A secure 2G-RFID-Sys mechanism for applying to the medical emergency system.

PubMed

Chen, Yu-Yi; Wang, Yao-Jen; Jan, Jinn-Ke

2013-06-01

In the Medical Emergency System, any moment of delay in an emergency such as ambulance dispatch, ambulance diversion and clinical handover communication can significantly reduce a patient's chance of survival. Without the disadvantage of centralized management, a new type of RFID application named 2G-RFID-Sys will be more efficient. It is suitable for the tagged ambulance dispatch management in a huge range. In this article, the prototype of 2G-RFID-Sys and the responsibility of each participant are refined. We take an example of applying the 2G-RFID-Sys to the Medical Emergency System, the traffic condition of the ambulance will be able to ensure.

Research of an emergency medical system for mass casualty incidents in Shanghai, China: a system dynamics model.

PubMed

Yu, Wenya; Lv, Yipeng; Hu, Chaoqun; Liu, Xu; Chen, Haiping; Xue, Chen; Zhang, Lulu

2018-01-01

Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command. Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people. The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise.

Medication errors in the emergency department: a systems approach to minimizing risk.

PubMed

Peth, Howard A

2003-02-01

Adverse drug events caused by medication errors represent a common cause of patient injury in the practice of medicine. Many medication errors are preventable and hence particularly tragic when they occur, often with serious consequences. The enormous increase in the number of available drugs on the market makes it all but impossible for physicians, nurses, and pharmacists to possess the knowledge base necessary for fail-safe medication practice. Indeed, the greatest single systemic factor associated with medication errors is a deficiency in the knowledge requisite to the safe use of drugs. It is vital that physicians, nurses, and pharmacists have at their immediate disposal up-to-date drug references. Patients presenting for care in EDs are usually unfamiliar to their EPs and nurses, and the unique patient factors affecting medication response and toxicity are obscured. An appropriate history, physical examination, and diagnostic workup will assist EPs, nurses, and pharmacists in selecting the safest and most optimum therapeutic regimen for each patient. EDs deliver care "24/7" and are open when valuable information resources, such as hospital pharmacists and previously treating physicians, may not be available for consultation. A systems approach to the complex problem of medication errors will help emergency clinicians eliminate preventable adverse drug events and achieve a goal of a zero-defects system, in which medication errors are a thing of the past. New developments in information technology and the advent of electronic medical records with computerized physician order entry, ward-based clinical pharmacists, and standardized bar codes promise substantial reductions in the incidence of medication errors and adverse drug events. ED patients expect and deserve nothing less than the safest possible emergency medicine service.

Using off-the-shelf medical devices for biomedical signal monitoring in a telemedicine system for emergency medical services.

PubMed

Thelen, Sebastian; Czaplik, Michael; Meisen, Philipp; Schilberg, Daniel; Jeschke, Sabina

2015-01-01

In order to study new methods of telemedicine usage in the context of emergency medical services, researchers need to prototype integrated telemedicine systems. To conduct a one-year trial phase-intended to study a new application of telemedicine in German emergency medical services-we used off-the-shelf medical devices and software to realize real-time patient monitoring within an integrated telemedicine system prototype. We demonstrate its feasibility by presenting the integrated real-time patient monitoring solution, by studying signal delay and transmission robustness regarding changing communication channel characteristics, and by evaluating issues reported by the physicians during the trial phase. Where standards like HL7 and the IEEE 11073 family are intended to enable interoperability of product grade medical devices, we show that research prototypes benefit from the use of web technologies and simple device interfaces, as they simplify product development for a manufacturer and ease integration efforts for research teams. Embracing this approach for the development of new medical devices eases the constraint to use off-the-shelf products for research trials investigating innovative use of telemedicine.

Research of an emergency medical system for mass casualty incidents in Shanghai, China: a system dynamics model

PubMed Central

Liu, Xu; Chen, Haiping; Xue, Chen

2018-01-01

Objectives Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. Methods This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command. Results Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people. Conclusion The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise. PMID:29440876

Emergency medical care in developing countries: is it worthwhile?

PubMed Central

Razzak, Junaid A.; Kellermann, Arthur L.

2002-01-01

Prevention is a core value of any health system. Nonetheless, many health problems will continue to occur despite preventive services. A significant burden of diseases in developing countries is caused by time-sensitive illnesses and injuries, such as severe infections, hypoxia caused by respiratory infections, dehydration caused by diarrhoea, intentional and unintentional injuries, postpartum bleeding, and acute myocardial infarction. The provision of timely treatment during life-threatening emergencies is not a priority for many health systems in developing countries. This paper reviews evidence indicating the need to develop and/or strengthen emergency medical care systems in these countries. An argument is made for the role of emergency medical care in improving the health of populations and meeting expectations for access to emergency care. We consider emergency medical care in the community, during transportation, and at first-contact and regional referral facilities. Obstacles to developing effective emergency medical care include a lack of structural models, inappropriate training foci, concerns about cost, and sustainability in the face of a high demand for services. A basic but effective level of emergency medical care responds to perceived and actual community needs and improves the health of populations. PMID:12481213

IMPRESS: medical location-aware decision making during emergencies

NASA Astrophysics Data System (ADS)

Gkotsis, I.; Eftychidis, G.; Leventakis, G.; Mountzouris, M.; Diagourtas, D.; Kostaridis, A.; Hedel, R.; Olunczek, A.; Hahmann, S.

2017-09-01

Emergency situations and mass casualties involve several agencies and public authorities, which need to gather data from the incident scene and exchange geo-referenced information to provide fast and accurate first aid to the people in need. Tracking patients on their way to the hospitals can prove critical in taking lifesaving decisions. Increased and continuous flow of information combined by vital signs and geographic location of emergency victims can greatly reduce the response time of the medical emergency chain and improve the efficiency of disaster medicine activity. Recent advances in mobile positioning systems and telecommunications are providing the technology needed for the development of location-aware medical applications. IMPRESS is an advanced ICT platform based on adequate technologies for developing location-aware medical response during emergencies. The system incorporates mobile and fixed components that collect field data from diverse sources, support medical location and situation-based services and share information on the patient's transport from the field to the hospitals. In IMPRESS platform tracking of victims, ambulances and emergency services vehicles is integrated with medical, traffic and crisis management information into a common operational picture. The Incident Management component of the system manages operational resources together with patient tracking data that contain vital sign values and patient's status evolution. Thus, it can prioritize emergency transport decisions, based on medical and location-aware information. The solution combines positioning and information gathered and owned by various public services involved in MCIs or large-scale disasters. IMPRESS solution, were validated in field and table top exercises in cooperation with emergency services and hospitals.

Physician medical direction and clinical performance at an established emergency medical services system.

PubMed

Munk, Marc-David; White, Shaun D; Perry, Malcolm L; Platt, Thomas E; Hardan, Mohammed S; Stoy, Walt A

2009-01-01

Few developed emergency medical services (EMS) systems operate without dedicated medical direction. We describe the experience of Hamad Medical Corporation (HMC) EMS, which in 2007 first engaged an EMS medical director to develop and implement medical direction and quality assurance programs. We report subsequent changes to system performance over time. Over one year, changes to the service's clinical infrastructure were made: Policies were revised, paramedic scopes of practice were adjusted, evidence-based clinical protocols were developed, and skills maintenance and education programs were implemented. Credentialing, physician chart auditing, clinical remediation, and online medical command/hospital notification systems were introduced. Following these interventions, we report associated improvements to key indicators: Chart reviews revealed significant improvements in clinical quality. A comparison of pre- and post-intervention audited charts reveals a decrease in cases requiring remediation (11% to 5%, odds ratio [OR] 0.43 [95% confidence interval (CI) 0.20-0.85], p = 0.01). The proportion of charts rated as clinically acceptable rose from 48% to 84% (OR 6 [95% CI 3.9-9.1], p < 0.001). The proportion of misplaced endotracheal tubes fell (3.8% baseline to 0.6%, OR 0.16 [95% CI 0.004-1.06], (exact) p = 0.05), corresponding to improved adherence to an airway placement policy mandating use of airway confirmation devices and securing devices (0.7% compliance to 98%, OR 714 [95% CI 64-29,334], (exact) p < 0.001). Intravenous catheter insertion in unstable cases increased from 67% of cases to 92% (OR 1.31 [95% CI 1.09-1.71], p = 0.004). EMS administration of aspirin to patients with suspected ischemic chest pain improved from 2% to 77% (OR 178 [95% CI 35-1,604], p < 0.001). We suggest that implementation of a physician medical direction is associated with improved clinical indicators and overall quality of care at an established EMS system.

Management of non-traumatic chest pain by the French Emergency Medical System: Insights from the DOLORES registry.

PubMed

Manzo-Silberman, Stéphane; Assez, Nathalie; Vivien, Benoît; Tazarourte, Karim; Mokni, Tarak; Bounes, Vincent; Greffet, Agnès; Bataille, Vincent; Mulak, Geneviève; Goldstein, Patrick; Ducassé, Jean Louis; Spaulding, Christian; Charpentier, Sandrine

2015-03-01

The early recognition of acute coronary syndromes is a priority in health care systems, to reduce revascularization delays. In France, patients are encouraged to call emergency numbers (15, 112), which are routed to a Medical Dispatch Centre where physicians conduct an interview and decide on the appropriate response. However, the effectiveness of this system has not yet been assessed. To describe and analyse the response of emergency physicians receiving calls for chest pain in the French Emergency Medical System. From 16 November to 13 December 2009, calls to the Medical Dispatch Centre for non-traumatic chest pain were included prospectively in a multicentre observational study. Clinical characteristics and triage decisions were collected. A total of 1647 patients were included in the study. An interview was conducted with the patient in only 30.5% of cases, and with relatives, bystanders or physicians in the other cases. A Mobile Intensive Care Unit was dispatched to 854 patients (51.9%) presenting with typical angina chest pains and a high risk of cardiovascular disease. Paramedics were sent to 516 patients (31.3%) and a general practitioner was sent to 169 patients (10.3%). Patients were given medical advice only by telephone in 108 cases (6.6%). Emergency physicians in the Medical Dispatch Centre sent an effecter to the majority of patients who called the Emergency Medical System for chest pain. The response level was based on the characteristics of the chest pain and the patient's risk profile. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Pediatric mental health emergencies in the emergency medical services system. American College of Emergency Physicians.

PubMed

Dolan, Margaret A; Mace, Sharon E

2006-10-01

Emergency departments (EDs) are vital in the management of pediatric patients with mental health emergencies (MHE). Pediatric MHE are an increasing part of emergency medical practice because EDs have become the safety net for a fragmented mental health infrastructure which is experiencing critical shortages in services in all sectors. EDs must safely, humanely, and in a culturally and developmentally appropriate manner manage pediatric patients with undiagnosed and known mental illnesses including those with mental retardation, autistic spectrum disorders, attention deficit hyperactivity disorder (ADHD), and those experiencing a behavioral crisis. EDs also manage patients with suicidal ideation, depression, escalating aggression, substance abuse, post traumatic stress disorder, maltreatment, and those exposed to violence and unexpected deaths. EDs must address not only the physical but also the mental health needs of patients during and after mass casualty incidents and disasters. The American Academy of Pediatrics and the American College of Emergency Physicians support the following actions: advocacy for increased mental health resources, including improved pediatric mental health tools for the ED, increased mental health insurance coverage, adequate reimbursement at all levels; acknowledgment of the importance of the child's medical home, and promotion of education and research for mental health emergencies.

Emerging Standards for Medical Logic

PubMed Central

Clayton, Paul D.; Hripcsak, George; Pryor, T. Allan

1990-01-01

Sharing medical logic has traditionally occurred in the form of lectures, conversations, books and journals. As knowledge based computer systems have demonstrated their utility in the health care arena, individuals have pondered the best way to transfer knowledge in a computer based representation (1). A simple representation which allows the knowledge to be shared can be constructed when the knowledge base is modular. Within this representation, units have been named Medical Logic Modules (MLM's) and a syntax has emerged which would allow multiple users to create, criticize, and share those types of medical logic which can be represented in this format. In this paper we talk about why standards exist and why they emerge in some areas and not in others. The appropriateness of using the proposed standards for medical logic modules is then examined against this broader context.

A priority dispatch system for emergency medical services.

PubMed

Slovis, C M; Carruth, T B; Seitz, W J; Thomas, C M; Elsea, W R

1985-11-01

A decision tree priority dispatch system for emergency medical services (EMS) was developed and implemented in Atlanta and Fulton County, Georgia. The dispatch system shortened the average response time from 14.2 minutes to 10.4 minutes for the 30% of patients deemed most urgent (P less than or equal to .05); resulted in a significant increase in the use of advanced life support units for this group (P less than or equal to .02); decreased the number of calls that required a backup ambulance service; and significantly increased conformity to national EMS response time standards for critically ill and injured patients (P less than or equal to .0009). Due to dispatch error, 0.3% of calls were dispatched as least severe but subsequently were found to be most urgent.

Emergency Medical Technician.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Center on Education and Training for Employment.

This document, which is designed for use in developing a tech prep competency profile for the occupation of emergency medical technician, lists technical competencies and competency builders for 18 units pertinent to the health technologies cluster in general and 4 units specific to the occupation of emergency medical technician. The following…

[Introduction of a bar coding pharmacy stock replenishment system in a prehospital emergency medical unit: economical impact].

PubMed

Dupuis, S; Fecci, J-L; Noyer, P; Lecarpentier, E; Chollet-Xémard, C; Margenet, A; Marty, J; Combes, X

2009-01-01

To assess economical impact after introduction of a bar coding pharmacy stock replenishment system in a prehospital emergency medical unit. Observational before and after study. A computer system using specific software and bare-code technology was introduced in the pre hospital emergency medical unit (Smur). Overall activity and costs related to pharmacy were recorded annually during two periods: the first 2 years period before computer system introduction and the second one during the 4 years following this system installation. The overall clinical activity increased by 10% between the two periods whereas pharmacy related costs continuously decreased after the start of pharmacy management computer system use. Pharmacy stock management was easier after introduction of the new stock replenishment system. The mean pharmacy related cost of one patient management was 13 Euros before and 9 Euros after the introduction of the system. The overall cost savings during the studied period was calculated to reach 134,000 Euros. The introduction of a specific pharmacy management computer system allowed to do important costs savings in a prehospital emergency medical unit.

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

PubMed

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

2014-01-01

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

The Emergency Medical System in Greece: Opening Aeolus’ Bag of Winds

PubMed Central

Kotsiou, Ourania S.; Srivastava, David S.; Kotsios, Panagiotis; Exadaktylos, Aristomenis K.; Gourgoulianis, Konstantinos I.

2018-01-01

An Emergency Medical Service (EMS) system must encompass a spectrum of care, with dedicated pre-hospital and in-hospital medical facilities. It has to be organised in such a way as to include all necessary services—such as triage accurate initial assessment, prompt resuscitation, efficient management of emergency cases, and transport to definitive care. The global economic downturn has had a direct effect on the health sector and poses additional threats to the healthcare system. Greece is one of the hardest-hit countries. This manuscript aims to present the structure of the Greek EMS system and the impact of the current economic recession on it. Nowadays, primary care suffers major shortages in crucial equipment, unmet health needs, and ineffective central coordination. Patients are also facing economic limitations that lead to difficulties in using healthcare services. The multi-factorial problem of in-hospital EMS overcrowding is also evident and has been linked with potentially poorer clinical outcomes. Furthermore, the ongoing refugee crisis challenges the national EMS. Adoption of a triage scale, expansion of the primary care network, and an effective primary–hospital continuum of care are urgently needed in Greece to provide comprehensive, culturally competent, and high-quality health care. PMID:29652816

The Emergency Medical System in Greece: Opening Aeolus' Bag of Winds.

PubMed

Kotsiou, Ourania S; Srivastava, David S; Kotsios, Panagiotis; Exadaktylos, Aristomenis K; Gourgoulianis, Konstantinos I

2018-04-13

An Emergency Medical Service (EMS) system must encompass a spectrum of care, with dedicated pre-hospital and in-hospital medical facilities. It has to be organised in such a way as to include all necessary services—such as triage accurate initial assessment, prompt resuscitation, efficient management of emergency cases, and transport to definitive care. The global economic downturn has had a direct effect on the health sector and poses additional threats to the healthcare system. Greece is one of the hardest-hit countries. This manuscript aims to present the structure of the Greek EMS system and the impact of the current economic recession on it. Nowadays, primary care suffers major shortages in crucial equipment, unmet health needs, and ineffective central coordination. Patients are also facing economic limitations that lead to difficulties in using healthcare services. The multi-factorial problem of in-hospital EMS overcrowding is also evident and has been linked with potentially poorer clinical outcomes. Furthermore, the ongoing refugee crisis challenges the national EMS. Adoption of a triage scale, expansion of the primary care network, and an effective primary–hospital continuum of care are urgently needed in Greece to provide comprehensive, culturally competent, and high-quality health care.

Addressing barriers to emergency anaphylaxis care: from emergency medical services to emergency department to outpatient follow-up.

PubMed

Fineman, Stanley M; Bowman, Steven H; Campbell, Ronna L; Dowling, Paul; O'Rourke, Dianne; Russell, W Scott; Sublett, J Wesley; Wallace, Dana

2015-10-01

Anaphylaxis is a systemic life-threatening allergic reaction that presents unique challenges for emergency care practitioners. Allergists and emergency physicians have a history of collaborating to promote an evidence-based, multidisciplinary approach to improve the emergency management and follow-up of patients with or at risk of anaphylaxis. To review recent scientific literature about anaphylaxis, discuss barriers to care, and recommend strategies to support improvement in emergency anaphylaxis care. An expert panel of allergists and emergency physicians was convened by the American College of Allergy, Asthma and Immunology in November 2014 to discuss current knowledge about anaphylaxis, identify opportunities for emergency practitioners and allergists to partner to address barriers to care, and recommend strategies to improve medical management of anaphylaxis along the continuum of care: from emergency medical systems and emergency department practitioners for acute management through appropriate outpatient follow-up with allergists to confirm diagnosis, identify triggers, and plan long-term care. The panel identified key barriers to anaphylaxis care, including difficulties in making an accurate diagnosis, low rates of epinephrine administration during acute management, and inadequate follow-up. Strategies to overcome these barriers were discussed and recommendations made for future allergist/emergency physician collaborations, and key messages to be communicated to emergency practitioners were proposed. The panel recommended that allergists and emergency physicians continue to work in partnership, that allergists be proactive in outreach to emergency care practitioners, and that easy-to-access educational programs and materials be developed for use by emergency medical systems and emergency department practitioners in the training environment and in practice. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study.

PubMed

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte; Zwisler, Stine Thorhauge

2018-01-05

Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

Medical Emergencies in Goa

PubMed Central

Saddichha, Sahoo; Saxena, Mukul Kumar

2010-01-01

Background: Most emergencies in Goa arise due to road traffic accidents and drowning, which have been compounded by the rise in number of recorded accidents in 2007 to be above 4000. It is believed that 11 people meet with an accident on Goa's roads every day and this is expected to rise by 10% by next year. Similar is the case with drownings and other medical emergencies. We therefore aimed to conduct a cross-sectional survey of medical emergencies and identify various types of emergencies presenting to emergency departments. Materials and Methods: Using a stratified random sampling design, all emergencies presenting to the three government hospitals in Goa, which handle 90% of all emergencies currently, were studied on specially designed data sheets in order to collect data. Emergency medical technicians (ETs) were placed in the Casualty Ward of the medical colleges and they recorded all emergencies on the data sheet. The collected data were then analyzed for stratification and mapping of emergencies. Results: GMC Hospital attended to majority of emergencies (62%), which were mainly of the nature of accidents or assaults (17%) and fever related (17%). Most emergencies were noncritical and about 1% expired. Maximum emergencies also presented from Salcette and Bardez, and occurred among young males in the age group of 19-45 years. Males were also more prone to accidents while females had pregnancies as emergencies. Conclusion: Potential emergency services need to target young males with higher concentrations required in Salcette in South Goa and Bardez in North Goa. PMID:20606921

Reconstruction of the Radiation Emergency Medical System From the Acute to the Sub-acute Phases After the Fukushima Nuclear Power Plant Crisis

PubMed Central

OJINO, Mayo; ISHII, Masami

2014-01-01

The radiation emergency medical system in Japan ceased to function as a result of the accident at the Fukushima Daiichi Nuclear Power Plant, which has commonly become known as the “Fukushima Accident.” In this paper, we review the reconstruction processes of the radiation emergency medical system in order of events and examine the ongoing challenges to overcoming deficiencies and reinforcing the system by reviewing relevant literature, including the official documents of the investigation committees of the National Diet of Japan, the Japanese government, and the Tokyo Electric Power Company, as well as technical papers written by the doctors involved in radiation emergency medical activities in Fukushima. Our review has revealed that the reconstruction was achieved in 6 stages from March 11 to July 1, 2011: (1) Re-establishment of an off-site center (March 13), (2) Re-establishment of a secondary radiation emergency hospital (March 14), (3) Reconstruction of the initial response system for radiation emergency care (April 2), (4) Reinforcement of the off-site center and stationing of disaster medical advisors at the off-site center (April 4), (5) Reinforcement of the medical care system and an increase in the number of hospitals for non-contaminated patients (From April 2 to June 23), and (6) Enhancement of the medical care system in the Fukushima Nuclear Power Plant and the construction of a new medical care system, involving both industrial medicine and emergency medicine (July 1). Medical resources such as voluntary efforts, academic societies, a local community medical system and university hospitals involved in medical care activities on 6 stages originally had not planned. In the future, radiation emergency medical systems should be evaluated with these 6 stages as a basis, in order to reinforce and enrich both the existing and backup systems so that minimal harm will come to nuclear power plant workers or evacuees and that they will receive proper care

Reconstruction of the Radiation Emergency Medical System From the Acute to the Sub-acute Phases After the Fukushima Nuclear Power Plant Crisis.

PubMed

Ojino, Mayo; Ishii, Masami

2014-02-01

The radiation emergency medical system in Japan ceased to function as a result of the accident at the Fukushima Daiichi Nuclear Power Plant, which has commonly become known as the "Fukushima Accident." In this paper, we review the reconstruction processes of the radiation emergency medical system in order of events and examine the ongoing challenges to overcoming deficiencies and reinforcing the system by reviewing relevant literature, including the official documents of the investigation committees of the National Diet of Japan, the Japanese government, and the Tokyo Electric Power Company, as well as technical papers written by the doctors involved in radiation emergency medical activities in Fukushima. Our review has revealed that the reconstruction was achieved in 6 stages from March 11 to July 1, 2011: (1) Re-establishment of an off-site center (March 13), (2) Re-establishment of a secondary radiation emergency hospital (March 14), (3) Reconstruction of the initial response system for radiation emergency care (April 2), (4) Reinforcement of the off-site center and stationing of disaster medical advisors at the off-site center (April 4), (5) Reinforcement of the medical care system and an increase in the number of hospitals for non-contaminated patients (From April 2 to June 23), and (6) Enhancement of the medical care system in the Fukushima Nuclear Power Plant and the construction of a new medical care system, involving both industrial medicine and emergency medicine (July 1). Medical resources such as voluntary efforts, academic societies, a local community medical system and university hospitals involved in medical care activities on 6 stages originally had not planned. In the future, radiation emergency medical systems should be evaluated with these 6 stages as a basis, in order to reinforce and enrich both the existing and backup systems so that minimal harm will come to nuclear power plant workers or evacuees and that they will receive proper care. This

Real-time Medical Emergency Response System: Exploiting IoT and Big Data for Public Health.

PubMed

Rathore, M Mazhar; Ahmad, Awais; Paul, Anand; Wan, Jiafu; Zhang, Daqiang

2016-12-01

Healthy people are important for any nation's development. Use of the Internet of Things (IoT)-based body area networks (BANs) is increasing for continuous monitoring and medical healthcare in order to perform real-time actions in case of emergencies. However, in the case of monitoring the health of all citizens or people in a country, the millions of sensors attached to human bodies generate massive volume of heterogeneous data, called "Big Data." Processing Big Data and performing real-time actions in critical situations is a challenging task. Therefore, in order to address such issues, we propose a Real-time Medical Emergency Response System that involves IoT-based medical sensors deployed on the human body. Moreover, the proposed system consists of the data analysis building, called "Intelligent Building," depicted by the proposed layered architecture and implementation model, and it is responsible for analysis and decision-making. The data collected from millions of body-attached sensors is forwarded to Intelligent Building for processing and for performing necessary actions using various units such as collection, Hadoop Processing (HPU), and analysis and decision. The feasibility and efficiency of the proposed system are evaluated by implementing the system on Hadoop using an UBUNTU 14.04 LTS coreTMi5 machine. Various medical sensory datasets and real-time network traffic are considered for evaluating the efficiency of the system. The results show that the proposed system has the capability of efficiently processing WBAN sensory data from millions of users in order to perform real-time responses in case of emergencies.

Emergency Medical Service Information System:the ARES 118 experience.

PubMed

Ientile, D A; Cardinale, M A; Cataldi, S; Parafati, M; Pasquarella, A; Trani, N; Corradi, M P

2017-01-01

In this paper we describe ARES 118, the prehospital Emergency Medical Service of the Region Lazio, Italy, focusing on its data system used to populate a data warehouse and to create ad hoc reports. ARES 118 is a regional public mono-specialized health company, established in 2004, that manages the emergency care throughout the Region Lazio. Being a peculiar company in its kind, and being the first experience of this kind in Italy, ARES 118 has begun to equip itself, in an autonomous way, with a corporate information system, starting from what already existed as data collection from the individual provincial operating Centers and then by activating a unique information system at a regional and company level by deploying a data warehouse. All operations were carried out using open source software. Currently, ARES 118 is equipped with a business information system that enables data collection with its storage, management and processing of the same in fairly and easy way. The system allows the production of specific reports and measures modulated on the user requests in order to highlight the different aspects of the activity. The production of ad hoc reports, with the possibility of developing specific indicators, allows the identification and analysis of critical areas/processes in order to implement any corrective actions and monitor the effectiveness of the sam.

Emergency Medical Services Program Guide.

ERIC Educational Resources Information Center

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

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

Preparedness of Finnish Emergency Medical Services for Chemical Emergencies.

PubMed

Jama, Timo J; Kuisma, Markku J

2016-08-01

Introduction The preparedness level of Finnish Emergency Medical Services (EMS) for treating chemical emergencies is unknown. The aim of this study was to survey the preparedness level of EMS systems for managing and handling mass-casualty chemical incidents in the prehospital phase in Finland. Hypothesis The study hypothesis was that university hospital districts would have better clinical capability to treat patients than would central hospital districts in terms of the number of patients treated in the field within one hour after dispatching as well as patients transported to hospital within one hour or two hours after dispatching. This cross-sectional study was conducted as a Webropol (Wuppertal, Germany) survey. All hospital districts (n=20) in continental Finland were asked about their EMS preparedness level in terms of capability of treating and transporting chemically affected patients in the field. Their capability for decontamination of affected patients in the field was also inquired. University hospital district-based EMS systems had at least 20% better absolute clinical capacity than central hospital-based EMS systems for treating chemically affected patients concerning all treatments inquired about, except the capacity for non-invasive ventilation (NIV)/continuous positive airway pressure (CPAP) treatment in the field. Overall, there was a good level of preparedness for treating chemical accident patients with supplemental oxygen, bronchodilators, and inhaled corticosteroids. Preparedness for providing antidote therapy in cases of cyanide gas exposure was, in general, low. The variation among the hospital districts was remarkable. Only nine of 15 central hospital district EMS had a mobile decontamination unit available, whereas four of five university hospital districts had one. Emergency Medical Services capacity in Finland for treating chemically affected patients in the field needs to be improved, especially in terms of antidote therapy. Mobile

Comparison of emergency medical services systems across Pan-Asian countries: a Web-based survey.

PubMed

Shin, Sang Do; Ong, Marcus Eng Hock; Tanaka, Hideharu; Ma, Matthew Huei-Ming; Nishiuchi, Tatsuya; Alsakaf, Omer; Karim, Sarah Abdul; Khunkhlai, Nalinas; Lin, Chih-Hao; Song, Kyoung Jun; Ryoo, Hyun Wook; Ryu, Hyun Ho; Tham, Lai Peng; Cone, David C

2012-01-01

There are great variations in out-of-hospital cardiac arrest (OHCA) survival outcomes among different countries and different emergency medical services (EMS) systems. The impact of different systems and their contribution to enhanced survival are poorly understood. This paper compares the EMS systems of several Asian sites making up the Pan-Asian Resuscitation Outcomes Study (PAROS) network. Some preliminary cardiac arrest outcomes are also reported. This is a cross-sectional descriptive survey study addressing population demographics, service levels, provider characteristics, system operations, budget and finance, medical direction (leadership), and oversight. Most of the systems are single-tiered. Fire-based EMS systems are predominant. Bangkok and Kuala Lumpur have hospital-based systems. Service level is relatively low, from basic to intermediate in most of the communities. Korea, Japan, Singapore, and Bangkok have intermediate emergency medical technician (EMT) service levels, while Taiwan and Dubai have paramedic service levels. Medical direction and oversight have not been systemically established, except in some communities. Systems are mostly dependent on public funding. We found variations in available resources in terms of ambulances and providers. The number of ambulances is 0.3 to 3.2 per 100,000 population, and most ambulances are basic life support (BLS) vehicles. The number of human resources ranges from 4.0 per 100,000 population in Singapore to 55.7 per 100,000 population in Taipei. Average response times vary between 5.1 minutes (Tainan) and 22.5 minutes (Kuala Lumpur). We found substantial variation in 11 communities across the PAROS EMS systems. This study will provide the foundation for understanding subsequent studies arising from the PAROS effort.

Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies, Part 1.

PubMed

Tucci, Veronica Theresa; Moukaddam, Nidal; Alam, Al; Rachal, James

2017-09-01

Patients presenting to the emergency department with mental illness or behavioral complaints merit workup for underlying physical conditions that can trigger, mimic, or worsen psychiatric symptoms. However, interdisciplinary consensus on medical clearance is lacking, leading to wide variations in quality of care and, quite often, poor medical care. Psychiatry and emergency medicine specialty guidelines support a tailored, customized approach. This article summarizes best-practice approaches to the medical clearance of patients with psychiatric illness, tips on history taking, system reviews, clinical or physical examination, and common pitfalls in the medical clearance process. Copyright © 2017 Elsevier Inc. All rights reserved.

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

ERIC Educational Resources Information Center

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

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

National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module VI. Cardiovascular System.

ERIC Educational Resources Information Center

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

This instructor's lesson plan guide on the cardiovascular system is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Seven units of study are presented: (1) the anatomy and physiology of the cardiovascular system; (2) patient assessment for the cardiac patient; (3) pathophysiology; (4) reading…

National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module V. Respiratory System.

ERIC Educational Resources Information Center

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

This instructor's lesson plan guide on the respiratory system is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Five units of study are presented: (1) anatomy and physiology of the respiratory system; (2) pathophysiology assessment of the patient; (3) pathophysiology and management of…

Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: a qualitative study

PubMed Central

Broccoli, Morgan C; Calvello, Emilie J B; Skog, Alexander P; Wachira, Benjamin; Wallis, Lee A

2015-01-01

Objectives We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members’ thoughts regarding high impact solutions to expand access to essential emergency services. Design We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach. Setting Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation. Results Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care—a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene. Conclusions Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region. PMID:26586324

Distributed virtual environment for emergency medical training

NASA Astrophysics Data System (ADS)

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

1997-07-01

paper we report on our prototype VER system and its distributed system architecture for an emergency department distributed virtual environment for emergency medical staff training. The virtual environment enables emergency department physicians and staff to develop their diagnostic and treatment skills using the virtual tools they need to perform diagnostic and treatment tasks. Virtual human imagery, and real-time virtual human response are used to create the virtual patient and present a scenario. Patient vital signs are available to the emergency department team as they manage the virtual case. The work reported here consists of the system architectures we developed for the distributed components of the virtual emergency room. The architectures we describe consist of the network level architecture as well as the software architecture for each actor within the virtual emergency room. We describe the role of distributed interactive simulation and other enabling technologies within the virtual emergency room project.

International Conference on Remote Emergency Medical Services

NASA Technical Reports Server (NTRS)

1975-01-01

An emergency medical system is characterized. Applications of NASA technology in biomedical telecommunication and bioinstrumentation are explored. The training and effectiveness of paramedics, technicians, nurses, and physicians are evaluated as applied to emergency situations and the operations of trauma centers. Civilian and military aeromedical evacuation is discussed.

[Development and application of emergency medical information management system].

PubMed

Wang, Fang; Zhu, Baofeng; Chen, Jianrong; Wang, Jian; Gu, Chaoli; Liu, Buyun

2011-03-01

To meet the needs of clinical practice of rescuing critical illness and develop the information management system of the emergency medicine. Microsoft Visual FoxPro, which is one of Microsoft's visual programming tool, is used to develop computer-aided system included the information management system of the emergency medicine. The system mainly consists of the module of statistic analysis, the module of quality control of emergency rescue, the module of flow path of emergency rescue, the module of nursing care in emergency rescue, and the module of rescue training. It can realize the system management of emergency medicine and,process and analyze the emergency statistical data. This system is practical. It can optimize emergency clinical pathway, and meet the needs of clinical rescue.

Real-time multimedia communications in medical emergency - the CONCERTO project solution.

PubMed

Martini, Maria G; Iacobelli, Lorenzo; Bergeron, Cyril; Hewage, Chaminda T; Panza, Gianmarco; Piri, Esa; Vehkapera, Janne; Amon, Peter; Mazzotti, Matteo; Savino, Ketty; Bokor, Laszlo

2015-01-01

The management of medical emergency, in particular cardiac emergency, requests prompt intervention and the possibility to communicate in real time from the emergency area / ambulance to the hospital as much diagnostic information as possible about the patient. This would enable a prompt emergency diagnosis and operation and the possibility to prepare the appropriate actions in the suitable hospital department. To address this scenario, the CONCERTO European project proposed a wireless communication system based on a novel cross-layer architecture, including the integration of building blocks for medical media content fusion, delivery and access. This paper describes the proposed system architecture, outlining the developed components and mechanisms, and the evaluation of the proposed system, carried out in a hospital with the support of medical staff. The technical results and the feedback received highlight the impact of the CONCERTO approach in the healthcare domain, in particular in enabling a prompt and reliable diagnosis in challenging medical emergency scenarios.

[Analysis of actions taken by medical rescue teams in the Polish Emergency Medical Servies system. Is the model of division into specialistad basic teams reasonable?].

PubMed

Guła, Przemysław; Wejnarski, Arkadiusz; Moryto, Remigiusz; Gałazkowski, Robert; Swiezewski, Stanisław

2014-01-01

The Polish Emergency Medical Services (EMS) system is based on two types of medical rescue teams (MRT): specialist (S)--with system doctors and basic (B)--only paramedics. The aim of this study is to assess the reasonability of dividing medical rescue teams into specialist and basic. The retrospective analysis of medical cards of rescue activities performed during 21,896 interventions by medical rescue teams, 15,877 of which--by basic medical rescue teams (B MRT) and 6,019--by specialist medical rescue teams (S MRT). The procedures executed by both types of teams were compared. In the analysed group of dispatches, 56.4% were unrelated to medical emergencies. Simultaneously, 52.7% of code 1 interventions and 59.2% of code 2 interventions did not result in transporting the patient to the hospital. The qualification of S teams' dispatches is characterised by a higher number of assigned codes 1 (53.2% vs. 15.9%). It is worth emphasising that the procedures that can be applied exclusively by system doctors do not exceed 1% of interventions. Moreover, the number of the actions performed in medical emergencies in the secured region by the S team that is dispatched as the first one is comparable to that performed by B teams. The low need for usinq S teams'aid by B teams (0.92% of the interventions) was also indicated. This study points to the necessity to discuss the implementation of straightforward principles of call qualification and the optimisation of the system doctors' role in prehospital activities.

Emergency Victim Care. A Textbook for Emergency Medical Personnel.

ERIC Educational Resources Information Center

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

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

National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module II. Human Systems and Patient Assessment.

ERIC Educational Resources Information Center

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

This instructor's lesson plan guide on human systems and patient assessment is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Four units are presented: (1) medical terminology, which covers some common prefixes and suffixes and the use of the medical dictionary; (2) an overview of the…

Information infrastructure for emergency medical services.

PubMed

Orthner, Helmuth; Mishra, Ninad; Terndrup, Thomas; Acker, Joseph; Grimes, Gary; Gemmill, Jill; Battles, Marcie

2005-01-01

The pre-hospital emergency medical and public safety information environment is nearing a threshold of significant change. The change is driven in part by several emerging technologies such as secure, high-speed wireless communication in the local and wide area networks (wLAN, 3G), Geographic Information Systems (GIS), Global Positioning Systems (GPS), and powerful handheld computing and communication services, that are of sufficient utility to be more widely adopted. We propose a conceptual model to enable improved clinical decision making in the pre-hospital environment using these change agents.

Direct costs of emergency medical care: a diagnosis-based case-mix classification system.

PubMed

Baraff, L J; Cameron, J M; Sekhon, R

1991-01-01

To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. Three community hospital EDs in Los Angeles County during selected times in 1984. Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients

The Rhode Island Medical Emergency Distribution System (MEDS).

PubMed

Banner, Greg

2004-01-01

The State of Rhode Island conducted an exercise to obtain and dispense a large volume of emergency medical supplies in response to a mass casualty incident. The exercise was conducted in stages that included requesting supplies from the Strategic National Stockpile and distributing the supplies around the state. The lessons learned included how to better structure an exercise, what types of problems were encountered with requesting and distributing supplies, how to better work with members of the private medical community who are not involved in disaster planning, and how to become aware of the needs of special population groups.

Design Constraints Regarding The Use Of Fluids In Emergency Medical Systems For Space Flight

NASA Technical Reports Server (NTRS)

McQuillen, John

2013-01-01

The Exploration Medical Capability Project of the Human Research Program is tasked with identifying, investigating and addressing gaps existing gaps in either knowledge or technology that need to be addressed in order to enable safer exploration missions. There are several gaps that involve treatment for emergency medical situations. Some of these treatments involve the handling of liquids in the spacecraft environment which involve gas-liquid mixtures handling, dissolution chemistry and thermal issues. Some of the recent technology efforts include the Intravenous fluid generation (IVGEN) experiment, the In-Suit Injection System (ISIS) experiment, and medical suction. Constraints include limited volume, shelf life, handling biohazards, availability of power, crew time and medical training.

