors, which was more significant in older patients (0.76, p<0.01) than young patients (0.10, p<0.05). Furthermore, patients with more severe conditions were shown to have a higher adjusted-R(2) (0.63, p<0.05 for critical as opposed to 0 for non-urgent patients). Weather effects were also found more significant in women (0.50, p<0.01) and CSSA recipients (0.54, p<0.01) when compared against their corresponding reference groups (respectively men at 0.46, p<0.01 and non-CSSA recipients at 0.45, p<0.01). Moreover, average temperature appeared to be a major weather effect. The presence of strong weather effects among different target groups indicates possibility for the development of a short-term forecast system of daily ambulance demand using weather variables. The availability of such a forecast system would render more effective deployment of the ambulance services to meet the unexpected increase in service demands.

  4. 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.

  5. 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

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

    PubMed

    Muecke, Sandy; Curac, Nada; Binks, Darryn

    2013-12-01

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

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

    PubMed Central

    Phillips, Sherwin E.; Gaskin, Pamela S.; Byer, David; Cadogan, W. L.; Brathwaite, Andrew; Nielsen, Anders L.

    2012-01-01

    Objectives. There are no published studies on the Barbados Emergency Ambulance Service and no assessment of the calls that end in nontransported individuals. We describe reasons for the nontransport of potential clients. Methods. We used the Emergency Medical Dispatch (Medical Priority Dispatch System) instrument, augmented with five local call types, to collect information on types of calls. The calls were categorised under 7 headings. Correlations between call types and response time were calculated. Results. Most calls were from the category medical (54%). Nineteen (19%) percent of calls were in the non-transported category. Calls from call type Cancelled accounted for most of these and this was related to response time, while Refused service was inversely related (P = 0.01). Conclusions. The Barbados Ambulance Service is mostly used by people with a known illness and for trauma cases. One-fifth of calls fall into a category where the ambulance is not used often due to cancellation which is related to response time. Other factors such as the use of alternative transport are also important. Further study to identify factors that contribute to the non-transported category of calls is necessary if improvements in service quality are to be made. PMID:23198147

  8. Changes in cardiac output during air ambulance repatriation.

    PubMed

    Malagon, I; Grounds, R M; Bennett, E D

    1996-12-01

    To measure, with the use of suprasternal Doppler ultrasound, the hemodynamic changes in patients and volunteers during air ambulance repatriation. Unblinded prospective observational study. Chartered air ambulances for the international repatriation of patients. Six medical crew members and seven patients transported back to hospitals in the UK. The measurement of non-invasive blood pressure, ECG, heart rate, oxygen saturation and hemodynamic variables with suprasternal Doppler. There was a drop in systolic and mean arterial blood pressure in the patient's group once in the air. Oxygen saturation dropped in both groups once at cruising altitude. Heart rate remained unchanged. Stroke distance and minute distance increased significantly in the patient's group and non-significantly in the volunteers. Peak velocity increased significantly in the patient's group. There was an overall reduction of systemic vascular resistance during take off and once at cruising altitude. Hemodynamic changes happen during air ambulance transportation in fit and healthy volunteers and patients alike. These may be due to a combination of hypobaric hypoxia and gravitational forces. It is necessary to establish if these changes have short- or long-term effects in the critically ill.

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

    PubMed Central

    Doyle, Joseph; Graves, John; Gruber, Jonathan

    2014-01-01

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

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

    PubMed

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

    2016-02-01

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

  11. Advanced training in trauma life support for ambulance crews.

    PubMed

    Jayaraman, Sudha; Sethi, Dinesh; Wong, Roger

    2014-08-21

    There is an increasing global burden of injury especially in low- and middle-income countries (LMICs). To address this, models of trauma care initially developed in high income countries are being adopted in LMIC settings. In particular, ambulance crews with advanced life support (ALS) training are being promoted in LMICs as a strategy for improving outcomes for victims of trauma. However, there is controversy as to the effectiveness of this health service intervention and the evidence has yet to be rigorously appraised. To quantify the impact of ALS-trained ambulance crews versus crews without ALS training on reducing mortality and morbidity in trauma patients. The search for studies was run on the 16th May 2014. We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), Embase Classic+Embase (Ovid), ISI WOS (SCI-EXPANDED, SSCI, CPCI-S & CPSI-SSH), CINAHL Plus (EBSCO), PubMed and screened reference lists. Randomised controlled trials, controlled trials and non-randomised studies, including before-and-after studies and interrupted time series studies, comparing the impact of ALS-trained ambulance crews versus crews without ALS training on the reduction of mortality and morbidity in trauma patients. Two review authors assessed study reports against the inclusion criteria, and extracted data. We found one controlled before-and-after trial, one uncontrolled before-and-after study, and one randomised controlled trial that met the inclusion criteria. None demonstrated evidence to support ALS training for pre-hospital personnel. In the uncontrolled before-and-after study, 'a priori' sub-group analysis showed an increase in mortality among patients who had a Glasgow Coma Scale score of less than nine and received care from ALS trained ambulance crews. Additionally

  12. Ambulation gains after knee surgery in children with arthrogryposis.

    PubMed

    Yang, Stephen Su; Dahan-Oliel, Noémi; Montpetit, Kathleen; Hamdy, Reggie C

    2010-12-01

    Arthrogryposis multiplex congenita is a rare congenital disorder associated with multiple musculoskeletal contractures that causes substantial morbidity. Knee involvement is commonly seen among children with arthrogryposis, with flexion contracture of the knee being the most frequent knee deformity. Knee flexion contractures in the pediatric population are particularly debilitating as they affect ambulation. Treatment for knee flexion contractures requires numerous orthopaedic procedures and an extensive follow-up period. The purpose of this study was to assess the effectiveness of orthopaedic procedures, namely distal femoral supracondylar extension osteotomy and/or Ilizarov external fixator, on the ambulation status of children with knee flexion contracture and whether any functional gains are maintained at the latest follow-up. All children with arthrogryposis followed at our institution who had surgical correction for knee flexion contractures were included in this study. Fourteen patients were identified and their medical records were reviewed. The etiology for all patients was amyoplasia. The mean age at first surgery was 7.0 years (range, 2 to 16 y). The mean length of follow-up was 59.3 months (range, 12 to 117 mo). Contractures were treated with femoral extension osteotomy (n=8), Ilizarov external fixator (n=1), or both (n=5). Three patients earlier had posterior soft tissue releases, including hamstrings lengthenings, proximal gastrocnemius release, and release of posterior capsule. Preoperatively, 11 patients were nonambulatory, 2 patients were household ambulators, and 1 patient walked with orthoses in the community. There was an average of 1.8 knee surgeries done per patient, namely distal femoral extension osteotomy and/or Ilizarov external fixator. At the latest follow-up, 8 patients were ambulatory with technical aids (orthosis, walker, braces, or rollator walker), 2 patients were household ambulators, 1 patient used a wheelchair but was independent

  13. 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

  14. Effects of isokinetic training on the rate of movement during ambulation in hemiparetic patients.

    PubMed

    Glasser, L

    1986-05-01

    The purpose of this study was to determine the effects of isokinetic training on the rate of movement during ambulation in hemiparetic patients. Ten male and 10 female subjects, aged 40 to 75 years, participated in the study. The 20 hemiparetic subjects were assigned randomly to either a control group or an experimental group. All of the subjects participated in a conventional therapeutic exercise program and gait training. The experimental group also received isokinetic training on the Kinetron exercise machine as part of their program. Functional ambulation profile tests were administered to each subject before and after the five-week experimental period. All of the subjects showed improvement in the rate of ambulation and in overall ambulation performance. The differences in ambulation times and functional ambulation profile scores between the two groups were shown to be insignificant.

  15. Active registration models

    NASA Astrophysics Data System (ADS)

    Marstal, Kasper; Klein, Stefan

    2017-02-01

    We present the Active Registration Model (ARM) that couples medical image registration with regularization using a statistical model of intensity. Inspired by Active Appearance Models (AAMs), the statistical model is embedded in the registration procedure as a regularization term that penalize differences between a target image and a synthesized model reconstruction of that image. We demonstrate that the method generalizes AAMs to 3D images, many different transformation models, and many different gradient descent optimization methods. The method is validated on magnetic resonance images of human brains.

  16. Interventions for improving community ambulation in individuals with stroke.

    PubMed

    Barclay, Ruth E; Stevenson, Ted J; Poluha, William; Ripat, Jacquie; Nett, Cristabel; Srikesavan, Cynthia S

    2015-03-13

    Community ambulation refers to the ability of a person to walk in their own community, outside of their home and also indoors in private or public locations. Some people choose to walk for exercise or leisure and may walk with others as an important aspect of social functioning. Community ambulation is therefore an important skill for stroke survivors living in the community whose walking ability has been affected. To determine: (1) whether interventions improve community ambulation for stroke survivors, and (2) if any specific intervention method improves community ambulation more than other interventions. We searched the Cochrane Stroke Group Trials Register (September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (November 2013), PubMed (1946 to November 2013), EMBASE (1980 to November 2013), CINAHL (1982 to November 2013), PsycINFO (1887 to November 2013), Scopus (1960 to November 2013), Web of Science (1900 to November 2013), SPORTDiscus (1975 to November 2013), and PEDro, CIRRIE and REHABDATA (November 2013). We also searched ongoing trials registers (November 2013) and reference lists, and performed a cited reference search. Selection criteria included parallel-group randomised controlled trials (RCTs) and cross-over RCTs, studies in which participants are adult (aged 18 years or more) stroke survivors, and interventions that were aimed at improving community ambulation. We defined the primary outcome as participation; secondary outcomes included activity level outcomes related to gait and self-efficacy. One review author independently screened titles. Two review authors screened abstracts and full text articles, with a third review author was available to resolve any disagreements. Two review authors extracted data and assessed risk of bias. All outcomes were continuous. The analysis for the primary outcome used the generic inverse variance methods for meta-analysis, using the standardised mean difference (SMD) and standard error (SE

  17. Registration Review Schedules

    EPA Pesticide Factsheets

    This schedule indicates plans for completion of risk assessments, proposed interim decisions and interim decisions for pesticides in the Registration Review program, EPA reviews all registered pesticides at least every 15 years as required by FIFRA.

  18. CSPP CDX Registration Guide

    EPA Pesticide Factsheets

    CDX allows users submitting data to the EPA to register for the specific program of interest. This Guide describes the registration process and information requirements associated with Submissions for the Chemical Safety and Pesticide Programs (CSPP).

  19. Lesson 6: Registration

    EPA Pesticide Factsheets

    Lesson 6 provides checklist items 1 through 4 are grouped under the Registration Process, where users establish their accounts in the system. This process typically requires users to provide information about them.

  20. Registration of Enlist Duo

    EPA Pesticide Factsheets

    EPA is proposing to amend the registration of Enlist Duo to allow use on GE cotton in the original 15 states and extend the use of Enlist Duo on GE corn, soybean and cotton to an additional 19 states.

  1. 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

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

    PubMed

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

    2011-06-01

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

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

    PubMed

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

    2014-07-01

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

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

    PubMed

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

    2012-01-01

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

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

    PubMed Central

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

    2012-01-01

    Background. Time from acute stroke to enrolment in clinical trials needs to be reduced to improve the chances of finding effective treatments. No completed randomised controlled trials of ambulance-based treatment for acute stroke have been reported in the UK, and the practicalities of recruiting, consenting, and treating patients are unknown. Methods. RIGHT is an ambulance based, single-blind, randomised controlled trial with blinded-outcome assessment. The trial will assess feasibility of using ambulance services to deliver ultra-acute stroke treatments; a secondary aim is to assess the effect of glyceryl trinitrate (GTN) on haemodynamic variables and functional outcomes. Initial consent, randomisation, and treatment are performed by paramedics prior to hospitalisation. Patients with ultra-acute stroke (≤4 hours of onset) are randomised to transdermal GTN (5 mg/24 hours) or gauze dressing daily for 7 days. The primary outcome is systolic blood pressure at 2 hours. Secondary outcomes include feasibility, haemodynamics, dependency, and other functional outcomes. A nested qualitative study is included. Trial Status. The trial has all relevant ethics and regulatory approvals and recruitment started on February 15, 2010. The trial stopped recruitment in December 2011 after 41 patients were recruited. Trial Registration. The trial registration number is ISRCTN66434824 and EudraCT number is 2007-004766-40. PMID:23125943

  6. 21 CFR 710.8 - Misbranding by reference to registration or to registration number.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... HUMAN SERVICES (CONTINUED) COSMETICS VOLUNTARY REGISTRATION OF COSMETIC PRODUCT ESTABLISHMENTS § 710.8 Misbranding by reference to registration or to registration number. Registration of a cosmetic product...

  7. 21 CFR 710.8 - Misbranding by reference to registration or to registration number.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... HUMAN SERVICES (CONTINUED) COSMETICS VOLUNTARY REGISTRATION OF COSMETIC PRODUCT ESTABLISHMENTS § 710.8 Misbranding by reference to registration or to registration number. Registration of a cosmetic product...

  8. 21 CFR 710.8 - Misbranding by reference to registration or to registration number.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HUMAN SERVICES (CONTINUED) COSMETICS VOLUNTARY REGISTRATION OF COSMETIC PRODUCT ESTABLISHMENTS § 710.8 Misbranding by reference to registration or to registration number. Registration of a cosmetic product...

  9. 21 CFR 710.8 - Misbranding by reference to registration or to registration number.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... HUMAN SERVICES (CONTINUED) COSMETICS VOLUNTARY REGISTRATION OF COSMETIC PRODUCT ESTABLISHMENTS § 710.8 Misbranding by reference to registration or to registration number. Registration of a cosmetic product...

  10. 21 CFR 710.8 - Misbranding by reference to registration or to registration number.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HUMAN SERVICES (CONTINUED) COSMETICS VOLUNTARY REGISTRATION OF COSMETIC PRODUCT ESTABLISHMENTS § 710.8 Misbranding by reference to registration or to registration number. Registration of a cosmetic product...

  11. 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.

  12. User Registration in EOSDIS

    NASA Astrophysics Data System (ADS)

    Murphy, K. J.; Mitchell, A. E.

    2009-12-01

    Throughout the lifetime of EOSDIS the topic of user registration has received varied attention. Initially, for example, users ordering data from the Earth Science Data Gateway were required to register for delivery of media orders, to check order status and save profile information for future interactions. As EOSDIS embraced evolution of its data systems, the mostly centralized search and order system was replaced with a more diverse set of interfaces allowing (mostly) anonymous online access to data, tools and services. The changes to EOSDIS were embraced by users but the anonymous nature of the interaction made it more difficult to characterize users, capture metrics and provide customized services that benefit users. Additionally, new tools and interfaces have been developed without a centralized registration system. Currently a patchwork of independent registration systems exists throughout EOSDIS for ordering data and interacting with online tools and services. Each requires a separate username and password that must be managed by users. A consolidation of registration systems presents an opportunity to improve not only the user experience through tool customization and simplification of password management, but the understanding of users. This work discusses the options for implementing a common user registration for the EOSDIS, anticipated benefits and pitfalls.

  13. 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.

  14. Stability of diazepam rectal gel in ambulance-like environments.

    PubMed

    Alldredge, Brian K; Venteicher, Robert; Calderwood, Thomas S

    2002-03-01

    The objective of the present study was to evaluate the stability of diazepam rectal gel (Diastat) in various conditions of temperature and light exposure as might be found in ambulances. Three lots of Diastat (Xcel Pharmaceuticals, San Diego, CA) in various fill/syringe configurations were evaluated in controlled conditions of a freeze-thaw cycle, hard freeze (-30 degrees C for 72 hours), extreme light exposure (1,000 ft candles for 1 month), and long-term evaluation at either 30 degrees C or 40 degrees C. In the various configurations and tests, diazepam concentration always exceeded 95% of label, with no changes of note in excipients or physicochemical properties. The estimated shelf-life at 30 degrees C exceeds 48 months. Based on the results of the present study, the restocking frequency of Diastat in ambient storage conditions (eg, ambulances), could be up to 48 months in nonfreezing environments, as long as this does not exceed the labeled expiration date on the product. Copyright 2002, Elsevier Science (USA). All rights reserved.)

  15. 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.

  16. 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

    ...This proposed rule addresses air ambulance and commercial helicopter operations, part 91 helicopter operations, and load manifest requirements for all part 135 aircraft. From 2002 to 2008, there has been an increase in fatal helicopter air ambulance accidents. To address these safety concerns, the FAA is proposing to implement operational procedures and require additional equipment on board......

  17. 42 CFR 414.620 - Publication of the ambulance fee schedule.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Section 414.620 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedule for Ambulance Services § 414.620 Publication of the ambulance fee schedule. Changes in payment rates resulting...

  18. An Evaluation of Ambulance Services at the Naval Regional Medical Center, Charleston, South Carolina.

    DTIC Science & Technology

    1980-08-01

    appropriate configuration for the ambulance program which balances medical benefits, J customer expectations, and available recources . This section...ambulance resources for this area at the Medical Center will result in greater efficiency of capital investment, and conservation of scarce human

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

    NASA Astrophysics Data System (ADS)

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

    2017-04-01

    Ambulances are an integral part of a country's infrastructure ensuring its citizens and visitors are kept healthy. The impact of weather, climate and climate change on ambulance services around the world has received increasing attention in recent years but most studies have been area specific and there is a need to establish basic relationships between ambulance data (both response and illness data) and meteorological parameters. In this presentation, the effects of temperature, other meteorological and air pollution variables on ambulance call out rates for different medical categories will be investigated. We use ambulance call out obtained from various ambulance services worldwide which have significantly different meteorologies, climatologies and pollution conditions. A time-series analysis is utilized to understand the relation between meteorological conditions, air pollutants and different call out categories. We will present findings that support the opinion that ambulance attendance call outs records are an effective and well-timed source of data and can be used for health early warning systems. Furthermore the presented results can much improve our understanding of the relationships between meteorology, climate, air pollution and human health thereby allowing for better prediction of ambulance use through the application of long and short-term weather, climate and pollution forecasts.

  20. Denial of ambulance reimbursement: can reviewers determine what is an emergency?

    PubMed

    Hauswald, Mark; Jambrosic, Mike

    2004-01-01

    Use of ambulances for nonemergency and routine transportation is thought to be a serious and growing problem. Third-party payers frequently refuse payment when ambulance use is deemed inappropriate. The authors attempted to determine whether cases in which ambulance transport was denied were done appropriately. Consecutive ambulance run forms of transports in which payment was denied by the state Medicaid carriers and corresponding emergency department (ED) charts were reviewed. Medical risk was evaluated by using the Evaluation and Management (E&M) Level of Care for the ED visit. Appropriateness of ambulance transport was evaluated by extracting the final diagnosis and the most serious written (and worked up) diagnosis in the differential. If either diagnosis could benefit from treatment in an ambulance or by rapid transport to a hospital, the transport was defined as appropriate. A total of 146 run forms and 104 corresponding charts were evaluated. Ambulance transport was appropriate in 63 (61%; 95% confidence interval, 51%-70%). Risk was minimal for two transports, low for two, moderate for 62, and high for 38 cases. Final diagnoses included several life-threatening ones. In this population of patients for whom payment of their ambulance bill was denied, a high percentage of corresponding ED visits were for potentially serious medical problems.

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

    PubMed Central

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

    2011-01-01

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

  2. 14 CFR 47.15 - Registration number.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Registration number. 47.15 Section 47.15... REGISTRATION General § 47.15 Registration number. (a) Number required. An applicant for aircraft registration must place a U.S. registration number (registration mark) on the Aircraft Registration Application, AC...

  3. 14 CFR 47.15 - Registration number.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Registration number. 47.15 Section 47.15... REGISTRATION General § 47.15 Registration number. (a) Number required. An applicant for aircraft registration must place a U.S. registration number (registration mark) on the Aircraft Registration Application, AC...

  4. 14 CFR 47.15 - Registration number.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Registration number. 47.15 Section 47.15... REGISTRATION General § 47.15 Registration number. (a) Number required. An applicant for aircraft registration must place a U.S. registration number (registration mark) on the Aircraft Registration Application,...

  5. 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

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

    PubMed

    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

  7. 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

  8. Image registration by parts

    NASA Technical Reports Server (NTRS)

    Chalermwat, Prachya; El-Ghazawi, Tarek; LeMoigne, Jacqueline

    1997-01-01

    In spite of the large number of different image registration techniques, most of these techniques use the correlation operation to match spatial image characteristics. Correlation is known to be one of the most computationally intensive operations and its computational needs grow rapidly with the increase in the image sizes. In this article, we show that, in many cases, it might be sufficient to determine image transformations by considering only one or several parts of the image rather than the entire image, which could result in substantial computational savings. This paper introduces the concept of registration by parts and investigates its viability. It describes alternative techniques for such image registration by parts and presents early empirical results that address the underlying trade-offs.

  9. Analysis of subpixel registration

    NASA Technical Reports Server (NTRS)

    Berenstein, C. A.; Kanal, L. N.; Lavine, D.; Olson, E. C.; Slud, E.

    1984-01-01

    The area of subpixel accuracy in image registration and edge detection was studied. Two main directions of research were pursued, edge detection and matching based on the digital geometry of edges, and random field models for probablistic analysis of registration error. In the edge detection approach, error bounds and error probabilities were computed using theoretical models. Algorithms were developed and tests on simulated imagery. The methods appear promising for high accuracy edge position estimation and registration, though further refinement of the procedures is required. Using random field models, a statistical measure of the quality of the cross correlation peak as an estimate of the offset between a sensed and a reference image was developed. Simulations were performed to determine the validity of this estimte with real imagery and to study the results of interpolating digital correlation functions to estimate the translation offset to subpixel accuracy.

  10. Towards operational multisensor registration

    NASA Technical Reports Server (NTRS)

    Rignot, Eric J. M.; Kwok, Ronald; Curlander, John C.

