40 CFR 265.56 - Emergency procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... FACILITIES Contingency Plan and Emergency Procedures § 265.56 Emergency procedures. (a) Whenever there is an... with designated response roles if their help is needed. (b) Whenever there is a release, fire, or... possible hazards to human health or the environment that may result from the release, fire, or explosion...

14 CFR 431.39 - Mission rules, procedures, contingency plans, and checklists.

Code of Federal Regulations, 2012 CFR

2012-01-01

... mission rules, procedures, checklists, emergency plans, and contingency abort plans, if any, that ensure..., procedures, checklists, emergency plans, and contingency abort plans must be contained in a safety directive...

14 CFR 431.39 - Mission rules, procedures, contingency plans, and checklists.

Code of Federal Regulations, 2014 CFR

2014-01-01

... mission rules, procedures, checklists, emergency plans, and contingency abort plans, if any, that ensure..., procedures, checklists, emergency plans, and contingency abort plans must be contained in a safety directive...

14 CFR 431.39 - Mission rules, procedures, contingency plans, and checklists.

Code of Federal Regulations, 2013 CFR

2013-01-01

... mission rules, procedures, checklists, emergency plans, and contingency abort plans, if any, that ensure..., procedures, checklists, emergency plans, and contingency abort plans must be contained in a safety directive...

Thirty-day emergency room visits and hospital admissions after outpatient non-vascular image-guided procedures.

PubMed

Nguyen, Quang; Mehta, Sahil V; Fang, Jieming; Sheiman, Robert; Kane, Robert; Ahmed, Muneeb; Sarwar, Ammar; Siewert, Bettina; Brook, Olga R

2017-10-01

To evaluate the rate of post-procedure emergency department (ED) visits and hospital admissions following outpatient non-vascular image-guided interventions performed under moderate sedation and to identify common and preventable causes of emergency department visits and hospital admissions. Institutional review board approval was acquired for this HIPAA-compliant retrospective study with waiver of informed consent. 1426 consecutive patients undergoing 1512 outpatient image-guided procedures under moderate sedation from November 2012 to August 2014 were included. The average patient age was 57.2 ± 15.2 years, and 602 (42%) patients were women. Major procedure categories included ultrasound-guided liver biopsies, ultrasound-guided kidney biopsies, and CT-guided lung biopsies/fiducial placement. Procedure details and medical follow-up within and after 30 days of the procedure were analyzed. A total of 168 (11.8%) patients were admitted to the hospital within 30 days of the procedure, with 29 of the admissions (17.3% of total admissions and 1.9% of total procedures) being procedure related. The most common procedure-related complication that required admission was hemorrhage (10/29, 34.5% of procedure-related admissions, 6.0% of total admissions, and 0.7% of total procedures), followed by pneumothorax (9/29, 31%, 5.4%, 0.6%), infection (4/29, 13.8%, 2.4%, 0.3%), and pain (3/29, 10.3%, 1.8%, 0.2%). Eighteen (62.1%) procedure-related admissions were immediately indicated. Thirty patients visited the ED and were subsequently discharged without admission with eight of the visits being procedure related (8/1512, 0.5%). All the procedure-related ED visits were due to pain. There were two deaths (2/1512, 0.1%) related to procedures, one from a thromboembolic event and another from post-biopsy hemorrhage. Outpatient non-vascular image-guided procedures result in a 30-day 1.9% hospital admission, 30-day 0.5% emergency room visit, and 30-day 0.1% mortality rate.

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2010 CFR

2010-07-01

... responsibilities at all times; (2) Keep written standard operating procedures that address anticipated emergency... the employer's standard operating procedures; (5) Train new fire response employees before they engage in emergency operations; (6) At least quarterly, provide training on the written operating procedures...

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2013 CFR

2013-07-01

... responsibilities at all times; (2) Keep written standard operating procedures that address anticipated emergency... the employer's standard operating procedures; (5) Train new fire response employees before they engage in emergency operations; (6) At least quarterly, provide training on the written operating procedures...

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2014 CFR

2014-07-01

... responsibilities at all times; (2) Keep written standard operating procedures that address anticipated emergency... the employer's standard operating procedures; (5) Train new fire response employees before they engage in emergency operations; (6) At least quarterly, provide training on the written operating procedures...

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2012 CFR

2012-07-01

... responsibilities at all times; (2) Keep written standard operating procedures that address anticipated emergency... the employer's standard operating procedures; (5) Train new fire response employees before they engage in emergency operations; (6) At least quarterly, provide training on the written operating procedures...

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2011 CFR

2011-07-01

... responsibilities at all times; (2) Keep written standard operating procedures that address anticipated emergency... the employer's standard operating procedures; (5) Train new fire response employees before they engage in emergency operations; (6) At least quarterly, provide training on the written operating procedures...

41 CFR 301-70.500 - What governing policies and procedures should we establish relating to emergency travel?

Code of Federal Regulations, 2010 CFR

2010-07-01

... and procedures should we establish relating to emergency travel? 301-70.500 Section 301-70.500 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES... Emergency Travel of Employee Due to Illness or Injury § 301-70.500 What governing policies and procedures...

Emergent Conditional Relations in a Go/No-Go Procedure: Figure-Ground and Stimulus-Position Compound Relations

ERIC Educational Resources Information Center

Debert, Paula; Huziwara, Edson M.; Faggiani, Robson Brino; de Mathis, Maria Eugenia Simoes; McIlvane, William J.

2009-01-01

Past research has demonstrated emergent conditional relations using a go/no-go procedure with pairs of figures displayed side-by-side on a computer screen. The present study sought to extend applications of this procedure. In Experiment 1, we evaluated whether emergent conditional relations could be demonstrated when two-component stimuli were…

Garrison Clinical Setting Inadequate for Maintenance of Procedural Skills for Emergency Medicine Physicians: A Cross-Sectional Study.

PubMed

Schauer, Steven G; Varney, Shawn M; Cox, Kristin L

2015-01-01

Emergency medicine physicians (EPs) are often placed in far-forward, isolated areas in theater. Maintenance of their emergency intervention skills is vital to keep the medical forces deployment ready. The US Army suggests that working at a Military Treatment Facility (MTF) is sufficient to keep emergency procedural skills at a deployment-ready level. We sought to compare the volume of emergency procedures that providers reported necessary to maintain their skills with the number available in the MTF setting. EPs were surveyed to quantify the number of procedures they reported they would need to perform yearly to stay deployment-ready. We obtained procedure data for their duty stations and compared the procedure volume with the survey responses to determine if working at an MTF is sufficient to keep providers' skills deployment ready. The reported necessary average numbers per year were as follows: tube thoracostomy (5.9), intubation (11.4), cricothyrotomy (4.2), lumbar puncture (5.2), central line (10.0), focused assessment with sonography for trauma (FAST) (21.3), reductions (10.6), splints (10.5), and sedations (11.7). None of the procedure volumes at MTFs met provider requirements with the exception of FAST examinations at the only trauma center. This suggests the garrison clinical environment is inadequate for maintaining procedure skills. Further research is needed to determine modalities that will provide adequate training volume. 2015.

Contemporary results of open aortic arch surgery.

PubMed

Thomas, Mathew; Li, Zhuo; Cook, David J; Greason, Kevin L; Sundt, Thoralf M

2012-10-01

The success of endovascular therapies for descending thoracic aortic disease has turned attention toward stent graft options for repair of aortic arch aneurysms. Defining the role of such techniques demands understanding of contemporary results of open surgery. The outcomes of open arch procedures performed on a single surgical service from July 1, 2001 to August 30, 2010, were examined as defined per The Society of Thoracic Surgeons national database. During the study period, 209 patients (median age, 65 years; range, 26-88) underwent arch operations, of which 159 were elective procedures. In 65 the entire arch was replaced, 22 of whom had portions of the descending thoracic aorta simultaneously replaced via bilateral thoracosternotomy. Antegrade cerebral perfusion was used in 78 patients and retrograde cerebral perfusion in 1. Operative mortality was 2.5% in elective circumstances and 10% in emergency cases (P = .04). The stroke rate was 5.0% when procedures were performed electively and 11.8% when on an emergency basis (P = .11). Procedure-specific mortality rates were 5.5% for elective and 10% for emergency procedures with total arch replacement, and 1.0% for elective and 10% for emergency procedures with hemiarch replacement. Stratified by extent, neurologic event rates were 5.5% for elective and 10% for emergency procedures with total arch and 4.8% for elective and 12.5% for emergency procedures with hemiarch replacement. Open aortic arch replacement can be performed with low operative mortality and stroke rates, especially in elective circumstances, by a team with particular focus on the procedure. The results of novel endovascular therapies should be benchmarked against contemporary open series performed in such a setting. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

How to teach emergency procedural skills in an outdoor environment using low-fidelity simulation.

PubMed

Saxon, Kathleen D; Kapadia, Alison P R; Juneja, Nadia S; Bassin, Benjamin S

2014-03-01

Teaching emergency procedural skills in a wilderness setting can be logistically challenging. To teach these skills as part of a wilderness medicine elective for medical students, we designed an outdoor simulation session with low-fidelity models. The session involved 6 stations in which procedural skills were taught using homemade low-fidelity simulators. At each station, the students encountered a "victim," who required an emergency procedure that was performed using the low-fidelity model. The models are easy and inexpensive to construct, and their design and implementation in the session is described here. Using low-fidelity simulation models in an outdoor setting is an effective teaching tool for emergency wilderness medicine procedures and can easily be reproduced in future wilderness medicine courses. © 2014 Wilderness Medical Society Published by Wilderness Medical Society All rights reserved.

RMP Guidance for Chemical Distributors - Chapter 8: Emergency Response Program

EPA Pesticide Factsheets

Depending on the level of processes at your facility, part 68 may require an emergency response program: an emergency response plan, emergency response equipment procedures, employee training, and procedures to ensure the program is up-to-date.

47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

Donation after cardiac death and the emergency department: ethical issues.

PubMed

Simon, Jeremy R; Schears, Raquel M; Padela, Aasim I

2014-01-01

Organ donation after cardiac death (DCD) is increasingly considered as an option to address the shortage of organs available for transplantation, both in the United States and worldwide. The procedures for DCD differ from procedures for donation after brain death and are likely less familiar to emergency physicians (EPs), even as this process is increasingly involving emergency departments (EDs). This article explores the ED operational and ethical issues surrounding this procedure. © 2013 by the Society for Academic Emergency Medicine.

28 CFR 65.85 - Procedures for State or local governments applying for funding.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Procedures for State or local governments applying for funding. 65.85 Section 65.85 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.85 Procedures for State or...

28 CFR 65.85 - Procedures for State or local governments applying for funding.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Procedures for State or local governments applying for funding. 65.85 Section 65.85 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.85 Procedures for State or...

28 CFR 65.85 - Procedures for State or local governments applying for funding.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Procedures for State or local governments applying for funding. 65.85 Section 65.85 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.85 Procedures for State or...

28 CFR 65.85 - Procedures for State or local governments applying for funding.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Procedures for State or local governments applying for funding. 65.85 Section 65.85 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.85 Procedures for State or...

28 CFR 65.85 - Procedures for State or local governments applying for funding.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Procedures for State or local governments applying for funding. 65.85 Section 65.85 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.85 Procedures for State or...

77 FR 64821 - Notice of Submission of Proposed Information Collection to OMB; Emergency Comment Request; Real...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-23

... Proposed Information Collection to OMB; Emergency Comment Request; Real Estate Settlement Procedures Act... Proposal: Real Estate Settlement Procedures Act (RESPA) Disclosures. OMB Control Number, if applicable... reinstatement of a discontinued information collection. The Real Estate Settlement Procedures Act of 1974...

27 CFR 22.22 - Alternate methods or procedures; and emergency variations from requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Alternate methods or procedures; and emergency variations from requirements. 22.22 Section 22.22 Alcohol, Tobacco Products and... OF TAX-FREE ALCOHOL Administrative Provisions Authorities § 22.22 Alternate methods or procedures...

27 CFR 22.22 - Alternate methods or procedures; and emergency variations from requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Alternate methods or procedures; and emergency variations from requirements. 22.22 Section 22.22 Alcohol, Tobacco Products and... OF TAX-FREE ALCOHOL Administrative Provisions Authorities § 22.22 Alternate methods or procedures...

27 CFR 22.22 - Alternate methods or procedures; and emergency variations from requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Alternate methods or procedures; and emergency variations from requirements. 22.22 Section 22.22 Alcohol, Tobacco Products and... OF TAX-FREE ALCOHOL Administrative Provisions Authorities § 22.22 Alternate methods or procedures...

27 CFR 22.22 - Alternate methods or procedures; and emergency variations from requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Alternate methods or procedures; and emergency variations from requirements. 22.22 Section 22.22 Alcohol, Tobacco Products and... OF TAX-FREE ALCOHOL Administrative Provisions Authorities § 22.22 Alternate methods or procedures...

27 CFR 22.22 - Alternate methods or procedures; and emergency variations from requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Alternate methods or procedures; and emergency variations from requirements. 22.22 Section 22.22 Alcohol, Tobacco Products and... OF TAX-FREE ALCOHOL Administrative Provisions Authorities § 22.22 Alternate methods or procedures...

Understanding the "Weekend Effect" for Emergency General Surgery.

PubMed

Hoehn, Richard S; Go, Derek E; Dhar, Vikrom K; Kim, Young; Hanseman, Dennis J; Wima, Koffi; Shah, Shimul A

2018-02-01

Several studies have identified a "weekend effect" for surgical outcomes, but definitions vary and the cause is unclear. Our aim was to better characterize the weekend effect for emergency general surgery using mortality as a primary endpoint. Using data from the University HealthSystem Consortium from 2009 to 2013, we identified urgent/emergent hospital admissions for seven procedures representing 80% of the national burden of emergency general surgery. Patient characteristics and surgical outcomes were compared between cases that were performed on weekdays vs weekends. Hospitals varied widely in the proportion of procedures performed on the weekend. Of the procedures examined, four had higher mortality for weekend cases (laparotomy, lysis of adhesions, partial colectomy, and small bowel resection; p < 0.01), while three did not (appendectomy, cholecystectomy, and peptic ulcer disease repair). Among the four procedures with increased weekend mortality, patients undergoing weekend procedures also had increased severity of illness and shorter time from admission to surgery (p < 0.01). Multivariate analysis adjusting for patient characteristics demonstrated independently higher mortality on weekends for these same four procedures (p < 0.01). For the first time, we have identified specific emergency general surgery procedures that incur higher mortality when performed on weekends. This may be due to acute changes in patient status that require weekend surgery or indications for urgent procedures (ischemia, obstruction) compared to those without a weekend mortality difference (infection). Hospitals that perform weekend surgery must acknowledge and identify ways to manage this increased risk.

18 CFR 376.209 - Procedures during periods of emergency requiring activation of the Continuity of Operations Plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... periods of emergency requiring activation of the Continuity of Operations Plan. 376.209 Section 376.209... GENERAL RULES ORGANIZATION, MISSION, AND FUNCTIONS; OPERATIONS DURING EMERGENCY CONDITIONS Commission Operation During Emergency Conditions § 376.209 Procedures during periods of emergency requiring activation...

28 CFR 65.82 - Procedure for requesting a Presidential determination of an immigration emergency.

Code of Federal Regulations, 2010 CFR

2010-07-01

... determination of an immigration emergency. 65.82 Section 65.82 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.82 Procedure for requesting a Presidential determination of an immigration emergency. (a) The President may make a...

TU-D-201-07: Severity Indication in High Dose Rate Brachytherapy Emergency Response Procedure

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, K; Rustad, F

Purpose: Understanding the corresponding dose to different staff during the High Dose Rate (HDR) Brachytherapy emergency response procedure could help to develop a strategy in efficiency and effective action. In this study, the variation and risk analysis methodology was developed to simulation the HDR emergency response procedure based on severity indicator. Methods: A GammaMedplus iX HDR unit from Varian Medical System was used for this simulation. The emergency response procedure was decomposed based on risk management methods. Severity indexes were used to identify the impact of a risk occurrence on the step including dose to patient and dose to operationmore » staff by varying the time, HDR source activity, distance from the source to patient and staff and the actions. These actions in 7 steps were to press the interrupt button, press emergency shutoff switch, press emergency button on the afterloader keypad, turn emergency hand-crank, remove applicator from the patient, disconnect transfer tube and move afterloader from the patient, and execute emergency surgical recovery. Results: Given the accumulated time in second at the assumed 7 steps were 15, 5, 30, 15, 180, 120, 1800, and the dose rate of HDR source is 10 Ci, the accumulated dose in cGy to patient at 1cm distance were 188, 250, 625, 813, 3063, 4563 and 27063, and the accumulated exposure in rem to operator at outside the vault, 1m and 10cm distance were 0.0, 0.0, 0.1, 0.1, 22.6, 37.6 and 262.6. The variation was determined by the operators in action at different time and distance from the HDR source. Conclusion: The time and dose were estimated for a HDR unit emergency response procedure. It provided information in making optimal decision during the emergency procedure. Further investigation would be to optimize and standardize the responses for other emergency procedure by time-spatial-dose severity function.« less

SSET Project: Cost-effectiveness Analysis of Surgical Specialty Emergency Trays in the Emergency Department.

PubMed

Humphries, Laura S; Shenaq, Deana S; Teven, Chad M; Park, Julie E; Song, David H

2018-01-01

We hypothesize that reusable, on-site specialty instrument trays available to plastic surgery residents in the emergency department (ED) for bedside procedures are more cost-effective than disposable on-site and remote re-usable operating room (OR) instruments at our institution. We completed a cost-effectiveness analysis comparing the use of disposable on-site kits and remote OR trays to a hypothetical, custom, reusable tray for ED procedures completed by PRS residents. Material costs of existing OR trays were used to estimate the purchasing and use-cost of a custom on-site tray for the same procedures. Cost of per procedure 'consult time' was estimated using procedure and resident salary. Sixteen bedside procedures were completed over a 4.5 month period. A mean of 2.14 disposable kits were used per-procedure. Mean consultation time was 1.66 hours. Procedures that used OR trays took 3 times as long as procedures that used on-site kits (4 vs. 1.1 hours). Necessary, additional instruments were unavailable for 75% of procedures. Mean cost of using disposable kits and OR trays was $115.03/procedure versus an estimated $26.67/procedure cost of using a custom tray, yielding $88.36/procedure cost-savings. Purchase of a single custom tray ($1,421.55) would be redeemed after 2.3 weeks at 1 procedure/day. Purchasing 4 trays has projected annual cost-savings of $26,565.20. The purchase of specialized procedure trays will yield valuable time and cost-savings while providing quality patient care. Improving time efficiency will help achieve the Accreditation Council of Graduate Medical Education (ACGME) goals of maintaining resident well-being and developing quality improvement competency.

40 CFR 6.210 - Emergency circumstances.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 6.210 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY ACT AND ASSESSING THE ENVIRONMENTAL EFFECTS ABROAD OF EPA ACTIONS EPA's NEPA Environmental Review Procedures § 6.210 Emergency circumstances. If emergency circumstances...

Critical Emergency Medicine Procedural Skills: A Comparative Study of Methods for Teaching and Assessment.

ERIC Educational Resources Information Center

Chapman, Dane M.; And Others

Three critical procedural skills in emergency medicine were evaluated using three assessment modalities--written, computer, and animal model. The effects of computer practice and previous procedure experience on skill competence were also examined in an experimental sequential assessment design. Subjects were six medical students, six residents,…

Training Implications of the Tactical Aircraft Recapitalization

DTIC Science & Technology

2008-06-13

and Wayne L. Waag , The Use of Simulators for Training In-Flight and Emergency Procedures in AGARD-AG-248 (Neuilly-Sur-Seine, France: Advisory Group...11 Edward E. Eddowes and Wayne L. Waag , The Use of Simulators for Training In-Flight and Emergency Procedures in AGARD-AG-248 (Neuilly-Sur...17 Edward E. Eddowes and Wayne L. Waag , The Use of Simulators for Training In-Flight and Emergency Procedures in AGARD-AG-248 (Neuilly-Sur-Seine

Developing technical expertise in emergency medicine--the role of simulation in procedural skill acquisition.

PubMed

Wang, Ernest E; Quinones, Joshua; Fitch, Michael T; Dooley-Hash, Suzanne; Griswold-Theodorson, Sharon; Medzon, Ron; Korley, Frederick; Laack, Torrey; Robinett, Adam; Clay, Lamont

2008-11-01

Developing technical expertise in medical procedures is an integral component of emergency medicine (EM) practice and training. This article is the work of an expert panel composed of members from the Society for Academic Emergency Medicine (SAEM) Interest Group, the SAEM Technology in Medical Education Committee, and opinions derived from the May 2008 Academic Emergency Medicine Consensus Conference, "The Science of Simulation in Healthcare." The writing group reviewed the simulation literature on procedures germane to EM training, virtual reality training, and instructional learning theory as it pertains to skill acquisition and procedural skills decay. The authors discuss the role of simulation in teaching technical expertise, identify training conditions that lead to effective learning, and provide recommendations for future foci of research.

Postmortem procedures in the emergency department: using the recently dead to practise and teach.

PubMed Central

Iserson, K V

1993-01-01

In generations past, it was common practice for doctors to learn lifesaving technical skills on patients who had recently died. But this practice has lately been criticised on religious, legal, and ethical grounds, and has fallen into disuse in many hospitals and emergency departments. This paper uses four questions to resolve whether doctors in emergency departments should practise and teach non-invasive and minimally invasive procedures on the newly dead: Is it ethically and legally permissible to practise and teach non-invasive and minimally invasive procedures on the newly dead emergency-department patient? What are the alternatives or possible consequences of not practising non-invasive and minimally invasive procedures on newly dead patients? Is consent from relatives required? Should doctors in emergency departments allow or even encourage this use of newly dead patients? PMID:8331644

44 CFR 206.202 - Application procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Application procedures. 206.202 Section 206.202 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Public Assistance Project...

44 CFR 360.4 - Administrative procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Administrative procedures. 360.4 Section 360.4 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS STATE ASSISTANCE PROGRAMS FOR TRAINING AND EDUCATION IN...

49 CFR 601.47 - Review Procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Review Procedures. 601.47 Section 601.47 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ORGANIZATION, FUNCTIONS, AND PROCEDURES Emergency Procedures for Public...

44 CFR 17.630 - Certification requirements and procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Certification requirements and procedures. 17.630 Section 17.630 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE...

44 CFR 78.14 - Alternative procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Alternative procedures. 78.14 Section 78.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION...

44 CFR 78.14 - Alternative procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Alternative procedures. 78.14 Section 78.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION...

44 CFR 78.14 - Alternative procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Alternative procedures. 78.14 Section 78.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION...

44 CFR 78.14 - Alternative procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Alternative procedures. 78.14 Section 78.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION...

44 CFR 78.14 - Alternative procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Alternative procedures. 78.14 Section 78.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION...

14 CFR 1204.1406 - Procedures in the event of a declared in-flight emergency.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Procedures in the event of a declared in-flight emergency. 1204.1406 Section 1204.1406 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE... the Benefit of the Federal Government § 1204.1406 Procedures in the event of a declared in-flight...

14 CFR 1204.1406 - Procedures in the event of a declared in-flight emergency.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Procedures in the event of a declared in-flight emergency. 1204.1406 Section 1204.1406 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE... the Benefit of the Federal Government § 1204.1406 Procedures in the event of a declared in-flight...

14 CFR 1204.1406 - Procedures in the event of a declared in-flight emergency.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Procedures in the event of a declared in-flight emergency. 1204.1406 Section 1204.1406 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE... the Benefit of the Federal Government § 1204.1406 Procedures in the event of a declared in-flight...

14 CFR 1204.1406 - Procedures in the event of a declared in-flight emergency.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Procedures in the event of a declared in-flight emergency. 1204.1406 Section 1204.1406 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE... the Benefit of the Federal Government § 1204.1406 Procedures in the event of a declared in-flight...

14 CFR 125.73 - Contents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... in the briefing under § 125.327; (l) Flight locating procedures, when applicable; (m) Procedures for... required crewmembers in connection with an emergency and emergency evacuation; (n) The approved airplane...

44 CFR 206.436 - Application procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Application procedures. 206.436 Section 206.436 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... application will identify one or more mitigation measures for which funding is requested. The application must...

Standard operating procedures, water immersion facility, revision B

NASA Technical Reports Server (NTRS)

1979-01-01

General guideline procedures to identify those factors that are common to all spacecraft design laboratory support group emergency procedures and to establish the basic rescue plan are presented. This eliminates needless repetition of the fundamentals from the other, more specific procedures.

44 CFR 206.120 - State administration of other needs assistance.

Code of Federal Regulations, 2010 CFR

2010-10-01

...), Recovery of funds. (4) Procedures for financial management, accountability and oversight. (i) Procedures... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false State administration of other needs assistance. 206.120 Section 206.120 Emergency Management and Assistance FEDERAL EMERGENCY...

14 CFR 135.83 - Operating information required.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the following procedures: (1) Before starting engines; (2) Before takeoff; (3) Cruise; (4) Before... controls. (3) Engine inoperative procedures. (4) Any other emergency procedures necessary for safety. ...

14 CFR 135.83 - Operating information required.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the following procedures: (1) Before starting engines; (2) Before takeoff; (3) Cruise; (4) Before... controls. (3) Engine inoperative procedures. (4) Any other emergency procedures necessary for safety. ...

14 CFR 135.83 - Operating information required.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the following procedures: (1) Before starting engines; (2) Before takeoff; (3) Cruise; (4) Before... controls. (3) Engine inoperative procedures. (4) Any other emergency procedures necessary for safety. ...

14 CFR 135.83 - Operating information required.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the following procedures: (1) Before starting engines; (2) Before takeoff; (3) Cruise; (4) Before... controls. (3) Engine inoperative procedures. (4) Any other emergency procedures necessary for safety. ...

14 CFR 135.83 - Operating information required.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the following procedures: (1) Before starting engines; (2) Before takeoff; (3) Cruise; (4) Before... controls. (3) Engine inoperative procedures. (4) Any other emergency procedures necessary for safety. ...

Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?

PubMed

Klinginsmith, Michael; Jolley, Jennifer; Lomelin, Daniel; Krause, Crystal; Heiden, Jace; Oleynikov, Dmitry

2016-05-01

Laparoscopic repair of paraesophageal hernia (PEH) with fundoplication is currently the preferred elective strategy, but emergent cases are often done open without an anti-reflux (AR) procedure. This study examined PEH repair in elective and urgent/emergent settings and investigated patient characteristic influence on the use of adjunctive techniques, such as AR procedures or gastrostomy tube (GT) placement. Utilizing the University HealthSystem Consortium Clinical Database Resource Manager, selected discharge data were retrieved using International Classification of Disease 9 diagnosis codes for PEH and procedure specific codes. Chi-squared and paired t tests were applied (α = 0.05). Discharge data from October 2010 through June 2014 indicated 7950 patients (≥18 years) underwent PEH surgery, 84.7 % were performed laparoscopically and 15.3 % open. 24.6 % of cases were classified urgent/emergent upon admission, and almost 70 % of these were completed laparoscopically. Open paraesophageal hernia repairs (OHR) represented a higher proportion of urgent/emergent cases but were only 30 % of this total. Laparoscopic paraesophageal hernia repair (LHR) patients were more likely to receive an AR procedure in all situations (54.9 % LHR vs. 26.3 % OHR). Almost 90 % of elective PEH repairs in this cohort were laparoscopic. Elective cases were more commonly associated with AR procedures than emergent cases which frequently incorporated GT placement. We demonstrate that laparoscopic PEH repair has become accepted in emergent cases. Open PEH repair is often reserved for emergent surgeries and less commonly includes an AR procedure. Laparoscopy with an AR procedure is clearly the standard of care in elective surgery. The decision to perform an open or laparoscopic surgery, with or without adjunctive techniques, may be based more on the physician's comfort with laparoscopic surgery and surgical practices than the patient's condition. Long-term follow-up studies are needed to determine the functional outcomes of these strategies.

[Preparation of sedation-analgesia procedures in spanish paediatric emergency departments: A descriptive study].

PubMed

Míguez Navarro, Concepción; Oikonomopoulou, Niki; Lorente Romero, Jorge; Vázquez López, Paula

2017-07-24

The objective of this study was to describe the current practice regarding the preparation of the sedation-analgesia (SA) procedures performed in the paediatric emergency centres in Spain. A multicentre, observational and prospective analytical study was carried out on the SA procedures that were performed on children under 18 years-old in 18 paediatric emergency departments between February 2015 and January 2016. A total of 658 SA procedures were registered in 18 hospitals of Spain, most of them to children older than 24 months. The type of the procedure was: simple analgesia in 57 (8.6%), sedation in 44 (6.7%), SA for a not very painful procedure in 275 (41.8%), and SA for a very painful procedure in 282 (42.9%). Informed consent was requested in 98.6% of the cases. The written form was more frequently preferred in the group of patients that received SA for a very painful procedure (76.6%) in comparison to a painful procedure or to simple analgesia (62.9% and 54.4%, respectively, P<.001). The staff that most frequently performed the SA procedures were the paediatricians of the emergency departments (64.3%), followed by Paediatrics Residents (30.7%). The most frequent reasons for the SA were traumatological (35.9%) and surgical (28.4%). Fasting was observed in 81% of the cases. More than two-thirds (67.3%, n=480) children were monitored, the majority (95.8%) of them using pulse oximetry. The pharmacological strategy used was the administration of one drug in 443 (67.3%) of the cases, mostly nitrous oxide, and a combination of drugs in 215 (32.7%), especially midazolam/ketamine (46.9%). The majority of the SA procedures analysed in this study have been carried out correctly and prepared in accordance with the current guidelines. Copyright © 2017. Publicado por Elsevier España, S.L.U.

45 CFR 1634.12 - Emergency procedures and waivers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... COMPETITIVE BIDDING FOR GRANTS AND CONTRACTS § 1634.12 Emergency procedures and waivers. The President of the... requirements imposed by law on the awards of grants and contracts for a particular fiscal year. ...

45 CFR 1634.12 - Emergency procedures and waivers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... COMPETITIVE BIDDING FOR GRANTS AND CONTRACTS § 1634.12 Emergency procedures and waivers. The President of the... requirements imposed by law on the awards of grants and contracts for a particular fiscal year. ...

Ketamine versus Ketamine / magnesium Sulfate for Procedural Sedation and Analgesia in the Emergency Department: A Randomized Clinical Trial

PubMed Central

Azizkhani, Reza; Bahadori, Azadeh; Shariati, Mohammadreza; Golshani, Keyhan; Ahmadi, Omid; Masoumi, Babak

2018-01-01

Background: The present study was designed to evaluate the effectiveness of magnesium sulfate (MgSO4) in procedural sedation and analgesia (PSA) when combined with ketamine in patients with fractures in emergency departments and required short and painful emergency procedures. Materials and Methods: In this study, 100 patients with fractures and dislocations who were presented to the emergency departments and required PSA for short and painful emergency procedures were randomly allocated to groups of ketamine plus MgSO4 or ketamine alone. Train of four (TOF) stimulation pattern was assessed using nerve stimulator machine and compared between groups. Results: The mean age of studied patients was 46.9 ± 9.3 years old. 48% were male and 52% were female. No significant differences were noted between groups in demographic variables. The status of TOF, 2 min after the injection of ketamine (1.5 mg/kg), in both groups was similar. After the injection of the second dose of ketamine (1 mg/kg) the status of TOF in four patients in ketamine plus MgSO4 (0.45 mg/kg) group changed, it was three quarters but in ketamine group, the status of TOF in all patients was four quarters. The difference between groups was not statistically significant (P = 0.12). Conclusion: The findings revealed that for muscle relaxation during medical procedures in the emergency department, ketamine in combination with MgSO4 with this dose was not effective for muscle relaxation during procedures. PMID:29456990

Ketamine versus Ketamine / magnesium Sulfate for Procedural Sedation and Analgesia in the Emergency Department: A Randomized Clinical Trial.

PubMed

Azizkhani, Reza; Bahadori, Azadeh; Shariati, Mohammadreza; Golshani, Keyhan; Ahmadi, Omid; Masoumi, Babak

2018-01-01

The present study was designed to evaluate the effectiveness of magnesium sulfate (MgSO 4 ) in procedural sedation and analgesia (PSA) when combined with ketamine in patients with fractures in emergency departments and required short and painful emergency procedures. In this study, 100 patients with fractures and dislocations who were presented to the emergency departments and required PSA for short and painful emergency procedures were randomly allocated to groups of ketamine plus MgSO 4 or ketamine alone. Train of four (TOF) stimulation pattern was assessed using nerve stimulator machine and compared between groups. The mean age of studied patients was 46.9 ± 9.3 years old. 48% were male and 52% were female. No significant differences were noted between groups in demographic variables. The status of TOF, 2 min after the injection of ketamine (1.5 mg/kg), in both groups was similar. After the injection of the second dose of ketamine (1 mg/kg) the status of TOF in four patients in ketamine plus MgSO 4 (0.45 mg/kg) group changed, it was three quarters but in ketamine group, the status of TOF in all patients was four quarters. The difference between groups was not statistically significant ( P = 0.12). The findings revealed that for muscle relaxation during medical procedures in the emergency department, ketamine in combination with MgSO 4 with this dose was not effective for muscle relaxation during procedures.