Medical Emergency Workload of a Regional UK HEMS Service.

PubMed

McQueen, Carl; Crombie, Nick; Cormack, Stef; Wheaton, Steve

2015-01-01

Regionalized trauma networks have been established in England to centralize specialist care at dedicated centers of excellence throughout the country. Helicopter emergency medical services (HEMS) in the West Midlands region have been redesigned to form an integrated component of such systems. The continued use of such valuable and scarce resources for medical emergencies requires evaluation. A retrospective review of mission data for a regional Air Ambulance Service in England over a two year period. Medical emergencies continue to contribute a large proportion of the overall workload of the service. Requirement for advanced interventions at the scene was rare, with less than 10% of patients attended by HEMS teams having care needs that fall beyond the scope of standard paramedic practice. Dynamic solutions are needed to ensure that HEMS support for cases of medical emergency are appropriately targeted to incidents in which clinical benefit is conferred to the patient. Intelligent tasking of appropriate resources has the potential to improve the HEMS response to medical emergencies while optimizing the availability of resources to respond to other incidents, most notably cases of major trauma. Copyright © 2015 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Designated Medical Directors for Emergency Medical Services: Recruitment and Roles

ERIC Educational Resources Information Center

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

2009-01-01

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

Impact of specialist care on clinical outcomes for medical emergencies.

PubMed

Moore, Stuart; Gemmell, Islay; Almond, Solomon; Buchan, Iain; Osman, Isameldin; Glover, Andrew; Williams, Peter; Carroll, Nadine; Rhodes, Jonathan

2006-01-01

General hospitals have commonly involved a wide range of medical specialists in the care of unselected medical emergency admissions. In 1999, the Royal Liverpool University Hospital, a 915-bed hospital with a busy emergency service, changed its system of care for medical emergencies to allow early placement of admitted patients under the care of the most appropriate specialist team, with interim care provided by specialist acute physicians on an acute medicine unit - a system we have termed 'specialty triage'. Here we describe a retrospective study in which all 133,509 emergency medical admissions from February 1995 to January 2003 were analysed by time-series analysis with correction for the underlying downward trend from 1995 to 2003. This showed that the implementation of specialty triage in May 1999 was associated with a subsequent additional reduction in the mortality of the under-65 age group by 0.64% (95% CI 0.11 to 1.17%; P=0.021) from the 2.4% mortality rate prior to specialty triage, equivalent to approximately 51 fewer deaths per year. No significant effect was seen for those over 65 or all age groups together when corrected for the underlying trend. Length of stay and readmission rates showed a consistent downward trend that was not significantly affected by specialty triage. The data suggest that appropriate specialist management improves outcomes for medical emergencies, particularly amongst younger patients.

Thirsk during CHeCS medical emergency training

NASA Image and Video Library

2009-07-02

ISS020-E-016866 (2 July 2009) --- Canadian Space Agency astronaut Robert Thirsk, Expedition 20 flight engineer, participates in Crew Health Care Systems (CHeCS) medical emergency training in the Destiny laboratory of the International Space Station.

Assessment of Emergency Medical Services in the Ashanti Region of Ghana.

PubMed

Mould-Millman, N K; Oteng, R; Zakariah, A; Osei-Ampofo, M; Oduro, G; Barsan, W; Donkor, P; Kowalenko, T

2015-09-01

We aimed to assess the structure, function and performance of Ashanti Region's emergency medical services system in the context of the regional need for prehospital emergency care. A mixed-methods approach was employed, using retrospective collection of quantitative data and prospectively gathered qualitative data. Setting - pertinent data were collected from Ghanaian and international sources; interviews and technical assessments were performed primarily in the Ashanti Region of Ghana. All stakeholders relevant to emergency medical services in the Ashanti Region of Ghana were assessed; there was a special focus on National Ambulance Service (NAS) and Ashanti Region healthcare personnel. This was an observational study using qualitative and quantitative assessment techniques. The structure, function and performance of the Ashanti emergency medical services system, guided by a relevant technical assessment framework. NAS is the premier and only true prehospital agency in the Ashanti Region. NAS has developed almost every essential aspect of an EMS system necessary to achieve its mission within a low-resource setting. NAS continues to increase its number of response units to address the overwhelming Ashanti region demand, especially primary calls. Deficient areas in need of development are governance, reliable revenue, public access, community integration, clinical care guidelines, research and quality assurance processes. The Ashanti Region has a growing and thriving emergency medical services system. Although many essential areas for development were identified, NAS is well poised to meet the regional demand for prehospital emergency care and transport.

14 CFR 121.803 - Emergency medical equipment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Emergency medical equipment. 121.803... REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Emergency Medical Equipment and Training § 121.803 Emergency medical equipment. (a) No person may operate a passenger-carrying airplane under this part unless...

75 FR 49507 - Recovery Policy, RP9525.4, Emergency Medical Care and Medical Evacuations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-13

...] Recovery Policy, RP9525.4, Emergency Medical Care and Medical Evacuations AGENCY: Federal Emergency... Management Agency (FEMA) is accepting comments on RP9525.4, Emergency Medical Care and Medical Evacuations... emergency medical care and medical evacuation expenses that are eligible for reimbursement under the...

Improving rural emergency medical services (EMS) through transportation system enhancements.

DOT National Transportation Integrated Search

2014-05-01

Improved emergency medical services (EMS) will impact traffic safety and public health in rural : communities. Better planned, designed, and operated roadway networks that connect hospitals with : communities in need will enhance EMS performance. To ...

Shuttle abort landing site emergency medical services

NASA Technical Reports Server (NTRS)

Mckenas, David K.; Jennings, Richard T.

1991-01-01

NASA and DOD studies of medical-planning and logistical problems are reviewed as applicable to providing emergency medical care at remote transoceanic abort landing (TAL) sites. Two options are analyzed including a modified surgical response team and a combination physician/medical technician team. The two concepts are examined in terms of cost-effectiveness, specific types of medical support such as blood procurement, and search-and-rescue requirements. It is found that the physician/technician team is more economically efficient, and the description of the concept permits the development of an effective TAL-site astronaut medical-support system. A balance is struck between the competing problems of cost and medical capability by planning for on-scene medical stabilization and air evacuation to DOD tertiary medical centers.

22 CFR 71.10 - Emergency medical assistance.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Emergency medical assistance. 71.10 Section 71... ESTATES PROTECTION AND WELFARE OF CITIZENS AND THEIR PROPERTY Emergency Medical/Dietary Assistance for U.S. Nationals Incarcerated Abroad § 71.10 Emergency medical assistance. (a) Eligibility criteria. A U.S...

22 CFR 71.10 - Emergency medical assistance.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Emergency medical assistance. 71.10 Section 71... ESTATES PROTECTION AND WELFARE OF CITIZENS AND THEIR PROPERTY Emergency Medical/Dietary Assistance for U.S. Nationals Incarcerated Abroad § 71.10 Emergency medical assistance. (a) Eligibility criteria. A U.S...

The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system.

PubMed

Mortaro, Alberto; Pascu, Diana; Zerman, Tamara; Vallaperta, Enrico; Schönsberg, Alberto; Tardivo, Stefano; Pancheri, Serena; Romano, Gabriele; Moretti, Francesca

2015-07-01

The role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives. An ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010. During the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population. Despite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a "learning organization" and improve both efficacy and safety of first aid care.

38 CFR 1.485 - Medical emergencies.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Medical emergencies. 1... PROVISIONS Disclosures Without Patient Consent § 1.485 Medical emergencies. (a) General rule. Under the... §§ 1.460 through 1.499 of this part may be disclosed to medical personnel who have a need for...

38 CFR 1.485 - Medical emergencies.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Medical emergencies. 1... PROVISIONS Disclosures Without Patient Consent § 1.485 Medical emergencies. (a) General rule. Under the... §§ 1.460 through 1.499 of this part may be disclosed to medical personnel who have a need for...

38 CFR 1.485 - Medical emergencies.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Medical emergencies. 1... PROVISIONS Disclosures Without Patient Consent § 1.485 Medical emergencies. (a) General rule. Under the... §§ 1.460 through 1.499 of this part may be disclosed to medical personnel who have a need for...

38 CFR 1.485 - Medical emergencies.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Medical emergencies. 1... PROVISIONS Disclosures Without Patient Consent § 1.485 Medical emergencies. (a) General rule. Under the... §§ 1.460 through 1.499 of this part may be disclosed to medical personnel who have a need for...

Who killed Rambhor?: The state of emergency medical services in India

PubMed Central

Garg, Rajesh H

2012-01-01

In India, the healthcare delivery system starts up from the sub-center at the village level and reaches up to super specialty medical centers providing state of the art emergency medical services (EMS). These highest centers, located in big cities, are considered the last referral points for the patients from nearby cities and states. As the incidents of rail and road accidents have increased in recent years, the role of EMS becomes critical in saving precious lives. But when the facilities and management of these emergency centers succumbs before the patient, then the question arises regarding the adequate availability and quality of EMS. The death of an unknown common man, Rambhor, for want of EMS in three big hospitals in the national capital of India put a big question on the “health” of the emergency health services in India. The emergency services infrastructure seems inadequate and quality and timely provision of EMS to critical patients appears unsatisfactory. There is lack of emergency medicine (EM) specialists in India and also the postgraduation courses in EM have not gained foot in our medical education system. Creation of a Centralized Medical Emergency Body, implementation of management techniques, modification of medical curriculum, and fixing accountability are some of the few steps which are required to improve the EMS in India. PMID:22416155

Rotorcraft-based emergency medical services in the Caribbean Basin

NASA Technical Reports Server (NTRS)

Smith, R. W.; Alton, L. R.

1987-01-01

There is a pressing need for improved health care in general and emergency health care in particular throughout the Caribbean Basin. The importance of rotorcraft as an integral part of the needed system of emergency medical care in the region was investigated. Many of the larger countries in the region currently have the needed infrastructure to implement a national system of rotorcraft-based emergency medical centers within their borders. By helping to establish a system of rotorcraft based health care centers in strategic locations in the Lesser Antilles, the U.S. can assist the islands of the region by demonstrating the concept and establishing a potential training site for the other larger countries of the region. There is sufficient demand for rotorcraft based emergency health care within the Lesser Antilles to locate one center on the island of Puerto Rico and another one of the southern-most islands. With the use of fixed wing aircraft or long range helicopters, the two rotorcraft based centers could provide the region with rapid and efficient emergency health care. The superior speed and range of the XV-15 Tilt Rotor aircraft make it an attractive possibility for emergency transport and rescue in this region.

Outcomes of medical emergencies on commercial airline flights.

PubMed

Peterson, Drew C; Martin-Gill, Christian; Guyette, Francis X; Tobias, Adam Z; McCarthy, Catherine E; Harrington, Scott T; Delbridge, Theodore R; Yealy, Donald M

2013-05-30

Worldwide, 2.75 billion passengers fly on commercial airlines annually. When in-flight medical emergencies occur, access to care is limited. We describe in-flight medical emergencies and the outcomes of these events. We reviewed records of in-flight medical emergency calls from five domestic and international airlines to a physician-directed medical communications center from January 1, 2008, through October 31, 2010. We characterized the most common medical problems and the type of on-board assistance rendered. We determined the incidence of and factors associated with unscheduled aircraft diversion, transport to a hospital, and hospital admission, and we determined the incidence of death. There were 11,920 in-flight medical emergencies resulting in calls to the center (1 medical emergency per 604 flights). The most common problems were syncope or presyncope (37.4% of cases), respiratory symptoms (12.1%), and nausea or vomiting (9.5%). Physician passengers provided medical assistance in 48.1% of in-flight medical emergencies, and aircraft diversion occurred in 7.3%. Of 10,914 patients for whom postflight follow-up data were available, 25.8% were transported to a hospital by emergency-medical-service personnel, 8.6% were admitted, and 0.3% died. The most common triggers for admission were possible stroke (odds ratio, 3.36; 95% confidence interval [CI], 1.88 to 6.03), respiratory symptoms (odds ratio, 2.13; 95% CI, 1.48 to 3.06), and cardiac symptoms (odds ratio, 1.95; 95% CI, 1.37 to 2.77). Most in-flight medical emergencies were related to syncope, respiratory symptoms, or gastrointestinal symptoms, and a physician was frequently the responding medical volunteer. Few in-flight medical emergencies resulted in diversion of aircraft or death; one fourth of passengers who had an in-flight medical emergency underwent additional evaluation in a hospital. (Funded by the National Institutes of Health.).

Outcomes of Medical Emergencies on Commercial Airline Flights

PubMed Central

Peterson, Drew C.; Martin-Gill, Christian; Guyette, Francis X.; Tobias, Adam Z.; McCarthy, Catherine E.; Harrington, Scott T.; Delbridge, Theodore R.; Yealy, Donald M.

2013-01-01

Background Worldwide, 2.75 billion passengers fly on commercial airlines annually. When inflight medical emergencies occur, access to care is limited. We describe in-flight medical emergencies and the outcomes of these events. Methods We reviewed records of in-flight medical emergency calls from five domestic and international airlines to a physician-directed medical communications center from January 1, 2008, through October 31, 2010. We characterized the most common medical problems and the type of on-board assistance rendered. We determined the incidence of and factors associated with unscheduled aircraft diversion, transport to a hospital, and hospital admission, and we determined the incidence of death. Results There were 11,920 in-flight medical emergencies resulting in calls to the center (1 medical emergency per 604 flights). The most common problems were syncope or presyncope (37.4% of cases), respiratory symptoms (12.1%), and nausea or vomiting (9.5%). Physician passengers provided medical assistance in 48.1% of in-flight medical emergencies, and aircraft diversion occurred in 7.3%. Of 10,914 patients for whom postflight follow-up data were available, 25.8% were transported to a hospital by emergency-medical-service personnel, 8.6% were admitted, and 0.3% died. The most common triggers for admission were possible stroke (odds ratio, 3.36; 95% confidence interval [CI], 1.88 to 6.03), respiratory symptoms (odds ratio, 2.13; 95% CI, 1.48 to 3.06), and cardiac symptoms (odds ratio, 1.95; 95% CI, 1.37 to 2.77). Conclusions Most in-flight medical emergencies were related to syncope, respiratory symptoms, or gastrointestinal symptoms, and a physician was frequently the responding medical volunteer. Few in-flight medical emergencies resulted in diversion of aircraft or death; one fourth of passengers who had an in-flight medical emergency underwent additional evaluation in a hospital. (Funded by the National Institutes of Health.) PMID:23718164

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

PubMed Central

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

2009-01-01

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

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

PubMed

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

2009-05-12

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

Intranasal medications in pediatric emergency medicine.

PubMed

Del Pizzo, Jeannine; Callahan, James M

2014-07-01

Intranasal medication administration in the emergency care of children has been reported for at least 20 years and is gaining popularity because of ease of administration, rapid onset of action, and relatively little pain to the patient. The ability to avoid a needle stick is often attractive to practitioners, in addition to children and their parents. In time-critical situations for which emergent administration of medication is needed, the intranasal route may be associated with more rapid medication administration. This article reviews the use of intranasal medications in the emergency care of children. Particular attention will be paid to anatomy and its impact on drug delivery, pharmacodynamics, medications currently administered by this route, delivery devices available, tips for use, and future directions.

Pediatric issues in disaster management, Part 1: the emergency medical system and surge capacity.

PubMed

Mace, Sharon E; Sharieff, Ghazala; Bern, Andrew; Benjamin, Lee; Burbulys, Dave; Johnson, Ramon; Schreiber, Merritt

2010-01-01

Although children and infants are likely to be victims in a disaster and are more vulnerable in a disaster than adults, disaster planning and management has often overlooked the specific needs of pediatric patients. The authors discuss key components of disaster planning and management for pediatric patients, including emergency medical services, hospital/facility issues, evacuation centers, family separation/reunification, children with special healthcare needs (SHCNs), mental health issues, and overcrowding/surge capacity. Specific policy recommendations and an appendix with detailed practical information and algorithms are included. The first part of this three-part series on pediatric issues in disaster management addresses the emergency medical system from the field to the hospital and surge capacity including the impact of crowding. The second part addresses the appropriate setup and functioning of evacuation centers and family separation and reunification. The third part deals with special patient populations: children with SHCNs and mental health issues.

Improving Rural Emergency Medical Services (EMS) through transportation system enhancements Phase II.

DOT National Transportation Integrated Search

2015-12-01

Providing acute medical care outside of the hospital, Emergency Medical Services (EMS) is crucial in rural environments where hospitals are not close by and are difficult to access. Establishing EMS performance measures is critical in improving a rur...

Emergency medical dispatch : national standard curriculum ready

DOT National Transportation Integrated Search

1996-05-01

This Traffic Tech describes the recently updated "Emergency Medical Dispatch: National Standard Curriculum," which was developed in 1972. Emergency service providers use these uniform standards to develop or select an emergency medical dispatch progr...

National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module VII. Central Nervous System.

ERIC Educational Resources Information Center

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

This instructor's lesson plan guide on the central nervous system is one of fifteen modules designed for use in the training of emergency medical technicians. Four units of study are presented: (1) anatomy and physiology; (2) assessment of patients with neurological problems; (3) pathophysiology and management of neurological problems; (4)…

Medical emergency announcements on cruise ships: an audit of outcome.

PubMed

Taylor, Christopher James

2015-01-01

Public address announcements are an effective way of alerting staff on cruise ships to life -threatening medical emergencies on-board, but should only be used when truly necessary. An audit to investigate the outcome following this method of activating the medical emergency response team (MERT) suggested system flaws. A new elementary first aid training programme for the crew was then developed, emphasising patient assessment and the correct determination of appropriate levels of response. Following fleet-wide implementation, post-intervention audits were performed on two other company ships to evaluate the impact of the new approach. Data from all MERT activations initiated by public address announcement were prospectively collected during the audit periods, including subsequent means of transfer to the ship's medical centre and duration of medical intervention as indicators of clinical severity. After changing the training programme the overall rate of public announcements for medical emergencies fell by 43%. The proportion of patients requiring transfer by stretcher increased from 5% to 33%, whilst the proportion of patients requiring ≥ 4 h of medical intervention increased from 5% to 44%. The audits suggest that the new training programme may have improved the first aid responders' decision-making as there were fewer inappropriate emergency announcements over the public address system. However, two-thirds of all MERT activations were still for patients either well enough to walk or only needing a wheelchair for subsequent transfer, indicating ongoing opportunity for improvement.

National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module XI. Obstetric/Gynecologic Emergencies.

ERIC Educational Resources Information Center

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

This instructor's lesson plan guide on obstetric/gynecologic emergencies is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Six units of study are presented: (1) anatomy and physiology of the female reproductive system; (2) patient assessment; (3) pathophysiology and management of gynecologic…

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

PubMed

Gałazkowski, Robert

2010-01-01

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

5 CFR 630.910 - Termination of medical emergency.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Termination of medical emergency. 630.910... AND LEAVE Voluntary Leave Transfer Program § 630.910 Termination of medical emergency. (a) The medical... that the leave recipient is no longer affected by a medical emergency; (3) At the end of the biweekly...

5 CFR 630.910 - Termination of medical emergency.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Termination of medical emergency. 630.910... AND LEAVE Voluntary Leave Transfer Program § 630.910 Termination of medical emergency. (a) The medical... that the leave recipient is no longer affected by a medical emergency; (3) At the end of the biweekly...

5 CFR 630.910 - Termination of medical emergency.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Termination of medical emergency. 630.910... AND LEAVE Voluntary Leave Transfer Program § 630.910 Termination of medical emergency. (a) The medical... that the leave recipient is no longer affected by a medical emergency; (3) At the end of the biweekly...

Very serious and non-ignorable problem: Crisis in emergency medical response in catastrophic event.

PubMed

Shen, Weifeng; Jiang, Libing; Zhang, Mao; Ma, Yuefeng; Jiang, Guanyu; He, Xiaojun

2015-12-01

The crisis of medical response caused by catastrophic events might significantly affect emergency response, and might even initiate more serious social crisis. Therefore, early identification and timely blocking the formation of crisis in the early phase after a major disaster will improve the efficiency of medical response in a major disaster and avoid serious consequences. In the present paper, we described the emergency strategy to crisis management of medical response after a major disaster. Major catastrophic events often lead to various crises, including excess demand, the crisis of response in barrier and the structural crisis in response. The corresponding emergency response strategies include: (i) shunt of catastrophic medical surge; (ii) scalability of medical surge capacity; (iii) matching of the structural elements of response; (iv) maintaining the functions of support system for medical response and maximising the operation of the integrated response system; and (v) selection of appropriate care 'standard' in extreme situations of overload of disaster medical surge. In conclusion, under the impact of a major catastrophic event, medical response is often complex and the medical surge beyond the conventional response capacity and it is easy to be in crisis. In addition to the current consensus of disaster response, three additional aspects should be considered. First, all relevant society forces led by the government and military should be linkages. Second, a powerful medical response system must be based on a strong support system. Third, countermeasures of medical surge should be applied flexibly to the special and specific disaster environment, to promote the effective medical response force. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Characteristics and outcomes of patients admitted to ICU following activation of the medical emergency team: impact of introducing a two-tier response system.

PubMed

Aneman, Anders; Frost, Steven A; Parr, Michael J; Hillman, Ken M

2015-04-01

To determine the impact of introducing a two-tier system for responding to deteriorating ward patients on ICU admissions after medical emergency team review. Retrospective database review before (2006-2009) and after (2011-2013) the introduction of a two-tier system. Tertiary, university-affiliated hospital. A total of 1,564 ICU admissions. Two-tier rapid response system. The median number of medical emergency team activations/1,000 hospitalizations increased from 22 to 31 (difference [95% CI], 9 [5-10]; p<0.0001) with a decreased rate of medical emergency team activations leading to ICU admission (from median 11 to 8; difference [95% CI], 3 [3-4]; p=0.03). The median proportion of medical emergency team reviews leading to ICU admission increased for those triggered by tachypnoea (from 11% to 15%; difference [95% CI], 4 [3-5]; p<0.0001) and by hypotension (from 27% to 43%; difference [95% CI], 15 [12-19]; p<0.0001) and decreased for those triggered by reduced level of consciousness (from 20% to 17%; difference [95% CI], 3 [2-4]; p<0.0001) and by clinical concern (from 18% to 9%; difference [95% CI], 10 [9-13]; p<0.0001). The proportions of ICU admissions following medical emergency team review did not change significantly for tachycardia, seizure, or cardiorespiratory arrest. The overall ICU mortality for admissions following medical emergency team review for tachypnoea, tachycardia, and clinical concern decreased (from 29% to 9%: difference [95% CI], 20 [11-29]; p<0.0001) but did not change for the other triggers. The Acute Physiology and Chronic Health Evaluation predicted and observed ICU mortality and the proportion of patients dying with a not-for-resuscitation order decreased. The introduction of a two-tier response to clinical deterioration increased ICU admissions triggered by cardiorespiratory criteria, whereas admissions triggered by more subjective criteria decreased. The overall ICU mortality for patients admitted following medical emergency team review

78 FR 59623 - Emergency Medical Equipment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-27

.... FAA-2000-7119] RIN 2120-AG89 Emergency Medical Equipment AGENCY: Federal Aviation Administration (FAA... accordance with the FAA master minimum equipment list does not adversely affect aviation safety. This action... relief for use of emergency medical equipment. DATES: This action becomes effective September 27, 2013...

Conceptualizing and Managing Medical Emergencies Where No Formal Paramedical System Exists: Perspectives from a Remote Indigenous Community in Canada.

PubMed

Curran, Jeffrey; Ritchie, Stephen D; Beardy, Jackson; VanderBurgh, David; Born, Karen; Lewko, John; Orkin, Aaron M

2018-02-04

(1) Background: Remote communities in Canada lack an equitable emergency medical response capacity compared to other communities. Community-based emergency care (CBEC) training for laypeople is a model that has the potential to enhance the medical emergency response capacity in isolated and resource-limited contexts. The purpose of this study was to understand the characteristics of medical emergencies and to conceptualize and present a framework for what a medical emergency is for one remote Indigenous community in northwestern Ontario, in order to inform the development of CBEC training. (2) Methods: This study adhered to the principles of community-based participatory research and realist evaluation; it was an integrated component of the formative evaluation of the second Sachigo Lake Wilderness Emergency Response Education Initiative (SLWEREI) training course in 2012. Twelve members of Sachigo Lake First Nation participated in the training course, along with local nursing staff, police officers, community Elders, and course instructors (n = 24 total), who participated in interviews, focus groups, and a collaborative discussion of local health issues in the development of the SLWEREI. (3) Results: The qualitative results are organized into sections that describe the types of local health emergencies and the informal response system of community members in addressing these emergencies. Prominent themes of health adversity that emerged were an inability to manage chronic conditions and fears of exacerbations, the lack of capacity for addressing mental illness, and the high prevalence of injury for community members. (4) Discussion: A three-point framework of what constitutes local perceptions of an emergency emerged from the findings in this study: (1) a sense of isolation; (2) a condition with a potentially adverse outcome; and (3) a need for help.

5 CFR 630.1010 - Termination of medical emergency.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Termination of medical emergency. 630... ABSENCE AND LEAVE Voluntary Leave Bank Program § 630.1010 Termination of medical emergency. (a) The medical emergency affecting a leave recipient shall terminate— (1) When the leave recipient's Federal...

5 CFR 630.1010 - Termination of medical emergency.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Termination of medical emergency. 630... ABSENCE AND LEAVE Voluntary Leave Bank Program § 630.1010 Termination of medical emergency. (a) The medical emergency affecting a leave recipient shall terminate— (1) When the leave recipient's Federal...

5 CFR 630.1010 - Termination of medical emergency.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Termination of medical emergency. 630... ABSENCE AND LEAVE Voluntary Leave Bank Program § 630.1010 Termination of medical emergency. (a) The medical emergency affecting a leave recipient shall terminate— (1) When the leave recipient's Federal...

Autonomic nervous system activity as risk predictor in the medical emergency department: a prospective cohort study.

PubMed

Eick, Christian; Rizas, Konstantinos D; Meyer-Zürn, Christine S; Groga-Bada, Patrick; Hamm, Wolfgang; Kreth, Florian; Overkamp, Dietrich; Weyrich, Peter; Gawaz, Meinrad; Bauer, Axel

2015-05-01

To evaluate heart rate deceleration capacity, an electrocardiogram-based marker of autonomic nervous system activity, as risk predictor in a medical emergency department and to test its incremental predictive value to the modified early warning score. Prospective cohort study. Medical emergency department of a large university hospital. Five thousand seven hundred thirty consecutive patients of either sex in sinus rhythm, who were admitted to the medical emergency department of the University of Tübingen, Germany, between November 2010 and March 2012. None. Deceleration capacity of heart rate was calculated within the first minutes after emergency department admission. The modified early warning score was assessed from respiratory rate, heart rate, systolic blood pressure, body temperature, and level of consciousness as previously described. Primary endpoint was intrahospital mortality; secondary endpoints included transfer to the ICU as well as 30-day and 180-day mortality. One hundred forty-two patients (2.5%) reached the primary endpoint. Deceleration capacity was highly significantly lower in nonsurvivors than survivors (2.9 ± 2.1 ms vs 5.6 ± 2.9 ms; p < 0.001) and yielded an area under the receiver-operator characteristic curve of 0.780 (95% CI, 0.745-0.813). The modified early warning score model yielded an area under the receiver-operator characteristic curve of 0.706 (0.667-0.750). Implementing deceleration capacity into the modified early warning score model led to a highly significant increase of the area under the receiver-operator characteristic curve to 0.804 (0.770-0.835; p < 0.001 for difference). Deceleration capacity was also a highly significant predictor of 30-day and 180-day mortality as well as transfer to the ICU. Deceleration capacity is a strong and independent predictor of short-term mortality among patients admitted to a medical emergency department.

The preparedness level of final year medical students for an adequate medical approach to emergency cases: computer-based medical education in emergency medicine

PubMed Central

2014-01-01

Background We aimed to observe the preparedness level of final year medical students in approaching emergencies by computer-based simulation training and evaluate the efficacy of the program. Methods A computer-based prototype simulation program (Lsim), designed by researchers from the medical education and computer science departments, was used to present virtual cases for medical learning. Fifty-four final year medical students from Ondokuz Mayis University School of Medicine attended an education program on June 20, 2012 and were trained with Lsim. Volunteer attendants completed a pre-test and post-test exam at the beginning and end of the course, respectively, on the same day. Results Twenty-nine of the 54 students who attended the course accepted to take the pre-test and post-test exams; 58.6% (n = 17) were female. In 10 emergency medical cases, an average of 3.9 correct medical approaches were performed in the pre-test and an average of 9.6 correct medical approaches were performed in the post-test (t = 17.18, P = 0.006). Conclusions This study’s results showed that the readiness level of students for an adequate medical approach to emergency cases was very low. Computer-based training could help in the adequate approach of students to various emergency cases. PMID:24386919

Comparison of emergency medical services systems in the pan-Asian resuscitation outcomes study countries: Report from a literature review and survey.

PubMed

Ong, Marcus E H; Cho, Jungheum; Ma, Matthew Huei-Ming; Tanaka, Hideharu; Nishiuchi, Tatsuya; Al Sakaf, Omer; Abdul Karim, Sarah; Khunkhlai, Nalinas; Atilla, Ridvan; Lin, Chih-Hao; Shahidah, Nur; Lie, Desiree; Shin, Sang Do

2013-02-01

Asia-Pacific countries have unique prehospital emergency care or emergency medical services (EMS) systems, which are different from European or Anglo-American models. We aimed to compare the EMS systems of eight Asia-Pacific countries/regions as part of the Pan Asian Resuscitation Outcomes Study (PAROS), to provide a basis for future comparative studies across systems of care. In the first phase, a systematic literature review of EMS system within the eight PAROS countries/regions of interest was conducted. In the second phase, PAROS site directors were surveyed for additional information about the demographics and characteristics of EMS services at their sites. The database and bibliography search identified 25 eligible articles. The survey of EMS systems was completed by seven PAROS directors. By combining information sources from phases 1 and 2, we found that all PAROS EMS systems were single-tiered, and most were public (vs private) and fire-based (Thailand, Malaysia, Singapore, Taiwan, Japan, Korea). Ambulance personnel were primarily emergency medical technicians and paramedics, except for Thailand and Turkey, whose personnel include nurses and physicians. Personnel were trained to use automated external defibrillators and have basic cardiac life support certification. The service capability of each EMS system in terms of dispatch, airway management and medications, for example, varied greatly. We found variation in the EMS systems across the eight Asia-Pacific countries/regions studied. The findings will inform the construction of a multinational Asia-Pacific research network for future comparative studies and could serve as a model for international research networks. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Conceptualizing and Managing Medical Emergencies Where No Formal Paramedical System Exists: Perspectives from a Remote Indigenous Community in Canada

PubMed Central

Curran, Jeffrey; Ritchie, Stephen D.; Beardy, Jackson; VanderBurgh, David; Born, Karen; Lewko, John; Orkin, Aaron M.

2018-01-01

(1) Background: Remote communities in Canada lack an equitable emergency medical response capacity compared to other communities. Community-based emergency care (CBEC) training for laypeople is a model that has the potential to enhance the medical emergency response capacity in isolated and resource-limited contexts. The purpose of this study was to understand the characteristics of medical emergencies and to conceptualize and present a framework for what a medical emergency is for one remote Indigenous community in northwestern Ontario, in order to inform the development of CBEC training. (2) Methods: This study adhered to the principles of community-based participatory research and realist evaluation; it was an integrated component of the formative evaluation of the second Sachigo Lake Wilderness Emergency Response Education Initiative (SLWEREI) training course in 2012. Twelve members of Sachigo Lake First Nation participated in the training course, along with local nursing staff, police officers, community Elders, and course instructors (n = 24 total), who participated in interviews, focus groups, and a collaborative discussion of local health issues in the development of the SLWEREI. (3) Results: The qualitative results are organized into sections that describe the types of local health emergencies and the informal response system of community members in addressing these emergencies. Prominent themes of health adversity that emerged were an inability to manage chronic conditions and fears of exacerbations, the lack of capacity for addressing mental illness, and the high prevalence of injury for community members. (4) Discussion: A three-point framework of what constitutes local perceptions of an emergency emerged from the findings in this study: (1) a sense of isolation; (2) a condition with a potentially adverse outcome; and (3) a need for help. PMID:29401706

Registered nurses' experiences of their decision-making at an Emergency Medical Dispatch Centre.

PubMed

Ek, Bosse; Svedlund, Marianne

2015-04-01

To describe registered nurses' experiences at an Emergency Medical Dispatch Centre. It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, Emergency Medical Dispatch centres cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Nurses worldwide are involved in patient triage, both before the patient's arrival to the hospital and in the subsequent emergency care. Ambulance dispatching is traditionally a duty for operators at Emergency Medical Dispatch centres, and in Sweden this duty has become increasingly performed by registered nurses. A qualitative design was used for this study. Fifteen registered nurses with experience at Emergency Medical Dispatch centres were interviewed. The participants were asked to describe the content of their work and their experiences. They also described the most challenging and difficult situations according to the critical incidence technique. Content analysis was used. Two themes emerged during the analysis: 'Having a profession with opportunities and obstacles' and 'Meeting serious and difficult situations', with eight sub-themes. The results showed that the decisions to dispatch ambulances were both challenging and difficult. Difficulties included conveying medical advice without seeing the patient, teaching cardio-pulmonary resuscitation via telephone and dealing with intoxicated and aggressive callers. Conflicts with colleagues and ambulance crews as well as fear of making wrong decisions were also mentioned. Work at Emergency Medical Dispatch centres is a demanding but stimulating duty for registered nurses. Great benefits can be achieved using experienced triage nurses, including increased patient safety and better use of medical resources. Improved internal support systems at Emergency Medical Dispatch centres and striving for a blame

14 CFR 1250.103-6 - Medical emergencies.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Medical emergencies. 1250.103-6 Section... Medical emergencies. Notwithstanding the provisions of §§ 1250.103 to 1250.103-5, a recipient of Federal... impairment of his health, and such service or other benefit cannot be provided except by or through a medical...

14 CFR 1250.103-6 - Medical emergencies.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Medical emergencies. 1250.103-6 Section... Medical emergencies. Notwithstanding the provisions of §§ 1250.103 to 1250.103-5, a recipient of Federal... impairment of his health, and such service or other benefit cannot be provided except by or through a medical...

14 CFR 1250.103-6 - Medical emergencies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Medical emergencies. 1250.103-6 Section... Medical emergencies. Notwithstanding the provisions of §§ 1250.103 to 1250.103-5, a recipient of Federal... impairment of his health, and such service or other benefit cannot be provided except by or through a medical...

[Relations with emergency medical care and primary care doctor, home health care].

PubMed

Azuma, Kazunari; Ohta, Shoichi

2016-02-01

Medical care for an ultra-aging society has been shifted from hospital-centered to local community-based. This shift has yielded the so-called Integrated Community Care System. In the system, emergency medical care is considered important, as primary care doctors and home health care providers play a crucial role in coordinating with the department of emergency medicine. Since the patients move depending on their physical condition, a hospital and a community should collaborate in providing a circulating service. The revision of the medical payment system in 2014 clearly states the importance of "functional differentiation and strengthen and coordination of medical institutions, improvement of home health care". As part of the revision, the subacute care unit has been integrated into the community care unit, which is expected to have more than one role in community coordination. The medical fee has been set for the purpose of promoting the home medical care visit, and enhancing the capability of family doctors. In the section of end-of-life care for the elderly, there have been many issues such as reduction of the readmission rate and endorsement of a patient's decision-making, and judgment for active emergency medical care for patient admission. The concept of frailty as an indicator of prognosis has been introduced, which might be applied to the future of emergency medicine. As described above, the importance of a primary doctor and a family doctor should be identified more in the future; thereby it becomes essential for doctors to closely work with the hospital. Advancing the cooperation between a hospital and a community for seamless patient-centered care, the emergency medicine as an integrated community care will further develop by adapting to an ultra-aging society.

Bystander Intervention Prior to The Arrival of Emergency Medical Services: Comparing Assistance across Types of Medical Emergencies

PubMed Central

Faul, Mark; Aikman, Shelley N.; Sasser, Scott M.

2016-01-01

Objective To determine the situational circumstances associated with bystander interventions to render aid during a medical emergency. Methods This study examined 16.2 million Emergency Medical Service (EMS) events contained within the National Emergency Medical Services Information System. The records of patients following a 9-1-1 call for emergency medical assistance were analyzed using logistic regression to determine what factors influenced bystander interventions. The dependent variable of the model was whether or not a bystander intervened. Results EMS providers recorded bystander assistance 11% of the time. The logistic regression model correctly predicted bystander intervention occurrence 71.4% of the time. Bystanders were more likely to intervene when the patient was male (aOR = 1.12, 95% CI = 1.12–1.3) and if the patient was older (progressive aOR = 1.10, 1.46 age group 20–29 through age group 60–99). Bystanders were less likely to intervene in rural areas compared to urban areas (aOR = 0.58, 95% CI = 0.58–0.59). The highest likelihood of bystander intervention occurred in a residential institution (aOR = 1.86, 95% CI = 1.85–1.86) and the lowest occurred on a street or a highway (aOR = 0.96, 95% CI = 0.95–0.96). Using death as a reference group, bystanders were most likely to intervene when the patient had cardiac distress/chest pain (aOR = 11.38, 95% CI = 10.93–11.86), followed by allergic reaction (aOR = 7.63, 95% CI = 7.30–7.99), smoke inhalation (aOR = 6.65, 95% CI = 5.98–7.39), and respiration arrest/distress (aOR = 6.43, 95% CI = 6.17–6.70). A traumatic injury was the most commonly recorded known event, and it was also associated with a relatively high level of bystander intervention (aOR = 5.81, 95% CI = 5.58–6.05). The type of injury/illness that prompted the lowest likelihood of bystander assistance was Sexual Assault/Rape (aOR = 1.57, 95% CI = 1.32–1.84) followed by behavioral/psychiatric disorder (aOR = 1.64, 95% CI = 1

Bystander Intervention Prior to The Arrival of Emergency Medical Services: Comparing Assistance across Types of Medical Emergencies.