    1991-01-01

    To use data from a number of different remote sensors in a synergistic manner, a multidimensional analysis of the data is necessary. However, prior to this analysis, processing to correct for the systematic geometric distortion characteristic of each sensor is required. Furthermore, the registration process must be fully automated to handle a large volume of data and high data rates. A conceptual approach towards an operational multisensor registration algorithm is presented. The performance requirements of the algorithm are first formulated given the spatially, temporally, and spectrally varying factors that influence the image characteristics and the science requirements of various applications. Several registration techniques that fit within the structure of this algorithm are also presented. Their performance was evaluated using a multisensor test data set assembled from LANDSAT TM, SEASAT, SIR-B, Thermal Infrared Multispectral Scanner (TIMS), and SPOT sensors.

  11. 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.

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

    PubMed Central

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

    2008-01-01

    Background To estimate the prevalence of anxiety and depression symptoms, and their association with professional help-seeking, among operational ambulance personnel and a general working population, and to study the symptoms of musculoskeletal pain and disturbed sleep among ambulance personnel. Methods The results of a comprehensive nationwide questionnaire survey of operational ambulance personnel (n = 1180) were compared with the findings of a population-based Norwegian health study of working people (n = 31,987). The questionnaire included measures of help-seeking, the Hospital Anxiety and Depression Scale, the Subjective Health Complaints Questionnaire, the Karolinska Sleep Questionnaire and the Need for Recovery after Work Scale. Results Compared with those in the reference population, the mean of level anxiety symptoms in the ambulance sample was lower for men (3.5 vs. 3.9, P <0.001) and women (4.0 vs. 4.4, P <0.05), and the mean level of depression symptoms in ambulance workers was lower for men (2.3 vs. 2.8, P <0.05) but not for women (2.9 vs. 3.1, P = 0.22). A model adjusted for anxiety and depression symptoms indicated that ambulance personnel had lower levels of help-seeking except for seeing a chiropractor (12% vs. 5%, P <0.01). In the ambulance sample, symptoms of musculoskeletal pain were most consistently associated with help-seeking. In the adjusted model, only symptoms of disturbed sleep were associated with help-seeking from a psychologist/psychiatrist (total sample = 2.3%). Help-seeking was more often reported by women but was largely unaffected by age. Conclusion The assumption that ambulance personnel have more anxiety and depression symptoms than the general working population was not supported. The level of musculoskeletal pain and, accordingly, the level of help-seeking from a chiropractor were higher for ambulance workers. More research should address the physical strains among ambulance personnel. PMID:18177497

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

    PubMed

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

    2014-02-01

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

  14. Earth Science Imagery Registration

    NASA Technical Reports Server (NTRS)

    LeMoigne, Jacqueline; Morisette, Jeffrey; Cole-Rhodes, Arlene; Johnson, Kisha; Netanyahu, Nathan S.; Eastman, Roger; Stone, Harold; Zavorin, Ilya

    2003-01-01

    The study of global environmental changes involves the comparison, fusion, and integration of multiple types of remotely-sensed data at various temporal, radiometric, and spatial resolutions. Results of this integration may be utilized for global change analysis, as well as for the validation of new instruments or for new data analysis. Furthermore, future multiple satellite missions will include many different sensors carried on separate platforms, and the amount of remote sensing data to be combined is increasing tremendously. For all of these applications, the first required step is fast and automatic image registration, and as this need for automating registration techniques is being recognized, it becomes necessary to survey all the registration methods which may be applicable to Earth and space science problems and to evaluate their performances on a large variety of existing remote sensing data as well as on simulated data of soon-to-be-flown instruments. In this paper we present one of the first steps toward such an exhaustive quantitative evaluation. First, the different components of image registration algorithms are reviewed, and different choices for each of these components are described. Then, the results of the evaluation of the corresponding algorithms combining these components are presented o n several datasets. The algorithms are based on gray levels or wavelet features and compute rigid transformations (including scale, rotation, and shifts). Test datasets include synthetic data as well as data acquired over several EOS Land Validation Core Sites with the IKONOS and the Landsat-7 sensors.

  15. Registration Priorities: A Report.

    ERIC Educational Resources Information Center

    Walters, Judy E.

    In May 1993, the California Community Colleges' Board of Governors adopted systemwide guidelines recommending student registration priorities to help address current discrepancies between available resources and courses and the colleges' open-door mission. This report describes the guidelines and results of a study conducted to determine their…

  16. Distributed Continuous Registration.

    ERIC Educational Resources Information Center

    Myers, Donald L.

    1981-01-01

    The development, implementation, and features of Northern Colorado's continuous registration system are described. The system is an online distributed processing system, written in COBOL for an IBM Series I under the CPS operating system. Course selection, permit to enroll, and drop/add forms are provided. (Author/MLW)

  17. Distributed Continuous Registration.

    ERIC Educational Resources Information Center

    Myers, Donald L.

    1981-01-01

    The development, implementation, and features of Northern Colorado's continuous registration system are described. The system is an online distributed processing system, written in COBOL for an IBM Series I under the CPS operating system. Course selection, permit to enroll, and drop/add forms are provided. (Author/MLW)

  18. Registration Study. Research Note.

    ERIC Educational Resources Information Center

    Baratta, Mary Kathryne

    During spring 1977 registration, 3,255 or 45% of Moraine Valley Community College (MVCC) registering students responded to a scheduling preferences and problems questionnaire covering enrollment status, curriculum load, program preference, ability to obtain courses, schedule conflicts, preferred times for class offerings, actual scheduling of…

  19. CUNY's Voter Registration System.

    ERIC Educational Resources Information Center

    Hershenson, Jay; And Others

    This collection of items including public testimony by the Vice Chancellor, Jay Hershenson, a formal resolution, a press release, and brochures, documents the City University of New York's (CUNY) unique voter registration system, "CUNY Project Vote". As the press release describes it, Project Vote is the nation's largest student voter…

  20. Suspension of Registrations under FIFRA

    EPA Pesticide Factsheets

    Under FIFRA Section 3(c)(2)(B), this generally halts further distribution and sale of the suspended pesticide product by the registrant. Find suspension listings by product name, active ingredient, registrant name, date, and contact information.

  1. 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

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

    PubMed

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

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

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

    PubMed

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

    2014-01-01

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

  4. The hidden KPI registration accuracy.

    PubMed

    Shorrosh, Paul

    2011-09-01

    Determining the registration accuracy rate is fundamental to improving revenue cycle key performance indicators. A registration quality assurance (QA) process allows errors to be corrected before bills are sent and helps registrars learn from their mistakes. Tools are available to help patient access staff who perform registration QA manually.

  5. Off-Campus Registration Procedures.

    ERIC Educational Resources Information Center

    Maas, Michael L.

    Registration is one of the more critical functions that a college staff encounters each semester. To have a smooth, efficient, college-wide registration, it is essential that all segments of the college be aware of registration procedures as well as data control operations. This packet was designed to acquaint interested parties with the…

  6. Registration Documents for Enlist Duo Herbicide (2014)

    EPA Pesticide Factsheets

    See details of the registration of Enlist Duo in 2014, including the notification to the registrant, the details of the assessment and registration decision, and the response to public comment on the proposed registration.

  7. [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.

  8. The linkage among ambulance transports, death and climate parameters in Asahikawa City, Japan.

    PubMed

    Kataoka, Hiroaki; Mochimasu, Kazumi Dokai; Katayama, Akihiko; Kanda, Kanae Oda; Sakano, Noriko; Tanaka, Keiko; Miyatake, Nobuyuki

    2015-01-01

    The aim of this study was to investigate the linkage among climate parameters, total ambulance transports and the number of deaths in Asahikawa City in northern Japan. Monthly data on total ambulance transports and the number of deaths from January 2004 to December 2011 were obtained from Asahikawa City Fire Department and the Asahikawa City official website. Climate parameters for the required period were also obtained from the Japan Meteorological Agency, Japan. To adjust for the population, we also used monthly population data on Asahikawa City. The linkage among climate parameters, total ambulance transports and the number of deaths was evaluated by ecological analysis. The mean air temperature in the Asahikawa area was 7.3 ± 10.1 °C. Total ambulance transports (/a hundred thousand people/day) and the number of deaths (/a hundred thousand people/day) were 10.0 ± 0.6 and 2.6 ± 0.3, respectively. Using quadratic curves, total ambulance transports and the number of deaths were weakly correlated with some climate parameters. The number of deaths was weakly and positively correlated with total ambulance transports. A weak linkage among climate parameters, total ambulance transports and the number of deaths was noted in Asahikawa City, Japan. However, these associations were not as high as expected.

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

    PubMed

    Durham, Mark; Faulkner, Mark; Deakin, Charles

    2016-12-01

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

  10. Ambulance calls to suspected overdoses: New South Wales patterns July 1997 to June 1999.

    PubMed

    Degenhardt, L; Hall, W; Adelstein, B A

    2001-10-01

    Using data on New South Wales ambulance calls to suspected overdoses from July 1997 to June 1999 to: a) examine temporal and geographic trends in calls; and b) compare geographic patterns of fatal and non-fatal opioid overdose. The NSW Ambulance Service provided data on the occasions when an ambulance attended a person on whom the drug overdose/poisonings protocol was used, and to whom naloxone was administered. The geographic distribution of ambulance attendances was approximated to the Australian Bureau of Statistics Statistical Local Area (SLA) and Statistical Subdivision (SSD). Estimates of social disadvantage were correlated with the rate of ambulance attendances for each region. 9,116 callouts were made. In cases with data on age and gender, 89% were aged 15-44 years, and 31% were female. South Sydney (n=1,819) and Liverpool (n=1,602) SLAs accounted for 37% of calls; the higher rates outside Sydney were in Newcastle, Orange and Kiama. There was a strong correlation between rates of ambulance callouts and fatal heroin overdoses. The number of calls increased from an average of 361 calls per month in 1997-98 to 399 in 1998-99. The majority of calls (54%) were made between midday and 9 pm. Rates of ambulance attendance at suspected overdoses is a promising indicator that allows monitoring of trends and identification of areas with high rates of opioid use.

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

    PubMed

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

    2014-07-01

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

  12. 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

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

    PubMed

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

    2008-11-01

    Oxygen is widely used but poorly studied in emergency medicine, with a limited evidence base for its use in specific conditions. There are safety concerns about the underuse of oxygen in patients with critical illness and its overuse in conditions such as chronic obstructive pulmonary disease (COPD). A baseline audit was required to assess current practice prior to the introduction of new national emergency oxygen guidelines in late 2008. The use of pulse oximetry and oxygen therapy was audited in patients brought by ambulance to the "majors" section of the emergency department (ED) in a university hospital. Oxygen therapy in the ambulance and the ED was subsequently documented. Oxygen use in ambulances was compared with Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidance and with subsequent patient management. The ambulance and ED records of 1022 patients were audited manually. Oxygen saturation (SpO(2)) was recorded for 90% of patients, 17% of whom had SpO(2) <94% at some time and 7% had SpO(2) <90%, including 33% of patients with COPD and 5.5% of patients without COPD. 34% of patients received oxygen in the ambulance and almost half of these had oxygen discontinued in the ED. Only 62% of ambulance oxygen use was in accordance with JRCALC guidance, but most "undertreated" patients were stable normoxaemic patients for whom guidance recommends high-flow oxygen. Only 58% of patients with COPD were correctly identified in the ambulance and 73% of these patients were treated with flow rates >4 l/min (equivalent to >35% oxygen). Oxygen use in ambulances is very common, equivalent to 2.2 million episodes annually in the UK. The quality of oxygen use is suboptimal, especially for patients with COPD. Emergency oxygen therapy will become simpler when new evidence-based UK emergency oxygen guidelines are published, and it is hoped that future audits will show better protocol adherence.

  14. 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.

  15. An evaluation of pre-hospital communication between ambulances and an accident and emergency department.

    PubMed

    Rowlands, Andrew

    2003-01-01

    We studied pre-hospital notification and the quality of data received from ambulance crews transporting seriously ill or injured patients to an accident and emergency department. During a two-month study period, pre-hospital notification was received for 54 patients. However, the department was notified about only 25 of 62 patients (40%) who, on arrival by ambulance, were triaged as emergencies. Despite developing a data protocol for emergency pre-hospital communication and being equipped to receive emergency ambulance calls directly, many such patients still arrived either unannounced or described in insufficient detail to allow appropriate preparations to be made for them.

  16. PROFESSIONAL REGISTRATION OF GOVERNMENT ENGINEERS.

    USGS Publications Warehouse

    Buchanan, Thomas J.

    1985-01-01

    The American Society of Civil Engineers views professional registration as an appropriate requirement for engineers, including those in government. The National Society of Professional Engineers makes registration a requirement for the grade of member and full privileges in the society. Some Federal agencies require engineering registration for certain positions in their agencies. Engineers in government service should consider the value of engineering registration to themselves and to their agencies and take pride in their professions and in their own capabilities by becoming registered engineers. They should also take steps to encourage their agencies to give more attention to engineering registration.

  17. Image registration with uncertainty analysis

    DOEpatents

    Simonson, Katherine M [Cedar Crest, NM

    2011-03-22

    In an image registration method, edges are detected in a first image and a second image. A percentage of edge pixels in a subset of the second image that are also edges in the first image shifted by a translation is calculated. A best registration point is calculated based on a maximum percentage of edges matched. In a predefined search region, all registration points other than the best registration point are identified that are not significantly worse than the best registration point according to a predetermined statistical criterion.

  18. 14 CFR 47.43 - Invalid registration.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Invalid registration. 47.43 Section 47.43... REGISTRATION Certificates of Aircraft Registration § 47.43 Invalid registration. (a) The registration of an...) compliance with 49 U.S.C. 44101-44104. (b) If the registration of an aircraft is invalid under paragraph...

  19. 32 CFR 1615.1 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Registration. 1615.1 Section 1615.1 National... REGISTRATION § 1615.1 Registration. (a) Registration under selective service law consists of: (1) Completing a registration card or other method of registration prescribed by the Director of Selective Service by a...

  20. 32 CFR 1615.1 - Registration.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Registration. 1615.1 Section 1615.1 National... REGISTRATION § 1615.1 Registration. (a) Registration under selective service law consists of: (1) Completing a registration card or other method of registration prescribed by the Director of Selective Service by a...

  1. 14 CFR 47.43 - Invalid registration.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Invalid registration. 47.43 Section 47.43... REGISTRATION Certificates of Aircraft Registration § 47.43 Invalid registration. (a) The registration of an...) compliance with 49 U.S.C. 44101-44104. (b) If the registration of an aircraft is invalid under paragraph...

  2. 14 CFR 47.43 - Invalid registration.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Invalid registration. 47.43 Section 47.43... REGISTRATION Certificates of Aircraft Registration § 47.43 Invalid registration. (a) The registration of an...) compliance with 49 U.S.C. 44101-44104. (b) If the registration of an aircraft is invalid under paragraph...

  3. 32 CFR 1615.1 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Registration. 1615.1 Section 1615.1 National... REGISTRATION § 1615.1 Registration. (a) Registration under selective service law consists of: (1) Completing a registration card or other method of registration prescribed by the Director of Selective Service by a...

  4. 32 CFR 1615.1 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Registration. 1615.1 Section 1615.1 National... REGISTRATION § 1615.1 Registration. (a) Registration under selective service law consists of: (1) Completing a registration card or other method of registration prescribed by the Director of Selective Service by a...

  5. Asymmetric Image-Template Registration

    PubMed Central

    Sabuncu, Mert R.; Yeo, B.T. Thomas; Van Leemput, Koen; Vercauteren, Tom; Golland, Polina

    2010-01-01

    A natural requirement in pairwise image registration is that the resulting deformation is independent of the order of the images. This constraint is typically achieved via a symmetric cost function and has been shown to reduce the effects of local optima. Consequently, symmetric registration has been successfully applied to pairwise image registration as well as the spatial alignment of individual images with a template. However, recent work has shown that the relationship between an image and a template is fundamentally asymmetric. In this paper, we develop a method that reconciles the practical advantages of symmetric registration with the asymmetric nature of image-template registration by adding a simple correction factor to the symmetric cost function. We instantiate our model within a log-domain diffeomorphic registration framework. Our experiments show exploiting the asymmetry in image-template registration improves alignment in the image coordinates. PMID:20426033

  6. Spacecraft camera image registration

    NASA Technical Reports Server (NTRS)

    Kamel, Ahmed A. (Inventor); Graul, Donald W. (Inventor); Chan, Fred N. T. (Inventor); Gamble, Donald W. (Inventor)

    1987-01-01

    A system for achieving spacecraft camera (1, 2) image registration comprises a portion external to the spacecraft and an image motion compensation system (IMCS) portion onboard the spacecraft. Within the IMCS, a computer (38) calculates an image registration compensation signal (60) which is sent to the scan control loops (84, 88, 94, 98) of the onboard cameras (1, 2). At the location external to the spacecraft, the long-term orbital and attitude perturbations on the spacecraft are modeled. Coefficients (K, A) from this model are periodically sent to the onboard computer (38) by means of a command unit (39). The coefficients (K, A) take into account observations of stars and landmarks made by the spacecraft cameras (1, 2) themselves. The computer (38) takes as inputs the updated coefficients (K, A) plus synchronization information indicating the mirror position (AZ, EL) of each of the spacecraft cameras (1, 2), operating mode, and starting and stopping status of the scan lines generated by these cameras (1, 2), and generates in response thereto the image registration compensation signal (60). The sources of periodic thermal errors on the spacecraft are discussed. The system is checked by calculating measurement residuals, the difference between the landmark and star locations predicted at the external location and the landmark and star locations as measured by the spacecraft cameras (1, 2).

  7. Articulated registration: elastic registration based on a wire-model

    NASA Astrophysics Data System (ADS)

    Martin-Fernandez, Miguel A.; Munyoz-Moreno, Emma; Martin-Fernandez, Marcos; Alberola-Lopez, Carlos

    2005-04-01

    In this paper we propose a new method of elastic registration of anatomical structures that bears an inner skeleton, such as the knee, hand or spine. Such a method has to deal with great degrees of variability, specially for the case of inter-subject registration; but even for the intra-subject case the degree of variability of images will be large since the structures we bear in mind are articulated. Rigid registration methods are clearly inappropriate for this problem, and well-known elastic methods do not usually incorporate the restriction of maintaining long skeletal structures straight. A new method is therefore needed to deal with such a situation; we call this new method "articulated registration". The inner bone skeleton is modeled with a wire model, where wires are drawn by connecting landmarks located in the main joints of the skeletal structure to be registered (long bones). The main feature of our registration method is that within the bone axis (specifically, where the wires are) an exact registration is guaranteed, while for the remaining image points an elastic registration is carried out based on a distance transform (with respect to the model wires); this causes the registration on long bones to be affine to all practical purposes, while the registration of soft tissue -- far from the bones -- is elastic. As a proof-of-concept of this method we describe the registration of hands on radiographs.

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

    PubMed

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

    2005-06-01

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

  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. Placental Mesenchymal Stromal Cells Rescue Ambulation in Ovine Myelomeningocele

    PubMed Central

    Brown, Erin G.; Lankford, Lee; Keller, Benjamin A.; Pivetti, Christopher D.; Sitkin, Nicole A.; Beattie, Michael S.; Bresnahan, Jacqueline C.; Farmer, Diana L.

    2015-01-01

    applied fetal lamb model of MMC. Treatment with human PMSCs significantly and dramatically improved neurologic function and preserved spinal cord neuron density in experimental animals. Sixty-seven percent of the PMSC-treated lambs were able to ambulate independently, with two exhibiting no motor deficits whatsoever. In contrast, none of the lambs treated with the vehicle alone were capable of ambulation. The locomotor rescue demonstrated in PMSC-treated lambs indicates great promise for future clinical trials to improve paralysis in children afflicted with MMC. PMID:25911465

  11. 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.

  12. Complexity, fractal dynamics and determinism in treadmill ambulation: Implications for clinical biomechanists.

    PubMed

    Hollman, John H; Watkins, Molly K; Imhoff, Angela C; Braun, Carly E; Akervik, Kristen A; Ness, Debra K

    2016-08-01

    Reduced inter-stride complexity during ambulation may represent a pathologic state. Evidence is emerging that treadmill training for rehabilitative purposes may constrain the locomotor system and alter gait dynamics in a way that mimics pathological states. The purpose of this study was to examine the dynamical system components of gait complexity, fractal dynamics and determinism during treadmill ambulation. Twenty healthy participants aged 23.8 (1.2) years walked at preferred walking speeds for 6min on a motorized treadmill and overground while wearing APDM 6 Opal inertial monitors. Stride times, stride lengths and peak sagittal plane trunk velocities were measured. Mean values and estimates of complexity, fractal dynamics and determinism were calculated for each parameter. Data were compared between overground and treadmill walking conditions. Mean values for each gait parameter were statistically equivalent between overground and treadmill ambulation (P>0.05). Through nonlinear analyses, however, we found that complexity in stride time signals (P<0.001), and long-range correlations in stride time and stride length signals (P=0.005 and P=0.024, respectively), were reduced on the treadmill. Treadmill ambulation induces more predictable inter-stride time dynamics and constrains fluctuations in stride times and stride lengths, which may alter feedback from destabilizing perturbations normally experienced by the locomotor control system during overground ambulation. Treadmill ambulation, therefore, may provide less opportunity for experiencing the adaptability necessary to successfully ambulate overground. Investigators and clinicians should be aware that treadmill ambulation will alter dynamic gait characteristics. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    PubMed

    Byran, Eyal; Gilad, Issachar

    2012-01-01

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

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

    PubMed

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

    2013-08-01

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

  15. Ambulation of people with lower-limb amputations: relationship between capacity and performance measures.

    PubMed

    Parker, Kim; Kirby, R Lee; Adderson, James; Thompson, Kara

    2010-04-01

    To examine the relationship between measures of ambulation capacity obtained in a clinical setting and measures of ambulation performance in the community, and to explore what demographic and clinical variables influence ambulation performance in people with lower-limb amputations. A cross-sectional, correlational and descriptive study. Rehabilitation center and participants' homes and community environments. Community-dwelling people (N=52) with lower-limb amputations at the unilateral transfemoral (n=16), unilateral transtibial (n=30), and bilateral transtibial (n=6) levels. All had been fit with prostheses for over 1 year. Not applicable. Measures of ambulation capacity were the Locomotor Capabilities Index version 5, the 2-Minute Walk Test (2MWT), and the Timed Up and Go Test. Measures of ambulation performance included a commercially available step activity monitor (SAM; steps per day, minutes active per day, peak activity index) and self-reported performance with the Activity Restriction subscales of the Trinity Amputation and Prosthesis Experience Scales (TAPES). Most relationships among capacity and performance measures were in the moderate to high range (Spearman correlation coefficients, rho=.41-.78, P<.05). The highest correlation coefficient was between the 2MWT and SAM peak activity index (rho=.78, P=.000). A multivariate analysis found the 2MWT was significantly related to increased performance as measured by SAM mean steps per day (P=.026) and TAPES (P=.016). Depressive symptoms were also a significant predictor (P=.003) of decreased performance (TAPES). The 2MWT, a measure of ambulation capacity, correlates well with most SAM measures of ambulation performance. Exploratory regression analysis indicated that the 2MWT is related to ambulation performance, while depression is only related to self-reported performance. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Call selection for the Helicopter Emergency Medical Service: implications for ambulance control.