First Aid Procedures for Dental Emergencies.

ERIC Educational Resources Information Center

Barsky, Nancy Happel; Londeree, Kathy

1982-01-01

Guidelines for first aid procedures for temporary relief of dental emergencies include information on: (1) dental first aid supplies; (2) treatment of oral injuries; (3) orthodontic emergencies; (4) toothaches; and (5) prolonged bleeding due to an extraction. Consulting a dentist as soon as possible is strongly recommended. (JN)

Emergencies and Problems: A Procedures Manual for Trinity University Library.

ERIC Educational Resources Information Center

Pettit, Katherine D.

The first of six sections in this manual outlines a series of steps to be followed when an emergency or problem occurs. These procedures are divided into four categories: (1) behavioral emergencies, i.e., bomb threats, building takeover, problem patrons, or thefts; (2) building emergencies, i.e., elevator failure, fire, flooding of building/water…

Current UK practice in emergency laparotomy

PubMed Central

Barrow, E; Varley, S; Pichel, AC; Peden, CJ; Saunders, DI; Murray, D

2013-01-01

Introduction Emergency laparotomy is a common procedure, with 30,000–50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. Methods Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. Results Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. ‘True’ emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. Conclusions This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study. PMID:24165345

Current UK practice in emergency laparotomy.

PubMed

Barrow, E; Anderson, I D; Varley, S; Pichel, A C; Peden, C J; Saunders, D I; Murray, D

2013-11-01

Emergency laparotomy is a common procedure, with 30,000-50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. 'True' emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.

Associations between ASA Physical Status and postoperative mortality at 48 h: a contemporary dataset analysis compared to a historical cohort.

PubMed

Hopkins, Thomas J; Raghunathan, Karthik; Barbeito, Atilio; Cooter, Mary; Stafford-Smith, Mark; Schroeder, Rebecca; Grichnik, Katherine; Gilbert, Richard; Aronson, Solomon

2016-01-01

In this study, we examined the association between American Society of Anesthesiologists Physical Status (ASA PS) designation and 48-h mortality for both elective and emergent procedures in a large contemporary dataset (patient encounters between 2009 and 2014) and compared this association with data from a landmark study published by Vacanti et al. in 1970. Patient history, hospital characteristics, anesthetic approach, surgical procedure, efficiency and quality indicators, and patient outcomes were prospectively collected for 732,704 consecutive patient encounters between January 1, 2009, and December 31, 2014, at 233 anesthetizing locations across 19 facilities in two US states and stored in the Quantum™ Clinical Navigation System (QCNS) database. The outcome (death within 48 h of procedure) was tabulated against ASA PS designations separately for patients with and without "E" status labels. To maintain consistency with the historical cohort from the landmark study performed by Vacanti et al. on adult men at US naval hospitals in 1970, we then created a comparison cohort in the contemporary dataset that consisted of 242,103 adult male patients (with/without E designations) undergoing elective and emergent procedures. Differences in the relationship between ASA PS and 48-h mortality in the historical and contemporary cohorts were assessed for patients undergoing elective and emergent procedures. As reported nearly five decades ago, we found a significant trend toward increased mortality with increasing ASA PS for patients undergoing both elective and emergent procedures in a large contemporary cohort ( p  < 0.0001). Additionally, the overall mortality rate at 48 h was significantly higher among patients undergoing emergent compared to elective procedures in the large contemporary cohort (1.27 versus 0.03 %, p  < 0.0001). In the comparative analysis with the historical cohort that focused on adult males, we found the overall 48-h mortality rate was significantly lower among patients undergoing elective procedures in the contemporary cohort (0.05 % now versus 0.24 % in 1970, p  < 0.0001) but not significantly lower among those undergoing emergent procedures (1.88 % now versus 1.22 % in 1970, p  < 0.0001). The association between increasing ASA PS designation (1-5) and mortality within 48 h of surgery is significant for patients undergoing both elective and emergent procedures in a contemporary dataset consisting of over 700,000 patient encounters. Emergency surgery was associated with a higher risk of patient death within 48 h of surgery in this contemporary dataset. These data trends are similar to those observed nearly five decades ago in a landmark study evaluating the association between ASA PS and 48-h surgical mortality on adult men at US naval hospitals. When a comparison cohort was created from the contemporary dataset and compared to this landmark historical cohort, the absolute 48-h mortality rate was significantly lower in the contemporary cohort for elective procedures but not significantly lower for emergency procedures. The underlying implications of these findings remain to be determined.

14 CFR § 1204.1406 - Procedures in the event of a declared in-flight emergency.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Procedures in the event of a declared in-flight emergency. § 1204.1406 Section § 1204.1406 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE... the Benefit of the Federal Government § 1204.1406 Procedures in the event of a declared in-flight...

14 CFR 91.1069 - Flight crew: Instrument proficiency check requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... procedures. The instrument approach procedure or procedures must include at least one straight-in approach... conducted to published minimums for that procedure. (d) The instrument proficiency checks required by... emergencies, and standard instrument approaches involving navigational facilities which that pilot is to be...

14 CFR 91.1069 - Flight crew: Instrument proficiency check requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... procedures. The instrument approach procedure or procedures must include at least one straight-in approach... conducted to published minimums for that procedure. (d) The instrument proficiency checks required by... emergencies, and standard instrument approaches involving navigational facilities which that pilot is to be...

10 CFR 205.379 - Application for approval of the installation of permanent facilities for emergency use only.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Emergency Interconnection of Electric Facilities and the Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power § 205.379 Application for approval of the installation of...

Recommended Procedures for Handling Emergency Illnesses and Accidents at School.

ERIC Educational Resources Information Center

North Dakota State Dept. of Health, Bismarck.

Recommended procedures for handling emergency illnesses and accidents are provided in this guide for school personnel prepared by the North Dakota State Department of Health. Following five general recommendations for steps to take in emergency situations, advice and techniques are given for handling: nose bleeds; abdominal pain; toothaches and…

28 CFR 61.9 - Emergencies.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Emergencies. 61.9 Section 61.9 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY... following otherwise applicable procedural requirements under NEPA. ...

28 CFR 61.9 - Emergencies.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Emergencies. 61.9 Section 61.9 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY... following otherwise applicable procedural requirements under NEPA. ...

28 CFR 61.9 - Emergencies.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Emergencies. 61.9 Section 61.9 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY... following otherwise applicable procedural requirements under NEPA. ...

28 CFR 61.9 - Emergencies.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Emergencies. 61.9 Section 61.9 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY... following otherwise applicable procedural requirements under NEPA. ...

28 CFR 61.9 - Emergencies.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Emergencies. 61.9 Section 61.9 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY... following otherwise applicable procedural requirements under NEPA. ...

Interprofessional and interdisciplinary simulation-based training leads to safe sedation procedures in the emergency department.

PubMed

Sauter, Thomas C; Hautz, Wolf E; Hostettler, Simone; Brodmann-Maeder, Monika; Martinolli, Luca; Lehmann, Beat; Exadaktylos, Aristomenis K; Haider, Dominik G

2016-08-02

Sedation is a procedure required for many interventions in the Emergency department (ED) such as reductions, surgical procedures or cardioversions. However, especially under emergency conditions with high risk patients and rapidly changing interdisciplinary and interprofessional teams, the procedure caries important risks. It is thus vital but difficult to implement a standard operating procedure for sedation procedures in any ED. Reports on both, implementation strategies as well as their success are currently lacking. This study describes the development, implementation and clinical evaluation of an interprofessional and interdisciplinary simulation-based sedation training concept. All physicians and nurses with specialised training in emergency medicine at the Berne University Department of Emergency Medicine participated in a mandatory interdisciplinary and interprofessional simulation-based sedation training. The curriculum consisted of an individual self-learning module, an airway skill training course, three simulation-based team training cases, and a final practical learning course in the operating theatre. Before and after each training session, self-efficacy, awareness of emergency procedures, knowledge of sedation medication and crisis resource management were assessed with a questionnaire. Changes in these measures were compared via paired tests, separately for groups formed based on experience and profession. To assess the clinical effect of training, we collected patient and team satisfaction as well as duration and complications for all sedations in the ED within the year after implementation. We further compared time to beginning of procedure, time for duration of procedure and time until discharge after implementation with the one year period before the implementation. Cohen's d was calculated as effect size for all statistically significant tests. Fifty staff members (26 nurses and 24 physicians) participated in the training. In all subgroups, there is a significant increase in self-efficacy and knowledge with high effect size (d z  = 1.8). The learning is independent of profession and experience level. In the clinical evaluation after implementation, we found no major complications among the sedations performed. Time to procedure significantly improved after the introduction of the training (d = 0.88). Learning is independent of previous working experience and equally effective in raising the self-efficacy and knowledge in all professional groups. Clinical outcome evaluation confirms the concepts safety and feasibility. An interprofessional and interdisciplinary simulation-based sedation training is an efficient way to implement a conscious sedation concept in an ED.

23 CFR 668.113 - Program and project procedures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Program and project procedures. 668.113 Section 668.113 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS EMERGENCY RELIEF PROGRAM Procedures for Federal-Aid Highways § 668.113 Program and project procedures. (a...

Trust in decision-making authorities dictates the form of the interactive relationship between outcome fairness and procedural fairness.

PubMed

Bianchi, Emily C; Brockner, Joel; van den Bos, Kees; Seifert, Matthias; Moon, Henry; van Dijke, Marius; De Cremer, David

2015-01-01

Reactions to decisions are shaped by both outcome and procedural fairness. Moreover, outcome and procedural fairness interact to influence beliefs and behaviors. However, different types of "process/outcome" interaction effects have emerged. Many studies have shown that people react particularly negatively when they receive unfair or unfavorable outcomes accompanied by unfair procedures (the "low-low" interactive pattern). However, others find that people react especially positively when they receive fair or favorable outcomes accompanied by fair procedures (the "high-high" interactive pattern). We propose that trust in decision-making authorities dictates the form of the process/outcome interaction. Across three studies, when trust was high, the "low-low" interactive pattern emerged. When trust was low, the "high-high" interactive pattern emerged. The findings suggest that when people's experience of outcome and procedural fairness diverged from how they expected to be treated, they reacted in the direction of their experiences; otherwise, their reactions were consistent with their expectations. © 2014 by the Society for Personality and Social Psychology, Inc.

Impact of the 80-hour work week on resident emergency operative experience.

PubMed

Feanny, Mark A; Scott, Bradford G; Mattox, Kenneth L; Hirshberg, Asher

2005-12-01

The goal of this study was to analyze the impact of the 80-hour work week on the emergency operative experience of surgical residents. A 2-year retrospective comparison of the operative experience in emergency abdominal procedures of postgraduate year 4 and 5 residents in a city hospital before (group 1) and after (group 2) duty hour restriction. There was no difference between groups in the mean number of procedures performed as the primary surgeon, but group 2 showed a 40% decrease in technically advanced procedures with a 44% increase in basic procedures. The study also demonstrated a 54% decrease in the operative volume as first assistant. Operative continuity of care by residents decreased from 60% to 26% of cases. The ACGME regulatory environment is adversely affecting the emergency operative experience of surgical residents. Our findings underscore the need to develop alternative methods to augment the residents' operative experience.

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department.

PubMed

Thomas, Anita A; Uspal, Neil G; Oron, Assaf P; Klein, Eileen J

2016-12-01

Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills ( P  < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use ( P  = .30, paired difference -0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use ( P  < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use ( P  < .05, paired difference -0.4 points). Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training.

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department

PubMed Central

Thomas, Anita A.; Uspal, Neil G.; Oron, Assaf P.; Klein, Eileen J.

2016-01-01

Background  Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. Objective  We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Methods  Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Results  Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills (P < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use (P = .30, paired difference −0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use (P < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use (P < .05, paired difference −0.4 points). Conclusions  Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training. PMID:28018542

76 FR 78015 - Revised Analysis and Mapping Procedures for Non-Accredited Levees

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-15

...] Revised Analysis and Mapping Procedures for Non-Accredited Levees AGENCY: Federal Emergency Management... comments on the proposed solution for Revised Analysis and Mapping Procedures for Non-Accredited Levees. This document proposes a revised procedure for the analysis and mapping of non-accredited levees on...

14 CFR 135.340 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2010 CFR

2010-01-01

... principles of the teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor... certificate holder's policies and procedures. (3) The applicable methods, procedures, and techniques for... approved methods, procedures, and limitations for performing the required normal, abnormal, and emergency...

14 CFR 135.340 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2014 CFR

2014-01-01

... principles of the teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor... certificate holder's policies and procedures. (3) The applicable methods, procedures, and techniques for... approved methods, procedures, and limitations for performing the required normal, abnormal, and emergency...

14 CFR 135.340 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2012 CFR

2012-01-01

... principles of the teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor... certificate holder's policies and procedures. (3) The applicable methods, procedures, and techniques for... approved methods, procedures, and limitations for performing the required normal, abnormal, and emergency...

14 CFR 135.340 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2013 CFR

2013-01-01

... principles of the teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor... certificate holder's policies and procedures. (3) The applicable methods, procedures, and techniques for... approved methods, procedures, and limitations for performing the required normal, abnormal, and emergency...

14 CFR 135.340 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2011 CFR

2011-01-01

... principles of the teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor... certificate holder's policies and procedures. (3) The applicable methods, procedures, and techniques for... approved methods, procedures, and limitations for performing the required normal, abnormal, and emergency...

44 CFR 59.30 - A pilot inspection procedure.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false A pilot inspection procedure... PROVISIONS Pilot Inspection Program § 59.30 A pilot inspection procedure. (a) Purpose. This section sets forth the criteria for implementing a pilot inspection procedure in Monroe County and the Village of...

44 CFR 59.30 - A pilot inspection procedure.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false A pilot inspection procedure... PROVISIONS Pilot Inspection Program § 59.30 A pilot inspection procedure. (a) Purpose. This section sets forth the criteria for implementing a pilot inspection procedure in Monroe County and the Village of...

Emergency Management of Tension Pneumothorax for Health Professionals on Remote Cat Island Bahamas

PubMed Central

Parsons, Michael; Francis, Leathe; Senoro, Cristian; Chriswell, Caroline; Saunders, Rose; Hollander, Charles

2017-01-01

Patients living in remote areas have higher rates of injury-related death than those living in cities. Rural and remote health professionals working in sparsely populated places, such as Cat Island Bahamas, may have scant resources for treating emergency conditions. Local health professionals must be prepared to rely solely upon clinical judgment to perform emergency “high-stakes low-frequency” procedures while also accurately and effectively communicating with distantly located receiving specialists. However, these health providers may not recently have performed or had the opportunity to practice such emergency procedures. Telesimulation may be a useful way to teach remote practitioners both emergency procedures and communication skills. This technical report describes a simulation exercise for teaching these skills. PMID:28775930

10 CFR 205.377 - Reports.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Emergency Interconnection of Electric Facilities and the Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power § 205.377 Reports. In addition...

49 CFR 193.2509 - Emergency procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 3 2010-10-01 2010-10-01 false Emergency procedures. 193.2509 Section 193.2509 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY LIQUEFIED NATURAL GAS FACILITIES...

Outcomes of surgery in patients aged ≥90 years in the general surgical setting.

PubMed

Sudlow, A; Tuffaha, H; Stearns, A T; Shaikh, I A

2018-03-01

Introduction An increasing proportion of the population is living into their nineties and beyond. These high risk patients are now presenting more frequently to both elective and emergency surgical services. There is limited research looking at outcomes of general surgical procedures in nonagenarians and centenarians to guide surgeons assessing these cases. Methods A retrospective analysis was conducted of all patients aged ≥90 years undergoing elective and emergency general surgical procedures at a tertiary care facility between 2009 and 2015. Vascular, breast and endocrine procedures were excluded. Patient demographics and characteristics were collated. Primary outcomes were 30-day and 90-day mortality rates. The impact of ASA (American Society of Anesthesiologists) grade, operation severity and emergency presentation was assessed using multivariate analysis. Results Overall, 161 patients (58 elective, 103 emergency) were identified for inclusion in the study. The mean patient age was 92.8 years (range: 90-106 years). The 90-day mortality rates were 5.2% and 19.4% for elective and emergency procedures respectively (p=0.013). The median survival was 29 and 19 months respectively (p=0.001). Emergency and major gastrointestinal operations were associated with a significant increase in mortality. Patients undergoing emergency major colonic or upper gastrointestinal surgery had a 90-day mortality rate of 53.8%. Conclusions The risk for patients aged over 90 years having an elective procedure differs significantly in the short term from those having emergency surgery. In selected cases, elective surgery carries an acceptable mortality risk. Emergency surgery is associated with a significantly increased risk of death, particularly after major gastrointestinal resections.

Comparison of 30-day outcomes after emergency general surgery procedures: potential for targeted improvement.

PubMed

Ingraham, Angela M; Cohen, Mark E; Bilimoria, Karl Y; Raval, Mehul V; Ko, Clifford Y; Nathens, Avery B; Hall, Bruce L

2010-08-01

Patients who undergo emergency operations represent a high-risk population and have been shown to have a high risk of poor outcomes. Little is known, however, about the variability in the quality of emergency general surgical care across hospitals or within hospitals across different procedures. The objectives of this study were to identify risk factors associated with adverse events, to compare 30-day outcomes after 3 common emergency general surgery procedures within and across hospitals, and thus, to determine whether the quality of emergency surgical care is procedure-dependent or intrinsic to other aspects of the hospital environment. Patients who underwent emergency appendectomy, cholecystectomy, or colorectal resection at 95 hospitals that submitted at least 20 of each procedure were identified in the 2005-2008 American College of Surgeons National Surgical Quality Improvement Project database. Outcomes of interest included 30-day overall morbidity and serious morbidity/mortality. Step-wise logistic regression generated patient-level predicted probabilities of an outcome. Based on the expected probabilities, observed to expected (O/E) ratios for each outcome, after each of the 3 procedures, were calculated for each hospital. Hospitals were divided into terciles based on O/E ratios. The agreement on hospital outcomes performance for overall morbidity and serious morbidity/mortality after appendectomy, cholecystectomy, and colorectal resection was assessed using weighted kappa statistics. Of the 30,788 appendectomies, 1,984 (6.44%) patients had any morbidity, and 1,140 (3.70%) patients had a serious morbidity or died. Of the 5,824 cholecystectomies, 503 (8.64%) patients had any morbidity, and 371 (6.37%) patients had a serious morbidity or died. Of the 8,990 colorectal resections, 4,202 (46.74%) patients had any morbidity, and 3,736 (41.56%) patients had a serious morbidity or died. For overall morbidity, O/E ratios for appendectomy ranged from 0.26 to 2.36; O/E ratios for cholecystectomy ranged from 0 to 3.04; O/E ratios for colorectal resection ranged from 0.45 to 1.51. For serious morbidity/mortality, O/E ratios for appendectomy ranged from 0.23 to 2.54; O/E ratios for cholecystectomy ranged from 0 to 4.28; O/E ratios for colorectal resection ranged from 0.59 to 1.75. Associations of risk-adjusted hospital outcomes based on tercile rank between procedures demonstrated slight but significant agreement for both overall morbidity (weighted kappa between 0.20 and 0.22) and serious morbidity/mortality (weighted kappa between 0.18 and 0.22). Despite this, 7 (7.4%) hospitals for overall morbidity and 9 (9.5%) hospitals for serious morbidity/mortality were rated in the highest (best) tercile for all procedures. Eight (8.4%) hospitals for overall morbidity and 8 (8.4%) hospitals for serious morbidity/mortality were rated in the lowest tercile for all procedures. Emergency general surgery procedures, particularly colorectal resections, were associated with substantial 30-day overall morbidity and serious morbidity/mortality. Most hospitals did not have consistent risk-adjusted outcomes across all 3 procedures, but for a substantive minority of institutions (7-10%), good or bad performance was generalizable across procedures. Individual hospitals should examine their procedure-specific outcomes after emergency general surgery operations to focus quality improvement initiatives appropriately. Copyright 2010 Mosby, Inc. All rights reserved.

Distinguishing Acts of War in Cyberspace: Assessment Criteria, Policy Considerations, and Response Implications

DTIC Science & Technology

2014-10-01

process will help to harmonize important work on cyber policy and procedures within NATO and at the national level to ensure that the Alliance’s...conducts and practices its Emergency Action Procedures to defend the nation through interagency emergency cyber pro- cedures. During these conferences...via cyberspace, and does so in compliance with all applicable laws, policies, and procedures . The conduct of all U.S. intelligence operations is 64

Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia

PubMed Central

Vigneswaran, Yalini; Ujiki, Michael B

2015-01-01

Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy (LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure. PMID:26468336

Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years.

PubMed

Caesar, Ulla; Karlsson, Jon; Hansson, Elisabeth

2018-01-01

Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital's resources permit and/or the patients' health status has been optimised as needed. This may affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies. The main purpose of this retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital's records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied. We found that 24% (8474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. Eighty per cent of these delays were due to organisational causes. Twenty-one per cent of all the delayed patients had surgery within 24 h, whilst 41% waited for more than 24 h, up to 3 days. A large number of the clinic's emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes.

Emergency Simulation Drill

NASA Image and Video Library

2013-12-04

ISS038-E-011708 (4 Dec. 2013) --- In the International Space Station?s Zvezda Service Module, Russian cosmonaut Sergey Ryazanskiy, Expedition 38 flight engineer, reads a procedures checklist during an emergency simulation drill with participation from flight controllers on the ground. During the exercise, the crew practiced emergency communication and procedures in response to a predetermined scenario such as pressure leak.

40 CFR 267.56 - What are the required emergency procedures for the emergency coordinator?

Code of Federal Regulations, 2014 CFR

2014-07-01

... FACILITIES OPERATING UNDER A STANDARDIZED PERMIT Contingency Plan and Emergency Procedures § 267.56 What are... designated response roles if their help is needed. (b) Whenever there is a release, fire, or explosion, the... environment that may result from the release, fire, or explosion. This assessment must consider both direct...

40 CFR 267.56 - What are the required emergency procedures for the emergency coordinator?

Code of Federal Regulations, 2012 CFR

2012-07-01

... FACILITIES OPERATING UNDER A STANDARDIZED PERMIT Contingency Plan and Emergency Procedures § 267.56 What are... designated response roles if their help is needed. (b) Whenever there is a release, fire, or explosion, the... environment that may result from the release, fire, or explosion. This assessment must consider both direct...

40 CFR 267.56 - What are the required emergency procedures for the emergency coordinator?

Code of Federal Regulations, 2011 CFR

2011-07-01

... FACILITIES OPERATING UNDER A STANDARDIZED PERMIT Contingency Plan and Emergency Procedures § 267.56 What are... designated response roles if their help is needed. (b) Whenever there is a release, fire, or explosion, the... environment that may result from the release, fire, or explosion. This assessment must consider both direct...

Fire Prevention and Emergency Procedures. Module SH-05. Safety and Health.

ERIC Educational Resources Information Center

Center for Occupational Research and Development, Inc., Waco, TX.

This student module on fire prevention and emergency procedures is one of 50 modules concerned with job safety and health. This module discusses the chemistry of fire and the methods for extinguishment, along with the steps necessary for emergency action. Following the introduction, 10 objectives (each keyed to a page in the text) the student is…

Incidence and patterns of surgical glove perforations: experience from Addis Ababa, Ethiopia.

PubMed

Bekele, Abebe; Makonnen, Nardos; Tesfaye, Lidya; Taye, Mulat

2017-03-20

Surgical glove perforation is a common event. The operating staff is not aware of the perforation until the procedure is complete, sometimes in as high as 70% of the incidences. Data from Ethiopia indicates that the surgical workforce suffers from a very surgery related accidents, however there is paucity of data regarding surgical glove perforation. The main objective is to describe the incidence and patterns of surgical glove perforation during surgical procedures and to compare the rates between emergency and elective surgeries at one of the main hospitals in Addis Ababa Ethiopia. This is a prospective study, performed at the Minilik II referral hospital, Addis Ababa. All surgical gloves worn during all major surgical procedures (Emergency and Elective) from June 1-July 20, 2016 were collected and used for the study. Standardised visual and hydro insufflation techniques were used to test the gloves for perforations. Parameters recorded included type of procedure performed, number of perforations, localisation of perforation and the roles of the surgical team. A total of 2634 gloves were tested, 1588 from elective and 1026 from emergency procedures. The total rate of perforation in emergency procedures was 41.4%, while perforation in elective surgeries was 30.0%. A statistically significant difference (P < 0.05) was found in between emergency and elective surgeries. There were a very high rate of perforations of gloves among first surgeons 40.6% and scrub nurses 38.8% during elective procedures and among first surgeons (60.14%), and second assistants (53.0%) during emergency surgeries. Only 0.4% of inner gloves were perforated. The left hand, the left index finger and thumb were the most commonly perforated parts of the glove. Glove perforation rate was low among consultant surgeons than residents. Our reported perforation rate is higher than most publications, and this shows that the surgical workforce in Ethiopia is under a clear and present threat. Measures such as double gloving seems to have effectively prevented cutaneous blood exposure and thus should become a routine for all surgical procedures. Manufacturing related defects and faults in glove quality may also be contributing factors.

40 CFR 231.7 - Emergency procedure.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., or recreational areas, and that the public health, interest, or safety requires, the Administrator... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Emergency procedure. 231.7 Section 231.7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) OCEAN DUMPING SECTION 404(c...

40 CFR 231.7 - Emergency procedure.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., or recreational areas, and that the public health, interest, or safety requires, the Administrator... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Emergency procedure. 231.7 Section 231.7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) OCEAN DUMPING SECTION 404(c...

40 CFR 231.7 - Emergency procedure.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., or recreational areas, and that the public health, interest, or safety requires, the Administrator... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Emergency procedure. 231.7 Section 231.7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) OCEAN DUMPING SECTION 404(c...

40 CFR 231.7 - Emergency procedure.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., or recreational areas, and that the public health, interest, or safety requires, the Administrator... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Emergency procedure. 231.7 Section 231.7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) OCEAN DUMPING SECTION 404(c...

10 CFR 39.63 - Operating and emergency procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and... radiation surveys, including surveys for detecting contamination, as required by § 39.67(c)-(e); (d...

10 CFR 39.63 - Operating and emergency procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and... radiation surveys, including surveys for detecting contamination, as required by § 39.67(c)-(e); (d...

10 CFR 39.63 - Operating and emergency procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and... radiation surveys, including surveys for detecting contamination, as required by § 39.67(c)-(e); (d...

10 CFR 39.63 - Operating and emergency procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and... radiation surveys, including surveys for detecting contamination, as required by § 39.67(c)-(e); (d...

10 CFR 39.63 - Operating and emergency procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and... radiation surveys, including surveys for detecting contamination, as required by § 39.67(c)-(e); (d...

10 CFR 205.376 - Rates and charges.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Emergency Interconnection of Electric Facilities and the Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power § 205.376 Rates and charges...

Use of National Burden to Define Operative Emergency General Surgery.

PubMed

Scott, John W; Olufajo, Olubode A; Brat, Gabriel A; Rose, John A; Zogg, Cheryl K; Haider, Adil H; Salim, Ali; Havens, Joaquim M

2016-06-15

Emergency general surgery (EGS) represents 11% of surgical admissions and 50% of surgical mortality in the United States. However, there is currently no established definition of the EGS procedures. To define a set of procedures accounting for at least 80% of the national burden of operative EGS. A retrospective review was conducted using data from the 2008-2011 National Inpatient Sample. Adults (age, ≥18 years) with primary EGS diagnoses consistent with the American Association for the Surgery of Trauma definition, admitted urgently or emergently, who underwent an operative procedure within 2 days of admission were included in the analyses. Procedures were ranked to account for national mortality and complication burden. Among ranked procedures, contributions to total EGS frequency, mortality, and hospital costs were assessed. The data query and analysis were performed between November 15, 2015, and February 16, 2016. Overall procedure frequency, in-hospital mortality, major complications, and inpatient costs calculated per 3-digit International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. The study identified 421 476 patient encounters associated with operative EGS, weighted to represent 2.1 million nationally over the 4-year study period. The overall mortality rate was 1.23% (95% CI, 1.18%-1.28%), the complication rate was 15.0% (95% CI, 14.6%-15.3%), and mean cost per admission was $13 241 (95% CI, $12 957-$13 525). After ranking the 35 procedure groups by contribution to EGS mortality and morbidity burden, a final set of 7 operative EGS procedures were identified, which collectively accounted for 80.0% of procedures, 80.3% of deaths, 78.9% of complications, and 80.2% of inpatient costs nationwide. These 7 procedures included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy. Only 7 procedures account for most admissions, deaths, complications, and inpatient costs attributable to the 512 079 EGS procedures performed in the United States each year. National quality benchmarks and cost reduction efforts should focus on these common, complicated, and costly EGS procedures.

The current status of emergency operations at a high-volume cancer center.

PubMed

Komori, Koji; Kimura, Kenya; Kinoshita, Takashi; Ito, Seiji; Abe, Tetsuya; Senda, Yoshiki; Misawa, Kazunari; Ito, Yuichi; Uemura, Norihisa; Natsume, Seiji; Kawai, Ryosuke; Kawakami, Jiro; Asano, Tomonari; Iwata, Yoshinori; Kurahashi, Shintaro; Tsutsuyama, Masayuki; Shigeyoshi, Itaru; Shimizu, Yasuhiro

2014-01-01

This study aimed to assess the pathogenic causes, clinical conditions, surgical procedures, in-hospital mortality, and operative death associated with emergency operations at a high-volume cancer center. Although many reports have described the contents, operative procedures, and prognosis of elective surgeries in high-volume cancer centers, emergency operations have not been studied in sufficient detail. We retrospectively enrolled 28 consecutive patients who underwent emergency surgery. Cases involving operative complications were excluded. The following surgical procedures were performed during emergency operations: closure in 3 cases (10.7%), diversion in 22 cases (78.6%), ileus treatment in 2 cases (7.1%), and hemostasis in 1 case (3.6%). Closure alone was performed only once for peritonitis. Diversion was performed in 17 cases (77.3%) of peritonitis, 4 cases (18.2%) of stenosis of the gastrointestinal tract, and 1 case (4.5%) of bleeding. There was a significant overall difference (P = 0.001). The frequency of emergency operations was very low at a high-volume cancer center. However, the recent shift in treatment approaches toward nonoperative techniques may enhance the status of emergency surgical procedures. The results presented in this study will help prepare for emergency situations and resolve them as quickly and efficiently as possible.

47 CFR 211.0 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL EMERGENCY RESTORATION PRIORITY PROCEDURES FOR TELECOMMUNICATIONS SERVICES § 211.0 Purpose. This part establishes policies and procedures.... 820), policies, plans, and procedures developed pursuant to the Executive order shall be in consonance...

47 CFR 211.0 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL EMERGENCY RESTORATION PRIORITY PROCEDURES FOR TELECOMMUNICATIONS SERVICES § 211.0 Purpose. This part establishes policies and procedures.... 820), policies, plans, and procedures developed pursuant to the Executive order shall be in consonance...

47 CFR 211.0 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL EMERGENCY RESTORATION PRIORITY PROCEDURES FOR TELECOMMUNICATIONS SERVICES § 211.0 Purpose. This part establishes policies and procedures.... 820), policies, plans, and procedures developed pursuant to the Executive order shall be in consonance...

47 CFR 211.0 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL EMERGENCY RESTORATION PRIORITY PROCEDURES FOR TELECOMMUNICATIONS SERVICES § 211.0 Purpose. This part establishes policies and procedures.... 820), policies, plans, and procedures developed pursuant to the Executive order shall be in consonance...

47 CFR 211.0 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL EMERGENCY RESTORATION PRIORITY PROCEDURES FOR TELECOMMUNICATIONS SERVICES § 211.0 Purpose. This part establishes policies and procedures.... 820), policies, plans, and procedures developed pursuant to the Executive order shall be in consonance...

Emergent conditional relations in a Go/No-Go procedure: figure-ground and stimulus-position compound relations.

PubMed

Debert, Paula; Huziwara, Edson M; Faggiani, Robson Brino; De Mathis, Maria Eugênia Simões; McIlvane, William J

2009-09-01

Past research has demonstrated emergent conditional relations using a go/no-go procedure with pairs of figures displayed side-by-side on a computer screen. The present study sought to extend applications of this procedure. In Experiment 1, we evaluated whether emergent conditional relations could be demonstrated when two-component stimuli were displayed in figure-ground relationships-abstract figures displayed on backgrounds of different colors. Five normally capable adults participated. During training, each two-component stimulus was presented successively. Responses emitted in the presence of some stimulus pairs (A1B1, A2B2, A3B3, B1C1, B2C2 and B3C3) were reinforced, whereas responses emitted in the presence of other pairs (A1B2, A1B3, A2B1, A2B3, A3B1, A3B2, B1C2, B1C3, B2C1, B2C3, B3C1 and B3C2) were not. During tests, new configurations (AC and CA) were presented, thus emulating structurally the matching-to-sample tests employed in typical equivalence studies. All participants showed emergent relations consistent with stimulus equivalence during testing. In Experiment 2, we systematically replicated the procedures with stimulus compounds consisting of four figures (A1, A2, C1 and C2) and two locations (left - B1 and right - B2). All 6 normally capable adults exhibited emergent stimulus-stimulus relations. Together, these experiments show that the go/no-go procedure is a potentially useful alternative for studying emergent conditional relations when matching-to-sample is procedurally cumbersome or impossible to use.