PubMed

Faul, Mark; Aikman, Shelley N; Sasser, Scott M

2016-01-01

To determine the situational circumstances associated with bystander interventions to render aid during a medical emergency. This study examined 16.2 million Emergency Medical Service (EMS) events contained within the National Emergency Medical Services Information System. The records of patients following a 9-1-1 call for emergency medical assistance were analyzed using logistic regression to determine what factors influenced bystander interventions. The dependent variable of the model was whether or not a bystander intervened. EMS providers recorded bystander assistance 11% of the time. The logistic regression model correctly predicted bystander intervention occurrence 71.4% of the time. Bystanders were more likely to intervene when the patient was male (aOR = 1.12, 95% CI = 1.12-1.3) and if the patient was older (progressive aOR = 1.10, 1.46 age group 20-29 through age group 60-99). Bystanders were less likely to intervene in rural areas compared to urban areas (aOR = 0.58, 95% CI = 0.58-0.59). The highest likelihood of bystander intervention occurred in a residential institution (aOR = 1.86, 95% CI = 1.85-1.86) and the lowest occurred on a street or a highway (aOR = 0.96, 95% CI = 0.95-0.96). Using death as a reference group, bystanders were most likely to intervene when the patient had cardiac distress/chest pain (aOR = 11.38, 95% CI = 10.93-11.86), followed by allergic reaction (aOR = 7.63, 95% CI = 7.30-7.99), smoke inhalation (aOR = 6.65, 95% CI = 5.98-7.39), and respiration arrest/distress (aOR = 6.43, 95% CI = 6.17-6.70). A traumatic injury was the most commonly recorded known event, and it was also associated with a relatively high level of bystander intervention (aOR = 5.81, 95% CI = 5.58-6.05). The type of injury/illness that prompted the lowest likelihood of bystander assistance was Sexual Assault/Rape (aOR = 1.57, 95% CI = 1.32-1.84) followed by behavioral/psychiatric disorder (aOR = 1.64, 95% CI = 1.57-1.71). Bystander intervention varies greatly on

Feasibility of Using Distributed Wireless Mesh Networks for Medical Emergency Response

PubMed Central

Braunstein, Brian; Trimble, Troy; Mishra, Rajesh; Manoj, B. S.; Rao, Ramesh; Lenert, Leslie

2006-01-01

Achieving reliable, efficient data communications networks at a disaster site is a difficult task. Network paradigms, such as Wireless Mesh Network (WMN) architectures, form one exemplar for providing high-bandwidth, scalable data communication for medical emergency response activity. WMNs are created by self-organized wireless nodes that use multi-hop wireless relaying for data transfer. In this paper, we describe our experience using a mesh network architecture we developed for homeland security and medical emergency applications. We briefly discuss the architecture and present the traffic behavioral observations made by a client-server medical emergency application tested during a large-scale homeland security drill. We present our traffic measurements, describe lessons learned, and offer functional requirements (based on field testing) for practical 802.11 mesh medical emergency response networks. With certain caveats, the results suggest that 802.11 mesh networks are feasible and scalable systems for field communications in disaster settings. PMID:17238308

Civilian exposure to toxic agents: emergency medical response.

PubMed

Baker, David

2004-01-01

Civilian populations are at risk from exposure to toxic materials as a result of accidental or deliberate exposure. In addition to industrial hazards, toxic agents designed for use in warfare now are a potential hazard in everyday life through terrorist action. Civil emergency medical responders should be able to adapt their plans for dealing with casualties from hazardous materials (HazMat) to deal with the new threat. Chemical and biological warfare (CBW) and HazMat agents can be viewed as a continuous spectrum. Each of these hazards is characterized by qualities of toxicity, latency of action, persistency, and transmissibility. The incident and medical responses to release of any agent is determined by these characteristics. Chemical and biological wardare agents usually are classified as weapons of mass destruction, but strictly, they are agents of mass injury. The relationship between mass injury and major loss of life depends very much on the protection, organization, and emergency care provided. Detection of a civil toxic agent release where signs and symptoms in casualties may be the first indicator of exposure is different from the military situation where intelligence information and tuned detection systems generally will be available. It is important that emergency medical care should be given in the context of a specific action plan. Within an organized and protected perimeter, triage and decontamination (if the agent is persistent) can proceed while emergency medical care is provided at the same time. The provision of advanced life support (TOXALS) in this zone by protected and trained medical responders now is technically feasible using specially designed ventilation equipment. Leaving life support until after decontamination may have fatal consequences. Casualties from terrorist attacks also may suffer physical as well as toxic trauma and the medical response also should be capable of dealing with mixed injuries.

14 CFR 1250.103-6 - Medical emergencies.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Medical emergencies. 1250.103-6 Section 1250... Medical emergencies. Notwithstanding the provisions of §§ 1250.103 to 1250.103-5, a recipient of Federal... impairment of his health, and such service or other benefit cannot be provided except by or through a medical...

Emergency medical services

NASA Technical Reports Server (NTRS)

Billica, Roger; Chandler, Michael

1994-01-01

When NASA was established in 1958, it was known that space flight would require efforts beyond those of NASA to ensure the health and safety of our astronauts. On 10 Aug. 1958, a Secretary of Defense memorandum was signed that assigned the first Department of Defense (DOD) Manager to provide support to NASA for Project Mercury. This established a chain of command through the Joint Chiefs of Staff to the Secretary of Defense. The current charter is dated 19 Mar. 1986 and assigns the DOD Manager responsibilities to the Commander and Chief, US Space Command. The DOD Managers charter has many support areas and among them are recovery of astronauts and medical support. Today these efforts support the Space Shuttle and Space Station Programs. Briefly, the program works with each organization tasking the other through a requirements document. Level of care, communications, and recovery requirements are established; NASA and the DOD provide the capability to meet them. NASA is also responsible for the specialized training and equipment needed to meet these requirements. A Shuttle launch a KSC requires an Emergency Medical Services (EMS) coordinator on console to facilitate communications, ensure proper coverage, and coordinate with area hospitals. A contingent of NASA medical personnel are assembled to provide triage and medical support capabilities. The DOD provides medical evacuation (MEDEVAC) helicopters with surgeons and pararescue specialists (PJ's) or emergency medical technicians (EMT's). Each helicopter is equipped with at least one doctor and one PJ/EMT per astronaut crew member. Transoceanic abort landing (TAL) sites and end of mission (EOM) sites have similar structures, with TAL sites utilizing fixed wingg aircraft for MEDEVAC. The DOD also supports contingency planning for the support and return of crew members from the Space Station Freedom. Much of this support has been directed at the recovery of crew members following the landing of an Assured Crew Return

[Emergency Medical Technician profile in Spain].

PubMed

Martínez-Isasi, Santiago; Rodríguez-Lorenzo, María José; Vázquez-Santamariña, David; Abella-Lorenzo, Javier; Castro Dios, Diana Josefa; Fernández García, Daniel

2017-12-11

The emergency medical technician plays a fundamental role and is the most important figure quantitatively in pre-hospital emergencies. The aim was to asses the socio-demographic, work-related, health characteristics and technical skills of an Emergency Medical Technician in Spain. Cross-sectional descriptive study. An ad hoc questionnaire was managed using Google Docs® that was delivered between April-June 2014 via email and social networks. A total of 705 questionnaires were collected. Statistical analysis was performed with SPSS ® 20.0 Windows version. A significance level p≤0.05 was used for all analyzes. The data analyzed show that the profile of the Emergency Medical Technician in Spain is an 39 year-old man, married or living as a couple and has a child. The average BMI is 27 kg/m2, does regular exercise, does not smoke. His seniority in the company is 10 years and has the Medium Cycle of Emergency Medical Technician. The analysis for gender shows that men have an average of 40, an average BMI of 27, 5 kg/m2 and work in an advanced life support unit; while women have an average of 36,5 years, an average BMI of 24,7 kg/m2, mainly work in Basic Life Support Unit and her seniority in the company is 6,76 years. Emergency Medical Technician profile is a overweight men, who refer to practise regular exercise, his seniority in the company is 10 years and is in possession of CMTES; differences were observed according to gender in BMI, resource where they perform their work, seniority and age.

Emergency medical equipment on board German airliners.

PubMed

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

2014-01-01

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

Emergency Medical Service (EMS): Rotorcraft Technology Workshop

NASA Technical Reports Server (NTRS)

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

1981-01-01

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

The National Disaster Medical System

NASA Technical Reports Server (NTRS)

Reutershan, Thomas P.

1991-01-01

The Emergency Mobilization Preparedness Board developed plans for improved national preparedness in case of major catastrophic domestic disaster or the possibility of an overseas conventional conflict. Within the health and medical arena, the working group on health developed the concept and system design for the National Disaster Medical System (NDMS). A description of NDMS is presented including the purpose, key components, medical response, patient evacuation, definitive medical care, NDMS activation and operations, and summary and benefits.

The Use of Autonomous Systems in Emergency Medical Services: Bridging Human Intelligence and Technology

DTIC Science & Technology

2015-12-01

significant impact on emergency medical services ( EMS ). EMS provider organizations must be prepared to not only interact with AS by having response... EMS will be high, that the number of opportunities to improve required emergency response and deliver expedient medical care will be diminished, and...that strengths may be nonexistent. The thesis focuses on the analysis of what AS are, how they are used in the provision of EMS today, how they may be

Patient-directed intelligent and interactive computer medical history-gathering systems: a utility and feasibility study in the emergency department.

PubMed

Benaroia, Mark; Elinson, Roman; Zarnke, Kelly

2007-04-01

Patients can be used as a resource to enter their own pertinent medical information. This study will evaluate the feasibility of an intelligent computer medical history-taking device directed at patients in the emergency department (ED). Two of the authors (MB, RE) developed an expert system that can take patient-directed medical histories. Patients interacted with the computer in the ED waiting room while it gathered a medical history based on chief complaint (CC). A survey was completed post history. A sub-study assessed the computer's ability to take an adequate history for an index CC. We compared the computer and emergency physician histories for the presence or absence of important historical elements. Sixty-seven patients used the interactive computer system. The mean time to complete the history was 5 min and 32s +/- 1 min and 21s. The patient response rate was 97%. Over 83% felt that the computer was very easy to use and over 92% would very much use the computer again. A total of 15 patients with abdominal pain (index CC) were evaluated for the sub-study. The computer history asked 90+/-7%, and the emergency physician asked 55+/-18%, of the important historical elements. These groups were statistically different with a p-value of <0.00001. This feasibility study has shown that the computer history-taking device is well accepted by patients and that such a system can be integrated into the normal process of patient triage without delaying patient care. Such a system can serve as an initial mode for documentation and data acquisition directly from the patient.

NASA Worldwide Emergency Medical Assistance

NASA Technical Reports Server (NTRS)

Martin, George A.; Tipton, David A.; Long, Irene D.

1997-01-01

In an effort to maintain employee health and welfare, ensure customer satisfaction, and to deliver high quality emergency medical care when necessary to employees located overseas, NASA has instituted a new contract with International SOS Assistance INC. International SOS Assistance INC. will provide civil servants and contractors engaged in official NASA business with many services upon request during a medical or personal emergency. Through the years, International SOS Assistance INC. has developed the expertise necessary to provide medical service in all remote areas of the world. One phone call connects you to the SOS network of multilingual staff trained to help resolve travel, medical, legal, and security problems. The SOS network of critical care and aeromedical specialists operates 24 hours a day, 365 days a year from SOS Alarm Centers around the world. This exhibit illustrates the details of the NASA-International SOS Assistance INC. agreement.

A seamless ubiquitous emergency medical service for crisis situations.

PubMed

Lin, Bor-Shing

2016-04-01

In crisis situations, a seamless ubiquitous communication is necessary to provide emergency medical service to save people's lives. An excellent prehospital emergency medicine provides immediate medical care to increase the survival rate of patients. On their way to the hospital, ambulance personnel must transmit real-time and uninterrupted patient information to the hospital to apprise the physician of the situation and provide options to the ambulance personnel. In emergency and crisis situations, many communication channels can be unserviceable because of damage to equipment or loss of power. Thus, data transmission over wireless communication to achieve uninterrupted network services is a major obstacle. This study proposes a mobile middleware for cognitive radio (CR) for improving the wireless communication link. CRs can sense their operating environment and optimize the spectrum usage so that the mobile middleware can integrate the existing wireless communication systems with a seamless communication service in heterogeneous network environments. Eventually, the proposed seamless mobile communication middleware was ported into an embedded system, which is compatible with the actual network environment without the need for changing the original system architecture. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 3--Anatomy and Physiology. Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This student manual, the third in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains one section covering the following topics: general anatomical terms, the body cavities and contents, the integumentary system, the skeletal system, the muscular system, the nervous system, the respiratory…

Emergency Medical Care Training and Adolescents.

ERIC Educational Resources Information Center

Topham, Charles S.

1982-01-01

Describes an 11-week emergency medical care training program for adolescents focusing on: pretest results; factual emergency instruction and first aid; practical experience training; and assessment. (RC)

Tactical emergency medical support programs: a comprehensive statewide survey.

PubMed

Bozeman, William P; Morel, Benjamin M; Black, Timothy D; Winslow, James E

2012-01-01

Specially trained tactical emergency medical support (TEMS) personnel provide support to law enforcement special weapons and tactics (SWAT) teams. These programs benefit law enforcement agencies, officers, suspects, and citizens. TEMS programs are increasingly popular, but there are wide variations in their organization and operation and no recent data on their prevalence. We sought to measure the current prevalence and specific characteristics of TEMS programs in a comprehensive fashion in a single southeastern state. North Carolina emergency medical services (EMS) systems have county-based central EMS oversight; each system was surveyed by phone and e-mail. The presence and selected characteristics of TEMS programs were recorded. U.S. Census data were used to measure the population impact of the programs. All of the 101 EMS systems statewide were successfully contacted. Thirty-three counties (33%) have TEMS programs providing medical support to 56 local law enforcement agencies as well as state and federal agencies. TEMS programs tend to be located in more populated urban and suburban areas, serving a population base of 5.9 million people, or 64% of the state's population. Tactical medics in the majority of these programs (29/33; 88%) are not sworn law enforcement officers. Approximately one-third of county-based EMS systems in North Carolina have TEMS programs. These programs serve almost two-thirds of the state's population base, using primarily nonsworn tactical medics. Comparison with other regions of the country will be useful to demonstrate differences in prevalence and program characteristics. Serial surveillance will help track trends and measure the growth and impact of this growing subspecialty field.

A feasibility study for an emergency medical services system to serve the Permian basin in the state of Texas

NASA Technical Reports Server (NTRS)

1975-01-01

The development of an Emergency Medical Services System grant application for the Permian Basin Region of West Texas is described along with the application of NASA-developed technology. Conclusions and recommendations are included.

75 FR 27917 - Emergency Medical Services Week, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-18

... Part III The President Proclamation 8519--Emergency Medical Services Week, 2010 Executive Order... Medical Services Week, 2010 By the President of the United States of America A Proclamation Every day of... enhancing our country's preparedness and resilience. During Emergency Medical Services Week, we recommit to...

The evolutions of medical building network structure for emerging infectious disease protection and control.

PubMed

Liu, Nan; Zhang, Hongzhe; Zhang, Shanshan

2014-12-01

Emerging infectious disease is one of the most minatory threats in modern society. A perfect medical building network system need to be established to protect and control emerging infectious disease. Although in China a preliminary medical building network is already set up with disease control center, the infectious disease hospital, infectious diseases department in general hospital and basic medical institutions, there are still many defects in this system, such as simple structural model, weak interoperability among subsystems, and poor capability of the medical building to adapt to outbreaks of infectious disease. Based on the characteristics of infectious diseases, the whole process of its prevention and control and the comprehensive influence factors, three-dimensional medical architecture network system is proposed as an inevitable trend. In this conception of medical architecture network structure, the evolutions are mentioned, such as from simple network system to multilayer space network system, from static network to dynamic network, and from mechanical network to sustainable network. Ultimately, a more adaptable and corresponsive medical building network system will be established and argued in this paper.

Planning emergency medical communications

DOT National Transportation Integrated Search

1996-06-01

This technical bulletin summarizes a two volume publication entitled "Planning Emergency Medical Communications." Volume One, the State Level Planning Guide, contains general background information about a two tiered approach to EMS communications pl...

Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

PubMed Central

Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y.; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

2017-01-01

This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients’ biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient’s biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios. PMID:28117724

Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation.

PubMed

Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

2017-01-21

This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients' biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient's biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.

Job Involvement and Organizational Commitment of Employees of Prehospital Emergency Medical System

PubMed Central

Rahati, Alireza; Sotudeh-Arani, Hossein; Adib-Hajbaghery, Mohsen; Rostami, Majid

2015-01-01

Background: Several studies are available on organizational commitment of employees in different organizations. However, the organizational commitment and job involvement of the employees in the prehospital emergency medical system (PEMS) of Iran have largely been ignored. Objectives: This study aimed to investigate the organizational commitment and job involvement of the employees of PEMS and the relationship between these two issues. Materials and Methods: This cross-sectional study was conducted on 160 employees of Kashan PEMS who were selected through a census method in 2014. A 3-part instrument was used in this study, including a demographic questionnaire, the Allen and Miller’s organizational commitment inventory, and the Lodahl and Kejner’s job involvement inventory. We used descriptive statistics, Spearman correlation coefficient, Kruskal-Wallis, Friedman, analysis of variance, and Tukey post hoc tests to analyze the data. Results: The mean job involvement and organizational commitment scores were 61.78 ± 10.69 and 73.89 ± 13.58, respectively. The mean scores of job involvement and organizational commitment were significantly different in subjects with different work experiences (P = 0.043 and P = 0.012, respectively). However, no significant differences were observed between the mean scores of organizational commitment and job involvement in subjects with different fields of study, different levels of interest in the profession, and various educational levels. A direct significant correlation was found between the total scores of organizational commitment and job involvement of workers in Kashan PEMS (r = 0.910, P < 0.001). Conclusions: This study showed that the employees in the Kashan PEMS obtained half of the score of organizational commitment and about two-thirds of the job involvement score. Therefore, the higher level managers of the emergency medical system are advised to implement some strategies to increase the employees’ job involvement

Job Involvement and Organizational Commitment of Employees of Prehospital Emergency Medical System.

PubMed

Rahati, Alireza; Sotudeh-Arani, Hossein; Adib-Hajbaghery, Mohsen; Rostami, Majid

2015-12-01

Several studies are available on organizational commitment of employees in different organizations. However, the organizational commitment and job involvement of the employees in the prehospital emergency medical system (PEMS) of Iran have largely been ignored. This study aimed to investigate the organizational commitment and job involvement of the employees of PEMS and the relationship between these two issues. This cross-sectional study was conducted on 160 employees of Kashan PEMS who were selected through a census method in 2014. A 3-part instrument was used in this study, including a demographic questionnaire, the Allen and Miller's organizational commitment inventory, and the Lodahl and Kejner's job involvement inventory. We used descriptive statistics, Spearman correlation coefficient, Kruskal-Wallis, Friedman, analysis of variance, and Tukey post hoc tests to analyze the data. The mean job involvement and organizational commitment scores were 61.78 ± 10.69 and 73.89 ± 13.58, respectively. The mean scores of job involvement and organizational commitment were significantly different in subjects with different work experiences (P = 0.043 and P = 0.012, respectively). However, no significant differences were observed between the mean scores of organizational commitment and job involvement in subjects with different fields of study, different levels of interest in the profession, and various educational levels. A direct significant correlation was found between the total scores of organizational commitment and job involvement of workers in Kashan PEMS (r = 0.910, P < 0.001). This study showed that the employees in the Kashan PEMS obtained half of the score of organizational commitment and about two-thirds of the job involvement score. Therefore, the higher level managers of the emergency medical system are advised to implement some strategies to increase the employees' job involvement and organizational commitment.

An emergency medical planning guide for commercial spaceflight events.

PubMed

Law, Jennifer; Vanderploeg, James

2012-09-01

Commercial spaceflight events transporting paying passengers into space will begin to take place at various spaceports around the country within the next few years. Many spaceports are located in remote areas that are far from major hospitals and trauma centers. Spaceport medical directors should develop emergency medical plans (EMPs) to prepare for potential medical contingencies that may occur during commercial spaceflight events. The aim of this article is to guide spaceport medical directors in emergency medical planning for commercial spaceflight events. This guide is based on our experience and a recently developed EMP for Spaceport America which incorporated a literature review of mass gathering medicine, existing planning guides for mass gathering events, and EMPs for analogous aerospace events. We propose a multipronged approach to emergency medical planning, consisting of event planning, medical reconnaissance, medical personnel, protocols, physical facility and hardware, and documentation. Medical directors should use this guide to develop an emergency medical plan tailored to the resources and constraints specific to their events.

Hospital referral patterns: how emergency medical care is accessed in a disaster.

PubMed

Reilly, Michael J; Markenson, David

2010-10-01

A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning. We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data. Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care. Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for

Medical and radiological aspects of emergency preparedness and response at SevRAO facilities.

PubMed

Savkin, M N; Sneve, M K; Grachev, M I; Frolov, G P; Shinkarev, S M; Jaworska, A

2008-12-01

response at SevRAO facilities is a priority task within the general system of emergency preparedness; (b) there is an effective and improving interaction between SevRAO and the local medical institutions of FMBA and other territorial medical units; (c) the infrastructure of emergency response at SevRAO facilities has been created and operates within the framework of Russian legal and normative requirements. Further proposals have been made aimed at increasing the effectiveness of the available system of emergency preparedness and response, and to promote interagency cooperation.

Impact of patient-centered medical home assignment on emergency room visits among uninsured patients in a county health system.

PubMed

Roby, Dylan H; Pourat, Nadereh; Pirritano, Matthew J; Vrungos, Shelley M; Dajee, Himmet; Castillo, Dan; Kominski, Gerald F

2010-08-01

The Medical Services Initiative program--a safety net-based system of care--in Orange County included assignment of uninsured, low-income residents to a patient-centered medical home. The medical home provided case management, a team-based approach for treating disease, and increased access to primary and specialty care among other elements of a patient-centered medical home. Providers were paid an enhanced fee and pay-for-performance incentives to ensure delivery of comprehensive treatment. Medical Services Initiative enrollees who were assigned to a medical home for longer time periods were less likely to have any emergency room (ER) visits or multiple ER visits. Switching medical homes three or more times was associated with enrollees being more likely to have any ER visits or multiple ER visits. The findings provide evidence that successful implementation of the patient-centered medical home model in a county-based safety net system is possible and can reduce unnecessary ER use.

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 10. Injuries of the Eye, Ear, Nose, Abdomen, Central Nervous System and Genitalia. Burns and Environmental Injuries. Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers injuries of the eyes, ears, nose, abdomen, central nervous system (CNS), and genitalia; burns; and environmental injuries. Objectives stated for the two chapters are for the student to be able to describe procedures…

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 11--Childbirth, Pediatric Emergencies. Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers childbirth and pediatric emergencies. Objectives stated for the two chapters are for the students to be able to describe: emergency procedures for normal childbirth, unusual childbirth emergencies, emergency care for…

Evaluation of emergency medical text processor, a system for cleaning chief complaint text data.

PubMed

Travers, Debbie A; Haas, Stephanie W

2004-11-01

Emergency Medical Text Processor (EMT-P) version 1, a natural language processing system that cleans emergency department text (e.g., chst pn, chest pai), was developed to maximize extraction of standard terms (e.g., chest pain). The authors compared the number of standard terms extracted from raw chief complaint (CC) data with that for CC data cleaned with EMT-P and evaluated the accuracy of EMT-P. This cross-sectional observation study included CC text entries for all emergency department visits to three tertiary care centers in 2001. Terms were extracted from CC entries before and after cleaning with EMT-P. Descriptive statistics included number and percentage of all entries (tokens) and all unique entries (types) that matched a standard term from the Unified Medical Language System (UMLS). An expert panel rated the accuracy of the CC-UMLS term matches; inter-rater reliability was measured with kappa. The authors collected 203,509 CC entry tokens, of which 63,946 were unique entry types. For the raw data, 89,337 tokens (44%) and 5,081 types (8%) matched a standard term. After EMT-P cleaning, 168,050 tokens (83%) and 44,430 types (69%) matched a standard term. The expert panel reached consensus on 201 of the 222 CC-UMLS term matches reviewed (kappa=0.69-0.72). Ninety-six percent of the 201 matches were rated equivalent or related. Thirty-eight percent of the nonmatches were found to match UMLS concepts. EMT-P version 1 is relatively accurate, and cleaning with EMT-P improved the CC-UMLS term match rate over raw data. The authors identified areas for improvement in future EMT-P versions and issues to be resolved in developing a standard CC terminology.

Teaching Emergency Care to First-Year Medical Students

ERIC Educational Resources Information Center

McCally, Michael; And Others

1977-01-01

At the George Washington University School of Medicine a 52-hour course in emergency care was adapted for first-year medical students from an 81-hour program for training emergency medical technicians. (Author/LBH)

Towards systemic sustainable performance of TBI care systems: emergency leadership frontiers.

PubMed

Caro, Denis H J

2010-11-10

Traumatic brain injuries (TBIs) continue as a twenty-first century subterranean and almost invisible scourge internationally. TBI care systems provide a safety net for survival, recovery, and reintegration into social communities from this scourge, particularly in Canada, the European Union, and the USA. This paper examines the underlying issues of systemic performance and sustainability of TBI care systems, in the light of decreasing care resources and increasing demands for services. This paper reviews the extant literature on TBI care systems, systems reengineering, and emergency leadership literature. This paper presents a seven care layer paradigm, which forms the essence of systemic performance in the care of patients with TBIs. It also identifies five key strategic drivers that hold promise for the future systemic sustainability of TBI care systems. Transformational leadership and engagement from the international emergency medical community is the key to generating positive change. The sustainability/performance care framework is relevant and pertinent for consideration internationally and in the context of other emergency medical populations.

Implementing a nationwide criteria-based emergency medical dispatch system: A register-based follow-up study

PubMed Central

2013-01-01

Background A criteria-based nationwide Emergency Medical Dispatch (EMD) system was recently implemented in Denmark. We described the system and studied its ability to triage patients according to the severity of their condition by analysing hospital admission and case-fatality risks. Methods This was a register-based follow-up study of all 1-1-2 calls in a 6-month period that were triaged according to the Danish Index – the new criteria-based dispatch protocol. Danish Index data were linked with hospital and vital status data from national registries. Confidence intervals (95%) for proportions with binomial data were computed using exact methods. To test for trend the Wald test was used. Results Information on level of emergency according to the Danish Index rating was available for 67,135 patients who received ambulance service. Emergency level A (urgent cases) accounted for 51.4% (n = 34,489) of patients, emergency level B for 46.3% (n = 31,116), emergency level C for 2.1% (n = 1,391) and emergency level D for 0.2% (n = 139). For emergency level A, the median time from call receipt to ambulance dispatch was 2 min 1 s, and the median time to arrival was 6 min 11 s. Data concerning admission and case fatality was available for 55,270 patients. The hospital admission risk for emergency level A patients was 64.4% (95% CI = 63.8-64.9). There was a significant trend (p < 0.001) towards lower admission risks for patients with lower levels of emergency. The case fatality risk for emergency level A patients on the same day as the 1-1-2 call was 4.4% (95% CI = 4.1-4.6). The relative case-fatality risk among emergency level A patients compared to emergency level B–D patients was 14.3 (95% CI: 11.5-18.0). Conclusion The majority of patients were assessed as Danish Index emergency level A or B. Case fatality and hospital admission risks were substantially higher for emergency level A patients than for emergency level B–D patients. Thus

Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies, Part 2: Special Psychiatric Populations and Considerations.

PubMed

Alam, Al; Rachal, James; Tucci, Veronica Theresa; Moukaddam, Nidal

2017-09-01

Patients who present to the emergency department (ED) with mental illness or behavioral complaints merit workup for underlying physical conditions that can trigger, mimic, or worsen psychiatric symptoms. However, there are wide variations in quality of care for these individuals. Psychiatry and emergency medicine specialty guidelines support a tailored, customized approach to patients. Our group has long advocated a dynamic comanagement approach for medical clearance in the ED, and this article summarizes best-practice approaches to the medical clearance of patients with psychiatric illness, tips on history taking, system reviews, clinical/physical examination, and common pitfalls in the medical clearance process. Copyright © 2017 Elsevier Inc. All rights reserved.

The emergency patient's participation in medical decision-making.

PubMed

Wang, Li-Hsiang; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Han, Chin-Yen; Liu, Hsueh-Erh

2016-09-01

The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. The findings fill a gap in knowledge about the decision-making process among emergency patients. The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff. © 2016 John Wiley & Sons Ltd.

24 CFR 291.530 - Eligible firefighter/emergency medical technicians.

Code of Federal Regulations, 2010 CFR

2010-04-01

... medical technicians. 291.530 Section 291.530 Housing and Urban Development Regulations Relating to Housing... medical technicians. A person qualifies as a firefighter/emergency medical technician for the purposes of... technician by a fire department or emergency medical services responder unit of the federal government, a...

14 CFR § 1250.103-6 - Medical emergencies.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Medical emergencies. § 1250.103-6 Section... § 1250.103-6 Medical emergencies. Notwithstanding the provisions of §§ 1250.103 to 1250.103-5, a... through a medical institution which refuses or fails to comply with § 1250.103-1. ...

Linking medical records to an expert system

NASA Technical Reports Server (NTRS)

Naeymi-Rad, Frank; Trace, David; Desouzaalmeida, Fabio

1991-01-01

This presentation will be done using the IMR-Entry (Intelligent Medical Record Entry) system. IMR-Entry is a software program developed as a front-end to our diagnostic consultant software MEDAS (Medical Emergency Decision Assistance System). MEDAS (the Medical Emergency Diagnostic Assistance System) is a diagnostic consultant system using a multimembership Bayesian design for its inference engine and relational database technology for its knowledge base maintenance. Research on MEDAS began at the University of Southern California and the Institute of Critical Care in the mid 1970's with support from NASA and NSF. The MEDAS project moved to Chicago in 1982; its current progress is due to collaboration between Illinois Institute of Technology, The Chicago Medical School, Lake Forest College and NASA at KSC. Since the purpose of an expert system is to derive a hypothesis, its communication vocabulary is limited to features used by its knowledge base. The development of a comprehensive problem based medical record entry system which could handshake with an expert system while creating an electronic medical record at the same time was studied. IMR-E is a computer based patient record that serves as a front end to the expert system MEDAS. IMR-E is a graphically oriented comprehensive medical record. The programs major components are demonstrated.

10 CFR 4.14 - Medical emergencies.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Medical emergencies. 4.14 Section 4.14 Energy NUCLEAR... and Title IV of the Energy Reorganization Act of 1974 Discrimination Prohibited § 4.14 Medical... health, and such service or other benefit cannot be provided except by or through a medical institution...

10 CFR 4.14 - Medical emergencies.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Medical emergencies. 4.14 Section 4.14 Energy NUCLEAR... and Title IV of the Energy Reorganization Act of 1974 Discrimination Prohibited § 4.14 Medical... health, and such service or other benefit cannot be provided except by or through a medical institution...

10 CFR 4.14 - Medical emergencies.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Medical emergencies. 4.14 Section 4.14 Energy NUCLEAR... and Title IV of the Energy Reorganization Act of 1974 Discrimination Prohibited § 4.14 Medical... health, and such service or other benefit cannot be provided except by or through a medical institution...

10 CFR 4.14 - Medical emergencies.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Medical emergencies. 4.14 Section 4.14 Energy NUCLEAR... and Title IV of the Energy Reorganization Act of 1974 Discrimination Prohibited § 4.14 Medical... health, and such service or other benefit cannot be provided except by or through a medical institution...

10 CFR 4.14 - Medical emergencies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Medical emergencies. 4.14 Section 4.14 Energy NUCLEAR... and Title IV of the Energy Reorganization Act of 1974 Discrimination Prohibited § 4.14 Medical... health, and such service or other benefit cannot be provided except by or through a medical institution...

Medical issues in flight and updating the emergency medical kit.

PubMed

Verjee, Mohamud A; Crone, Robert; Ostrovskiy, Grigory

2018-01-01

Airline travel is more affordable than ever and likely safer than ever too. Within half a day, a passenger can be on the other side of the world. However, medical care in-flight has been an issue for those with medical conditions and for those who fall sick during a journey. While airlines have the advice of multiple recognized organizations on needs and standards of care, in-flight emergencies occur at various levels. An emergency medical kit (EMK) together with trained cabin crew can be very effective at resolving the minor problems that arise and reducing the risk of escalation. On occasion, an overhead plea may be announced for additional medical expertise. Having the right content in a medical kit is more important in modern day travel, coupled with advances in equipment and passenger expectations. The authors address current issues of illness and other relevant conditions and suggest a content enhancement for an onboard EMK.

Medical issues in flight and updating the emergency medical kit

PubMed Central

Verjee, Mohamud A; Crone, Robert; Ostrovskiy, Grigory

2018-01-01

Airline travel is more affordable than ever and likely safer than ever too. Within half a day, a passenger can be on the other side of the world. However, medical care in-flight has been an issue for those with medical conditions and for those who fall sick during a journey. While airlines have the advice of multiple recognized organizations on needs and standards of care, in-flight emergencies occur at various levels. An emergency medical kit (EMK) together with trained cabin crew can be very effective at resolving the minor problems that arise and reducing the risk of escalation. On occasion, an overhead plea may be announced for additional medical expertise. Having the right content in a medical kit is more important in modern day travel, coupled with advances in equipment and passenger expectations. The authors address current issues of illness and other relevant conditions and suggest a content enhancement for an onboard EMK. PMID:29750057

Response capability during civil air carrier inflight medical emergencies.

DOT National Transportation Integrated Search

1991-03-01

Expanded civil aircraft medical emergency kits have been mandated on U.S. carriers since August 1986. Airlines provided the Federal Aviation Agency reports on medical kit usage and outcomes of the associated medical emergencies; 1,016 inflight medica...

Basic management of medical emergencies: recognizing a patient's distress.

PubMed

Reed, Kenneth L

2010-05-01

Medical emergencies can happen in the dental office, possibly threatening a patient's life and hindering the delivery of dental care. Early recognition of medical emergencies begins at the first sign of symptoms. The basic algorithm for management of all medical emergencies is this: position (P), airway (A), breathing (B), circulation (C) and definitive treatment, differential diagnosis, drugs, defibrillation (D). The dentist places an unconscious patient in a supine position and comfortably positions a conscious patient. The dentist then assesses airway, breathing and circulation and, when necessary, supports the patient's vital functions. Drug therapy always is secondary to basic life support (that is, PABCD). Prompt recognition and efficient management of medical emergencies by a well-prepared dental team can increase the likelihood of a satisfactory outcome. The basic algorithm for managing medical emergencies is designed to ensure that the patient's brain receives a constant supply of blood containing oxygen.

Implementation of Emergency Medical Text Classifier for Syndromic Surveillance

PubMed Central

Travers, Debbie; Haas, Stephanie W.; Waller, Anna E.; Schwartz, Todd A.; Mostafa, Javed; Best, Nakia C.; Crouch, John

2013-01-01

Public health officials use syndromic surveillance systems to facilitate early detection and response to infectious disease outbreaks. Emergency department clinical notes are becoming more available for surveillance but present the challenge of accurately extracting concepts from these text data. The purpose of this study was to implement a new system, Emergency Medical Text Classifier (EMT-C), into daily production for syndromic surveillance and evaluate system performance and user satisfaction. The system was designed to meet user preferences for a syndromic classifier that maximized positive predictive value and minimized false positives in order to provide a manageable workload. EMT-C performed better than the baseline system on all metrics and users were slightly more satisfied with it. It is vital to obtain user input and test new systems in the production environment. PMID:24551413

Implementation of Emergency Medical Text Classifier for syndromic surveillance.

PubMed

Travers, Debbie; Haas, Stephanie W; Waller, Anna E; Schwartz, Todd A; Mostafa, Javed; Best, Nakia C; Crouch, John

2013-01-01

Public health officials use syndromic surveillance systems to facilitate early detection and response to infectious disease outbreaks. Emergency department clinical notes are becoming more available for surveillance but present the challenge of accurately extracting concepts from these text data. The purpose of this study was to implement a new system, Emergency Medical Text Classifier (EMT-C), into daily production for syndromic surveillance and evaluate system performance and user satisfaction. The system was designed to meet user preferences for a syndromic classifier that maximized positive predictive value and minimized false positives in order to provide a manageable workload. EMT-C performed better than the baseline system on all metrics and users were slightly more satisfied with it. It is vital to obtain user input and test new systems in the production environment.

[Hospital emergency and health system organization in France].

PubMed

Moreau, François

2003-01-01

There is no legal definition of the term "emergency" in France. Given the vagueness of this term, a law was passed on 6 January 1986 in France defining the principle of urgent medical assistance as "providing the sick, the wounded and pregnant women, wherever they are, with the appropriate emergency care to meet their condition". The Ethical Medical Code of 6 September 1995 (Art. 77) specifies that "regarding constant availability of health care, the duty of every doctor is to take part in the day and night on-call rota". To understand the emergency care system in France, it should be stressed that the health system is a joint system, with a private sector and a public sector jointly organizing and providing health care. The patient can access either system as he chooses.

Patients who leave the emergency department against medical advice.