    PubMed Central

    Coats, T J; Newton, A

    1994-01-01

    The increasing sophistication of pre-hospital care, with paramedics and many types of 'rapid response' units, requires the use of advanced systems of ambulance control. The introduction of call selection by a paramedic in the ambulance control room significantly improved the tasking of the Helicopter Emergency Medical Service. This paper illustrates the need for a system to grade 999 calls, so that the appropriate pre-hospital response can be directed to each patient. PMID:8182675

  17. 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]).

  18. 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

  19. 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.

  20. The aging population and future demand for emergency ambulances in Japan.

    PubMed

    Hagihara, Akihito; Hasegawa, Manabu; Hinohara, Yukako; Abe, Takeru; Motoi, Midori

    2013-08-01

    Demand for emergency ambulances has been increasing in developmentally advanced countries, and in Japan demand has been increasing due to the aging population since 2008, when the total population began to decrease. However, we do not know how acceleration of the aging population relates to the demand for emergency ambulances. Thus, we estimated future demand for emergency ambulances in Japan. A regression with autocorrelated errors model was used to estimate future demand for emergency ambulance dispatches and emergency transports. In the estimation, data on emergency ambulance dispatches, emergency transports, and population data from 1963 to 2011, and an estimate of the population of Japan from 2012 to 2025 were used. The number of emergency ambulance dispatches has increased since 2008, and it is expected to continue to increase until around 2023 or 2024, when it will reach a peak of ~6.2 million per year. Similarly, the number of emergency transports is expected to continue to increase until 2022 or 2023, when it will reach a peak of ~5.3 million per year. Although we need to be careful when evaluating numbers predicted for the remote future due to methodological limitations, the findings might be useful for updating emergency medical care systems to prepare for future increases in demand.

  1. A dynamic ambulance management model for rural areas : Computing redeployment actions for relevant performance measures.

    PubMed

    van Barneveld, T C; Bhulai, S; van der Mei, R D

    2017-06-01

    We study the Dynamic Ambulance Management (DAM) problem in which one tries to retain the ability to respond to possible future requests quickly when ambulances become busy. To this end, we need models for relocation actions for idle ambulances that incorporate different performance measures related to response times. We focus on rural regions with a limited number of ambulances. We model the region of interest as an equidistant graph and we take into account the current status of both the system and the ambulances in a state. We do not require ambulances to return to a base station: they are allowed to idle at any node. This brings forth a high degree of complexity of the state space. Therefore, we present a heuristic approach to compute redeployment actions. We construct several scenarios that may occur one time-step later and combine these scenarios with each feasible action to obtain a classification of actions. We show that on most performance indicators, the heuristic policy significantly outperforms the classical compliance table policy often used in practice.

  2. 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

  3. When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation?

    PubMed Central

    Marsden, A. K.; Ng, G. A.; Dalziel, K.; Cobbe, S. M.

    1995-01-01

    OBJECTIVE--To determine whether patients with unexpected prehospital cardiac arrest could be identified in whom ambulance resuscitation attempts would be futile. DESIGN--Review of ambulance and hospital records; detailed review of automated external defibrillator rhythm strips of patients in whom no shock was advised. SETTING--Scottish Ambulance Service; all cardiopulmonary resuscitation attempts after cardiorespiratory arrest during 1988-94 included in the Heartstart Scotland database. SUBJECT--414 cardiorespiratory arrest patients with no pulse or breathing on arrival of ambulance personnel, no bystander cardiopulmonary resuscitation performed, and more than 15 minutes from time of arrest to arrival of ambulance. Patients were stratified into those with "shockable" and "non-shockable" rhythms. MAIN OUTCOME MEASURES--Return of spontaneous circulation, or survival to reach hospital alive, or survival to discharge, or all three. RESULTS--No patient with a non-shockable rhythm who met the entry criteria for analysis survived a resuscitation attempt. Review of the defibrillator rhythm strips of these patients failed to find any case in which the tracing was deemed compatible with survival. CONCLUSION--On the basis that it would be inappropriate to initiate vigorous resuscitation in patients who can be identified as "dead" and beyond help an algorithm was prepared to guide ambulance personnel. Images p49-a PMID:7613330

  4. Registrations and vehicle miles of travel of light duty vehicles, 1985--1995

    SciTech Connect

    Hu, P.S.; Davis, S.C.; Schmoyer, R.L.

    1998-02-01

    To obtain vehicle registration data that consistently and accurately reflect the distinction between automobiles and light-duty trucks, Oak Ridge National Laboratory (ORNL) was asked by FHWA to estimate the current and historical vehicle registration numbers of automobiles and of other two-axle four-tire vehicles (i.e., light-duty trucks), and their associated travel. The term automobile is synonymous with passenger car. Passenger cars are defined as all sedans, coupes, and station wagons manufactured primarily for the purpose of carrying passengers. This includes taxicabs, rental cars, and ambulances and hearses on an automobile chassis. Light-duty trucks refer to all two-axle four-tire vehicles other than passenger cars. They include pickup trucks, panel trucks, delivery and passenger vans, and other vehicles such as campers, motor homes, ambulances on a truck chassis, hearses on a truck chassis, and carryalls. In this study, light-duty trucks include four major types: (1) pickup truck, (2) van, (3) sport utility vehicle, and (4) other 2-axle 4-tire truck. Specifically, this project re-estimates statistics that appeared in Tables MV-1 and MV-9 of the 1995 Highway Statistics. Given the complexity of the approach developed in this effort and the incompleteness and inconsistency of the state-submitted data, it is recommended that alternatives be considered by FHWA to obtain vehicle registration data. One alternative is the Polk`s NVPP data (via the US Department of Transportation`s annual subscription to Polk). The second alternative is to obtain raw registration files from individual states` Departments of Motor Vehicles and to decode individual VINs.

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

    PubMed

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

    2016-07-01

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

  6. Microbial Air Quality and Bacterial Surface Contamination in Ambulances During Patient Services

    PubMed Central

    Luksamijarulkul, Pipat; Pipitsangjan, Sirikun

    2015-01-01

    Objectives We sought to assess microbial air quality and bacterial surface contamination on medical instruments and the surrounding areas among 30 ambulance runs during service. Methods We performed a cross-sectional study of 106 air samples collected from 30 ambulances before patient services and 212 air samples collected during patient services to assess the bacterial and fungal counts at the two time points. Additionally, 226 surface swab samples were collected from medical instrument surfaces and the surrounding areas before and after ambulance runs. Groups or genus of isolated bacteria and fungi were preliminarily identified by Gram’s stain and lactophenol cotton blue. Data were analyzed using descriptive statistics, t-test, and Pearson’s correlation coefficient with a p-value of less than 0.050 considered significant. Results The mean and standard deviation of bacterial and fungal counts at the start of ambulance runs were 318±485cfu/m3 and 522±581cfu/m3, respectively. Bacterial counts during patient services were 468±607cfu/m3 and fungal counts were 656±612cfu/m3. Mean bacterial and fungal counts during patient services were significantly higher than those at the start of ambulance runs, p=0.005 and p=0.030, respectively. For surface contamination, the overall bacterial counts before and after patient services were 0.8±0.7cfu/cm2 and 1.3±1.1cfu/cm2, respectively (p<0.001). The predominant isolated bacteria and fungi were Staphylococcus spp. and Aspergillus spp., respectively. Additionally, there was a significantly positive correlation between bacterial (r=0.3, p<0.010) and fungal counts (r=0.2, p=0.020) in air samples and bacterial counts on medical instruments and allocated areas. Conclusions This study revealed high microbial contamination (bacterial and fungal) in ambulance air during services and higher bacterial contamination on medical instrument surfaces and allocated areas after ambulance services compared to the start of ambulance runs

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

    PubMed

    Tennyson, Joseph C; Quale, Mark R

    2014-02-01

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

  8. [Transportation by ambulance in a rural district in Iceland during the years 1990-1996.].

    PubMed

    Valdimarsson, H

    1997-09-01

    The Health Centre at Kirkjubaejarklaustur serves a large rural district with a population a little over 600. Agriculture and various services including tourism are the main occupations. Almost 20% of the population are over 65 years of age, which is an unusually high figure compared to the rest of the country. Ambulance transports are one of the health centre's responsibilities. Most of these are surface transports to hospitals, 200-250 kilometres away. The purpose of this study was to explore and explain the nature of all ambulance transports provided by the Kirkjubaejarklaustur Health Centre from 1990-1996. A retrospective analysis was performed on all ambulance transports provided by the Kirkjubaejarklaustur Health Centre during the period. The data provided by the Health Centre and by transport personnel was used. Information was relatively easy to get since documentation was done by very few persons. The transports were looked at in terms of prevalence, age, gender, points of departure and destination, diagnosis, time of day, attending person and whether a local person or a tourist was being transported. Annual ambulance transport prevalence is 50 for every 1000 inhabitants. The prevalence for the whole country is 72, for the city of Reykjavik 90. Tourists account for 27% of transports. Accidents were the reason for transport in almost one third of cases. Males and elderly persons account for a significant number of the transports. This is congruent with other studies. Ambulance transport decreased significantly during the last two years of the study period. The most plausible explanation of this is the opening of a 20 bed nursing home in the district in mid year 1994. Ambulance transport including the preparation of the sick or injured person is an important part of health care in this region. General practitioners need to be well versed in emergency medicine and ambulance attendants in preparing the patient for transport. Therefore continuing education is an

  9. 17 CFR 250.1 - Registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Registration. 250.1 Section... AND REGULATIONS, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 Registration and General Exemptions § 250.1 Registration. (a) Notification of registration. Notifications of registration pursuant to...

  10. 14 CFR 47.43 - Invalid registration.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Invalid registration. 47.43 Section 47.43... REGISTRATION Certificates of Aircraft Registration § 47.43 Invalid registration. Link to an amendment published... registration of an aircraft is invalid if, at the time it is made— (1) The aircraft is registered in a...

  11. 14 CFR 47.43 - Invalid registration.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Invalid registration. 47.43 Section 47.43... REGISTRATION Certificates of Aircraft Registration § 47.43 Invalid registration. Link to an amendment published... registration of an aircraft is invalid if, at the time it is made— (1) The aircraft is registered in a...

  12. 17 CFR 250.1 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 17 Commodity and Securities Exchanges 3 2011-04-01 2011-04-01 false Registration. 250.1 Section... AND REGULATIONS, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 Registration and General Exemptions § 250.1 Registration. (a) Notification of registration. Notifications of registration pursuant to...

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

    PubMed

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

    2008-12-02

    High levels of stress among ambulance personnel have been attributed to the conditions of ambulance work. However, there is little research to support this notion, and it has been questioned whether ambulance work is inherently stressful. We compared the severity and frequency level of organizational and ambulance-specific stressors, and studied their relationship to organizational conditions and individual differences A comprehensive nationwide questionnaire survey of ambulance personnel (n = 1180) in operational duty. The questionnaire included the Job Stress Survey, the Norwegian Ambulance Stress Survey, the Basic Character Inventory, General Self-Efficacy Scale, and questions addressing organizational conditions. Serious operational tasks and physical demands were identified as the two most severe stressors. Lack of support from co-workers was the most severe and frequent organizational stressor. Higher frequency of stressors was most strongly associated with size of service districts (beta ranging between .18 and .30, p < .01) and working overtime (beta ranging from .13 to .27, p < .05). Stressor severity was related to lack of support after exposure to critical event (beta ranging from .11 to .24, p < .01) and working overtime. Neuroticism (beta ranging from .09 to .17, p < .01) and low general self-efficacy (beta ranging from -.12 to -.16, p < .001) were equally strongly related to severity of stressors, as were organizational conditions. Ambulance-specific stressors were reported as both more severe and more frequently occurring stressors than were organizational stressors. Organizational working conditions were more strongly related to frequency of job stressors than were individual differences. In general, the relationship between occupational stressors and individual differences was weak.

  14. Preventing and reducing the impacts of intimate partner violence: Opportunities for Australian ambulance services.

    PubMed

    Sawyer, Simon; Coles, Jan; Williams, Angela; Williams, Brett

    2015-08-01

    Violence against women is pervasive worldwide, and a high proportion of the most damaging violence is perpetrated by male intimate partners. The Australian government is committed to action to prevent such violence; however, strategies require input and collaboration from all agencies engaging patients, including ambulance services. To date no Australian ambulance service has published comprehensive guidelines or strategies to improve health outcomes for intimate partner violence patients in line with national strategies. To propose key actions for Australian ambulance services to undertake to reduce the impacts of intimate partner violence in line with national strategies. We reviewed the Australian government's National Plan to reduce violence towards women and its supporting literature, and created key actions for Australian ambulance services. Our review has yielded four key actions that Australian ambulance services could undertake immediately for the benefit of intimate partner violence patients. Actions include collaboration with external agencies, education, data collection and championing values promoting zero tolerance of violence towards women. Australian ambulance services are currently underserving intimate partner violence patients and must undertake immediate action. Successful strategies to address knowledge and policy gaps will require significant input and guidance from key organisations, including advocacy groups, police and EDs. It is likely that EDs will need to take the lead in creating comprehensive policies and guidelines from which ambulance services can derive their own policies. Failure to address this practice gap might result in paramedics becoming a barrier for intimate partner patients to receive appropriate care and support. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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

    PubMed

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

    2014-09-01

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

  16. Simulation-based decision support framework for dynamic ambulance redeployment in Singapore.

    PubMed

    Lam, Sean Shao Wei; Ng, Clarence Boon Liang; Nguyen, Francis Ngoc Hoang Long; Ng, Yih Yng; Ong, Marcus Eng Hock

    2017-10-01

    Dynamic ambulance redeployment policies tend to introduce much more flexibilities in improving ambulance resource allocation by capitalizing on the definite geospatial-temporal variations in ambulance demand patterns over the time-of-the-day and day-of-the-week effects. A novel modelling framework based on the Approximate Dynamic Programming (ADP) approach leveraging on a Discrete Events Simulation (DES) model for dynamic ambulance redeployment in Singapore is proposed in this paper. The study was based on the Singapore's national Emergency Medical Services (EMS) system. Based on a dataset comprising 216,973 valid incidents over a continuous two-years study period from 1 January 2011-31 December 2012, a DES model for the EMS system was developed. An ADP model based on linear value function approximations was then evaluated using the DES model via the temporal difference (TD) learning family of algorithms. The objective of the ADP model is to derive approximate optimal dynamic redeployment policies based on the primary outcome of ambulance coverage. Considering an 8min response time threshold, an estimated 5% reduction in the proportion of calls that cannot be reached within the threshold (equivalent to approximately 8000 dispatches) was observed from the computational experiments. The study also revealed that the redeployment policies which are restricted within the same operational division could potentially result in a more promising response time performance. Furthermore, the best policy involved the combination of redeploying ambulances whenever they are released from service and that of relocating ambulances that are idle in bases. This study demonstrated the successful application of an approximate modelling framework based on ADP that leverages upon a detailed DES model of the Singapore's EMS system to generate approximate optimal dynamic redeployment plans. Various policies and scenarios relevant to the Singapore EMS system were evaluated. Copyright © 2017

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

    PubMed

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

    2017-05-01

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

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

    PubMed Central

    2010-01-01

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

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

    PubMed

    Coleman, Gill; Wiggins, Liz

    2017-08-21

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

  20. A trauma resource allocation model for ambulances and hospitals.

    PubMed Central

    Branas, C C; MacKenzie, E J; ReVelle, C S

    2000-01-01

    OBJECTIVE: To develop a mathematical model for the location of trauma care resources. DATA SOURCES/STUDY SETTING: Severely injured patients queried from Maryland hospital discharge and vital statistics data. A spatial injury profile was created by parsing these patients into ZIP codes. STUDY DESIGN: The Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) was formulated using integer and heuristic programming. To maximize coverage of severely injured patients, trauma centers and aeromedical depots were simultaneously sited using TRAMAH. A severe injury was considered covered if at least one trauma center was sited within a time standard by ground, or if an aeromedical depot-trauma center pair was sited in such a way that the sum of the flying time from the aeromedical depot to the scene of injury plus the flying time from the scene of injury to the trauma center was within the same time standard. PRINCIPAL FINDINGS: From 1992 to 1994, 26,774 severe injuries were considered for coverage. Across Maryland, 94.8 percent of severely injured residents had access to trauma system resources within 30 minutes and 70.3 percent had access within 15 minutes. For the same number of resources as the existing Maryland Trauma System, TRAMAH achieved a coverage objective of 99.97 percent within 30 minutes. This translated into an additional 461 severely injured people covered each year. Holding in place the trauma centers of the existing system, approximately the same percentage of coverage as that of the existing system was achieved within 15 minutes by optimally locating six fewer aeromedical depots. CONCLUSIONS: TRAMAH will allow trauma systems planners to better locate their resources with respect to spatial needs and response times. Images Figure 1 Figure 2 PMID:10857473

  1. Ambulance helicopter contribution to search and rescue in North Norway.

    PubMed

    Glomseth, Ragnar; Gulbrandsen, Fritz I; Fredriksen, Knut

    2016-09-13

    Search and rescue (SAR) operations constitute a significant proportion of Norwegian ambulance helicopter missions, and they may limit the service's capacity for medical operations. We compared the relative contribution of the different helicopter resources using a common definition of SAR-operation in order to investigate how the SAR workload had changed over the last years. We searched the mission databases at the relevant SAR and helicopter emergency medical service (HEMS) bases and the Joint Rescue Coordination Centre (North) for helicopter-supported SAR operations within the potential operation area of the Tromsø HEMS base in 2000-2010. We defined SAR operations as missions over land or sea within 10 nautical miles from the coast with an initial search phase, missions with use of rescue hoist or static rope, and avalanche operations. There were 769 requests in 639 different SAR operations, and 600 missions were completed. The number increased during the study period, from 46 in 2000 to 77 in 2010. The Tromsø HEMS contributed with the highest number of missions and experienced the largest increase, from 10 % of the operations in 2000 to 50 % in 2010. Simple terrain and sea operations dominated, and avalanches accounted for as many as 12 % of all missions. The helicopter crews used static rope or rescue hoist in 141 operations. We have described all helicopter supported SAR operations in our area by combining databases. The Tromsø HEMS service had taken over one half of the missions by 2010. Increased availability for SAR work is one potential explanation. The number of SAR missions increased during 2000-2010, and the Tromsø HEMS experienced the greatest increase in workload.

  2. Registration Delay and Student Performance

    ERIC Educational Resources Information Center

    Siefken, Jason

    2017-01-01

    Tracking the difference between the time a first-year student is allowed to register for a course and the time he or she does register for a course (a student's registration delay), we notice a negative correlation between registration delay and final grade in a course. The difference between a student who registers within the first two minutes…

  3. Automatic registration of satellite imagery

    NASA Technical Reports Server (NTRS)

    Fonseca, Leila M. G.; Costa, Max H. M.; Manjunath, B. S.; Kenney, C.

    1997-01-01

    Image registration is one of the basic image processing operations in remote sensing. With the increase in the number of images collected every day from different sensors, automated registration of multi-sensor/multi-spectral images has become an important issue. A wide range of registration techniques has been developed for many different types of applications and data. The objective of this paper is to present an automatic registration algorithm which uses a multiresolution analysis procedure based upon the wavelet transform. The procedure is completely automatic and relies on the grey level information content of the images and their local wavelet transform modulus maxima. The registration algorithm is very simple and easy to apply because it needs basically one parameter. We have obtained very encouraging results on test data sets from the TM and SPOT sensor images of forest, urban and agricultural areas.

  4. Public Participation Process for Registration Actions

    EPA Pesticide Factsheets

    Describes the process for registration actions which provides the opportunity for the public to comment on major registration decisions at a point in the registration process when comprehensive information and analysis are available.

  5. 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

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

    PubMed

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

    2016-06-01

    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. 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. 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 = 0.03). The uptake of freely available transport in connection with women

  7. 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.

  8. 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

  9. 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.

  10. Air ambulance services in the Arctic 1999-2009: a Norwegian study

    PubMed Central

    2011-01-01

    Background Air ambulance services in the Arctic have to deal with remote locations, long distances, rough weather conditions and seasonable darkness. Despite these challenges, the people living in the area expect a high quality of specialist health care. Aims The objective of this study was to analyse the air ambulance operations performed in the Norwegian Arctic and study variations in diagnoses and flight patterns around the year. Methods A retrospective analysis. All air ambulance operations performed during the time 1999 - 2009 period were analysed. The subjects were patients transported and flights performed. The primary outcome measures were patients' diagnoses and task patterns around the year. Results A total of 345 patients were transported and 321 flights performed. Coronary heart and vascular disease, bone fractures and infections were the most common diagnoses. Most patients (85%) had NACA score 3 or 4. Half of all fractures occurred in April and August. Most patients were males (66%), and one fourth was not Norwegian. The median flying time (one way) was 3 h 33 m. Ten percent of the flights were delayed, and only 14% were performed between midnight and 8.00 AM. The period April to August was the busiest one (58% of operations). Conclusions Norway has run a safe air ambulance service in the Arctic for the last 11 years. In the future more shipping and polar adventure operations may influence the need for air ambulances, especially during summer and autumn. PMID:21407997

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

    PubMed

    Kilner, T

    2004-05-01

    To identify those attributes experts regard as desirable qualities in the ambulance technician, paramedic, and clinical supervisor. 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. 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. 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.