Emergency percutaneous treatment in surgical bile duct injury.

PubMed

Carrafiello, Gianpaolo; Laganà, Domenico; Dizonno, Massimiliano; Ianniello, Andrea; Cotta, Elisa; Dionigi, Gianlorenzo; Dionigi, Renzo; Fugazzola, Carlo

2008-09-01

The aim of this study is to evaluate the efficacy of emergency percutaneous treatment in patients with surgical bile duct injury (SBDI). From May 2004 to May 2007, 11 patients (five men, six women; age range 26-80 years; mean age 58 years) with a critical clinical picture (severe jaundice, bile peritonitis, septic state) due to SBDI secondary to surgical or laparoscopic procedures were treated by percutaneous procedures. We performed four ultrasound-guided percutaneous drainages, four external-internal biliary drainages, one bilioplasty, and two plastic biliary stenting after 2 weeks of external-internal biliary drainage placement. All procedures had 100% technical success with no complications. The clinical emergencies resolved in 3-4 days in 100% of cases. All patients had a benign clinical course, and reoperation was avoided in 100% of cases. Interventional radiological procedures are effective in the emergency management of SBDI since they are minimally invasive and have a high success rate and a low incidence of complications compared to the more complex and dangerous surgical or laparoscopic options.

Emergency Kausch-Whipple procedure: indications and experiences.

PubMed

Standop, Jens; Glowka, Tim; Schmitz, Volker; Schaefer, Nico; Hirner, Andreas; Kalff, Jörg C

2010-03-01

Pancreaticoduodenectomy is a demanding procedure even in selected patients but becomes formidable when performed in cases of emergency. This study analyzed our experience with urgent pancreatoduodenectomies; special emphases were put on the evaluation of diagnostic means and the validation of existing indications for performance of this procedure. Three hundred one patients who underwent pancreatoduodenectomy between 1989 and 2008 were identified from a pancreatic resection database and reviewed for emergency indications. Six patients (2%) underwent emergency pancreatoduodenectomy. Indications included endoscopy-related perforation, postoperative complications, and uncontrollable intraduodenal tumor bleeding. Length of stay and occurrence of nonsurgical complications were increased in emergency compared with elective pancreatoduodenectomies. Although increased, no significant differences were found regarding mortality and surgery-related complications. Indications for emergency pancreatoduodenectomies were based on clinical decisions rather than on radiologic diagnostics. Urgent pancreatic head resections may be considered as an option in selected patients if handling of local complications by interventional measures or limited surgery seems unsafe.

The information needs of patients receiving procedural sedation in a hospital emergency department.

PubMed

Revell, Sue; Searle, Judy; Thompson, Shona

2017-07-01

This research investigated the information needs of patients receiving ED procedural sedation to determine the best format to consistently deliver key information in a way acceptable to all involved. Of particular interest was the question concerning patients' need for receiving written information. A descriptive exploratory study gathered qualitative data through face-to-face interviews and focus groups involving patients, nurses and medical staff. Individual interviews were conducted with eight adult patients following procedural sedation. They identified very few gaps in terms of specific information they needed pertaining to procedural sedation and rejected the need for receiving information in a written format. Their information needs related to a central concern for safety and trust. Focus groups, reflecting on the findings from patients, were conducted with five ED nurses and four emergency medicine consultants/registrars who regularly provided procedural sedation. Themes that emerged from the analysis of data from all three groups identified the issues concerning patient information needs as being: competence and efficiency of staff; explanations of procedures and progress; support person presence; and medico-legal issues. The research confirms that the quality of the patient's ED experience, specifically related to procedural sedation, is enhanced by ED staff, especially nurses, providing them with ongoing and repeated verbal information relevant to their circumstances. Copyright © 2017 Elsevier Ltd. All rights reserved.

Preliminary Investigation of Time Remaining Display on the Computer-based Emergency Operating Procedure

NASA Astrophysics Data System (ADS)

Suryono, T. J.; Gofuku, A.

2018-02-01

One of the important thing in the mitigation of accidents in nuclear power plant accidents is time management. The accidents should be resolved as soon as possible in order to prevent the core melting and the release of radioactive material to the environment. In this case, operators should follow the emergency operating procedure related with the accident, in step by step order and in allowable time. Nowadays, the advanced main control rooms are equipped with computer-based procedures (CBPs) which is make it easier for operators to do their tasks of monitoring and controlling the reactor. However, most of the CBPs do not include the time remaining display feature which informs operators of time available for them to execute procedure steps and warns them if the they reach the time limit. Furthermore, the feature will increase the awareness of operators about their current situation in the procedure. This paper investigates this issue. The simplified of emergency operating procedure (EOP) of steam generator tube rupture (SGTR) accident of PWR plant is applied. In addition, the sequence of actions on each step of the procedure is modelled using multilevel flow modelling (MFM) and influenced propagation rule. The prediction of action time on each step is acquired based on similar case accidents and the Support Vector Regression. The derived time will be processed and then displayed on a CBP user interface.

10 CFR 34.81 - Copies of operating and emergency procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Copies of operating and emergency procedures. 34.81 Section 34.81 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.81 Copies of...

10 CFR 34.81 - Copies of operating and emergency procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Copies of operating and emergency procedures. 34.81 Section 34.81 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.81 Copies of...

10 CFR 34.81 - Copies of operating and emergency procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Copies of operating and emergency procedures. 34.81 Section 34.81 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.81 Copies of...

10 CFR 34.81 - Copies of operating and emergency procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Copies of operating and emergency procedures. 34.81 Section 34.81 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.81 Copies of...

10 CFR 34.81 - Copies of operating and emergency procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Copies of operating and emergency procedures. 34.81 Section 34.81 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.81 Copies of...

40 CFR 304.23 - Disclosure and challenge procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Disclosure and challenge procedures. 304.23 Section 304.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST...

40 CFR 304.23 - Disclosure and challenge procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Disclosure and challenge procedures. 304.23 Section 304.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST...

40 CFR 304.23 - Disclosure and challenge procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Disclosure and challenge procedures. 304.23 Section 304.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST...

14 CFR 121.422 - Aircraft dispatchers: Initial and transition ground training.

Code of Federal Regulations, 2011 CFR

2011-01-01

... computations; (iv) Basic airplane performance dispatch requirements and procedures; (v) Flight planning including track selection, flight time analysis, and fuel requirements; and (vi) Emergency procedures. (3... procedures, and other subjects having a bearing on dispatcher duties and responsibilities; (ii) Flight...

14 CFR 121.422 - Aircraft dispatchers: Initial and transition ground training.

Code of Federal Regulations, 2012 CFR

2012-01-01

... computations; (iv) Basic airplane performance dispatch requirements and procedures; (v) Flight planning including track selection, flight time analysis, and fuel requirements; and (vi) Emergency procedures. (3... procedures, and other subjects having a bearing on dispatcher duties and responsibilities; (ii) Flight...

14 CFR 121.422 - Aircraft dispatchers: Initial and transition ground training.

Code of Federal Regulations, 2013 CFR

2013-01-01

... computations; (iv) Basic airplane performance dispatch requirements and procedures; (v) Flight planning including track selection, flight time analysis, and fuel requirements; and (vi) Emergency procedures. (3... procedures, and other subjects having a bearing on dispatcher duties and responsibilities; (ii) Flight...

14 CFR 121.422 - Aircraft dispatchers: Initial and transition ground training.

Code of Federal Regulations, 2010 CFR

2010-01-01

... computations; (iv) Basic airplane performance dispatch requirements and procedures; (v) Flight planning including track selection, flight time analysis, and fuel requirements; and (vi) Emergency procedures. (3... procedures, and other subjects having a bearing on dispatcher duties and responsibilities; (ii) Flight...

14 CFR 121.422 - Aircraft dispatchers: Initial and transition ground training.

Code of Federal Regulations, 2014 CFR

2014-01-01

... computations; (iv) Basic airplane performance dispatch requirements and procedures; (v) Flight planning including track selection, flight time analysis, and fuel requirements; and (vi) Emergency procedures. (3... procedures, and other subjects having a bearing on dispatcher duties and responsibilities; (ii) Flight...

3D force/torque characterization of emergency cricothyroidotomy procedure using an instrumented scalpel.

PubMed

Ryason, Adam; Sankaranarayanan, Ganesh; Butler, Kathryn L; DeMoya, Marc; De, Suvranu

2016-08-01

Emergency Cricothyroidotomy (CCT) is a surgical procedure performed to secure a patient's airway. This high-stakes, but seldom-performed procedure is an ideal candidate for a virtual reality simulator to enhance physician training. For the first time, this study characterizes the force/torque characteristics of the cricothyroidotomy procedure, to guide development of a virtual reality CCT simulator for use in medical training. We analyze the upper force and torque thresholds experienced at the human-scalpel interface. We then group individual surgical cuts based on style of cut and cut medium and perform a regression analysis to create two models that allow us to predict the style of cut performed and the cut medium.

44 CFR 19.135 - Designation of responsible employee and adoption of grievance procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Introduction... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Designation of responsible employee and adoption of grievance procedures. 19.135 Section 19.135 Emergency Management and Assistance...

A PROTOTYPE MANUAL ON CIVIL DEFENSE ASPECTS OF WATERWORKS OPERATIONS

DTIC Science & Technology

survival and recovery in the event of a nuclear war; (2) to stimulate and assist water utilities i developing emergency plans to cope with a nuclear ... disaster ; (3) to provide a procedural guide for restoration and for training personnel in postattack emergency repair procedures, recovery techniques, and safety measures.

28 CFR 65.84 - Procedures for the Attorney General when seeking State or local assistance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.84 Procedures for... operational direction to State or local law enforcement officers assisting in a Federal response pursuant to... local law enforcement officers to exercise Federal immigration enforcement authority under the...

28 CFR 65.84 - Procedures for the Attorney General when seeking State or local assistance.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.84 Procedures for... operational direction to State or local law enforcement officers assisting in a Federal response pursuant to... local law enforcement officers to exercise Federal immigration enforcement authority under the...

28 CFR 65.84 - Procedures for the Attorney General when seeking State or local assistance.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.84 Procedures for... operational direction to State or local law enforcement officers assisting in a Federal response pursuant to... local law enforcement officers to exercise Federal immigration enforcement authority under the...

28 CFR 65.84 - Procedures for the Attorney General when seeking State or local assistance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.84 Procedures for... operational direction to State or local law enforcement officers assisting in a Federal response pursuant to... local law enforcement officers to exercise Federal immigration enforcement authority under the...

10 CFR 36.53 - Operating and emergency procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Operating and emergency procedures. 36.53 Section 36.53 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR IRRADIATORS Operation... the source storage pool; (6) A prolonged loss of electrical power; (7) A fire alarm or explosion in...

10 CFR 36.53 - Operating and emergency procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Operating and emergency procedures. 36.53 Section 36.53 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR IRRADIATORS Operation... the source storage pool; (6) A prolonged loss of electrical power; (7) A fire alarm or explosion in...

10 CFR 36.53 - Operating and emergency procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Operating and emergency procedures. 36.53 Section 36.53 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR IRRADIATORS Operation... the source storage pool; (6) A prolonged loss of electrical power; (7) A fire alarm or explosion in...

49 CFR 192.605 - Procedural manual for operations, maintenance, and emergencies.

Code of Federal Regulations, 2011 CFR

2011-10-01

... maintenance activities and for emergency response. For transmission lines, the manual must also include... and effective manner. (5) Starting up and shutting down any part of the pipeline in a manner designed... control room management procedures required by § 192.631. (c) Abnormal operation. For transmission lines...

Accidental fetal lacerations during cesarean delivery: experience in an Italian level III university hospital.

PubMed

Dessole, Salvatore; Cosmi, Erich; Balata, Antonio; Uras, Luisa; Caserta, Donatella; Capobianco, Giampiero; Ambrosini, Guido

2004-11-01

The purpose of this study was to investigate the incidence, type, location, and risk factors of accidental fetal lacerations during cesarean delivery. Total deliveries, cesarean deliveries, and neonatal records for documented accidental fetal lacerations were reviewed retrospectively in our level III university hospital. The gestational age, the presenting part of the fetus, the cesarean delivery indication, the type of incision, and the surgeon who performed the procedure were recorded. Cesarean deliveries were divided into scheduled, unscheduled, and emergency procedures. Fetal lacerations were divided into mild, moderate, and severe. Neonatal follow-up examinations regarding laceration sequelae were available for 6 months. Of 14926 deliveries, 3108 women were delivered by cesarean birth (20.82%). Neonatal records documented 97 accidental fetal lacerations. Of these accidental lacerations, 94 were mild; 2 were moderate, and 1 was severe. The overall rate of accidental fetal laceration per cesarean delivery was 3.12%; the accidental laceration rate in the cohort of fetuses was 2.46%. The crude odds ratios were 0.34 for scheduled procedures, 0.57 for unscheduled procedures, and 1.7 for emergency procedures. The risk for fetal accidental lacerations was higher in fetuses who underwent emergency cesarean birth and lower for unscheduled and scheduled cesarean births (P < .001). Fetal accidental laceration may occur during cesarean delivery; the incidence is significantly higher during emergency cesarean delivery compared with elective procedures. The patient should be counseled about the occurrence of fetal laceration during cesarean delivery to avoid litigation.

Factors associated with no dental treatment in preschoolers with toothache: a cross-sectional study in outpatient public emergency services.

PubMed

Machado, Geovanna C M; Daher, Anelise; Costa, Luciane R

2014-08-08

Many parents rely on emergency services to deal with their children's dental problems, mostly pain and infection associated with dental caries. This cross-sectional study analyzed the factors associated with not doing an oral procedure in preschoolers with toothache attending public dental emergency services. Data were obtained from the clinical files of preschoolers treated at all nine dental emergency centers in Goiania, Brazil, in 2011. Data were children's age and sex, involved teeth, oral procedures, radiography request, medications prescribed and referrals. A total of 531 files of children under 6 years old with toothache out of 1,108 examined were selected. Children's mean age was 4.1 (SD 1.0) years (range 1-5 years) and 51.6% were girls. No oral procedures were performed in 49.2% of cases; in the other 50.8%, most of the oral procedures reported were endodontic intervention and temporary restorations. Primary molars were involved in 48.4% of cases. With the exception of "sex", the independent variables tested in the regression analysis significantly associated with non-performance of oral procedures: age (OR 0.7; 95% CI 0.5-0.8), radiography request (OR 3.8; 95% CI 1.7-8.2), medication prescribed (OR 7.5; 95% CI 4.9-11.5) and patient referred to another service (OR 5.7; 3.0-10.9). Many children with toothache received no oral procedure for pain relief.

23 CFR 668.215 - Programming and project procedures.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 23 Highways 1 2013-04-01 2013-04-01 false Programming and project procedures. 668.215 Section 668.215 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS EMERGENCY RELIEF PROGRAM Procedures for Federal Agencies for Federal Roads § 668.215 Programming...

23 CFR 668.215 - Programming and project procedures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 23 Highways 1 2014-04-01 2014-04-01 false Programming and project procedures. 668.215 Section 668.215 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS EMERGENCY RELIEF PROGRAM Procedures for Federal Agencies for Federal Roads § 668.215 Programming...

23 CFR 668.215 - Programming and project procedures.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 23 Highways 1 2012-04-01 2012-04-01 false Programming and project procedures. 668.215 Section 668.215 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS EMERGENCY RELIEF PROGRAM Procedures for Federal Agencies for Federal Roads § 668.215 Programming...

14 CFR 125.287 - Initial and recurrent pilot testing requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., instrument approach facilities and procedures; (5) Air traffic control procedures, including IFR procedures... certificate holder; (2) For each type of airplane to be flown by the pilot, the airplane powerplant, major components and systems, major appliances, performance and operating limitations, standard and emergency...

44 CFR 208.52 - Reimbursement procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement procedures. 208... Reimbursement Claims and Appeals § 208.52 Reimbursement procedures. (a) General. A Sponsoring Agency must present a claim for reimbursement to DHS in such manner as the Assistant Administrator specifies . (b...

23 CFR 668.215 - Programming and project procedures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Programming and project procedures. 668.215 Section 668.215 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS EMERGENCY RELIEF PROGRAM Procedures for Federal Agencies for Federal Roads § 668.215 Programming...

44 CFR 7.948 - Alternate funds disbursal procedure.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Alternate funds disbursal... Investigation, Conciliation, and Enforcement Procedures § 7.948 Alternate funds disbursal procedure. (a) When FEMA withholds funds from recipient under this regulation, the Administrator may, if allowable under...

23 CFR 668.215 - Programming and project procedures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Programming and project procedures. 668.215 Section 668.215 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS EMERGENCY RELIEF PROGRAM Procedures for Federal Agencies for Federal Roads § 668.215 Programming...

Definition of Specific Functions and Procedural Skills Required by Cuban Specialists in Intensive Care and Emergency Medicine.

PubMed

Véliz, Pedro L; Berra, Esperanza M; Jorna, Ana R

2015-07-01

INTRODUCTION Medical specialties' core curricula should take into account functions to be carried out, positions to be filled and populations to be served. The functions in the professional profile for specialty training of Cuban intensive care and emergency medicine specialists do not include all the activities that they actually perform in professional practice. OBJECTIVE Define the specific functions and procedural skills required of Cuban specialists in intensive care and emergency medicine. METHODS The study was conducted from April 2011 to September 2013. A three-stage methodological strategy was designed using qualitative techniques. By purposive maximum variation sampling, 82 professionals were selected. Documentary analysis and key informant criteria were used in the first stage. Two expert groups were formed in the second stage: one used various group techniques (focus group, oral and written brainstorming) and the second used a three-round Delphi method. In the final stage, a third group of experts was questioned in semistructured in-depth interviews, and a two-round Delphi method was employed to assess priorities. RESULTS Ultimately, 78 specific functions were defined: 47 (60.3%) patient care, 16 (20.5%) managerial, 6 (7.7%) teaching, and 9 (11.5%) research. Thirty-one procedural skills were identified. The specific functions and procedural skills defined relate to the profession's requirements in clinical care of the critically ill, management of patient services, teaching and research at the specialist's different occupational levels. CONCLUSIONS The specific functions and procedural skills required of intensive care and emergency medicine specialists were precisely identified by a scientific method. This product is key to improving the quality of teaching, research, administration and patient care in this specialty in Cuba. The specific functions and procedural skills identified are theoretical, practical, methodological and social contributions to inform future curricular reform and to help intensive care specialists enhance their performance in comprehensive patient care. KEYWORDS Intensive care, urgent care, emergency medicine, continuing medical education, curriculum, diagnostic techniques and procedures, medical residency, Cuba.

Human Factors and ISS Medical Systems: Highlights of Procedures and Equipment Findings

NASA Technical Reports Server (NTRS)

Byrne, V. E.; Hudy, C.; Smith, D.; Whitmore, M.

2005-01-01

As part of the Space Human Factors Engineering Critical Questions Roadmap, a three year Technology Development Project (TDP) was funded by NASA Headquarters to examine emergency medical procedures on ISS. The overall aim of the emergency medical procedures project was to determine the human factors issues in the procedures, training, communications and equipment, and to recommend solutions that will improve the survival rate of crewmembers in the event of a medical emergency. Currently, each ISS crew remains on orbit for six month intervals. As there is not standing requirement for a physician crewmember, during such time, the maintenance of crew health is dependant on individual crewmembers. Further, in the event of an emergency, crew will need to provide prolonged maintenance care, as well as emergency treatment, to an injured crewmember while awaiting transport to Earth. In addition to the isolation of the crew, medical procedures must be carried out within the further limitations imposed by the physical environment of the space station. For example, in order to administer care on ISS without the benefit of gravity, the Crew Medical Officers (CMOs) must restrain the equipment required to perform the task, restrain the injured crewmember, and finally, restrain themselves. Both the physical environment and the physical space available further limit the technology that can be used onboard. Equipment must be compact, yet able to withstand high levels of radiation and function without gravity. The focus here is to highlight the human factors impacts from our three year project involving the procedures and equipment areas that have been investigated and provided valuable to ISS and provide groundwork for human factors requirements for medical applications for exploration missions.

Standard operating procedures improve acute neurologic care in a sub-Saharan African setting

PubMed Central

Jaiteh, Lamin E.S.; Helwig, Stefan A.; Jagne, Abubacarr; Ragoschke-Schumm, Andreas; Sarr, Catherine; Walter, Silke; Lesmeister, Martin; Manitz, Matthias; Blaß, Sebastian; Weis, Sarah; Schlund, Verena; Bah, Neneh; Kauffmann, Jil; Fousse, Mathias; Kangankan, Sabina; Ramos Cabrera, Asmell; Kronfeld, Kai; Ruckes, Christian; Liu, Yang; Nyan, Ousman

2017-01-01

Objective: Quality of neurologic emergency management in an under-resourced country may be improved by standard operating procedures (SOPs). Methods: Neurologic SOPs were implemented in a large urban (Banjul) and a small rural (Brikama) hospital in the Gambia. As quality indicators of neurologic emergency management, performance of key procedures was assessed at baseline and in the first and second implementation years. Results: At Banjul, 100 patients of the first-year intervention group exhibited higher rates of general procedures of emergency management than 105 control patients, such as neurologic examination (99.0% vs 91.4%; p < 0.05) and assessments of respiratory rate (98.0% vs 81.9%, p < 0.001), temperature (60.0% vs 36.2%; p < 0.001), and glucose levels (73.0% vs 58.1%; p < 0.05), in addition to written directives by physicians (96.0% vs 88.6%, p < 0.05), whereas assessments of other vital signs remained unchanged. In stroke patients, rates of stroke-related procedures increased: early CT scanning (24.3% vs 9.9%; p < 0.05), blood count (73.0% vs 49.3%; p < 0.01), renal and liver function tests (50.0% vs 5.6%, p < 0.001), aspirin prophylaxis (47.3% vs 9.9%; p < 0.001), and physiotherapy (41.9% vs 4.2%; p < 0.001). Most effects persisted until the second-year evaluation. SOP implementation was similarly feasible and beneficial at the Brikama hospital. However, outcomes did not significantly differ in the hospitals. Conclusions: Implementing SOPs is a realistic, low-cost option for improving process quality of neurologic emergency management in under-resourced settings. Classification of evidence: This study provides Class IV evidence that, for patients with suspected neurologic emergencies in sub-Saharan Africa, neurologic SOPs increase the rate of performance of guideline-recommended procedures. PMID:28600460

33 CFR 203.72 - Eligibility criteria and procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 3 2014-07-01 2014-07-01 false Eligibility criteria and procedures. 203.72 Section 203.72 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE EMERGENCY EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Advance...

33 CFR 203.72 - Eligibility criteria and procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 3 2012-07-01 2012-07-01 false Eligibility criteria and procedures. 203.72 Section 203.72 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE EMERGENCY EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Advance...

33 CFR 203.72 - Eligibility criteria and procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 3 2013-07-01 2013-07-01 false Eligibility criteria and procedures. 203.72 Section 203.72 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE EMERGENCY EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Advance...

46 CFR 309.1 - Procedure.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Procedure. 309.1 Section 309.1 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS VALUES FOR WAR RISK INSURANCE § 309.1 Procedure... vessels upon which interim binders for war risk hull insurance have been issued. Such values shall be...

46 CFR 309.1 - Procedure.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Procedure. 309.1 Section 309.1 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS VALUES FOR WAR RISK INSURANCE § 309.1 Procedure... vessels upon which interim binders for war risk hull insurance have been issued. Such values shall be...

46 CFR 309.1 - Procedure.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Procedure. 309.1 Section 309.1 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS VALUES FOR WAR RISK INSURANCE § 309.1 Procedure... vessels upon which interim binders for war risk hull insurance have been issued. Such values shall be...

46 CFR 309.1 - Procedure.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Procedure. 309.1 Section 309.1 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS VALUES FOR WAR RISK INSURANCE § 309.1 Procedure... vessels upon which interim binders for war risk hull insurance have been issued. Such values shall be...

46 CFR 309.1 - Procedure.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Procedure. 309.1 Section 309.1 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS VALUES FOR WAR RISK INSURANCE § 309.1 Procedure... vessels upon which interim binders for war risk hull insurance have been issued. Such values shall be...

Skin resurfacing procedures: new and emerging options

PubMed Central

Loesch, Mathew M; Somani, Ally-Khan; Kingsley, Melanie M; Travers, Jeffrey B; Spandau, Dan F

2014-01-01

The demand for skin resurfacing and rejuvenating procedures has progressively increased in the last decade and has sparked several advances within the skin resurfacing field that promote faster healing while minimizing downtime and side effects for patients. Several technological and procedural skin resurfacing developments are being integrated into clinical practices today allowing clinicians to treat a broader range of patients’ skin types and pathologies than in years past, with noteworthy outcomes. This article will discuss some emerging and developing resurfacing therapies and treatments that are present today and soon to be available. PMID:25210469

Skin resurfacing procedures: new and emerging options.

PubMed

Loesch, Mathew M; Somani, Ally-Khan; Kingsley, Melanie M; Travers, Jeffrey B; Spandau, Dan F

2014-01-01

The demand for skin resurfacing and rejuvenating procedures has progressively increased in the last decade and has sparked several advances within the skin resurfacing field that promote faster healing while minimizing downtime and side effects for patients. Several technological and procedural skin resurfacing developments are being integrated into clinical practices today allowing clinicians to treat a broader range of patients' skin types and pathologies than in years past, with noteworthy outcomes. This article will discuss some emerging and developing resurfacing therapies and treatments that are present today and soon to be available.

17 CFR Appendix B to Part 36 - Guidance on, and Acceptable Practices in, Compliance With Core Principles

Code of Federal Regulations, 2010 CFR

2010-04-01

... decision-making process and the reasons for using its emergency action authority. Information on steps... have clear procedures and guidelines for decision-making regarding emergency intervention in the market, including procedures and guidelines to avoid conflicts of interest while carrying out such decision-making...

Robotics in endoscopy.

PubMed

Klibansky, David; Rothstein, Richard I

2012-09-01

The increasing complexity of intralumenal and emerging translumenal endoscopic procedures has created an opportunity to apply robotics in endoscopy. Computer-assisted or direct-drive robotic technology allows the triangulation of flexible tools through telemanipulation. The creation of new flexible operative platforms, along with other emerging technology such as nanobots and steerable capsules, can be transformational for endoscopic procedures. In this review, we cover some background information on the use of robotics in surgery and endoscopy, and review the emerging literature on platforms, capsules, and mini-robotic units. The development of techniques in advanced intralumenal endoscopy (endoscopic mucosal resection and endoscopic submucosal dissection) and translumenal endoscopic procedures (NOTES) has generated a number of novel platforms, flexible tools, and devices that can apply robotic principles to endoscopy. The development of a fully flexible endoscopic surgical toolkit will enable increasingly advanced procedures to be performed through natural orifices. The application of platforms and new flexible tools to the areas of advanced endoscopy and NOTES heralds the opportunity to employ useful robotic technology. Following the examples of the utility of robotics from the field of laparoscopic surgery, we can anticipate the emerging role of robotic technology in endoscopy.

Assessing physician-parent communication during emergency medical procedures in children: an observational study in a low-literacy Latino patient population.

PubMed

Dahl, Aaron; Sinha, Madhumita; Rosenberg, David I; Tran, Melissa; Valdez, André

2015-05-01

Effective physician-patient communication is critical to the clinical decision-making process. We studied parental recall of information provided during an informed consent discussion process before performance of emergency medical procedures in a pediatric emergency department of an inner-city hospital with a large bilingual population. Fifty-five parent/child dyads undergoing emergency medical procedures were surveyed prospectively in English/Spanish postprocedure for recall of informed consent information. Exact logistic regression was used to predict the ability to name a risk, benefit, and alternative to the procedure based on a parent's language, education, and acculturation. Among English-speaking parents, there tended to be higher proportions that could name a risk, benefit, or alternative. Our regression models showed overall that the parents with more than a high school education tended to have nearly 5 times higher odds of being able to name a risk. A gap in communication may exist between physicians and patients (or parents of patients) during the consent-taking process, and this gap may be impacted by socio-demographic factors such as language and education level.

14 CFR 121.315 - Cockpit check procedure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Cockpit check procedure. 121.315 Section 121.315 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... emergencies. The procedures must be designed so that a flight crewmember will not need to rely upon his memory...

47 CFR 214.6 - Postattack procedures and actions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Postattack procedures and actions. 214.6 Section 214.6 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR THE USE AND COORDINATION OF THE RADIO SPECTRUM DURING A WARTIME EMERGENCY § 214.6 Postattack...

47 CFR 214.6 - Postattack procedures and actions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Postattack procedures and actions. 214.6 Section 214.6 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR THE USE AND COORDINATION OF THE RADIO SPECTRUM DURING A WARTIME EMERGENCY § 214.6 Postattack...

47 CFR 214.6 - Postattack procedures and actions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Postattack procedures and actions. 214.6 Section 214.6 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR THE USE AND COORDINATION OF THE RADIO SPECTRUM DURING A WARTIME EMERGENCY § 214.6 Postattack...

47 CFR 214.6 - Postattack procedures and actions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 5 2011-10-01 2011-10-01 false Postattack procedures and actions. 214.6 Section 214.6 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR THE USE AND COORDINATION OF THE RADIO SPECTRUM DURING A WARTIME EMERGENCY § 214.6 Postattack...

Behavior changes after minor emergency procedures.

PubMed

Brodzinski, Holly; Iyer, Srikant

2013-10-01

Procedures are common in pediatric emergency departments and frequently cause distress from pain and/or anxiety. The objective of this study was to describe the incidence, types, and magnitude of long-term behavior changes after procedures in the emergency setting. This is a descriptive pilot study to determine if children display negative behavioral changes after a minor emergency department procedure (abscess drainage or laceration repair). Behavior change was measured at 1 week by telephone follow-up using the 27-item Post Hospitalization Behavior Questionnaire, a well-validated instrument that measures behavior changes across 6 categories: general anxiety, separation anxiety, anxiety about sleep, eating disturbances, aggression toward authority, and apathy/withdrawal. Significant behavior change was defined as 5 or more negative behavior changes on the 27-item questionnaire. Twenty percent of children who underwent abscess drainage (n = 30) and 20% who underwent laceration repair (n = 30) displayed significant negative behavior change at 1 week. Children who displayed significant negative behavior change tended to be younger (3.6 vs 5.9 years) and trended toward being more likely to have received anxiolysis or sedation (16.7% vs 8.3%). Separation anxiety, sleep difficulties, and aggression toward authority were the most common behavior changes. In this pilot study, a significant percentage of children undergoing common emergency procedures exhibited an appreciable burden of negative behavior change at 1 week; these results demonstrate the need for further rigorous investigation of predictors of these changes and interventions, which can ameliorate these changes.

Medical Operations Console Procedure Evaluation: BME Response to Crew Call Down for an Emergency

NASA Technical Reports Server (NTRS)

Johnson-Troop; Pettys, Marianne; Hurst, Victor, IV; Smaka, Todd; Paul, Bonnie; Rosenquist, Kevin; Gast, Karin; Gillis, David; McCulley, Phyllis

2006-01-01

International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task completion and/or navigation, in particular the execution of the Surgeon call sequence. Debrief comments were used to analyze unclear procedural steps and to discern any discrepancies between the procedure and generally accepted BME actions. The sequence followed by BME participants differed considerably from the sequence intended by the procedure. Common deviations included the call sequence used to contact Surgeon, the content of BME and crew interaction and the gathering of pertinent console resources. Differing perceptions of task priority and imprecise language seem to have caused multiple deviations from the procedure s intended sequence. The study generated 40 recommendations for the procedure, of which 34 are being implemented. These recommendations address improving the clarity of the instructions, identifying training considerations, expediting Surgeon contact, improving cues for anticipated flight control team communication and identifying missing console tools.

Changing trends in abdominal surgical complications following cardiac surgery in an era of advanced procedures. A retrospective cohort study.

PubMed

Ashfaq, Awais; Johnson, Daniel J; Chapital, Alyssa B; Lanza, Louis A; DeValeria, Patrick A; Arabia, Francisco A

2015-03-01

Abdominal complications following cardiopulmonary bypass (CPB) procedures may have mortality rates as high as 25%. Advanced procedures such as ventricular assist devices, artificial hearts and cardiac transplantation are being increasingly employed, changing the complexity of interventions. This study was undertaken to examine the changing trends in complications and the impact of cardiac surgery on emergency general surgery (EGS) coverage. A retrospective review was conducted of all CPB procedures admitted to our ICU between Jan. 2007 and Mar. 2010. The procedures included coronary bypass (CABG), valve, combination (including adult congenital) and advanced heart failure (AHF) procedures. The records were reviewed to obtain demographics, need for EGS consult/procedure and outcomes. Mean age of the patients was 66 ± 8.5 years, 71% were male. There were 945 CPB procedures performed on 914 patients during this study period. Over 39 months, 23 EGS consults were obtained, resulting in 10 operations and one hospital death (10% operative mortality). CABG and valve procedures had minimal impact on EGS workload while complex cardiac and AHF procedures accounted for significantly more EGS consultations (p < 0.005) and operations (p < 0.005). The majority of consultations were for small bowel obstruction/ileus (n = 4, 17%), cholecystitis (n = 3, 13%) and to rule out ischemia (n = 2, 9%) In the era of modern critical care and cardiac surgery, advanced technology has increased the volume of complex CPB procedures increasing the EGS workload. Emergency general surgeons working in institutions that perform advanced procedures should be aware of the potential for general surgical complications perioperatively and the resultant nuances that are associated with operative management in this patient population. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. 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.