PubMed

Lee, Choung Ah; Cho, Joon Pil; Choi, Sang Cheon; Kim, Hyuk Hoon; Park, Ju Ok

2016-06-01

Discharge against medical advice (DAMA) from the emergency department (ED) accounts for 0.1% to 2.7% of all ED discharges. DAMA carries a risk of increased mortality and readmissions. Our aim was to investigate the general characteristics of DAMA patients and the differences between them and non-DAMA patients. We reviewed data collected by the National Emergency Medical Center between 2010 and 2011. Subjects were categorized into 2 groups, namely, the DAMA group and the non-DAMA group. We compared these groups with respect to age, gender, trauma or non-trauma status, type of hospital, health insurance, level of consciousness on admission, and diagnosis. Of 8,000,529 patients, 222,389 (2.78%) left against medical advice. The risk factors for DAMA across all age groups were as follows: no medical insurance (odds ratio [OR], 1.993), initial response to voice (OR, 2.753) or pain (OR, 2.101), trauma admission (OR, 1.126), admission to a local emergency medical center (OR, 1.215), and increased age. A high risk of DAMA was observed among patients with immune, endocrine, psychiatric, neurological, circulatory diseases, and external causes of morbidity and mortality. Although DAMA cases account for only a small percentage of hospital discharges, they are important because DAMA patients have high readmission and mortality rates. It is therefore important to understand the general characteristics and predictors of DAMA in order to improve patient outcome and minimize the economic burden on the healthcare system.

Lights and siren: a review of emergency vehicle warning systems.

PubMed

De Lorenzo, R A; Eilers, M A

1991-12-01

Emergency medical services providers routinely respond to emergencies using lights and siren. This practice is not without risk of collision. Audible and visual warning devices and vehicle markings are integral to efficient negotiation of traffic and reduction of collision risk. An understanding of warning system characteristics is necessary to implement appropriate guidelines for prehospital transportation systems. The pertinent literature on emergency vehicle warning systems is reviewed, with emphasis on potential health hazards associated with these techniques. Important findings inferred from the literature are 1) red flashing lights alone may not be as effective as other color combinations, 2) there are no data to support a seizure risk with strobe lights, 3) lime-yellow is probably superior to traditional emergency vehicle colors, 4) the siren is an extremely limited warning device, and 5) exposure to siren noise can cause hearing loss. Emergency physicians must ensure that emergency medical services transportation systems consider the pertinent literature on emergency vehicle warning systems.

Toward Ubiquitous Communication Platform for Emergency Medical Care

NASA Astrophysics Data System (ADS)

Ishibashi, Kenichi; Morishima, Naoto; Kanbara, Masayuki; Sunahara, Hideki; Imanishi, Masami

Interaction between emergency medical technicians (EMTs) and doctors is essential in emergency medical care. Doctors require diverse information related to a patient to provide efficient aid. In 2005, we started the Ikoma119 project and have developed a ubiquitous communication platform for emergency medical care called Mobile ER. Our platform, which is based on wireless internet technology, has such desirable properties as low-cost, location-independent service, and ease of service introduction. We provide an overview of our platform and describe the services that we have developed. We also discuss the remaining issues to realize our platform's actual operation.

National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module XV. Telemetry and Communications.

ERIC Educational Resources Information Center

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

This instructor's lesson plan guide on telemetry and communications is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Two units of study are presented: (1) emergency medical services communications systems (items of equipment and such radio communications concepts as frequency allocation,…

Towards systemic sustainable performance of TBI care systems: emergency leadership frontiers

PubMed Central

2010-01-01

Background Traumatic brain injuries (TBIs) continue as a twenty-first century subterranean and almost invisible scourge internationally. TBI care systems provide a safety net for survival, recovery, and reintegration into social communities from this scourge, particularly in Canada, the European Union, and the USA. Aims This paper examines the underlying issues of systemic performance and sustainability of TBI care systems, in the light of decreasing care resources and increasing demands for services. Methods This paper reviews the extant literature on TBI care systems, systems reengineering, and emergency leadership literature. Results This paper presents a seven care layer paradigm, which forms the essence of systemic performance in the care of patients with TBIs. It also identifies five key strategic drivers that hold promise for the future systemic sustainability of TBI care systems. Conclusions Transformational leadership and engagement from the international emergency medical community is the key to generating positive change. The sustainability/performance care framework is relevant and pertinent for consideration internationally and in the context of other emergency medical populations. PMID:21373305

Development of new core competencies for Taiwanese Emergency Medical Technicians.

PubMed

Chang, Yu-Tung; Tsai, Kuang-Chau; Williams, Brett

2018-01-01

Core competencies are considered the foundation for establishing Emergency Medical Technician (EMT) and paramedic curricula, and for ensuring performance standards in the delivery of prehospital care. This study surveyed EMT instructors and medical directors to identify the most desirable core competencies for all levels of EMTs in Taiwan. A principal components analysis with Varimax rotation was conducted. An online questionnaire was distributed to obtain perspectives of EMT instructors and medical directors on the most desirable core competencies for EMTs. The target population was EMT training-course instructors and medical directors of fire departments in Taiwan. The questionnaire comprised 61 competency items, and multiple-choice and open-ended questions were used to obtain respondents' perspectives of the Taiwanese EMT training and education system. The results identified three factors at EMT-1 and EMT-2 levels and five factors at the EMT-Paramedic level. The factors for EMT-1 and EMT-2 were similar, and those for EMT-Paramedics identified further comprehensive competence perspectives. The key factors that appear to influence the development of the Taiwanese Emergency Medical Services (EMS) education system are the attitude of authorities, the licensure system, and legislation. The findings present new core competencies for the Taiwanese EMT system and provide capacity to redesign curricula and reconsider roles for EMT-1 and EMT-2 technicians. At the EMT-Paramedic level, the findings demonstrate the importance of incorporating competency standards in the current skills-based curriculum. Moreover, the core-competencies gap that exists between Taiwanese EMT-1s, EMT-2s, and EMT-Paramedics and internationally recognized core competencies needs to be addressed. By identifying the key factors that potentially impact the development of the EMS education system, such as the attitude of authorities, the licensure system, and legislation, these findings will inform

Development of new core competencies for Taiwanese Emergency Medical Technicians

PubMed Central

Chang, Yu-Tung; Tsai, Kuang-Chau; Williams, Brett

2018-01-01

Objectives Core competencies are considered the foundation for establishing Emergency Medical Technician (EMT) and paramedic curricula, and for ensuring performance standards in the delivery of prehospital care. This study surveyed EMT instructors and medical directors to identify the most desirable core competencies for all levels of EMTs in Taiwan. Methods A principal components analysis with Varimax rotation was conducted. An online questionnaire was distributed to obtain perspectives of EMT instructors and medical directors on the most desirable core competencies for EMTs. The target population was EMT training-course instructors and medical directors of fire departments in Taiwan. The questionnaire comprised 61 competency items, and multiple-choice and open-ended questions were used to obtain respondents’ perspectives of the Taiwanese EMT training and education system. Results The results identified three factors at EMT-1 and EMT-2 levels and five factors at the EMT-Paramedic level. The factors for EMT-1 and EMT-2 were similar, and those for EMT-Paramedics identified further comprehensive competence perspectives. The key factors that appear to influence the development of the Taiwanese Emergency Medical Services (EMS) education system are the attitude of authorities, the licensure system, and legislation. Conclusion The findings present new core competencies for the Taiwanese EMT system and provide capacity to redesign curricula and reconsider roles for EMT-1 and EMT-2 technicians. At the EMT-Paramedic level, the findings demonstrate the importance of incorporating competency standards in the current skills-based curriculum. Moreover, the core-competencies gap that exists between Taiwanese EMT-1s, EMT-2s, and EMT-Paramedics and internationally recognized core competencies needs to be addressed. By identifying the key factors that potentially impact the development of the EMS education system, such as the attitude of authorities, the licensure system, and

28 CFR 115.182 - Access to emergency medical services.

Code of Federal Regulations, 2013 CFR

2013-07-01

... medical services. (a) Detainee victims of sexual abuse in lockups shall receive timely, unimpeded access to emergency medical treatment. (b) Treatment services shall be provided to the victim without... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Access to emergency medical services. 115...

28 CFR 115.182 - Access to emergency medical services.

Code of Federal Regulations, 2014 CFR

2014-07-01

... medical services. (a) Detainee victims of sexual abuse in lockups shall receive timely, unimpeded access to emergency medical treatment. (b) Treatment services shall be provided to the victim without... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Access to emergency medical services. 115...

28 CFR 115.182 - Access to emergency medical services.

Code of Federal Regulations, 2012 CFR

2012-07-01

... medical services. (a) Detainee victims of sexual abuse in lockups shall receive timely, unimpeded access to emergency medical treatment. (b) Treatment services shall be provided to the victim without... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Access to emergency medical services. 115...

Teaching emergency medicine with workshops improved medical student satisfaction in emergency medicine education.

PubMed

Sricharoen, Pungkava; Yuksen, Chaiyaporn; Sittichanbuncha, Yuwares; Sawanyawisuth, Kittisak

2015-01-01

There are different teaching methods; such as traditional lectures, bedside teaching, and workshops for clinical medical clerkships. Each method has advantages and disadvantages in different situations. Emergency Medicine (EM) focuses on emergency medical conditions and deals with several emergency procedures. This study aimed to compare traditional teaching methods with teaching methods involving workshops in the EM setting for medical students. Fifth year medical students (academic year of 2010) at Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand participated in the study. Half of students received traditional teaching, including lectures and bedside teaching, while the other half received traditional teaching plus three workshops, namely, airway workshop, trauma workshop, and emergency medical services workshop. Student evaluations at the end of the clerkship were recorded. The evaluation form included overall satisfaction, satisfaction in overall teaching methods, and satisfaction in each teaching method. During the academic year 2010, there were 189 students who attended the EM rotation. Of those, 77 students (40.74%) were in the traditional EM curriculum, while 112 students were in the new EM curriculum. The average satisfaction score in teaching method of the new EM curriculum group was higher than the traditional EM curriculum group (4.54 versus 4.07, P-value <0.001). The top three highest average satisfaction scores in the new EM curriculum group were trauma workshop, bedside teaching, and emergency medical services workshop. The mean (standard deviation) satisfaction scores of those three teaching methods were 4.70 (0.50), 4.63 (0.58), and 4.60 (0.55), respectively. Teaching EM with workshops improved student satisfaction in EM education for medical students.

Assessment of a group of nigerian dental students' education on medical emergencies.

PubMed

Ehigiator, O; Ehizele, Ao; Ugbodaga, Pi

2014-03-01

The training of dental students in the management of medical emergencies is of utmost importance as they may encounter some of these emergencies at some point in their career. The aim of this study was to evaluate the medical emergency education in a Nigerian Dental School. This descriptive cross-sectional study was carried out among 124 final year dental students of the University of Benin, Benin City. Data was collected using a self-administered questionnaire. The questionnaire elicited information on demography, knowledge of inclusion of a medical emergency in the dental curriculum, knowledge of guidelines on medical emergency formulated by any dental authority, opinion on the comprehensiveness of the present training on medical emergency, type of medical emergency training received, previous encounter with a medical emergency, previous participation in emergency drills and knowledge of the content of an emergency kit. Descriptive statistics was carried out on the collected data. Only 58.1% (72/124) respondents were aware of the inclusion of a medical emergency in the dental curriculum and fewer, 17.7% (22/124), were aware of guidelines on medical emergency formulated by any dental authority. Fifty-two out of all the respondents (41.9%) claimed not to have received any form of training on medical emergency. Only 22.6% (28/123) had previously participated in an emergency drills and just 34.7% (43/124) had ever seen an emergency kit. It can be concluded from this study that the level of training and level of knowledge on medical emergencies of the studied dental students is below desirable standard. It is therefore necessary to put proper strategies in place to strengthen their identified areas of weakness.

Prescription errors before and after introduction of electronic medication alert system in a pediatric emergency department.

PubMed

Sethuraman, Usha; Kannikeswaran, Nirupama; Murray, Kyle P; Zidan, Marwan A; Chamberlain, James M

2015-06-01

Prescription errors occur frequently in pediatric emergency departments (PEDs).The effect of computerized physician order entry (CPOE) with electronic medication alert system (EMAS) on these is unknown. The objective was to compare prescription errors rates before and after introduction of CPOE with EMAS in a PED. The hypothesis was that CPOE with EMAS would significantly reduce the rate and severity of prescription errors in the PED. A prospective comparison of a sample of outpatient, medication prescriptions 5 months before and after CPOE with EMAS implementation (7,268 before and 7,292 after) was performed. Error types and rates, alert types and significance, and physician response were noted. Medication errors were deemed significant if there was a potential to cause life-threatening injury, failure of therapy, or an adverse drug effect. There was a significant reduction in the errors per 100 prescriptions (10.4 before vs. 7.3 after; absolute risk reduction = 3.1, 95% confidence interval [CI] = 2.2 to 4.0). Drug dosing error rates decreased from 8 to 5.4 per 100 (absolute risk reduction = 2.6, 95% CI = 1.8 to 3.4). Alerts were generated for 29.6% of prescriptions, with 45% involving drug dose range checking. The sensitivity of CPOE with EMAS in identifying errors in prescriptions was 45.1% (95% CI = 40.8% to 49.6%), and the specificity was 57% (95% CI = 55.6% to 58.5%). Prescribers modified 20% of the dosing alerts, resulting in the error not reaching the patient. Conversely, 11% of true dosing alerts for medication errors were overridden by the prescribers: 88 (11.3%) resulted in medication errors, and 684 (88.6%) were false-positive alerts. A CPOE with EMAS was associated with a decrease in overall prescription errors in our PED. Further system refinements are required to reduce the high false-positive alert rates. © 2015 by the Society for Academic Emergency Medicine.

Emergency Telemedicine: Achieving and Maintaining Compliance with the Emergency Medical Treatment and Labor Act.

PubMed

Rockwell, Kimberly Lovett; Gilroy, Alexis

2018-03-12

Telemedicine is a growing and important platform for medical delivery in the emergency department. Emergency telemedicine outlays often confront and conflict with important federal healthcare regulations. Because of this, academic medical centers, critical access hospitals, and other providers interested in implementing emergency telemedicine have often delayed or forgone such services due to reasonable fears of falling out of compliance with regulatory restrictions imposed by the Emergency Medical Treatment and Labor Act ("EMTALA"). This article offers insights into methods for implementing emergency telemedicine services while maintaining EMTALA compliance. Critical analysis of EMTALA and its attendant regulations. The primary means of ensuring EMTALA compliance while implementing emergency telemedicine programs include incorporating critical clinical details into the services contracts and implementing robust written policies that anticipate division of labor issues, the need for backup coverage, triaging, patient transfer protocols, and credentialing issues. With adequate up-front due diligence and meaningful contracting, hospitals and telemedicine providers can avoid common EMTALA liability pitfalls.

Management of in-flight medical emergencies: are senior medical students prepared to respond to this community need?

PubMed

Katzer, Robert J; Duong, David; Weber, Matthew; Memmer, Amy; Buchanan, Ian

2014-11-01

In-flight medical emergencies on commercial aircraft are common in both domestic and international flights. We hypothesized that fourth-year medical students feel inadequately prepared to lend assistance during in-flight medical emergencies. This multicenter study of two U.S. medical schools obtains a baseline assessment of knowledge and confidence in managing in-flight medical emergencies. A 25-question survey was administered to fourth-year medical students at two United States medical schools. Questions included baseline knowledge of in-flight medicine (10 questions) and perceived ability to respond to in-flight medical emergencies. 229 participants completed the survey (75% response rate). The average score on the fund of knowledge questions was 64%. Responses to the 5-point Likert scale questions indicated that, on average, students did not feel confident or competent responding to an in-flight medical emergency. Participants on average also disagreed with statements that they had adequate understanding of supplies, flight crew training, and ground-based management. This multicenter survey indicates that fourth-year medical students do not feel adequately prepared to respond to in-flight medical emergencies and may have sub-optimal knowledge. This study provides an initial step in identifying a deficiency in current medical education.

Management of In-Flight Medical Emergencies: Are Senior Medical Students Prepared to Respond to this Community Need?

PubMed Central

Katzer, Robert J.; Duong, David; Weber, Matthew; Memmer, Amy; Buchanan, Ian

2014-01-01

Introduction In-flight medical emergencies on commercial aircraft are common in both domestic and international flights. We hypothesized that fourth-year medical students feel inadequately prepared to lend assistance during in-flight medical emergencies. This multicenter study of two U.S. medical schools obtains a baseline assessment of knowledge and confidence in managing in-flight medical emergencies. Methods A 25-question survey was administered to fourth-year medical students at two United States medical schools. Questions included baseline knowledge of in-flight medicine (10 questions) and perceived ability to respond to in-flight medical emergencies. Results 229 participants completed the survey (75% response rate). The average score on the fund of knowledge questions was 64%. Responses to the 5-point Likert scale questions indicated that, on average, students did not feel confident or competent responding to an in-flight medical emergency. Participants on average also disagreed with statements that they had adequate understanding of supplies, flight crew training, and ground-based management. Conclusion This multicenter survey indicates that fourth-year medical students do not feel adequately prepared to respond to in-flight medical emergencies and may have sub-optimal knowledge. This study provides an initial step in identifying a deficiency in current medical education. PMID:25493155

Highway Safety Program Manual: Volume 11: Emergency Medical Services.

ERIC Educational Resources Information Center

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

Volume 11 of the 19-volume Highway Safety Program Manual (which provides guidance to State and local governments on preferred highway safety practices) concentrates on emergency medical services. The purpose of the program, Federal authority in the area of medical services, and policies related to an emergency medical services (EMS) program are…

On-line telemetry: prospective assessment of accuracy in an all-volunteer emergency medical service system.

PubMed

Hollander, J E; Delagi, R; Sciammarella, J; Viccellio, P; Ortiz, J; Henry, M C

1995-04-01

To evaluate the need for on-line telemetry control in an all-volunteer, predominantly advanced emergency medical technician (A-EMT) ambulance system. Emergency medical service (EMS) advanced life support (ALS) providers were asked to transmit the ECG rhythms of monitored patients over a six-month period in 1993. The ECG rhythm interpretations of volunteer EMS personnel were compared with those of the on-line medical control physician. All discordant readings were reviewed by a panel of physicians to decide whether the misdiagnosis would have resulted in treatment aberrations had transmission been unavailable. Patients were monitored and rhythms were transmitted in 1,825 cases. 1,642 of 1,825 rhythms were correctly interpreted by the EMS providers (90%; 95% CI 89-91%). The accuracy of the EMS providers was dependent on the patient's rhythm (chi-square, p < 0.00001), the chief complaint (chi-square, p = 0.0001), and the provider's level of training (chi-square, p = 0.02). Correct ECG rhythm interpretations were more common when the out-of-hospital interpretation was sinus rhythm (95%), ventricular fibrillation (87%), paced rhythm (94%), or agonal rhythm (96%). The EMS providers were frequently incorrect when the out-of-hospital rhythm interpretation was atrial fibrillation/flutter (71%), supraventricular tachycardia (46%), ventricular tachycardia (59%), or atrioventricular block (50%). Of the 183 discordant cases, 124 (68%) involved missing a diagnosis of, or incorrectly diagnosing, atrial fibrillation/flutter. Review of the discordant readings identified 11 cases that could have resulted in treatment errors had the rhythms not been transmitted, one of which might have resulted in an adverse outcome. In this all-volunteer, predominantly A-EMT ALS system, patients with a field interpretation of a sinus rhythm do not require ECG rhythm transmission. Field interpretations of atrial fibrillation/flutter, supraventricular tachycardia, ventricular tachycardia, and

Employability Competencies for Entry Level Emergency Medical Aides.

ERIC Educational Resources Information Center

Werner, Claire

This document describes competencies needed by persons who complete the Los Angeles Schools' emergency medical aide competency-based program, which is designed to enhance their ability to obtain certification as an Emergency Medical Technician (EMT). The overall competency statement ("goal") of the program heads each page and is defined by one or…

Updated posters to help manage medical emergencies in the dental practice.

PubMed

Jevon, P

2015-09-11

Medical emergencies can occur in the dental practice. Medical Emergencies in the Dental Practice and Emergency Drugs in the Dental Practice posters have been designed to help dental practitioners to respond effectively and safely to a medical emergency. These posters, endorsed by the British Dental Association, are included with this issue of the British Dental Journal. Further copies can be downloaded from: https://www.walsallhealthcare.nhs.uk/medical-education.aspx.

Educating medical staff about responding to a radiological or nuclear emergency.

PubMed

McCurley, M Carol; Miller, Charles W; Tucker, Florie E; Guinn, Amy; Donnelly, Elizabeth; Ansari, Armin; Holcombe, Maire; Nemhauser, Jeffrey B; Whitcomb, Robert C

2009-05-01

A growing body of audience research reveals medical personnel in hospitals are unprepared for a large-scale radiological emergency such as a terrorist event involving radioactive or nuclear materials. Also, medical personnel in hospitals lack a basic understanding of radiation principles, as well as diagnostic and treatment guidelines for radiation exposure. Clinicians have indicated that they lack sufficient training on radiological emergency preparedness; they are potentially unwilling to treat patients if those patients are perceived to be radiologically contaminated; and they have major concerns about public panic and overloading of clinical systems. In response to these findings, the Centers for Disease Control and Prevention (CDC) has developed a tool kit for use by hospital medical personnel who may be called on to respond to unintentional or intentional mass-casualty radiological and nuclear events. This tool kit includes clinician fact sheets, a clinician pocket guide, a digital video disc (DVD) of just-in-time basic skills training, a CD-ROM training on mass-casualty management, and a satellite broadcast dealing with medical management of radiological events. CDC training information emphasizes the key role that medical health physicists can play in the education and support of emergency department activities following a radiological or nuclear mass-casualty event.

Personal medical information system using laser card

NASA Astrophysics Data System (ADS)

Cho, Seong H.; Kim, Keun Ho; Choi, Hyung-Sik; Park, Hyun Wook

1996-04-01

The well-known hospital information system (HIS) and the picture archiving and communication system (PACS) are typical applications of multimedia to medical area. This paper proposes a personal medical information save-and-carry system using a laser card. This laser card is very useful, especially in emergency situations, because the medical information in the laser card can be read at anytime and anywhere if there exists a laser card reader/writer. The contents of the laser card include the clinical histories of a patient such as clinical chart, exam result, diagnostic reports, images, and so on. The purpose of this system is not a primary diagnosis, but emergency reference of clinical history of the patient. This personal medical information system consists of a personal computer integrated with laser card reader/writer, color frame grabber, color CCD camera and a high resolution image scanner optionally. Window-based graphical user interface was designed for easy use. The laser card has relatively sufficient capacity to store the personal medical information, and has fast access speed to restore and load the data with a portable size as compact as a credit card. Database items of laser card provide the doctors with medical data such as laser card information, patient information, clinical information, and diagnostic result information.

Pakistan: the new target of terrorism. Are Karachi's emergency medical response systems adequately prepared?

PubMed

Siddiqui, Muhammad Ahmed; Jawad, Ahmed; Minhas, Saeed; Ansari, Asma; Siddiqui, Afrah; Mehtab, Sana

2009-07-01

To assess the efficacy and preparedness of the pre-hospital and hospital emergency medical systems and post graduate trainees in the city to deal with a massive terrorist strike. A cross-sectional survey of postgraduate trainees was conducted at Jinnah Postgraduate Medical Center and Civil Hospital Karachi from 21st July 2007 to 24th July 2007, to evaluate the preparedness and self identified deficiencies of doctors involved in massive trauma casualty management. To assess the pre-hospital care in Karachi, structured telephonic interviews were conducted of administrators of two private run charity based ambulance services. Out of the 90 respondents questioned regarding a self assessment of their training, only 3 (3.3%) of them were confident about their management of bomb blast victims. Eighty-seven (96.6%) of the respondents felt they required some further training (44.4%) or comprehensive training (52.2%). No simulated drills or courses had been conducted for disaster management in the emergency department of the surveyed Hospitals. Most of the ambulance drivers had no paramedic training. Ambulances are equipped with a stretcher and an oxygen cylinder only. No resuscitation measures are available in the ambulances. With an increasing number of terrorist attacks in the country, massive influx of casualties in a relatively short time span has become a regular feature of the Pakistani hospital system. Lack of adequate training at pre-hospital and in hospital levels may translate into increasing morbidities and mortalities. It is imperative that training of junior doctors and paramedical staff be conducted regularly and an effective regional communication base established for efficient interdepartmental coordination.

Retrospective on the construction and practice of a state-level emergency medical rescue team.

PubMed

Lei, Zhang; Haitao, Guo; Xin, Wang; Yundou, Wang

2014-10-01

For the past few years, disasters like earthquakes, landslides, mudslides, tsunamis, and traffic accidents have occurred with an ever-growing frequency, coverage, and intensity greatly beyond the expectation of the public. In order to respond effectively to disasters and to reduce casualties and property damage, countries around the world have invested more efforts in the theoretical study of emergency medicine and the construction of emergency medical rescue forces. Consequently, emergency medical rescue teams of all scales and types have come into being and have played significant roles in disaster response work. As the only state-level emergency medical rescue force from the Chinese People's Armed Police Forces, the force described here has developed, through continuous learning and practice, a characteristic mode in terms of grouping methods, equipment system construction, and training.

Using ArcGIS software in the pre-hospital emergency medical system.

PubMed

Manole, M; Duma, Odetta; Custură, Maria Alexandra; Petrariu, F D; Manole, Alina

2014-01-01

To measure the accessibility to healtcare services in order to reveal their quality and to improve the overall coverage, continuity and other features. We used the software ESRI Arc GIS 9.3, the Network Analyst function and data provided by Ambulance Service of Iasi (A.S.I.) with emergencies statistics for the first four months of 2012, processed by Microsoft Office Excel 2010. As examples, we chose "St. Maria" Children's Emergency Hospital and "St. Spiridon" Emergency Hospital. ArcGIS Network Analyst finds the best route to get from one location to another or a route that includes multiple locations. Each route is characterized by three stops. The starting point is always the office of Ambulance Service of Iasi (A.S.I.), a second stop at the case address and the third to the hospital unit chosen according to the patient's diagnosis and age. Spatial distribution of emergency cases for the first four months of 2012 in these two examples is one unequable, with higher concentrations in districts located in two areas of the city. The presented examples highlight the poor coverage of healthcare services for the population of Iasi, Romania, especially the South-West area and its vulnerability in situations of emergency. Implementing such a broad project would lead to more complex analyses that would improve the situation of pre-hospital emergency medical services, with final goal to deserve the population, improve the quality of healthcare and develop the interdisciplinary relationships.

High-Fidelity Simulation: Preparing Dental Hygiene Students for Managing Medical Emergencies.

PubMed

Bilich, Lisa A; Jackson, Sarah C; Bray, Brenda S; Willson, Megan N

2015-09-01

Medical emergencies can occur at any time in the dental office, so being prepared to properly manage the situation can be the difference between life and death. The entire dental team must be properly trained regarding all aspects of emergency management in the dental clinic. The aim of this study was to evaluate a new educational approach using a high-fidelity simulator to prepare dental hygiene students for medical emergencies. This study utilized high-fidelity simulation (HFS) to evaluate the abilities of junior dental hygiene students at Eastern Washington University to handle a medical emergency in the dental hygiene clinic. Students were given a medical emergency scenario requiring them to assess the emergency and implement life-saving protocols in a simulated "real-life" situation using a high-fidelity manikin. Retrospective data were collected for four years from the classes of 2010 through 2013 (N=114). The results indicated that learning with simulation was effective in helping the students identify the medical emergency in a timely manner, implement emergency procedures correctly, locate and correctly utilize contents of the emergency kit, administer appropriate intervention/treatment for a specific patient, and provide the patient with appropriate follow-up instructions. For dental hygiene programs seeking to enhance their curricula in the area of medical emergencies, this study suggests that HFS is an effective tool to prepare students to appropriately handle medical emergencies. Faculty calibration is essential to standardize simulation.

A Longitudinal Emergency Medical Services Track in Emergency Medicine Residency.

PubMed

Adams, Daniel; Bischof, Jason; Larrimore, Ashley; Krebs, William; King, Andrew

2017-03-30

Emergency medicine residency programs offer Emergency Medical Services (EMS) curricula to address Accreditation Council for Graduate Medical Education (ACGME) milestones. While some programs offer advanced clinical tracks in EMS, no standard curriculum exists. We sought to establish a well-defined EMS curriculum to allow interested residents to develop advanced clinical skills and scholarship within this subspecialty. Core EMS fellowship trained faculty were recruited to help develop the curriculum. Building on ACGME graduation requirements and milestones, important elements of EMS fellowship training were incorporated into the curriculum to develop the final document. The final curriculum focuses on scholarly activities relating to the four core areas of EMS identified by The American Board of Emergency Medicine and serves as an intermediary between ACGME graduation requirements for education in EMS and fellowship level training. Standardization of the EMS scholarly track can provide residents with the potential to obtain competency beyond ACGME requirements and prepare them for success in fellowship training and/or leadership within EMS on graduation.

A Longitudinal Emergency Medical Services Track in Emergency Medicine Residency

PubMed Central

Bischof, Jason; Larrimore, Ashley; Krebs, William; King, Andrew

2017-01-01

Emergency medicine residency programs offer Emergency Medical Services (EMS) curricula to address Accreditation Council for Graduate Medical Education (ACGME) milestones. While some programs offer advanced clinical tracks in EMS, no standard curriculum exists. We sought to establish a well-defined EMS curriculum to allow interested residents to develop advanced clinical skills and scholarship within this subspecialty. Core EMS fellowship trained faculty were recruited to help develop the curriculum. Building on ACGME graduation requirements and milestones, important elements of EMS fellowship training were incorporated into the curriculum to develop the final document. The final curriculum focuses on scholarly activities relating to the four core areas of EMS identified by The American Board of Emergency Medicine and serves as an intermediary between ACGME graduation requirements for education in EMS and fellowship level training. Standardization of the EMS scholarly track can provide residents with the potential to obtain competency beyond ACGME requirements and prepare them for success in fellowship training and/or leadership within EMS on graduation. PMID:28465874

Ethics curriculum for emergency medicine graduate medical education.

PubMed

Marco, Catherine A; Lu, Dave W; Stettner, Edward; Sokolove, Peter E; Ufberg, Jacob W; Noeller, Thomas P

2011-05-01

Ethics education is an essential component of graduate medical education in emergency medicine. A sound understanding of principles of bioethics and a rational approach to ethical decision-making are imperative. This article addresses ethics curriculum content, educational approaches, educational resources, and resident feedback and evaluation. Ethics curriculum content should include elements suggested by the Liaison Committee on Medical Education, Accreditation Council for Graduate Medical Education, and the Model of the Clinical Practice of Emergency Medicine. Essential ethics content includes ethical principles, the physician-patient relationship, patient autonomy, clinical issues, end-of-life decisions, justice, education in emergency medicine, research ethics, and professionalism. The appropriate curriculum in ethics education in emergency medicine should include some of the content and educational approaches outlined in this article, although the optimal methods for meeting these educational goals may vary by institution. Copyright © 2011 Elsevier Inc. All rights reserved.

Exploration Medical System Demonstration

NASA Technical Reports Server (NTRS)

Rubin, D. A.; Watkins, S. D.

2014-01-01

BACKGROUND: Exploration class missions will present significant new challenges and hazards to the health of the astronauts. Regardless of the intended destination, beyond low Earth orbit a greater degree of crew autonomy will be required to diagnose medical conditions, develop treatment plans, and implement procedures due to limited communications with ground-based personnel. SCOPE: The Exploration Medical System Demonstration (EMSD) project will act as a test bed on the International Space Station (ISS) to demonstrate to crew and ground personnel that an end-to-end medical system can assist clinician and non-clinician crew members in optimizing medical care delivery and data management during an exploration mission. Challenges facing exploration mission medical care include limited resources, inability to evacuate to Earth during many mission phases, and potential rendering of medical care by non-clinicians. This system demonstrates the integration of medical devices and informatics tools for managing evidence and decision making and can be designed to assist crewmembers in nominal, non-emergent situations and in emergent situations when they may be suffering from performance decrements due to environmental, physiological or other factors. PROJECT OBJECTIVES: The objectives of the EMSD project are to: a. Reduce or eliminate the time required of an on-orbit crew and ground personnel to access, transfer, and manipulate medical data. b. Demonstrate that the on-orbit crew has the ability to access medical data/information via an intuitive and crew-friendly solution to aid in the treatment of a medical condition. c. Develop a common data management framework that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all activities pertaining to crew health and life sciences. d. Ensure crew access to medical data during periods of restricted ground communication. e. Develop a common data management framework that

Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations.

PubMed

Marco, Catherine A; Brenner, Jay M; Kraus, Chadd K; McGrath, Norine A; Derse, Arthur R

2017-11-01

Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. Informed consent should also be obtained for emergency medical interventions that may entail significant risk. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

[Discussion of the implementation of MIMIC database in emergency medical study].

PubMed

Li, Kaiyuan; Feng, Cong; Jia, Lijing; Chen, Li; Pan, Fei; Li, Tanshi

2018-05-01

To introduce Medical Information Mart for Intensive Care (MIMIC) database and elaborate the approach of critically emergent research with big data based on the feature of MIMIC and updated studies both domestic and overseas, we put forward the feasibility and necessity of introducing medical big data to research in emergency. Then we discuss the role of MIMIC database in emergency clinical study, as well as the principles and key notes of experimental design and implementation under the medical big data circumstance. The implementation of MIMIC database in emergency medical research provides a brand new field for the early diagnosis, risk warning and prognosis of critical illness, however there are also limitations. To meet the era of big data, emergency medical database which is in accordance with our national condition is needed, which will provide new energy to the development of emergency medicine.

Emergency medical services outcomes evaluation

DOT National Transportation Integrated Search

2003-07-01

The provision of prehospital (Emergency Medical Services (EMS)) care has come under increased scrutiny in recent years. Many have questioned the value of the range of EMS services currently provided. There is a persistent concern about the lack of pr...

Interprofessional education of medical students and paramedics in emergency medicine.

PubMed

Hallikainen, J; Väisänen, O; Rosenberg, P H; Silfvast, T; Niemi-Murola, L

2007-03-01

Emergency medicine is team work from the field to the hospital and therefore it is also important for physicians to understand the work of paramedics, and vice versa. Interprofessional emergency medicine education for medical and paramedic students in Helsinki was started in 2001. It consisted of a 15 European credit transfer system (ECTS) credits programme combining 22 students in 2001. In 2005, the number of students had increased to 25. The programme consisted of three parts: acute illness in childhood and adults (AI), advanced life support (ALS) and trauma life support (TLS). In this paper, we describe the concept of interprofessional education of medical students and paramedics in emergency medicine. After finishing the programmes in 2001 and in 2005, the students' opinions regarding the education were collected using a standardized questionnaire. There were good ratings for the courses in AI (2001 vs. 2005, whole group; 4.3 +/- 0.7 vs. 4.2 +/- 0.4, P = 0.44) ALS (4.7 +/- 0.5 vs. 4.4 +/- 0.5, P = 0.06) and TLS (3.9 +/- 0.7 vs. 4.4 +/- 0.5, P = 0.01) in both years. Most of the medical students considered that this kind of co-education should be arranged for all medical students (2001 vs. 2005; 4.8 +/- 0.6 vs. 4.4 +/- 0.5, P = 0.02) and should be obligatory (3.5 +/- 1.5 vs. 3.1 +/- 1.3, P = 0.35). Co-education was well received and determined by the students as an effective way of improving their knowledge of emergency medicine and medical skills. The programme was rated as very useful and it should be included in the educational curriculum of both student groups.

Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept.

PubMed

Choi, Bryan Y; Blumberg, Charles; Williams, Kenneth

2016-03-01

Mobile integrated health care and community paramedicine are models of health care delivery that use emergency medical services (EMS) personnel to fill gaps in local health care infrastructure. Community paramedics may perform in an expanded role and require additional training in the management of chronic disease, communication skills, and cultural sensitivity, whereas other models use all levels of EMS personnel without additional training. Currently, there are few studies of the efficacy, safety, and cost-effectiveness of mobile integrated health care and community paramedicine programs. Observations from existing program data suggest that these systems may prevent congestive heart failure readmissions, reduce EMS frequent-user transports, and reduce emergency department visits. Additional studies are needed to support the clinical and economic benefit of mobile integrated health care and community paramedicine. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Medical emergencies at a major international airport: in-flight symptoms and ground-based follow-up.

PubMed

Chan, Shu B; Hogan, Teresita M; Silva, Julio C

2002-10-01

There is limited recent data about the treatments and outcomes of commercial airline passengers who suffer in-flight medical symptoms resulting in subsequent EMS evaluation. The study objectives are to determine incidence, post-flight treatments, outcomes, morbidity, and mortality of these in-flight medical emergencies (IFMEs). A 1-yr retrospective study of emergency medical service (EMS), emergency department (ED), and inpatient hospital records of IFME patients from Chicago O'Hare International Airport was completed. All commercial passengers or crew with in-flight medical symptoms who subsequently activated the EMS system on flight arrival are included in the study. The main outcome measures are: in-flight sudden deaths, post-flight mortality, hospital admission rate, ICU admission rate, ED procedures, inpatient procedures, and discharge diagnoses. There were 744 IFMEs for an incidence of 21.3 per million passengers per year. The hospital admission rate was 24.5%. The ICU admission rate was 5.9%. There were five in-flight sudden deaths and six in-hospital deaths for an overall mortality rate of 0.3 per million passengers per year. Emergency stabilization procedures were required on 4.8% of patients. Cardiac emergencies accounted for 29.1% of inpatient diagnoses and 13.1% of all discharge diagnoses. The incidence of in-flight medical emergencies is small but these IFMEs are potentially lethal. Although the majority of IFME patients have uneventful outcomes, there is associated morbidity and mortality. These included in-flight deaths, in-hospital deaths, and emergency procedures. Cardiac emergencies were the most common of serious EMS evaluated in-flight medical emergencies.

[Emergency medical aid in a paediatrics context].

PubMed

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

2016-01-01

In France, the organisation of aid involves the intervention of the emergency medical services (Samu), which coordinate the medical regulation platforms for site 15 and the mobile emergency and intensive care services (Smur). Since they were created, the Samu have been tirelessly adapting their response to the various characteristics of pre-hospital assignments. Pre- and inter-hospital paediatrics has seen the development of specialised teams with the aim of providing effective aid which is adapted to the youngest and most vulnerable patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Emergency Medical Considerations in a Space-Suited Patient.