  13. 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

  14. 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

  15. The limited potential of special ambulance services in the management of cardiac arrest.

    PubMed Central

    Rowley, J M; Garner, C; Hampton, J R

    1990-01-01

    For six months a survey was made of all the patients in the Nottingham District Health Authority who died or who were brought to hospital after a cardiac arrest outside hospital. During this period just under half of the emergency ambulance shifts were covered by specially trained crews with defibrillators. During the study period the ICD coding of death certificates indicated that 894 (25%) of the 3575 deaths were due to ischaemic heart disease. During this period the ambulance service received 17,749 emergency calls, which included 445 patients who had cardiac arrests outside hospital. One hundred and forty seven of these patients were carried by ambulances equipped with defibrillators and resuscitation was attempted in 83. Seven patients survived to leave hospital. The special ambulance service was cost effective--a simple calculation suggests that the cost per life saved was approximately 2600 pounds, but it seems unlikely that special ambulance services will materially affect community fatality rates from ischaemic heart disease. PMID:2101595

  16. Risk Stratification-based Surveillance of Bacterial Contamination in Metropolitan Ambulances

    PubMed Central

    Noh, Hyun; Kim, Nam Joong; Ro, Young Sun; Oh, Hyang Soon; Joo, Se Ik; Kim, Jung In; Ong, Marcus Eng Hock

    2011-01-01

    We aimed to know the risk-stratification-based prevalence of bacterial contamination of ambulance vehicle surfaces, equipment, and materials. This study was performed in a metropolitan area with fire-based single-tiered Basic Life Support ambulances. Total 13 out of 117 ambulances (11.1%) were sampled and 33 sites per each ambulance were sampled using a soft rayon swab and aseptic containers. These samples were then plated onto a screening media of blood agar and MacConkey agar. Specific identification with antibiotic susceptibility was performed. We categorized sampling sites into risk stratification-based groups (Critical, Semi-critical, and Non-critical equipment) related to the likelihood of direct contact with patients' mucosa. Total 214 of 429 samples showed positive results (49.9%) for any bacteria. Four of these were pathogenic (0.9%) (MRSA, MRCoNS, and K. pneumoniae), and 210 of these were environmental flora (49.0%). However, the prevalence (positive/number of sample) of bacterial contamination in critical, semi-critical airway, semi-critical breathing apparatus group was as high as 15.4% (4/26), 30.7% (16/52), and 46.2% (48/104), respectively. Despite current formal guidelines, critical and semi-critical equipments were contaminated with pathogens and normal flora. This study suggests the need for strict infection control and prevention for ambulance services. PMID:21218040

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

    PubMed

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

    2017-01-01

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

  18. R.I.P. squad bench. European ambulances designed around the patient, not the vehicle.

    PubMed

    Heightman, A J

    2013-07-01

    You can see and hear more about my journey throughout Germany and England in a special, archived, free Webcast on jems.com. And in future articles, videos and Web presentations, you'll see and learn about the different EMS delivery models I saw, the men and women whom I met and rode with on calls, and, most importantly, their impressive attitude about patient care, customer service and safety. Progressive American and Canadian ambulance manufacturers now agree with safety experts and forward-thinking ambulance operators that the squad bench is dead. These manufacturers now offer innovative seats that are much safer and functional than those coffin-like obstructions that gobbled up so much space in our rigs for the past three decades. Design your next ambulance around the needs and safety of your crews and their patients, and spec a patient compartment that is laid out logiclaly and efficient.

  19. [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".

  20. 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.

  1. Image Registration: A Necessary Evil

    NASA Technical Reports Server (NTRS)

    Bell, James; McLachlan, Blair; Hermstad, Dexter; Trosin, Jeff; George, Michael W. (Technical Monitor)

    1995-01-01

    Registration of test and reference images is a key component of nearly all PSP data reduction techniques. This is done to ensure that a test image pixel viewing a particular point on the model is ratioed by the reference image pixel which views the same point. Typically registration is needed to account for model motion due to differing airloads when the wind-off and wind-on images are taken. Registration is also necessary when two cameras are used for simultaneous acquisition of data from a dual-frequency paint. This presentation will discuss the advantages and disadvantages of several different image registration techniques. In order to do so, it is necessary to propose both an accuracy requirement for image registration and a means for measuring the accuracy of a particular technique. High contrast regions in the unregistered images are most sensitive to registration errors, and it is proposed that these regions be used to establish the error limits for registration. Once this is done, the actual registration error can be determined by locating corresponding points on the test and reference images, and determining how well a particular registration technique matches them. An example of this procedure is shown for three transforms used to register images of a semispan model. Thirty control points were located on the model. A subset of the points were used to determine the coefficients of each registration transform, and the error with which each transform aligned the remaining points was determined. The results indicate the general superiority of a third-order polynomial over other candidate transforms, as well as showing how registration accuracy varies with number of control points. Finally, it is proposed that image registration may eventually be done away with completely. As more accurate image resection techniques and more detailed model surface grids become available, it will be possible to map raw image data onto the model surface accurately. Intensity

  2. 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.

  3. 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

  4. A Systematic Review of the Implementation Challenges of Telemedicine Systems in Ambulances.

    PubMed

    Rogers, Hunter; Madathil, Kapil Chalil; Agnisarman, Sruthy; Narasimha, Shraddhaa; Ashok, Aparna; Nair, Aswathi; Welch, Brandon M; McElligott, James T

    2017-09-01

    Telemedicine systems are gaining attention nationwide as a means for providing care in remote areas and allowing a small number of providers to impact a large geographic region. We systematically reviewed the literature to identify the efficacy and implementation challenges of telemedicine systems in ambulances. A search for published studies on Web of Science and PubMed was completed. Studies were selected if they included at least a pilot study and they focused on feasibility or implementation of telemedicine systems in ambulances. A total of 864 articles were used for title and abstract screening. Full text screening was completed for 102 articles, with 23 being selected for final review. Sixty-one percent of the studies included in the review focused on general emergency care, while 26% focused on stroke care and 13% focused on myocardial infarction care. The reviewed studies found that telemedicine is feasible and effective in decreasing treatment times, report a high diagnosis accuracy rate, show higher rates of positive task completion than in regular ambulances, and demonstrate that stroke evaluation is completed with comparable accuracy to the standard way of delivering care. Although this review identified life-saving benefits of telemedicine, it also showed the paucity of the scientifically sound research in its implementation, prompting further studies. Further research is needed to analyze the capabilities and challenges involved in implementing telemedicine in ambulances, especially studies focusing on human-system integration and human factors' considerations in the implementation of telemedicine systems in ambulances, the development of advanced Internet connectivity paradigms, additional applications for triaging, and the implications of ambulance location.

  5. 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.

  6. 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.

  7. 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

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for ambulance services, emergency and... § 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance... equivalent, where other means of transportation would endanger the beneficiary's health. (b) Emergency and...

  8. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules for ambulance services, emergency and... Special rules for ambulance services, emergency and urgently needed services, and maintenance and post... means of transportation would endanger the beneficiary's health. (b) Emergency and urgently needed...

  9. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for ambulance services, emergency and... § 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance... equivalent, where other means of transportation would endanger the beneficiary's health. (b) Emergency and...

  10. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules for ambulance services, emergency and... § 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance... equivalent, where other means of transportation would endanger the beneficiary's health. (b) Emergency and...

  11. Reflective and collaborative skills enhances Ambulance nurses' competence - A study based on qualitative analysis of professional experiences.

    PubMed

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

    2017-05-01

    The Swedish ambulance health care services are changing and developing, with the ambulance nurse playing a central role in the development of practice. The competence required by ambulance nurses in the profession remains undefined and provides a challenge. The need for a clear and updated description of ambulance nurses' competence, including the perspective of professional experiences, seems to be essential. The aim of this study was to elucidate ambulance nurses' professional experiences and to describe aspects affecting their competence. For data collection, the study used the Critical Incident Technique, interviewing 32 ambulance nurses. A qualitative content analysis was applied. This study elucidates essential parts of the development, usage and perceptions of the competence of ambulance nurses and how, in various ways, this is affected by professional experiences. The development of competence is strongly affected by the ability and possibility to reflect on practice on a professional and personal level, particularly in cooperation with colleagues. Experiences and communication skills are regarded as decisive in challenging clinical situations. The way ambulance nurses perceive their own competence is closely linked to patient outcome. The results of this study can be used in professional and curriculum development. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. 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…

  13. Using Behavioral Skills Training to Promote Safe and Correct Staff Guarding and Ambulation Distance of Students with Multiple Physical Disabilities

    ERIC Educational Resources Information Center

    Nabeyama, Bobby; Sturmey, Peter

    2010-01-01

    The study analyzed the effects of self-recording and behavioral skills training on guarding responses of 3 staff members while they assisted 3 students with multiple disabilities to ambulate. The intervention increased the percentage of correct posture and guarding responses and the distance that students ambulated. These effects generalized when…

  14. Explanation of Registration Review Schedule

    EPA Pesticide Factsheets

    Updated information on EPA's schedule for opening dockets to begin pesticide registration reviews during the next several years. The schedule is subdivided into conventional pesticides, antimicrobials, biochemicals, and microbials.

  15. Individual Pesticides in Registration Review

    EPA Pesticide Factsheets

    You can used the Chemical Search database to search pesticides by chemical name and find their registration review dockets, along with Work Plans, risk assessments, interim and final decisions, tolerance rules, and cancellation actions.

  16. Validation of histology image registration

    NASA Astrophysics Data System (ADS)

    Shojaii, Rushin; Karavardanyan, Tigran; Yaffe, Martin; Martel, Anne L.

    2011-03-01

    The aim of this paper is to validate an image registration pipeline used for histology image alignment. In this work a set of histology images are registered to their correspondent optical blockface images to make a histology volume. Then multi-modality fiducial markers are used to validate the alignment of histology images. The fiducial markers are catheters perfused with a mixture of cuttlefish ink and flour. Based on our previous investigations this fiducial marker is visible in medical images, optical blockface images and it can also be localized in histology images. The properties of this fiducial marker make it suitable for validation of the registration techniques used for histology image alignment. This paper reports on the accuracy of a histology image registration approach by calculation of target registration error using these fiducial markers.

  17. Spherical demons: fast surface registration.

    PubMed

    Yeo, B T Thomas; Sabuncu, Mert; Vercauteren, Tom; Ayache, Nicholas; Fischl, Bruce; Golland, Polina

    2008-01-01

    We present the fast Spherical Demons algorithm for registering two spherical images. By exploiting spherical vector spline interpolation theory, we show that a large class of regularizers for the modified demons objective function can be efficiently implemented on the sphere using convolution. Based on the one parameter subgroups of diffeomorphisms, the resulting registration is diffeomorphic and fast - registration of two cortical mesh models with more than 100k nodes takes less than 5 minutes, comparable to the fastest surface registration algorithms. Moreover, the accuracy of our method compares favorably to the popular FreeSurfer registration algorithm. We validate the technique in two different settings: (1) parcellation in a set of in-vivo cortical surfaces and (2) Brodmann area localization in ex-vivo cortical surfaces.

  18. Spherical Demons: Fast Surface Registration

    PubMed Central

    Yeo, B.T. Thomas; Sabuncu, Mert; Vercauteren, Tom; Ayache, Nicholas; Fischl, Bruce; Golland, Polina

    2009-01-01

    We present the fast Spherical Demons algorithm for registering two spherical images. By exploiting spherical vector spline interpolation theory, we show that a large class of regularizers for the modified demons objective function can be efficiently implemented on the sphere using convolution. Based on the one parameter subgroups of diffeomorphisms, the resulting registration is diffeomorphic and fast – registration of two cortical mesh models with more than 100k nodes takes less than 5 minutes, comparable to the fastest surface registration algorithms. Moreover, the accuracy of our method compares favorably to the popular FreeSurfer registration algorithm. We validate the technique in two different settings: (1) parcellation in a set of in-vivo cortical surfaces and (2) Brodmann area localization in ex-vivo cortical surfaces. PMID:18979813

  19. Data Requirements for Pesticide Registration

    EPA Pesticide Factsheets

    In evaluating a pesticide registration application, we assess a wide variety of potential human health and environmental effects associated with use of the product. Learn about these data requirements.

  20. 32 CFR 1615.1 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... on the Selective Service Internet web site (http://www.sss.gov), telephonic registration... Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ADMINISTRATION OF REGISTRATION § 1615.1 Registration. (a) Registration under selective service law consists of: (1) Completing a...

  1. 44 CFR 206.112 - Registration period.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Registration period. 206.112... Households § 206.112 Registration period. (a) Initial period. The standard FEMA registration period is 60...) Extension of the registration period. The regional administrator or his/her designee may extend...

  2. 22 CFR 122.3 - Registration fees.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Registration fees. 122.3 Section 122.3 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS REGISTRATION OF MANUFACTURERS AND EXPORTERS § 122.3 Registration fees. (a) Frequency of registration and fee. A person who is required...

  3. 27 CFR 17.21 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Registration. 17.21... PRODUCTS Registration § 17.21 Registration. Every person claiming drawback under this part must register annually as a nonbeverage domestic drawback claimant. Registration will be accomplished when the...

  4. 49 CFR 390.201 - USDOT Registration.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 5 2014-10-01 2014-10-01 false USDOT Registration. 390.201 Section 390.201... SAFETY REGULATIONS; GENERAL Unified Registration System § 390.201 USDOT Registration. (a) Purpose. This section establishes who must register with FMCSA under the Unified Registration System, the...

  5. 9 CFR 381.179 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Registration. 381.179 Section 381.179... CERTIFICATION POULTRY PRODUCTS INSPECTION REGULATIONS Records, Registration, and Reports § 381.179 Registration... effective date. All information submitted shall be current and correct. The registration form shall...

  6. 40 CFR 79.23 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 16 2011-07-01 2011-07-01 false Registration. 79.23 Section 79.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGISTRATION OF FUELS AND FUEL ADDITIVES Additive Registration Procedures § 79.23 Registration. (a) If...

  7. 17 CFR 48.3 - Registration required.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 17 Commodity and Securities Exchanges 2 2014-04-01 2014-04-01 false Registration required. 48.3...) REGISTRATION OF FOREIGN BOARDS OF TRADE § 48.3 Registration required. (a) Except as specified in this part, it... Registration to the foreign board of trade pursuant to the provisions of this part. (b) It shall be...

  8. 17 CFR 48.5 - Registration procedures.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 17 Commodity and Securities Exchanges 2 2014-04-01 2014-04-01 false Registration procedures. 48.5...) REGISTRATION OF FOREIGN BOARDS OF TRADE § 48.5 Registration procedures. (a) A foreign board of trade seeking registration with the Commission pursuant to this part must electronically file an application for...

  9. 40 CFR 79.13 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 17 2014-07-01 2014-07-01 false Registration. 79.13 Section 79.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGISTRATION OF FUELS AND FUEL ADDITIVES Fuel Registration Procedures § 79.13 Registration. (a) If...

  10. 44 CFR 206.112 - Registration period.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Registration period. 206.112... Households § 206.112 Registration period. (a) Initial period. The standard FEMA registration period is 60...) Extension of the registration period. The regional administrator or his/her designee may extend...

  11. 44 CFR 206.112 - Registration period.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Registration period. 206.112... Households § 206.112 Registration period. (a) Initial period. The standard FEMA registration period is 60...) Extension of the registration period. The regional administrator or his/her designee may extend...

  12. 40 CFR 79.23 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Registration. 79.23 Section 79.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGISTRATION OF FUELS AND FUEL ADDITIVES Additive Registration Procedures § 79.23 Registration. (a) If...

  13. 27 CFR 25.112 - Dealer registration.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Dealer registration. 25..., DEPARTMENT OF THE TREASURY LIQUORS BEER Dealer Registration and Recordkeeping § 25.112 Dealer registration... appropriate TTB officer, will constitute the brewer's registration as a dealer at the brewery. Every...

  14. 27 CFR 17.21 - Registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Registration. 17.21... PRODUCTS Registration § 17.21 Registration. Every person claiming drawback under this part must register annually as a nonbeverage domestic drawback claimant. Registration will be accomplished when the...

  15. 28 CFR 5.200 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Registration. 5.200 Section 5.200 Judicial Administration DEPARTMENT OF JUSTICE ADMINISTRATION AND ENFORCEMENT OF FOREIGN AGENTS REGISTRATION ACT OF 1938, AS AMENDED § 5.200 Registration. (a) Registration under the Act is accomplished by...

  16. 40 CFR 79.13 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 16 2011-07-01 2011-07-01 false Registration. 79.13 Section 79.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGISTRATION OF FUELS AND FUEL ADDITIVES Fuel Registration Procedures § 79.13 Registration. (a) If...

  17. 40 CFR 79.13 - Registration.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Registration. 79.13 Section 79.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGISTRATION OF FUELS AND FUEL ADDITIVES Fuel Registration Procedures § 79.13 Registration. (a) If...

  18. 40 CFR 79.23 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 17 2014-07-01 2014-07-01 false Registration. 79.23 Section 79.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGISTRATION OF FUELS AND FUEL ADDITIVES Additive Registration Procedures § 79.23 Registration. (a) If...

  19. 27 CFR 25.112 - Dealer registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Dealer registration. 25..., DEPARTMENT OF THE TREASURY LIQUORS BEER Dealer Registration and Recordkeeping § 25.112 Dealer registration... appropriate TTB officer, will constitute the brewer's registration as a dealer at the brewery. Every...

  20. 44 CFR 206.112 - Registration period.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Registration period. 206.112... Households § 206.112 Registration period. (a) Initial period. The standard FEMA registration period is 60...) Extension of the registration period. The regional administrator or his/her designee may extend...

  1. 28 CFR 5.200 - Registration.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Registration. 5.200 Section 5.200 Judicial Administration DEPARTMENT OF JUSTICE ADMINISTRATION AND ENFORCEMENT OF FOREIGN AGENTS REGISTRATION ACT OF 1938, AS AMENDED § 5.200 Registration. (a) Registration under the Act is accomplished by...

  2. 40 CFR 79.13 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Registration. 79.13 Section 79.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGISTRATION OF FUELS AND FUEL ADDITIVES Fuel Registration Procedures § 79.13 Registration. (a) If...

  3. 27 CFR 25.112 - Dealer registration.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Dealer registration. 25..., DEPARTMENT OF THE TREASURY ALCOHOL BEER Dealer Registration and Recordkeeping § 25.112 Dealer registration... appropriate TTB officer, will constitute the brewer's registration as a dealer at the brewery. Every...

  4. 44 CFR 206.112 - Registration period.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Registration period. 206.112... Households § 206.112 Registration period. (a) Initial period. The standard FEMA registration period is 60...) Extension of the registration period. The regional administrator or his/her designee may extend...

  5. 32 CFR 634.19 - Registration policy.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Registration policy. 634.19 Section 634.19... CRIMINAL INVESTIGATIONS MOTOR VEHICLE TRAFFIC SUPERVISION Motor Vehicle Registration § 634.19 Registration... registration of off-road vehicles and bicycles under a separate local system. (c) Commanders can grant...

  6. 7 CFR 800.34 - Registration fee.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 7 2011-01-01 2011-01-01 false Registration fee. 800.34 Section 800.34 Agriculture... ADMINISTRATION (FEDERAL GRAIN INSPECTION SERVICE), DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS Registration § 800.34 Registration fee. An applicant shall submit the registration fee prescribed in § 800.71...

  7. 7 CFR 800.34 - Registration fee.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Registration fee. 800.34 Section 800.34 Agriculture... ADMINISTRATION (FEDERAL GRAIN INSPECTION SERVICE), DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS Registration § 800.34 Registration fee. An applicant shall submit the registration fee prescribed in § 800.71...

  8. 28 CFR 5.200 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 1 2012-07-01 2012-07-01 false Registration. 5.200 Section 5.200 Judicial Administration DEPARTMENT OF JUSTICE ADMINISTRATION AND ENFORCEMENT OF FOREIGN AGENTS REGISTRATION ACT OF 1938, AS AMENDED § 5.200 Registration. (a) Registration under the Act is accomplished by...

  9. 9 CFR 381.179 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Registration. 381.179 Section 381.179... CERTIFICATION POULTRY PRODUCTS INSPECTION REGULATIONS Records, Registration, and Reports § 381.179 Registration... effective date. All information submitted shall be current and correct. The registration form shall...

  10. 27 CFR 25.112 - Dealer registration.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Dealer registration. 25..., DEPARTMENT OF THE TREASURY LIQUORS BEER Dealer Registration and Recordkeeping § 25.112 Dealer registration... appropriate TTB officer, will constitute the brewer's registration as a dealer at the brewery. Every...

  11. 28 CFR 811.7 - Initial registration.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Initial registration. 811.7 Section 811.7... OFFENDER REGISTRATION § 811.7 Initial registration. (a) Duties of sex offender. (1) A sex offender must... purpose of registration, and must cooperate in such a meeting, including: (i) Providing any...

  12. 7 CFR 800.34 - Registration fee.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 7 2013-01-01 2013-01-01 false Registration fee. 800.34 Section 800.34 Agriculture... ADMINISTRATION (FEDERAL GRAIN INSPECTION SERVICE), DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS Registration § 800.34 Registration fee. An applicant shall submit the registration fee prescribed in § 800.71...

  13. 28 CFR 5.200 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Registration. 5.200 Section 5.200 Judicial Administration DEPARTMENT OF JUSTICE ADMINISTRATION AND ENFORCEMENT OF FOREIGN AGENTS REGISTRATION ACT OF 1938, AS AMENDED § 5.200 Registration. (a) Registration under the Act is accomplished by...

  14. 40 CFR 79.23 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 17 2013-07-01 2013-07-01 false Registration. 79.23 Section 79.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGISTRATION OF FUELS AND FUEL ADDITIVES Additive Registration Procedures § 79.23 Registration. (a) If...