Tele-mentored damage-control and emergency trauma surgery: A feasibility study using live-tissue models.

PubMed

Dawe, Philip; Kirkpatrick, Andrew; Talbot, Max; Beckett, Andrew; Garraway, Naisan; Wong, Heather; Hameed, Syed Morad

2018-05-01

Damage-control and emergency surgical procedures in trauma have the potential to save lives. They may occasionally not be performed due to clinician inexperience or lack of comfort and knowledge. Canadian Armed Forces (CAF) non-surgeon Medical Officers (MOs) participated in a live tissue training exercise. They received tele-mentoring assistance using a secure video-conferencing application on a smartphone/tablet platform. Feasibility of tele-mentored surgery was studied by measuring their effectiveness at completing a set series of tasks in this pilot study. Additionally, their comfort and willingness to perform studied procedures was gauged using pre- and post-study surveys. With no pre-procedural teaching, participants were able to complete surgical airway, chest tube insertion and resuscitative thoracotomy with 100% effectiveness with no noted complications. Comfort level and willingness to perform these procedures were improved with tele-mentoring. Participants felt that tele-mentored surgery would benefit their performance of resuscitative thoracotomy most. The use of tele-mentored surgery to assist non-surgeon clinicians in the performance of damage-control and emergency surgical procedures is feasible. More study is required to validate its effectiveness. Copyright © 2018 Elsevier Inc. All rights reserved.

Men and Cosmetics: Social and Psychological Trends of an Emerging Demographic.

PubMed

Rieder, Evan A; Mu, Euphemia W; Brauer, Jeremy A

2015-09-01

Though still accounting for a small fraction of all cosmetic procedures in the United States, men are an emerging and rapidly expanding demographic in the field of aesthetic medicine. In this article we highlight the trends contributing to the rise of male aesthetic procedures in dermatology, touching on social influences, psychological motivations, and treatment outcomes.

Transcatheter intervention for the treatment of congenital cardiac defects.

PubMed Central

Grifka, R G

1997-01-01

Cardiac catheterization has an illustrious history, originating in 1929 when Werner Forsmann, a surgical resident, performed a heart catheterization on himself. Transcatheter interventional procedures have been performed since the 1960s. The 1st intracardiac procedure to become standard therapy was a balloon atrial septostomy. Skeptics attacked this innovative procedure. However, the balloon septostomy procedure soon became the standard emergency procedure for certain congenital heart defects, and was the impetus for other investigators in the field of transcatheter intervention. We will discuss transcatheter treatment for congenital vascular stenoses and vascular occlusion. Images PMID:9456482

Apollo-Soyuz test project. Operations handbook command/service/docking modules (CSM 119/DM 1): Operational procedures reference issue

NASA Technical Reports Server (NTRS)

1974-01-01

Operational and configuration checks for the Apollo-Soyuz Test Project are presented. The checks include: backup crew prelaunch, prime crew prelaunch, boost and insertion, G and C reference data, G and N reference modes, rendezvous, navigation, Apollo-Soyuz operations, abort procedures, and emergency procedures.

14 CFR 93.309 - General operating procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false General operating procedures. 93.309... Vicinity of Grand Canyon National Park, AZ § 93.309 General operating procedures. Except in an emergency... authorized in writing by the Flight Standards District Office: (1) Northbound. 11,500 or 13,500 feet MSL. (2...

14 CFR 93.309 - General operating procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false General operating procedures. 93.309... Vicinity of Grand Canyon National Park, AZ § 93.309 General operating procedures. Except in an emergency... authorized in writing by the Flight Standards District Office: (1) Northbound. 11,500 or 13,500 feet MSL. (2...

14 CFR 93.309 - General operating procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false General operating procedures. 93.309... Vicinity of Grand Canyon National Park, AZ § 93.309 General operating procedures. Except in an emergency... authorized in writing by the Flight Standards District Office: (1) Northbound. 11,500 or 13,500 feet MSL. (2...

14 CFR 93.309 - General operating procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false General operating procedures. 93.309... Vicinity of Grand Canyon National Park, AZ § 93.309 General operating procedures. Except in an emergency... authorized in writing by the Flight Standards District Office: (1) Northbound. 11,500 or 13,500 feet MSL. (2...

14 CFR 93.309 - General operating procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false General operating procedures. 93.309... Vicinity of Grand Canyon National Park, AZ § 93.309 General operating procedures. Except in an emergency... authorized in writing by the Flight Standards District Office: (1) Northbound. 11,500 or 13,500 feet MSL. (2...

47 CFR 64.402 - Policies and procedures for the provision of priority access service by commercial mobile radio...

Code of Federal Regulations, 2010 CFR

2010-10-01

... priority access service by commercial mobile radio service providers. 64.402 Section 64.402... RULES RELATING TO COMMON CARRIERS Procedures for Handling Priority Services in Emergencies § 64.402 Policies and procedures for the provision of priority access service by commercial mobile radio service...

Apollo Operations Handbook Lunar Module (LM 11 and Subsequent) Vol. 2 Operational Procedures

NASA Technical Reports Server (NTRS)

1971-01-01

The Apollo Operations Handbook (AOH) is the primary means of documenting LM descriptions and procedures. The AOH is published in two separately bound volumes. This information is useful in support of program management, engineering, test, flight simulation, and real time flight support efforts. This volume contains crew operational procedures: normal, backup, abort, malfunction, and emergency. These procedures define the sequence of actions necessary for safe and efficient subsystem operation.

Allergic Reaction to Ketamine as Monotherapy for Procedural Sedation.

PubMed

Nguyen, Tammy T; Baker, Bethany; Ferguson, Jeffrey D

2017-04-01

Ketamine is a cyclohexamine derivative that acts as a noncompetitive N-methyl D-aspartate receptor antagonist. Its use for procedural sedation is recommended by national clinical policy. However, its immunogenic potential is not well documented. We report a case of allergic reaction associated with the administration of intravenous ketamine for procedural sedation in a 16-year-old male. Minutes after administration, the patient developed a morbilliform, erythematous rash that extended to the upper and lower torso and resolved with intravenous diphenhydramine. It is most likely that this allergic reaction was caused by a ketamine-induced histamine release that has been described in vitro. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This is the first case report in which ketamine was used as monotherapy in the emergency department for the facilitation of procedural sedation that resulted in an allergic reaction. Supportive measures, including advanced airway procedures and hemodynamic support, may be necessary in more severe anaphylactic cases. Providers should be aware of this potential adverse effect when using ketamine for procedural sedation. Copyright © 2016 Elsevier Inc. All rights reserved.

14 CFR 431.37 - Mission readiness.

Code of Federal Regulations, 2014 CFR

2014-01-01

... contingency abort plans and procedures, if any, as required under § 431.39; (vi) Unresolved safety issues.... (2) Procedures that ensure mission constraints, rules, contingency abort and emergency abort...

14 CFR 431.37 - Mission readiness.

Code of Federal Regulations, 2012 CFR

2012-01-01

... contingency abort plans and procedures, if any, as required under § 431.39; (vi) Unresolved safety issues.... (2) Procedures that ensure mission constraints, rules, contingency abort and emergency abort...

14 CFR 431.37 - Mission readiness.

Code of Federal Regulations, 2013 CFR

2013-01-01

... contingency abort plans and procedures, if any, as required under § 431.39; (vi) Unresolved safety issues.... (2) Procedures that ensure mission constraints, rules, contingency abort and emergency abort...

14 CFR 431.37 - Mission readiness.

Code of Federal Regulations, 2011 CFR

2011-01-01

... contingency abort plans and procedures, if any, as required under § 431.39; (vi) Unresolved safety issues.... (2) Procedures that ensure mission constraints, rules, contingency abort and emergency abort...

14 CFR 431.37 - Mission readiness.

Code of Federal Regulations, 2010 CFR

2010-01-01

... contingency abort plans and procedures, if any, as required under § 431.39; (vi) Unresolved safety issues.... (2) Procedures that ensure mission constraints, rules, contingency abort and emergency abort...

Lessons learned from a single institution's retrospective analysis of emergent cesarean delivery following external cephalic version with and without neuraxial anesthesia.

PubMed

Ainsworth, A; Sviggum, H P; Tolcher, M C; Weaver, A L; Holman, M A; Arendt, K W

2017-05-01

To evaluate the risk of emergent cesarean delivery with the use of neuraxial anesthesia for external cephalic version in a single practice. Randomized trials have shown increased external cephalic version success when neuraxial anesthesia is used, without additional risk. We hypothesized that in our actual clinical practice, outside the confines of randomized trials, neuraxial anesthesia could be associated with an increased risk of emergent cesarean delivery. This retrospective cohort study included all women who underwent external cephalic version at a single institution with and without neuraxial anesthesia. The primary outcome was the incidence of emergent cesarean delivery (defined as delivery within 4hours of version). Secondary outcomes were version success and ultimate mode of delivery. A total of 135 women underwent external cephalic version procedures; 58 with neuraxial anesthesia (43.0%) and 77 without (57.0%). Location of the procedure, tocolytic therapy, and gestational age were different between groups. An increased rate of emergent cesarean delivery was found in procedures with neuraxial anesthesia compared to procedures without (5/58 (8.6%) compared to 0/77 (0.0%); 95% CI for difference, 1.4 to 15.8%; P=0.013). In this single hospital's practice, patients who may be at higher risk of complications and have a lesser likelihood of success were provided NA for ECV. As a result, the use of neuraxial anesthesia for external cephalic version was associated with a higher rate of emergent cesarean delivery. Obstetric and anesthetic practices should evaluate their patient selection and procedure protocol for external cephalic version under neuraxial anesthesia. Copyright © 2017 Elsevier Ltd. All rights reserved.

Intelligent Pilot Aids for Flight Re-Planning in Emergencies

NASA Technical Reports Server (NTRS)

Pritchett, Amy R.

2002-01-01

Experimental studies were conducted with pilots to investigate the attributes of automation that would be appropriate for aiding pilots in emergencies. The specific focus of this year was on methods of mitigating automation brittleness. Brittleness occurs when the automatic system is used in circumstances it was not designed for, causing it to choose an incorrect action or make an inaccurate decision for the situation. Brittleness is impossible to avoid since it is impossible to predict every potential situation the automatic system will be exposed to over its life. However, operators are always ultimately responsible for the actions and decisions of the automation they are monitoring or using, which means they must evaluate the automation's decisions and actions for accuracy. As has been pointed out, this is a difficult thing for human operators to do. There have been various suggestions as to how to aid operators with this evaluation. In the study described in this report we studied how presentation of contextual information about an automatic system's decision might impact the ability of the human operators to evaluate that decision. This study focused on the planning of emergency descents. Fortunately, emergencies (e.g., mechanical or electrical malfunction, on-board fire, and medical emergency) happen quite rarely. However, they can be catastrophic when they do. For all predictable or conceivable emergencies, pilots have emergency procedures that they are trained on, but those procedures often end with 'determine suitable airport and land as quickly as possible.' Planning an emergency descent to an unplanned airport is a difficult task, particularly under the time pressures of an emergency. Automatic decision aids could be very efficient at the task of determining an appropriate airport and calculating an optimal trajectory to that airport. This information could be conveyed to the pilot through an emergency descent procedure listing all of the actions necessary to safely land the plane. However, there is still the potential problem of brittleness. This study examined the impact of contextual information in presentations of emergency descent procedures to see if they might impact the pilot's evaluation of the feasibility of the presented procedure. The study and its results are described in detail.

International Variability in Gastrointestinal Decontamination With Acute Poisonings.

PubMed

Mintegi, Santiago; Dalziel, Stuart R; Azkunaga, Beatriz; Prego, Javier; Arana-Arri, Eunate; Acedo, Yordana; Martinez-Indart, Lorea; Benito, Javier; Kuppermann, Nathan

2017-08-01

Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments. This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures. We included 1688 patients, 338 of whom (20.0%, 95% confidence interval 18.1%-22.0%) underwent the following GID procedures: activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51.2%), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred ( P < .001). Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented. Copyright © 2017 by the American Academy of Pediatrics.

Emergency Contraceptive Pill (ECP) Use and Experiences at College Health Centers in the Mid-Atlantic United States: Changes since ECP Went Over-the-Counter

ERIC Educational Resources Information Center

Miller, Laura M.

2011-01-01

Objective: To investigate the availability of emergency contraceptive pills (ECPs) at college health centers since ECP went over-the-counter (OTC) in 2006. Related issues, such as distribution procedure, existence of a written protocol, personnel involved, contraindications, follow-up procedures, methods of advertising, and staff attitudes, were…

Go/No-Go Procedure with Compound Stimuli: Effects of Training Structure on the Emergence of Equivalence Classes

ERIC Educational Resources Information Center

Grisante, Priscila C.; Galesi, Fernanda L.; Sabino, Nathali M.; Debert, Paula; Arntzen, Erik; McIlvane, William J.

2013-01-01

When the matching-to-sample (MTS) procedure is used, different training structures imply differences in the successive discriminations required in training and test conditions. When the go/no-go procedure with compound stimuli is used, however, differences in training structures do not imply such differences. This study assessed whether the…

Relational Discrimination by Pigeons in a Go/No-Go Procedure with Compound Stimuli: A Methodological Note

ERIC Educational Resources Information Center

Campos, Heloisa Cursi; Debert, Paula; Barros, Romariz da Silva; McIlvane, William J.

2011-01-01

A go/no-go procedure with compound stimuli typically establishes emergent behavior that parallels in structure and typical outcome that of conventional tests for symmetric, transitive, and equivalence relations in normally capable adults. The present study employed a go/no-go compound stimulus procedure with pigeons. During training, pecks to…

7 CFR 799.11 - Expedited procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... THE NATIONAL ENVIRONMENTAL POLICY ACT § 799.11 Expedited procedures. Where emergency circumstances... of the NEPA regulations issued by CEQ, USDA, and FSA, FSA will, by working through the USDA Office of...

Standard operating procedures improve acute neurologic care in a sub-Saharan African setting.

PubMed

Jaiteh, Lamin E S; Helwig, Stefan A; Jagne, Abubacarr; Ragoschke-Schumm, Andreas; Sarr, Catherine; Walter, Silke; Lesmeister, Martin; Manitz, Matthias; Blaß, Sebastian; Weis, Sarah; Schlund, Verena; Bah, Neneh; Kauffmann, Jil; Fousse, Mathias; Kangankan, Sabina; Ramos Cabrera, Asmell; Kronfeld, Kai; Ruckes, Christian; Liu, Yang; Nyan, Ousman; Fassbender, Klaus

2017-07-11

Quality of neurologic emergency management in an under-resourced country may be improved by standard operating procedures (SOPs). Neurologic SOPs were implemented in a large urban (Banjul) and a small rural (Brikama) hospital in the Gambia. As quality indicators of neurologic emergency management, performance of key procedures was assessed at baseline and in the first and second implementation years. At Banjul, 100 patients of the first-year intervention group exhibited higher rates of general procedures of emergency management than 105 control patients, such as neurologic examination (99.0% vs 91.4%; p < 0.05) and assessments of respiratory rate (98.0% vs 81.9%, p < 0.001), temperature (60.0% vs 36.2%; p < 0.001), and glucose levels (73.0% vs 58.1%; p < 0.05), in addition to written directives by physicians (96.0% vs 88.6%, p < 0.05), whereas assessments of other vital signs remained unchanged. In stroke patients, rates of stroke-related procedures increased: early CT scanning (24.3% vs 9.9%; p < 0.05), blood count (73.0% vs 49.3%; p < 0.01), renal and liver function tests (50.0% vs 5.6%, p < 0.001), aspirin prophylaxis (47.3% vs 9.9%; p < 0.001), and physiotherapy (41.9% vs 4.2%; p < 0.001). Most effects persisted until the second-year evaluation. SOP implementation was similarly feasible and beneficial at the Brikama hospital. However, outcomes did not significantly differ in the hospitals. Implementing SOPs is a realistic, low-cost option for improving process quality of neurologic emergency management in under-resourced settings. This study provides Class IV evidence that, for patients with suspected neurologic emergencies in sub-Saharan Africa, neurologic SOPs increase the rate of performance of guideline-recommended procedures. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

STS-32 MS Dunbar wearing LES prepares for WETF water egress training

NASA Technical Reports Server (NTRS)

1989-01-01

STS-32 Mission Specialist (MS) Bonnie J. Dunbar, wearing a launch and entry suit (LES), orange parachute harness and life vest, is briefed on emergency egress procedures in JSC's Weightless Environment Training Facility (WETF) Bldg 29. During the exercises the crew practiced the procedures to follow in the event of an emergency aboard the Space Shuttle and familiarized themselves with post-Challenger pole system of emergency egress. The crewmembers will simulate parachuting into water by using the WETF's nearby 25 ft deep pool.

Emergency therapeutic leukapheresis in a case of acute myeloid leukemia M5

PubMed Central

Ranganathan, Sudha; Sesikeran, Shyamala; Gupta, Vineet; Vanajakshi

2008-01-01

Cell separators in India are routinely used for plateletpheresis, peripheral blood stem cell collections and therapeutic plasma exchange. Therapeutic leukapheresis, particularly as an emergency procedure, has been uncommonly performed and reported. Here, a case of a 53-year-old male, diagnosed with acute myeloid leukemia subtype M5 (AML M5) with hyperleukocytosis, who underwent emergency leukaphereis, is reported. After two procedures, there was a decrease of WBC count by 85%, which enabled cytotoxic therapy to be initiated. PMID:20041073

Cancellation of scheduled procedures as a mechanism to generate hospital bed surge capacity-a pilot study.

PubMed

Soremekun, Olan A; Zane, Richard D; Walls, Andrew; Allen, Matthew B; Seefeld, Kimberly J; Pallin, Daniel J

2011-06-01

The ability to generate hospital beds in response to a mass-casualty incident is an essential component of public health preparedness. Although many acute care hospitals' emergency response plans include some provision for delaying or cancelling elective procedures in the event of an inpatient surge, no standardized method for implementing and quantifying the impact of this strategy exists in the literature. The aim of this study was to develop a methodology to prospectively emergency plan for implementing a strategy of delaying procedures and quantifying the potential impact of this strategy on creating hospital bed capacity. This is a pilot study. A categorization methodology was devised and applied retrospectively to all scheduled procedures during four one-week periods chosen by convenience. The categorization scheme grouped procedures into four categories: (A) procedures with no impact on inpatient capacity; (B) procedures that could be delayed indefinitely; (C) procedures that could be delayed by one week; and (D) procedures that could not be delayed. The categorization scheme was applied by two research assistants and an emergency medicine resident. All three raters categorized the first 100 cases to allow for calculation of inter-rater reliability. Maximal hospital bed capacity was defined as the 95th percentile weekday occupancy, as this is more representative of functional bed capacity than is the number of licensed beds. The main outcome was the number of hospital beds that could be created by postponing procedures in categories B and C. Maximal hospital bed capacity was 816 beds. Mean occupancy during weekdays was 759 versus 694 on weekends. By postponing Group B and C procedures, a mean of 60 beds (51 general medical/surgical and nine intensive care unit (ICU)) could be created on weekdays, and four beds (three general medical/surgical and one ICU) on weekends. This represents 7.3% and 0.49% of maximal hospital bed capacity and ICU capacity, respectively. In the event that sustained surge is needed, delaying all category B and C procedures for one week would lead to the generation of 1,235 hospital-bed days. Inter-rater reliability was high (kappa = 0.74) indicating good agreement between all three raters. For the institution studied, the strategy of delaying scheduled procedures could generate inpatient capacity with maximal impact during weekdays and little impact on weekends. Future research is needed to validate the categorization scheme and increase the ability to predict inpatient surge capacity across various hospital types and sizes.

47 CFR 214.6 - Postattack procedures and actions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROCEDURES FOR THE USE AND COORDINATION OF THE RADIO SPECTRUM DURING A WARTIME EMERGENCY § 214.6 Postattack... Radio Spectrum and the Government Master File; (2) Accomplish such coordination as appropriate and...

32 CFR 989.34 - Special and emergency procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Special procedures. During the EIAP, unique situations may arise that require EIAP strategies different.... Coordination in this instance must take place as soon as practicable. [64 FR 38129, July 15, 1999, as amended...

Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications.

PubMed

Wilcox, Susan R; Bittner, Edward A; Elmer, Jonathan; Seigel, Todd A; Nguyen, Nicole Thuy P; Dhillon, Anahat; Eikermann, Matthias; Schmidt, Ulrich

2012-06-01

Emergent intubation is associated with a high rate of complications. Neuromuscular blocking agents are routinely used in the operating room and emergency department to facilitate intubation. However, use of neuromuscular blocking agents during emergent airway management outside of the operating room and emergency department is controversial. We hypothesized that the use of neuromuscular blocking agents is associated with a decreased prevalence of hypoxemia and reduced rate of procedure-related complications. Five hundred sixty-six patients undergoing emergent intubations in two tertiary care centers, Massachusetts General Hospital, Boston, MA, and the University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA, were enrolled in a prospective, observational study. The 112 patients intubated during cardiopulmonary resuscitation were excluded, leaving 454 patients for analysis. All intubations were supervised by attendings trained in Critical Care Medicine. We measured intubating conditions, oxygen saturation during and 5 mins following intubation. We assessed the prevalence of procedure-related complications defined as esophageal intubation, traumatic intubation, aspiration, dental injury, and endobronchial intubation. The use of neuromuscular blocking agents was associated with a lower prevalence of hypoxemia (10.1% vs. 17.4%, p = .022) and a lower prevalence of procedure-related complications (3.1% vs. 8.3%, p = .012). This association persisted in a multivariate analysis, which controlled for airway grade, sedation, and institution. Use of neuromuscular blocking agents was associated with significantly improved intubating conditions (laryngeal view, p = .014; number of intubation attempts, p = .049). After controlling for the number of intubation attempts and laryngoscopic view, muscle relaxant use is an independent predictor of complications associated with emergency intubation (p = .037), and there is a trend towards improvement of oxygenation (p = .07). The use of neuromuscular blocking agents, when used by intensivists with a high level of training and experience, is associated with a decrease in procedure-related complications.

Emergent pediatric thoracotomy following traumatic arrest.

PubMed

Easter, Joshua S; Vinton, Deborah T; Haukoos, Jason S

2012-12-01

Emergent thoracotomy is a potentially life-saving procedure following traumatic cardiac arrest. The procedure has been studied extensively in adults, but its role in pediatric traumatic cardiac arrest remains unclear. We aimed to determine the prevalence of survival following emergent resuscitative thoracotomy in children. This was a retrospective cohort study that included consecutive patients<18 years old who underwent emergent thoracotomy following traumatic cardiac arrest over a 15-year period. Factors previously associated with survival following thoracotomy in adults were measured. During the study period, 29 patients underwent emergent thoracotomy. Of these, 3 (10%, 95% confidence interval [CI]: 2-27%) survived to hospital discharge. All survivors sustained penetrating trauma to the heart and had signs of life on arrival of emergency medical services. Of the 13 patients who sustained blunt trauma, 0 (0%, 95% CI: 0-25%) survived, despite 69% (9/13) demonstrating signs of life on arrival of emergency medical services and 38% (5/13) having temporary return of spontaneous circulation. Emergent thoracotomy is a potentially life-saving procedure for children following traumatic cardiac arrest. It appears most successful in children suffering penetrating trauma to the heart with signs of life on arrival of emergency medical services. Larger studies are needed to determine the factors associated with this survival benefit for emergent thoracotomy in children. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A Methodology for Training International Space Station Crews to Respond to On-Orbit Emergencies

NASA Technical Reports Server (NTRS)

Balmain, Clinton; Fleming, Mark

2009-01-01

Most spaceflight crewmembers agree that emergency training is among the most important training they receive. If an emergency event occurs on-orbit crewmembers want to be able to rely on a thorough and proficient knowledge of emergency operations and procedures. The inherent complexity of ISS and the international nature of the onboard operations have resulted in emergency procedures that are complex by any measure; as a result, a very robust apparatus has been developed to give crewmembers initial training on emergency procedures and ensure proficiency up to (and even after) launch. One of the most important aspects of complex onboard operations in general, and emergency operations specifically, is learning how to coordinate roles and responsibilities with fellow crewmembers. A primary goal of NASA s emergency training program is to allow the crewmembers who will actually be together on-orbit to practice executing the emergency responses together before they fly. As with any operation that includes the use of software and hardware, the fidelity of the simulation environment is a critical element to successful training. The NASA training division has spent considerable time and effort to develop a simulator that addresses the most important aspects of emergency response, working within very difficult space and budgetary constraints.

Do instability markers predict satisfactory reduction and requirement for later surgery in emergency department patients with wrist fracture?

PubMed

Winayak, Amar; Gossat, Alyza; Cooper, Jenny; Ritchie, Peter; Lim, Wei; Klim, Sharon; Kelly, Anne-Maree

2018-02-01

Research suggests that the presence of instability markers in patients with displaced distal radial fractures is associated with poorer outcome. Our aims were to determine whether the presence of previously defined instability markers could predict the likelihood of successful ED reduction and requirement for a secondary procedure after ED reduction. Retrospective cohort study performed by medical record review. Adult ED patients coded as having an isolated wrist fracture and having fracture reduction in ED were eligible for inclusion. Data collected included demographics, history of osteoporosis, mechanism of injury, radiological features on X-rays and performance of a secondary procedure. Outcomes of interest were the rate of successful fracture reduction in ED (against defined radiological criteria), the rate of secondary procedures and the association between the number of defined instability risk factors and successful reduction and performance of a secondary surgical procedure. Analysis was by χ 2 test, receiver operating characteristic curve, logistic regression analyses. Three hundred and nineteen patients were studied; median age 62 years, 77% female. Sixty-five per cent of patients had satisfactory fracture reduction in ED (95% CI 59%-70%). Eighty-six patients underwent a secondary procedure to reduce/stabilise their fracture (28%, 95% CI 23%-33%). Younger age, lack of satisfactory ED reduction and increased number of instability factors were independently predictive of the performance of a secondary procedure. Instability risk factors are common in patients with wrist fractures requiring reduction in ED. The number of instability factors is not a strong predictor of the performance of secondary procedures. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Post Accident Procedures for Chemicals and Propellants.

DTIC Science & Technology

1982-09-01

METHODS AND PROCEDURES ............ 4-1 4.1 Overview of Emergency Response Procedures " and Resources Available .......................... 4-1 L1 TABLE...7-1 7.1 Criteria forTwelve Critical Operations ........................ 7-1 7.1.1 On-Scene Methods for Identifying the Ingredients...Establishing A Protocol for Selecting the Hazards Mitigation and Cleanup Methods for Single Material Spills and Multiple Materials Mixing

Immediate Adverse Events in Interventional Pain Procedures: A Multi-Institutional Study.

PubMed

Carr, Carrie M; Plastaras, Christopher T; Pingree, Matthew J; Smuck, Matthew; Maus, Timothy P; Geske, Jennifer R; El-Yahchouchi, Christine A; McCormick, Zachary L; Kennedy, David J

2016-12-01

Interventional procedures directed toward sources of pain in the axial and appendicular musculoskeletal system are performed with increasing frequency. Despite the presence of evidence-based guidelines for such procedures, there are wide variations in practice. Case reports of serious complications such as spinal cord infarction or infection from spine injections lack appropriate context and create a misleading view of the risks of appropriately performed interventional pain procedures. To evaluate adverse event rate for interventional spine procedures performed at three academic interventional spine practices. Quality assurance databases at three academic interventional pain management practices that utilize evidence-based guidelines [1] were interrogated for immediate complications from interventional pain procedures. Review of the electronic medical record verified or refuted the occurrence of a complication. Same-day emergency department transfers or visits were also identified by a records search. Immediate complication data were available for 26,061 consecutive procedures. A radiology practice performed 19,170 epidural steroid (primarily transforaminal), facet, sacroiliac, and trigger point injections (2006-2013). A physiatry practice performed 6,190 spine interventions (2004-2009). A second physiatry practice performed 701 spine procedures (2009-2010). There were no major complications (permanent neurologic deficit or clinically significant bleeding [e.g., epidural hematoma]) with any procedure. Overall complication rate was 1.9% (493/26,061). Vasovagal reactions were the most frequent event (1.1%). Nineteen patients (<0.1%) were transferred to emergency departments for: allergic reactions, chest pain, symptomatic hypertension, and a vasovagal reaction. This study demonstrates that interventional pain procedures are safely performed with extremely low immediate adverse event rates when evidence-based guidelines are observed. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

49 CFR 601.40 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Applicability. 601.40 Section 601.40 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ORGANIZATION, FUNCTIONS, AND PROCEDURES Emergency Procedures for Public...

A Retrospective Propensity Score-Matched Early Thromboembolic Event Analysis of Prothrombin Complex Concentrate vs Fresh Frozen Plasma for Warfarin Reversal Prior to Emergency Neurosurgical Procedures.

PubMed

Agarwal, Prateek; Abdullah, Kalil G; Ramayya, Ashwin G; Nayak, Nikhil R; Lucas, Timothy H

2017-06-29

Reversal of therapeutic anticoagulation prior to emergency neurosurgical procedures is required in the setting of intracranial hemorrhage. Multifactor prothrombin complex concentrate (PCC) promises rapid efficacy but may increase the probability of thrombotic complications compared to fresh frozen plasma (FFP). To compare the rate of thrombotic complications in patients treated with PCC or FFP to reverse therapeutic anticoagulation prior to emergency neurosurgical procedures in the setting of intracranial hemorrhage at a level I trauma center. Sixty-three consecutive patients on warfarin therapy presenting with intracranial hemorrhage who received anticoagulation reversal prior to emergency neurosurgical procedures were retrospectively identified between 2007 and 2016. They were divided into 2 cohorts based on reversal agent, either PCC (n = 28) or FFP (n = 35). The thrombotic complications rates within 72 h of reversal were compared using the χ 2 test. A multivariate propensity score matching analysis was used to limit the threat to interval validity from selection bias arising from differences in demographics, laboratory values, history, and clinical status. Thrombotic complications were uncommon in this neurosurgical population, occurring in 1.59% (1/63) of treated patients. There was no significant difference in the thrombotic complication rate between groups, 3.57% (1/28; PCC group) vs 0% (0/35; FFP group). Propensity score matching analysis validated this finding after controlling for any selection bias. In this limited sample, thrombotic complication rates were similar between use of PCC and FFP for anticoagulation reversal in the management of intracranial hemorrhage prior to emergency neurosurgical procedures. Copyright © 2017 by the Congress of Neurological Surgeons

General considerations and updates in pediatric gastrointestinal diagnostic endoscopy

PubMed Central

2010-01-01

Gastrointestinal and colonic endoscopic examinations have been performed in pediatric patients in Korea for 3 decades. Endoscopic procedures are complex and may be unsafe if special concerns are not considered. Many things have to be kept in mind before, during, and after the procedure. Gastrointestinal endoscopy is one of the most frequently performed procedure in children nowadays, Since the dimension size of the endoscopy was modified for pediatric patients 15 years ago, endoscopic procedures are almost performed routinely in pediatric gastrointestinal patients. The smaller size of the scope let the physicians approach the diagnostic and therapeutic endoscopic procedures. But this is an invasive procedure, so the procedure itself may provoke an emergence state. The procedure-related complications can more easily occur in pediatric patients. Sedation-related or procedure-related respiratory, cardiovascular complications are mostly important and critical in the care. The endoscopists are required to consider diverse aspects of the procedure - patient preparation, indications and contraindications, infection controls, sedation methods, sedative medicines and the side effects of each medicine, monitoring during and after the procedure, and complications related with the procedure and medicines - to perform the procedure successfully and safely. This article presents some important guidelines and recommendations for gastrointestinal endoscopy through literature review. PMID:21189965

Office-based procedures for diagnosis and treatment of esophageal pathology.

PubMed

Wellenstein, David J; Schutte, Henrieke W; Marres, Henri A M; Honings, Jimmie; Belafsky, Peter C; Postma, Gregory N; Takes, Robert P; van den Broek, Guido B

2017-09-01

Diagnostic and therapeutic office-based procedures under topical anesthesia are emerging in the daily practice of laryngologists and head and neck surgeons. Since the introduction of the transnasal esophagoscope, office-based procedures for the esophagus are increasingly performed. We conducted a systematic review of literature on office-based procedures under topical anesthesia for the esophagus. Transnasal esophagoscopy is an extensively investigated office-based procedure. This procedure shows better patient tolerability and equivalent accuracy compared to conventional transoral esophagoscopy, as well as time and cost savings. Secondary tracheoesophageal puncture, esophageal dilatation, esophageal sphincter injection, and foreign body removal are less investigated, but show promising results. With the introduction of the transnasal esophagoscope, an increasing number of diagnostic and therapeutic office-based procedures for the esophagus are possible, with multiple advantages. Further investigation must prove the clinical feasibility and effectiveness of the therapeutic office-based procedures. © 2017 Wiley Periodicals, Inc.