PubMed

Garbino, Alejandro; Nusbaum, Derek M; Buckland, Daniel M; Menon, Anil S; Clark, Jonathan B; Antonsen, Erik L

The Stratex Project is a high altitude balloon flight that culminated in a freefall from 41,422 m (135,890 ft), breaking the record for the highest freefall to date. Crew recovery operations required an innovative approach due to the unique nature of the event as well as the equipment involved. The parachutist donned a custom space suit similar to a NASA Extravehicular Mobility Unit (EMU), with life support system mounted to the front and a parachute on the back. This space suit had a metal structure around the torso, which, in conjunction with the parachute and life support assembly, created a significant barrier to extraction from the suit in the event of a medical emergency. For this reason the Medical Support Team coordinated with the pressure suit assembly engineer team for integration, training in suit removal, definition of a priori contingency leadership on site, creation of color-coded extraction scenarios, and extraction drills with a suit mock-up that provided insight into limitations to immediate access. This paper discusses novel extraction processes and contrasts the required medical preparation for this type of equipment with the needs of the prior record-holding jump that used a different space suit with easier immediate access. Garbino A, Nusbaum DM, Buckland DM, Menon AS, Clark JB, Antonsen EL. Emergency medical considerations in a space-suited patient. Aerosp Med Hum Perform. 2016; 87(11):958-962.

Chemical and Biological Terrorism: Improvements to Emergency Medical Response.

ERIC Educational Resources Information Center

DeGraffenreid, Jeff Gordon

The challenge facing many emergency medical services (EMS) is the implementation of a comprehensive educational strategy to address emergency responses to terrorism. One such service, Johnson County (Kansas) Medical Action, needed a strategy that would keep paramedics safe and offer the community an effective approach to mitigation. A…

30 CFR 75.1713 - Emergency medical assistance; first-aid.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Emergency medical assistance; first-aid. 75... Emergency medical assistance; first-aid. [Statutory Provisions] Each operator shall make arrangements in... trained in first-aid and first-aid training shall be made available to all miners. Each coal mine shall...

The "prudent layperson" definition of an emergency medical condition.

PubMed

Li, James; Galvin, Hannah K; Johnson, Sandra C

2002-01-01

The study objectives, based on federal and state legislative language, were to objectively define symptoms and signs commonly agreed on by "prudent laypersons" as "emergency medical conditions." After comprehensive tabulation of symptom classifications from the International Classification of Diseases (ICD-9), we performed a survey of nonmedical laypersons. Data analysis included descriptive statistics, proportional calculations, and 95% confidence intervals. A minority of symptoms and signs (25/87, 29%) were considered emergency medical conditions by more than half of nonmedical survey respondents who were self-defined as prudent laypersons. The leading conditions deemed emergencies were loss of consciousness, seizure, no recognition of one side of the body, paralysis, shock, gangrene, coughing blood, trouble breathing, chest pain, and choking. Pain, except for renal colic or chest pain, was not considered an emergency. No symptoms or signs specifically related to gynecologic disorders were considered emergencies. Most symptoms and signs tabulated in the diagnostic coding manual, ICD-9, are not considered emergency medical conditions by self-designated prudent laypersons. These include many conditions that are commonly investigated and treated in the emergency department setting. Use of the prudent layperson standard for reimbursable emergency health services may not reflect the actual scope of symptoms necessitating emergency care.

Emergency medical rescue efforts after a major earthquake: lessons from the 2008 Wenchuan earthquake.

PubMed

Zhang, Lulu; Liu, Xu; Li, Youping; Liu, Yuan; Liu, Zhipeng; Lin, Juncong; Shen, Ji; Tang, Xuefeng; Zhang, Yi; Liang, Wannian

2012-03-03

Major earthquakes often result in incalculable environmental damage, loss of life, and threats to health. Tremendous progress has been made in response to many medical challenges resulting from earthquakes. However, emergency medical rescue is complicated, and great emphasis should be placed on its organisation to achieve the best results. The 2008 Wenchuan earthquake was one of the most devastating disasters in the past 10 years and caused more than 370,000 casualties. The lessons learnt from the medical disaster relief effort and the subsequent knowledge gained about the regulation and capabilities of medical and military back-up teams should be widely disseminated. In this Review we summarise and analyse the emergency medical rescue efforts after the Wenchuan earthquake. Establishment of a national disaster medical response system, an active and effective commanding system, successful coordination between rescue forces and government agencies, effective treatment, a moderate, timely and correct public health response, and long-term psychological support are all crucial to reduce mortality and morbidity and promote overall effectiveness of rescue efforts after a major earthquake. Copyright © 2012 Elsevier Ltd. All rights reserved.

An Independent Human Factors Analysis and Evaluation of the Emergency Medical Protocol Checklist for the International Space Station

NASA Technical Reports Server (NTRS)

Marshburn, Thomas; Whitmore, Mihriban; Ortiz, Rosie; Segal, Michele; Smart, Kieran; Hughes, Catherine

2003-01-01

Emergency medical capabilities aboard the ISS include a Crew Medical Officer (CMO) (not necessarily a physician), and back-up, resuscitation equipment, and a medical checklist. It is essential that CMOs have reliable, usable and informative medical protocols that can be carried out independently in flight. The study evaluates the existing ISS Medical Checklist layout against a checklist updated to reflect a human factors approach to structure and organization. Method: The ISS Medical checklist was divided into non-emergency and emergency sections, and re-organized based on alphabetical and a body systems approach. A desk-top evaluation examined the ability of subjects to navigate to specific medical problems identified as representative of likely non-emergency events. A second evaluation aims to focus on the emergency section of the Medical Checklist, based on the preliminary findings of the first. The final evaluation will use Astronaut CMOs as subjects comparing the original checklist against the updated layout in the task of caring for a "downed crewmember" using a Human Patient Simulator [Medical Education Technologies, Inc.]. Results: Initial results have demonstrated a clear improvement of the re-organized sections to determine the solution to the medical problems. There was no distinct advantage for either alternative, although subjects stated having a preference for the body systems approach. In the second evaluation, subjects will be asked to identify emergency medical conditions, with measures including correct diagnosis, time to completion and solution strategy. The third evaluation will compare the original and fully updated checklists in clinical situations. Conclusions: Initial findings indicate that the ISS Medical Checklist will benefit from a reorganization. The present structure of the checklist has evolved over recent years without systematic testing of crewmember ability to diagnose medical problems. The improvements are expected to enable ISS

Weather Webcam System for the Safety of Helicopter Emergency Medical Services in Miyazaki, Japan.

PubMed

Kanemaru, Katsuhiro; Katzer, Robert; Hanato, Syu; Nakamura, Koji; Matsuoka, Hiroshi; Ochiai, Hidenobu

In Japan, the helicopter emergency medical services (HEMS) system was initiated in 2001 and introduced to Miyazaki Prefecture in 2012. Mountainous areas occupy 88% of Miyazaki's land area, and HEMS flights can be subject to the effects of weather. Therefore, ensuring safety in changing weather conditions is a necessity for HEMS. The weather webcam system (WWS) was established to observe the meteorological conditions in 29 locations. Assessments of the probability of a flight based on conventional data including a weather chart provided by the Japan Meteorological Agency and meteorological reports provided by the Miyazaki Airport were compared with the assessment based on the combination of the information obtained from the WWS and the conventional data. The results showed that the probability of a flight by HEMS increased when using the WSS, leading to an increased transportation opportunity for patients in the mountains who rely on HEMS. In addition, the results indicate that the WWS may prevent flights in unfavorable weather conditions. The WWS used in conjunction with conventional weather data within Miyazaki HEMS increased the pilot's awareness of current weather conditions throughout the Prefecture, increasing the probability of accepting a flight. Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Incidence, source, and nature of complaints received in a large, urban emergency medical services system.

PubMed

Curka, P A; Pepe, P E; Zachariah, B S; Gray, G D; Matsumoto, C

1995-06-01

To document the incidence, source, and reasons for all complaints received by a large municipal emergency medical services (EMS) program. A retrospective review of all complaints received during three consecutive years (1990-1992) in a centralized EMS system serving a large municipality (population 2 million). All cases were categorized by year, source, and nature of the complaint. In the three study years, EMS responded to 416,892 incidents with nearly a half-million patient contacts. Concurrently, 371 complaints were received (incidence of 1.12 per thousand); 132 in 1990, 129 in 1991, and 110 in 1992. Most complaints involved either: 1) allegations of "rude or unprofessional conduct" (34%), 2) "didn't take patient to the hospital" (19%), or 3) "problems with medical treatment" (13%). Only 1.6% (n = 6) were response-time complaints. Other complaints included "lost/damaged property," "taken to the wrong hospital," "inappropriate billing," and "poor driving habits." The most common sources were patient's families (39%) and the patients themselves (30%). Only 7.8% were from health care providers. Reviews of complaints provide information regarding EMS system performance and reveal targets for quality improvement. For the EMS system examined, this study suggests a future training focus on interpersonal skills and heightened sensitivities, not only toward patients, but also toward bystanders and family members.

[Medical emergencies and sea rescue].

PubMed

Lefebvre, Fabien; Albert, Christophe; Gunepin, David; Pondaven, Eric; Querellou, Emgan

2013-01-01

Military nurses and doctors are on permanent standby to respond to any medical emergency which may arise at sea. This atypical form of practice is part of a specific organisation, in order to provide optimal, high-quality care in the most remote places of the oceans.

Usefulness of emergency medical teams in sport stadiums.

PubMed

Leusveld, E; Kleijn, S; Umans, V A W M

2008-03-01

In August 2006, the new AZ Alkmaar soccer stadium (capacity 17,000) opened. To provide adequate emergency support, medical teams of Red Cross volunteers and coronary care unit and emergency room nurses were formed, and facilities including automated external defibrillators were made available at the stadium. During every match, 3 teams are placed among the spectators. All patients who had cardiac events were stabilized by the teams and transported to the hospital. They formed the study group. From August 2006 to May 2007, >800,000 individuals attended soccer matches at the new stadium. Four cardiac events (3 out-of-hospital-resuscitations for ventricular fibrillation, 1 patient with chest pain) requiring emergency medical support occurred. On-site resuscitations using defibrillators were successful. Two patients with triple-vessel disease subsequently underwent coronary bypass surgery and implantable cardioverter-defibrillator implantation. One patient had single-vessel disease of the circumflex branch, for which he received a coronary stent. All had uneventful recoveries. An acute coronary syndrome was ruled out in the patient presenting with chest pain. In conclusion, the presence of emergency medical teams at a large sport stadium was of vital importance in the immediate care of critically ill patients. On-site resuscitation using automated external defibrillators was lifesaving in all cases. The presence of medical teams equipped with defibrillators and emergency action plans is recommended at large venues that host sports and other activities.

Portable Medical System

NASA Technical Reports Server (NTRS)

1982-01-01

Portable Medical Status and Treatment System (PMSTS) is designed for use in remote areas where considerable time may elapse before a patient can be transported to a hospital. First units were delivered to the Department of Transportation last year and tested in two types of medical emergency environments: one in a rural Pennsylvania community and another aboard a U.S. Coast Guard rescue helicopter operating along Florida's Gulf Coast. The system has the capability to transmit vital signs to a distantly located physician, who can perform diagnosis and relay treatment instructions to the attendant at the scene. The battery powered PMSTS includes a vital signs monitor and a defibrillator. Narco has also developed a companion system, called Porta-Fib III designed for use in a hospital environment with modifications accordingly. Both systems are offshoots of an earlier NASA project known as the Physician's Black Bag developed by Telecare, Inc., a company now acquired by NARCO.

Medical Emergency Education in Dental Hygiene Programs.

ERIC Educational Resources Information Center

Stach, Donna J.; And Others

1995-01-01

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

Evaluation of EMERGE, a Medical Decision Making Aid for Analysis of Chest Pain

PubMed Central

Hudson, Donna L.; Cohen, Moses E.; Deedwania, Prakash C.; Watson, Patricia E.

1983-01-01

EMERGE, a rule-based medical decision making aid for analysis of chest pain in the emergency room, was evaluated using retrospective patient data. The analysis consisted of two phases. In the initial phase, patient cases were run in order to make minor modifications and adjustments in the criteria used for determination of admission. In the second phase, patient cases were analyzed to determine the effectiveness of the EMERGE system in arriving at the proper conclusion.

Development of a National Consensus for Tactical Emergency Medical Support (TEMS) Training Programs--Operators and Medical Providers.

PubMed

Schwartz, Richard; Lerner, Brooke; Llwewllyn, Craig; Pennardt, Andre; Wedmore, Ian; Callaway, David; Wightman, John; Casillas, Raymond; Eastman, Alex; Gerold, Kevin; Giebner, Stephen; Davidson, Robert; Kamin, Richard; Piazza, Gina; Bollard, Glenn; Carmona, Phillip; Sonstrom, Ben; Seifarth, William; Nicely, Barbara; Croushorn, John; Carmona, Richard

2014-01-01

Tactical teams are at high risk of sustaining injuries. Caring for these casualties in the field involves unique requirements beyond what is provided by traditional civilian emergency medical services (EMS) systems. Despite this need, the training objectives and competencies are not uniformly agreed to or taught. An expert panel was convened that included members from the Departments of Defense, Homeland Security, Justice, and Health and Human Services, as well as federal, state, and local law-enforcement officers who were recruited through requests to stakeholder agencies and open invitations to individuals involved in Tactical Emergency Medical Services (TEMS) or its oversight. Two face-to-face meetings took place. Using a modified Delphi technique, previously published TEMS competencies were reviewed and updated. The original 17 competency domains were modified and the most significant changes were the addition of Tactical Emergency Casualty Care (TECC), Tactical Familiarization, Legal Aspects of TEMS, and Mass Casualty Triage to the competency domains. Additionally, enabling and terminal learning objectives were developed for each competency domain. This project has developed a minimum set of medical competencies and learning objectives for both tactical medical providers and operators. This work should serve as a platform for ensuring minimum knowledge among providers, which will serve enhance team interoperability and improve the health and safety of tactical teams and the public. 2014.

A cross-functional service-oriented architecture to support real-time information exchange in emergency medical response.

PubMed

Hauenstein, Logan; Gao, Tia; Sze, Tsz Wo; Crawford, David; Alm, Alex; White, David

2006-01-01

Real-time information communication presents a persistent challenge to the emergency response community. During a medical emergency, various first response disciplines including Emergency Medical Service (EMS), Fire, and Police, and multiple health service facilities including hospitals, auxiliary care centers and public health departments using disparate information technology systems must coordinate their efforts by sharing real-time information. This paper describes a service-oriented architecture (SOA) that uses shared data models of emergency incidents to support the exchange of data between heterogeneous systems. This architecture is employed in the Advanced Health and Disaster Aid Network (AID-N) system, a testbed investigating information technologies to improve interoperation among multiple emergency response organizations in the Washington DC Metropolitan region. This architecture allows us to enable real-time data communication between three deployed systems: 1) a pre-hospital patient care reporting software system used on all ambulances in Arlington County, Virginia (MICHAELS), 2) a syndromic surveillance system used by public health departments in the Washington area (ESSENCE), and 3) a hazardous material reference software system (WISER) developed by the National Library Medicine. Additionally, we have extended our system to communicate with three new data sources: 1) wireless automated vital sign sensors worn by patients, 2) web portals for admitting hospitals, and 3) PDAs used by first responders at emergency scenes to input data (SIRP).

Emergency medical service attitudes toward geriatric prehospital care and continuing medical education in geriatrics.

PubMed

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

2009-03-01

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

Stormy weather: a retrospective analysis of demand for emergency medical services during epidemic thunderstorm asthma

PubMed Central

Nehme, Ziad; Bernard, Stephen; Abramson, Michael J; Newbigin, Ed; Piper, Ben; Dunlop, Justin; Holman, Paul; Smith, Karen

2017-01-01

Abstract Objectives To describe the demand for emergency medical assistance during the largest outbreak of thunderstorm asthma reported globally, which occurred on 21 November 2016. Design A time series analysis was conducted of emergency medical service caseload between 1 January 2015 and 31 December 2016. Demand during the thunderstorm asthma event was compared to historical trends for the overall population and across specific subgroups. Setting Victoria, Australia. Main outcome measures Number of overall cases attended by emergency medical services, and within patient subgroups. Results On 21 November 2016, the emergency medical service received calls for 2954 cases, which was 1014 more cases than the average over the historical period. Between 6 pm and midnight, calls for 1326 cases were received, which was 2.5 times higher than expected. A total of 332 patients were assessed by paramedics as having acute respiratory distress on 21 November, compared with a daily average of 52 during the historical period. After adjustment for temporal trends, thunderstorm asthma was associated with a 42% (95% confidence interval 40% to 44%) increase in overall caseload for the emergency medical service and a 432% increase in emergency medical attendances for acute respiratory distress symptoms. Emergency transports to hospital increased by 17% (16% to 19%) and time critical referrals from general practitioners increased by 47% (21% to 80%). Large increases in demand were seen among patients with a history of asthma and bronchodilator use. The incidence of out-of-hospital cardiac arrest increased by 82% (67% to 99%) and pre-hospital deaths by 41% (29% to 55%). Conclusions An unprecedented outbreak of thunderstorm asthma was associated with substantial increase in demand for emergency medical services and pre-hospital cardiac arrest. The health impact of future events may be minimised through use of preventive measures by patients and predictive early warning systems. PMID

Rural emergency medical technician pre-hospital electrocardiogram transmission.

PubMed

Powell, A M; Halon, J M; Nelson, J

2014-01-01

Emergent care of the acute heart attack patient continues to be at the forefront of quality and cost reduction strategies throughout the healthcare industry. Although the average cardiac door-to-balloon (D2B) times have decreased substantially over the past few years, there are still vast disparities found in D2B times in populations that reside in rural areas. Such disparities are mostly related to prolonged travel time and subsequent delays in cardiac catherization lab team activation. Urban ambulance companies that are routinely staffed with paramedic level providers have been successful in the implementation of pre-hospital 12-lead electrocardiogram (ECG) protocols as a strategy to reduce D2B times. The authors sought to evaluate the evidence related to the risk and benefits associated with the replication of an ECG transmission protocol in a small rural emergency medical service. The latter is staffed with emergency medical technician-basics (EMT-B), emergency medical technician-advanced (EMT-A), and emergency medical technician-intermediate (EMT-I) level. The evidence reviewed was limited to studies with relevant data regarding the challenges and complexities of the ECG transmission process, the difficulties associated with ECG transmission in rural settings, and ECG transmission outcomes by provider level. The evidence supports additional research to further evaluate the feasibility of ECG transmission at the non-paramedic level. Multiple variables must be investigated including equipment cost, utilization, and rural transmission capabilities. Clearly, pre-hospital ECG transmission and early activation of the cardiac catheterization laboratory are critical components to successfully decreasing D2B times.

Multilocation teleradiology system for emergency triage consultation

NASA Astrophysics Data System (ADS)

Herron, John M.; Yonas, Howard

1996-05-01

A remote consultation system is available at the University of Pittsburgh Medical Center (UPMC) which links four outlying hospitals in Western Pennsylvania and Eastern Ohio. This system has the potential to improve short and long term clinical outcomes and to reduce overall medical care cost by establishing improved emergency triage capability. An EMED, Inc. teleradiology system permits rapid, high-quality transfer of digitized film and CT images from the remote sites to the tertiary care center (UPMC). The images are sent over dial-on- demand ISDN and SW56 lines from the remote hospitals to a central server where they are transmitted to a dual 2K monitor workstation in the Emergency Department, thirteen Eastman Kodak PDS workstations within UPMC, and to three physician homes. Transmission to a workstation at each of the physician homes over ISDN lines enables `after hours' consultation. The radiographic images along with voice and fax communications provide a technique where physicians in outlying hospitals will be able to consult with specialists at any time. A study is in progress to evaluate the effectiveness of this system in terms of perception of utility and its potential to improve emergency triage capability, as well as selection of the appropriate transportation mode (helicopter versus ambulance).

Snow shovel-related injuries and medical emergencies treated in US EDs, 1990 to 2006.

PubMed

Watson, Daniel S; Shields, Brenda J; Smith, Gary A

2011-01-01

Injuries and medical emergencies associated with snow shovel use are common in the United States. This is a retrospective analysis of data from the National Electronic Injury Surveillance System. This study analyzes the epidemiologic features of snow shovel-related injuries and medical emergencies treated in US emergency departments (EDs) from 1990 to 2006. An estimated 195 100 individuals (95% confidence interval, 140 400-249 800) were treated in US EDs for snow shovel-related incidents during the 17-year study period, averaging 11 500 individuals annually (SD, 5300). The average annual rate of snow shovel-related injuries and medical emergencies was 4.15 per 100 000 population. Approximately two thirds (67.5%) of these incidents occurred among males. Children younger than 18 years comprised 15.3% of the cases, whereas older adults (55 years and older) accounted for 21.8%. The most common diagnosis was soft tissue injury (54.7%). Injuries to the lower back accounted for 34.3% of the cases. The most common mechanism of injury/nature of medical emergency was acute musculoskeletal exertion (53.9%) followed by slips and falls (20.0%) and being struck by a snow shovel (15.0%). Cardiac-related ED visits accounted for 6.7% of the cases, including all of the 1647 deaths in the study. Patients required hospitalization in 5.8% of the cases. Most snow shovel-related incidents (95.6%) occurred in and around the home. This is the first study to comprehensively examine snow shovel-related injuries and medical emergencies in the United States using a nationally representative sample. There are an estimated 11 500 snow shovel-related injuries and medical emergencies treated annually in US EDs. Copyright © 2011 Elsevier Inc. All rights reserved.

Medical emergencies on board commercial airlines: is documentation as expected?

PubMed Central

2012-01-01

Introduction The purpose of this study was to perform a descriptive, content-based analysis on the different forms of documentation for in-flight medical emergencies that are currently provided in the emergency medical kits on board commercial airlines. Methods Passenger airlines in the World Airline Directory were contacted between March and May 2011. For each participating airline, sample in-flight medical emergency documentation forms were obtained. All items in the sample documentation forms were subjected to a descriptive analysis and compared to a sample "medical incident report" form published by the International Air Transport Association (IATA). Results A total of 1,318 airlines were contacted. Ten airlines agreed to participate in the study and provided a copy of their documentation forms. A descriptive analysis revealed a total of 199 different items, which were summarized into five sub-categories: non-medical data (63), signs and symptoms (68), diagnosis (26), treatment (22) and outcome (20). Conclusions The data in this study illustrate a large variation in the documentation of in-flight medical emergencies by different airlines. A higher degree of standardization is preferable to increase the data quality in epidemiologic aeromedical research in the future. PMID:22397530

SYMBIOmatics: synergies in Medical Informatics and Bioinformatics--exploring current scientific literature for emerging topics.

PubMed

Rebholz-Schuhman, Dietrich; Cameron, Graham; Clark, Dominic; van Mulligen, Erik; Coatrieux, Jean-Louis; Del Hoyo Barbolla, Eva; Martin-Sanchez, Fernando; Milanesi, Luciano; Porro, Ivan; Beltrame, Francesco; Tollis, Ioannis; Van der Lei, Johan

2007-03-08

The SYMBIOmatics Specific Support Action (SSA) is "an information gathering and dissemination activity" that seeks "to identify synergies between the bioinformatics and the medical informatics" domain to improve collaborative progress between both domains (ref. to http://www.symbiomatics.org). As part of the project experts in both research fields will be identified and approached through a survey. To provide input to the survey, the scientific literature was analysed to extract topics relevant to both medical informatics and bioinformatics. This paper presents results of a systematic analysis of the scientific literature from medical informatics research and bioinformatics research. In the analysis pairs of words (bigrams) from the leading bioinformatics and medical informatics journals have been used as indication of existing and emerging technologies and topics over the period 2000-2005 ("recent") and 1990-1990 ("past"). We identified emerging topics that were equally important to bioinformatics and medical informatics in recent years such as microarray experiments, ontologies, open source, text mining and support vector machines. Emerging topics that evolved only in bioinformatics were system biology, protein interaction networks and statistical methods for microarray analyses, whereas emerging topics in medical informatics were grid technology and tissue microarrays. We conclude that although both fields have their own specific domains of interest, they share common technological developments that tend to be initiated by new developments in biotechnology and computer science.

Medical Emergency Exceptions in State Abortion Statutes: The Statistical Record.

PubMed

Linton, Paul Benjamin

2016-01-01

This article attempts to determine, first, whether emergency exceptions in statutes regulating abortion have been abused and, second, whether the standard used in such an exception--subjective or objective--makes a difference in the reported incidence of such emergencies. A review of the statistical data supports two conclusions. First, physicians who perform abortions and have complied with state reporting requirements have not relied upon the medical emergency exceptions in state abortion statutes to evade the requirements of those statutes. Second, the use of an objective standard for evaluating medical emergencies ("reasonable medical judgment") has not been associated with fewer reported emergencies (per number of abortions performed) than the use of a subjective standard ("good faith clinical judgment"). Both of these conclusions may be relevant in drafting other abortion statutes including prohibitions (e.g., post-viability abortions).

Emergency medical technician education and training.

PubMed

Lauro, Joseph; Sullivan, Francis; Williams, Kenneth A

2013-12-03

Emergency Medical Services (EMS) training and education are vital and vibrant aspects of a young and evolving profession. This article provides a perspective on this effort in the United States and reviews current activity in Rhode Island.

Physiological scoring: an aid to emergency medical services transport decisions?

PubMed

Challen, Kirsty; Walter, Darren

2010-01-01

Attendance at UK emergency departments is rising steadily despite the proliferation of alternative unscheduled care providers. Evidence is mixed on the willingness of emergency medical services (EMS) providers to decline to transport patients and the safety of incorporating such an option into EMS provision. Physiologically based Early Warning Scores are in use in many hospitals and emergency departments, but not yet have been proven to be of benefit in the prehospital arena. The use of a physiological-social scoring system could safely identify patients calling EMS who might be diverted from the emergency department to an alternative, unscheduled, care provider. This was a retrospective, cohort study of patients with a presenting complaint of "shortness of breath" or "difficulty breathing" transported to the emergency department by EMS. Retrospective calculation of a physiological social score (PMEWS) based on first recorded data from EMS records was performed. Outcome measures of hospital admission and need for physiologically stabilizing treatment in the emergency department also were performed. A total of 215 records were analyzed. One hundred thirty-nine (65%) patients were admitted from the emergency department or received physiologically stabilizing treatment in the emergency department. Area Under the Receiver Operating Characteristic Curve (AUROC) for hospital admission was 0.697 and for admission or physiologically stabilizing treatment was 0.710. No patient scoring<2 was admitted or received stabilizing treatment. Despite significant over-triage, this system could have diverted 79 patients safely from the emergency department to alternative, unscheduled, care providers.

An emergency medical communications system by low altitude platform at the early stages of a natural disaster in Indonesia.

PubMed

Qiantori, Andri; Sutiono, Agung Budi; Hariyanto, Hadi; Suwa, Hirohiko; Ohta, Toshizumi

2012-02-01

A natural disaster is a consequence of a natural hazard, such as a tsunami, earthquake or volcanic eruption, affecting humans. In order to support emergency medical communication services in natural disaster areas where the telecommunications facility has been seriously damaged, an ad hoc communication network backbone should be build to support emergency medical services. Combinations of requirements need to be considered before deciding on the best option. In the present study we have proposed a Low Altitude Platform consisting of tethered balloons combined with Wireless Fidelity (WiFi) 802.11 technology. To confirm that the suggested network would satisfy the emergency medical service requirements, a communications experiment, including performance service measurement, was carried out.

Medical emergencies in the dermatology office: incidence and options for crisis preparedness.

PubMed

Hazen, Paul G; Daoud, Shaza; Hazen, Brent P; Engstrom, Conley W; Turgeon, Karen L; Reep, Michael D; Tanphaichitr, Arthapol; Styron, Brandie T

2014-05-01

Medical emergencies may occur in any setting, including dermatology offices. We examined the incidence of medical emergencies in a survey of 34 dermatologists northeast Ohio. Fifty-five events occurred over 565 combined years of clinical practice, an incidence of 1 episode every 10.3 years. We also review options for better preparedness for medical emergencies in dermatology practices, ranging from an emergency action plan for emergency personnel, basic life support (BLS) certification, advanced cardiac life support (ACLS) certification, and on-site automatic electronic defibrillators (AEDs).

Elimination of Emergency Department Medication Errors Due To Estimated Weights.

PubMed

Greenwalt, Mary; Griffen, David; Wilkerson, Jim

2017-01-01

From 7/2014 through 6/2015, 10 emergency department (ED) medication dosing errors were reported through the electronic incident reporting system of an urban academic medical center. Analysis of these medication errors identified inaccurate estimated weight on patients as the root cause. The goal of this project was to reduce weight-based dosing medication errors due to inaccurate estimated weights on patients presenting to the ED. Chart review revealed that 13.8% of estimated weights documented on admitted ED patients varied more than 10% from subsequent actual admission weights recorded. A random sample of 100 charts containing estimated weights revealed 2 previously unreported significant medication dosage errors (.02 significant error rate). Key improvements included removing barriers to weighing ED patients, storytelling to engage staff and change culture, and removal of the estimated weight documentation field from the ED electronic health record (EHR) forms. With these improvements estimated weights on ED patients, and the resulting medication errors, were eliminated.

Handling of drug-related emergencies: an evaluation of emergency medical dispatch.

PubMed

Tonje, Lorem; Elisabeth, Saether; Lars, Wik

2009-02-01

Documenting the quality of emergency dispatch centres handling of emergency calls regarding intoxicated unconscious patients. Interview with eight emergency dispatch centre directors and a nationwide survey among 313 dispatchers in Norway were performed. In addition, a customized scoring system was used to evaluate dispatcher log recordings of real cases. The recordings were compared with information from corresponding ambulance records. Ninety-nine percent of the dispatchers stated that they used the Norwegian protocol for medical emergencies and 89% of them found it useful. The interviews, the survey, and the recordings, however, documented frequent deviation from the protocol. This instructs ambulance dispatch for any unconscious patient, but 21% stated that they would not dispatch any resource for an unconscious patient without further survey in alcohol-related cases. This was significantly more often (P<0.05) than for the narcotic, combination and prescription - drug-related cases with 4, 10 and 7%, respectively. The recordings revealed deviation from the protocol with dispatchers only determining the patients' level of consciousness and respiratory status in 64 and 70% of the cases, respectively. For 16% of the cases, the dispatcher did not ask the caller about consciousness at all, even though these patients later were found with reduced consciousness. On the basis of the interviews and the survey, cases were handled according to guidelines. The log recordings, however, disclosed deviation from the protocol. Alcohol intoxication was associated with higher rate of deviation from the protocol compared with other intoxications.

The German emergency and disaster medicine and management system-history and present.

PubMed

Hecker, Norman; Domres, Bernd Dieter

2018-04-01

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the "Golden Standard" of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach. Copyright © 2018. Production and hosting by Elsevier B.V.

The prehospital emergency care system in Mexico City: a system's performance evaluation.

PubMed

Peralta, Luis Mauricio Pinet

2006-01-01

Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1-44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design. The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems. This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the soc ial, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The p aper includesdata obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers. The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow

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

PubMed

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

2009-05-09

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

Psychiatric nurses' beliefs, attitudes, and perceived barriers about medical emergency teams.

PubMed

Herisko, Camellia; Puskar, Kathryn; Mitchell, Ann M

2013-10-01

A literature review of nurses' attitudes, beliefs, and barriers regarding the medical emergency team (MET) process is limited to medical hospitals. How psychiatric nurses view the MET process and their prior experiences with METs are important because they are often the ones assessing the need for, and then calling, the MET. This article examines psychiatric nurses' attitudes, beliefs, and barriers toward the MET process in a 310-bed psychiatric hospital that is part of an urban academic medical center. Through the use of key informant interviews, nurses were asked for their feedback and input regarding the current MET practices. The results may be useful in improving the current operating system.

31 CFR 594.507 - Authorization of emergency medical services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS... medical services. The provision of nonscheduled emergency medical services in the United States to persons...

Understanding the value of mixed methods research: the Children’s Safety Initiative-Emergency Medical Services

PubMed Central

Hansen, Matthew; O’Brien, Kerth; Meckler, Garth; Chang, Anna Marie; Guise, Jeanne-Marie

2016-01-01

Mixed methods research has significant potential to broaden the scope of emergency care and specifically emergency medical services investigation. Mixed methods studies involve the coordinated use of qualitative and quantitative research approaches to gain a fuller understanding of practice. By combining what is learnt from multiple methods, these approaches can help to characterise complex healthcare systems, identify the mechanisms of complex problems such as medical errors and understand aspects of human interaction such as communication, behaviour and team performance. Mixed methods approaches may be particularly useful for out-of-hospital care researchers because care is provided in complex systems where equipment, interpersonal interactions, societal norms, environment and other factors influence patient outcomes. The overall objectives of this paper are to (1) introduce the fundamental concepts and approaches of mixed methods research and (2) describe the interrelation and complementary features of the quantitative and qualitative components of mixed methods studies using specific examples from the Children’s Safety Initiative-Emergency Medical Services (CSI-EMS), a large National Institutes of Health-funded research project conducted in the USA. PMID:26949970

Basic Training Program for Emergency Medical Technician Ambulance: Course Guide.

ERIC Educational Resources Information Center

Fucigna, Joseph T.; And Others

In an effort to upgrade or further develop the skills levels of all individuals involved in the emergency medical care service, this training program was developed for the National Highway Safety Bureau. This specific course is an attempt to organize, conduct, and standardize a basic training course for emergency medical technicians (EMTs). The…

The Longitudinal Emergency Medical Technician (EMT) Attributes and Demographics Study (LEADS): The First 10 Years and a Look at Public Perception of Emergency Medical Services (EMS).

PubMed

Crowe, Remle P; Bentley, Melissa A; Levine, Roger

2016-12-01

Crowe RP , Bentley MA , Levine R . The Longitudinal Emergency Medical Technician (EMT) Attributes and Demographics Study (LEADS): the first 10 years and a look at public perception of Emergency Medical Services (EMS). Prehosp Disaster Med. 2016;31(Suppl. 1):s1-s6.

75 FR 71792 - Federal Interagency Committee on Emergency Medical Services Meeting Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-24

..., Directorate of Emergency Preparedness and Response of the Department of Homeland Security, to provide.... NHTSA-2010-0156] Federal Interagency Committee on Emergency Medical Services Meeting Notice AGENCY... Committee on Emergency Medical Services. SUMMARY: NHTSA announces a meeting of the Federal Interagency...

Perception of medical care systems and stress responses in preschoolers' caregivers at a pediatric emergency department in Taiwan.

PubMed

Kao, Jun-Kai; Cherng, Chian-Fang G; Tsai, Ru-Chiao; Tsao, Lon-Yen; Hung, Chin-Yi

2012-11-01

This study was undertaken to understand caregivers' perception of medical care systems and their stress responses throughout their stay with preschoolers at a pediatric emergency department (ED). Overall, 201 preschoolers' caregivers in pediatric ED were recruited in this study. They were asked to answer self-made questionnaires regarding the perception of medical care systems and their stress responses immediately before preschoolers' release. The results show that caregivers with a low education or low income level were prone to exhibit greater appreciation for the efficiency of medical care systems and greater degree of anxiety for their lack of treatment and care knowledge than those of caregivers with a high education or high income level. Interestingly, caregivers older than 38 years reported greater emotional responses and physical exhaustion than did younger caregivers. Immigrant caregivers had higher emotional reaction and lower concentration than did Taiwanese caregivers. Paradoxically, caregivers undergoing over 3-time pediatric ED visits for observation expressed stronger stress reactions as compared with caregivers with less observation experiences. Not surprisingly, caregivers reported the highest emotional responses when their preschoolers were diagnosed as having very urgent degree in triage classification. Finally, caregivers' perception of "lack of family support" and "lack of treatment and care knowledge" correlated positively with all aspects of the stress responses. These results indicate that attention should be paid to the specific psychological weakness and need for the caregivers with certain demographic characteristics by the medical team in pediatric ED.

[Development of medical emergency response system for accidents due to chemicals in Chongqing municipality].

PubMed

Ning, Xu; Dong, Zhao-jun; Mu, Ling; Zhai, Jian-cai

2006-12-01

To plan and develop a Chongqing chemical accident rescue command system. Based on the modes of leakage and diffusion of various poisonous gases and chemicals, different modes of injuries produced, and their appropriate rescue and treatments, also taking the following factors such as the condition of storage of chemicals, meteorological and geographic conditions, medical institutions and equipment, and their rescuing capacity into consideration, a plan was drafted to establish the rescue system. Real-time simulation technology, data analysis, evaluation technology and database technology were employed in the planning. Using Visual Studio 6.0 as the software development platform, this project aimed to design the software of an emergency command system for chemical accidents in Chongqing which could be operated with the Windows 2000/XP operating system. This system provided a dynamic scope of the endangered area, casualty number estimates, and recommendation of measures and a rescue plan for various chemical accidents. Furthermore, the system helped retrieve comprehensive information regarding the physical and chemical characteristics of more than 4 200 dangerous poisonous chemicals and their appropriate treatment modalities. This system is easy to operate with a friendly interface, functions rapidly and can provide real-time analysis with comparatively precise results. This system could satisfy the requirements of executing the command and the rescue of a chemical accident with good prospects of application.

Nautical officers at sea: emergency experience and need for medical training

PubMed Central

2014-01-01

Background On merchant ships, the medical treatment including emergency interventions on the high seas are carried out by nautical officers who have to pass a forty hours medical refresher course every five years in order to meet international requirements. This study aims to show the most frequent kinds of medical emergencies on the high seas and to assess the seafarers’ knowledge about their treatment. Methods 465 nautical officers who participated in the medical refresher course at the Institute for Occupational and Maritime Medicine in Hamburg, within the period from 2006 to 2013, were interviewed about their experience of serious diseases and accidents on board, which had led to an emergency port call, a course deviation or an evacuation. Furthermore, prior to the course the officers were asked to answer 18 basic medical questions about common medical issues on board. Results 133 seafarers (28.6%) reported that they had been confronted with at least one serious medical emergency at sea. These emergencies encompassed trauma (37.9%), cardiovascular diseases (18.2%), severe gastrointestinal diseases (15.9%), serious skin or pulmonary infections (9.8%), neurological (9.1%) and urological diseases (4.5%) as well as burns (4.5%). With regards to the basic medical questions, an average of 70.7% of the total score had been achieved (from 26.8% to 100%). On average, 65.5% of internal and 65.6% of surgical questions had been answered correctly. Proper answers to toxicological and infectious questions had been given by 93.3% and 94.1% respectively and to topics of hypothermia and medical treatment by 59.4% and 61.0%. In total, a significant number of younger seafarers answered the questions correctly (p = 0.001). Conclusions According to this study, serious emergencies on board are most frequently related to trauma or cardiovascular diseases. Taking into account the acquired medical knowledge, there seems to be a need to train deck officers within these fields more

Wearable medical systems for p-Health.