  15. 40 CFR 79.13 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 17 2013-07-01 2013-07-01 false Registration. 79.13 Section 79.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGISTRATION OF FUELS AND FUEL ADDITIVES Fuel Registration Procedures § 79.13 Registration. (a) If...

  16. 32 CFR 634.19 - Registration policy.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Registration policy. 634.19 Section 634.19... CRIMINAL INVESTIGATIONS MOTOR VEHICLE TRAFFIC SUPERVISION Motor Vehicle Registration § 634.19 Registration... registration of off-road vehicles and bicycles under a separate local system. (c) Commanders can grant...

  17. 9 CFR 381.179 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Registration. 381.179 Section 381.179... CERTIFICATION POULTRY PRODUCTS INSPECTION REGULATIONS Records, Registration, and Reports § 381.179 Registration... effective date. All information submitted shall be current and correct. The registration form shall...

  18. 40 CFR 79.23 - Registration.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Registration. 79.23 Section 79.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGISTRATION OF FUELS AND FUEL ADDITIVES Additive Registration Procedures § 79.23 Registration. (a) If...

  19. 7 CFR 800.34 - Registration fee.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 7 2014-01-01 2014-01-01 false Registration fee. 800.34 Section 800.34 Agriculture... ADMINISTRATION (FEDERAL GRAIN INSPECTION SERVICE), DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS Registration § 800.34 Registration fee. An applicant shall submit the registration fee prescribed in § 800.71...

  20. 32 CFR 634.19 - Registration policy.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Registration policy. 634.19 Section 634.19... CRIMINAL INVESTIGATIONS MOTOR VEHICLE TRAFFIC SUPERVISION Motor Vehicle Registration § 634.19 Registration... registration of off-road vehicles and bicycles under a separate local system. (c) Commanders can grant...

  1. 32 CFR 634.19 - Registration policy.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Registration policy. 634.19 Section 634.19... CRIMINAL INVESTIGATIONS MOTOR VEHICLE TRAFFIC SUPERVISION Motor Vehicle Registration § 634.19 Registration... registration of off-road vehicles and bicycles under a separate local system. (c) Commanders can grant...

  2. 28 CFR 5.200 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Registration. 5.200 Section 5.200 Judicial Administration DEPARTMENT OF JUSTICE ADMINISTRATION AND ENFORCEMENT OF FOREIGN AGENTS REGISTRATION ACT OF 1938, AS AMENDED § 5.200 Registration. (a) Registration under the Act is accomplished by...

  3. 27 CFR 17.21 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Registration. 17.21... PRODUCTS Registration § 17.21 Registration. Every person claiming drawback under this part must register annually as a nonbeverage domestic drawback claimant. Registration will be accomplished when the...

  4. 27 CFR 25.112 - Dealer registration.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Dealer registration. 25..., DEPARTMENT OF THE TREASURY ALCOHOL BEER Dealer Registration and Recordkeeping § 25.112 Dealer registration... appropriate TTB officer, will constitute the brewer's registration as a dealer at the brewery. Every...

  5. 27 CFR 17.21 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Registration. 17.21... PRODUCTS Registration § 17.21 Registration. Every person claiming drawback under this part must register annually as a nonbeverage domestic drawback claimant. Registration will be accomplished when the...

  6. 9 CFR 381.179 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Registration. 381.179 Section 381.179... CERTIFICATION POULTRY PRODUCTS INSPECTION REGULATIONS Records, Registration, and Reports § 381.179 Registration... effective date. All information submitted shall be current and correct. The registration form shall...

  7. 27 CFR 17.21 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Registration. 17.21... PRODUCTS Registration § 17.21 Registration. Every person claiming drawback under this part must register annually as a nonbeverage domestic drawback claimant. Registration will be accomplished when the...

  8. 7 CFR 800.34 - Registration fee.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 7 2012-01-01 2012-01-01 false Registration fee. 800.34 Section 800.34 Agriculture... ADMINISTRATION (FEDERAL GRAIN INSPECTION SERVICE), DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS Registration § 800.34 Registration fee. An applicant shall submit the registration fee prescribed in § 800.71...

  9. Rectification and Registration of Remotely Sensed Data.

    DTIC Science & Technology

    2014-09-26

    intelligence Image registration Resampling Mapping Change detection Geometrical distortions Multisensor Signal processing Synthetic aperture radar...rectification and registration of images generated by onboard sensors. Accurate registration is a key requirement for detecting changes (in position...or "unwarping" of the image data before registration and information extraction, in the form of geometric and radiometric corrections and data

  10. A Remote Registration Based on MIDAS

    NASA Astrophysics Data System (ADS)

    JIN, Xin

    2017-04-01

    We often need for software registration to protect the interests of the software developers. This article narrated one kind of software long-distance registration technology. The registration method is: place the registration information in a database table, after the procedure starts in check table registration information, if it has registered then the procedure may the normal operation; Otherwise, the customer must input the sequence number and registers through the network on the long-distance server. If it registers successfully, then records the registration information in the database table. This remote registration method can protect the rights of software developers.

  11. 75 FR 52859 - Re-Registration and Renewal of Aircraft Registration; OMB Approval of Information Collection

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-30

    ... Federal Aviation Administration 14 CFR Parts 13, 47, and 91 RIN 2120-AI89 Re-Registration and Renewal of... final rule, ``Re-Registration and Renewal of Aircraft Registration,'' which was published on July 20..., the FAA published the final rule, ``Re-Registration and Renewal of Aircraft Registration'' (75...

  12. 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.

  13. 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…

  14. Effects of international football matches on ambulance call profiles and volumes during the 2006 World Cup

    PubMed Central

    Deakin, Charles D; Thompson, Fizz; Gibson, Caroline; Green, Mark

    2007-01-01

    Background Prompt ambulance attendance is aimed at improving patient care. With finite resources struggling to meet performance targets, unforeseen demand precludes the ability to tailor resources to cope with increased call volumes, and can have a marked detrimental effect on performance and hence patient care. The effects of the 2006 World Cup football matches on call volumes and profiles were analysed to understand how public events can influence demands on the ambulance service. Methods All emergency calls to the Hampshire Ambulance Service NHS Trust (currently the Hampshire Division of South Central Ambulance Service, Winchester, UK) during the first weekend of the 2006 World Cup football matches were analysed by call volume and classification of call (call type). Results On the day of the first football match, call volume was over 50% higher than that on a typical Saturday, with distinct peaks before and after the inaugural match. Call profile analysis showed increases in alcohol‐related emergencies, including collapse, unconsciousness, assault and road traffic accidents. The increase in assaults was particularly marked at the end of each match and increased again into the late evening. Conclusion A detailed mapping of call volumes and profiles during the World Cup football shows a significant increase in overall emergency calls, mostly alcohol related. Mapping of limited resources to these patterns will allow improved responses to emergency calls. PMID:17513536

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

    PubMed

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

    2015-12-01

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

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

    NASA Astrophysics Data System (ADS)

    Chae, Hee Dong; Choi, Seung-Bok

    2015-01-01

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

  17. 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…

  18. 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

  19. 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.

  20. [Comparative analysis of attitudes of ambulance personnel and paramedic students regarding death and dying].

    PubMed

    Pék, Emese; Székely-Benke, Zoltán; Betlehem, József; Fullér, Noémi

    2015-10-04

    The emergency care staff witness the experience of dying and death on a daily basis. The aim of the study was to evaluate and compare the current and future ambulance personnel's fear of death and its influencing factors. Quantitative, cross-sectional comparative study was conducted including 106 participants (active rescue ambulance personnel, n = 45 persons; paramedic students, n = 61). A voluntary, anonymous questionnaire survey method (the Neimeyer-Moore Multidimensional Fear of Death Scale) was used for data collection. The data were analyzed using descriptive and mathematical statistical tests (T-test, analysis of variance). The students had a greater fear in the "Fear for Significant Others" factor (p = 0.001). Students showed stronger fear who lived in cities, had higher educational qualifications, who where women (p = 0.036), singles (p = 0.046), those who have not seen a dying person (p = 0.017) and those who were never witnessed death. Greater fear characterized the ambulance personnel who were village residents, those living in a partnership (p = 0.027), those with lower educational level (p = 0.041) and those who had been working for a longer time. There is no significant difference between the levels of fear of death of the present and future ambulance personnel. However, the practice-oriented education is very important and, training associated with death and dying should be integrated in the educational schedules of the paramedic students.

  1. 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.

  2. 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

  3. [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).

  4. 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…

  5. Epidemiology of ambulance responses to older people who have fallen in New South Wales, Australia.

    PubMed

    Simpson, Paul M; Bendall, Jason C; Patterson, Jillian; Tiedemann, Anne; Middleton, Paul M; Close, Jacqueline Ct

    2013-09-01

    To quantify the size and scope of the operational burden for a large ambulance service arising from older people who have fallen and to describe this population. Retrospective analysis of ambulance records from New South Wales, Australia for emergency calls classified as 'falls' in the period 1 July 2008 to 30 June 2009. There were 42 331 responses to people aged 65 years or older, constituting 5.1% of total emergency workload. The median age of patients was 83 (interquartile range 76-87) and 62% were women. The transport rate was 76%. Transport to hospital was more likely during the day (odds ratio (OR) 1.8, 95% confidence interval (CI) 1.7-1.9) and on weekends (OR 1.06, 95%CI 1.0-1.1). Falls by older people constitute approximately 5% of all emergency responses, of which one quarter are not transported to emergency department (ED) after paramedic assessment. Increasing the sophistication of ambulance dispatch processes to older people who have fallen, and continuing with the development of new models of care aimed at decreasing unnecessary transports to the EDs, should be a priority when planning ambulance service delivery for older people who have fallen. © 2012 The Authors. Australasian Journal on Ageing © 2012 ACOTA.

  6. 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

  7. 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…

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

    PubMed

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

    2014-03-01

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

  9. [Health survey of ambulance workers with a generic questionnaire (SF-36)].

    PubMed

    Pék, Emese; Mártai, István; Marton, József; Betlehem, József

    2013-11-24

    The high work-related stress among ambulance workers is a widely known a phenomenon. The aim of the authors was to asses self-reported health status of ambulance workers. An anonym self-fill-in questionnaire applying SF-36 was used among workers from the northern and western regions of Hungarian National Ambulance Service. Based on the dimensions of the SF-36 questionnaire the responders considered their "Physical Functioning" the best, while "Vitality" was regarded the worst. The more time an employee have been worked at the Ambulance Service the worse his health was in the first four dimensions including "Physical Functioning", "Role-Physical", "Bodily Pain" and "General Health": p<0.001. Those working in part-time jobs considered their health in all dimensions worse. The respondents who did some kind of sports hold their health in all dimensions better (p<0.001). The workers with higher body mass index regarded their health status worse, in four dimensions: "Physical Functioning" (p = 0.001), "Role-Physical" (p = 0.013), "General Health" (p<0.001) and "Role-Emotional" (p = 0.05). According to the subjective perception of health and measurable parameters of health status of workers proved to be insufficient. Poor physical health can lead indirectly to psychological problems, which may lower the quality of the work and can lead to high turn-over. .

  10. 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…

  11. A Survey of Adolescent and Post-Adolescent Cerebral Palsied Individuals Toward Ambulation.

    ERIC Educational Resources Information Center

    Ottman, Ronald A.

    Attitudes toward their ambulatory status of two groups of cerebral palsied (50 wheelchair status and 54 crutches and braces status) adolescents and young adults were compared. Analysis of questionnaire and demographic survey responses indicated that the wheelchair group viewed ambulation with crutches and braces in a more favorable light than did…

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

    ERIC Educational Resources Information Center

    Slater, Alan

    2017-01-01

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

  13. Factors associated with utilization of motorcycle ambulances by pregnant women in rural eastern Uganda: a cross-sectional study.

    PubMed

    Ssebunya, Rogers; Matovu, Joseph K B

    2016-03-03

    Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda. This was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool. Of the 391 women, 189 (48.3%) reported that they had ever utilized motorcycle ambulances. Of these, 94.7% were currently married or living together with a partner while 50.8% earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95% CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95% CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95% CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95% CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances

  14. The association between ambulance hospital turnaround times and patient acuity, destination hospital, and time of day.

    PubMed

    Vandeventer, Steve; Studnek, Jonathan R; Garrett, John S; Ward, Steven R; Staley, Kevin; Blackwell, Tom

    2011-01-01

    The availability of ambulances to respond to emergency calls is related to their ability to return to service from the hospital. Extended hospital turnaround times decrease the number of available unit hours ambulances are deployed, which in turn can increase coverage costs or sacrifice coverage. To determine whether ambulance turnaround times were associated with patient acuity, destination hospital, and time of day. This retrospective analysis of ambulance hospital turnaround times utilized 12 months of data from a single, countywide, metropolitan emergency medical services (EMS) service. Turnaround time was defined as the interval between the time of ambulance arrival at the hospital and the time the ambulance became available to respond to another call. Independent variables included patient acuity (low [BLS nonemergency transport], medium [ALS care and nonemergency transport], and high [ALS care and emergency transport]), destination hospital (seven regional hospitals), and time of day (one-hour intervals). Data analysis consisted of descriptive statistics, t-tests, and linear regression. Of the 61,094 patient transports, the mean turnaround time was 35.6 minutes (standard deviation [SD] = 16.5). Turnaround time was significantly associated with patient acuity (p < 0.001). High-acuity calls had a mean turnaround time of 52.5 minutes (SD = 21.5), whereas moderate-acuity and low-acuity calls had mean turnaround times of 42.0 minutes (SD = 16.4) and 32.5 minutes (SD = 14.4), respectively. A statistically significant relationship between destination hospital and turnaround time was found, with the differences in means ranging from 30 seconds to 8 minutes. Similarly, time of day was associated with turnaround time, with the longest turnaround times occurring between 0600 and 1500 hours. This study demonstrated that patient acuity, destination hospital, and time of day were associated with variation in ambulance turnaround times. Research describing other system

  15. 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

  16. Tissue plasminogen activator (rt-PA) in acute ischemic stroke: Outcomes associated with ambulation.

    PubMed

    Lawson, T R; Brown, I E; Westerkam, D L; Blackhurst, D W; Sternberg, S; Leacock, R; Nathaniel, T I

    2015-01-01

    Several clinical trials have highlighted general favorable outcomes of intravenous tissue type plasminogen activator (rt-PA) in acute ischemic stroke using different measures including, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Findings from most of these measures indicate that the benefits of rt-PA are time dependent, thus, supporting intensive efforts to fast-track hospital thrombolytic treatment in patients with stroke. Despite the widespread benefits of rt-PA, the effectiveness of this therapy on specific functions such as ambulatory performance of the recovering stroke patient is not fully investigated. We aim to investigate this issue in the current study. We analyzed data from a retrospective cohort of acute ischemic stroke patients admitted to Greenville Health System (GHS) between 2010-2013. We identified patients who received rt-PA within a 4.5 hour time frame following the onset of acute ischemic stroke symptoms. Our analysis compared ambulatory variables and hospital-level characteristics in proportions of patients receiving rt-PA with those not receiving rt-PA. This analysis determined whether early treatment with rt-PA is associated with favorable changes in ambulatory status from admission to discharge following acute ischemic stroke. Among 663 patients with ischemic stroke who were eligible to receive rt-PA, 241 patients received rt-PA and 422 patients did not due to several risk factors. We found a statistically significant difference (P < 0.001) for changes in ambulation status from hospital admission to discharge between patients receiving rt-PA and patients who did not receive rt-PA. Among patients who received rt-PA, 27.8% improved in their ambulation status, 41.9% saw no change in their ambulation status, 0.4% worsened in their ambulation status, and 29.9% were unable to be determined. Of the patients who did not receive rt-PA, 20.1% improved in their ambulation status, 61.8% saw no change in their

  17. Potential Exposure to Ebola Virus from Body Fluids due to Ambulance Compartment Permeability in Sierra Leone.

    PubMed

    Casey, Megan L; Nguyen, Duong T; Idriss, Barrie; Bennett, Sarah; Dunn, Angela; Martin, Stephen

    2015-12-01

    Prehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control. An ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance. A convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed. Many vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a

  18. Intuitive control of a powered prosthetic leg during ambulation: a randomized clinical trial.

    PubMed

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

    2015-06-09

    Some patients with lower leg amputations may be candidates for motorized prosthetic limbs. Optimal control of such devices requires accurate classification of the patient's ambulation mode (eg, on level ground or ascending stairs) and natural transitions between different ambulation modes. To determine the effect of including electromyographic (EMG) data and historical information from prior gait strides in a real-time control system for a powered prosthetic leg capable of level-ground walking, stair ascent and descent, ramp ascent and descent, and natural transitions between these ambulation modes. Blinded, randomized crossover clinical trial conducted between August 2012 and November 2013 in a research laboratory at the Rehabilitation Institute of Chicago. Participants were 7 patients with unilateral above-knee (n = 6) or knee-disarticulation (n = 1) amputations. All patients were capable of ambulation within their home and community using a passive prosthesis (ie, one that does not provide external power). Electrodes were placed over 9 residual limb muscles and EMG signals were recorded as patients ambulated and completed 20 circuit trials involving level-ground walking, ramp ascent and descent, and stair ascent and descent. Data were acquired simultaneously from 13 mechanical sensors embedded on the prosthesis. Two real-time pattern recognition algorithms, using either (1) mechanical sensor data alone or (2) mechanical sensor data in combination with EMG data and historical information from earlier in the gait cycle, were evaluated. The order in which patients used each configuration was randomized (1:1 blocked randomization) and double-blinded so patients and experimenters did not know which control configuration was being used. The main outcome of the study was classification error for each real-time control system. Classification error is defined as the percentage of steps incorrectly predicted by the control system. Including EMG signals and

  19. Grey areas: New Zealand ambulance personnel's experiences of challenging resuscitation decision-making.

    PubMed

    Anderson, Natalie Elizabeth; Gott, Merryn; Slark, Julia

    2017-09-04

    When faced with a patient in cardiac arrest, ambulance personnel must rapidly make complex decisions with limited information. Much of the research examining decisions to commence, continue, withhold or terminate resuscitation has used retrospective audits of registry data and clinical documentation. This study offers a provider-perspective which characterises uncertainty and highlights clinical, cognitive, emotional and physical demands associated with decision-making in the cardiac arrest context. Semi-structured interviews with a purposive sample of sixteen demographically diverse ambulance personnel, currently employed in a variety of emergency ambulance response roles across New Zealand. All participants readily identified clinical, cognitive, emotional and ethical challenges associated with resuscitation decision-making. Four main themes were identified: grey areas; exceptional cases; scene challenges; and personal responses. A lack of information or a mix of favourable and unfavourable prognostic factors created decision-making uncertainty or "grey areas". Exceptional cases such as first-encounters also increased uncertainty and presented emotional, ethical and clinical challenges. Cardiac arrest scenes were often challenging, and participants described managing bystander expectations and responses and logistical limitations including adverse environmental conditions, fatigue and task-overload, and crew resource management. This unique research presents a provider-perspective on the challenges faced by ambulance personnel deciding to commence, continue, withhold or terminate resuscitation efforts. Knowledge of personal values and strategies for managing personal responses appear to be central to certainty and coping. Simulated training should move beyond resuscitation task performance, to incorporate challenging elements and encourage ambulance personnel to explore their personal values, stressors and coping strategies. Copyright © 2017 Elsevier Ltd. All

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

    PubMed

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

    2009-12-01

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

  1. Urban sprawl and delayed ambulance arrival in the U.S.

    PubMed

    Trowbridge, Matthew J; Gurka, Matthew J; O'Connor, Robert E

    2009-11-01

    Minimizing emergency medical service (EMS) response time is a central objective of prehospital care, yet the potential influence of built environment features such as urban sprawl on EMS system performance is often not considered. This study measures the association between urban sprawl and EMS response time to test the hypothesis that features of sprawling development increase the probability of delayed ambulance arrival. In 2008, EMS response times for 43,424 motor-vehicle crashes were obtained from the Fatal Analysis Reporting System, a national census of crashes involving > or =1 fatality. Sprawl at each crash location was measured using a continuous county-level index previously developed by Ewing et al. The association between sprawl and the probability of a delayed ambulance arrival (> or =8 minutes) was then measured using generalized linear mixed modeling to account for correlation among crashes from the same county. Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival (p=0.03). This probability increases quadratically as the severity of sprawl increases while controlling for nighttime crash occurrence, road conditions, and presence of construction. For example, in sprawling counties (e.g., Fayette County GA), the probability of a delayed ambulance arrival for daytime crashes in dry conditions without construction was 69% (95% CI=66%, 72%) compared with 31% (95% CI=28%, 35%) in counties with prominent smart-growth characteristics (e.g., Delaware County PA). Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival following motor-vehicle crashes in the U.S. The results of this study suggest that promotion of community design and development that follows smart-growth principles and regulates urban sprawl may improve EMS performance and reliability.