STS-32 Commander Brandenstein in LES prepares for WETF water egress training

NASA Technical Reports Server (NTRS)

1989-01-01

STS-32 Commander Daniel C. Brandenstein, wearing a launch and entry suit (LES), orange parachute harness and life vest, is briefed on emergency egress procedures in JSC's Weightless Environment Training Facility Bldg 29. The crew used the WETF's nearby 25 ft deep pool for the exercises, which familiarize assigned space shuttle crewmembers with procedures associated with the post-Challenger pole system of emergency egress.

49 CFR 601.45 - Required information.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Required information. 601.45 Section 601.45 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ORGANIZATION, FUNCTIONS, AND PROCEDURES Emergency Procedures for Public...

Endoscopic hip osteotomies: less invasive approaches to peri-acetabular, proximal femoral and pubic symphyseal procedures

PubMed Central

Matsuda, Dean K.; Matsuda, Nicole A.

2015-01-01

Beyond the recent expansion of extra-articular hip arthroscopy into the peri-trochanteric and subgluteal space, this instructional course lecture introduces three innovative procedures: endoscopy-assisted periacetabular osteotomy, closed derotational proximal femoral osteotomy and endoscopic pubic symphysectomy. Supportive rationale, evolving indications, key surgical techniques and emerging outcomes are presented for these innovative less invasive procedures. PMID:27011827

Surface extra-vehicular activity emergency scenario management: Tools, procedures, and geologically related implications

NASA Astrophysics Data System (ADS)

Zea, Luis; Diaz, Alejandro R.; Shepherd, Charles K.; Kumar, Ranganathan

2010-07-01

Extra-vehicular activities (EVAs) are an essential part of human space exploration, but involve inherently dangerous procedures which can put crew safety at risk during a space mission. To help mitigate this risk, astronauts' training programs spend substantial attention on preparing for surface EVA emergency scenarios. With the help of two Mars Desert Research Station (MDRS) crews (61 and 65), wearing simulated spacesuits, the most important of these emergency scenarios were examined at three different types of locations that geologically and environmentally resemble lunar and Martian landscapes. These three platforms were analyzed geologically as well as topographically (utilizing a laser range finder with slope estimation capabilities and a slope determination software). Emergency scenarios were separated into four main groups: (1) suit issues, (2) general physiological, (3) attacks and (4) others. Specific tools and procedures were developed to address each scenario. The tools and processes were tested in the field under Mars-analog conditions with the suited subjects for feasibility and speed of execution.

[When should a patient with abdominal pain be referred to the emergency ward?].

PubMed

de Saussure, Wassila Oulhaci; Andereggen, Elisabeth; Sarasin, François

2010-08-25

When should a patient with abdominal pain be referred to the emergency ward? The following goals must be achieved upon managing patients with acute abdominal pain: 1) identify vital emergency situations; 2) detect surgical conditions that require emergency referral without further diagnostic procedures; 3) in "non surgical acute abdomen patients" perform appropriate diagnostic procedures, or in selected cases delay tests and reevaluate the patient after an observation period, after which a referral decision is made. Clues from the history and physical examination are critical to perform this evaluation. A good knowledge of the most frequent acute abdominal conditions, and identifying potential severity criteria allow an appropriate management and decision about emergency referral.

STS-26 crew during emergency egress exercise at LC 39 launch pad B

NASA Image and Video Library

1988-05-04

S88-40898 (4 May 1988) --- Astronauts, members of the orbiter close-out crew and fire and rescue personnel participate in a simulated emergency egress exercise near the slide wire termination point bunker at Launch Pad 39B. The simulated exercise was performed to familiarize personnel with evacuation routes as well as emergency equipment and procedures. Reasons for conducting the emergency exercises include the need to validate recent post-Challenger upgrades to the launch pad's emergency escape system and the new procedures developed in preparation for STS-26. (NOTE: The astronaut pictured and many of the others who participated in the exercises are not members of STS-26 prime crew).

The role of emergency medicine clerkship e-Portfolio to monitor the learning experience of students in different settings: a prospective cohort study.

PubMed

Cevik, Arif Alper; Shaban, Sami; El Zubeir, Margret; Abu-Zidan, Fikri M

2018-04-12

Although emergency departments provide acute care learning opportunities for medical students, student exposure to recommended curriculum presentations and procedures are limited. In this perspective, clinical environments providing learning opportunities for students should be monitored as part of an ongoing quality improvement process. This study aims to analyze student exposures and their involvement levels in two different hospitals (Tawam and Al Ain) so as to improve the teaching and learning activities. This is a prospective study on all 76 final year medical students' electronic logbooks (e-Portfolio) of the academic year 2016/2017. Students recorded 5087 chief complaints and 3721 procedures. The average patient and procedure exposure in a shift per student in Al Ain Hospital compared with Tawam Hospital were 7.2 vs 6.4 and 5.8 vs 4.3, respectively. The highest full involvement with presentations was seen in the pediatric unit (67.1%, P < 0.0001). Urgent care shifts demonstrated the highest area of "full involvement" with procedures for our students (73.2%, P < 0.0001). Students' highest involvement with presentations and procedures were found during the night shifts (P < 0.0001, 66.5 and 75.1%, respectively). The electronic portfolio has proven to be a very useful tool in defining the learning activities of final year medical students during their emergency medicine clerkship and in comparing activities in two different clinical settings. Data collected and analyzed using this e-Portfolio has the potential to help medical educators and curriculum designers improve emergency medicine teaching and learning activities.

49 CFR 601.46 - Processing of petitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Processing of petitions. 601.46 Section 601.46 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ORGANIZATION, FUNCTIONS, AND PROCEDURES Emergency Procedures for Public...

49 CFR 601.43 - Opening the docket.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Opening the docket. 601.43 Section 601.43 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ORGANIZATION, FUNCTIONS, AND PROCEDURES Emergency Procedures for Public...

49 CFR 601.41 - Petitions for relief.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Petitions for relief. 601.41 Section 601.41 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ORGANIZATION, FUNCTIONS, AND PROCEDURES Emergency Procedures for Public...

Analysis of safety reports involving area navigation and required navigation performance procedures.

DOT National Transportation Integrated Search

2010-11-03

In order to achieve potential operational and safety benefits enabled by Area Navigation (RNAV) and Required Navigation Performance (RNP) procedures it is important to monitor emerging issues in their initial implementation. Reports from the Aviation...

Utilization of available skills and materials in fire prevention

NASA Technical Reports Server (NTRS)

Martin, H. W.

1971-01-01

Procedures for installing fire protection systems in large buildings are discussed. Factors considered in the safety management are: (1) distribution of water supply, (2) design and location of exits, (3) emergency power system, and (4) maintenance procedures.

Clinical Experiences in Athletic Training.

ERIC Educational Resources Information Center

Knight, Kenneth L.

This book offers a systematic approach to teaching athletic training. Modules are separated into 10 content areas: direct clinical experience; policies and procedures; emergency procedures; modality operation; advanced modality operation; taping, wrapping, bracing, and padding; management of specific injuries; examination; supervision; and…

Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System.

PubMed

Tseng, Phillip; Kaplan, Robert S; Richman, Barak D; Shah, Mahek A; Schulman, Kevin A

2018-02-20

Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of professional revenue, professional billing costs were estimated to represent 14.5% for primary care visits, 25.2% for emergency department visits, 8.0% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures, and 3.1% for inpatient surgical procedures. In a time-driven activity-based costing study in a large academic health care system with a certified electronic health record system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure. Knowledge of how specific billing and insurance-related activities contribute to administrative costs may help inform policy solutions to reduce these expenses.

Patient and family attitudes regarding the practice of procedures on the newly deceased.

PubMed

Manifold, C A; Storrow, A; Rodgers, K

1999-02-01

Performance of emergency lifesaving procedures is an integral part of emergency medicine resident training. To assess attitudes of ED patients regarding the practice of procedures on the newly deceased. A descriptive survey was administered to a convenience sample of ED patients and their families at two urban military Level-1 trauma centers. Subjects were asked about their overall opinions regarding the practice of nontherapeutic procedural skills on themselves or relatives immediately after death in the ED. Subgroup analysis included the issue of advanced permission and opinions regarding procedures defined by the investigators as noninvasive (e.g., laryngeal mask airway) or invasive (e.g., cricothyrotomy). Data were analyzed descriptively and with chi-square as appropriate. For comparison of proportions, a sample size of at least 140 was chosen for an alpha of 0.05 and a beta of 0.10 to detect an effect size of 0.3. Alpha was corrected for multiple comparisons prior to the study. Three hundred seventeen surveys were collected and 88% (n = 280) were complete. Seventy-five percent (n = 290) and 70% (n = 273) of the respondents agreed to after-death procedures on themselves or their relatives, respectively. However, only 40% (n = 106) and 50% (n = 131) would allow such procedures without prior permission. Seventy-one percent (n = 189) were willing to give permission in a living will, while 85% (n = 238) indicated support of a wallet card format. There was no significant difference in permission rates when contrasting individual noninvasive and invasive procedures. Most patients are willing to have procedures performed on themselves or relatives shortly after death, yet the majority request that permission be obtained in advance. A living will or carried card would be acceptable for such permission.

Trochleoplasty: Indications and Technique.

PubMed

Nolan, John E; Schottel, Patrick C; Endres, Nathan K

2018-05-09

Trochlear dysplasia is a well-described risk factor for patellar instability. Trochleoplasty has emerged as a procedure within the surgical armamentarium for patellar instability, yet its role is unclear. A variety of trochleoplasty procedures have emerged. The purpose of this review is to clarify indications for trochleoplasty, outline the technical steps involved in performing common trochleoplasties and report the published outcomes and potential complications of these procedures. Patellar instability with severe trochlear dysplasia is the main indication for trochleoplasty. Three types of trochleoplasty have emerged: (1) lateral facet elevation; (2) sulcus deepening; and (3) recession wedge. Deepening and recession wedge trochleoplasties are the most commonly performed. Trochleoplasty is a surgical option for addressing patellar instability in patients with severe trochlear dysplasia. Deepening and recession wedge trochleoplasties that address Dejour B and D dysplastic trochleas are the most studied, with both short- and midterm outcomes reported. Long-term outcomes are lacking and comparative studies are needed.

Effect of family presence on pain and anxiety during invasive nursing procedures in an emergency department: A randomized controlled experimental study.

PubMed

İşlekdemir, Burcu; Kaya, Nurten

2016-01-01

Patients generally prefer to have their family present during medical or nursing interventions. Family presence is assumed to reduce anxiety, especially during painful interventions. This study employed a randomized controlled experimental design to determine the effects of family presence on pain and anxiety during invasive nursing procedures. The study population consisted of patients hospitalized in the observation unit of the internal medicine section in the emergency department of a university hospital. The sample comprised 138 patients assigned into the experimental and control groups by drawing lots. The invasive nursing procedure was carried out in the presence of family members, for members of the experimental group, and without family members, for members of the control group. Thus, the effects of family presence on pain and anxiety during the administration of an invasive nursing procedure to patients were analyzed. The results showed that members of the experimental and control groups did not differ with respect to the pain and state anxiety scores during the intervention. Family presence does not influence the participants' pain and anxiety during an invasive nursing procedure. Thus, the decision regarding family presence during such procedures should be based on patient preference. Copyright © 2015 Elsevier Ltd. All rights reserved.

Procedural and short-term safety of bronchial thermoplasty in clinical practice: evidence from a national registry and Hospital Episode Statistics.

PubMed

Burn, Julie; Sims, Andrew J; Keltie, Kim; Patrick, Hannah; Welham, Sally A; Heaney, Liam G; Niven, Robert M

2017-10-01

Bronchial thermoplasty (BT) is a novel treatment for severe asthma. Its mode of action and ideal target patient group remain poorly defined, though clinical trials provided some evidence on efficacy and safety. This study presents procedural and short-term safety evidence from routine UK clinical practice. Patient characteristics and safety outcomes (procedural complications, 30-day readmission and accident and emergency (A&E) attendance, length of stay) were assessed using two independent data sources, the British Thoracic Society UK Difficult Asthma Registry (DAR) and Hospital Episodes Statistics (HES) database. A matched cohort (with records in both) was used to estimate safety outcome event rates and compare them with clinical trials. Between June 2011 and January 2015, 215 procedure records (83 patients; 68 treated in England) were available from DAR and 203 (85 patients) from HES. 152 procedures matched (59 patients; 6 centres), and of these, 11.2% reported a procedural complication, 11.8% resulted in emergency respiratory readmission, 0.7% in respiratory A&E attendance within 30 days (20.4% had at least one event) and 46.1% involved a post-procedure stay. Compared with published clinical trials which found lower hospitalisation rates, BT patients in routine clinical practice were, on average, older, had worse baseline lung function and asthma quality of life. A higher proportion of patients experienced adverse events compared with clinical trials. The greater severity of disease amongst patients treated in clinical practice may explain the observed rate of post-procedural stay and readmission. Study of long-term safety and efficacy requires continuing data collection.

Validation and refinement of a rule to predict emergency intervention in adult trauma patients.

PubMed

Haukoos, Jason S; Byyny, Richard L; Erickson, Catherine; Paulson, Stephen; Hopkins, Emily; Sasson, Comilla; Bender, Brooke; Gravitz, Craig S; Vogel, Jody A; Colwell, Christopher B; Moore, Ernest E

2011-08-01

Trauma centers use "secondary triage" to determine the necessity of trauma surgeon involvement. A clinical decision rule, which includes penetrating injury, an initial systolic blood pressure less than 100 mm Hg, or an initial pulse rate greater than 100 beats/min, was developed to predict which trauma patients require emergency operative intervention or emergency procedural intervention (cricothyroidotomy or thoracotomy) in the emergency department. Our goal was to validate this rule in an adult trauma population and to compare it with the American College of Surgeons' major resuscitation criteria. We used Level I trauma center registry data from September 1, 1995, through November 30, 2008. Outcomes were confirmed with blinded abstractors. Sensitivity, specificity, and 95% confidence intervals (CIs) were calculated. Our patient sample included 20,872 individuals. The median Injury Severity Score was 9 (interquartile range 4 to 16), 15.3% of patients had penetrating injuries, 13.5% had a systolic blood pressure less than 100 mm Hg, and 32.5% had a pulse rate greater than 100 beats/min. Emergency operative intervention or procedural intervention was required in 1,099 patients (5.3%; 95% CI 5.0% to 5.6%). The sensitivities and specificities of the rule and the major resuscitation criteria for predicting emergency operative intervention or emergency procedural intervention were 95.6% (95% CI 94.3% to 96.8%) and 56.1% (95% CI 55.4% to 56.8%) and 85.5% (95% CI 83.3% to 87.5%) and 80.9% (95% CI 80.3% to 81.4%), respectively. This new rule was more sensitive for predicting the need for emergency operative intervention or emergency procedural intervention directly compared with the American College of Surgeons' major resuscitation criteria, which may improve the effectiveness and efficiency of trauma triage. Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

49 CFR 601.44 - Posting to the docket.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Posting to the docket. 601.44 Section 601.44 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ORGANIZATION, FUNCTIONS, AND PROCEDURES Emergency Procedures for Public...

40 CFR 305.34 - Filing the transcript.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Filing the transcript. 305.34 Section 305.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.34 - Filing the transcript.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Filing the transcript. 305.34 Section 305.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.23 - Motions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Motions. 305.23 Section 305.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND... (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Prehearing Procedures § 305.23...

40 CFR 305.30 - Scheduling the hearing.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Scheduling the hearing. 305.30 Section 305.30 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.31 - Evidence.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Evidence. 305.31 Section 305.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND... (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure § 305.31...

40 CFR 305.34 - Filing the transcript.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Filing the transcript. 305.34 Section 305.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.31 - Evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Evidence. 305.31 Section 305.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND... (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure § 305.31...

40 CFR 305.36 - Final order; costs.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Final order; costs. 305.36 Section 305.36 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.36 - Final order; costs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Final order; costs. 305.36 Section 305.36 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.23 - Motions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Motions. 305.23 Section 305.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND... (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Prehearing Procedures § 305.23...

40 CFR 305.30 - Scheduling the hearing.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Scheduling the hearing. 305.30 Section 305.30 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.36 - Final order; costs.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Final order; costs. 305.36 Section 305.36 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.30 - Scheduling the hearing.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Scheduling the hearing. 305.30 Section 305.30 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.23 - Motions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Motions. 305.23 Section 305.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND... (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Prehearing Procedures § 305.23...

40 CFR 305.31 - Evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Evidence. 305.31 Section 305.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND... (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure § 305.31...

10 CFR 205.350 - General purpose.

Code of Federal Regulations, 2011 CFR

2011-01-01

... developing legislative recommendations and reports to the Congress. (Approved by the Office of Management and... OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205...

10 CFR 205.350 - General purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... developing legislative recommendations and reports to the Congress. (Approved by the Office of Management and... OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205...

10 CFR 205.352 - Information to be reported.

Code of Federal Regulations, 2014 CFR

2014-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205... involved; and whether any known critical services such as hospitals, military installations, pumping...

10 CFR 205.352 - Information to be reported.

Code of Federal Regulations, 2013 CFR

2013-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205... involved; and whether any known critical services such as hospitals, military installations, pumping...

10 CFR 205.352 - Information to be reported.

Code of Federal Regulations, 2012 CFR

2012-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205... involved; and whether any known critical services such as hospitals, military installations, pumping...

10 CFR 205.352 - Information to be reported.

Code of Federal Regulations, 2011 CFR

2011-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205... involved; and whether any known critical services such as hospitals, military installations, pumping...

Feasibility of obtaining family consent for teaching cricothyrotomy on the newly dead in the emergency department.

PubMed

Olsen, J; Spilger, S; Windisch, T

1995-05-01

To determine whether family members of recently deceased emergency department patients would consent to the performance of a cricothyrotomy on the deceased for educational purposes. Prospective study. Suburban tertiary care teaching hospital. Family members of 51 patients older than 18 years who were pronounced dead in the ED from atraumatic causes. Family members were approached by an attending physician for consent to perform a cricothyrotomy as a learning opportunity for physicians on their recently deceased family members. If consent was given, the procedure was performed by an emergency medicine resident physician under the attending physician's supervision. Of 51 deaths, 20 families (39%) consented to postmortem cricothyrotomy, 23 families (45%) refused consent, and 8 families (16%) were too distraught to be approached for consent. All 20 families that consented to the procedure were white, with little representation from other ethnic groups. Although there are difficulties in obtaining consent to perform invasive procedures on the recently deceased in the ED for educational purposes, our study demonstrates that many families will consent to such procedures if adequate information and explanation are provided. The results of this study may not be applicable to institutions serving patients with different cultural and ethnic backgrounds.

[Acute care of patients with bacterial meningitis].

PubMed

Stetefeld, H R; Dohmen, C

2016-04-01

Bacterial meningitis is a life-threatening emergency that is still associated with high mortality and poor outcome. The purpose of this article is to provide a review of clinical presentation, diagnostic procedure, therapy, and prognosis in bacterial meningitis. Prognostic factors which could be influenced positively are identified and a focused procedure in the emergency setting and for the treatment of complications are provided. This work is based on a literature search (PubMed, guidelines) and personal experience (standard operating procedures, SOP). Despite improved health care, bacterial meningitis is still associated with high mortality and poor neurological outcome, which has remained largely unaltered during recent decades. Diagnosis and, more importantly, effective therapy of bacterial meningitis are often delayed, having an immediate negative influence on clinical outcome. Neurological and nonneurological complications often necessitate intensive care and may occur rapidly or in the further course of the disease. Immediate initiation of effective therapy is crucial to positively influence mortality and neurological outcome. Antibiotics should be administered within 30 min after admission. To achieve this, a focused and well-organized procedure in the emergency setting is necessary. Because of intra- and extracranial complications, patients need to be treated on intensive care units including neurological expertise and interdisciplinary support.

ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES.

PubMed

Onakpoya, O H; Asudo, F D; Adeoye, A O

2014-03-01

Ophthalmic surgical procedures are performed under anaesthesia to enhance comfort and cooperation of patient. To review factors influencing the choice of anaesthesia for ophthalmic surgical procedures. Restrospective descriptive study. Eye unit of a tertiary hospital. All patients who had ophthalmic surgeries in the operating theatre from January 2002 to December 2009. Two hundred and ninety ophthalmic surgeries were carried out during the study period. Age range was 1-95 years and mean of 61.0 ± 1.9; most (55%) were elderly while 4.8% were children. One hundred and fourty seven (50.7%) were males, 143(49.3%) females; male:female of 1.03:1. Local anaesthesia was the more commonly (92.1%) employed while general anaesthesia was used in 23(7.9%) patients. General anaesthesia was used more frequently (71.4%) in children compared to other age groups; the mean age and standard error of means for patients who had general anaesthesia (27.2 /5.4 years) is smaller compared to 63.9/0.93 years for patients who had local anaesthesia (p < 0.0001). Regional anaesthesia was the most frequently used for all types of procedures except for eye wall repairs in which general anaesthesia was used for 71.4% of patients (p < 0.0001). General anaesthesia was indicated in seven (41.2%) of emergency ophthalmic surgical procedures as compared to 16 (5.9%) of elective ophthalmic procedures P < 0.0001. General anaesthesia was more commonly employed in children, eye wall repairs and emergency ophthalmic surgical procedures.

Surgical skills needed for humanitarian missions in resource-limited settings: common operative procedures performed at Médecins Sans Frontières facilities.

PubMed

Wong, Evan G; Trelles, Miguel; Dominguez, Lynette; Gupta, Shailvi; Burnham, Gilbert; Kushner, Adam L

2014-09-01

Surgeons in high-income countries increasingly are expressing interest in global surgery and participating in humanitarian missions. Knowledge of the surgical skills required to adequately respond to humanitarian emergencies is essential to prepare such surgeons and plan for interventions. A retrospective review of all surgical procedures performed at Médecins Sans Frontières Brussels facilities from June 2008 to December 2012 was performed. Individual data points included country of project; patient age and sex; and surgical indication and surgical procedure. Between June 2008 and December 2012, a total of 93,385 procedures were performed on 83,911 patients in 21 different countries. The most common surgical indication was for fetal-maternal pathologies, accounting for 25,548 of 65,373 (39.1%) of all cases. The most common procedure was a Cesarean delivery, accounting for a total of 24,182 or 25.9% of all procedures. Herniorrhaphies (9,873/93,385, 10.6%) and minor surgeries (11,332/93,385, 12.1%), including wound debridement, abscess drainage and circumcision, were also common. A basic skill set that includes the ability to provide surgical care for a wide variety of surgical morbidities is urgently needed to cope with the surgical need of humanitarian emergencies. This review of Médecins Sans Frontières's operative procedures provides valuable insight into the types of operations with which an aspiring volunteer surgeon should be familiar. Copyright © 2014 Mosby, Inc. All rights reserved.

40 CFR 305.24 - Default order.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Default order. 305.24 Section 305.24 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND... (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Prehearing Procedures § 305.24...

40 CFR 305.24 - Default order.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Default order. 305.24 Section 305.24 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND... (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Prehearing Procedures § 305.24...

40 CFR 305.24 - Default order.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Default order. 305.24 Section 305.24 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND... (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Prehearing Procedures § 305.24...

Utilization of an Academic Nursing Center.

ERIC Educational Resources Information Center

Cole, Frank L.; Mackey, Thomas

1996-01-01

Using data from an academic nursing center that cared for 3,263 patients over eight months, diseases were classified using International Classification of Diseases codes, and procedures were classified using Current Procedural Terminology codes. Patterns of health care emerged, with implications for clinical teaching. (SK)

49 CFR 195.446 - Control room management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... written control room management procedures that implement the requirements of this section. The procedures... define the roles and responsibilities of a controller during normal, abnormal, and emergency operating... operator must define each of the following: (1) A controller's authority and responsibility to make...

33 CFR 203.72 - Eligibility criteria and procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., DEPARTMENT OF DEFENSE EMERGENCY EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Advance... potential Advance Measures activities. Occasionally weather phenomena occur which produce a much higher than... phenomenon, based on requests for assistance from such tribal, State, and local agencies. Specific Advance...

33 CFR 203.72 - Eligibility criteria and procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., DEPARTMENT OF DEFENSE EMERGENCY EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Advance... potential Advance Measures activities. Occasionally weather phenomena occur which produce a much higher than... phenomenon, based on requests for assistance from such tribal, State, and local agencies. Specific Advance...

PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art.

PubMed

Cazzato, Roberto Luigi; Garnon, Julien; Shaygi, Behnam; Koch, Guillaume; Tsoumakidou, Georgia; Caudrelier, Jean; Addeo, Pietro; Bachellier, Philippe; Namer, Izzie Jacques; Gangi, Afshin

2018-02-01

Positron emission tomography/computed tomography (PET/CT) represents an emerging imaging guidance modality that has been applied to successfully guide percutaneous procedures such as biopsies and tumour ablations. The aim of the present narrative review is to report the indications, advantages and disadvantages of PET/CT-guided procedures in the field of interventional oncology and to briefly describe the experience gained with this new emerging technique while performing biopsies and tumor ablations.

Visually guided male urinary catheterization: a feasibility study.

PubMed

Willette, Paul A; Banks, Kevin; Shaffer, Lynn

2013-01-01

Ten percent to 15% of urinary catheterizations involve complications. New techniques to reduce risks and pain are indicated. This study examines the feasibility and safety of male urinary catheterization by nursing personnel using a visually guided device in a clinical setting. The device, a 0.6-mm fiber-optic bundle inside a 14F triple-lumen flexible urinary catheter with a lubricious coating, irrigation port, and angled tip, connects to a camera, allowing real-time viewing of progress on a color monitor. Two emergency nurses were trained to use the device. Male patients 18 years or older presenting to the emergency department with an indication for urinary catheterization using a standard Foley or Coudé catheter were eligible to participate in the study. Exclusion criteria were a current suprapubic tube or gross hematuria prior to the procedure. Twenty-five patients were enrolled. Data collected included success of placement, total procedure time, pre-procedure pain and maximum pain during the procedure, gross hematuria, abnormalities or injuries identified if catheterization failed, occurrence of and reason for equipment failures, and number of passes required for placement. All catheters were successfully placed. The median number of passes required was 1. For all but one patient, procedure time was ≤ 17 minutes. A median increase in pain scores of 1 point from baseline to the maximum was reported. Gross hematuria was observed in 2 patients. The success rate for placement of a Foley catheter with the visually guided device was 100%, indicating its safety, accuracy, and feasibility in a clinical setting. Minimal pain was associated with the procedure. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe procedure?

PubMed

Jiménez Fuertes, Montiel; Costa Navarro, David

2012-05-01

Large-bowel obstruction and perforation are still frequently occurring entities for the acute care surgeon. In these cases, Hartmann's procedure is the most commonly used surgical technique. However, recent papers demonstrate that colon resection and primary anastomosis (RPA) in the emergency setting is a safe and feasible procedure. We present our series of left colon resection and primary anastomosis procedures from Torrevieja Hospital (Alicante, Spain), performed without bowel irrigation or a diverting ileostomy. Thirty-two RPA procedures were performed in emergency settings for perforation or obstruction, or both, during an 18-month period. The following data were prospectively collected: age, gender, nationality, diagnoses, ASA score, body mass index (BMI), POSSUM score (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity), and the score according to the Hinchey classification. Furthermore, duration of the operation, length of postoperative hospital stay, and mortality and morbidity data were recorded. Sixteen of these patients were diagnosed with acute diverticulitis, 14 patients with neoplasm (of which 9 cases had obstruction, 2 cases had perforation, and 3 cases had both), and foreign body perforation in the remaining 2 cases. The mean hospital stay was 7.8 (range, 4-10) days. The physiological POSSUM score was 24.4 (range, 15-39), and the surgical POSSUM score was 19.8 (range, 16-24). None of the patients died (0% mortality). Seven patients developed some kind of complication (21.9%), all of which were managed conservatively. The results of this study suggest that RPA for left colon obstruction and perforation in emergency settings can be safely performed in certain surgical conditions.

47 CFR 212.2 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 5 2013-10-01 2013-10-01 false Scope. 212.2 Section 212.2 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR OBTAINING INTERNATIONAL TELECOMMUNICATION SERVICE FOR USE DURING A WARTIME EMERGENCY § 212.2 Scope. The procedures in this...

10 CFR 205.351 - Reporting requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205.351 Reporting requirements. For the purpose of this section, a report or a part of a report may be...

10 CFR 205.351 - Reporting requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205.351 Reporting requirements. For the purpose of this section, a report or a part of a report may be...

10 CFR 205.351 - Reporting requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205.351 Reporting requirements. For the purpose of this section, a report or a part of a report may be...

10 CFR 205.373 - Application procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... power. (k) A showing that, to the best of the applicant's knowledge, the requested relief will not... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports... Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power § 205.373 Application...

40 CFR 305.32 - Objections and offers of proof.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Objections and offers of proof. 305.32 Section 305.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.32 - Objections and offers of proof.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Objections and offers of proof. 305.32 Section 305.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

40 CFR 305.32 - Objections and offers of proof.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Objections and offers of proof. 305.32 Section 305.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) ADMINISTRATIVE HEARING PROCEDURES FOR CLAIMS AGAINST THE SUPERFUND Hearing Procedure...

Suggested Guide for Fire Service Standard Operating Procedures.

ERIC Educational Resources Information Center

Gillett, Merl; Hertzler, Simon L.

Suggested guidelines for the development of fire service standard operating procedures are presented in this document. Section topics are as follow: chain of command; communications; emergency response; apparatus; fire service training; disaster response; aircraft fire safety; mutual aid; national reporting system (example reporting forms);…

47 CFR 212.2 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Scope. 212.2 Section 212.2 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR OBTAINING INTERNATIONAL TELECOMMUNICATION SERVICE FOR USE DURING A WARTIME EMERGENCY § 212.2 Scope. The procedures in this...

47 CFR 212.2 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Scope. 212.2 Section 212.2 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR OBTAINING INTERNATIONAL TELECOMMUNICATION SERVICE FOR USE DURING A WARTIME EMERGENCY § 212.2 Scope. The procedures in this...

47 CFR 212.2 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 5 2011-10-01 2011-10-01 false Scope. 212.2 Section 212.2 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR OBTAINING INTERNATIONAL TELECOMMUNICATION SERVICE FOR USE DURING A WARTIME EMERGENCY § 212.2 Scope. The procedures in this...

47 CFR 212.2 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Scope. 212.2 Section 212.2 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR OBTAINING INTERNATIONAL TELECOMMUNICATION SERVICE FOR USE DURING A WARTIME EMERGENCY § 212.2 Scope. The procedures in this...

10 CFR 205.352 - Information to be reported.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205... stations or air traffic control systems, were or are interrupted. To the extent known or reasonably...

42 CFR 485.64 - Condition of participation: Disaster procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and records; (2) Procedures for notifying community emergency personnel (for example, fire department, ambulance, etc.); (3) Instructions regarding the location and use of alarm systems and signals and fire...'s written disaster plan must be developed and maintained with assistance of qualified fire, safety...

Mapping superintegrable quantum mechanics to resonant spacetimes

NASA Astrophysics Data System (ADS)

Evnin, Oleg; Demirchian, Hovhannes; Nersessian, Armen

2018-01-01

We describe a procedure naturally associating relativistic Klein-Gordon equations in static curved spacetimes to nonrelativistic quantum motion on curved spaces in the presence of a potential. Our procedure is particularly attractive in application to (typically, superintegrable) problems whose energy spectrum is given by a quadratic function of the energy level number, since for such systems the spacetimes one obtains possess evenly spaced, resonant spectra of frequencies for scalar fields of a certain mass. This construction emerges as a generalization of the previously studied correspondence between the Higgs oscillator and anti-de Sitter spacetime, which has been useful for both understanding weakly nonlinear dynamics in anti-de Sitter spacetime and algebras of conserved quantities of the Higgs oscillator. Our conversion procedure ("Klein-Gordonization") reduces to a nonlinear elliptic equation closely reminiscent of the one emerging in relation to the celebrated Yamabe problem of differential geometry. As an illustration, we explicitly demonstrate how to apply this procedure to superintegrable Rosochatius systems, resulting in a large family of spacetimes with resonant spectra for massless wave equations.

Confidence level in performing clinical procedures among medical officers in nonspecialist government hospitals in Penang, Malaysia.