PubMed

Teng, Xiao-Fei; Zhang, Yuan-Ting; Poon, Carmen C Y; Bonato, Paolo

2008-01-01

Driven by the growing aging population, prevalence of chronic diseases, and continuously rising healthcare costs, the healthcare system is undergoing a fundamental transformation, from the conventional hospital-centered system to an individual-centered system. Current and emerging developments in wearable medical systems will have a radical impact on this paradigm shift. Advances in wearable medical systems will enable the accessibility and affordability of healthcare, so that physiological conditions can be monitored not only at sporadic snapshots but also continuously for extended periods of time, making early disease detection and timely response to health threats possible. This paper reviews recent developments in the area of wearable medical systems for p-Health. Enabling technologies for continuous and noninvasive measurements of vital signs and biochemical variables, advances in intelligent biomedical clothing and body area networks, approaches for motion artifact reduction, strategies for wearable energy harvesting, and the establishment of standard protocols for the evaluation of wearable medical devices are presented in this paper with examples of clinical applications of these technologies.

Prudent layperson definition of an emergent pediatric medical condition.

PubMed

Huang, Craig J; Poirier, Michael P; Cantwell, John R; Ermis, Peter R; Isaacman, Daniel J

2006-03-01

This study was designed to assess how well parents rated pediatric medical conditions based on their perceived degree of urgency so as to determine if the "Prudent Layperson Standard'' is reasonable. A self-administered, supervised survey was given to a convenience sample of 340 caregivers in the emergency department of an urban children's hospital. Respondents were asked to rank the urgency of 15 scenarios. A caregiver response within 1 point of the physician score was considered concordant with medical opinion. A 2-week-old infant with a rectal temperature of 103.7 degrees F was the only emergent scenario underestimated by caregivers. A 1 1/2-yr-old child with an upper respiratory tract infection, a 7-year-old child with ringworm, an 8-month-old infant with a simple forehead contusion, and a 4-year-old child with conjunctivitis were the non-urgent scenarios overestimated by caregivers. Laypeople are able to identify cases constructed to represent obvious pediatric medical emergencies. Several patient subgroups frequently overestimate medical urgency.

SYMBIOmatics: Synergies in Medical Informatics and Bioinformatics – exploring current scientific literature for emerging topics

PubMed Central

Rebholz-Schuhman, Dietrich; Cameron, Graham; Clark, Dominic; van Mulligen, Erik; Coatrieux, Jean-Louis; Del Hoyo Barbolla, Eva; Martin-Sanchez, Fernando; Milanesi, Luciano; Porro, Ivan; Beltrame, Francesco; Tollis, Ioannis; Van der Lei, Johan

2007-01-01

Background The SYMBIOmatics Specific Support Action (SSA) is "an information gathering and dissemination activity" that seeks "to identify synergies between the bioinformatics and the medical informatics" domain to improve collaborative progress between both domains (ref. to ). As part of the project experts in both research fields will be identified and approached through a survey. To provide input to the survey, the scientific literature was analysed to extract topics relevant to both medical informatics and bioinformatics. Results This paper presents results of a systematic analysis of the scientific literature from medical informatics research and bioinformatics research. In the analysis pairs of words (bigrams) from the leading bioinformatics and medical informatics journals have been used as indication of existing and emerging technologies and topics over the period 2000–2005 ("recent") and 1990–1990 ("past"). We identified emerging topics that were equally important to bioinformatics and medical informatics in recent years such as microarray experiments, ontologies, open source, text mining and support vector machines. Emerging topics that evolved only in bioinformatics were system biology, protein interaction networks and statistical methods for microarray analyses, whereas emerging topics in medical informatics were grid technology and tissue microarrays. Conclusion We conclude that although both fields have their own specific domains of interest, they share common technological developments that tend to be initiated by new developments in biotechnology and computer science. PMID:17430562

Severe sepsis and septic shock in pre-hospital emergency medicine: survey results of medical directors of emergency medical services concerning antibiotics, blood cultures and algorithms.

PubMed

Casu, Sebastian; Häske, David

2016-06-01

Delayed antibiotic treatment for patients in severe sepsis and septic shock decreases the probability of survival. In this survey, medical directors of different emergency medical services (EMS) in Germany were asked if they are prepared for pre-hospital sepsis therapy with antibiotics or special algorithms to evaluate the individual preparations of the different rescue areas for the treatment of patients with this infectious disease. The objective of the survey was to obtain a general picture of the current status of the EMS with respect to rapid antibiotic treatment for sepsis. A total of 166 medical directors were invited to complete a short survey on behalf of the different rescue service districts in Germany via an electronic cover letter. Of the rescue districts, 25.6 % (n = 20) stated that they keep antibiotics on EMS vehicles. In addition, 2.6 % carry blood cultures on the vehicles. The most common antibiotic is ceftriaxone (third generation cephalosporin). In total, 8 (10.3 %) rescue districts use an algorithm for patients with sepsis, severe sepsis or septic shock. Although the German EMS is an emergency physician-based rescue system, special opportunities in the form of antibiotics on emergency physician vehicles are missing. Simultaneously, only 10.3 % of the rescue districts use a special algorithm for sepsis therapy. Sepsis, severe sepsis and septic shock do not appear to be prioritized as highly as these deadly diseases should be in the pre-hospital setting.

Emergency medical support system for extravehicular activity training held at weightless environment test building (WETS) of the Japan Aerospace Exploration Agency (JAXA) : future prospects and a look back over the past decade.

PubMed

Nakajima, Isao; Tachibana, Masakazu; Ohashi, Noriyoshi; Imai, Hiroshi; Asari, Yasushi; Matsuyama, Shigenori

2011-12-01

The Japan Aerospace Exploration Agency (JAXA) provides extravehicular activity (EVA) training to astronauts in a weightless environment test building (WETS) located in Tsukuba City. For EVA training, Tsukuba Medial Center Hospital (TMCH) has established an emergency medical support system, serving as operations coordinator. Taking the perspective of emergency physicians, this paper provides an overview of the medical support system and examines its activities over the past decade as well as future issues. Fortunately, no major accident has occurred during the past 10 years of NBS. Minor complaints (external otitis, acute otitis media, transient dizziness, conjunctival inflammation, upper respiratory inflammation, dermatitis, abraded wounds, etc.) among the support divers have been addressed onsite by attending emergency physicians. Operations related to the medical support system at the WETS have proceeded smoothly for the former NASDA and continue to proceed without event for JAXA, providing safe, high-quality emergency medical services. If an accident occurs at the WETS, transporting the patient by helicopter following initial treatment by emergency physicians can actually exacerbate symptoms, since the procedure exposes a patient who was recently within a hyperbaric environment to the low-pressure environment involved in air transportation. If a helicopter is used, the flight altitude should be kept as low as possible by taking routes over the river.

Emergency Medicine: On the Frontlines of Medical Education Transformation.

PubMed

Holmboe, Eric S

2015-11-01

Emergency medicine (EM) has always been on the frontlines of healthcare in the United States. I experienced this reality first hand as a young general medical officer assigned to an emergency department (ED) in a small naval hospital in the 1980s. For decades the ED has been the only site where patients could not be legally denied care. Despite increased insurance coverage for millions of Americans as a result of the Affordable Care Act, ED directors report an increase in patient volumes in a recent survey.1 EDs care for patients from across the socioeconomic spectrum suffering from a wide range of clinical conditions. As a result, the ED is still one of few components of the American healthcare system where social justice is enacted on a regular basis. Constant turbulence in the healthcare system, major changes in healthcare delivery, technological advances and shifting demographic trends necessitate that EM constantly adapt and evolve as a discipline in this complex environment.

Evaluating acute medical admissions through emergency departments in Hong Kong: can one adjust for case-mix variation?

PubMed

Rainer, T H; Sollich, P; Piotrowski, T; Coolen, A C C; Cheng, B; Graham, C A

2012-12-01

Healthcare systems are under pressure to efficiently and safely reduce acute care admissions to hospital. There is a need to develop a standardised system for assessing emergency department performance which takes into account case-mix variation. The objective of this study was to derive and validate a standardised tool for assessing variations in medical admissions through emergency departments in Hong Kong. Retrospective study of patients attending emergency departments of 14 acute hospitals in Hong Kong. Data were retrieved from a centralised administrative database. Of 2,531,225 patients who attended emergency departments between 1 January 2001 and 31 December 2003, 780,444 (30.8%) were admitted to medical wards. A model derived from 2001 data shows well-calibrated admission probabilities, with an area under the receiver operating characteristic curve for probability of admission of 90.3 (95% CI ±0.11). The areas under the receiver operating characteristic curves for 2002 and 2003 validation sets were 89.9 (95% CI ±0.11) and 89.0 (95% CI ±0.12), respectively. With an averaged benchmark, reductions in medical admissions of up to 19% could be achieved, while under the most optimistic assumption, reductions of up 36% could be achieved. A tool for benchmarking hospital medical admissions and minimising case-mix variation has been derived and validated in Hong Kong, but it requires further validation in other healthcare systems given the wide variations in admission thresholds internationally. This may be used as one potential method to evaluate the performance of emergency departments against a common standard.

Proceedings of a Conference on Medical Information Systems.

ERIC Educational Resources Information Center

Health Services and Mental Health Administration (DHEW), Bethesda, MD.

The purposes of this conference are: to define the current state of technology; to identify the problems, needs and emerging technology; and to consider alternative computer applications to multiple-facility medical information systems for the delivery of medical care and for health services research. The papers presented include: (1) General…

[Mobile emergency care medical records audit: the need for Tunisian guidelines].

PubMed

Mallouli, Manel; Hchaichi, Imen; Ammar, Asma; Sehli, Jihène; Zedini, Chekib; Mtiraoui, Ali; Ajmi, Thouraya

2017-03-06

Objective: This study was designed to assess the quality of the Gabès (Tunisia) mobile emergency care medical records and propose corrective actions.Materials and methods: A clinical audit was performed at the Gabès mobile emergency care unit (SMUR). Records of day, night and weekend primary and secondary interventions during the first half of 2014 were analysed according to a data collection grid comprising 56 criteria based on the SMUR guidelines and the 2013 French Society of Emergency Medicine evaluation guide. A non-conformance score was calculated for each section.Results: 415 medical records were analysed. The highest non-conformance rates (48.5%) concerned the “specificities of the emergency medical record” section. The lowest non-conformance rates concerned the surveillance data section (23.4%). The non-conformance score for the medical data audit was 24%.Conclusion: This audit identified minor dysfunctions that could be due to the absence of local guidelines concerning medical records in general and more specifically SMUR. Corrective measures were set up in the context of a short-term and intermediate-term action plan.

Emergency physician perceptions of medically unnecessary advanced diagnostic imaging.

PubMed

Kanzaria, Hemal K; Hoffman, Jerome R; Probst, Marc A; Caloyeras, John P; Berry, Sandra H; Brook, Robert H

2015-04-01

The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice. As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented. In this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board-certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation. Solutions most commonly felt to be "extremely" or "very" helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%). Overordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high

Brazilian dentists' attitudes about medical emergencies during dental treatment.

PubMed

Arsati, Franco; Montalli, Victor Angelo; Flório, Flavia Martão; Ramacciato, Juliana Cama; da Cunha, Fernanda Lopes; Cecanho, Rodrigo; de Andrade, Eduardo Dias; Motta, Rogério Heládio Lopes

2010-06-01

The main objective of this study was to evaluate the prevalence of emergencies in dental practices and the prepared-ness and the training experience in cardiopulmonary resuscitation (CPR) of Brazilian dentists in dealing with emergencies. The volunteer participants in the study were 498 Brazilian dentists who were present at the 27th International Congress of Dentistry in São Paulo. The most prevalent emergency was presyncope (reported by 54.20 percent of respondents), followed by orthostatic hypotension (44.37 percent), moderate allergic reactions (16.86 percent), hypertensive crisis (15.06 percent), asthma (15.06 percent), syncope (12.65 percent), angina (6.82 percent), convulsion (6.22 percent), hypoglycemia (5.62 percent), hyperventilation crisis (5.22 percent), choking (2.20 percent), and cerebrovascular accident (0.8 percent). Anaphylaxis, myocardial infarction, and cardiac arrest were the rarest emergencies, reported by only 0.4, 0.2, and 0.2 percent of dentists, respectively. Only 41 percent of the dentists judged themselves capable to diagnose the cause of an emergency during a dental visit. The majority responded that they would be capable of performing initial treatment of presyncope, syncope, orthostatic hypotension, convulsion, and choking. However, most of them felt unable to treat anaphylaxis, myocardial infarction, or cardiac arrest. Further, the majority felt unable to perform CPR or undertake an intravenous injection. It was concluded that the most prevalent medical emergencies in dental practice of Brazilian dentists are presyncope and orthostatic hypotension. The occurrence of life-threatening medical emergencies like anaphylaxis, myocardial infarction, cardiac arrest, and cerebrovascular accident is rare. Brazilian dentists are not fully prepared to manage medical emergencies and have insufficient experience training in CPR.

78 FR 30727 - Emergency Medical Services Week, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-22

... Medical Services Week, 2013 By the President of the United States of America A Proclamation In every.... During Emergency Medical Services Week, we pause to offer our gratitude to these remarkable men and women, whose dedication is fundamental to our society's well-being. In recent weeks, we have again seen the...

14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Helicopter hospital emergency medical....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... certificate holder may assign a helicopter flight crewmember, and no flight crewmember may accept an...

14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Helicopter hospital emergency medical....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... certificate holder may assign a helicopter flight crewmember, and no flight crewmember may accept an...

14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Helicopter hospital emergency medical....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... certificate holder may assign a helicopter flight crewmember, and no flight crewmember may accept an...

14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Helicopter hospital emergency medical....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... certificate holder may assign a helicopter flight crewmember, and no flight crewmember may accept an...

14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Helicopter hospital emergency medical....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... certificate holder may assign a helicopter flight crewmember, and no flight crewmember may accept an...

Successful strategies for recruitment of emergency medical volunteers.

PubMed

Hasselmann, Anne Rinchiuso

2013-06-01

A robust medical volunteer program is critical to ensuring a successful response to public health and medical emergencies. The New York City (NYC) Department of Health and Mental Hygiene created the NYC Medical Reserve Corps in 2003 to build a multidisciplinary team of health professionals who wish to assist NYC with response during large-scale health emergencies. This article reports on the search to determine which recruitment activities have been most successful to date, with the goal of modeling future activities upon those that worked best. A retrospective review of effectiveness of recruitment strategies to identify and register new NYC Medical Reserve Corps volunteers was undertaken. A broad range of recruitment activities have been implemented since the program's inception, with varying degrees of success. Various recruitment modalities were tried, including direct invitations to licensed professionals by the NYC Health Commissioner and announcements through professional organization partners. The direct invitation by the NYC Health Commissioner to health professionals licensed in 1 of the 5 boroughs of NYC has proved to be the most successful recruitment tool to date. The local health commissioner or other trusted community figure is an excellent messenger for recruiting emergency volunteers. It is also critical that recruitment messages reach as many potential volunteers as possible to ensure that the requisite number of volunteers and mix of professional disciplines are identified.

Rural Emergency Medical Services (EMS) and Trauma

MedlinePlus

... Toolkits Economic Impact Analysis Tool Community Health Gateway Sustainability Planning Tools Testing New Approaches Rural Health IT ... to the 2015 WWAMI Rural Health Research Center report, Prehospital Emergency Medical Services Personnel in Rural Areas: ...

Emergency Medical Technician-Ambulance: National Standard Curriculum. Student Study Guide (Third Edition).

ERIC Educational Resources Information Center

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

This student study guide is one of three documents prepared for the Emergency Medical Technician (EMT), National Standard Curriculum. The course is designed to develop skills in symptom recognition and in all emergency care procedures and techniques currently considered to be within the responsibilities of an EMT providing emergency medical care…

77 FR 46802 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-06

...-0100] National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory... Transportation (DOT). ACTION: Meeting Notice--National Emergency Medical Services Advisory Council. SUMMARY: The... NEMSAC is to provide a nationally recognized council of emergency medical services representatives and...

Development of the Inventory Management and Tracking System (IMATS) to Track the Availability of Public Health Department Medical Countermeasures During Public Health Emergencies

PubMed Central

Sahar, Liora; Faler, Guy; Hristov, Emil; Hughes, Susan; Lee, Leslie; Westnedge, Caroline; Erickson, Benjamin; Nichols, Barbara

2015-01-01

Objective To bridge gaps identified during the 2009 H1N1 influenza pandemic by developing a system that provides public health departments improved capability to manage and track medical countermeasures at the state and local levels and to report their inventory levels to the Centers for Disease Control and Prevention (CDC). Materials and Methods The CDC Countermeasure Tracking Systems (CTS) program designed and implemented the Inventory Management and Tracking System (IMATS) to manage, track, and report medical countermeasure inventories at the state and local levels. IMATS was designed by CDC in collaboration with state and local public health departments to ensure a “user-centered design approach.” A survey was completed to assess functionality and user satisfaction. Results IMATS was deployed in September 2011 and is provided at no cost to public health departments. Many state and local public health departments nationwide have adopted IMATS and use it to track countermeasure inventories during public health emergencies and daily operations. Discussion A successful response to public health emergencies requires efficient, accurate reporting of countermeasure inventory levels. IMATS is designed to support both emergency operations and everyday activities. Future improvements to the system include integrating barcoding technology and streamlining user access. To maintain system readiness, we continue to collect user feedback, improve technology, and enhance its functionality. Conclusion IMATS satisfies the need for a system for monitoring and reporting health departments’ countermeasure quantities so that decision makers are better informed. The “user-centered design approach” was successful, as evident by the many public health departments that adopted IMATS. PMID:26392843

Understanding the value of mixed methods research: the Children's Safety Initiative-Emergency Medical Services.

PubMed

Hansen, Matthew; O'Brien, Kerth; Meckler, Garth; Chang, Anna Marie; Guise, Jeanne-Marie

2016-07-01

Mixed methods research has significant potential to broaden the scope of emergency care and specifically emergency medical services investigation. Mixed methods studies involve the coordinated use of qualitative and quantitative research approaches to gain a fuller understanding of practice. By combining what is learnt from multiple methods, these approaches can help to characterise complex healthcare systems, identify the mechanisms of complex problems such as medical errors and understand aspects of human interaction such as communication, behaviour and team performance. Mixed methods approaches may be particularly useful for out-of-hospital care researchers because care is provided in complex systems where equipment, interpersonal interactions, societal norms, environment and other factors influence patient outcomes. The overall objectives of this paper are to (1) introduce the fundamental concepts and approaches of mixed methods research and (2) describe the interrelation and complementary features of the quantitative and qualitative components of mixed methods studies using specific examples from the Children's Safety Initiative-Emergency Medical Services (CSI-EMS), a large National Institutes of Health-funded research project conducted in the USA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

HSDPA (3.5G)-based ubiquitous integrated biotelemetry system for emergency care.

PubMed

Kang, Jaemin; Shin, Il Hyung; Koo, Yoonseo; Jung, Min Yang; Suh, Gil Joon; Kim, Hee Chan

2007-01-01

We have developed the second prototype system of Ubiquitous Integrated Biotelemetry System for Emergency Care(UIBSEC) using a HSDPA(High Speed Downlink Packet Access) modem to be used by emergency rescuers to get directions from medical doctors in providing emergency medical services for patients in ambulance. Five vital bio-signal instrumentation modules have been implemented, which include noninvasive arterial blood pressure (NIBP), arterial oxygen saturation (SaO2), 6-channel electro-cardiogram(ECG), blood glucose level, and body temperature and real-time motion picture of the patient and GPS information are also taken. Measured patient data, captured motion picture and GPS information are then transferred to a doctor's PC through the HSDPA and TCP/IP networks using stand-alone HSDPA modem. Most prominent feature of the developed system is that it is based on the HSDPA backbone networks available in Korea now, through which we will be able to establish a ubiquitous emergency healthcare service system.

Instructor Quality Affecting Emergency Medical Technician (EMT) Preparedness: A LEADS Project

ERIC Educational Resources Information Center

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

2005-01-01

This represents one of a series of studies of the Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS) being undertaken by the National Registry of Emergency Medical Technicians and the National Highway Traffic Safety Administration (NHTSA). This secondary analysis of the LEADS database, which provides a…

78 FR 49332 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-13

...-0091] National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory... Transportation (DOT). ACTION: Meeting Notice--National Emergency Medical Services Advisory Council. SUMMARY: The... emergency medical services representatives and consumers, is to advise and consult with DOT and the Federal...

Basic Training Course/Emergency Medical Technician (Second Edition). Instructor's Lesson Plan.

ERIC Educational Resources Information Center

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

This document containing instructor lesson plans is one of three prepared to update a basic training program for emergency medical technicians (EMTs). (A course guide containing planning and management information and a study guide are available separately.) Material covers all emergency medical techniques currently considered to be within the…

Basic Emergency Medical Technician Skills Manual.

ERIC Educational Resources Information Center

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

This manual was developed to help students preparing to become emergency medical technicians (EMTs) learn standardized basic skills in the field. The manual itemizes the steps and performance criteria of each required skill and uses an accompanying videotape series (not included) to enhance the educational experience. The five units of the manual,…

Review of Considerations, Management, and Treatment of Medical Emergencies During Commercial Flight

DTIC Science & Technology

2017-04-01

OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for...assistance during an in-flight medical emergency. 15. SUBJECT TERMS In-flight medical emergency, commercial air travel , in-flight medical care...England [7-10]. These ground-based medical consultation services establish a 24- hour, 7-day, 365-days-per-year response capability for real- time

Emergency Medical Services Instructor Training Program of the National Standard Curriculum Revised

DOT National Transportation Integrated Search

1996-05-01

In 1986, the National Highway Traffic Safety Administration (NHTSA) developed the first edition of the "Emergency Medical Services Instructor Training Program" to teach instructor skills to Emergency Medical Services (EMS) experts. In 1990, NHTSA rev...

The preparedness of private dental offices and polyclinics for medical emergencies

PubMed Central

Al-Sebaei, Maisa O.; Alkayyal, Moayyad A.; Alsulimani, Abdulelah H.; Alsulaimani, Othman S.; Habib, Weam T.

2015-01-01

Objectives: To assess preparedness for medical emergencies in private dental offices in Jeddah, Kingdom of Saudi Arabia (KSA). Methods: In this cross-sectional study, a survey was distributed to 70 dental offices and polyclinics in Jeddah, Saudi Arabia between October 2013 and January 2014. The questionnaire gathered information on the prevention of medical emergencies, the preparedness of the office personnel, and availability of emergency drugs and equipment. Results: For prevention, 92% (n=65) of the offices reported that they obtain a thorough medical history prior to treatment; however, only 11% (n=8) obtain vital signs for each visit. Using a preparedness percent score (0 to 100), the mean level of preparedness of the office personnel in all surveyed dental offices was 55.2±20. The availability of emergency drugs was 35±35, and equipment was 19±22. Conclusion: We found a deficiency in personnel training, availability of drugs, and emergency equipment in the surveyed dental clinics. More stringent rules and regulations for emergency preparedness must be reinforced to avoid disasters in these clinics. PMID:25737177

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 12. Water Accidents, Electrical Emergencies, Hazardous Materials and Radiation Accidents. Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers water accidents, electrical emergencies, and hazardous materials and radiation accidents. Objectives stated for the three chapters are for the students to be able to describe: emergency care for specified water…

[Structure, organization and capacity problems in emergency medical services, emergency admission and intensive care units].

PubMed

Dick, W

1994-01-01

Emergency medicine is subjected worldwide to financial stringencies and organizational evaluations of cost-effectiveness. The various links in the chain of survival are affected differently. Bystander assistance or bystander CPR is available in only 30% of the emergencies, response intervals--if at all required by legislation--are observed to only a limited degree or are too extended for survival in cardiac arrest. A single emergency telephone number is lacking. Too many different phone numbers for emergency reporting result in confusion and delays. Organizational realities are not fully overcome and impair efficiency. The position of the emergency physician in the EMS System is inadequately defined, the qualification of too many emergency physicians are unsatisfactory. In spite of this, emergency physicians are frequently forced to answer out-of-hospital emergency calls. Conflicts between emergency physicians and EMTs may be overcome by providing both groups with comparable qualifications as well as by providing an explicit definition of emergency competence. A further source of conflict occurs at the juncture of prehospital and inhospital emergency care in the emergency department. Deficiencies on either side play a decisive role. At least in principle there are solutions to the deficiencies in the EMSS and in intensive care medicine. They are among others: Adequate financial compensation of emergency personnel, availability of sufficient numbers of highly qualified personnel, availability of a central receiving area with an adjacent emergency ward, constant information flow to the dispatch center on the number of available emergency beds, maintaining 5% of all beds as emergency beds, establishing intermediate care facilities. Efficiency of emergency physician activities can be demonstrated in polytraumatized patients or in patients with ventricular fibrillation or acute myocardial infarction, in patients with acute myocardial insufficiency and other emergency

Highlights in emergency medicine medical education research: 2008.

PubMed

Farrell, Susan E; Coates, Wendy C; Khun, Gloria J; Fisher, Jonathan; Shayne, Philip; Lin, Michelle

2009-12-01

The purpose of this article is to highlight medical education research studies published in 2008 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine. Through a PubMed search of the English language literature in 2008, 30 medical education research studies were independently identified as hypothesis-testing investigations and measurements of educational interventions. Six reviewers independently rated and scored all articles based on eight anchors, four of which related to methodologic criteria. Articles were ranked according to their total rating score. A ranking agreement among the reviewers of 83% was established a priori as a minimum for highlighting articles in this review. Five medical education research studies met the a priori criteria for inclusion and are reviewed and summarized here. Four of these employed experimental or quasi-experimental methodology. Although technology was not a component of the structured literature search employed to identify the candidate articles for this review, 14 of the articles identified, including four of the five highlighted articles, employed or studied technology as a focus of the educational research. Overall, 36% of the reviewed studies were supported by funding; three of the highlighted articles were funded studies. This review highlights quality medical education research studies published in 2008, with outcomes of relevance to teaching and education in emergency medicine. It focuses on research methodology, notes current trends in the use of technology for learning in emergency medicine, and suggests future avenues for continued rigorous study in education.

Emergency Medical Care. A Manual for the Paramedic in the Field.

ERIC Educational Resources Information Center

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

This document is a textbook of emergency medical procedures to be used for training emergency medical technicians. The book is organized into 15 modules, each containing 1 to 10 units. Each module contains information illustrated with line drawings, a glossary, and references. The modules cover the following topics: the role of the emergency…

Management of chest pain in the French emergency healthcare system: the prospective observational EPIDOULTHO study.

PubMed

Charpentier, Sandrine; Beaune, Sebastien; Joly, Luc Marie; Khoury, Abdo; Duchateau, François-Xavier; Briot, Raphael; Renaud, Bertrand; Ageron, François-Xavier

2017-07-18

The aim of this paper was to describe the epidemiology, and diagnostic and therapeutic strategies that emergency physicians use to manage patients presenting with chest pain at all three levels of the French emergency medical system - that is, dispatch centres (SAMUs: the medical emergency system), which operate the mobile intensive care units (MICUs), and hospitals' emergency departments (EDs), with a focus on acute coronary syndrome (ACS). All patients with chest pain who contacted a SAMU and/or were managed by a MICU and/or were admitted into an ED were included in a 1-day multicentre prospective study carried out in January 2013. Data on diagnostic and therapeutic management and disposition were collected. An in-hospital follow-up was performed. In total, 1339 patients were included: 537 from SAMU, 187 attended by a MICU and 615 in EDs. Diagnosing ACS was the main diagnostic strategy of the French emergency care system, diagnosed in 16% of SAMU patients, 25% of MICU patients and 10% of ED patients. Among patients calling the SAMU, 76 (14%) received only medical advice, 15 (8%) patients remained at home after being seen by a MICU and 454 (74%) were discharged from an ED. Management of chest pain at the three levels of the French medical emergency system is mainly oriented towards ruling out ACS. The strategy of diagnostic management is based on minimizing missed diagnoses of ACS.

Proton beam therapy and the convoluted pathway to incorporating emerging technology into routine medical care in the United States.

PubMed

Steinberg, Michael L; Konski, Andre

2009-01-01

The pathway that emerging medical technologies take to incorporation into routine medical care in the United States is a product of the social, economic, and political milieu. Our review explores how this milieu brought the incorporation of proton beam therapy into the healthcare delivery system to its current point. We look at how new technologies are presently accepted into this system and discuss the emerging trends--such as the use of evidence-based assessment of technology, coverage with evidence policies, and comparative effectiveness analysis--that are affecting proton beam therapy's effort to finds its place in the pantheon of available medical treatments for patients with cancer.

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

Emergency Medical Services Utilization in EMS Priority Conditions in Beirut, Lebanon.

PubMed

El Sayed, Mazen; Tamim, Hani; Chehadeh, Ahel Al-Hajj; Kazzi, Amin A

2016-12-01

Early activation and use of Emergency Medical Services (EMS) are associated with improved patient outcomes in EMS priority conditions in developed EMS systems. This study describes patterns of EMS use and identifies predictors of EMS utilization in EMS priority conditions in Lebanon METHODS: This was a cross-sectional study of a random sample of adult patients presenting to the emergency department (ED) of a tertiary care center in Beirut with the following EMS priority conditions: chest pain, major trauma, respiratory distress, cardiac arrest, respiratory arrest, and airway obstruction. Patient/proxy survey (20 questions) and chart review were completed. The responses to survey questions were "disagree," "neutral," or "agree" and were scored as one, two, or three with three corresponding to higher likelihood of EMS use. A total scale score ranging from 20 to 60 was created and transformed from 0% to 100%. Data were analyzed based on mode of presentation (EMS vs other). Among the 481 patients enrolled, only 112 (23.3%) used EMS. Mean age for study population was 63.7 years (SD=18.8 years) with 56.5% males. Mean clinical severity score (Emergency Severity Index [ESI]) was 2.5 (SD=0.7) and mean pain score was 3.1 (SD=3.5) at ED presentation. Over one-half (58.8%) needed admission to hospital with 21.8% to an intensive care unit care level and with a mortality rate of 7.3%. Significant associations were found between EMS use and the following variables: severity of illness, degree of pain, familiarity with EMS activation, previous EMS use, perceived EMS benefit, availability of EMS services, trust in EMS response times and treatment, advice from family, and unavailability of immediate private mode of transport (P≤.05). Functional screening, or requiring full assistance (OR=4.77; 95% CI, 1.85-12.29); acute symptoms onset ≤ one hour (OR=2.14; 95% CI, 1.08-4.26); and higher scale scores (OR=2.99; 95% CI, 2.20-4.07) were significant predictors of EMS use. Patients

Psychiatry and emergency medicine: medical student and physician attitudes toward homeless persons.

PubMed

Morrison, Ann; Roman, Brenda; Borges, Nicole

2012-05-01

The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden curriculum" in medical education, in which values are communicated from teacher to student outside of the formal instruction. A group of 79 students on Psychiatry and 66 on Emergency Medicine clerkships were surveyed at the beginning and end of their rotation regarding their attitudes toward homeless persons by use of the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI). The HPATHI was also administered to 31 Psychiatry residents and faculty and 41 Emergency Medicine residents and faculty one time during the course of this study. For Psychiatry clerks, t-tests showed significant differences pre- and post-clerkship experiences on 2 of the 23 items on the HPATHI. No statistically significant differences were noted for the Emergency Medicine students. An analysis of variance revealed statistically significant differences on 7 out of the 23 survey questions for residents and faculty in Psychiatry, as compared with those in Emergency Medicine. Results suggest that medical students showed small differences in their attitudes toward homeless people following clerkships in Psychiatry but not in Emergency Medicine. Regarding resident and faculty results, significant differences between specialties were noted, with Psychiatry residents and faculty exhibiting more favorable attitudes toward homeless persons than residents and faculty in Emergency Medicine. Given that medical student competencies should be addressing the broader social issues of homelessness, medical schools need to first understand the attitudes of medical students to such issues, and then develop curricula to overcome inaccurate or stigmatizing beliefs.

Mobile emergency, an emergency support system for hospitals in mobile devices: pilot study.

PubMed

Bellini, Pierfrancesco; Boncinelli, Sergio; Grossi, Francesco; Mangini, Marco; Nesi, Paolo; Sequi, Leonardo

2013-05-23

Hospitals are vulnerable to natural disasters, man-made disasters, and mass causalities events. Within a short time, hospitals must provide care to large numbers of casualties in any damaged infrastructure, despite great personnel risk, inadequate communications, and limited resources. Communications are one of the most common challenges and drawbacks during in-hospital emergencies. Emergency difficulties in communicating with personnel and other agencies are mentioned in literature. At the moment of emergency inception and in the earliest emergency phases, the data regarding the true nature of the incidents are often inaccurate. The real needs and conditions are not yet clear, hospital personnel are neither efficiently coordinated nor informed on the real available resources. Information and communication technology solutions in health care turned out to have a great positive impact both on daily working practice and situations. The objective of this paper was to find a solution that addresses the aspects of communicating among medical personnel, formalizing the modalities and protocols and the information to guide the medical personnel during emergency conditions with a support of a Central Station (command center) to cope with emergency management and best practice network to produce and distribute intelligent content made available in the mobile devices of the medical personnel. The aim was to reduce the time needed to react and to cope with emergency organization, while facilitating communications. The solution has been realized by formalizing the scenarios, extracting, and identifying the requirements by using formal methods based on unified modeling language (UML). The system and was developed using mobile programming under iOS Apple and PHP: Hypertext Preprocessor My Structured Query Language (PHP MySQL). Formal questionnaires and time sheets were used for testing and validation, and a control group was used in order to estimate the reduction of time needed

Mobile Emergency, an Emergency Support System for Hospitals in Mobile Devices: Pilot Study

PubMed Central

2013-01-01

Background Hospitals are vulnerable to natural disasters, man-made disasters, and mass causalities events. Within a short time, hospitals must provide care to large numbers of casualties in any damaged infrastructure, despite great personnel risk, inadequate communications, and limited resources. Communications are one of the most common challenges and drawbacks during in-hospital emergencies. Emergency difficulties in communicating with personnel and other agencies are mentioned in literature. At the moment of emergency inception and in the earliest emergency phases, the data regarding the true nature of the incidents are often inaccurate. The real needs and conditions are not yet clear, hospital personnel are neither efficiently coordinated nor informed on the real available resources. Information and communication technology solutions in health care turned out to have a great positive impact both on daily working practice and situations. Objective The objective of this paper was to find a solution that addresses the aspects of communicating among medical personnel, formalizing the modalities and protocols and the information to guide the medical personnel during emergency conditions with a support of a Central Station (command center) to cope with emergency management and best practice network to produce and distribute intelligent content made available in the mobile devices of the medical personnel. The aim was to reduce the time needed to react and to cope with emergency organization, while facilitating communications. Methods The solution has been realized by formalizing the scenarios, extracting, and identifying the requirements by using formal methods based on unified modeling language (UML). The system and was developed using mobile programming under iOS Apple and PHP: Hypertext Preprocessor My Structured Query Language (PHP MySQL). Formal questionnaires and time sheets were used for testing and validation, and a control group was used in order to estimate

Emergency Communications Console

NASA Technical Reports Server (NTRS)

1978-01-01

NASA has applied its communications equipment expertise to development of a communications console that provides, in a compact package only slightly larger than an electric typewriter, all the emergency medical services communications functions needed for a regional hospital. A prototype unit, built by Johnson Space Center, has been installed in the Odessa (Texas) Medical Center Hospital. The hospital is the medical control center for the 17-county Permian Basin Emergency Medical System in west Texas. The console project originated in response to a request to NASA from the Texas governor's office, which sought a better way of providing emergency medical care in rural areas. Because ambulance travel time is frequently long in remote areas of west Texas, it is important that treatment begin at the scene of the emergency rather than at the hospital emergency room. A radio and telephone system linking ambulance emergency technicians and hospital staff makes this possible. But earlier equipment was complex, requiring specialized operators. A highly reliable system was needed to minimize breakdowns and provide controls of utmost simplicity, so that the system could be operated by physicians and nurses rather than by communications specialists. The resulting console has both radio and telephone sections. With the radio equipment, hospital personnel can communicate with ambulance drivers and paramedics, receive incoming electrocardiagrams, consult with other hospitals, page hospital staff and set up a radio-to-telephone "patch." The telephone portion of the system includes a hotline from the Permian Basin Emergency Medical Service's resource control center, an automatic dialer for contacting special care facilities in the Permian Basin network, a hospital intercom terminal and a means of relaying cardioscope displays and other data between hospitals. The integrated system also provides links with local disaster and civil defense organizations and with emergency "Dial 911

Work-family fit: the impact of emergency medical services work on the family system.

PubMed

Roth, Sheila Gillespie; Moore, Crystal Dea

2009-01-01

The stress associated with a career in emergency medical services (EMS) can impact the work-family fit and function of the family system for EMS personnel. Little research has been conducted on how the demands associated with a career in EMS influences family life. Objective. To describe salient EMS work factors that can impact the family system. Twelve family members (11 spouses and one parent) of EMS workers were interviewed using a semistructured qualitative interview guide that explored issues related to their family members' work that could impact the quality of family life. Using a phenomenological approach, transcribed interview data were examined for themes that illuminated factors that influence work-family fit. Data analysis revealed that shift work impacts numerous aspects of family life, including marital and parental roles, leisure and social opportunities, and home schedules and rhythms. Furthermore, families coped with challenges associated with their loved one's EMS work through negotiating role responsibilities, developing their own interests, giving their family member "space," and providing support by listening and helping the EMS worker process his or her reactions to difficult work. In addition, family members reported concern over their EMS worker's physical safety. Implications from the data are discussed vis-a-vis the work-family fit and family systems models. Education, communication, support systems, and individual interests are key ways to promote a healthy work-family fit.