  2. Trends in quetiapine use and non-fatal quetiapine-related ambulance attendances.

    PubMed

    Heilbronn, Cherie; Lloyd, Belinda; McElwee, Paul; Eade, Alan; Lubman, Dan I

    2013-07-01

    Concern about the non-medical use of quetiapine and related acute harms is growing. Case series cite quetiapine as a potential drug of misuse, while recent research questions its relative safety in comparison with other atypical antipsychotic preparations. This paper explores population-level patterns of quetiapine-related ambulance attendances over time, identifying associated risk factors and potential subpopulations at-risk of acute harms. A retrospective analysis of quetiapine-, olanzapine- and risperidone-related ambulance attendances in metropolitan Melbourne and prescription data in Victoria, Australia. Trends in ambulance attendance and prescription rates, attendance characteristics, and associated risk factors were explored from 2001 to 2010. Quetiapine was consistently associated with substantially higher rates of ambulance attendances relative to prescription availability than olanzapine or risperidone. Quetiapine prescribing rates increased at a significantly greater magnitude than olanzapine or risperidone, leading to substantial increases in quetiapine attendances by population. Quetiapine-related attendances were associated with concurrent heroin and opioid replacement therapy toxicity, history of heroin and alcohol misuse, mood disorders, low Glasgow Coma Scale and women. Trends in quetiapine-related ambulance attendances indicate rising community-level harms and greater harm relative to other atypical antipsychotics, while prescription patterns suggest increasing quetiapine availability. The association of quetiapine-related attendances with concurrent heroin and opioid replacement therapy toxicity as well as previous heroin and alcohol misuse suggest illicit and poly-drug users are a subpopulation at greater risk of quetiapine-related harms, consistent with emerging evidence of the use, misuse and diversion of quetiapine. © 2013 Turning Point Alcohol and Drug Centre, Eastern Health. Drug and Alcohol Review © 2013 Australasian Professional

  3. Inappropriate use of ambulance services by elderly patients with less urgent medical needs.

    PubMed

    Horibata, Ken; Takemura, Yousuke

    2015-02-01

    Elderly patients with less urgent medical needs represent a high proportion of all emergency patients in Japan; this trend is gradually increasing, presenting a burden on the emergency medical system. To design effective interventions, it is important to understand the basic characteristics of emergency service use. For elderly Japanese patients, there is currently no detailed report on less urgent cases (LUC), or those cases that could be diagnosed by primary care physicians. Since there is a need for a timely reporting of detailed LUC data, we used data of 2004-2006 from an immediately available database at the Yao Tokushukai General Hospital. With a focus on LUC, we analyzed 7,800 cases of elderly patients, aged over 65 years, who were transported via ambulance to a secondary emergency hospital in Osaka. Of these, 3,354 patients (43.0%) were classified as having initial emergencies and were given outpatient care in the emergency department, and 1,544 patients (19.8%) were LUC, in which 541 subjects (6.9%) may have used ambulance services somewhat inappropriately owing to a lack of alternate transportation. In the remaining 1,003 patients, ambulance use could have been avoided if primary care clinics were available at night and during holidays. We therefore focus on three important points: awareness-raising activities to prevent inappropriate ambulance use, strengthening of transport services to healthcare facilities, and expanding primary care clinic office hours. This study is the first detailed report on the use of ambulance services in Japan by elderly patients with less urgent medical needs.

  4. Detection and analysis of Staphylococcus aureus isolates found in ambulances in the Chicago metropolitan area.

    PubMed

    Rago, James V; Buhs, Lieutenant Keith; Makarovaite, Viktorija; Patel, Esha; Pomeroy, Melissa; Yasmine, Christian

    2012-04-01

    Given the frequency with which many different strains of Staphylococcus aureus are found in various prehospital settings, this study sought to characterize S aureus isolates taken from one such environment. The objectives were to determine the frequency of S aureus in front-line, advanced life support (ALS) ambulances throughout the Chicago metropolitan area, and to generate antibiograms (antibiotic resistance profiles) for each S aureus isolate using 8 clinically relevant antibiotics. Samples were obtained from 26 sites in 71 ambulances from 34 different Chicago-area municipalities. Selected colonies that demonstrated a growth pattern consistent with that of S aureus were subjected to a latex agglutination test specific for S aureus. Antibiograms and genetic analyses were performed on all latex agglutination test-positive isolates. At least one S aureus isolate was found in approximately 69% of all ambulances in the study. Of all isolates detected, 77% showed resistance to at least one antibiotic, and 34% displayed resistance to 2 or more antibiotics. Some level of oxacillin resistance was found in 21% of isolates; however, only slightly more than half of these oxacillin-resistant isolates were found to carry the methicillin-resistant S aureus-specific SCCmec cassette. Some 12% of all isolates were ultimately determined to be methicillin-resistant S aureus, whereas the remaining 88% were methicillin-sensitive S aureus with varying antibiograms. Antibiotic resistance appears to be prevalent in S aureus isolates detected in Chicago area ALS ambulances. Given the ease with which S aureus can survive on inanimate surfaces and exchange antibiotic resistance elements, a conscientious approach to the application of existing cleaning techniques, especially in key ambulance sites, is needed. Future work will include further characterizing isolates using multiple techniques, as well as follow-up studies with interested municipalities. Copyright © 2012 Association for

  5. Impact of first-stage ambulation on mode of delivery among women with epidural analgesia.

    PubMed

    Roberts, Christine L; Algert, Charles S; Olive, Emily

    2004-12-01

    New techniques for administering epidural analgesia allow increased mobility for labouring women with epidurals. To determine the effect of ambulation or upright positions in the first stage of labour among women with epidural analgesia on mode of delivery and other maternal and infant outcomes. We undertook a systematic review and meta-analysis of randomised controlled trials (RCT) of ambulation or upright positions versus recumbency in the first stage of labour among women with effective first-stage epidural analgesia in an uncomplicated pregnancy. Trials were identified by searching Medline, Embase and CINAHL databases and the Cochrane Trials Register to March 2004. Trial eligibility and outcomes were prespecified. Group tabular data were obtained for each trial and analysed using meta-analytic techniques. There were five eligible RCT, with a total of 1161 women. There was no statistically significant difference in the mode of delivery when women with an epidural ambulated in the first stage of labour compared with those who remained recumbent: instrumental delivery (relative risk (RR) = 1.16, 95% confidence interval (CI) 0.93-1.44) and Caesarean section (RR = 0.91, 95% CI 0.70-1.19). There were no significant differences between the groups in use of oxytocin augmentation, the duration of labour, satisfaction with analgesia or Apgar scores. There were no apparent adverse effects of ambulation, but data were reported by only a few trials. Although ambulation in the first stage of labour for women with epidural analgesia provided no clear benefit to delivery outcomes or satisfaction with analgesia, neither were there are any obvious harms.

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

    PubMed

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

    2012-08-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-10-01

    Objective. Spinal cord injury (SCI) often leaves affected individuals unable to ambulate. Electroencephalogram (EEG) based brain-computer interface (BCI) controlled lower extremity prostheses may restore intuitive and able-body-like ambulation after SCI. To test its feasibility, the authors developed and tested a novel EEG-based, data-driven BCI system for intuitive and self-paced control of the ambulation of an avatar within a virtual reality environment (VRE). Approach. Eight able-bodied subjects and one with SCI underwent the following 10-min training session: subjects alternated between idling and walking kinaesthetic motor imageries (KMI) while their EEG were recorded and analysed to generate subject-specific decoding models. Subjects then performed a goal-oriented online task, repeated over five sessions, in which they utilized the KMI to control the linear ambulation of an avatar and make ten sequential stops at designated points within the VRE. Main results. The average offline training performance across subjects was 77.2±11.0%, ranging from 64.3% (p = 0.001 76) to 94.5% (p = 6.26×10-23), with chance performance being 50%. The average online performance was 8.5±1.1 (out of 10) successful stops and 303±53 s completion time (perfect = 211 s). All subjects achieved performances significantly different than those of random walk (p < 0.05) in 44 of the 45 online sessions. Significance. By using a data-driven machine learning approach to decode users’ KMI, this BCI-VRE system enabled intuitive and purposeful self-paced control of ambulation after only 10 minutes training. The ability to achieve such BCI control with minimal training indicates that the implementation of future BCI-lower extremity prosthesis systems may be feasible.

  8. Army Air Ambulance Blood Product Program in the Combat Zone and Challenges to Best Practices.

    PubMed

    Powell-Dunford, Nicole; Quesada, Jose F; Gross, Kirby R; Shackelford, Stacy A

    2016-08-01

    Identify challenges and best practices in the development of an austere air ambulance transfusion program. A search of PubMed using combinations of the key terms 'prehospital,' 'blood product,' 'red blood cells,' 'damage control resuscitation,' 'transfusion,' 'air ambulance,' 'medical evacuation,' and 'medevac' yielded 196 articles for further analysis, with 14 articles suitable for addressing the background of prehospital transfusion within a helicopter. Retrospective analysis of unclassified briefs, after action reports, and procedures was also undertaken along with interview of subject matter experts. The initial series of 15 transfusions were discussed telephonically among flight crew, trauma surgeons, and lab specialists. Review of Joint Theater System data was readily available for 84 U.S. Army air ambulance transfusions between May-December 2012, with December marking the redeployment of the 25(th) Combat Aviation Brigade. Standardized implementation enabled safe blood product administration for 84 causalities from May-December 2012 without blood product shortage, expiration, or transfusion reaction. Challenges included developing transfusion competency, achieving high quality blood support, countering the potential for anti-U.S. sentiment, and diversity in coalition transfusion practices. Blood product administration aboard the air ambulance is logistically complex, requiring blood bank integration. Repetitive training enabled emergency medical technicians (EMTs) with basic medical training to safely perform transfusion in accordance with clinical operating guidelines. In the austere environment, logistic factors are significant challenges and political sensitivities are important considerations. Best practices may facilitate new en route transfusion programs. Powell-Dunford N, Quesada JF, Gross KR, Shackelford SA. Army air ambulance blood product program in the combat zone and challenges to best practices. Aerosp Med Hum Perform. 2016; 87(8):728-734.

  9. 21 CFR 1309.42 - Certificate of registration; denial of registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...; denial of registration. (a) The Administrator shall issue a Certificate of Registration (DEA Form 511) to..., shall hold a hearing on the application pursuant to § 1309.51. (b) The Certificate of Registration...

  10. 21 CFR 1301.35 - Certificate of registration; denial of registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... registration. (a) The Administrator shall issue a Certificate of Registration (DEA Form 223) to an applicant if... Federal Register. (c) The Certificate of Registration (DEA Form 223) shall contain the name, address,...

  11. Petition for Rulemaking to Evaluate Synergestic Effects of Pesticides during Registration and Registration Review

    EPA Pesticide Factsheets

    This petition from the Center for Biological Diversity asks that the Agency require all applicants and registrants to provide data on the potential synergistic effects of pesticides during the registration and registration review processes.

  12. 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.

  13. 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. © 2012 APJPH.

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

    PubMed

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

    2009-09-01

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

  15. Registration of interferometric SAR images

    NASA Technical Reports Server (NTRS)

    Lin, Qian; Vesecky, John F.; Zebker, Howard A.

    1992-01-01

    Interferometric synthetic aperture radar (INSAR) is a new way of performing topography mapping. Among the factors critical to mapping accuracy is the registration of the complex SAR images from repeated orbits. A new algorithm for registering interferometric SAR images is presented. A new figure of merit, the average fluctuation function of the phase difference image, is proposed to evaluate the fringe pattern quality. The process of adjusting the registration parameters according to the fringe pattern quality is optimized through a downhill simplex minimization algorithm. The results of applying the proposed algorithm to register two pairs of Seasat SAR images with a short baseline (75 m) and a long baseline (500 m) are shown. It is found that the average fluctuation function is a very stable measure of fringe pattern quality allowing very accurate registration.

  16. Pesticide Registration Manual: Chapter 10 - Data Compensation Requirements

    EPA Pesticide Factsheets

    This chapter provides information about data compensation requirements, procedures, and obligations when submitting an application for registration, amended registration, reregistration or registration review.

  17. Contacts in the Office of Pesticide Programs, Registration Division

    EPA Pesticide Factsheets

    The Registration Division (RD) is responsible product registrations, amendments, registrations, tolerances, experimental use permits, and emergency exemptions for conventional chemical pesticides. Find contacts in this division.

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

    PubMed Central

    2012-01-01

    Background Ambulance personnel play an essential role in the ‘Chain of Survival’. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island. Methods The Basic Life Support (BLS) and Automated External Defibrillator (AED) skills of the ambulance personnel were tested in a simulated cardiac arrest. Points were given according to a scoring sheet. One sample t test was used to analyze the deviation from optimal care according to the 2005 guidelines. After each assessment, individual feedback was given. Results On 3 consecutive days, we assessed the individual EMS teams responding to OHCA on the island. Overall, 70% of the maximal points were achieved. The hands-off ratio was 40%. Correct compression/ventilation ratio (30:2) was used by 80%. A mean compression depth of 40–50 mm was achieved by 55% and the mean compression depth was 42 mm (SD 7 mm). The mean compression rate was 123 per min (SD 15/min). The mean tidal volume was 746 ml (SD 221 ml). Only the mean tidal volume deviated significantly from the recommended (p = 0.01). During the rhythm analysis, 65% did not perform any visual or verbal safety check. Conclusion The EMS providers achieved 70% of the maximal points. Tidal volumes were larger than recommended when mask ventilation was applied. Chest compression depth was optimally performed by 55% of the staff. Defibrillation safety checks were not performed in 65% of EMS providers. PMID:22569089

  19. Description of the ambulance services participating in the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry.

    PubMed

    Beck, Ben; Bray, Janet E; Smith, Karen; Walker, Tony; Grantham, Hugh; Hein, Cindy; Thorrowgood, Melanie; Smith, Anthony; Inoue, Madoka; Smith, Tony; Dicker, Bridget; Swain, Andy; Bosley, Emma; Pemberton, Katherine; McKay, Michael; Johnston-Leek, Malcolm; Cameron, Peter; Perkins, Gavin D; Finn, Judith

    2016-12-01

    The present study aimed to describe and examine similarities and differences in the current service provision and resuscitation protocols of the ambulance services participating in the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest (OHCA) Epistry. Understanding these similarities and differences is important in identifying ambulance service factors that might explain regional variation in survival of OHCA in the Aus-ROC Epistry. A structured questionnaire was completed by each of the ambulance services participating in the Aus-ROC Epistry. These ambulance services were SA Ambulance Service, Ambulance Victoria, St John Ambulance Western Australia, Queensland Ambulance Service, St John Ambulance NT, St John New Zealand and Wellington Free Ambulance. The survey aimed to describe ambulance service and dispatch characteristics, resuscitation protocols and details of cardiac arrest registries. We observed similarities between services with respect to the treatment of OHCA and dispatch systems. Differences between services were observed in the serviced population; the proportion of paramedics with basic life support, advanced life support or intensive care training skills; the number of OHCA cases attended; guidelines related to withholding or terminating resuscitation attempts; and the variables that might be used to define 'attempted resuscitation'. All seven participating ambulance services were noted to have existing OHCA registries. There is marked variation between ambulance services currently participating in the Aus-ROC Australian and New Zealand OHCA Epistry with respect to workforce characteristics and key variable definitions. This variation between ambulance services might account for a proportion of the regional variation in survival of OHCA. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  20. 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

    2017-05-01

    Emergency ambulance calls represent one of the routes of emergency hospital admissions from care homes. We aimed to describe the pattern of ambulance call rates from care homes and identify factors predicting those homes calling for an ambulance most frequently. We obtained data from South Western Ambulance Service NHS Foundation Trust on 3138 ambulance calls relating to people aged 65 and over from care homes in the Torbay region between 1 April 2012 and 31 July 2013. We supplemented this with data from the Care Quality Commission (CQC) website on home characteristics and outcomes of CQC inspections. We used descriptive statistics to identify variation in ambulance call rates for residential and nursing homes and fitted negative binomial regression models to determine if call rates were predicted by home type (nursing versus residential), the five standards in the CQC reports, dementia care status or travel time to hospital. One hundred and forty-six homes (119 residential and 27 nursing) were included in the analysis. The number of calls made ranged from 1 to 99. The median number (IQR; range) of calls per resident per year was 0.51 (0.21-0.89; 0.03-2.45). Nursing homes had a lower call rate than residential homes [adjusted rate ratio (ARR) 0.29; 95% CI: 0.22-0.40; P < 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. © 2016 John Wiley & Sons Ltd.

  1. USDA registration and rectification requirements

    NASA Technical Reports Server (NTRS)

    Allen, R.

    1982-01-01

    Some of the requirements of the United States Department of Agriculture for accuracy of aerospace acquired data, and specifically, requirements for registration and rectification of remotely sensed data are discussed. Particular attention is given to foreign and domestic crop estimation and forecasting, forestry information applications, and rangeland condition evaluations.

  2. ACIR: automatic cochlea image registration

    NASA Astrophysics Data System (ADS)

    Al-Dhamari, Ibraheem; Bauer, Sabine; Paulus, Dietrich; Lissek, Friedrich; Jacob, Roland

    2017-02-01

    Efficient Cochlear Implant (CI) surgery requires prior knowledge of the cochlea's size and its characteristics. This information helps to select suitable implants for different patients. To get these measurements, a segmentation method of cochlea medical images is needed. An important pre-processing step for good cochlea segmentation involves efficient image registration. The cochlea's small size and complex structure, in addition to the different resolutions and head positions during imaging, reveals a big challenge for the automated registration of the different image modalities. In this paper, an Automatic Cochlea Image Registration (ACIR) method for multi- modal human cochlea images is proposed. This method is based on using small areas that have clear structures from both input images instead of registering the complete image. It uses the Adaptive Stochastic Gradient Descent Optimizer (ASGD) and Mattes's Mutual Information metric (MMI) to estimate 3D rigid transform parameters. The use of state of the art medical image registration optimizers published over the last two years are studied and compared quantitatively using the standard Dice Similarity Coefficient (DSC). ACIR requires only 4.86 seconds on average to align cochlea images automatically and to put all the modalities in the same spatial locations without human interference. The source code is based on the tool elastix and is provided for free as a 3D Slicer plugin. Another contribution of this work is a proposed public cochlea standard dataset which can be downloaded for free from a public XNAT server.

  3. Multiple Kernel Point Set Registration.

    PubMed

    Nguyen, Thanh Minh; Wu, Q M Jonathan

    2015-12-22

    The finite Gaussian mixture model with kernel correlation is a flexible tool that has recently received attention for point set registration. While there are many algorithms for point set registration presented in the literature, an important issue arising from these studies concerns the mapping of data with nonlinear relationships and the ability to select a suitable kernel. Kernel selection is crucial for effective point set registration. We focus here on multiple kernel point set registration. We make several contributions in this paper. First, each observation is modeled using the Student's t-distribution, which is heavily tailed and more robust than the Gaussian distribution. Second, by automatically adjusting the kernel weights, the proposed method allows us to prune the ineffective kernels. This makes the choice of kernels less crucial. After parameter learning, the kernel saliencies of the irrelevant kernels go to zero. Thus, the choice of kernels is less crucial and it is easy to include other kinds of kernels. Finally, we show empirically that our model outperforms state-of-the-art methods recently proposed in the literature.

  4. Multiple Kernel Point Set Registration.

    PubMed

    Nguyen, Thanh Minh; Wu, Q M Jonathan

    2016-06-01

    The finite Gaussian mixture model with kernel correlation is a flexible tool that has recently received attention for point set registration. While there are many algorithms for point set registration presented in the literature, an important issue arising from these studies concerns the mapping of data with nonlinear relationships and the ability to select a suitable kernel. Kernel selection is crucial for effective point set registration. We focus here on multiple kernel point set registration. We make several contributions in this paper. First, each observation is modeled using the Student's t-distribution, which is heavily tailed and more robust than the Gaussian distribution. Second, by automatically adjusting the kernel weights, the proposed method allows us to prune the ineffective kernels. This makes the choice of kernels less crucial. After parameter learning, the kernel saliencies of the irrelevant kernels go to zero. Thus, the choice of kernels is less crucial and it is easy to include other kinds of kernels. Finally, we show empirically that our model outperforms state-of-the-art methods recently proposed in the literature.

  5. Fuels Registration, Reporting, and Compliance Help

    EPA Pesticide Factsheets

    Information about the requirements for registration and health effects testing of new fuels or fuel additives and mandatory registration for fuels reporting and about mandatory reporting forms for parties regulated under EPA fuel programs.

  6. Registration of video sequences from multiple sensors

    NASA Technical Reports Server (NTRS)

    Sharma, Ravi K.; Pavel, Misha

    1997-01-01

    In this paper, we describe an approach for registration of video sequences from a suite of multiple sensors including television, infrared and radar. Video sequences generated by these sensors may contain abrupt changes in local contrast and inconsistent image features, which pose additional difficulties for registration. Our approach to registration addresses the difficulties caused by using multiple sensors. We use a representation for registration that is invariant to local contrast changes, followed by smoothing of the resulting error measure used for registration, for robust estimation of registration parameters. We use an iterative procedure to reduce the effect of inconsistent features. Finally, we describe a method that uses same-sensor registration to aide in performing registration of sequences of video frames across multiple sensors.

  7. Focus Meetings for Pesticide Registration Review

    EPA Pesticide Factsheets

    Focus meetings with affected registrants and possibly other stakeholders are based around the information needs identified by the EPA chemical review team and management for consideration during our registration reevaluation of a pesticide.

  8. 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.

  9. 14 CFR 47.3 - Registration required.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Registration required. 47.3 Section 47.3... REGISTRATION General § 47.3 Registration required. (a) An aircraft may be registered under 49 U.S.C. 44103 only... eligible for registration under 49 U.S.C. 44101-44104, unless the aircraft— (1) Has been registered by...

  10. 14 CFR 47.3 - Registration required.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Registration required. 47.3 Section 47.3... REGISTRATION General § 47.3 Registration required. (a) An aircraft may be registered under 49 U.S.C. 44103 only... person may operate an aircraft that is eligible for registration under 49 U.S.C. 44101-44104, unless...

  11. 14 CFR 47.3 - Registration required.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Registration required. 47.3 Section 47.3... REGISTRATION General § 47.3 Registration required. (a) An aircraft may be registered under 49 U.S.C. 44103 only... person may operate an aircraft that is eligible for registration under 49 U.S.C. 44101-44104, unless...

  12. 14 CFR 47.3 - Registration required.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Registration required. 47.3 Section 47.3... REGISTRATION General § 47.3 Registration required. (a) An aircraft may be registered under 49 U.S.C. 44103 only... person may operate an aircraft that is eligible for registration under 49 U.S.C. 44101-44104, unless...

  13. 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

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

    NASA Astrophysics Data System (ADS)

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

    2011-12-01

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

  15. 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.

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

    PubMed

    van Bergen, Leo

    2010-01-01

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

  17. 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.

  18. 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.

  19. 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

  20. 16 CFR 1130.8 - Requirements for Web site registration or alternative e-mail registration.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Requirements for Web site registration or... PRODUCTS § 1130.8 Requirements for Web site registration or alternative e-mail registration. (a) Link to registration page. The manufacturer's Web site, or other Web site established for the purpose of...