PubMed

Othman, Mohamad Sabri; Merican, Hassan; Lee, Yew Fong; Ch'ng, Kean Siang; Thurairatnam, Dharminy

2015-03-01

A prospective cross-sectional study was conducted at 3 government hospitals over 6 months to evaluate the confidence level of medical officers (MOs) to perform clinical procedure in nonspecialist government hospitals in Penang. An anonymous self-administered questionnaire in English was designed based on the elective and emergency procedures stated in the houseman training logbook. The questionnaire was distributed to the MOs from Penang State Health Department through the respective hospital directors and returned to Penang State Health Department on completion. The results showed that there was statistically significant difference between those who had undergone 12 months and 24 months as houseman in performing both elective and emergency procedures. MOs who had spent 24 months as housemen expressed higher confidence level than those who had only 12 months of experience. We also found that the confidence level was statistically and significantly influenced by visiting specialist and working together with cooperative experienced paramedics. © 2013 APJPH.

Pain scores for intravenous cannulation and arterial blood gas test among emergency department patients.

PubMed

Ballesteros-Peña, Sendoa; Vallejo-De la Hoz, Gorka; Fernández-Aedo, Irrintzi

2017-12-23

To analyse vein catheterisation and blood gas test-related pain among adult patients in the emergency department and to explore pain score-related factors. An observational and multicentre research study was performed. Patients undergoing vein catheterisation or arterial puncture for gas test were included consecutively. After each procedure, patients scored the pain experienced using the NRS-11. 780 vein catheterisations and 101 blood gas tests were analysed. Venipuncture was scored with an average score of 2.8 (95% CI: 2.6-3), and arterial puncture with 3.6 (95%CI 3.1-4). Iatrogenic pain scores were associated with moderate - high difficulty procedures (P<.001); with the choice of the humeral rather than the radial artery (P=.02) in the gas test and correlated to baseline pain in venipunctures (P<.001). Pain scores related to other variables such as sex, place of origin or needle gauge did not present statistically significant differences. Vein catheterisation and blood gas test-related pain can be considered mild to moderately and moderately painful procedures, respectively. The pain score is associated with certain variables such as the difficulty of the procedure, the anatomic area of the puncture or baseline pain. A better understanding of painful effects related to emergency nursing procedures and the factors associated with pain self-perception could help to determine when and how to act to mitigate this undesired effect. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Assessing hospital emergency management plans: a guide for infection preventionists.

PubMed

Rebmann, Terri

2009-11-01

Hospital emergency management plans are essential and must include input from an infection preventionist (IP). Multiple hospital planning documents exist, but many do not address infection prevention issues, combine them with noninfection prevention issues, or are disease/event specific. An all-encompassing emergency management planning guide for IPs is needed. A literature review and Internet search were conducted in December 2008. Data from relevant sources were extracted. A spreadsheet was created that delineated hospital emergency management plan components of interest to IPs. Of the sources screened, 49 were deemed relevant. Eleven domains were identified: (1) having a plan; (2) assessing hospital readiness; (3) having infection prevention policies and procedures; (4) having occupational health policies and procedures; (5) conducting surveillance and triage; (6) reporting incidents, having a communication plan, and managing information; (7) having laboratory support; (8) addressing surge capacity issues; (9) having anti-infective therapy and/or vaccines; (10) providing infection prevention education; and (11) managing physical plant issues. Infection preventionists should use this article as an assessment tool for evaluating their hospital emergency management plan and for developing policies and procedures that will decrease the risk of infection transmission during a mass casualty event.

Chapter 1. Introduction. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Sprung, Charles L; Cohen, Robert; Adini, Bruria

2010-04-01

In December 2007, the European Society of Intensive Care Medicine established a Task Force to develop standard operating procedures (SOPs) for operating intensive care units (ICU) during an influenza epidemic or mass disaster. To provide direction for health care professionals in the preparation and management of emergency ICU situations during an influenza epidemic or mass disaster, standardize activities, and promote coordination and communication among the medical teams. Based on a literature review and contributions of content experts, a list of essential categories for managing emergency situations in the ICU were identified. Based on three cycles of a modified Delphi process, consensus was achieved regarding the categories. A primary author along with an expert group drafted SOPs for each category. Based on the Delphi cycles, the following key topics were found to be important for emergency preparedness: triage, infrastructure, essential equipment, manpower, protection of staff and patients, medical procedures, hospital policy, coordination and collaboration with interface units, registration and reporting, administrative policies and education. The draft SOPs serve as benchmarks for emergency preparedness and response of ICUs to emergencies or outbreak of pandemics.

Ethics in American health 1: ethical approaches to health policy.

PubMed

Ruger, Jennifer Prah

2008-10-01

I trace the evolution of ethical approaches to health policy in the United States and examine a number of critical unresolved issues pertaining to the current set of frameworks. Several themes emerge. First, fair procedures claim more attention than substantive and procedural principles. Second, in the case of public deliberation, more focus has been placed on factors such as procedural mechanisms than on understanding how individuals and groups value different aspects of health and agree on health-related decisions. Third, the nation needs workable frameworks to guide collective choices about valuable social ends and their trade-offs; purely procedural strategies are limited in illuminating overarching health policy and ethics questions. There is a need to integrate consequential and procedural approaches to health ethics and policy.

In situ medical simulation investigation of emergency department procedural sedation with randomized trial of experimental bedside clinical process guidance intervention.

PubMed

Siegel, Nathan A; Kobayashi, Leo; Dunbar-Viveiros, Jennifer A; Devine, Jeffrey; Al-Rasheed, Rakan S; Gardiner, Fenwick G; Olsson, Krister; Lai, Stella; Jones, Mark S; Dannecker, Max; Overly, Frank L; Gosbee, John W; Portelli, David C; Jay, Gregory D

2015-06-01

Patient safety during emergency department procedural sedation (EDPS) can be difficult to study. Investigators sought to delineate and experimentally assess EDPS performance and safety practices of senior-level emergency medicine residents through in situ simulation. Study sessions used 2 pilot-tested EDPS scenarios with critical action checklists, institutional forms, embedded probes, and situational awareness questionnaires. An experimental informatics system was separately developed for bedside EDPS process guidance. Postgraduate year 3 and 4 subjects completed both scenarios in randomized order; only experimental subjects were provided with the experimental system during second scenarios. Twenty-four residents were recruited into a control group (n = 12; 6.2 ± 7.4 live EDPS experience) and experimental group (n = 12; 11.3 ± 8.2 live EDPS experience [P = 0.10]). Critical actions for EDPS medication selection, induction, and adverse event recognition with resuscitation were correctly performed by most subjects. Presedation evaluations, sedation rescue preparation, equipment checks, time-outs, and documentation were frequently missed. Time-outs and postsedation assessments increased during second scenarios in the experimental group. Emergency department procedural sedation safety probe detection did not change across scenarios in either group. Situational awareness scores were 51% ± 7% for control group and 58% ± 12% for experimental group. Subjects using the experimental system completed more time-outs and scored higher Simulation EDPS Safety Composite Scores, although without comprehensive improvements in EDPS practice or safety. Study simulations delineated EDPS and assessed safety behaviors in senior emergency medicine residents, who exhibited the requisite medical knowledge base and procedural skill set but lacked some nontechnical skills that pertain to emergency department microsystem functions and patient safety. The experimental system exhibited limited impact only on in-simulation time-out compliance.

Laparoscopic Colorectal Surgery in the Emergency Setting: Trends in the Province of Ontario.

PubMed

Musselman, Reilly P; Gomes, Tara; Chan, Beverley P; Auer, Rebecca C; Moloo, Husein; Mamdani, Muhammad; Al-Omran, Mohammed; Al-Obeed, Omar; Boushey, Robin P

2015-10-01

The purpose of this study was to examine the adoption trends of emergency laparoscopic colorectal surgery in the province of Ontario. We conducted a retrospective time-series analysis examining rates of emergency colorectal surgery among 10.5 million adults in Ontario, Canada from April 1, 2002 to December 31, 2009. We linked administrative claims databases and the Ontario Cancer Registry to assess procedure rates over time. Procedure trends were assessed using time-series analysis. Over the 8-year period, 29,676 emergency colorectal procedures were identified. A total of 2582 (8.7%) were performed laparoscopically and 27,094 (91.3%) were open. Open and laparoscopic patients were similar with respect age, sex, and Charlson Comorbidity Index. The proportion of surgery for benign (63.8% of open cases vs. 65.6% laparoscopic, standardized difference=0.04) and malignant disease (36.2% open vs. 34.4% laparoscopic, standardized difference=0.04) was equal between groups. The percentage of emergency colorectal surgery performed laparoscopically increased from 5.7% in 2002 to 12.0% in 2009 (P<0.01). The use of laparoscopy increased for both benign and malignant disease. Statistically significant upward trends in laparoscopic surgery were seen for inflammatory bowel disease (P<0.01), obstruction (P<0.01), and colon cancer (P<0.01). From 2002 to 2009, annual procedure rates increased at a greater rate in nonacademic centers (P<0.01). Laparoscopic emergency colorectal surgery has increased significantly between 2002 and 2009 for both benign and malignant disease and for a wide range of diagnoses. This was driven in part by steadily rising usage of laparoscopy in nonacademic centers.

Emergency, anaesthetic and essential surgical capacity in the Gambia

PubMed Central

Shivute, Nestor; Bickler, Stephen; Cole-Ceesay, Ramou; Jargo, Bakary; Abdullah, Fizan; Cherian, Meena

2011-01-01

Abstract Objective To assess the resources for essential and emergency surgical care in the Gambia. Methods The World Health Organization’s Tool for Situation Analysis to Assess Emergency and Essential Surgical Care was distributed to health-care managers in facilities throughout the country. The survey was completed by 65 health facilities – one tertiary referral hospital, 7 district/general hospitals, 46 health centres and 11 private health facilities – and included 110 questions divided into four sections: (i) infrastructure, type of facility, population served and material resources; (ii) human resources; (iii) management of emergency and other surgical interventions; (iv) emergency equipment and supplies for resuscitation. Questionnaire data were complemented by interviews with health facility staff, Ministry of Health officials and representatives of nongovernmental organizations. Findings Important deficits were identified in infrastructure, human resources, availability of essential supplies and ability to perform trauma, obstetric and general surgical procedures. Of the 18 facilities expected to perform surgical procedures, 50.0% had interruptions in water supply and 55.6% in electricity. Only 38.9% of facilities had a surgeon and only 16.7% had a physician anaesthetist. All facilities had limited ability to perform basic trauma and general surgical procedures. Of public facilities, 54.5% could not perform laparotomy and 58.3% could not repair a hernia. Only 25.0% of them could manage an open fracture and 41.7% could perform an emergency procedure for an obstructed airway. Conclusion The present survey of health-care facilities in the Gambia suggests that major gaps exist in the physical and human resources needed to carry out basic life-saving surgical interventions. PMID:21836755

Conditional Relations with Compound Abstract Stimuli Using a Go/No-Go Procedure

ERIC Educational Resources Information Center

Debert, Paula; Matos, Maria Amelia; McIlvane, William

2007-01-01

The aim of this study was to evaluate whether emergent conditional relations could be established with a go/no-go procedure using compound abstract stimuli. The procedure was conducted with 6 adult humans. During training, responses emitted in the presence of certain stimulus compounds (A1B1, A2B2, A3B3, B1C1, B2C2, and B3C3) were followed by…

9 CFR 318.308 - Deviations in processing.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Deviations in processing (or process deviations) must be handled according to: (1)(i) A HACCP plan for canned...) of this section. (c) [Reserved] (d) Procedures for handling process deviations where the HACCP plan... accordance with the following procedures: (a) Emergency stops. (1) When retort jams or breakdowns occur...

9 CFR 381.308 - Deviations in processing.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) must be handled according to: (1)(i) A HACCP plan for canned product that addresses hazards associated... (d) of this section. (c) [Reserved] (d) Procedures for handling process deviations where the HACCP... accordance with the following procedures: (a) Emergency stops. (1) When retort jams or breakdowns occur...

49 CFR 192.605 - Procedural manual for operations, maintenance, and emergencies.

Code of Federal Regulations, 2010 CFR

2010-10-01

... operations and maintenance activities are conducted. (b) Maintenance and normal operations. The manual... personnel to determine the effectiveness, and adequacy of the procedures used in normal operation and... or flow rate outside normal operating limits; (iii) Loss of communications; (iv) Operation of any...

47 CFR 214.2 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 5 2013-10-01 2013-10-01 false Scope. 214.2 Section 214.2 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR THE USE AND COORDINATION OF THE RADIO SPECTRUM DURING A WARTIME EMERGENCY § 214.2 Scope. This part covers procedures for...

47 CFR 214.2 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Scope. 214.2 Section 214.2 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR THE USE AND COORDINATION OF THE RADIO SPECTRUM DURING A WARTIME EMERGENCY § 214.2 Scope. This part covers procedures for...

47 CFR 214.2 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Scope. 214.2 Section 214.2 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR THE USE AND COORDINATION OF THE RADIO SPECTRUM DURING A WARTIME EMERGENCY § 214.2 Scope. This part covers procedures for...

47 CFR 214.2 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 5 2011-10-01 2011-10-01 false Scope. 214.2 Section 214.2 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR THE USE AND COORDINATION OF THE RADIO SPECTRUM DURING A WARTIME EMERGENCY § 214.2 Scope. This part covers procedures for...

47 CFR 214.2 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Scope. 214.2 Section 214.2 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL PROCEDURES FOR THE USE AND COORDINATION OF THE RADIO SPECTRUM DURING A WARTIME EMERGENCY § 214.2 Scope. This part covers procedures for...

10 CFR 73.46 - Fixed site physical protection systems, subsystems, components, and procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., components, and procedures. 73.46 Section 73.46 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) PHYSICAL... Energy couriers engaged in the transport of special nuclear material. The search function for detection... of Energy vehicles engaged in transporting special nuclear material and emergency vehicles under...

10 CFR 73.46 - Fixed site physical protection systems, subsystems, components, and procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., components, and procedures. 73.46 Section 73.46 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) PHYSICAL... Energy couriers engaged in the transport of special nuclear material. The search function for detection... of Energy vehicles engaged in transporting special nuclear material and emergency vehicles under...

14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2014 CFR

2014-01-01

... consumption and cruise control; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The..., DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT... manager's flight locating procedures; (2) Principles and methods for determining weight and balance, and...

14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2013 CFR

2013-01-01

... consumption and cruise control; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The..., DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT... manager's flight locating procedures; (2) Principles and methods for determining weight and balance, and...

14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2012 CFR

2012-01-01

... consumption and cruise control; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The..., DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT... manager's flight locating procedures; (2) Principles and methods for determining weight and balance, and...

39 CFR 776.5 - Review procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Floodplain Management § 776.5 Review procedures. Officials shall follow the decision-making process outlined in paragraphs (a) through (f) of this section, when a facility action may involve floodplain issues... Emergency Management Agency (FEMA) maps, or more detailed maps if available. If such maps are not available...

A prospective comparison of procedural sedation and ultrasound-guided interscalene nerve block for shoulder reduction in the emergency department.

PubMed

Blaivas, Michael; Adhikari, Srikar; Lander, Lina

2011-09-01

Emergency physicians (EPs) are beginning to use ultrasound (US) guidance to perform regional nerve blocks. The primary objective of this study was to compare length of stay (LOS) in patients randomized to US-guided interscalene block or procedural sedation to facilitate reduction of shoulder dislocation in the emergency department (ED). The secondary objectives were to compare one-on-one health care provider time, pain experienced by the patient during reduction, and patient satisfaction between the two groups. This was a prospective, randomized study of patients presenting to the ED with shoulder dislocation. The study was conducted at an academic Level I trauma center ED with an annual census of approximately 80,000. Patients were eligible for the study if they were at least 18 years of age and required reduction of a shoulder dislocation. A convenience sample of patients was randomized to either traditional procedural sedation or US-guided interscalene nerve block. Procedural sedation was performed with etomidate as the sole agent. Interscalene blocks were performed by hospital-credentialed EPs using sterile technique and a SonoSite MicroMaxx US machine with a high-frequency linear array transducer. Categorical variables were evaluated using Fisher's exact test, and continuous variables were analyzed using the Wilcoxon rank sum test. Forty-two patients were enrolled, with 21 patients randomized to each group. The groups were not significantly different with respect to sex or age. The mean (±SD) LOS in the ED was significantly higher in the procedural sedation group (177.3 ± 37.9 min) than in the US-guided interscalene block group (100.3 ± 28.2 minutes; p < 0.0001). The mean (±SD) one-on-one health care provider time was 47.1 (±9.8) minutes for the sedation group and 5 (±0.7) minutes for the US-guided interscalene block group (p < 0.0001). There was no statistically significant difference between the two groups in patient satisfaction or pain experienced during the procedure. There were no significant differences between groups with respect to complications such as hypoxia or hypotension (p = 0.49). In this study, patients undergoing shoulder dislocation reduction using US-guided interscalene block spent less time in the ED and required less one-on-one health care provider time compared to those receiving procedural sedation. There was no difference in pain level or satisfaction when compared to procedural sedation patients. © 2011 by the Society for Academic Emergency Medicine.

A Study on the Validity of a Task Complexity Measure for Emergency Operating Procedures of Nuclear Power Plants—Comparing With a Subjective Workload

NASA Astrophysics Data System (ADS)

Park, J.; Jung, W.

2006-10-01

In this study, the appropriateness of the task complexity (TACOM) measure that can quantify the complexity of emergency tasks was investigated by comparing subjective workload scores with the associated TACOM scores. To this end, based on the NASA-TLX (task load index) technique, 18 operators were asked to subjectively estimate perceived workload for 23 emergency tasks that were specified in the emergency operating procedures of the reference nuclear power plants. As the result of comparisons, it was observed that subjective workload scores increase in proportion to the increase of TACOM scores. Therefore, it is expect that the TACOM measure can be used as a serviceable method to quantify the complexity of emergency tasks

Pediatric surgical capacity building - a pathway to improving access to pediatric surgical care in Haiti.

PubMed

Kaseje, Neema; Jenny, Hillary; Jeudy, Andre Patrick; MacLee, Jean Louis; Meara, John G; Ford, Henri R

2018-02-01

Lack of human resources is a major barrier to accessing pediatric surgical care globally. Our aim was to establish a model for pediatric surgical training of general surgery residents in a resource constrained region. A pediatric surgical program with a pediatric surgical rotation for general surgery residents in a tertiary hospital in Haiti in 2015 was established. We conducted twice daily patient rounds, ran an outpatient clinic, and provided emergent and elective pediatric surgical care, with tasks progressively given to residents until they could run clinic and perform the most common elective and emergent procedures. We conducted baseline and post-intervention knowledge exams and dedicated 1 day a week to teaching and research activities. We measured the following outcomes: number of residents that completed the rotation, mean pre and post intervention test scores, patient volume in clinic and operating room, postoperative outcomes, resident ability to perform most common elective and emergent procedures, and resident participation in research. Nine out of 9 residents completed the rotation; 987 patients were seen in outpatient clinic, and 564 procedures were performed in children <15years old. There was a 50% increase in volume of pediatric cases and a 100% increase in procedures performed in children <4years old. Postoperative outcomes were: 0% mortality for elective cases and 18% mortality for emergent cases, 3% complication rate for elective cases and 6% complication rate for emergent cases. Outcomes did not change with increased responsibility given to residents. All senior residents (n=4) could perform the most common elective and emergent procedures without changes in mortality and complication rates. Increases in mean pre and post intervention test scores were 12% (PGY1), 24% (PGY2), and 10% (PGY3). 75% of senior residents participated in research activities as first or second authors. Establishing a program in pediatric surgery with capacity building of general surgery residents for pediatric surgical care provision is feasible in a resource constrained setting without negative effects on patient outcomes. This model can be applied in other resource constrained settings to increase human resources for global pediatric surgical care provision. III. Copyright © 2017 Elsevier Inc. All rights reserved.

Teaching and assessing procedural skills: a qualitative study.

PubMed

Touchie, Claire; Humphrey-Murto, Susan; Varpio, Lara

2013-05-14

Graduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures. Little is known about resident experiences of acquiring procedural skills proficiency, of practicing these techniques, or of being assessed on their proficiency. The purpose of this study was to qualitatively investigate resident 1) experiences of the acquisition of procedural skills and 2) perceptions of procedural skills assessment methods available to them. Focus groups were conducted in the weeks following an assessment of procedural skills incorporated into an objective structured clinical examination (OSCE). Using fundamental qualitative description, emergent themes were identified and analyzed. Residents perceived procedural skills assessment on the OSCE as a useful formative tool for direct observation and immediate feedback. This positive reaction was regularly expressed in conjunction with a frustration with available assessment systems. Participants reported that proficiency was acquired through resident directed learning with no formal mechanism to ensure acquisition or maintenance of skills. The acquisition and assessment of procedural skills in Internal Medicine programs should move toward a more structured system of teaching, deliberate practice and objective assessment. We propose that directed, self-guided learning might meet these needs.

Human Factors Considerations for Performance-Based Navigation

NASA Technical Reports Server (NTRS)

Barhydt, Richard; Adams, Catherine A.

2006-01-01

A transition toward a performance-based navigation system is currently underway in both the United States and around the world. Performance-based navigation incorporates Area Navigation (RNAV) and Required Navigation Performance (RNP) procedures that do not rely on the location of ground-based navigation aids. These procedures offer significant benefits to both operators and air traffic managers. Under sponsorship from the Federal Aviation Administration (FAA), the National Aeronautics and Space Administration (NASA) has undertaken a project to document human factors issues that have emerged during RNAV and RNP operations and propose areas for further consideration. Issues were found to include aspects of air traffic control and airline procedures, aircraft systems, and procedure design. Major findings suggest the need for human factors-specific instrument procedure design guidelines. Ongoing industry and government activities to address air-ground communication terminology, procedure design improvements, and chart-database commonality are strongly encouraged.

44 CFR 1.1 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Purpose. 1.1 Section 1.1... GENERAL RULEMAKING; POLICY AND PROCEDURES General § 1.1 Purpose. (a) This part contains the basic policies... procedures for implementation of the Regulatory Flexibility Act which took effect January 1, 1981. (d) A FEMA...

44 CFR 1.15 - Hearings.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Hearings. 1.15 Section 1.15... GENERAL RULEMAKING; POLICY AND PROCEDURES Procedures for Rulemaking § 1.15 Hearings. (a) The provisions of 5 U.S.C. 556 and 557, which govern formal hearings in adjudicatory proceedings, do not apply to...

44 CFR 1.15 - Hearings.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Hearings. 1.15 Section 1.15... GENERAL RULEMAKING; POLICY AND PROCEDURES Procedures for Rulemaking § 1.15 Hearings. (a) The provisions of 5 U.S.C. 556 and 557, which govern formal hearings in adjudicatory proceedings, do not apply to...

44 CFR 1.15 - Hearings.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Hearings. 1.15 Section 1.15... GENERAL RULEMAKING; POLICY AND PROCEDURES Procedures for Rulemaking § 1.15 Hearings. (a) The provisions of 5 U.S.C. 556 and 557, which govern formal hearings in adjudicatory proceedings, do not apply to...

76 FR 72961 - Flood Hazard Determinations (Including Flood Elevation Determinations)-Change in Notification and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-28

... opportunity for comment and appeal. These other types of flood hazard determinations include new and modified... Appeal Procedures AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Pursuant to... rules. This new procedure will not affect the notice or appeals process for these determinations. FEMA...

78 FR 20832 - Energy Conservation Program for Consumer Products and Certain Commercial and Industrial Equipment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-08

... ``leak significantly'' to mean the visible emergence of water from parts of the showerhead other than the... Procedures for Showerheads, Faucets, Water Closets, Urinals, and Commercial Prerinse Spray Valves AGENCY... notice of proposed rulemaking related to DOE test procedures for showerheads, faucets, water closets...

44 CFR 1.6 - Ex parte communications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Ex parte communications. 1.6... HOMELAND SECURITY GENERAL RULEMAKING; POLICY AND PROCEDURES General § 1.6 Ex parte communications. In rulemaking proceedings subject only to the procedural requirements of 5 U.S.C. 553: (a) All oral...

47 CFR 64.402 - Policies and procedures for the provision of priority access service by commercial mobile radio...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Policies and procedures for the provision of... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) MISCELLANEOUS... National Security and Emergency Preparedness personnel shall provide priority access service in accordance...

75 FR 50713 - Procedural Changes to the Fire Management Assistance Declaration Process

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-17

... FEMA-2010-0036] RIN-1660-AA72 Procedural Changes to the Fire Management Assistance Declaration Process... Federal Emergency Management Agency (FEMA) is updating its Fire Management Assistance Grant Program regulations to reflect a change in the internal delegation of authority for fire management assistance...

10 CFR 205.372 - Filing procedures; number of copies.

Code of Federal Regulations, 2010 CFR

2010-01-01

....372 Energy DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System... Electric Facilities and the Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power... and reports required under §§ 205.370 through 205.379 shall be filed with the Division of Power Supply...

44 CFR 1.15 - Hearings.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Hearings. 1.15 Section 1.15... GENERAL RULEMAKING; POLICY AND PROCEDURES Procedures for Rulemaking § 1.15 Hearings. (a) The provisions of 5 U.S.C. 556 and 557, which govern formal hearings in adjudicatory proceedings, do not apply to...

10 CFR 205.372 - Filing procedures; number of copies.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and reports required under §§ 205.370 through 205.379 shall be filed with the Division of Power Supply....372 Energy DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System... Electric Facilities and the Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power...

10 CFR 26.27 - Written policy and procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Program Elements § 26.27 Written policy and... respond to an emergency, the procedure must— (A) Require a determination of fitness by breath alcohol... require him or her to be subject to this subpart, if the results of the determination of fitness indicate...

10 CFR 26.27 - Written policy and procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Program Elements § 26.27 Written policy and... respond to an emergency, the procedure must— (A) Require a determination of fitness by breath alcohol... require him or her to be subject to this subpart, if the results of the determination of fitness indicate...

Functional and Structural Analyses of Behavior: Approaches Leading to Reduced Use of Punishment Procedures?

ERIC Educational Resources Information Center

Axelrod, Saul

1987-01-01

Emerging approaches for dealing with inappropriate behaviors of the disabled involve conducting a functional or structural behavior analysis to isolate the factors responsible for the aberrant behavior and implementing corrective procedures (often alternatives to punishment) relevant to the function of the inappropriate behavior. (Author/DB)

Efficacy of Ethnographic Research in Education

ERIC Educational Resources Information Center

Sajan, K. S.; Sindhu, M.

2014-01-01

Ethnographic research is an emerging research technique in the field of education. Ethnographic research was a procedure usually used in anthropology but now it is getting popular in educational field. This kind of research relies on qualitative data, its perspective is holistic and its procedures of data analysis involve contextualization. Data…

44 CFR 1.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Purpose. 1.1 Section 1.1... GENERAL RULEMAKING; POLICY AND PROCEDURES General § 1.1 Purpose. (a) This part contains the basic policies... procedures for implementation of the Regulatory Flexibility Act which took effect January 1, 1981. (d) A FEMA...

44 CFR 1.1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Purpose. 1.1 Section 1.1... GENERAL RULEMAKING; POLICY AND PROCEDURES General § 1.1 Purpose. (a) This part contains the basic policies... procedures for implementation of the Regulatory Flexibility Act which took effect January 1, 1981. (d) A FEMA...

44 CFR 1.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Purpose. 1.1 Section 1.1... GENERAL RULEMAKING; POLICY AND PROCEDURES General § 1.1 Purpose. (a) This part contains the basic policies... procedures for implementation of the Regulatory Flexibility Act which took effect January 1, 1981. (d) A FEMA...

Establishing Derived Equivalence Relations of Basic Geography Skills in Children with Autism

ERIC Educational Resources Information Center

Dixon, Mark R.; Stanley, Caleb; Belisle, Jordan; Galliford, Megan E.; Alholail, Amani; Schmick, Ayla M.

2017-01-01

The present study evaluated the efficacy of a stimulus-equivalence training procedure in teaching basic geography skills to two children with autism. The procedures were taken directly from a standardized training curriculum based in stimulus equivalence theory called "Promoting the Emergence of Advanced Knowledge Equivalence Module"…

40 CFR 265.55 - Emergency coordinator.

Code of Federal Regulations, 2010 CFR

2010-07-01

... FACILITIES Contingency Plan and Emergency Procedures § 265.55 Emergency coordinator. At all times, there must... aspects of the facility's contingency plan, all operations and activities at the facility, the location... out the contingency plan. [Comment: The emergency coordinator's responsibilities are more fully...

What To Do, What To Do? Determining a Course of Action at the Operational Level of War

DTIC Science & Technology

1992-05-18

and making choices can expand the limits of human rationality . 5 Where decisions involve the lives of soldiers and the future of nations, any edge or...ANALYSIS 15. N5Iu,,3E•a -r PAGES115 OPERATIONAL DECISION - MAKING MISSION ANALYSIS 115 COURSE OF ACTION SELECTION STAFF ESTIMATES I1. SECUlPIT... decision - making procedures for the operational level of war. These doctrinal procedures are found in emerging joint doctrine. For these procedures to be

Sources of emergency water supplies in San Mateo County, California

USGS Publications Warehouse

Wood, P.R.

1975-01-01

San Mateo County has several densely populated urban areas that get most of their water supplies from surface-water sources that could by damaged by a major earthquake or other general disaster. In the event of such a disaster, limited supplies of potable water may be obtained from selected wells, springs, and perennial streams. This report outlines the principal sources of existing water supplies, gives information on the need for emergency water-supply procedures, presents general criteria needed for selecting emergency water-supply wells, summarizes information for 60 selected water wells, numerous springs, and perennial streams that can be used as sources of water, and describes emergency water-purification procedures that can be used by individuals or small groups of people.

The status of penile enhancement procedures.

PubMed

Vardi, Yoram; Gruenwald, Ilan

2009-11-01

Most men who request surgical penile enhancement have a normal-sized and fully functional penis but visualize their penises as small (psychological dysmorphism). This fact by itself leads to controversy regarding the true indications for penile enhancement procedures in men without micropenis. One of the typical aspects of penile enhancement is the lack of true methodological evaluation of the more commonly performed procedures. Even recently, only few solid scientific studies are available which can shed some light on results and outcome of these controversial procedures. Although some additional data has emerged during the past year, there is still no consensus in regard to indications and surgical techniques used for penile augmentation or penile girth enhancement. There is further need for more studies to provide a better overview of the value and worthiness of these procedures.

Ethics in American Health 1: Ethical Approaches to Health Policy

PubMed Central

2008-01-01

I trace the evolution of ethical approaches to health policy in the United States and examine a number of critical unresolved issues pertaining to the current set of frameworks. Several themes emerge. First, fair procedures claim more attention than substantive and procedural principles. Second, in the case of public deliberation, more focus has been placed on factors such as procedural mechanisms than on understanding how individuals and groups value different aspects of health and agree on health-related decisions. Third, the nation needs workable frameworks to guide collective choices about valuable social ends and their trade-offs; purely procedural strategies are limited in illuminating overarching health policy and ethics questions. There is a need to integrate consequential and procedural approaches to health ethics and policy. PMID:18703449

30 CFR 49.9 - Mine emergency notification plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Metal and Nonmetal Mines § 49.9 Mine emergency... procedures to follow in notifying the mine rescue teams when there is an emergency that requires their...

30 CFR 49.9 - Mine emergency notification plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

... TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Metal and Nonmetal Mines § 49.9 Mine emergency... procedures to follow in notifying the mine rescue teams when there is an emergency that requires their...

30 CFR 49.9 - Mine emergency notification plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

... TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Metal and Nonmetal Mines § 49.9 Mine emergency... procedures to follow in notifying the mine rescue teams when there is an emergency that requires their...

Performance Support Tools for Space Medical Operations

NASA Technical Reports Server (NTRS)

Byrne, Vicky E.; Schmidt, Josef; Barshi, Immanuel

2009-01-01

The early Constellation space missions are expected to have medical capabilities very similar to those currently on the Space Shuttle and International Space Station (ISS). For Crew Exploration Vehicle (CEV) missions to ISS, medical equipment will be located on ISS, and carried into CEV in the event of an emergency. Flight Surgeons (FS) on the ground in Mission Control will be expected to direct the Crew Medical Officer (CMO) during medical situations. If there is a loss of signal and the crew is unable to communicate with the ground, a CMO would be expected to carry out medical procedures without the aid of a FS. In these situations, performance support tools can be used to reduce errors and time to perform emergency medical tasks. Human factors personnel at Johnson Space Center have recently investigated medical performance support tools for CMOs on-orbit, and FSs on the ground. This area of research involved the feasibility of Just-in-time (JIT) training techniques and concepts for real-time medical procedures. In Phase 1, preliminary feasibility data was gathered for two types of prototype display technologies: a hand-held PDA, and a Head Mounted Display (HMD). The PDA and HMD were compared while performing a simulated medical procedure using ISS flight-like medical equipment. Based on the outcome of Phase 1, including data on user preferences, further testing was completed using the PDA only. Phase 2 explored a wrist-mounted PDA, and compared it to a paper cue card. For each phase, time to complete procedures, errors, and user satisfaction were captured. Information needed by the FS during ISS mission support, especially for an emergency situation (e.g. fire onboard ISS), may be located in many different places around the FS s console. A performance support tool prototype is being developed to address this issue by bringing all of the relevant information together in one place. The tool is designed to include procedures and other information needed by a FS during an emergency, as well as procedures and information to be used after the emergency is resolved. Several walkthroughs of the prototype with FSs have been completed within a mockup of an ISS FS console. Feedback on the current tool design as well as recommendations for existing ISS FS displays were captured.