Factors influencing nurses' decisions to activate medical emergency teams.

PubMed

Pantazopoulos, Ioannis; Tsoni, Aikaterini; Kouskouni, Evangelia; Papadimitriou, Lila; Johnson, Elizabeth O; Xanthos, Theodoros

2012-09-01

To evaluate the relationship between nurse demographics and correct identification of clinical situations warranting specific nursing actions, including activation of the medical emergency team. If abnormal physiology is left untreated, the patient may develop cardiac arrest. Nurses in general wards are those who perceive any clinical deterioration in patients. A descriptive, quantitative design was selected. An anonymous survey with 13 multiple choice questions was distributed to 150 randomly selected nurses working in general medical and surgical wards of a large tertiary hospital in Athens, Greece. After explanation of the purposes of the study, 94 nurses (response ratio: 62%) agreed to respond to the questionnaire. Categories with the greatest nursing concern were patients with heart rate<40/minute, an atypical thoracic pain, foreign body airway obstruction and bronchial secretions, respiratory rate<5/minute and heart rate=100/minute. However, almost 50% of nurses were able to accurately identify the critical nursing action for patients with respiratory rate<4/minute, 72% for patients with airway obstruction and 73% for patients with chest pain. Nurses who had graduated from a four-year educational programme identified clinical situations that necessitated medical emergency team activation in a significantly higher rate and also scored significantly higher in questions concerning clinical evaluation than nurses who had graduated from a two-year educational programme. Activation of the medical emergency team is influenced by factors such as level of education and cardiopulmonary resuscitation courses attendance. Graduating from a four-year educational programme helps nurses identify emergencies. However, irrespective of the educational programme they have followed, undertaking a basic life support or advanced life support provider course is critical as it helps them identify cardiac or respiratory emergencies. © 2012 Blackwell Publishing Ltd.

Challenges to effective crisis management: using information and communication technologies to coordinate emergency medical services and emergency department teams.

PubMed

Reddy, Madhu C; Paul, Sharoda A; Abraham, Joanna; McNeese, Michael; DeFlitch, Christopher; Yen, John

2009-04-01

The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.

[The nurse within emergency medical-psychological units].

PubMed

Darbon, Rémy; Dalphin, Catherine; Prieto, Nathalie; Cheucle, Éric

2017-04-01

The growing recognition of post-traumatic stress disorders and the need to intervene early justifies the creation of emergency medical-psychological units. The nurse has a major role to play within these teams. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Significant acceleration of emergency response using smartphone geolocation data and a worldwide emergency call support system.

PubMed

Weinlich, Michael; Kurz, Peter; Blau, Melissa B; Walcher, Felix; Piatek, Stefan

2018-01-01

When patients are disorientated or experience language barriers, it is impossible to activate the emergency response system. In these cases, the delay for receiving appropriate help can extend to several hours. A worldwide emergency call support system (ECSS), including geolocation of modern smartphones (GPS, WLAN and LBS), was established referring to E911 and eCall systems. The system was tested for relevance in quickly forwarding abroad emergency calls to emergency medical services (EMS). To verify that geolocation data from smartphones are exact enough to be used for emergency cases, the accuracy of GPS (global positioning system), Wi-Fi (wireless LAN network) and LBS (location based system) was tested in eleven different countries and compared to actual location. The main objective was analyzed by simulation of emergencies in different countries. The time delay in receiving help in unsuccessful emergency call cases by using the worldwide emergency call support system (ECSS) was measured. GPS is the gold standard to locate patients with an average accuracy of 2.0 ± 3.3 m. Wi-Fi can be used within buildings with an accuracy of 7.0 ± 24.1 m. Using ECSS, the emergency call leads to a successful activation of EMS in 22.8 ± 10.8 min (Median 21 min). The use of a simple app with one button to touch did never cause any delay. The worldwide emergency call support system (ECSS) significantly improves the emergency response in cases of disorientated patients or language barriers. Under circumstances without ECSS, help can be delayed by 2 or more hours and might have relevant lifesaving effects. This is the first time that Wi-Fi geolocation could prove to be a useful improvement in emergencies to enhance GPS, especially within or close to buildings.

Horizon scanning of new and emerging medical technology in Australia: its relevance to Medical Services Advisory Committee health technology assessments and public funding.

PubMed

O'Malley, Sue P; Jordan, Ernest

2009-07-01

In 1998, a formal process using full health technology assessments (HTAs) was implemented to determine the suitability for public subsidy of new and emerging medical technologies in the Australian private healthcare sector. This process is overseen by the Medical Services Advisory Committee (MSAC). In 2004, horizon scanning was introduced in Australia with the stated objective of identifying new and emerging medical technologies into the public healthcare sector, with consideration to the publicly subsidized private healthcare sector. How well horizon scanning works in identifying new and emerging technologies suitable for government subsidized funding in the private healthcare sector is examined in this study. A descriptive evaluation of the impact of horizon scanning as an early alert and awareness system identifying new and emerging technologies before these technologies are submitted to MSAC for a full HTA. All MSAC HTAs commenced after the introduction of horizon scanning in 2004 were cross-checked with the list of Prioritizing Summaries or Horizon Scanning Reports to determine whether a prior Prioritizing Summary or Horizon Scanning Report had been carried out. Of the forty-three technologies that were the subject of a full MSAC HTAs in the time period examined, only eleven had been the subject of either a Prioritizing Summary or Horizon Scanning Report. As a result of a full MSAC HTA, twelve of the technologies that were not the subject of a Prioritizing Summary or Horizon Scanning Report were given positive recommendations for public funding. Horizon scanning was set up to scan the introduction of new and emerging medical technologies into the public healthcare sector, with consideration to the publicly subsidized private healthcare sector. Based on the number of new and emerging technologies that have been the subject of a full MSAC HTA without first being subjected to either a Prioritizing Summary or Horizon Scanning Report, horizon scanning in Australia

Influence of awareness and availability of medical alternatives on parents seeking paediatric emergency care.

PubMed

Ellbrant, Julia A; Åkeson, S Jonas; Karlsland Åkeson, Pia M

2018-06-01

Direct seeking of care at paediatric emergency departments may result from an inadequate awareness or a short supply of medical alternatives. We therefore evaluated the care-seeking patterns, availability of medical options and initial medical assessments - with overall reference to socioeconomic status - of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare. The parents of children assessed by paediatric emergency department physicians at a Swedish university hospital over a 25-day winter period completed a questionnaire on recent medical contacts and their reasons for attendance. Additional information was obtained from ledgers, patient records and population demographics. In total, 657 of 713 eligible patients (92%) were included. Seventy-nine per cent of their parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours ( p=0.014) and were scored as less urgent ( p=0.014). A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status ( p=0.027). Although most parents in this Swedish study tried to seek medical advice before attending a paediatric emergency department, perceived emergency, a short supply of telephone health line or primary care facilities and lower socioeconomic status contributed to direct care-seeking by almost 40% of parents. Pre-hospital awareness and the availability of medical alternatives with an emphasis on major differences in socioeconomic status should therefore be considered to further optimize care-seeking in paediatric emergency departments.

Patient expectations from an emergency medical service.

PubMed

Qidwai, Waris; Ali, Syed Sohail; Baqir, Muhammad; Ayub, Semi

2005-01-01

Patient expectation survey at the Emergency Medical Services can improve patient satisfaction. A need was established to conduct such a survey in order to recommend its use as a quality improvement tool. The study was conducted on patients visiting the Emergency Medical Services, Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and expectations of patients. The ethical requirements for conducting the study were met. A hundred patients were surveyed. The majority was relatively young, married men and women, well educated and better socio-economically placed. The majority of the patients expected a waiting time and a consultation time of less than 30 minutes and 20 minutes, respectively. The majority of respondents expected and agreed to be examined by a trainee but there were reluctant to be examined by the students. There was an expectation that the consultant will examine patients and not advice the attending team over the phone. The majority of the patients expected intravenous fluid therapy. There was a desire to have patient attendant present during the consultation process. The majority of the patients expected to pay less than three thousand rupees for the visit. An expectation exists for investigations and hospitalization. Involvement of patients in decisions concerning their treatment and written feedback on their visit was expected. We have documented the need and value of patient expectation survey at the Emergency Medical Services department. The use of such a tool is recommended in order to improve the satisfaction levels of patients visiting such facilities.

GPS and GPRS Based Telemonitoring System for Emergency Patient Transportation

PubMed Central

Satyanarayana, K.; Sarma, A. D.; Sravan, J.; Malini, M.; Venkateswarlu, G.

2013-01-01

Telemonitoring during the golden hour of patient transportation helps to improve medical care. Presently there are different physiological data acquisition and transmission systems using cellular network and radio communication links. Location monitoring systems and video transmission systems are also commercially available. The emergency patient transportation systems uniquely require transmission of data pertaining to the patient, vehicle, time of the call, physiological signals (like ECG, blood pressure, a body temperature, and blood oxygen saturation), location information, a snap shot of the patient, and voice. These requirements are presently met by using separate communication systems for voice, physiological data, and location that result in a lot of inconvenience to the technicians, maintenance related issues, in addition to being expensive. This paper presents design, development, and implementation of such a telemonitoring system for emergency patient transportation employing ARM 9 processor module. This system is found to be very useful for the emergency patient transportation being undertaken by organizations like the Emergency Management Research Institute (EMRI). PMID:27019844

Military Emergency Medical Service System Assessment: Application of the National Park Service Needs Assessment and Program Audit to Objectively Evaluate the Military EMS System of Okinawa, Japan.

PubMed

Ross, Elliot M; Harper, Stephen A; Cunningham, Cord; Walrath, Benjamin D; DeMers, Gerard; Kharod, Chetan U

2017-03-01

As part of a Military Emergency Medical Services (EMS) system process improvement initiative, the authors sought to objectively evaluate the U.S. military EMS system for the island of Okinawa. They applied a program evaluation tool currently utilized by the U.S. National Park Service (NPS). A comprehensive needs assessment was conducted to evaluate the current Military EMS system in Okinawa, Japan. The NPS EMS Program Audit Worksheet was used to get an overall "score" of our assessment. After all the data had been collected, a joint committee of Military EMS physicians reviewed the findings and made formal recommendations. From 2011 to 2014, U.S. military EMS on Okinawa averaged 1,345 ± 137 patient transports annually. An advanced life support (ALS) provider would have been dispatched on 558 EMS runs (38%) based on chief complaint in 2014 had they been available. Over 36,000 man-hours were expended during this period to provide National Registry Emergency Medical Technician (EMT)-accredited instruction to certify 141 Navy Corpsman as EMT Basics. The NPS EMS Program Audit Worksheet was used and the program scored a total of 31, suggesting the program is well planned and operating within standards. This evaluation of the Military EMS system on Okinawa using the NPS program assessment and audit worksheet demonstrates the NPS evaluation instruments may offer a useful assessment tool for the evaluation of Military EMS systems. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

The relationship between managers' leadership styles and emergency medical technicians' job satisfaction.

PubMed

Ghorbanian, Azimeh; Bahadori, Mohammadkarim; Nejati, Mostafa

2012-01-01

Leadership plays a crucial role in many professions, especially in challenging positions such as emergency medical service jobs. The purpose of this study was to explore the relationship between managers' leadership styles and emergency medical technicians' job satisfaction. This is a descriptive and cross-sectional study that was carried out in 2010. The research population included 21 managers and 87 emergency medical technicians working in 23 stations in Isfahan city, Iran. The main tools used for data accumulation were the Multiple Leadership Questionnaire for evaluating leadership styles and the Job Descriptive Index for measuring job satisfaction levels. Also, the Pearson correlation analysis test was used to evaluate the relationship between leadership style and job satisfaction. Among both managers and technicians, the highest mean score related to the transformational management style, whereas the lowest mean score related to the laissez-faire management style. Moreover, a significant relationship (P<0.01) was found between the transformational and transactional leadership styles and job satisfaction. However, no significant relationship was observed between the laissez-faire management style and job satisfaction. Considering the importance of job satisfaction in medical emergencies, it is recommended that health sector policy makers should provide the groundwork for implementing the transformational leadership style to enhance job satisfaction of the medical emergency staff.

Commercial Airline In-Flight Emergency: Medical Student Response and Review of Medicolegal Issues.

PubMed

Bukowski, Josh H; Richards, John R

2016-01-01

As the prevalence of air travel increases, in-flight medical emergencies occur more frequently. A significant percentage of these emergencies occur when there is no certified physician, nurse, or paramedic onboard. During these situations, flight crews might enlist the help of noncertified passengers, such as medical students, dentists, or emergency medical technicians in training. Although Good Samaritan laws exist, many health care providers are unfamiliar with the limited legal protections and resources provided to them after responding to an in-flight emergency. A 78-year-old woman lost consciousness and became pulseless onboard a commercial aircraft. No physician was available. A medical student responded and coordinated care with the flight crew, ground support physician, and other passengers. After receiving a packet (4 g) of sublingual sucrose and 1 L i.v. crystalloid, the patient regained pulses and consciousness. The medical student made the decision not to divert the aircraft based on the patient's initial response to therapy and, 45 min later, the patient had normal vital signs. Upon landing, she was met and taken by paramedics to the nearest emergency department for evaluation of her collapse. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians are the most qualified to assist in-flight emergencies, but they might not be aware of the medicolegal risks involved with in-flight care, the resources available, and the role of the flight crew in liability and decision making. This case, which involved a medical student who was not given explicit protection under Good Samaritan laws, illustrates the authority of the flight crew during these events and highlights areas of uncertainty in the legislation for volunteer medical professionals. Copyright © 2016 Elsevier Inc. All rights reserved.

A simulated emergency department for medical students.

PubMed

Johnson, Patricia; Brazil, Victoria; Raymond-Dufresne, Éliane; Nielson, Tracy

2017-08-01

During their training, medical students often undertake a rotation in an emergency department (ED), where they are exposed to a wide variety of patient presentations. Simulation can be an effective teaching strategy to help prepare learners for the realities of the clinical environment. Simulating an ED shift can provide students with the opportunity to perform a range of clinical activities, within their scope of practice, in a supervised and supportive learning environment. Medical students often undertake a rotation in an emergency department CONTEXT: There is limited literature describing the structure, syllabus, feasibility and perceived usefulness of simulating a typical ED for medical student training. We developed a simulated ED (simED) teaching session for medical students at our university. Students were informed of the purpose and learning tasks of the session prior to attendance. At the start of their 2-hour simED shift students were allocated 'patients' by the Triage nurse. At the completion of their shift, students attended a debriefing discussion. Student feedback indicated that they felt that the simED: provided a good opportunity to practise skills and apply theory to practice; was realistic and challenging; highlighted the importance of teamwork; and enabled them to identify skills requiring further practise. Suggestions for improvements included a longer time spent in the simED and the opportunity to see more patients. The simED approach seemed to be well received and perceived by medical students as useful preparation for the ED. An overview of the structure, materials and resources used is provided to assist educators seeking to implement similar ED clinical scenarios in their curriculum. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Color-Coded Prefilled Medication Syringes Decrease Time to Delivery and Dosing Error in Simulated Emergency Department Pediatric Resuscitations.

PubMed

Moreira, Maria E; Hernandez, Caleb; Stevens, Allen D; Jones, Seth; Sande, Margaret; Blumen, Jason R; Hopkins, Emily; Bakes, Katherine; Haukoos, Jason S

2015-08-01

The Institute of Medicine has called on the US health care system to identify and reduce medical errors. Unfortunately, medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients when dosing requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national health care priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared with conventional medication administration, in simulated pediatric emergency department (ED) resuscitation scenarios. We performed a prospective, block-randomized, crossover study in which 10 emergency physician and nurse teams managed 2 simulated pediatric arrest scenarios in situ, using either prefilled, color-coded syringes (intervention) or conventional drug administration methods (control). The ED resuscitation room and the intravenous medication port were video recorded during the simulations. Data were extracted from video review by blinded, independent reviewers. Median time to delivery of all doses for the conventional and color-coded delivery groups was 47 seconds (95% confidence interval [CI] 40 to 53 seconds) and 19 seconds (95% CI 18 to 20 seconds), respectively (difference=27 seconds; 95% CI 21 to 33 seconds). With the conventional method, 118 doses were administered, with 20 critical dosing errors (17%); with the color-coded method, 123 doses were administered, with 0 critical dosing errors (difference=17%; 95% CI 4% to 30%). A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by emergency physician and nurse teams during simulated pediatric ED resuscitations. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

A Wireless Emergency Telemedicine System for Patients Monitoring and Diagnosis

PubMed Central

Abo-Zahhad, M.; Ahmed, Sabah M.; Elnahas, O.

2014-01-01

Recently, remote healthcare systems have received increasing attention in the last decade, explaining why intelligent systems with physiology signal monitoring for e-health care are an emerging area of development. Therefore, this study adopts a system which includes continuous collection and evaluation of multiple vital signs, long-term healthcare, and a cellular connection to a medical center in emergency case and it transfers all acquired raw data by the internet in normal case. The proposed system can continuously acquire four different physiological signs, for example, ECG, SpO2, temperature, and blood pressure and further relayed them to an intelligent data analysis scheme to diagnose abnormal pulses for exploring potential chronic diseases. The proposed system also has a friendly web-based interface for medical staff to observe immediate pulse signals for remote treatment. Once abnormal event happened or the request to real-time display vital signs is confirmed, all physiological signs will be immediately transmitted to remote medical server through both cellular networks and internet. Also data can be transmitted to a family member's mobile phone or doctor's phone through GPRS. A prototype of such system has been successfully developed and implemented, which will offer high standard of healthcare with a major reduction in cost for our society. PMID:24883059

Developing research criteria to define medical necessity in emergency medical services.

PubMed

Cone, David C; Schmidt, Terri A; Mann, N Clay; Brown, Lawrence

2004-01-01

"The Neely Conference: Developing Research Criteria to Define Medical Necessity in EMS" convened emergency medical services (EMS) physicians, researchers, administrators, providers, and federal agency representatives to begin the development of a set of uniform triage criteria and outcome measures that could be used to study and evaluate medical necessity among EMS patients. These standardized criteria might be used in research studies examining EMS dispatch and response (e.g., dispatch triage protocols, alternative response configurations), and EMS treatment and transport (e.g., field triage protocols, alternative care destinations). The conference process included review and analysis of the literature, expert judgment, and consensus building. There was general agreement on the following: 1. Any dispatch triage or field triage system that is developed must be designed to offer patients alternatives to EMS, not to refuse care to patients. 2. It is theoretically possible to develop a set of clinical criteria for need. Some groups of patients will clearly need a traditional EMS response and other groups will not, but this has yet to be defined. 3. In addition to clinical criteria, certain social and other nonclinical criteria such as pain or potential abuse may be used to justify a response. 4. Communication barriers, patient age, special needs, and other conditions complicate patient assessment but should not exclude patients from consideration for alternate triage or transport. 5. These research questions are important, and standard sets of outcome measures are needed so that different studies and innovative programs can be compared.

National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module IX. Musculoskeletal.

ERIC Educational Resources Information Center

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

This instructor's lesson plan guide on the musculoskeletal system is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Five units of study are presented: (1) the major bones, joints, and muscles of the body; (2) patient assessment of a musculoskeletal injury; (3) pathophysiology and management…

Medical care at mass gatherings: emergency medical services at large-scale rave events.

PubMed

Krul, Jan; Sanou, Björn; Swart, Eleonara L; Girbes, Armand R J

2012-02-01

The objective of this study was to develop comprehensive guidelines for medical care during mass gatherings based on the experience of providing medical support during rave parties. Study design was a prospective, observational study of self-referred patients who reported to First Aid Stations (FASs) during Dutch rave parties. All users of medical care were registered on an existing standard questionnaire. Health problems were categorized as medical, trauma, psychological, or miscellaneous. Severity was assessed based on the Emergency Severity Index. Qualified nurses, paramedics, and doctors conducted the study after training in the use of the study questionnaire. Total number of visitors was reported by type of event. During the 2006-2010 study period, 7,089 persons presented to FASs for medical aid during rave parties. Most of the problems (91.1%) were categorized as medical or trauma, and classified as mild. The most common medical complaints were general unwell-being, nausea, dizziness, and vomiting. Contusions, strains and sprains, wounds, lacerations, and blisters were the most common traumas. A small portion (2.4%) of the emergency aid was classified as moderate (professional medical care required), including two cases (0.03%) that were considered life-threatening. Hospital admission occurred in 2.2% of the patients. Fewer than half of all patients presenting for aid were transported by ambulance. More than a quarter of all cases (27.4%) were related to recreational drugs. During a five-year field research period at rave dance parties, most presentations on-site for medical evaluation were for mild conditions. A medical team of six healthcare workers for every 10,000 rave party visitors is recommended. On-site medical staff should consist primarily of first aid providers, along with nurses who have event-specific training on advanced life support, event-specific injuries and incidents, health education related to self-care deficits, interventions for

Factors influencing readiness to deploy in disaster response: findings from a cross-sectional survey of the Department of Veterans Affairs Disaster Emergency Medical Personnel System.

PubMed

Zagelbaum, Nicole K; Heslin, Kevin C; Stein, Judith A; Ruzek, Josef; Smith, Robert E; Nyugen, Tam; Dobalian, Aram

2014-07-19

The Disaster Emergency Medical Personnel System (DEMPS) program provides a system of volunteers whereby active or retired Department of Veterans Affairs (VA) personnel can register to be deployed to support other VA facilities or the nation during national emergencies or disasters. Both early and ongoing volunteer training is required to participate. This study aims to identify factors that impact willingness to deploy in the event of an emergency. This analysis was based on responses from 2,385 survey respondents (response rate, 29%). Latent variable path models were developed and tested using the EQS structural equations modeling program. Background demographic variables of education, age, minority ethnicity, and female gender were used as predictors of intervening latent variables of DEMPS Volunteer Experience, Positive Attitude about Training, and Stress. The model had acceptable fit statistics, and all three intermediate latent variables significantly predicted the outcome latent variable Readiness to Deploy. DEMPS Volunteer Experience and a Positive Attitude about Training were associated with Readiness to Deploy. Stress was associated with decreased Readiness to Deploy. Female gender was negatively correlated with Readiness to Deploy; however, there was an indirect relationship between female gender and Readiness to Deploy through Positive Attitude about Training. These findings suggest that volunteer emergency management response programs such as DEMPS should consider how best to address the factors that may make women less ready to deploy than men in order to ensure adequate gender representation among emergency responders. The findings underscore the importance of training opportunities to ensure that gender-sensitive support is a strong component of emergency response, and may apply to other emergency response programs such as the Medical Reserve Corps and the American Red Cross.

Medical emergencies: atrial fibrillation and myocardial infarction.

PubMed

Somasundaram, K; Ball, J

2013-01-01

In this, the first of two article on medical emergencies, we discuss the definitions, epidemiology, pathophysiology, acute and chronic management of atrial fibrillation and acute myocardial necrosis in the peri-operative and intensive care settings. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

Emergency medical services and congestion : urban sprawl and pre-hospital emergency care time.

DOT National Transportation Integrated Search

2009-01-01

This research measured the association between urban sprawl and emergency medical service (EMS) response time. The purpose was to test the hypothesis that features of the built environment increase the probability of delayed ambulance arrival. Using ...

In-flight medical emergencies during airline operations: a survey of physicians on the incidence, nature, and available medical equipment

PubMed Central

Hinkelbein, Jochen; Neuhaus, Christopher; Böhm, Lennert; Kalina, Steffen; Braunecker, Stefan

2017-01-01

Background Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society. Materials and methods Using unipark.de (QuestBack GmbH, Cologne, Germany), an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM) were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015). Chi-square test was used for statistical analysis (p<0.05 was considered significant). Results Altogether, 121 members of the society responded to the survey (n=335 sent out). Of the 121 respondents, n=54 (44.6%) of the participants (89.9% male and 10.1% female; mean age, 54.1 years; n=121) were involved in at least one in-flight medical emergency. Demographic parameters in this survey were in concordance with the society members’ demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median). Cardiovascular (40.0%) and neurological disorders (17.8%) were the most frequent diagnoses. The medical equipment (78.7%) provided was sufficient. An emergency diversion was undertaken in 10.6% of the cases. Although using a different method of data acquisition, this survey confirms previous data on the nature of emergencies and gives plausible numbers. Conclusion Our data strongly argue for the establishment of a standardized database for recording the incidence and nature of in-flight medical emergencies. Such a database could inform on required medical equipment and cabin crew training

In-flight medical emergencies during airline operations: a survey of physicians on the incidence, nature, and available medical equipment.

PubMed

Hinkelbein, Jochen; Neuhaus, Christopher; Böhm, Lennert; Kalina, Steffen; Braunecker, Stefan

2017-01-01

Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society. Using unipark.de (QuestBack GmbH, Cologne, Germany), an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM) were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015). Chi-square test was used for statistical analysis ( p <0.05 was considered significant). Altogether, 121 members of the society responded to the survey (n=335 sent out). Of the 121 respondents, n=54 (44.6%) of the participants (89.9% male and 10.1% female; mean age, 54.1 years; n=121) were involved in at least one in-flight medical emergency. Demographic parameters in this survey were in concordance with the society members' demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median). Cardiovascular (40.0%) and neurological disorders (17.8%) were the most frequent diagnoses. The medical equipment (78.7%) provided was sufficient. An emergency diversion was undertaken in 10.6% of the cases. Although using a different method of data acquisition, this survey confirms previous data on the nature of emergencies and gives plausible numbers. Our data strongly argue for the establishment of a standardized database for recording the incidence and nature of in-flight medical emergencies. Such a database could inform on required medical equipment and cabin crew training.

National Characteristics of Emergency Medical Services Responses for Older Adults in the United States.

PubMed

Duong, Hieu V; Herrera, Lauren Nicholas; Moore, Justin Xavier; Donnelly, John; Jacobson, Karen E; Carlson, Jestin N; Mann, N Clay; Wang, Henry E

2018-01-01

Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports, and standby responses. We defined older adults as age ≥65 years. We compared patient demographics (age, sex, race, primary payer), response characteristics (dispatch time, location type, time intervals), and clinical course (clinical impression, injury, procedures, medications) between older and younger adult EMS emergency 9-1-1 responses. During the study period there were 20,212,245 EMS emergency responses. Among the 16,116,219 adult EMS responses, there were 6,569,064 (40.76%) older and 9,547,155 (59.24%) younger adults. Older EMS patients were more likely to be white and the EMS incident to be located in healthcare facilities (clinic, hospital, nursing home). Compared with younger patients, older EMS patients were more likely to present with syncope (5.68% vs. 3.40%; OR 1.71; CI: 1.71-1.72), cardiac arrest/rhythm disturbance (3.27% vs. 1.69%; OR 1.97; CI: 1.96-1.98), stroke (2.18% vs. 0.74%; OR 2.99; CI: 2.96-3.02) and shock (0.77% vs. 0.38%; OR 2.02; CI: 2.00-2.04). Common EMS interventions performed on older persons included intravenous access (32.02%), 12-lead ECG (14.37%), CPR (0.87%), and intubation (2.00%). The most common EMS drugs administered to older persons included epinephrine, atropine, furosemide, amiodarone, and albuterol or ipratropium. One of every three U.S. EMS emergency responses involves older adults. EMS personnel must be prepared to care for the older patient.

[The characteristics of medical technologies in emergency medical care hospital].

PubMed

Murakhovskiĭ, A G; Babenko, A I; Bravve, Iu I; Tataurova, E A

2013-01-01

The article analyzes the implementation of major 12 diagnostic and 17 treatment technologies applied during medical care of patients with 12 key nosology forms of diseases in departments of the emergency medical care hospital No 2 of Omsk. It is established that key groups of technologies in the implementation of diagnostic process are the laboratory clinical diagnostic analyses and common diagnostic activities at reception into hospital and corresponding departments. The percentage of this kind of activities is about 78.3% of all diagnostic technologies. During the realization of treatment process the priority technologies are common curative and rehabilitation activities, intensive therapy activities and clinical diagnostic monitoring activities. All of them consist 80.1% of all curative technologies.

The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care.

PubMed

Dvorak, Jiri; Kramer, Efraim B; Schmied, Christian M; Drezner, Jonathan A; Zideman, David; Patricios, Jon; Correia, Luis; Pedrinelli, André; Mandelbaum, Bert

2013-12-01

Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.

Mammalian synthetic biology: emerging medical applications

PubMed Central

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

2015-01-01

In this review, we discuss new emerging medical applications of the rapidly evolving field of mammalian synthetic biology. We start with simple mammalian synthetic biological components and move towards more complex and therapy-oriented gene circuits. A comprehensive list of ON–OFF switches, categorized into transcriptional, post-transcriptional, translational and post-translational, is presented in the first sections. Subsequently, Boolean logic gates, synthetic mammalian oscillators and toggle switches will be described. Several synthetic gene networks are further reviewed in the medical applications section, including cancer therapy gene circuits, immuno-regulatory networks, among others. The final sections focus on the applicability of synthetic gene networks to drug discovery, drug delivery, receptor-activating gene circuits and mammalian biomanufacturing processes. PMID:25808341

Structured inspection of medications carried and stored by emergency medical services agencies identifies practices that may lead to medication errors.

PubMed

Kupas, Douglas F; Shayhorn, Meghan A; Green, Paul; Payton, Thomas F

2012-01-01

Medications are essential to emergency medical services (EMS) agencies when providing lifesaving care, but the EMS environment has challenges related to safe medication storage when compared with a hospital setting. We developed a structured process, based on common pharmacy practices, to review medications carried by EMS agencies to identify situations that may lead to medication error and to determine some best practices that may reduce potential errors and the risk of patient harm. To provide a descriptive account of EMS practices related to carrying and storing medications that have the potential for causing a medication administration error or patient harm. Using a structured process for inspection, an emergency medicine pharmacist and emergency physician(s) reviewed the medication carrying and storage practices of all nine advanced life support ambulance agencies within a five-county EMS region. Each medication carried and stored by the EMS agency was inspected for predetermined and spontaneously observed issues that could lead to medication error. These issues were documented and photographed. Two EMS medical directors reviewed each potential error for the risk of producing patient harm and assigned each to a category of high, moderate, or low risk. Because issues of temperature on EMS medications have been addressed elsewhere, this study concentrated on potential for EMS medication administration errors exclusive of storage temperatures. When reviewing medications carried by the nine EMS agencies, 38 medication safety issues were identified (range 1 to 8 per EMS agency). Of these, 16 were considered to be high risk, 14 moderate risk, and eight low risk for patient harm. Examples of potential issues included carrying expired medications, container-labeling issues, different medications stored in look-alike vials or prefilled syringes in the same compartment, and carrying crystalloid solutions next to solutions premixed with a medication. When reviewing

Emergency Medical Technician-Ambulance: National Standard Curriculum. Instructor's Lesson Plans (Third Edition).

ERIC Educational Resources Information Center

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

This set of instructor's lesson plans is one of three documents prepared for the Emergency Medical Technician (EMT) National Standard Curriculum. It contains detailed outlines of course content and guidance for teaching each course lesson. The training course contains 33 lessons covering all emergency medical techniques currently considered to be…

Medical emergencies in the dental surgery. Part 1: Preparation of the office and basic management.

PubMed

Malamed, Stanley F

2015-12-01

Medical emergencies can and do happen in the dental surgery. In the 20- to 30-year practice lifetime of the typical dentist, he/she will encounter between five and seven emergency situations. Being prepared in advance of the emergency increases the likelihood of a successful outcome. PURPOSE OF THE PAPER: To prepare members of the dental office staff to be able to promptly recognize and efficiently manage those medical emergency situations that can occur in the dental office environment. Preparation of the dental office to promptly recognize and efficiently manage medical emergencies is predicated on successful implementation of the following four steps: basic life support for ALL members of the dental office staff; creation of a dental office emergency team; activation of emergency medial services (EMS) when indicated; and basic emergency drugs and equipment. The basic emergency algorithm (P->C->A->B->D) is designed for implementation in all emergency situations. Prompt implementation of the basic emergency management protocol can significantly increase the likelihood of a successful result when medical emergencies occur in the dental office environment.

Architecture of a prehospital emergency patient care report system (PEPRS).

PubMed

Majeed, Raphael W; Stöhr, Mark R; Röhrig, Rainer

2013-01-01

In recent years, prehospital emergency care adapted to the technology shift towards tablet computers and mobile computing. In particular, electronic patient care report (e-PCR) systems gained considerable attention and adoption in prehospital emergency medicine [1]. On the other hand, hospital information systems are already widely adopted. Yet, there is no universal solution for integrating prehospital emergency reports into electronic medical records of hospital information systems. Previous projects either relied on proprietary viewing workstations or examined and transferred only data for specific diseases (e.g. stroke patients[2]). Using requirements engineering and a three step software engineering approach, this project presents a generic architecture for integrating prehospital emergency care reports into hospital information systems. Aim of this project is to describe a generic architecture which can be used to implement data transfer and integration of pre hospital emergency care reports to hospital information systems. In summary, the prototype was able to integrate data in a standardized manner. The devised methods can be used design generic software for prehospital to hospital data integration.

Emergency Medical Technician Training During Medical School: Benefits for the Hidden Curriculum.

PubMed

Russ-Sellers, Rebecca; Blackwell, Thomas H

2017-07-01

Medical schools are encouraged to introduce students to clinical experiences early, to integrate biomedical and clinical sciences, and to expose students to interprofessional health providers and teams. One important goal is for students to gain a better understanding of the patients they will care for in the future and how their social and behavioral characteristics may affect care delivery. To promote early clinical exposure and biomedical integration, in 2012 the University of South Carolina School of Medicine Greenville incorporated emergency medical technician (EMT) training into the curriculum. This report describes the program; outlines changes (made after year 1) to improve biomedical integration; and provides a brief analysis and categorization of comments from student reflections to determine whether particular themes, especially related to the hidden curriculum, appeared. Medical students wrote frequently about EMT-related experiences: 29% of reflections in the charter year (1.2 per student) and 38% of reflections in the second year (1.5 per student) focused on EMT-related experiences. Reflections related to patient care, professionalism, systems-based practice, and communication/interpersonal skills. The frequency of themes in student reflections may provide insight into a medical program's hidden curriculum. This information may serve to inform curricula that focus on biosocial elements such as professionalism and communication with the goal of enhancing future physicians' tolerance, empathy, and patient-centeredness. The authors plan to conduct further qualitative analysis of student reflections to iteratively revise curricula to address gaps both in learning and in the differences between the explicit curriculum and actual experiences.

A qualitative study about experiences and emotions of emergency medical technicians and out-of-hospital emergency nurses after performing cardiopulmonary resuscitation resulting in death.

PubMed

Fernández-Aedo, I; Pérez-Urdiales, I; Unanue-Arza, S; García-Azpiazu, Z; Ballesteros-Peña, S

To explore the experiences, emotions and coping skills among emergency medical technicians and emergency nurses after performing out-of-hospital cardiopulmonary resuscitation manoeuvres resulting in death. An exploratory qualitative research was performed. Seven emergency medical technicians and six emergency nurses were selected by non-probability sampling among emergency medical system workers. The meetings took place up to information saturation, achieved after six individual interviews and a focal group. The meetings were then transcribed and a manual and inductive analysis of the contents performed. After a failed resuscitation several short and long-term reactions appear. They can be negatives, such as sadness or uncertainty, or positives, such as the feeling of having done everything possible to save the patient's life. Emotional stress increases when ambulance staff have to talk with the deceased's family or when the patient is a child. The workers don't know of a coping strategy other than talking about their emotions with their colleagues. Death after a failed resuscitation can be viewed as a traumatic experience for rescuers. Being in contact with the suffering of others is an emotional, stress-generating factor with direct repercussions on the working and personal lives of emergency staff. Nevertheless, structured coping techniques are not common among those professionals. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Flight diversions due to onboard medical emergencies on an international commercial airline.

PubMed

Valani, Rahim; Cornacchia, Marisa; Kube, Douglas

2010-11-01

Each year, close to 2 billion passengers travel on commercial airlines. In-flight medical events result in suboptimal care due to a variety of factors. Flight diversions due to medical emergencies carry a significant financial and legal cost. The purpose of this study was to determine the causes of in-flight medical diversions from Air Canada. This was a review of in-flight medical emergencies from 2004-2008. Both telemedicine and Air Canada databases were crossreferenced to capture all incidents. Presenting complaints were categorized by systems. Descriptive statistics were used to analyze the data. Over the 5 yr, there were 220 diversions, of which 91 (41.4%) of the decisions were made by pilots or onboard medical personnel. During this period there were 5386 telemedicine contacts with ground support providers, who on average recommended 2.4 diversions per 100 calls. The rate for diversions almost doubled from 2006 to 2007, with a sharp drop in telemedicine contacts during the same period. The four most common categories resulting in diversions were cardiac (58 diversions, 26.4%), neurological (43 diversions, 19.5%), gastrointestinal (GI) (25 diversions, 11.4%), and syncope (22 diversions, 10.0%). Only 6.8% of all diversions were due to cardiac arrest. Medical conditions most commonly leading to diversions were cardiac, neurological, gastrointestinal, and syncope. Our study showed that a decrease in telemedicine contact during this period was accompanied by an increase in diversions, while increased pre-screening of passengers did not prove effective in decreasing diversion rates.