  1. 16 CFR 1130.8 - Requirements for Web site registration or alternative e-mail registration.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Requirements for Web site registration or... PRODUCTS (Eff. June 28, 2010) § 1130.8 Requirements for Web site registration or alternative e-mail registration. (a) Link to registration page. The manufacturer's Web site, or other Web site established for...

  2. 16 CFR 1130.7 - Requirements for Web site registration or alternative e-mail registration.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Requirements for Web site registration or... PRODUCTS § 1130.7 Requirements for Web site registration or alternative e-mail registration. (a) Link to registration page. The manufacturer's Web site, or other Web site established for the purpose of...

  3. 16 CFR 1130.8 - Requirements for Web site registration or alternative e-mail registration.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Requirements for Web site registration or... PRODUCTS § 1130.8 Requirements for Web site registration or alternative e-mail registration. (a) Link to registration page. The manufacturer's Web site, or other Web site established for the purpose of...

  4. 21 CFR 710.6 - Notification of registrant; cosmetic product establishment registration number.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 7 2014-04-01 2014-04-01 false Notification of registrant; cosmetic product... OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS VOLUNTARY REGISTRATION OF COSMETIC PRODUCT ESTABLISHMENTS § 710.6 Notification of registrant; cosmetic product establishment registration number. The...

  5. 21 CFR 710.6 - Notification of registrant; cosmetic product establishment registration number.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 7 2012-04-01 2012-04-01 false Notification of registrant; cosmetic product... OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS VOLUNTARY REGISTRATION OF COSMETIC PRODUCT ESTABLISHMENTS § 710.6 Notification of registrant; cosmetic product establishment registration number. The...

  6. 21 CFR 710.6 - Notification of registrant; cosmetic product establishment registration number.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 7 2013-04-01 2013-04-01 false Notification of registrant; cosmetic product... OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS VOLUNTARY REGISTRATION OF COSMETIC PRODUCT ESTABLISHMENTS § 710.6 Notification of registrant; cosmetic product establishment registration number. The...

  7. 21 CFR 710.6 - Notification of registrant; cosmetic product establishment registration number.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... permanent registration number will be assigned to each cosmetic product establishment registered in... establishment registration number. 710.6 Section 710.6 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT... ESTABLISHMENTS § 710.6 Notification of registrant; cosmetic product establishment registration number. The...

  8. 75 FR 58292 - Re-Registration and Renewal of Aircraft Registration; OMB Approval of Information Collection...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... Federal Aviation Administration 14 CFR Part 47 RIN 2120-AI89 Re-Registration and Renewal of Aircraft... requirements contained in the ``Re-Registration and Renewal of Aircraft Registration'' final rule. The final.... SUPPLEMENTARY INFORMATION: Background On July 20, 2010, the FAA published the final rule ``Re- Registration...

  9. 49 CFR 368.5 - Re-registration of certain carriers holding certificates of registration.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false Re-registration of certain carriers holding certificates of registration. 368.5 Section 368.5 Transportation Other Regulations Relating to Transportation... MUNICIPALITIES. § 368.5 Re-registration of certain carriers holding certificates of registration. (a) Each...

  10. 21 CFR 710.6 - Notification of registrant; cosmetic product establishment registration number.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 7 2010-04-01 2010-04-01 false Notification of registrant; cosmetic product... OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS VOLUNTARY REGISTRATION OF COSMETIC PRODUCT ESTABLISHMENTS § 710.6 Notification of registrant; cosmetic product establishment registration number. The...

  11. 21 CFR 1301.52 - Termination of registration; transfer of registration; distribution upon discontinuance of business.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... registration; distribution upon discontinuance of business. 1301.52 Section 1301.52 Food and Drugs DRUG... of registration; transfer of registration; distribution upon discontinuance of business. (a) Except... discontinues business or professional practice. Any registrant who ceases legal existence or discontinues...

  12. 29 CFR 500.145 - Registration determinations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Registration determinations. 500.145 Section 500.145 Labor... SEASONAL AGRICULTURAL WORKER PROTECTION Enforcement § 500.145 Registration determinations. Section 500.51... revoke, a Certificate of Registration (including a Farm Labor Contractor Employee Certificate...

  13. 17 CFR 48.3 - Registration required.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 17 Commodity and Securities Exchanges 1 2012-04-01 2012-04-01 false Registration required. 48.3 Section 48.3 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION REGISTRATION OF FOREIGN BOARDS OF TRADE § 48.3 Registration required. (a) Except as specified in this part, it shall...

  14. 14 CFR 380.62 - Registration applications.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Registration applications. 380.62 Section... PROCEEDINGS) SPECIAL REGULATIONS PUBLIC CHARTERS Registration of Foreign Charter Operators § 380.62 Registration applications. (a) To be registered under this subpart, a foreign charter operator shall file...

  15. 27 CFR 26.171 - Claimant registration.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Claimant registration. 26... Drawback on Eligible Articles From Puerto Rico § 26.171 Claimant registration. Any person filing claim for... as a nonbeverage domestic drawback claimant. Registration will be accomplished when the...

  16. 46 CFR 389.3 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 8 2012-10-01 2012-10-01 false Registration. 389.3 Section 389.3 Shipping MARITIME... VESSELS FOR TRANSPORTATION OF PLATFORM JACKETS § 389.3 Registration. In order to provide timely... notification as outlined in this section. (a) Registration of coastwise-qualified vessel for platform...

  17. 29 CFR 500.145 - Registration determinations.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 3 2014-07-01 2014-07-01 false Registration determinations. 500.145 Section 500.145 Labor... SEASONAL AGRICULTURAL WORKER PROTECTION Enforcement § 500.145 Registration determinations. Section 500.51... revoke, a Certificate of Registration (including a Farm Labor Contractor Employee Certificate...

  18. 32 CFR 935.150 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Registration. 935.150 Section 935.150 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE TERRITORIAL AND INSULAR REGULATIONS WAKE ISLAND CODE Registration and Island Permits § 935.150 Registration. (a) Each person who...

  19. 5 CFR 330.207 - Registration area.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Registration area. 330.207 Section 330..., SELECTION, AND PLACEMENT (GENERAL) Reemployment Priority List (RPL) § 330.207 Registration area. (a) Except as provided in paragraphs (b) through (e) of this section, RPL registration is limited to the...

  20. 32 CFR 1615.3 - Registration procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Registration procedures. 1615.3 Section 1615.3 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ADMINISTRATION OF REGISTRATION § 1615.3 Registration procedures. Persons required by selective service law and the...

  1. 18 CFR 390.1 - Electronic registration.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Electronic registration. 390.1 Section 390.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY PROCEDURAL RULES ELECTRONIC REGISTRATION § 390.1 Electronic registration. Any person...

  2. 17 CFR 48.5 - Registration procedures.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 17 Commodity and Securities Exchanges 1 2012-04-01 2012-04-01 false Registration procedures. 48.5 Section 48.5 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION REGISTRATION OF FOREIGN BOARDS OF TRADE § 48.5 Registration procedures. (a) A foreign board of trade seeking...

  3. 22 CFR 122.1 - Registration requirements.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Registration requirements. 122.1 Section 122.1 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS REGISTRATION OF MANUFACTURERS AND EXPORTERS § 122.1 Registration requirements. (a) Any person who engages in the United...

  4. 47 CFR 64.1195 - Registration requirement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 3 2012-10-01 2012-10-01 false Registration requirement. 64.1195 Section 64....1195 Registration requirement. (a) Applicability. A telecommunications carrier that will provide interstate telecommunications service shall file the registration information described in paragraph (b)...

  5. 14 CFR 380.62 - Registration applications.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Registration applications. 380.62 Section... PROCEEDINGS) SPECIAL REGULATIONS PUBLIC CHARTERS Registration of Foreign Charter Operators § 380.62 Registration applications. (a) To be registered under this subpart, a foreign charter operator shall file...

  6. 8 CFR 1244.17 - Annual registration.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Annual registration. 1244.17 Section 1244... REGULATIONS TEMPORARY PROTECTED STATUS FOR NATIONALS OF DESIGNATED STATES § 1244.17 Annual registration. (a... jurisdiction over their place of residence. Such registration will apply to nationals of those foreign...

  7. 31 CFR 346.2 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Registration. 346.2 Section 346.2 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... RETIREMENT BONDS § 346.2 Registration. (a) General. The registration of Individual Retirement Bonds...

  8. 32 CFR 935.150 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Registration. 935.150 Section 935.150 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE TERRITORIAL AND INSULAR REGULATIONS WAKE ISLAND CODE Registration and Island Permits § 935.150 Registration. (a) Each person who...

  9. 14 CFR 380.62 - Registration applications.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Registration applications. 380.62 Section... PROCEEDINGS) SPECIAL REGULATIONS PUBLIC CHARTERS Registration of Foreign Charter Operators § 380.62 Registration applications. (a) To be registered under this subpart, a foreign charter operator shall file...

  10. 9 CFR 320.5 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Registration. 320.5 Section 320.5... CERTIFICATION RECORDS, REGISTRATION, AND REPORTS § 320.5 Registration. (a) Except as provided in paragraph (c... therein upon said effective date. All information submitted shall be current and correct. The...

  11. 46 CFR 389.3 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Registration. 389.3 Section 389.3 Shipping MARITIME... VESSELS FOR TRANSPORTATION OF PLATFORM JACKETS § 389.3 Registration. In order to provide timely... notification as outlined in this section. (a) Registration of coastwise-qualified vessel for platform...

  12. 27 CFR 24.52 - Dealer registration.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Dealer registration. 24.52... OF THE TREASURY LIQUORS WINE Administrative and Miscellaneous Provisions Dealer Registration and Recordkeeping § 24.52 Dealer registration. Every proprietor who sells or offers for sale any alcohol...

  13. 27 CFR 19.202 - Dealer registration.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Dealer registration. 19..., DEPARTMENT OF THE TREASURY LIQUORS DISTILLED SPIRITS PLANTS Dealer Registration and Recordkeeping § 19.202 Dealer registration. Every proprietor that sells or offers for sale any alcoholic product...

  14. 25 CFR 81.11 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Registration. 81.11 Section 81.11 Indians BUREAU OF... STATUTE § 81.11 Registration. (a) Only registered voters will be entitled to vote, and all determinations... member not residing on the reservation shall be accompanied by a preaddressed registration form (BIA...

  15. 8 CFR 244.17 - Annual registration.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Annual registration. 244.17 Section 244.17... FOR NATIONALS OF DESIGNATED STATES § 244.17 Annual registration. (a) Aliens granted Temporary... of residence. Such registration will apply to nationals of those foreign states designated...

  16. 29 CFR 500.145 - Registration determinations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 3 2012-07-01 2012-07-01 false Registration determinations. 500.145 Section 500.145 Labor... SEASONAL AGRICULTURAL WORKER PROTECTION Enforcement § 500.145 Registration determinations. Section 500.51... revoke, a Certificate of Registration (including a Farm Labor Contractor Employee Certificate...

  17. 8 CFR 1244.17 - Annual registration.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Annual registration. 1244.17 Section 1244... REGULATIONS TEMPORARY PROTECTED STATUS FOR NATIONALS OF DESIGNATED STATES § 1244.17 Annual registration. (a... jurisdiction over their place of residence. Such registration will apply to nationals of those foreign...

  18. 27 CFR 447.31 - Registration requirement.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Registration requirement. 447.31 Section 447.31 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS... IMPLEMENTS OF WAR Registration § 447.31 Registration requirement. Persons engaged in the business, in...

  19. 25 CFR 81.11 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true Registration. 81.11 Section 81.11 Indians BUREAU OF INDIAN....11 Registration. (a) Only registered voters will be entitled to vote, and all determinations of the... residing on the reservation shall be accompanied by a preaddressed registration form (BIA Form 8302)...

  20. 31 CFR 346.2 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Registration. 346.2 Section 346.2 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... RETIREMENT BONDS § 346.2 Registration. (a) General. The registration of Individual Retirement Bonds...

  1. 32 CFR 1615.3 - Registration procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Registration procedures. 1615.3 Section 1615.3 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ADMINISTRATION OF REGISTRATION § 1615.3 Registration procedures. Persons required by selective service law and the...

  2. 22 CFR 122.3 - Registration fees.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Registration fees. 122.3 Section 122.3 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS REGISTRATION OF MANUFACTURERS AND EXPORTERS § 122.3 Registration fees. (a) A person who is required to register must do so on an annual...

  3. 27 CFR 447.31 - Registration requirement.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Registration requirement. 447.31 Section 447.31 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS... IMPLEMENTS OF WAR Registration § 447.31 Registration requirement. Persons engaged in the business, in...

  4. 22 CFR 122.3 - Registration fees.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Registration fees. 122.3 Section 122.3 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS REGISTRATION OF MANUFACTURERS AND EXPORTERS § 122.3 Registration fees. (a) A person who is required to register must do so on an annual...

  5. 27 CFR 26.307 - Claimant registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Claimant registration. 26... Drawback on Eligible Articles From the Virgin Islands § 26.307 Claimant registration. Any person filing... must register annually as a nonbeverage domestic drawback claimant. Registration will be...

  6. 32 CFR 636.9 - Registration requirement.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Registration requirement. 636.9 Section 636.9... § 636.9 Registration requirement. In addition to the requirements of § 634.20 of this subchapter: (a... insurance will be required at the time of registration. (e) Vehicle safety inspections are not required...

  7. 27 CFR 26.171 - Claimant registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Claimant registration. 26... Drawback on Eligible Articles From Puerto Rico § 26.171 Claimant registration. Any person filing claim for... as a nonbeverage domestic drawback claimant. Registration will be accomplished when the...

  8. 49 CFR 107.503 - Registration statement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 2 2012-10-01 2012-10-01 false Registration statement. 107.503 Section 107.503... PROGRAM PROCEDURES Registration of Cargo Tank and Cargo Tank Motor Vehicle Manufacturers, Assemblers, Repairers, Inspectors, Testers, and Design Certifying Engineers § 107.503 Registration statement. (a)...

  9. 5 CFR 330.207 - Registration area.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Registration area. 330.207 Section 330..., SELECTION, AND PLACEMENT (GENERAL) Reemployment Priority List (RPL) § 330.207 Registration area. (a) Except as provided in paragraphs (b) through (e) of this section, RPL registration is limited to the...

  10. 50 CFR 600.1405 - Angler registration.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 10 2011-10-01 2011-10-01 false Angler registration. 600.1405 Section 600... United States § 600.1405 Angler registration. (a) Effective January 1, 2010, the requirements of this..., license or registration requirements; (7) Holds a commercial fishing license or permit issued by NMFS or...

  11. 32 CFR 935.150 - Registration.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Registration. 935.150 Section 935.150 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE TERRITORIAL AND INSULAR REGULATIONS WAKE ISLAND CODE Registration and Island Permits § 935.150 Registration. (a) Each person who...

  12. 27 CFR 19.202 - Dealer registration.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Dealer registration. 19..., DEPARTMENT OF THE TREASURY ALCOHOL DISTILLED SPIRITS PLANTS Dealer Registration and Recordkeeping § 19.202 Dealer registration. Every proprietor that sells or offers for sale any alcoholic product...

  13. 14 CFR 380.62 - Registration applications.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Registration applications. 380.62 Section... PROCEEDINGS) SPECIAL REGULATIONS PUBLIC CHARTERS Registration of Foreign Charter Operators § 380.62 Registration applications. (a) To be registered under this subpart, a foreign charter operator shall file...

  14. 17 CFR 48.3 - Registration required.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 17 Commodity and Securities Exchanges 1 2013-04-01 2013-04-01 false Registration required. 48.3 Section 48.3 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION REGISTRATION OF FOREIGN BOARDS OF TRADE § 48.3 Registration required. (a) Except as specified in this part, it shall...

  15. 27 CFR 24.52 - Dealer registration.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Dealer registration. 24.52... OF THE TREASURY ALCOHOL WINE Administrative and Miscellaneous Provisions Dealer Registration and Recordkeeping § 24.52 Dealer registration. Every proprietor who sells or offers for sale any alcohol...

  16. 5 CFR 330.207 - Registration area.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Registration area. 330.207 Section 330..., SELECTION, AND PLACEMENT (GENERAL) Reemployment Priority List (RPL) § 330.207 Registration area. (a) Except as provided in paragraphs (b) through (e) of this section, RPL registration is limited to the...

  17. 8 CFR 1244.17 - Annual registration.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Annual registration. 1244.17 Section 1244... REGULATIONS TEMPORARY PROTECTED STATUS FOR NATIONALS OF DESIGNATED STATES § 1244.17 Annual registration. (a... jurisdiction over their place of residence. Such registration will apply to nationals of those foreign...

  18. 9 CFR 320.5 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Registration. 320.5 Section 320.5... CERTIFICATION RECORDS, REGISTRATION, AND REPORTS § 320.5 Registration. (a) Except as provided in paragraph (c... therein upon said effective date. All information submitted shall be current and correct. The...

  19. 31 CFR 346.2 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Registration. 346.2 Section 346.2 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... RETIREMENT BONDS § 346.2 Registration. (a) General. The registration of Individual Retirement Bonds...

  20. 27 CFR 24.52 - Dealer registration.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Dealer registration. 24.52... OF THE TREASURY ALCOHOL WINE Administrative and Miscellaneous Provisions Dealer Registration and Recordkeeping § 24.52 Dealer registration. Every proprietor who sells or offers for sale any alcohol...

  1. 27 CFR 24.52 - Dealer registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Dealer registration. 24.52... OF THE TREASURY LIQUORS WINE Administrative and Miscellaneous Provisions Dealer Registration and Recordkeeping § 24.52 Dealer registration. Every proprietor who sells or offers for sale any alcohol...

  2. 40 CFR 68.160 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 16 2012-07-01 2012-07-01 false Registration. 68.160 Section 68.160... ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.160 Registration. (a) The owner or operator shall complete a single registration form and include it in the RMP. The form shall cover all...

  3. 27 CFR 447.31 - Registration requirement.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Registration requirement. 447.31 Section 447.31 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS... IMPLEMENTS OF WAR Registration § 447.31 Registration requirement. Persons engaged in the business, in...

  4. 32 CFR 935.150 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Registration. 935.150 Section 935.150 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE TERRITORIAL AND INSULAR REGULATIONS WAKE ISLAND CODE Registration and Island Permits § 935.150 Registration. (a) Each person who...

  5. 50 CFR 600.1405 - Angler registration.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Angler registration. 600.1405 Section 600... United States § 600.1405 Angler registration. (a) Effective January 1, 2010, the requirements of this..., license or registration requirements; (7) Holds a commercial fishing license or permit issued by NMFS or...

  6. 22 CFR 122.1 - Registration requirements.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Registration requirements. 122.1 Section 122.1 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS REGISTRATION OF MANUFACTURERS AND EXPORTERS § 122.1 Registration requirements. (a) Any person who engages in the United...

  7. 32 CFR 1615.3 - Registration procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Registration procedures. 1615.3 Section 1615.3 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ADMINISTRATION OF REGISTRATION § 1615.3 Registration procedures. Persons required by selective service law and the...

  8. 7 CFR 1219.102 - Registration.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Registration. 1219.102 Section 1219.102 Agriculture..., AND INFORMATION Referendum Procedures § 1219.102 Registration. An eligible producer or importer of... referendum under § 1219.104(b). Registration information shall be confidential under § 1219.108....

  9. 50 CFR 600.1405 - Angler registration.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Angler registration. 600.1405 Section 600... United States § 600.1405 Angler registration. (a) Effective January 1, 2010, the requirements of this..., license or registration requirements; (7) Holds a commercial fishing license or permit issued by NMFS or...

  10. 46 CFR 389.3 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Registration. 389.3 Section 389.3 Shipping MARITIME... VESSELS FOR TRANSPORTATION OF PLATFORM JACKETS § 389.3 Registration. In order to provide timely... notification as outlined in this section. (a) Registration of coastwise-qualified vessel for platform...

  11. 25 CFR 81.11 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Registration. 81.11 Section 81.11 Indians BUREAU OF... STATUTE § 81.11 Registration. (a) Only registered voters will be entitled to vote, and all determinations... member not residing on the reservation shall be accompanied by a preaddressed registration form (BIA...

  12. 29 CFR 500.145 - Registration determinations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 3 2013-07-01 2013-07-01 false Registration determinations. 500.145 Section 500.145 Labor... SEASONAL AGRICULTURAL WORKER PROTECTION Enforcement § 500.145 Registration determinations. Section 500.51... revoke, a Certificate of Registration (including a Farm Labor Contractor Employee Certificate...

  13. 27 CFR 26.171 - Claimant registration.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Claimant registration. 26... Drawback on Eligible Articles From Puerto Rico § 26.171 Claimant registration. Any person filing claim for... as a nonbeverage domestic drawback claimant. Registration will be accomplished when the...

  14. 27 CFR 26.307 - Claimant registration.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Claimant registration. 26... Drawback on Eligible Articles From the Virgin Islands § 26.307 Claimant registration. Any person filing... must register annually as a nonbeverage domestic drawback claimant. Registration will be...

  15. 8 CFR 1244.17 - Annual registration.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Annual registration. 1244.17 Section 1244... REGULATIONS TEMPORARY PROTECTED STATUS FOR NATIONALS OF DESIGNATED STATES § 1244.17 Annual registration. (a... jurisdiction over their place of residence. Such registration will apply to nationals of those foreign...

  16. 9 CFR 320.5 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Registration. 320.5 Section 320.5... CERTIFICATION RECORDS, REGISTRATION, AND REPORTS § 320.5 Registration. (a) Except as provided in paragraph (c... therein upon said effective date. All information submitted shall be current and correct. The...

  17. 32 CFR 1615.3 - Registration procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Registration procedures. 1615.3 Section 1615.3 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ADMINISTRATION OF REGISTRATION § 1615.3 Registration procedures. Persons required by selective service law and the...

  18. 8 CFR 244.17 - Annual registration.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Annual registration. 244.17 Section 244.17... FOR NATIONALS OF DESIGNATED STATES § 244.17 Annual registration. (a) Aliens granted Temporary... of residence. Such registration will apply to nationals of those foreign states designated...