Australasian emergency physicians: a learning and educational needs analysis. Part Four: CPD topics desired by emergency physicians.

PubMed

Dent, Andrew W; Weiland, Tracey J; Paltridge, Debbie

2008-06-01

To report the preferences of Fellows of the Australasian College for Emergency Medicine for topics they would desire for their continuing professional development (CPD). A mailed survey of Fellows of the Australasian College for Emergency Medicine asked for Likert type responses on the desirability of CPD on 15 procedural skills, 13 management skills, 11 clinical emergency topics, 9 topics related to teaching, 7 related to diagnostics and 5 evidence based practice topics. CPD in procedural skills of advanced and surgical airways, ED ultrasound, ventilation, skills, plastic procedures and regional anaesthesia were nominated as desirable by 85% of emergency physicians (EP). More than 90% desired CPD in ophthalmological, otorhinolaryngeal, neonatal and paediatric emergencies. Of diagnostic skills, more than 80% considered CPD on computerized tomography, electrocardiography and plain X-ray interpretation as desirable, well as CPD about teaching in general, simulation and preparing candidates for fellowship exams. Of the 12 management skills, 11 were seen as desirable topics by more than 70%, with counter disaster planning, giving feedback and dealing with complaints the most popular. All evidence based practice related skills, including interpreting statistics and undertaking literature searches were seen as desirable topics by more than 80% of EP. This information may assist in the planning of future educational interventions for emergency physicians. EP seek CPD on management, educational and other non clinical skills, as well as topics relating directly to patient care.

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…

Nitrous Oxide 70% for Procedural Analgosedation in a Pediatric Emergency Department With or Without Intranasal Fentanyl?: Analgesic Efficacy and Adverse Events if Combined With Intranasal Fentanyl.

PubMed

Seiler, Michelle; Landolt, Markus A; Staubli, Georg

2017-07-03

Nitrous oxide 70% (N20 70%) is an excellent medication for procedural analgosedation in a pediatric emergency department. However, its analgesic efficacy remains uncertain for painful procedures; therefore, a combination with intranasal fentanyl (INF), an opioid, was suggested. This study aimed at observing and assessing the analgesic efficacy and rate of adverse events using N20 70% with and without INF. Children who received N20 70% in a tertiary children's hospital emergency department from January 1, 2014 to June 30, 2015 were included in this observational study with prospective data collection. Physicians decided individually whether INF was administered. Medical staff documented the child's behavior during the procedure, adverse events, and satisfaction rate. A total of 442 children were included; 206 (46.6%) received INF. Group differences regarding patient behavior were not statistically significant; however, N20 70% application time was longer in the INF group (P = .02). Nausea was the most frequent adverse event with 13.1% in the INF group versus 8.1% without INF. Inadequate procedural analgosedation was documented only in the INF group, affecting 1.8% of all patients (P = .002). In contrast, anxiety was exclusively observed in the group without INF, which was presumably misjudged pain (P = .03); the satisfaction rate in the INF group was 95.6% compared with 98.7% without INF. Because of the study design and limitations, no conclusions about adding INF to N20 70% can be made. Additional research is needed to investigate the effect of combining N20 70% with INF.

49 CFR 220.47 - Emergency radio transmissions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Emergency radio transmissions. 220.47 Section 220... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD COMMUNICATIONS Radio and Wireless Communication Procedures § 220.47 Emergency radio transmissions. An initial emergency radio transmission shall be preceded by the...

49 CFR 220.47 - Emergency radio transmissions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD COMMUNICATIONS Radio and Wireless Communication Procedures § 220.47 Emergency radio transmissions. An initial emergency radio transmission shall be preceded by the... 49 Transportation 4 2014-10-01 2014-10-01 false Emergency radio transmissions. 220.47 Section 220...

49 CFR 220.47 - Emergency radio transmissions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD COMMUNICATIONS Radio and Wireless Communication Procedures § 220.47 Emergency radio transmissions. An initial emergency radio transmission shall be preceded by the... 49 Transportation 4 2013-10-01 2013-10-01 false Emergency radio transmissions. 220.47 Section 220...

44 CFR 334.2 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... system of planning procedures for integrating the emergency preparedness actions of federal, state and... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Policy. 334.2 Section 334.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY...

Emergency Procedures for the Strength and Conditioning Coach.

ERIC Educational Resources Information Center

Binkley, Helen M.; Williams, Lauren C.

2003-01-01

Presents suggested actions for strength and conditioning coaches to take when an emergency arises, focusing on: athlete collapse; thermoregulatory conditions (heat illness and cold illness and their prevention); asthma/bronchospasm and prevention of asthma/bronchospasm emergencies; diabetes and prevention of diabetic emergencies; and…

33 CFR 337.7 - Emergency actions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... measures to modify the emergency operation to reduce, avoid, or minimize adverse environmental impacts. If... DEFENSE PRACTICE AND PROCEDURE § 337.7 Emergency actions. After obtaining approval from the division..., as necessary, an environmental assessment, if this is practicable in view of the emergency situation...

33 CFR 337.7 - Emergency actions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... measures to modify the emergency operation to reduce, avoid, or minimize adverse environmental impacts. If... DEFENSE PRACTICE AND PROCEDURE § 337.7 Emergency actions. After obtaining approval from the division..., as necessary, an environmental assessment, if this is practicable in view of the emergency situation...

33 CFR 337.7 - Emergency actions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... measures to modify the emergency operation to reduce, avoid, or minimize adverse environmental impacts. If... DEFENSE PRACTICE AND PROCEDURE § 337.7 Emergency actions. After obtaining approval from the division..., as necessary, an environmental assessment, if this is practicable in view of the emergency situation...

33 CFR 337.7 - Emergency actions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... measures to modify the emergency operation to reduce, avoid, or minimize adverse environmental impacts. If... DEFENSE PRACTICE AND PROCEDURE § 337.7 Emergency actions. After obtaining approval from the division..., as necessary, an environmental assessment, if this is practicable in view of the emergency situation...

Robotic Camera Assistance and Its Benefit in 1033 Traditional Laparoscopic Procedures: Prospective Clinical Trial Using a Joystick-guided Camera Holder.

PubMed

Holländer, Sebastian W; Klingen, Hans Joachim; Fritz, Marliese; Djalali, Peter; Birk, Dieter

2014-11-01

Despite advances in instruments and techniques in laparoscopic surgery, one thing remains uncomfortable: the camera assistance. The aim of this study was to investigate the benefit of a joystick-guided camera holder (SoloAssist®, Aktormed, Barbing, Germany) for laparoscopic surgery and to compare the robotic assistance to human assistance. 1033 consecutive laparoscopic procedures were performed assisted by the SoloAssist®. Failures and aborts were documented and nine surgeons were interviewed by questionnaire regarding their experiences. In 71 of 1033 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of frequent changes of position, narrow spaces, and adverse angular degrees. One case of short circuit was reported. Emergency stop was necessary in three cases due to uncontrolled movement into the abdominal cavity. Eight of nine surgeons prefer robotic to human assistance, mostly because of a steady image and self-control. The SoloAssist® robot is a reliable system for laparoscopic procedures. Emergency shutdown was necessary in only three cases. Some minor weak spots could have been identified. Most surgeons prefer robotic assistance to human assistance. We feel that the SoloAssist® makes standard laparoscopic surgery more comfortable and further development is desirable, but it cannot fully replace a human assistant.

7 CFR 331.14 - Incident response. 6

Code of Federal Regulations, 2010 CFR

2010-01-01

... other natural disasters; workplace violence; bomb threats and suspicious packages; and emergencies such... equipment, and their locations; (10) Site security and control; (11) Procedures for emergency evacuation...

Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of Combined Procedures.

PubMed

Kaoutzanis, Christodoulos; Gupta, Varun; Winocour, Julian; Layliev, John; Ramirez, Roberto; Grotting, James C; Higdon, Kent

2017-06-01

Liposuction is among the most commonly performed aesthetic procedures, and is being performed increasingly as an adjunct to other procedures. To report the incidence and risk factors of significant complications after liposuction, and to determine whether adding liposuction to other cosmetic surgical procedures impacts the complication risk. A prospective cohort of patients who underwent liposuction between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major complications requiring emergency room visit, hospital admission, or reoperation within 30 days of the operation. Univariate and multivariate analysis evaluated risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, and combined procedures. Of the 31,010 liposuction procedures, only 11,490 (37.1%) were performed as a solitary procedure. Liposuction alone had a major complication rate of 0.7% with hematoma (0.15%), pulmonary complications (0.1%), infection (0.1%), and confirmed venous thromboembolism (VTE) (0.06%) being the most common. Independent predictors of major complications included combined procedures (Relative Risk (RR) 4.81), age (RR 1.01), BMI (RR 1.05), and procedures performed in hospitals (RR 1.36). When examining specifically other aesthetic procedures performed alone or with liposuction, combined procedures had a higher risk of confirmed VTE (RR 5.65), pulmonary complications (RR 2.72), and infection (RR 2.41), but paradoxically lower hematoma risk (RR 0.77) than solitary procedures. Liposuction performed alone is a safe procedure with a low risk of major complications. Combined procedures, especially on obese or older individuals, can significantly increase complication rates. The impact of liposuction on the risk of hematoma in combined procedures needs further investigation. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children's anxiety and pain levels in emergency department.

PubMed

Felluga, Margherita; Rabach, Ingrid; Minute, Marta; Montico, Marcella; Giorgi, Rita; Lonciari, Isabella; Taddio, Andrea; Barbi, Egidio

2016-05-01

The aim of the study is to investigate if the presence of medical clowns during painful procedures in the emergency department (ED) affects children's anxiety and pain. Forty children (4-11 years) admitted to the ED with the need of painful procedures were prospectively enrolled. They were randomly assigned to the clown group, where children interacted with clowns or to the control group in which they were entertained by parents and ED nurses. The children's anxiety was assessed by the Children's Anxiety and Pain Scales; pain was evaluated with the Numerical Rating Scale and Wong-Backer Scale, according to the children's age. Staff and clown's opinions were evaluated by means of dedicated questionnaires. Children's anxiety levels in the clown group were significantly lower than those compared with the control group, while children's pain levels did not change between the two groups. The presence of clowns in the ED before and during painful procedures was effective in reducing children's anxiety. • Anxiety and fear caused by medical procedures exacerbate children's pain and may interfere with the procedure. • To reduce anxiety, fear, and pain and to facilitate patient's evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: • The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children's anxiety.

Implementing Liberia's poverty reduction strategy: An assessment of emergency and essential surgical care.

PubMed

Sherman, Lawrence; Clement, Peter T; Cherian, Meena N; Ndayimirije, Nestor; Noel, Luc; Dahn, Bernice; Gwenigale, Walter T; Kushner, Adam L

2011-01-01

To document infrastructure, personnel, procedures performed, and supplies and equipment available at all county hospitals in Liberia using the World Health Organization Tool for Situational Analysis of Emergency and Essential Surgical Care. Survey of county hospitals using the World Health Organization Tool for Situational Analysis of Emergency and Essential Surgical Care. Sixteen county hospitals in Liberia. Infrastructure, personnel, procedures performed, and supplies and equipment available. Uniformly, gross deficiencies in infrastructure, personnel, and supplies and equipment were identified. The World Health Organization Tool for Situational Analysis of Emergency and Essential Surgical Care was useful in identifying baseline emergency and surgical conditions for evidenced-based planning. To achieve the Poverty Reduction Strategy and delivery of the Basic Package of Health and Social Welfare Services, additional resources and manpower are needed to improve surgical and anesthetic care.

An Audiovisual Teaching Module to Assist Examiners in the Administration of a Practical Performance Examination for the Emergency Medical Technician-Ambulance (EMT-A). Consisting of a 90-Minute Audiovisual Presentation In Either 16mm Sound or 3/4" Video-Cassette Plus a "User's Guide" Describing in Detail the Total Examination Procedure. Final Report.

ERIC Educational Resources Information Center

National Registry of Emergency Medical Technicians, Columbus, OH.

A structured, time-referenced, performance examination was designed as part of the certification procedure for Emergency Medical Technicians-Ambulance in an attempt to increase objectivity and standardization. This examination is based on a model developed by the University of Southern California, School of Medicine, Department of Emergency…

29 CFR 1910.38 - Emergency action plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... action plan must include at a minimum: (1) Procedures for reporting a fire or other emergency; (2... 29 Labor 5 2013-07-01 2013-07-01 false Emergency action plans. 1910.38 Section 1910.38 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Exit Routes and Emergency Planning § 1910.38 Emergency action plans...

Passenger Airlift Policies and Procedures Review. Volume 2.

DTIC Science & Technology

1986-04-02

4D- A191 921 PISSEMOER AIRLIFT POLICIES AND PROCEDURES REVIEW VOLUME I/ 2(U) DEPARTMENT OF DEFENSE NASHNTON DC 62 MR #6 ULASSIEDFO1/6 N mhhhhhhhhhhmhl...depoastlosregl at I. .ieWd crash rtowne support of c-pein for aoing of stain ned lUne 2. Aircraft clearace factlitim. 10. " Sweping 3. Emergency

28 CFR 65.84 - Procedures for the Attorney General when seeking State or local assistance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Procedures for the Attorney General when... the Attorney General when seeking State or local assistance. (a)(1) When the Attorney General... President has determined that an immigration emergency exists, the Attorney General shall negotiate the...

76 FR 12600 - Review of the Emergency Alert System

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-08

... appropriate, various administrative procedures for national tests, including test codes to be used and pre... administrative procedures for national tests, including test codes to be used and pre-test outreach. B. Summary... test codes to be used and pre-test outreach, the Commission has instructed the Bureau to factor in the...

Value of Artisanal Simulators to Train Veterinary Students in Performing Invasive Ultrasound-Guided Procedures

ERIC Educational Resources Information Center

Hage, Maria Cristina F. N. S.; Massaferro, Ana Beatriz; Lopes, Érika Rondon; Beraldo, Carolina Mariano; Daniel, Jéssika

2016-01-01

Pericardial effusion can lead to cardiac tamponade, which endangers an animal's life. Ultrasound-guided pericardiocentesis is used to remove abnormal liquid; however, it requires technical expertise. In veterinary medical education, the opportunity to teach this procedure to save lives during emergencies is rare; therefore, simulators are…

Flexible robotic catheters in the visceral segment of the aorta: advantages and limitations.

PubMed

Li, Mimi M; Hamady, Mohamad S; Bicknell, Colin D; Riga, Celia V

2018-06-01

Flexible robotic catheters are an emerging technology which provide an elegant solution to the challenges of conventional endovascular intervention. Originally developed for interventional cardiology and electrophysiology procedures, remotely steerable robotic catheters such as the Magellan system enable greater precision and enhanced stability during target vessel navigation. These technical advantages facilitate improved treatment of disease in the arterial tree, as well as allowing execution of otherwise unfeasible procedures. Occupational radiation exposure is an emerging concern with the use of increasingly complex endovascular interventions. The robotic systems offer an added benefit of radiation reduction, as the operator is seated away from the radiation source during manipulation of the catheter. Pre-clinical studies have demonstrated reduction in force and frequency of vessel wall contact, resulting in reduced tissue trauma, as well as improved procedural times. Both safety and feasibility have been demonstrated in early clinical reports, with the first robot-assisted fenestrated endovascular aortic repair in 2013. Following from this, the Magellan system has been used to successfully undertake a variety of complex aortic procedures, including fenestrated/branched endovascular aortic repair, embolization, and angioplasty.

Trainee participation is associated with adverse outcomes in emergency general surgery: an analysis of the National Surgical Quality Improvement Program database.

PubMed

Kasotakis, George; Lakha, Aliya; Sarkar, Beda; Kunitake, Hiroko; Kissane-Lee, Nicole; Dechert, Tracey; McAneny, David; Burke, Peter; Doherty, Gerard

2014-09-01

To identify whether resident involvement affects clinically relevant outcomes in emergency general surgery. Previous research has demonstrated a significant impact of trainee participation on outcomes in a broad surgical patient population. We identified 141,010 patients who underwent emergency general surgery procedures in the 2005-2010 Surgeons National Surgical Quality Improvement Program database. Because of the nonrandom assignment of complex cases to resident participation, patients were matched (1:1) on known risk factors [age, sex, inpatient status, preexisting comorbidities (obesity, diabetes, smoking, alcohol, steroid use, coronary artery disease, chronic renal failure, pulmonary disease)] and preoperatively calculated probability for morbidity and mortality. Clinically relevant outcomes were compared with a t or χ test. The impact of resident participation on outcomes was assessed with multivariable regression modeling, adjusting for risk factors and operative time. The most common procedures in the matched cohort (n = 83,790) were appendectomy (39.9%), exploratory laparotomy (8.8%), and adhesiolysis (6.6%). Trainee participation is independently associated with intra- and postoperative events, wound, pulmonary, and venous thromboembolic complications, and urinary tract infections. Trainee participation is associated with adverse outcomes in emergency general surgery procedures.

An hypnotic suggestion: review of hypnosis for clinical emergency care.

PubMed

Iserson, Kenneth V

2014-04-01

Hypnosis has been used in medicine for nearly 250 years. Yet, emergency clinicians rarely use it in emergency departments or prehospital settings. This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses reasons why the technique has not been widely adopted, and suggests methods of increasing its use in emergency care, including some potential research areas. A limited number of clinical studies and case reports suggest that hypnosis may be effective in a wide variety of conditions applicable to emergency medical care. These include providing analgesia for existing pain (e.g., fractures, burns, and lacerations), providing analgesia and sedation for painful procedures (e.g., needle sticks, laceration repair, and fracture and joint reductions), reducing acute anxiety, increasing children's cooperation for procedures, facilitating the diagnosis and treatment of acute psychiatric conditions, and providing analgesia and anxiolysis for obstetric/gynecologic problems. Although it is safe, fast, and cost-effective, emergency clinicians rarely use hypnosis. This is due, in part, to the myths surrounding hypnosis and its association with alternative-complementary medicine. Genuine barriers to its increased clinical use include a lack of assured effectiveness and a lack of training and training requirements. Based on the results of further research, hypnosis could become a powerful and safe nonpharmacologic addition to the emergency clinician's armamentarium, with the potential to enhance patient care in emergency medicine, prehospital care, and remote medical settings. Copyright © 2014 Elsevier Inc. All rights reserved.

Interdisciplinary Development of an Improved Emergency Department Procedural Work Surface Through Iterative Design and Use Testing in Simulated and Clinical Environments.

PubMed

Zhang, Xiao C; Bermudez, Ana M; Reddy, Pranav M; Sarpatwari, Ravi R; Chheng, Darin B; Mezoian, Taylor J; Schwartz, Victoria R; Simmons, Quinneil J; Jay, Gregory D; Kobayashi, Leo

2017-03-01

A stable and readily accessible work surface for bedside medical procedures represents a valuable tool for acute care providers. In emergency department (ED) settings, the design and implementation of traditional Mayo stands and related surface devices often limit their availability, portability, and usability, which can lead to suboptimal clinical practice conditions that may affect the safe and effective performance of medical procedures and delivery of patient care. We designed and built a novel, open-source, portable, bedside procedural surface through an iterative development process with use testing in simulated and live clinical environments. The procedural surface development project was conducted between October 2014 and June 2016 at an academic referral hospital and its affiliated simulation facility. An interdisciplinary team of emergency physicians, mechanical engineers, medical students, and design students sought to construct a prototype bedside procedural surface out of off-the-shelf hardware during a collaborative university course on health care design. After determination of end-user needs and core design requirements, multiple prototypes were fabricated and iteratively modified, with early variants featuring undermattress stabilizing supports or ratcheting clamp mechanisms. Versions 1 through 4 underwent 2 hands-on usability-testing simulation sessions; version 5 was presented at a design critique held jointly by a panel of clinical and industrial design faculty for expert feedback. Responding to select feedback elements over several surface versions, investigators arrived at a near-final prototype design for fabrication and use testing in a live clinical setting. This experimental procedural surface (version 8) was constructed and then deployed for controlled usability testing against the standard Mayo stands in use at the study site ED. Clinical providers working in the ED who opted to participate in the study were provided with the prototype surface and just-in-time training on its use when performing bedside procedures. Subjects completed the validated 10-point System Usability Scale postshift for the surface that they had used. The study protocol was approved by the institutional review board. Multiple prototypes and recursive design revisions resulted in a fully functional, portable, and durable bedside procedural surface that featured a stainless steel tray and intuitive hook-and-lock mechanisms for attachment to ED stretcher bed rails. Forty-two control and 40 experimental group subjects participated and completed questionnaires. The median System Usability Scale score (out of 100; higher scores associated with better usability) was 72.5 (interquartile range [IQR] 51.3 to 86.3) for the Mayo stand; the experimental surface was scored at 93.8 (IQR 84.4 to 97.5 for a difference in medians of 17.5 (95% confidence interval 10 to 27.5). Subjects reported several usability challenges with the Mayo stand; the experimental surface was reviewed as easy to use, simple, and functional. In accordance with experimental live environment deployment, questionnaire responses, and end-user suggestions, the project team finalized the design specification for the experimental procedural surface for open dissemination. An iterative, interdisciplinary approach was used to generate, evaluate, revise, and finalize the design specification for a new procedural surface that met all core end-user requirements. The final surface design was evaluated favorably on a validated usability tool against Mayo stands when use tested in simulated and live clinical settings. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Evaluation of flaws in carbon steel piping. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zahoor, A.; Gamble, R.M.; Mehta, H.S.

1986-10-01

The objective of this program was to develop flaw evaluation procedures and allowable flaw sizes for ferritic piping used in light water reactor (LWR) power generation facilities. The program results provide relevant ASME Code groups with the information necessary to define flaw evaluation procedures, allowable flaw sizes, and their associated bases for Section XI of the code. Because there are several possible flaw-related failure modes for ferritic piping over the LWR operating temperature range, three analysis methods were employed to develop the evaluation procedures. These include limit load analysis for plastic collapse, elastic plastic fracture mechanics (EPFM) analysis for ductilemore » tearing, and linear elastic fracture mechanics (LEFM) analysis for non ductile crack extension. To ensure the appropriate analysis method is used in an evaluation, a step by step procedure also is provided to identify the relevant acceptance standard or procedure on a case by case basis. The tensile strength and toughness properties required to complete the flaw evaluation for any of the three analysis methods are included in the evaluation procedure. The flaw evaluation standards are provided in tabular form for the plastic collapse and ductile tearing modes, where the allowable part through flaw depth is defined as a function of load and flaw length. For non ductile crack extension, linear elastic fracture mechanics analysis methods, similar to those in Appendix A of Section XI, are defined. Evaluation flaw sizes and procedures are developed for both longitudinal and circumferential flaw orientations and normal/upset and emergency/faulted operating conditions. The tables are based on margins on load of 2.77 and 1.39 for circumferential flaws and 3.0 and 1.5 for longitudinal flaws for normal/upset and emergency/faulted conditions, respectively.« less

Radiation exposure, and procedure and fluoroscopy times in endovascular treatment of intracranial aneurysms: a methodological comparison.

PubMed

Cheung, Nicholas K; Boutchard, Michelle; Carr, Michael W; Froelich, Jens J

2018-01-09

Limited data are available for radiation exposure, and procedure and fluoroscopy times in neuroendovascular treatment (NET) strategies. This study establishes and compares related parameters between coil embolization (COIL), balloon assisted coil embolization (BAC), stent assisted coil embolization (SAC), and flow diverting technology (FDT) in NET of intracranial aneurysms. Between 2010 and 2017, 249 consecutive intracranial aneurysms underwent NET at a single center, all performed by the same operator. Dose area products (DAP), and procedure and fluoroscopy times were recorded and compared between COIL, BAC, SAC, and FDT techniques. Differences in parameters between cohorts were analyzed for significance using the Mann-Whitney U test, unpaired t test and χ 2 test. Additional subgroup analysis was performed for emergency and elective cases. 83 aneurysms were treated with COIL (33%), 72 with BAC (29%), 61 with SAC (25%), and 33 with FDT (13%). Baseline characteristics were largely similar within these groups (P>0.05). Among COIL, BAC, and FDT cohorts, no significant difference was found for mean DAP, or procedure and fluoroscopy times (P>0.05). However, compared with all other cohorts, SAC was associated with a significantly higher DAP and longer procedure and fluoroscopy times (P<0.005). No significant difference was recorded for emergency and elective case subgroups. Compared with other NET strategies, SAC was associated with a significantly higher DAP, and longer procedure and fluoroscopy times. This study provides an initial dataset regarding radiation exposure, and procedure and fluoroscopy times for common NET, and may assist ALARA (As Low As Reasonably Achievable) principles to reduce radiation risks. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

44 CFR 68.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Definitions. 68.2 Section 68.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program ADMINISTRATIVE HEARING PROCEDURES...

44 CFR 68.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Definitions. 68.2 Section 68.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program ADMINISTRATIVE HEARING PROCEDURES...

44 CFR 68.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Definitions. 68.2 Section 68.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program ADMINISTRATIVE HEARING PROCEDURES...

33 CFR 230.8 - Emergency actions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... major in scope with potentially significant environmental impacts shall be referred through the division... DEFENSE PROCEDURES FOR IMPLEMENTING NEPA § 230.8 Emergency actions. In responding to emergency situations... this regulation. District commanders shall consider the probable environmental consequences in...

33 CFR 230.8 - Emergency actions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... major in scope with potentially significant environmental impacts shall be referred through the division... DEFENSE PROCEDURES FOR IMPLEMENTING NEPA § 230.8 Emergency actions. In responding to emergency situations... this regulation. District commanders shall consider the probable environmental consequences in...

33 CFR 230.8 - Emergency actions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... major in scope with potentially significant environmental impacts shall be referred through the division... DEFENSE PROCEDURES FOR IMPLEMENTING NEPA § 230.8 Emergency actions. In responding to emergency situations... this regulation. District commanders shall consider the probable environmental consequences in...

33 CFR 230.8 - Emergency actions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... major in scope with potentially significant environmental impacts shall be referred through the division... DEFENSE PROCEDURES FOR IMPLEMENTING NEPA § 230.8 Emergency actions. In responding to emergency situations... this regulation. District commanders shall consider the probable environmental consequences in...

The development and implementation of a Hospital Emergency Response Team (HERT) for out-of-hospital surgical care.

PubMed

Scott, Christopher; Putnam, Brant; Bricker, Scott; Schneider, Laura; Raby, Stephanie; Koenig, William; Gausche-Hill, Marianne

2012-06-01

Over the past two decades, Los Angeles County has implemented a Hospital Emergency Response Team (HERT) to provide on-scene, advanced surgical care of injured patients as an element of the local Emergency Medical Services (EMS) system. Since 2008, the primary responsibility of the team has been to perform surgical procedures in the austere field setting when prolonged extrication is anticipated. Following the maxim of "life over limb," the team is equipped to provide rapid amputation of an entrapped extremity as well as other procedures and medical care, such as anxiolytics and advanced pain control. This report describes the development and implementation of a local EMS system HERT.

Teaching and assessing procedural skills: a qualitative study

PubMed Central

2013-01-01

Background Graduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures. Little is known about resident experiences of acquiring procedural skills proficiency, of practicing these techniques, or of being assessed on their proficiency. The purpose of this study was to qualitatively investigate resident 1) experiences of the acquisition of procedural skills and 2) perceptions of procedural skills assessment methods available to them. Methods Focus groups were conducted in the weeks following an assessment of procedural skills incorporated into an objective structured clinical examination (OSCE). Using fundamental qualitative description, emergent themes were identified and analyzed. Results Residents perceived procedural skills assessment on the OSCE as a useful formative tool for direct observation and immediate feedback. This positive reaction was regularly expressed in conjunction with a frustration with available assessment systems. Participants reported that proficiency was acquired through resident directed learning with no formal mechanism to ensure acquisition or maintenance of skills. Conclusions The acquisition and assessment of procedural skills in Internal Medicine programs should move toward a more structured system of teaching, deliberate practice and objective assessment. We propose that directed, self-guided learning might meet these needs. PMID:23672617

House officer procedure documentation using a personal digital assistant: a longitudinal study

PubMed Central

Bird, Steven B; Lane, David R

2006-01-01

Background Personal Digital Assistants (PDAs) have been integrated into daily practice for many emergency physicians and house officers. Few objective data exist that quantify the effect of PDAs on documentation. The objective of this study was to determine whether use of a PDA would improve emergency medicine house officer documentation of procedures and patient resuscitations. Methods Twelve first-year Emergency Medicine (EM) residents were provided a Palm V (Palm, Inc., Santa Clara, California, USA) PDA. A customizable patient procedure and encounter program was constructed and loaded into each PDA. Residents were instructed to enter information on patients who had any of 20 procedures performed, were deemed clinically unstable, or on whom follow-up was obtained. These data were downloaded to the residency coordinator's desktop computer on a weekly basis for 36 months. The mean number of procedures and encounters performed per resident over a three year period were then compared with those of 12 historical controls from a previous residency class that had recorded the same information using a handwritten card system for 36 months. Means of both groups were compared a two-tailed Student's t test with a Bonferroni correction for multiple comparisons. One hundred randomly selected entries from both the PDA and handwritten groups were reviewed for completeness. Another group of 11 residents who had used both handwritten and PDA procedure logs for one year each were asked to complete a questionnaire regarding their satisfaction with the PDA system. Results Mean documentation of three procedures significantly increased in the PDA vs handwritten groups: conscious sedation 24.0 vs 0.03 (p = 0.001); thoracentesis 3.0 vs 0.0 (p = 0.001); and ED ultrasound 24.5 vs. 0.0 (p = 0.001). In the handwritten cohort, only the number of cardioversions/defibrillations (26.5 vs 11.5) was statistically increased (p = 0.001). Of the PDA entries, 100% were entered completely, compared to only 91% of the handwritten group, including 4% that were illegible. 10 of 11 questioned residents preferred the PDA procedure log to a handwritten log (mean ± SD Likert-scale score of 1.6 ± 0.9). Conclusion Overall use of a PDA did not significantly change EM resident procedure or patient resuscitation documentation when used over a three-year period. Statistically significant differences between the handwritten and PDA groups likely represent alterations in the standard of ED care over time. Residents overwhelmingly preferred the PDA procedure log to a handwritten log and more entries are complete using the PDA. These favorable comparisons and the numerous other uses of PDAs may make them an attractive alternative for resident documentation. PMID:16438709

Human Factors Considerations for Area Navigation Departure and Arrival Procedures

NASA Technical Reports Server (NTRS)

Barhydt, Richard; Adams, Catherine A.

2006-01-01

Area navigation (RNAV) procedures are being implemented in the United States and around the world as part of a transition to a performance-based navigation system. These procedures are providing significant benefits and have also caused some human factors issues to emerge. Under sponsorship from the Federal Aviation Administration (FAA), the National Aeronautics and Space Administration (NASA) has undertaken a project to document RNAV-related human factors issues and propose areas for further consideration. The component focusing on RNAV Departure and Arrival Procedures involved discussions with expert users, a literature review, and a focused review of the NASA Aviation Safety Reporting System (ASRS) database. Issues were found to include aspects of air traffic control and airline procedures, aircraft systems, and procedure design. Major findings suggest the need for specific instrument procedure design guidelines that consider the effects of human performance. Ongoing industry and government activities to address air-ground communication terminology, design improvements, and chart-database commonality are strongly encouraged. A review of factors contributing to RNAV in-service errors would likely lead to improved system design and operational performance.

Monitoring the use and outcomes of new devices and procedures: how does coding affect what Hospital Episode Statistics contribute? Lessons from 12 emerging procedures 2006-10.

PubMed

Patrick, Hannah; Sims, Andrew; Burn, Julie; Bousfield, Derek; Colechin, Elaine; Reay, Christopher; Alderson, Neil; Goode, Stephen; Cunningham, David; Campbell, Bruce

2013-03-01

New devices and procedures are often introduced into health services when the evidence base for their efficacy and safety is limited. The authors sought to assess the availability and accuracy of routinely collected Hospital Episodes Statistics (HES) data in the UK and their potential contribution to the monitoring of new procedures. Four years of HES data (April 2006-March 2010) were analysed to identify episodes of hospital care involving a sample of 12 new interventional procedures. HES data were cross checked against other relevant sources including national or local registers and manufacturers' information. HES records were available for all 12 procedures during the entire study period. Comparative data sources were available from national (5), local (2) and manufacturer (2) registers. Factors found to affect comparisons were miscoding, alternative coding and inconsistent use of subsidiary codes. The analysis of provider coverage showed that HES is sensitive at detecting centres which carry out procedures, but specificity is poor in some cases. Routinely collected HES data have the potential to support quality improvements and evidence-based commissioning of devices and procedures in health services but achievement of this potential depends upon the accurate coding of procedures.

Ethical triage and scarce resource allocation during public health emergencies: tenets and procedures.