An Energy-Efficient MAC Protocol for Medical Emergency Monitoring Body Sensor Networks

PubMed Central

Zhang, Chongqing; Wang, Yinglong; Liang, Yongquan; Shu, Minglei; Chen, Changfang

2016-01-01

Medical emergency monitoring body sensor networks (BSNs) monitor the occurrence of medical emergencies and are helpful for the daily care of the elderly and chronically ill people. Such BSNs are characterized by rare traffic when there is no emergency occurring, high real-time and reliable requirements of emergency data and demand for a fast wake-up mechanism for waking up all nodes when an emergency happens. A beacon-enabled MAC protocol is specially designed to meet the demands of medical emergency monitoring BSNs. The rarity of traffic is exploited to improve energy efficiency. By adopting a long superframe structure to avoid unnecessary beacons and allocating most of the superframe to be inactive periods, the duty cycle is reduced to an extremely low level to save energy. Short active time slots are interposed into the superframe and shared by all of the nodes to deliver the emergency data in a low-delay and reliable way to meet the real-time and reliable requirements. The interposition slots can also be used by the coordinator to broadcast network demands to wake-up all nodes in a low-delay and energy-efficient way. Experiments display that the proposed MAC protocol works well in BSNs with low emergency data traffic. PMID:26999145

An Introduction to Emergency Medical Services (EMS). Pre-Hospital Phase. Emergency Medical Services Orientation, Lesson Plan No. 9.

ERIC Educational Resources Information Center

Young, Derrick P.

Designed for use with interested students at high schools, community colleges, and four-year colleges, this lesson plan was developed to provide an introduction to the pre-hospital phase of Emergency Medical Services (EMS) and to serve as a recruitment tool for the EMS Program at Kapiolani Community College (KCC) in Hawaii. The objectives of the…

Prehospital paediatric emergencies treated by an Australian helicopter emergency medical service.

PubMed

Barker, Claire L; Weatherall, Andrew D

2014-04-01

The aim of this study was to describe the mechanism and severity of injuries in the paediatric population treated by an Australian helicopter emergency medical service and to examine the frequency and nature of interventions performed. This information is important for planning education and continuing professional development in prehospital medicine. The study is a retrospective cohort analysis of 349 patients under the age of 16 treated by CareFlight in Sydney, Australia, between April 2007 and April 2012. Data collected included age, type of incident, medication and fluid administered, procedures performed, receiving hospital, 24 h and 30-day mortality and injuries sustained. Falls (33%), motor vehicle incidents (30%), sport injury (14%) and immersion injury (12%) were the most common mechanisms. A total of 27 children died within 30 days; nontrauma cases were proportionally overrepresented in the deaths. With respect to tasking, 59% cases involved a severely or significantly injured child. Among the children, 97% with a traumatic mechanism were transferred directly to a paediatric trauma centre.In addition, 81% of children had at least one intervention by the helicopter emergency medical services team at the incident scene, most commonly intravenous cannulation (61%), crystalloid bolus (29%), intubation (21%) and intravenous analgesia administration (15%). Paediatric prehospital patients can be of high dependency, requiring urgent critical care procedures. Training in prehospital medicine should include paediatrics. It is essential that practitioners maintain skills in venous access, airway management and provision of adequate analgesia in children.

Characteristics of emergency pages using a computer-based anesthesiology paging system in children and adults undergoing procedures at a tertiary care medical center.

PubMed

Weingarten, Toby N; Abenstein, John P; Dutton, Claire H; Kohn, Melinda A; Lee, Elizabeth A; Mullenbach, Tami E; Narr, Bradly J; Schroeder, Darrell R; Sprung, Juraj

2013-04-01

In our large academic supervisory practice, attending anesthesiologists concomitantly care for multiple patients. To manage communications within the procedural environment, we use a proprietary electronic computer-based anesthesiology visual paging system. This system can send an emergency page that instantly alerts the attending anesthesiologist and other available personnel that immediate help is needed. We analyzed the characteristics of intraoperative emergency pages in children and adults. We identified all emergency page activations between January 1, 2005 and July 31, 2010 in our main operating rooms. Electronic medical records were reviewed for rates and characteristics of pages such as primary etiology, performed interventions, and outcomes. During the study period, 258,135 anesthetics were performed (n = 32,103 children, younger than 18 years) and 370 emergency pages (n = 309 adults, n = 61 children) were recorded (1.4 per 1000 cases; 95% confidence interval, 1.3-1.6). Infants had the highest rates (9.4 per 1000; 95% confidence interval, 5.7-14.4) of emergency page activations (P < 0.001 compared with each other age group). In adults, the most frequent causes were hemodynamic (55%), and in children respiratory and airway (60.7%) events. Emergency pages were rare in patients older than 2 years. Infants were more likely than children 1 to 2 years of age to have emergency page activation, despite both groups being cared for by pediatric fellowship trained anesthesiologists.

Ground and Helicopter Emergency Medical Services Time Tradeoffs Assessed with Geographic Information.

PubMed

Widener, Michael J; Ginsberg, Zac; Schleith, Daniel; Floccare, Douglas J; Hirshon, Jon Mark; Galvagno, Samuel

2015-07-01

We describe how geographic information systems (GIS) can be used to assess and compare estimated transport time for helicopter and ground emergency medical services. Recent research shows that while the odds of a trauma patient's survival increase with helicopter emergency medical services (HEMS), they may not increase to the extent necessary to make HEMS cost effective. This study offers an analytic tool to objectively quantify the patient travel time advantage that HEMS offers compared to ground emergency medical services (GEMS). Using helicopter dispatch data from the Maryland State Police from 2000-2011, we computed transport time estimates for HEMS and GEMS, compare these results to a reference transport time of 60 min, and use geospatial interpolation to extrapolate the total response times for each mode across the study region. Mapping the region's trauma incidents and modeling response times, our findings indicate the GIS framework for calculating transportation time tradeoffs is useful in identifying which areas can be better served by HEMS or GEMS. The use of GIS and the analytical methodology described in this study present a method to compare transportation by air and ground in the prehospital setting that accounts for how mode, distance, and road infrastructure impact total transport time. Whether used to generate regional maps in advance or applied real-time, the presented framework provides a tool to identify earlier incident locations that favor HEMS over GEMS transport modes.

Utilization of emergency medical kits by air carriers.

DOT National Transportation Integrated Search

1991-03-01

The Department of Transportation Emergency Medical Equipment Requirements Rule of January 9, 1986, mandated a period of 24 months (August 1986 - July 1988) during which all air carriers flying under Federal Aviation Regulation, Part 121, would monito...

[The five commandments for preparing the Israeli healthcare system for emergencies].

PubMed

Adini, Bruria; Laor, Danny; Cohen, Robert; Lev, Boaz; Israeli, Avi

2010-07-01

In the last decade, the Israeli healthcare system dealt with many casualties that resulted from terrorist actions and at the same time maintained preparedness for other potential hazards such as natural disasters, toxicological, chemical, radiological and biological events. There are various models for emergency preparedness that are utilized in different countries. The aim of the article is to present the structure and the methodology of the Israeli healthcare system for emergencies. Assuring emergency preparedness for the different scenarios is based on 5 major components that include: comprehensive contingency planning; control and command of operations; central control of readiness; capacity building; coordination and collaboration among the numerous emergency agencies. CLose working relationships between the military and civilian systems characterize the operations of the emergency system. There is a mutual sharing of information, coordinated operations to achieve risk assessment and determine priorities, and consensual allocation of resources. The ability of the medical system to operate in optimal coordination with interface bodies, including the Israel Defense Forces, is derived from three main elements: the shortage of resources necessitate that all agencies work together to develop an effective response to emergencies; the Israeli society is characterized by transition of personnel from the military to the civilian system which promotes joint operations, whereas in most other countries these systems are completely separated; and also developing mechanisms for continuous and coordinated operation in routine and emergency times, such as the Supreme Health Authority. The Israeli healthcare system was put to the test several times in the Last decade, during the terror wave that occurred between 2001-2006, the 2nd Lebanon War and in operation "Cast Lead". An extensive process of learning lessons, conducted during and following each of these periods, and the

AMON: a wearable multiparameter medical monitoring and alert system.

PubMed

Anliker, Urs; Ward, Jamie A; Lukowicz, Paul; Tröster, Gerhard; Dolveck, François; Baer, Michel; Keita, Fatou; Schenker, Eran B; Catarsi, Fabrizio; Coluccini, Luca; Belardinelli, Andrea; Shklarski, Dror; Alon, Menachem; Hirt, Etienne; Schmid, Rolf; Vuskovic, Milica

2004-12-01

This paper describes an advanced care and alert portable telemedical monitor (AMON), a wearable medical monitoring and alert system targeting high-risk cardiac/respiratory patients. The system includes continuous collection and evaluation of multiple vital signs, intelligent multiparameter medical emergency detection, and a cellular connection to a medical center. By integrating the whole system in an unobtrusive, wrist-worn enclosure and applying aggressive low-power design techniques, continuous long-term monitoring can be performed without interfering with the patients' everyday activities and without restricting their mobility. In the first two and a half years of this EU IST sponsored project, the AMON consortium has designed, implemented, and tested the described wrist-worn device, a communication link, and a comprehensive medical center software package. The performance of the system has been validated by a medical study with a set of 33 subjects. The paper describes the main concepts behind the AMON system and presents details of the individual subsystems and solutions as well as the results of the medical validation.

Emergency/disaster medical support in the restoration project for the Fukushima nuclear power plant accident

PubMed Central

Morimura, Naoto; Asari, Yasushi; Yamaguchi, Yoshihiro; Asanuma, Kazunari; Tase, Choichiro; Sakamoto, Tetsuya; Aruga, Tohru

2013-01-01

The Fukushima Daiichi Nuclear Power Plant (1F) suffered a series of radiation accidents after the Great East Japan Earthquake on 11 March 2011. In a situation where halting or delaying restoration work was thought to translate directly into a very serious risk for the entire country, it was of the utmost importance to strengthen the emergency and disaster medical system in addition to radiation emergency medical care for staff at the frontlines working in an environment that posed a risk of radiation exposure and a large-scale secondary disaster. The Japanese Association for Acute Medicine (JAAM) launched the ‘Emergency Task Force on the Fukushima Nuclear Power Plant Accident’ and sent physicians to the local response headquarters. Thirty-four physicians were dispatched as disaster medical advisors, response guidelines in the event of multitudinous injury victims were created and revised and, along with execution of drills, coordination and advice was given on transport of patients. Forty-nine physicians acted as directing physicians, taking on the tasks of triage, initial treatment and decontamination. A total of 261 patients were attended to by the dispatched physicians. None of the eight patients with external contamination developed acute radiation syndrome. In an environment where the collaboration between organisations in the framework of a vertically bound government and multiple agencies and institutions was certainly not seamless, the participation of the JAAM as the medical academic organisation in the local system presented the opportunity to laterally integrate the physicians affiliated with the respective organisations from the perspective of specialisation. PMID:23184925

Factors influencing readiness to deploy in disaster response: findings from a cross-sectional survey of the Department of Veterans Affairs Disaster Emergency Medical Personnel System

PubMed Central

2014-01-01

Background The Disaster Emergency Medical Personnel System (DEMPS) program provides a system of volunteers whereby active or retired Department of Veterans Affairs (VA) personnel can register to be deployed to support other VA facilities or the nation during national emergencies or disasters. Both early and ongoing volunteer training is required to participate. Methods This study aims to identify factors that impact willingness to deploy in the event of an emergency. This analysis was based on responses from 2,385 survey respondents (response rate, 29%). Latent variable path models were developed and tested using the EQS structural equations modeling program. Background demographic variables of education, age, minority ethnicity, and female gender were used as predictors of intervening latent variables of DEMPS Volunteer Experience, Positive Attitude about Training, and Stress. The model had acceptable fit statistics, and all three intermediate latent variables significantly predicted the outcome latent variable Readiness to Deploy. Results DEMPS Volunteer Experience and a Positive Attitude about Training were associated with Readiness to Deploy. Stress was associated with decreased Readiness to Deploy. Female gender was negatively correlated with Readiness to Deploy; however, there was an indirect relationship between female gender and Readiness to Deploy through Positive Attitude about Training. Conclusions These findings suggest that volunteer emergency management response programs such as DEMPS should consider how best to address the factors that may make women less ready to deploy than men in order to ensure adequate gender representation among emergency responders. The findings underscore the importance of training opportunities to ensure that gender-sensitive support is a strong component of emergency response, and may apply to other emergency response programs such as the Medical Reserve Corps and the American Red Cross. PMID:25038628

Emerging medical informatics research trends detection based on MeSH terms.

PubMed

Lyu, Peng-Hui; Yao, Qiang; Mao, Jin; Zhang, Shi-Jing

2015-01-01

The aim of this study is to analyze the research trends of medical informatics over the last 12 years. A new method based on MeSH terms was proposed to identify emerging topics and trends of medical informatics research. Informetric methods and visualization technologies were applied to investigate research trends of medical informatics. The metric of perspective factor (PF) embedding MeSH terms was appropriately employed to assess the perspective quality for journals. The emerging MeSH terms have changed dramatically over the last 12 years, identifying two stages of medical informatics: the "medical imaging stage" and the "medical informatics stage". The focus of medical informatics has shifted from acquisition and storage of healthcare data by integrating computational, informational, cognitive and organizational sciences to semantic analysis for problem solving and clinical decision-making. About 30 core journals were determined by Bradford's Law in the last 3 years in this area. These journals, with high PF values, have relative high perspective quality and lead the trend of medical informatics.

Demographics of emergency medical care at the Indianapolis 500 mile race (1983-1990).

PubMed

Bock, H C; Cordell, W H; Hawk, A C; Bowdish, G E

1992-10-01

The Indianapolis 500 Mile Race, the largest single-day, single-venue sporting event in the world, is attended by an estimated 400,000 people. Major illness and injury are treated at the Hanna Emergency Medical Center, the track hospital. Minor illness is treated at ten outlying aid stations. We describe the demographics of emergency medical care at the Hanna Emergency Medical Center. Descriptive. Patient care data for patients treated at the medical center are first recorded on paper charts and then coded and transferred to computer. Data regarding patients treated at the medical center during eight consecutive races (1983-1990) were analyzed. Frequency of treatment and medical cardiac arrest rates were calculated. Aid station data and medical center records from nonrace days were not analyzed. The average number of patients treated per year at the track hospital was 139. The total number treated over the eight-year period was 1,113, yielding a frequency of treatment of 0.35 per 1,000. Analysis showed 16.2% of the proprietary treatment codes involved intoxication; 15.4%, lacerations (other than feet); 11.0%, pre-existing conditions; and 8.5%, heat illness. During the eight years, there were four medical cardiac arrests (incidence of 0.0125 per 10,000 spectators), all resulting in death. A fifth spectator died after being struck by a wheel from a race car. There were no driver deaths on race day. Descriptive data regarding medical care of crowds may be useful to emergency specialists who must staff, order supplies, and plan treatment facilities for similar mass gatherings. It is evident from this and other mass-gathering studies that there is a need for consistency in nomenclature and data collection. This will allow more accurate comparisons of emergency medical care between venues.

A secure mobile multimedia system to assist emergency response teams.

PubMed

Belala, Yacine; Issa, Omneya; Gregoire, Jean-Charles; Wong, James

2008-08-01

Long wait times after injury and greater distances to travel between accident scenes and medical facilities contribute to increased, possibly unnecessary deaths. This paper describes a mobile emergency system aimed at reducing mortality by improving the readiness of hospital personnel, therefore allowing for more efficient treatment procedures to be performed when the victim arrives. The system is designed to provide a secure transmission of voice, medical data, and video in real-time over third-generation cellular networks. Test results obtained on a commercial network under real-life conditions demonstrate the ability to effectively transmit medical data over 3G networks, making them a viable option available to healthcare professionals.

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

ERIC Educational Resources Information Center

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

2008-01-01

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

Predictive Ability of an Emergency Medical Dispatch Stroke Diagnostic Tool in Identifying Hospital-Confirmed Strokes.

PubMed

Clawson, Jeff J; Scott, Greg; Gardett, Isabel; Youngquist, Scott; Taillac, Peter; Fivaz, Conrad; Olola, Christopher

2016-08-01

Early hospital notification of a possible stroke arriving via emergency medical services (EMS) can prepare stroke center personnel for timely treatment, especially timely administration of tissue plasminogen activator. Stroke center notification from the emergency dispatch center-before responders reach the scene-may promote even earlier and faster system activation, meaning that stroke center teams may be ready to receive patients as soon as the ambulance arrives. This study evaluates the use of a Medical Priority Dispatch System (MPDS; Priority Dispatch Corp., Salt Lake City, UT) Stroke Diagnostic Tool (SDxT) to identify possible strokes early by comparing the tools' results to on-scene and hospital findings. The retrospective descriptive study utilized stroke data from 3 sources: emergency medical dispatch, EMS, and emergency department/hospital. A total of 830 cases were collected between June 2012 and December 2013, of which 603 (72.7%) had matching dispatch records. Of the 603 cases, 304 (50.4%) were handled using MPDS Stroke Protocol 28. The SDxT had an 86.4% ability (OR [95% CI]: 2.3 [1.5, 3.5]) to effectively identify strokes among all the hospital-confirmed stroke cases (sensitivity), and a 26.6% ability to effectively identify nonstrokes among all the hospital-confirmed nonstroke cases (specificity). The SDxT demonstrated a very high sensitivity, compared to similar tools used in the field and at dispatch. The specificity was somewhat low, but this was expected-and is intended in the creation of protocols to be used over the phone in emergency situations. The tool is a valuable method for identifying strokes early and may allow early hospital notification. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Individual and Medical Characteristics of Adults Presenting to an Urban Emergency Department in Ghana.

PubMed

Oteng, R A; Whiteside, L K; Rominski, S D; Amuasi, J H; Carter, P M; Donkor, P; Cunningham, R

2015-09-01

The aims of this study were to characterize the patients seeking acute care for injury and non-injury complaints in an urban Emergency Department in Ghana in order to 1) inform the curriculum of the newly developed Emergency Medicine resident training program 2) improve treatment processes, and 3) direct future community-wide injury prevention policies. A prospective cross-sectional survey of patients 18 years or older seeking care in an urban Accident and Emergency Center (AEC) was conducted between 7/13/2009 and 7/30/2009. Questionnaires were administered by trained research staff and each survey took 10-15 minutes to complete. Patients were asked questions regarding demographics, overall health and chief complaint. 254 patients were included in the sample. Participants' chief complaints were classified as either medical or injury-related. Approximately one third (38%) of patients presented with injuries and 62% presented for medical complaints. The most common injury at presentation was due to a road traffic injury, followed by falls and assault/fight. The most common medical presentation was abdominal pain followed by difficulty breathing and fainting/ blackout. Only 13% arrived to AEC by ambulance and 51% were unable to ambulate at the time of presentation. Approximately one-third of non-fatal adult visits were for acute injury. Future research should focus on developing surveillance systems for both medical and trauma patients. Physicians that are specifically trained to manage both the acutely injured patient and the medical patient will serve this population well given the variety of patients that seek care at the AEC.

Medical emergencies: pulmonary embolism and acute severe asthma.

PubMed

Somasundaram, K; Ball, J

2013-01-01

In this, the second of two articles covering specific medical emergencies, we discuss the definitions, epidemiology, pathophysiology, acute and chronic management of pulmonary embolus and acute severe asthma. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

Emergency medical personnel training: I. An historical perspective.

PubMed

Sytkowski, P A; Jacobs, L M; Meany, M

1983-01-01

The status of Emergency Medical Technicians has evolved from an undefined role with few rules, regulations, or standards to an established health care profession and a nationally administered program. The evolution of this profession received major impetus from the 1966 report by the National Academy of Science/National Research Council that provided recommended training standards. Development of a training course curriculum for basic life support (BLS) followed. The need for coordinated training of Emergency Medical Technical Technicians was recognized, and funds became available to aid in the national standardization of education, examination, certification, and recertification procedures for EMTs. Concomitant with the attempt to standardize BLS training, advanced life support (ALS) programs grew in number. By 1977 the National Standard Training Curriculum became available and was soon followed by a national certification exam. As states have the option to accept or reject the federal standards embodied in the national training course, there remains variation among programs offered by each state. Because of the difference in need for specific emergency services among the states at a time of increased professional mobility, arguments still exist regarding the desirability of federally mandated training and certification programs.

Frequency and types of the medication errors in an academic emergency department in Iran: The emergent need for clinical pharmacy services in emergency departments.

PubMed

Zeraatchi, Alireza; Talebian, Mohammad-Taghi; Nejati, Amir; Dashti-Khavidaki, Simin

2013-07-01

Emergency departments (EDs) are characterized by simultaneous care of multiple patients with various medical conditions. Due to a large number of patients with complex diseases, speed and complexity of medication use, working in under-staffing and crowded environment, medication errors are commonly perpetrated by emergency care providers. This study was designed to evaluate the incidence of medication errors among patients attending to an ED in a teaching hospital in Iran. In this cross-sectional study, a total of 500 patients attending to ED were randomly assessed for incidence and types of medication errors. Some factors related to medication errors such as working shift, weekdays and schedule of the educational program of trainee were also evaluated. Nearly, 22% of patients experienced at least one medication error. The rate of medication errors were 0.41 errors per patient and 0.16 errors per ordered medication. The frequency of medication errors was higher in men, middle age patients, first weekdays, night-time work schedules and the first semester of educational year of new junior emergency medicine residents. More than 60% of errors were prescription errors by physicians and the remaining were transcription or administration errors by nurses. More than 35% of the prescribing errors happened during the selection of drug dose and frequency. The most common medication errors by nurses during the administration were omission error (16.2%) followed by unauthorized drug (6.4%). Most of the medication errors happened for anticoagulants and thrombolytics (41.2%) followed by antimicrobial agents (37.7%) and insulin (7.4%). In this study, at least one-fifth of the patients attending to ED experienced medication errors resulting from multiple factors. More common prescription errors happened during ordering drug dose and frequency. More common administration errors included dug omission or unauthorized drug.

Helicopter emergency medical services accident rates in different international air rescue systems

PubMed Central

Hinkelbein, J; Schwalbe, M; Genzwuerker, HV

2010-01-01

Aim Each year approximately two to four helicopter emergency medical services (HEMS) crashes occur in Germany. The aim of the present study was to compare crash rates and fatal crash rates in Germany to rates in other countries. Materials and methods A MEDLINE search from 1970 to 2009 was performed using combinations of the keywords “HEMS”, “rescue helicopter”, “accident”, “accident rate”, “crash”, and “crash rate”. The search was supplemented by additional published data. Data were compared on the basis of 10,000 missions and 100,000 helicopter flying hours. These data were allocated to specific time frames for analyis. Results Eleven relevant studies were identified. Five studies (three from Germany, one from the US, one from Australia) analyzing HEMS accidents on the basis of 10,000 missions were identified. Crash rates per 10,000 missions ranged between 0.4 and 3.05 and fatal crash rates between 0.04 and 2.12. In addition, nine studies (six from the US, two from Germany, one from Australia) used 100,000 flying hours as a denominator. Here, crash rates ranged between 1.7 and 13.4 and fatal crash rates between 0.91 and 4.7. Conclusions Data and accident rates were inhomogeneous and differed significantly. Data analysis was impeded by publication of mean data, use of different time frames, and differences in HEMS systems. PMID:27147837

Emergency medical preparedness during the 2006 World Cup in Frankfurt, Germany.

PubMed

Betlehem, Jozsef; Schaefer, Jurgen

2010-01-01

This paper describes emergency medical preparedness during FIFA (Fédération Internationale de Football Association) World Cup matches in Frankfurt, Germany, in 2006. The methods employed were document analysis and personal observation of games over five days in June-July 2006. The medical authorities in Frankfurt drew on a wide range of scientific literature and experiences to elaborate a National Concept. They paid attention to different models of handling mass catastrophes in shaping the final version of the document. The participation of designated authorities, associations, and volunteer organisations was coordinated sufficiently and the games in Frankfurt proceeded without great incident, even though more than 300,000 people in total attended. The adopted emergency medical procedure was appropriate for a mass gathering event. Official and volunteer organisations collaborated precisely in emergency preparedness. While one uniform concept for all mass gatherings events cannot be developed, case reports and experiences are useful tools.

Emergency medical care for spectators attending National Football League games.

PubMed

Roberts, D M; Blackwell, T H; Marx, J A

1997-01-01

average stadium staffs 8 EMT-Bs, 7 EMT-Ps, 3 registered nurses, and 2 physicians. Nine stadiums pay a predesignated fee per game to an agency to provide emergency care to spectators. Medical personnel are compensated by an hourly rate (n = 15), a fixed rate per event (n = 9), overtime wages (n = 3), or volunteerism (n = 4). Four NFL organizations pay their medical personnel by more than one type of compensation. Courtesy seats are provided to physicians and nurses in 1 stadium and to just physicians in 8 stadiums, with a range of 2 to 6 and a mean of 3.3 +/- 1.3. All stadiums use two-way radios for the communication and coordination of medical care in the stadium. Additionally, 20 use fixed telephones in the first aid rooms, 3 use cellular telephones, and 2 incorporate a pager system to dispatch personnel within the stadium. A wide variety of system designs, facilities, and personnel configurations are used to provide emergency medical care for spectators attending NFL games. This information may be useful for assisting those individuals responsible for organizing stadium medical coverage.

A Pilot Project Demonstrating that Combat Medics Can Safely Administer Parenteral Medications in the Emergency Department.

PubMed

Schauer, Steven G; Cunningham, Cord W; Fisher, Andrew D; DeLorenzo, Robert A

2017-12-01

Introduction Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration. Project Design This was a quality assurance project that monitored training of combat medics to administer parenteral medications and to ensure patient safety. Combat medics were provided training that included direct supervision during medication administration. Once proficiency was demonstrated, combat medics would prepare the medications under direct supervision, followed by indirect supervision during administration. As part of the quality assurance and safety processes, combat medics were required to document all medication administrations, supervising provider, and unexpected adverse events. Additional quality assurance follow-up occurred via complete chart review by the project lead. Data During the project period, the combat medics administered the following medications: ketamine (n=13), morphine (n=8), ketorolac (n=7), fentanyl (n=5), ondansetron (n=4), and other (n=6). No adverse events or patient safety events were reported by the combat medics or discovered during the quality assurance process. In this limited case series, combat medics safely administered parenteral medications under indirect provider supervision. Future research is needed to further develop this training model for both the military and civilian setting. Schauer SG , Cunningham C W, Fisher AD , DeLorenzo RA . A pilot project demonstrating that combat medics can safely administer parenteral medications in the emergency department. Prehosp Disaster Med. 2017;32(6):679-681.

Emergency medical kit for commercial airlines: an update.

PubMed

Thibeault, Claude

2002-06-01

As expected, the issue of medical kits for commercial airlines continues to attract attention, especially in light of the recent United States regulation on the subject. As promised in its first recommendation in 1998, the Air Transport Medicine (ATM) Committee has continued to monitor medical kit usage as well as pharmaceutical scientific developments and wishes to propose an update to its 1998 recommendation. Lists of contents are provided for emergency medical kits of two types: 1) those without defibrillator/monitor or monitor; and 2) those with defibrillator/monitor or monitor alone. Follow up and updates on this issue will be an ongoing task of the ATM Committee.

A review of emergency medical services events in US national parks from 2007 to 2011.

PubMed

Declerck, Matthieu P; Atterton, Laurie M; Seibert, Thomas; Cushing, Tracy A

2013-09-01

Outdoor recreation is growing in the United States, with more than 279 million annual visitors to areas controlled by the National Park Service (NPS). Emergency medical needs in these parks are overseen by the National Park's rangers within the NPS Emergency Medical Services (EMS) system. This study examines medical and traumatic emergencies throughout the NPS over a 5-year period to better understand the types of events and fatalities rangers encounter, both regionally and on a national scale. This is a retrospective review of the annual EMS reports published by the 7 NPS regions from 2007 to 2011. The following were compared and examined at a regional and national level: medical versus traumatic versus first aid events, cardiac events and outcomes, use of automated external defibrillators, and medical versus traumatic fatalities. The national incidence of EMS events was 45.9 events per 1 million visitors. Medical, traumatic, and first aid events composed 29%, 28%, and 43% of reports, respectively. Of medical episodes, 1.8% were cardiac arrests, of which 64.2% received automated external defibrillator treatment; 29.1% of cardiac arrests survived to hospital discharge. Of fatalities, 61.4% were traumatic in nature and the remaining 38.5% were nontraumatic (medical). Regional differences were found for all variables. On a national level, the NPS experiences an equal number of medical and traumatic EMS events. This differs from past observed trends that reported a higher incidence of traumatic events than medical events in wilderness settings. Cardiac events and automated external defibrillator usage are relatively infrequent. Traumatic fatalities are more common than medical fatalities in the NPS. Regional variations in events likely reflect differences in terrain, common activities, proximity to urban areas, and access to definitive care between regions. These data can assist the NPS in targeting the regions with the greatest number of incidents and fatalities for

Emergency medical service in the stroke chain of survival.

PubMed

Chenaitia, Hichem; Lefevre, Oriane; Ho, Vanessa; Squarcioni, Christian; Pradel, Vincent; Fournier, Marc; Toesca, Richard; Michelet, Pierre; Auffray, Jean Pierre

2013-02-01

The Emergency Medical Services (EMS) play a primordial role in the early management of adults with acute ischaemic stroke (AIS). The aim of this study was to evaluate the role and effectiveness of the EMS in the stroke chain of survival in Marseille. A retrospective observational study was conducted in patients treated for AIS or transient ischaemic attack in three emergency departments and at the Marseille stroke centre over a period of 12 months. In 2009, of 1034 patients ultimately presenting a diagnosis of AIS or transient ischaemic attack, 74% benefited from EMS activation. Dispatchers correctly diagnosed 57% of stroke patients. The symptoms most frequently reported included limb weakness, speech problems and facial paresis. Elements resulting in misdiagnosis by dispatchers were general discomfort, chest pain, dyspnoea, fall or vertigo. Stroke patients not diagnosed by emergency medical dispatchers but calling within 3 h of symptom onset accounted for 20% of cases. Our study demonstrates that public intervention programmes must stress the urgency of recognizing stroke symptoms and the importance of calling EMS through free telephone numbers. Further efforts are necessary to disseminate guidelines for healthcare providers concerning stroke recognition and the new therapeutic possibilities in order to increase the likelihood of acute stroke patients presenting to a stroke team early enough to be eligible for acute treatment. In addition, EMS dispatchers should receive further training about atypical stroke symptoms, and 'Face Arm Speech Test' tests must be included in the routine questionnaires used in emergency medical calls concerning elderly persons.

Using A Model-Based Systems Engineering Approach For Exploration Medical System Development

NASA Technical Reports Server (NTRS)

Hanson, A.; Mindock, J.; McGuire, K.; Reilly, J.; Cerro, J.; Othon, W.; Rubin, D.; Urbina, M.; Canga, M.

2017-01-01

NASA's Human Research Program's Exploration Medical Capabilities (ExMC) element is defining the medical system needs for exploration class missions. ExMC's Systems Engineering (SE) team will play a critical role in successful design and implementation of the medical system into exploration vehicles. The team's mission is to "Define, develop, validate, and manage the technical system design needed to implement exploration medical capabilities for Mars and test the design in a progression of proving grounds." Development of the medical system is being conducted in parallel with exploration mission architecture and vehicle design development. Successful implementation of the medical system in this environment will require a robust systems engineering approach to enable technical communication across communities to create a common mental model of the emergent engineering and medical systems. Model-Based Systems Engineering (MBSE) improves shared understanding of system needs and constraints between stakeholders and offers a common language for analysis. The ExMC SE team is using MBSE techniques to define operational needs, decompose requirements and architecture, and identify medical capabilities needed to support human exploration. Systems Modeling Language (SysML) is the specific language the SE team is utilizing, within an MBSE approach, to model the medical system functional needs, requirements, and architecture. Modeling methods are being developed through the practice of MBSE within the team, and tools are being selected to support meta-data exchange as integration points to other system models are identified. Use of MBSE is supporting the development of relationships across disciplines and NASA Centers to build trust and enable teamwork, enhance visibility of team goals, foster a culture of unbiased learning and serving, and be responsive to customer needs. The MBSE approach to medical system design offers a paradigm shift toward greater integration between

RME 1327 - Crew Medical Restraint System (CMRS)

NASA Image and Video Library

1997-02-18

STS081-318-031 (12-22 Jan. 1997) --- Astronauts Brent W. Jett, Jr. (left), STS-81 pilot, and John E. Blaha in the Spacehab Double Module (DM) evaluate the Crew Medical Restraint System (CMRS) carrier, onboard the Space Shuttle Atlantis. The device is an emergency aid forerunner for hardware on the International Space Station (ISS).

Video Laryngoscopic Techniques Associated with Intubation Success in a Helicopter Emergency Medical Service System.

PubMed

Naito, Hiromichi; Guyette, Francis X; Martin-Gill, Christian; Callaway, Clifton W

2016-01-01

Video laryngoscopy (VL) is a technical adjunct to facilitate endotracheal intubation (ETI). VL also provides objective data for training and quality improvement, allowing evaluation of the technique and airway conditions during ETI. Previous studies of factors associated with ETI success or failure are limited by insufficient nomenclature, individual recall bias and self-report. We tested whether the covariates in prehospital VL recorded data were associated with ETI success. We also measured association between time and clinical variables. Retrospective review was conducted in a non-physician staffed helicopter emergency medical service system. ETI was typically performed using sedation and neuromuscular-blockade under protocolized orders. We obtained process and outcome variables from digitally recorded VL data. Patient characteristics data were also obtained from the emergency medical service record and linked to the VL recorded data. The primary outcome was to identify VL covariates associated with successful ETI attempts. Among 304 VL recorded ETI attempts in 268 patients, ETI succeeded for 244 attempts and failed for 60 attempts (first-pass success rate, 82% and overall success rate, 94%). Laryngoscope blade tip usually moved from a shallow position in the oropharynx to the vallecula. In the multivariable logistic regression analysis, attempt time (p = 0.02; odds ratio [OR] 0.99), Cormack-Lehane view (p < 0.001; OR 0.23), bodily fluids obstructing the view (p = 0.01; OR 0.29), and VL equipment failure (p < 0.001; OR 0.14) were negatively associated with successful attempts. Bodily fluids obstructing the view (p < 0.001; hazard ratio [HR] 0.51), VL equipment failure (p = 0.003; HR 0.42), shallow placement of blade tip within 4 seconds (p < 0.001; HR 0.40), number of forward movements (p < 0.001; HR 0.84), trauma (p = 0.04; HR 0.65), and neurological diagnosis (p = 0.04; HR 0.60) were associated with longer ETI attempt time. Bodily fluids obstructing the view

Case-Based Independent Study for Medical Students in Emergency Psychiatry

ERIC Educational Resources Information Center

Hirshbein, Laura D.; Gay, Tamara

2005-01-01

OBJECTIVE: Brief cases designed for independent study were developed to allow third-year medical students some exposure to important concepts in emergency psychiatry during their required psychiatry clerkship. METHODS: Five independent study cases were given to University of Michigan third-year medical students during their psychiatry clerkship,…

Experimental Simulation-Based Performance Evaluation of an SMS-Based Emergency Geolocation Notification System

PubMed Central

Osebor, Isibor

2017-01-01

In an emergency, a prompt response can save the lives of victims. This statement generates an imperative issue in emergency medical services (EMS). Designing a system that brings simplicity in locating emergency scenes is a step towards improving response time. This paper therefore implemented and evaluated the performance of an SMS-based emergency geolocation notification system with emphasis on its SMS delivery time and the system's geolocation and dispatch time. Using the RAS metrics recommended by IEEE for evaluation, the designed system was found to be efficient and effective as its reliability stood within 62.7% to 70.0% while its availability stood at 99% with a downtime of 3.65 days/year. PMID:29065643

Blood cultures in emergency medical admissions: a key patient cohort.

PubMed

Chotirmall, Sanjay H; Callaly, Elizabeth; Lyons, Judith; O'Connell, Brian; Kelleher, Mary; Byrne, Declan; O'Riordan, Deirdre; Silke, Bernard

2016-02-01

Blood cultures are performed in the emergency room when sepsis is suspected, and a cohort of patients is thereby identified. The present study investigated the outcomes (mortality and length of hospital stay) in this group following an emergency medical admission. Prospective assessment of all emergency medical admissions presenting to the emergency department at St James's Hospital, Dublin, over an 11-year period (2002-2012) was carried out. Outcomes including 30-day in-hospital mortality and length of stay were explored in the context of an admission blood culture. Generalized estimating equations, logistic or zero-truncated Poisson multivariate models were used, with adjustment for confounding variables including illness severity, comorbidity, and chronic disabling disease, to assess the effect of an urgent blood culture on mortality and length of stay. A total of 60 864 episodes were recorded in 35 168 patients admitted over the time period assessed. Patients more likely to undergo blood cultures in the emergency department were male, younger, and had more comorbidity. Univariate and multivariate analyses showed that those who had a blood culture, irrespective of result, had increased mortality and a longer in-hospital stay. This was highest for those with a positive culture, irrespective of the organism isolated. A clinical decision to request a blood culture identified a subset of emergency admissions with markedly worse outcomes. This patient cohort warrants close monitoring in the emergency setting.

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 13--Extrication from Automobiles. Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers extrication of victims from automobiles. Objectives stated for the chapter are for the student to be able to describe how to use extrication equipment properly and the correct use of the long and short backboards to…

Portable, space-saving medical patient support system

DOEpatents

Bzorgi,; Fariborz, [Knoxville, TN

2011-02-01

A support platform having a stowed configuration and a deployed configuration on a floor. The support platform is related to stretcher devices that are used for transporting, confining, or conducting medical procedures on medical patients in medical emergencies. The support platform typically includes a work surface that has a geometric extent. A base that typically includes a plurality of frame members is provided, and the frame members are disposed across the geometric extent of, and proximal to, the work surface in the stowed configuration. The frame members are typically disposed on the floor in the deployed configuration. There is a foldable bracing system engaged with the work surface and engaged with the base. At least a portion of the foldable bracing system is disposed substantially inside at least a portion of the plurality of frame members in the stowed configuration. Further, the foldable bracing system is configured for translocation of the work surface distal from the base in the deployed configuration.

[Position paper of the German Society for Medical Intensive Care Medicine and Emergency Medicine (DGIIN) on medical intensive care medicine].

PubMed

Riessen, R; Janssens, U; Buerke, M; Kluge, S

2016-05-01