  19. 8 CFR 1244.17 - Annual registration.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Annual registration. 1244.17 Section 1244... REGULATIONS TEMPORARY PROTECTED STATUS FOR NATIONALS OF DESIGNATED STATES § 1244.17 Annual registration. (a... jurisdiction over their place of residence. Such registration will apply to nationals of those foreign...

  20. 31 CFR 346.2 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Registration. 346.2 Section 346.2 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... RETIREMENT BONDS § 346.2 Registration. (a) General. The registration of Individual Retirement Bonds...

  1. 9 CFR 320.5 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Registration. 320.5 Section 320.5... CERTIFICATION RECORDS, REGISTRATION, AND REPORTS § 320.5 Registration. (a) Except as provided in paragraph (c... therein upon said effective date. All information submitted shall be current and correct. The...

  2. 18 CFR 390.1 - Electronic registration.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false Electronic registration. 390.1 Section 390.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY PROCEDURAL RULES ELECTRONIC REGISTRATION § 390.1 Electronic registration. Any person...

  3. 22 CFR 122.1 - Registration requirements.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Registration requirements. 122.1 Section 122.1 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS REGISTRATION OF MANUFACTURERS AND EXPORTERS § 122.1 Registration requirements. (a) Any person who engages in the United...

  4. 47 CFR 64.1195 - Registration requirement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Registration requirement. 64.1195 Section 64....1195 Registration requirement. (a) Applicability. A telecommunications carrier that will provide interstate telecommunications service shall file the registration information described in paragraph (b)...

  5. 32 CFR 636.9 - Registration requirement.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Registration requirement. 636.9 Section 636.9... § 636.9 Registration requirement. In addition to the requirements of § 634.20 of this subchapter: (a... insurance will be required at the time of registration. (e) Vehicle safety inspections are not required...

  6. 47 CFR 64.1195 - Registration requirement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 3 2011-10-01 2011-10-01 false Registration requirement. 64.1195 Section 64....1195 Registration requirement. (a) Applicability. A telecommunications carrier that will provide interstate telecommunications service shall file the registration information described in paragraph (b)...

  7. 32 CFR 1615.3 - Registration procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Registration procedures. 1615.3 Section 1615.3 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ADMINISTRATION OF REGISTRATION § 1615.3 Registration procedures. Persons required by selective service law and the...

  8. 40 CFR 68.160 - Registration.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 16 2014-07-01 2014-07-01 false Registration. 68.160 Section 68.160... ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.160 Registration. (a) The owner or operator shall complete a single registration form and include it in the RMP. The form shall cover all...

  9. 32 CFR 636.9 - Registration requirement.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Registration requirement. 636.9 Section 636.9... § 636.9 Registration requirement. In addition to the requirements of § 634.20 of this subchapter: (a... insurance will be required at the time of registration. (e) Vehicle safety inspections are not required...

  10. 27 CFR 19.202 - Dealer registration.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Dealer registration. 19..., DEPARTMENT OF THE TREASURY ALCOHOL DISTILLED SPIRITS PLANTS Dealer Registration and Recordkeeping § 19.202 Dealer registration. Every proprietor that sells or offers for sale any alcoholic product...

  11. 7 CFR 1219.102 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Registration. 1219.102 Section 1219.102 Agriculture..., AND INFORMATION Referendum Procedures § 1219.102 Registration. An eligible producer or importer of... referendum under § 1219.104(b). Registration information shall be confidential under § 1219.108....

  12. 17 CFR 48.5 - Registration procedures.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 17 Commodity and Securities Exchanges 1 2013-04-01 2013-04-01 false Registration procedures. 48.5 Section 48.5 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION REGISTRATION OF FOREIGN BOARDS OF TRADE § 48.5 Registration procedures. (a) A foreign board of trade seeking...

  13. 22 CFR 122.3 - Registration fees.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Registration fees. 122.3 Section 122.3 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS REGISTRATION OF MANUFACTURERS AND EXPORTERS § 122.3 Registration fees. (a) A person who is required to register must do so on an annual...

  14. 18 CFR 390.1 - Electronic registration.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Electronic registration. 390.1 Section 390.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY PROCEDURAL RULES ELECTRONIC REGISTRATION § 390.1 Electronic registration. Any person...

  15. 27 CFR 26.171 - Claimant registration.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Claimant registration. 26... Drawback on Eligible Articles From Puerto Rico § 26.171 Claimant registration. Any person filing claim for... as a nonbeverage domestic drawback claimant. Registration will be accomplished when the...

  16. 46 CFR 389.3 - Registration.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Registration. 389.3 Section 389.3 Shipping MARITIME... VESSELS FOR TRANSPORTATION OF PLATFORM JACKETS § 389.3 Registration. In order to provide timely... notification as outlined in this section. (a) Registration of coastwise-qualified vessel for platform...

  17. 25 CFR 81.11 - Registration.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false Registration. 81.11 Section 81.11 Indians BUREAU OF... STATUTE § 81.11 Registration. (a) Only registered voters will be entitled to vote, and all determinations... member not residing on the reservation shall be accompanied by a preaddressed registration form (BIA...

  18. 7 CFR 1219.102 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Registration. 1219.102 Section 1219.102 Agriculture..., AND INFORMATION Referendum Procedures § 1219.102 Registration. An eligible producer or importer of... referendum under § 1219.104(b). Registration information shall be confidential under § 1219.108....

  19. 27 CFR 26.307 - Claimant registration.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Claimant registration. 26... Drawback on Eligible Articles From the Virgin Islands § 26.307 Claimant registration. Any person filing... must register annually as a nonbeverage domestic drawback claimant. Registration will be...

  20. 32 CFR 935.150 - Registration.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Registration. 935.150 Section 935.150 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE TERRITORIAL AND INSULAR REGULATIONS WAKE ISLAND CODE Registration and Island Permits § 935.150 Registration. (a) Each person who...

  1. 22 CFR 122.3 - Registration fees.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Registration fees. 122.3 Section 122.3 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS REGISTRATION OF MANUFACTURERS AND EXPORTERS § 122.3 Registration fees. (a) A person who is required to register must do so on an annual...

  2. 22 CFR 122.1 - Registration requirements.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Registration requirements. 122.1 Section 122.1 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS REGISTRATION OF MANUFACTURERS AND EXPORTERS § 122.1 Registration requirements. (a) Any person who engages in the United...

  3. 47 CFR 64.1195 - Registration requirement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 3 2013-10-01 2013-10-01 false Registration requirement. 64.1195 Section 64....1195 Registration requirement. (a) Applicability. A telecommunications carrier that will provide interstate telecommunications service shall file the registration information described in paragraph (b)...

  4. 27 CFR 26.307 - Claimant registration.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Claimant registration. 26... Drawback on Eligible Articles From the Virgin Islands § 26.307 Claimant registration. Any person filing... must register annually as a nonbeverage domestic drawback claimant. Registration will be...

  5. 31 CFR 346.2 - Registration.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Registration. 346.2 Section 346.2 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... RETIREMENT BONDS § 346.2 Registration. (a) General. The registration of Individual Retirement Bonds...

  6. 27 CFR 447.31 - Registration requirement.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Registration requirement. 447.31 Section 447.31 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS... IMPLEMENTS OF WAR Registration § 447.31 Registration requirement. Persons engaged in the business, in...

  7. 27 CFR 19.50 - Dealer registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Dealer registration. 19.50... OF THE TREASURY LIQUORS DISTILLED SPIRITS PLANTS Dealer Registration and Recordkeeping § 19.50 Dealer registration. Every proprietor who sells or offers for sale any alcoholic product (distilled spirits, wines,...

  8. 27 CFR 19.202 - Dealer registration.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Dealer registration. 19..., DEPARTMENT OF THE TREASURY LIQUORS DISTILLED SPIRITS PLANTS Dealer Registration and Recordkeeping § 19.202 Dealer registration. Every proprietor that sells or offers for sale any alcoholic product...

  9. 25 CFR 81.11 - Registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Registration. 81.11 Section 81.11 Indians BUREAU OF... STATUTE § 81.11 Registration. (a) Only registered voters will be entitled to vote, and all determinations... member not residing on the reservation shall be accompanied by a preaddressed registration form (BIA...

  10. 32 CFR 636.9 - Registration requirement.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Registration requirement. 636.9 Section 636.9... § 636.9 Registration requirement. In addition to the requirements of § 634.20 of this subchapter: (a... insurance will be required at the time of registration. (e) Vehicle safety inspections are not required...

  11. 27 CFR 26.171 - Claimant registration.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Claimant registration. 26... Drawback on Eligible Articles From Puerto Rico § 26.171 Claimant registration. Any person filing claim for... as a nonbeverage domestic drawback claimant. Registration will be accomplished when the...

  12. 14 CFR 380.62 - Registration applications.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Registration applications. 380.62 Section... PROCEEDINGS) SPECIAL REGULATIONS PUBLIC CHARTERS Registration of Foreign Charter Operators § 380.62 Registration applications. (a) To be registered under this subpart, a foreign charter operator shall file...

  13. 27 CFR 24.52 - Dealer registration.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Dealer registration. 24.52... OF THE TREASURY LIQUORS WINE Administrative and Miscellaneous Provisions Dealer Registration and Recordkeeping § 24.52 Dealer registration. Every proprietor who sells or offers for sale any alcohol...

  14. 27 CFR 447.31 - Registration requirement.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Registration requirement. 447.31 Section 447.31 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS... IMPLEMENTS OF WAR Registration § 447.31 Registration requirement. Persons engaged in the business, in...

  15. 47 CFR 64.1195 - Registration requirement.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false Registration requirement. 64.1195 Section 64....1195 Registration requirement. (a) Applicability. A telecommunications carrier that will provide interstate telecommunications service shall file the registration information described in paragraph (b)...

  16. 29 CFR 500.145 - Registration determinations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 3 2011-07-01 2011-07-01 false Registration determinations. 500.145 Section 500.145 Labor... SEASONAL AGRICULTURAL WORKER PROTECTION Enforcement § 500.145 Registration determinations. Section 500.51... revoke, a Certificate of Registration (including a Farm Labor Contractor Employee Certificate...

  17. Clinical trial registration in oral health journals.

    PubMed

    Smaïl-Faugeron, V; Fron-Chabouis, H; Durieux, P

    2015-03-01

    Prospective registration of randomized controlled trials (RCTs) represents the best solution to reporting bias. The extent to which oral health journals have endorsed and complied with RCT registration is unknown. We identified journals publishing RCTs in dentistry, oral surgery, and medicine in the Journal Citation Reports. We classified journals into 3 groups: journals requiring or recommending trial registration, journals referring indirectly to registration, and journals providing no reference to registration. For the 5 journals with the highest 2012 impact factors in each group, we assessed whether RCTs with results published in 2013 had been registered. Of 78 journals examined, 32 (41%) required or recommended trial registration, 19 (24%) referred indirectly to registration, and 27 (35%) provided no reference to registration. We identified 317 RCTs with results published in the 15 selected journals in 2013. Overall, 73 (23%) were registered in a trial registry. Among those, 91% were registered retrospectively and 32% did not report trial registration in the published article. The proportion of trials registered was not significantly associated with editorial policies: 29% with results in journals that required or recommended registration, 15% in those that referred indirectly to registration, and 21% in those providing no reference to registration (P = 0.05). Less than one-quarter of RCTs with results published in a sample of oral health journals were registered with a public registry. Improvements are needed with respect to how journals inform and require their authors to register their trials. © International & American Associations for Dental Research.

  18. 14 CFR 47.15 - Registration number.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Registration number. 47.15 Section 47.15 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRCRAFT REGISTRATION General § 47.15 Registration number. (a) Number required. An applicant for aircraft...

  19. 14 CFR 47.3 - Registration required.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Registration required. 47.3 Section 47.3 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRCRAFT REGISTRATION General § 47.3 Registration required. (a) An aircraft may be registered under 49 U.S.C. 44103...

  20. 32 CFR 1602.20 - Registrant.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Registrant. 1602.20 Section 1602.20 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.20 Registrant. A registrant is a person registered under the Selective Service Law....

  1. 77 FR 51898 - Registration of Intermediaries

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-28

    ... Traders. Section 3.12-- Registration of Associated Persons of Futures Commission Merchants, Retail Foreign... traders. Section 3.12 generally sets forth the registration requirements for natural persons associated... registered FCM. As proposed, Sec. 3.11 pertaining to registration of floor brokers and floor...

  2. 18 CFR 390.1 - Electronic registration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Electronic registration. 390.1 Section 390.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY PROCEDURAL RULES ELECTRONIC REGISTRATION § 390.1 Electronic registration. Any person who...

  3. 18 CFR 390.1 - Electronic registration.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Electronic registration. 390.1 Section 390.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY PROCEDURAL RULES ELECTRONIC REGISTRATION § 390.1 Electronic registration. Any person who...

  4. 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.

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

    DTIC Science & Technology

    2009-10-01

    Assess the Energie Expenditure of Yoga Exercise. Medicine & Science in Sports & Exercise, 39 (5), Supplement, p S177. [6] Gallagher, K. I. FACSM...Monitors During Free-Living Conditions. Medicine & Science in Sports & Exercise, 39 (5), Supplement, p S183. [3] Malavolti, A., Pietrobelli, A...Science in Sports & Exercise, 39 (5), Supplement, p S178. Quality of Ambulant Measures of Distance, Speed, Load and Energy Consumption During

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

    PubMed Central

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

    2017-01-01

    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. Methods Data routinely collected by the Ghana NAS from 2004–2014 were described, including: patient demographics, reason for the call, response location, target destination, and ti1mes of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported. Results In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%–80% and 10%–57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described. Conclusion The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving

  7. 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

  8. 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

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

    DTIC Science & Technology

    2014-11-01

    Malsby, Victoria Chou, Robert T. Gerhardt, Kirby Gross, and Stacy Shackelford 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7...Analysis of Air Ambulance Blood Product Administration in Combat Operations Nicole Powell-Dunford , Jose F. Quesada , Robert F. Malsby , Victoria ...Center, Fort Bragg, NC; Kirby Gross, M.D., FACS, U.S. CENTCOM Joint Theatre Trauma Systems Director, MacDill AFB, FL; Victoria Chou, Ph.D., USAF

  10. Validation of the Dutch clinical prediction rule for ambulation outcomes in an inpatient setting following traumatic spinal cord injury.

    PubMed

    van Silfhout, L; Peters, A E J; Graco, M; Schembri, R; Nunn, A K; Berlowitz, D J

    2016-08-01

    Retrospective study. To determine the accuracy of a previously described Dutch clinical prediction rule for ambulation outcome in routine clinical practice. Adult (⩾18 years) patients who were admitted to the Austin Hospital with a traumatic spinal cord injury between January 2006 and August 2014. Data from medical records were extracted to determine the score of the Dutch clinical ambulation prediction rule proposed by van Middendorp et al. in 2011. A receiver-operating characteristics (ROC) curve was generated to investigate the performance of the prediction rule. Univariate analyses were performed to investigate which factors significantly influence ambulation after a traumatic spinal cord injury. The area under the ROC curve (AUC) obtained during the current study (0.939, 95% confidence interval (CI) (0.892, 0.986)) was not significantly different from the AUC from the original Dutch clinical prediction model (0.956, 95% CI (0.936, 0.976)). Factors that were found to have a significant influence on ambulation outcome were time spent in the ICU, number of days hospitalised and injury severity. Age at injury initially showed a significant influence on ambulation however, this effect was not apparent after inclusion of the 24 patients who died due to the trauma (and therefore did not walk after their injuries). The Dutch ambulation prediction rule performed similarly in routine clinical practice as in the original, controlled study environment in which it was developed. The potential effect of survival bias in the original model requires further investigation.

  11. 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

  12. Changes in air temperature and its relation to ambulance transports due to heat stroke in all 47 prefectures of Japan.

    PubMed

    Murakami, Shoko; Miyatake, Nobuyuki; Sakano, Noriko

    2012-09-01

    Changes in air temperature and its relation to ambulance transports due to heat stroke in all 47 prefectures, in Japan were evaluated. Data on air temperature were obtained from the Japanese Meteorological Agency. Data on ambulance transports due to heat stroke was directly obtained from the Fire and Disaster Management Agency, Japan. We also used the number of deaths due to heat stroke from the Ministry of Health, Labour and Welfare, Japan, and population data from the Ministry of Internal Affairs and Communications. Chronological changes in parameters of air temperature were analyzed. In addition, the relation between air temperature and ambulance transports due to heat stroke in August 2010 was also evaluated by using an ecological study. Positive and significant changes in the parameters of air temperature that is, the mean air temperature, mean of the highest air temperature, and mean of the lowest air temperature were noted in all 47 prefectures. In addition, changes in air temperature were accelerated when adjusted for observation years. Ambulance transports due to heat stroke was significantly correlated with air temperature in the ecological study. The highest air temperature was significantly linked to ambulance transports due to heat stroke, especially in elderly subjects. Global warming was demonstrated in all 47 prefectures in Japan. In addition, the higher air temperature was closely associated with higher ambulance transports due to heat stroke in Japan.

  13. Preventing and alleviating patients' symptoms of nausea and vomiting while in the care of the ambulance service - a qualitative study.

    PubMed

    Westerlund, Anders; Vicente, Veronica; Hjelte Judell, Oscar; Lindström, Veronica

    2016-09-01

    The aim of this study was to describe the ambulance personnel's experiences of preventing and alleviating patients' symptoms of nausea and vomiting. Nausea is a common symptom in patients taken care of by the ambulance service. It is a complex subjective phenomenon and can cause several different illnesses. The ambulance personnel have an important assignment in preventing and alleviating nausea through early interventions. A descriptive and qualitative design including 16 semi-structured interviews and content analysis was used. One main category was identified: Adjusting care and medical treatment based on the individual patient's needs. By adjusting the care and medical treatment based on patients' individual needs and previous experience, the ambulance personnel experienced a possible relief of the patients' suffering caused by nausea and vomiting. In addition to the known multitude of underlying pathologies of nausea, the way of driving and the environment in the ambulances also may have an impact on the patients' nausea. A variety of nursing interventions and medical treatments are reported to be used to alleviate nausea for patients cared for by the ambulance service, but further research is needed to evaluate if and how the interventions have an effect on the patients' experiences. The findings in our study can be used when developing guidelines on how to care for patients suffering nausea and vomiting. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Prehospital use of adenosine by ambulance services in the Netherlands: Daily practice, literature overview and practical recommendations.

    PubMed

    Adams, R; Bon, V

    2003-05-01

    The prehospital use of adenosine in the treatment of supraventricular arrhythmias has recently been implemented in standard ambulance care. However, establishing the origin and nature of the arrhythmia with certainty is an absolute requirement for using adenosine. The ability of the ambulance nurse to predict supraventricular arrhythmias and the necessity of prehospital treatment of arrhythmias in general was evaluated. To do this, cardiologists at the Academic Medical Centre of Amsterdam were consulted and a literature search by means of an electronic search in Pubmed was performed. The search was complemented by a second survey concerning antagonists of adenosine using the keywords: adenosine and theophylline. Moreover, the Ambulance Nurse textbook, the National Protocol for Ambulance Care as well as the explanatory memorandum to the protocol were consulted. No strong indication for the prehospital use of adenosine was found, while detrimental effects of the drug can occur. There is no literature showing the ability of ambulance staff to correctly interpret complex cardiac arrhythmias in the Netherlands; the current ambulance protocol does not prevent an incorrect choice of therapy and medication. It is strongly advised against using antiarrhythmic medication for the treatment of tachycardias in a prehospital setting if this treatment can be postponed to the hospital environment.

  15. 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.

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

    PubMed

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

    2017-08-25

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

  17. Heroin and opiate emergencies in Vienna: analysis at the municipal ambulance service.

    PubMed

    Seidler, D; Schmeiser-Rieder, A; Schlarp, O; Laggner, A N

    2000-07-01

    Vienna suffered an epidemic of heroin abuse in recent years, with drug-deaths due to opioids increasing from 62 in 1991 to 143 in 1993. The aim of this study was to make observations about illicit opioid-use with the ambulance service as a data source. From June 1994 to August 1995, the structured run records of the ambulance service were reviewed. Those with a presumptive diagnosis of "heroin or opiate" overdose were collected, characteristics of emergencies and patients were analyzed. The run records demonstrated a large number of non-fatal emergencies due to opioids, involving 528 men and 179 women in 1087 emergencies. These emergencies were on the average 6.8 times as prevalent as drug-fatalities. A group of 189 persons could be identified, who caused 52.2% of all emergencies and showed a threefold mortality rate during the observation period. In Vienna, the records of the municipal ambulance service provided valuable insights on opioid-abuse. We suggest local analysis of non-fatal emergencies due to opioids, as this might lead to a new source of information on illicit abuse of these drugs.

  18. 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.

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

    PubMed

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

    2008-01-01

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

  20. Ambulance triage and treatment zones at major rugby events in Wellington, New Zealand: a sobering experience.

    PubMed

    Swain, Andrew H; Weaver, Amanda; Gray, Alasdair J; Bailey, Mark; Palmer, Stephen G

    2013-04-05

    A prospective analysis was undertaken of the workload of prehospital triage and treatment facilities established in Wellington for the 2011 and 2012 International Rugby Sevens, and the Rugby World Cup 2011 (RWC). The introduction of an alcohol intoxication pathway, the impact of the initiative on ambulance and Emergency Department (ED) workload, and its cost effectiveness were assessed. A log of patients seen and their diagnoses and treatment was maintained. An alcohol questionnaire was completed when applicable. Patients intoxicated with alcohol were managed in accordance with a flowchart designed for paramedic use. Costs and savings were calculated. Half the patients were New Zealanders. The average age was 25 years with a slight female preponderance (52.9% female). 30% were students. Alcohol was a contributory or causative factor for the patient's attendance in 80-90% of cases. Approximately 60% of the 121 patients seen at the last two events would have had to be transferred to the ED in the absence of the treatment centre. Cost savings for the ambulance service and ED for the RWC and 2012 Sevens are estimated to be NZ$70,000. No adverse clinical event was identified. With minimal supervision, event medics and paramedics can safely care for the majority of patients attending large rugby events in New Zealand, easing the pressure on ambulances and the ED, and generating significant cost savings for those services.