PubMed

Kuschner, Ware G; Pollard, John B; Ezeji-Okoye, Stephen C

2007-01-01

Public health emergencies may result in mass casualties and a surge in demand for hospital-based care. Healthcare standards may need to be altered to respond to an imbalance between demands for care and resources. Clinical decisions that involve triage and scarce resource allocation may present unique ethical challenges. To address these challenges, the authors detailed tenets and procedures to guide triage and scarce resource allocation during public health emergencies. The authors propose health care organizations deploy a Triage and Scarce Resource Allocation Team to over-see and guide ethically challenging clinical decision-making during a crisis period. The authors' goal is to help healthcare organizations and clinicians balance public health responsibilities and their duty to individual patients during emergencies in as equitable and humane a manner as possible.

Distraction Kits for Pain Management of Children Undergoing Painful Procedures in the Emergency Department: A Pilot Study.

PubMed

Ballard, Ariane; Le May, Sylvie; Khadra, Christelle; Lachance Fiola, Jacinthe; Charette, Sylvie; Charest, Marie-Claude; Gagnon, Hélène; Bailey, Benoit; Villeneuve, Edith; Tsimicalis, Argerie

2017-12-01

To assess the feasibility, usefulness, and acceptability of using distraction kits, tailored to age, for procedural pain management of young children visiting the emergency department and requiring a needle-related procedure. A pre-experimental design was piloted. A kit, tailored to age (infants-toddlers: 3 months-2 years; preschoolers: 3-5 years), was provided to parents before their child's needle-related procedure. Data was collected to assess feasibility, usefulness, and acceptability of the kits by parents and nurses. Pain was measured pre-, peri-, and postprocedure using the Face, Legs, Activity, Cry, Consolability scale. A total of 25 infants and toddlers (mean age: 1.4 ± .7 years) and 25 preschoolers (mean age: 4.0 ± .9) participated in the study. Parents and nurses considered the kits useful and acceptable for distraction in the emergency department, especially in the postprocedural period. Addition of more animated and interactive toys to the kits was suggested. In the infants-toddlers group, mean pain scores were 1.6 ± 2.5 preprocedure, 7.1 ± 3.0 periprocedure, and 2.5 ± 2.5 postprocedure. In the preschoolers group, mean pain scores were 1.6 ± 3.0 preprocedure, 4.8 ± 3.4 periprocedure, and 2.0 ± 3.2 postprocedure. Distraction kits were deemed useful and acceptable by parents and emergency nurses. They are an interesting nonpharmacologic option for nurses to distract children, giving them a sense of control over their pain and improving their hospital experience. Future research should address the feasibility of distraction kits for a broader population of patients and a variety of painful procedures. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Improving the efficiency of the cardiac catheterization laboratories through understanding the stochastic behavior of the scheduled procedures.

PubMed

Stepaniak, Pieter S; Soliman Hamad, Mohamed A; Dekker, Lukas R C; Koolen, Jacques J

2014-01-01

In this study, we sought to analyze the stochastic behavior of Catherization Laboratories (Cath Labs) procedures in our institution. Statistical models may help to improve estimated case durations to support management in the cost-effective use of expensive surgical resources. We retrospectively analyzed all the procedures performed in the Cath Labs in 2012. The duration of procedures is strictly positive (larger than zero) and has mostly a large minimum duration. Because of the strictly positive character of the Cath Lab procedures, a fit of a lognormal model may be desirable. Having a minimum duration requires an estimate of the threshold (shift) parameter of the lognormal model. Therefore, the 3-parameter lognormal model is interesting. To avoid heterogeneous groups of observations, we tested every group-cardiologist-procedure combination for the normal, 2- and 3-parameter lognormal distribution. The total number of elective and emergency procedures performed was 6,393 (8,186 h). The final analysis included 6,135 procedures (7,779 h). Electrophysiology (intervention) procedures fit the 3-parameter lognormal model 86.1% (80.1%). Using Friedman test statistics, we conclude that the 3-parameter lognormal model is superior to the 2-parameter lognormal model. Furthermore, the 2-parameter lognormal is superior to the normal model. Cath Lab procedures are well-modelled by lognormal models. This information helps to improve and to refine Cath Lab schedules and hence their efficient use.

A visual graphic/haptic rendering model for hysteroscopic procedures.

PubMed

Lim, Fabian; Brown, Ian; McColl, Ryan; Seligman, Cory; Alsaraira, Amer

2006-03-01

Hysteroscopy is an extensively popular option in evaluating and treating women with infertility. The procedure utilises an endoscope, inserted through the vagina and cervix to examine the intra-uterine cavity via a monitor. The difficulty of hysteroscopy from the surgeon's perspective is the visual spatial perception of interpreting 3D images on a 2D monitor, and the associated psychomotor skills in overcoming the fulcrum-effect. Despite the widespread use of this procedure, current qualified hysteroscopy surgeons have not been trained the fundamentals through an organised curriculum. The emergence of virtual reality as an educational tool for this procedure, and for other endoscopic procedures, has undoubtedly raised interests. The ultimate objective is for the inclusion of virtual reality training as a mandatory component for gynaecologic endoscopy training. Part of this process involves the design of a simulator, encompassing the technical difficulties and complications associated with the procedure. The proposed research examines fundamental hysteroscopy factors, current training and accreditation, and proposes a hysteroscopic simulator design that is suitable for educating and training.

Pediatric Interventional Radiology: Vascular Interventions.

PubMed

Kandasamy, Devasenathipathy; Gamanagatti, Shivanand; Gupta, Arun Kumar

2016-07-01

Pediatric interventional radiology (PIR) comprises a range of minimally invasive diagnostic and therapeutic procedures that are performed using image guidance. PIR has emerged as an essential adjunct to various surgical and medical conditions. Over the years, technology has undergone dramatic and continuous evolution, making this speciality grow. In this review, the authors will discuss various vascular interventional procedures undertaken in pediatric patients. It is challenging for the interventional radiologist to accomplish a successful interventional procedure. There are many vascular interventional radiology procedures which are being performed and have changed the way the diseases are managed. Some of the procedures are life saving and have become the treatment of choice in those patients. The future is indeed bright for the practice and practitioners of pediatric vascular and non-vascular interventions. As more and more of the procedures that are currently being performed in adults get gradually adapted for use in the pediatric population, it may be possible to perform safe and successful interventions in many of the pediatric vascular lesions that are otherwise being referred for surgery.

Identifying Nonprovider Factors Affecting Pediatric Emergency Medicine Provider Efficiency.

PubMed

Saleh, Fareed; Breslin, Kristen; Mullan, Paul C; Tillett, Zachary; Chamberlain, James M

2017-10-31

The aim of this study was to create a multivariable model of standardized relative value units per hour by adjusting for nonprovider factors that influence efficiency. We obtained productivity data based on billing records measured in emergency relative value units for (1) both evaluation and management of visits and (2) procedures for 16 pediatric emergency medicine providers with more than 750 hours worked per year. Eligible shifts were in an urban, academic pediatric emergency department (ED) with 2 sites: a tertiary care main campus and a satellite community site. We used multivariable linear regression to adjust for the impact of shift and pediatric ED characteristics on individual-provider efficiency and then removed variables from the model with minimal effect on productivity. There were 2998 eligible shifts for the 16 providers during a 3-year period. The resulting model included 4 variables when looking at both ED sites combined. These variables include the following: (1) number of procedures billed by provider, (2) season of the year, (3) shift start time, and (4) day of week. Results were improved when we separately modeled each ED location. A 3-variable model using procedures billed by provider, shift start time, and season explained 23% of the variation in provider efficiency at the academic ED site. A 3-variable model using procedures billed by provider, patient arrivals per hour, and shift start time explained 45% of the variation in provider efficiency at the satellite ED site. Several nonprovider factors affect provider efficiency. These factors should be considered when designing productivity-based incentives.

49 CFR 193.2509 - Emergency procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... plant; (ii) Potential hazards at the plant, including fires; (iii) Communication and emergency control... plant due to operating malfunctions, structural collapse, personnel error, forces of nature, and activities adjacent to the plant. (b) To adequately handle each type of emergency identified under paragraph...

Go/No-Go Procedure with Compound Stimuli with Children with Autism

ERIC Educational Resources Information Center

Silva, Rafael Augusto; Debert, Paula

2017-01-01

The go/no-go with compound stimuli is an alternative to matching-to-sample to produce conditional and emergent relations in adults. The aim of this study was to evaluate the effectiveness of this procedure with two children diagnosed with autism. We trained and tested participants to respond to conditional relations among arbitrary stimuli using…

Astronaut Curtis Brown on flight deck mockup during training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Curtis L. Brown, STS-66 pilot, mans the pilot's station during a rehearsal of procedures to be followed during the launch and entry phases of their scheduled November 1994 flight. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

Astronaut Scott Parazynski during egress training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Scott E. Parazynski looks at fellow STS-66 mission specialist Joseph R. Tanner, (foreground) during a rehearsal of procedures to be followed during the launch and entry phases of their scheduled November 1994 flight. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

20 CFR 10.304 - Are there any exceptions to these procedures for obtaining medical care?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Are there any exceptions to these procedures for obtaining medical care? 10.304 Section 10.304 Employees' Benefits OFFICE OF WORKERS' COMPENSATION... EMPLOYEES' COMPENSATION ACT, AS AMENDED Medical and Related Benefits Emergency Medical Care § 10.304 Are...

Procedural and Conceptual Print-Related Achievements in Young Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Lanter, Elizabeth; Freeman, Daniel; Dove, Stephanie

2013-01-01

A comparative analysis between emergent procedural and conceptual print-related achievements was conducted for 32 children with autism spectrum disorders (ASD) aged 4 to 8 years. To minimize the influence of linguistic competence on the assessment, the ASD print-related profile was compared with that of a language-matched sample of typically…

75 FR 42308 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-21

... previously by the FAA in a Flight Data Center (FDC) Notice to Airmen (NOTAM) as an emergency action of immediate flight safety relating directly to published aeronautical charts. The circumstances which created... Locks, CT, Bradley Intl, RNAV (RNP) Z RWY 15, Orig-A Orlando, FL, Kissimmee Gateway, ILS OR LOC RWY 15...

Stabilization and treatment of dental avulsions and fractures by emergency physicians using just-in-time training.

PubMed

McIntosh, Mark S; Konzelmann, Jason; Smith, Jeffrey; Kalynych, Colleen J; Wears, Robert L; Schneider, Howard; Wylie, Todd; Kaminski, Anne; Matar-Joseph, Madeline

2009-10-01

The objective of this investigation is to use a dental simulation model to compare splinting and bandaging methods for managing tooth avulsions and fractures, as measured by dentist evaluators for quality and time to complete each stabilization procedure. This was a randomized crossover study comparing 3 splinting techniques for managing a traumatically avulsed tooth (periodontal pack, wire, and bondable reinforcement ribbon) and 2 bandage techniques for managing a fractured tooth (calcium hydroxide paste and light-cured composite). After viewing a Just-in-Time training video, a convenience sample of emergency physicians performed the 5 stabilization techniques on dental models containing extracted teeth embedded in clay to simulate a segment of the human dentition. Data collected included time to complete each procedure, the evaluation of dentists about whether the procedure was performed satisfactorily or unsatisfactorily, and the ranking of dentists' and participants' preferred technique. Twenty-five emergency physicians participated in the study: 17 residents, 2 pediatric emergency medicine fellows, and 6 attending physicians. Reported median time, as well as minimum and maximum times to complete each splinting technique for an avulsed tooth, was as follows: periodontal pack 4.4 minutes (2.5 to 6.5 minutes), wire 8.6 minutes (5.8 to 12.9 minutes), and bondable reinforcement ribbon 8.9 minutes (5.6 to 15 minutes). Median time (and minimum and maximum times) to complete each protective bandaging technique for a fractured tooth was calcium hydroxide paste 4.6 minutes (3 to 9.6 minutes) and light-cured composite 7.1 minutes (5.5 to 14.1 minutes). When asked to choose a preferred splinting and bandaging technique according to the performance of the physicians, the dentists chose the bondable reinforcement ribbon 96% (24/25) and the light-cured composite 100% (25/25) of the time. Study participants had no measurable or agreeable preference for a particular splinting or bandaging technique. The results of this study suggest that of the stabilization procedures completed by emergency physicians, dentists preferred the bondable reinforcement ribbon for managing an avulsed tooth and the light-cured composite technique for managing a fractured tooth over the commonly taught and more frequently used procedures in emergency medicine.

29 CFR 2700.24 - Emergency response plan dispute proceedings.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 9 2013-07-01 2013-07-01 false Emergency response plan dispute proceedings. 2700.24... COMMISSION PROCEDURAL RULES Contests of Citations and Orders § 2700.24 Emergency response plan dispute... operator's emergency response plan, or any refusal by the Secretary to approve such a plan. Any referral...

29 CFR 2700.24 - Emergency response plan dispute proceedings.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Emergency response plan dispute proceedings. 2700.24... COMMISSION PROCEDURAL RULES Contests of Citations and Orders § 2700.24 Emergency response plan dispute... operator's emergency response plan, or any refusal by the Secretary to approve such a plan. Any referral...

A function-based approach to cockpit procedure aids

NASA Technical Reports Server (NTRS)

Phatak, Anil V.; Jain, Parveen; Palmer, Everett

1990-01-01

The objective of this research is to develop and test a cockpit procedural aid that can compose and present procedures that are appropriate for the given flight situation. The procedure would indicate the status of the aircraft engineering systems, and the environmental conditions. Prescribed procedures already exist for normal as well as for a number of non-normal and emergency situations, and can be presented to the crew using an interactive cockpit display. However, no procedures are prescribed or recommended for a host of plausible flight situations involving multiple malfunctions compounded by adverse environmental conditions. Under these circumstances, the cockpit procedural aid must review the prescribed procedures for the individual malfunction (when available), evaluate the alternatives or options, and present one or more composite procedures (prioritized or unprioritized) in response to the given situation. A top-down function-based conceptual approach towards composing and presenting cockpit procedures is being investigated. This approach is based upon the thought process that an operating crew must go through while attempting to meet the flight objectives given the current flight situation. In order to accomplish the flight objectives, certain critical functions must be maintained during each phase of the flight, using the appropriate procedures or success paths. The viability of these procedures depends upon the availability of required resources. If resources available are not sufficient to meet the requirements, alternative procedures (success paths) using the available resources must be constructed to maintain the critical functions and the corresponding objectives. If no success path exists that can satisfy the critical functions/objectives, then the next level of critical functions/objectives must be selected and the process repeated. Information is given in viewgraph form.

3D Printing Provides a Precise Approach in the Treatment of Tetralogy of Fallot, Pulmonary Atresia with Major Aortopulmonary Collateral Arteries.

PubMed

Anwar, Shafkat; Rockefeller, Toby; Raptis, Demetrios A; Woodard, Pamela K; Eghtesady, Pirooz

2018-02-03

Patients with tetralogy of Fallot, pulmonary atresia, and multiple aortopulmonary collateral arteries (Tet PA MAPCAs) have a wide spectrum of anatomy and disease severity. Management of these patients can be challenging and often require multiple high-risk surgical and interventional catheterization procedures. These interventions are made challenging by complex anatomy that require the proceduralist to mentally reconstruct three-dimensional anatomic relationships from two-dimensional images. Three-dimensional (3D) printing is an emerging medical technology that provides added benefits in the management of patients with Tet PA MAPCAs. When used in combination with current diagnostic modalities and procedures, 3D printing provides a precise approach to the management of these challenging, high-risk patients. Specifically, 3D printing enables detailed surgical and interventional planning prior to the procedure, which may improve procedural outcomes, decrease complications, and reduce procedure-related radiation dose and contrast load.

Multifunctional nanoparticles as a tissue adhesive and an injectable marker for image-guided procedures

NASA Astrophysics Data System (ADS)

Shin, Kwangsoo; Choi, Jin Woo; Ko, Giho; Baik, Seungmin; Kim, Dokyoon; Park, Ok Kyu; Lee, Kyoungbun; Cho, Hye Rim; Han, Sang Ihn; Lee, Soo Hong; Lee, Dong Jun; Lee, Nohyun; Kim, Hyo-Cheol; Hyeon, Taeghwan

2017-07-01

Tissue adhesives have emerged as an alternative to sutures and staples for wound closure and reconnection of injured tissues after surgery or trauma. Owing to their convenience and effectiveness, these adhesives have received growing attention particularly in minimally invasive procedures. For safe and accurate applications, tissue adhesives should be detectable via clinical imaging modalities and be highly biocompatible for intracorporeal procedures. However, few adhesives meet all these requirements. Herein, we show that biocompatible tantalum oxide/silica core/shell nanoparticles (TSNs) exhibit not only high contrast effects for real-time imaging but also strong adhesive properties. Furthermore, the biocompatible TSNs cause much less cellular toxicity and less inflammation than a clinically used, imageable tissue adhesive (that is, a mixture of cyanoacrylate and Lipiodol). Because of their multifunctional imaging and adhesive property, the TSNs are successfully applied as a hemostatic adhesive for minimally invasive procedures and as an immobilized marker for image-guided procedures.

Impact of a Dedicated Emergency Medicine Teaching Resident Rotation at a Large Urban Academic Center.

PubMed

Ahn, James; Golden, Andrew; Bryant, Alyssa; Babcock, Christine

2016-03-01

In the face of declining bedside teaching and increasing emergency department (ED) crowding, balancing education and patient care is a challenge. Dedicated shifts by teaching residents (TRs) in the ED represent an educational intervention to mitigate these difficulties. We aimed to measure the perceived learning and departmental impact created by having TR. TRs were present in the ED from 12 pm-10 pm daily, and their primary roles were to provide the following: assist in teaching procedures, give brief "chalk talks," instruct junior trainees on interesting cases, and answer clinical questions in an evidence-based manner. This observational study included a survey of fourth-year medical students (MSs), residents and faculty at an academic ED. Surveys measured the perceived effect of the TR on teaching, patient flow, ease of procedures, and clinical care. Survey response rates for medical students, residents, and faculty are 56%, 77%, and 75%, respectively. MSs perceived improved procedure performance with TR presence and the majority agreed that the TR was a valuable educational experience. Residents perceived increased patient flow, procedure performance, and MS learning with TR presence. The majority agreed that the TR improved patient care. Faculty agreed that the TR increased resident and MS learning, as well as improved patient care and procedure performance. The presence of a TR increased MS and resident learning, improved patient care and procedure performance as perceived by MSs, residents and faculty. A dedicated TR program can provide a valuable resource in achieving a balance of clinical education and high quality healthcare.

Impact of a Dedicated Emergency Medicine Teaching Resident Rotation at a Large Urban Academic Center

PubMed Central

Ahn, James; Golden, Andrew; Bryant, Alyssa; Babcock, Christine

2016-01-01

Introduction In the face of declining bedside teaching and increasing emergency department (ED) crowding, balancing education and patient care is a challenge. Dedicated shifts by teaching residents (TRs) in the ED represent an educational intervention to mitigate these difficulties. We aimed to measure the perceived learning and departmental impact created by having TR. Methods TRs were present in the ED from 12pm–10pm daily, and their primary roles were to provide the following: assist in teaching procedures, give brief “chalk talks,” instruct junior trainees on interesting cases, and answer clinical questions in an evidence-based manner. This observational study included a survey of fourth-year medical students (MSs), residents and faculty at an academic ED. Surveys measured the perceived effect of the TR on teaching, patient flow, ease of procedures, and clinical care. Results Survey response rates for medical students, residents, and faculty are 56%, 77%, and 75%, respectively. MSs perceived improved procedure performance with TR presence and the majority agreed that the TR was a valuable educational experience. Residents perceived increased patient flow, procedure performance, and MS learning with TR presence. The majority agreed that the TR improved patient care. Faculty agreed that the TR increased resident and MS learning, as well as improved patient care and procedure performance. Conclusion The presence of a TR increased MS and resident learning, improved patient care and procedure performance as perceived by MSs, residents and faculty. A dedicated TR program can provide a valuable resource in achieving a balance of clinical education and high quality healthcare. PMID:26973739

44 CFR 204.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... information on the procedures for the declaration and grants management processes for the Fire Management... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Purpose. 204.1 Section 204.1 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY...

75 FR 26773 - Public Readiness and Emergency Preparedness Act Countermeasures Injury Compensation Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-12

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Public Readiness and Emergency Preparedness Act Countermeasures Injury Compensation Program, Procedures for... and Emergency Preparedness Act (PREP Act). The PREP Act provides compensation to individuals for...

33 CFR 203.32 - Policy.

Code of Federal Regulations, 2013 CFR

2013-07-01

... EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Emergency Operations § 203.32 Policy... Corps assistance. Corps assistance will be limited to major floods or coastal storm disasters resulting... Emergency Management Agency (FEMA) has been requested to make an emergency or disaster declaration; a...

33 CFR 203.31 - Authority.

Code of Federal Regulations, 2011 CFR

2011-07-01

... EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Emergency Operations § 203.31 Authority... a disaster and the provision of disaster relief efforts under authority of The Stafford Act. (a... the Governor's request to the Federal Emergency Management Agency for an emergency or disaster...

33 CFR 203.31 - Authority.

Code of Federal Regulations, 2012 CFR

2012-07-01

... EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Emergency Operations § 203.31 Authority... a disaster and the provision of disaster relief efforts under authority of The Stafford Act. (a... the Governor's request to the Federal Emergency Management Agency for an emergency or disaster...

33 CFR 203.31 - Authority.

Code of Federal Regulations, 2014 CFR

2014-07-01

... EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Emergency Operations § 203.31 Authority... a disaster and the provision of disaster relief efforts under authority of The Stafford Act. (a... the Governor's request to the Federal Emergency Management Agency for an emergency or disaster...

33 CFR 203.31 - Authority.

Code of Federal Regulations, 2013 CFR

2013-07-01

... EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Emergency Operations § 203.31 Authority... a disaster and the provision of disaster relief efforts under authority of The Stafford Act. (a... the Governor's request to the Federal Emergency Management Agency for an emergency or disaster...

33 CFR 203.32 - Policy.

Code of Federal Regulations, 2012 CFR

2012-07-01

... EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL DISASTER PROCEDURES Emergency Operations § 203.32 Policy... Corps assistance. Corps assistance will be limited to major floods or coastal storm disasters resulting... Emergency Management Agency (FEMA) has been requested to make an emergency or disaster declaration; a...

44 CFR 68.12 - Relief.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Relief. 68.12 Section 68.12 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program ADMINISTRATIVE HEARING PROCEDURES § 68.12...

44 CFR 68.12 - Relief.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Relief. 68.12 Section 68.12 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program ADMINISTRATIVE HEARING PROCEDURES § 68.12...

44 CFR 68.12 - Relief.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Relief. 68.12 Section 68.12 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program ADMINISTRATIVE HEARING PROCEDURES § 68.12...

Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations.

PubMed

Long, Brit; Koyfman, Alex; Vivirito, Michael A

2017-12-01

Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. This review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms. Capnography includes the noninvasive measurement of CO 2 , providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients. Since the 1990s, capnography has been utilized extensively for cardiac arrest and procedural sedation. Qualitative capnography includes a colorimetric device, changing color on the amount of CO 2 present. Quantitative capnography provides a numeric value (end-tidal CO 2 ), and capnography most commonly includes a waveform as a function of time. Conditions in which capnography is informative include cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Patients with seizure, trauma, and respiratory conditions, such as pulmonary embolism and obstructive airway disease, can benefit from capnography, but further study is needed. Limitations include use of capnography in conditions with mixed pathophysiology, patients with low tidal volumes, and equipment malfunction. Capnography should be used in conjunction with clinical assessment. Capnography demonstrates benefit in cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Further study is required in patients with seizure, trauma, and respiratory conditions. It should only be used in conjunction with other patient factors and clinical assessment. Published by Elsevier Inc.

Gastric cancer perforation: experience from a tertiary care hospital.

PubMed

Kandel, Bishnu Prasad; Singh, Yogendra; Singh, Keshav Prasad; Khakurel, Mahesh

2013-01-01

Gastric cancer perforation can occurs in advanced stage of the disease and is often associated with a high morbidity and mortality. Peritonitis due to perforation needs emergency laparotomy and different surgical procedures can be performed for definitive treatment. Surgical procedures largely depend on the stage of the disease and general condition of the patient. This study was carried out to evaluate the outcome and role of different surgical procedures in gastric cancer perforation. Medical record of patients with gastric perforation, who were treated during ten years period, was reviewed retrospectively. Data regarding clinical presentation, surgical procedures, staging and survival of patients were obtained. Features suggestive of diffuse peritonitis were evident in all cases. The majority of the patients underwent emergency surgery except one who died during resuscitation. The majority of patients were in stage III and stage IV. Surgical procedure includes simple closure and omental patch in five patients, simple closure and gastrojejunostomy in nine patients, gastrectomy in six patients and Devine's antral exclusion in one patient. Surgical site infection was the most common (45.5%) postoperative complication. Four patients died within one month of the surgery. Three patients who underwent gastrectomy survived for one year and one patient survived for five years. Although gastric cancer perforation usually occurs in advanced stage of the disease, curative resection should be considered as far as possible.

[Treatment of emergencies in the hospital--problems and management].

PubMed

Sablotzki, A; Schubert, S; Kuhn, C; Radke, J; Czeslick, E

2003-01-01

Due to the growing number of high-risk patients, the increasing proportion of geriatric patients and the expansion of surgical and invasive-diagnostic procedures, medical stuff in hospitals are confronted with a rising number of emergency situations. Nearly 50% are of cardio-circulatory origin and occur during surgical interventions or immediately afterwards. Another cause of life-threatening complications are side-effects of orally or intravenously administered agents, especially after treatment with antibiotics, anaesthetics, analgetics and sedatives. Due to a lack of emergency training and management in most hospitals, the survival rate after cardiopulmonary resuscitation in general wards lies between just two and 35%. Thus it seems necessary to perform special training in CPR procedures and emergency management at regular intervals for the entire medical stuff. In addition, a special infrastructure for giving sufficient treatment in emergencies has to be established (emergency team, emergency telephone number, intra-hospital emergency car). The second part of this review presents current diagnostic and therapeutic strategies for the most common emergency situations, e.g. anaphylaxis, myocardial infarction, pulmonary embolism, gastrointestinal bleeding, and heparin-induced thrombocytopenia (HIT).

New Developments in Robotics and Single-site Gynecologic Surgery.

PubMed

Matthews, Catherine A

2017-06-01

Within the last 10 years there have been significant advances in minimal-access surgery. Although no emerging technology has demonstrated improved outcomes or fewer complications than standard laparoscopy, the introduction of the robotic surgical platform has significantly lowered abdominal hysterectomy rates. While operative time and cost were higher in robotic-assisted procedures when the technology was first introduced, newer studies demonstrate equivalent or improved robotic surgical efficiency with increased experience. Single-port hysterectomy has not improved postoperative pain or subjective cosmetic results. Emerging platforms with flexible, articulating instruments may increase the uptake of single-port procedures including natural orifice transluminal endoscopic cases.

Realtime ultrasound guided percutaneous tracheostomy in emergency setting: the glass ceiling has been broken.

PubMed

Ravi, Parli Raghavan; Vijai, M N; Shouche, Sachin

2017-01-01

In recent years ultrasound guided percutaneous tracheostomy (USPCT) has become a routine practice in critical care units. Its safety and superiority over conventional percutaneous tracheostomy and bronchoscopic guided PCT is proven to be non-inferior in elective cases. However its role in emergency percutaneous tracheostomy has never been studied, since percutaneous tracheostomy itself remains an enigma in accessing emergency airway. There is no report of use of ultrasound guided percutaneous tracheostomy in emergency setting so far in the literature. We report our early experience with USPCT in emergency setting. Sixteen adult patients who required access to an emergency surgical airway after failure to accomplish emergency oro-tracheal intubation were the study population. Their airway was accessed by USPCT. Recorded data included clinical and demographic data including time taken to perform the procedure and complications. Short term and long term follow ups for a period of 2 years were done for the survivors. Twelve male and four female patients underwent the procedure and the average time of the procedure was 3.6 min with no failures nor conversions to surgical tracheostomy and no complications. The average oxygen saturation was 86% and average Glasgow coma scale was 8.4. This time period included the oxygen insufflation time. 10 patients were decannulated while six patients died due to the pathology of the disease itself. There were no complications in either short term or long term follow up. USPCT has a definitive role in emergency both in trauma and non-trauma setting. It is safe, feasible and faster in experienced hands. Use of USPCT in emergency setting has further narrowed the list of contraindications of percutaneous tracheostomy.

Department of Transportation - Civil Emergency Preparedness Policies and Program(s)

DOT National Transportation Integrated Search

1984-03-15

This Order establishes policies, programs, and procedures; and identifies : and assigns specific emergency preparedness responsibilities to Departmental elements for the planning, management, and coordination of the Department of Transportation civil...

49 CFR 109.17 - Emergency Orders.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS AND OIL TRANSPORTATION DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS PROCEDURAL REGULATIONS FOR OPENING OF PACKAGES, EMERGENCY ORDERS, AND...

49 CFR 109.17 - Emergency Orders.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS AND OIL TRANSPORTATION DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS PROCEDURAL REGULATIONS FOR OPENING OF PACKAGES, EMERGENCY ORDERS, AND...

49 CFR 109.17 - Emergency Orders.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS AND OIL TRANSPORTATION DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS PROCEDURAL REGULATIONS FOR OPENING OF PACKAGES, EMERGENCY ORDERS, AND...

28 CFR 571.52 - Procedures-committed fines.

Code of Federal Regulations, 2010 CFR

2010-07-01

... for emergency family, emergency personal needs or furlough purposes. (2) This rule of impounding an... impoundment. (c) Staff shall interview the inmate with an unpaid committed fine at least 75 days prior to the...

30 CFR 49.9 - Mine emergency notification plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... TRAINING MINE RESCUE TEAMS § 49.9 Mine emergency notification plan. (a) Each underground mine shall have a mine rescue notification plan outlining the procedures to follow in notifying the mine rescue teams...

30 CFR 49.9 - Mine emergency notification plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRAINING MINE RESCUE TEAMS § 49.9 Mine emergency notification plan. (a) Each underground mine shall have a mine rescue notification plan outlining the procedures to follow in notifying the mine rescue teams...

Attachment stability and the emergence of unresolved representations during adolescence.

PubMed

Aikins, Julie Wargo; Howes, Carollee; Hamilton, Claire

2009-09-01

This 15-year longitudinal study examined the stability of attachment representations from infancy to adolescence and investigated the emergence of unresolved representations during adolescence in a sample of 47 16-year-olds. Attachment was assessed at 12 months using the Strange Situation Procedure, at 4 years using the modified Strange Situation Procedure, and again at 16 years with the Adult Attachment Projective (AAP). The emergence of unresolved classifications in adolescence (AAP) was associated with higher rates of negative life events, low levels of early mother-child relationship security (an aggregate measure of the 12-month and 4-year measures), negative teacher-child relationship experiences in middle childhood, and low early adolescent friendship quality. The results support the growing body of evidence suggesting that changes in attachment are lawful, while adding to the growing understanding of the emergence of unresolved attachment representations.

Social validation and training of emergency fire safety skills for potential injury prevention and life saving.

PubMed Central

Jones, R T; Kazdin, A E; Haney, J I

1981-01-01

A multifaceted behavioral program designed to teach emergency fire escape procedures to children was evaluated in a multiple-baseline design. Five children were trained to respond correctly to nine home emergency fire situations under simulated conditions. The situations and responses focused upon in training were identified by a social validation procedure involving consultation with several safety agencies, including the direct input of firefighters. Training, carried out in simulated bedrooms at school, resulted in significant improvements in both overt behavior and self-report of fire safety skills. The gains were maintained at a post-check assessment 2 weeks after training had been terminated. The results are discussed in relation both to the importance of social validation of targets and outcomes and the implications for further research in assessing and developing emergency response skills. PMID:7298537

Simulation trainer for practicing emergent open thoracotomy procedures.

PubMed

Hamilton, Allan J; Prescher, Hannes; Biffar, David E; Poston, Robert S

2015-07-01

An emergent open thoracotomy (OT) is a high-risk, low-frequency procedure uniquely suited for simulation training. We developed a cost-effective Cardiothoracic (CT) Surgery trainer and assessed its potential for improving technical and interprofessional skills during an emergent simulated OT. We modified a commercially available mannequin torso with artificial tissue models to create a custom CT Surgery trainer. The trainer's feasibility for simulating emergent OT was tested using a multidisciplinary CT team in three consecutive in situ simulations. Five discretely observable milestones were identified as requisite steps in carrying out an emergent OT; namely (1) diagnosis and declaration of a code situation, (2) arrival of the code cart, (3) arrival of the thoracotomy tray, (4) initiation of the thoracotomy incision, and (5) defibrillation of a simulated heart. The time required for a team to achieve each discrete step was measured by an independent observer over the course of each OT simulation trial and compared. Over the course of the three OT simulation trials conducted in the coronary care unit, there was an average reduction of 29.5% (P < 0.05) in the times required to achieve the five critical milestones. The time required to complete the whole OT procedure improved by 7 min and 31 s from the initial to the final trial-an overall improvement of 40%. In our preliminary evaluation, the CT Surgery trainer appears to be useful for improving team performance during a simulated emergent bedside OT in the coronary care unit. Copyright © 2015 Elsevier Inc. All rights reserved.

Robotic Whipple Procedure for Pancreatic Cancer: The Moffitt Cancer Center Pathway.

PubMed

Rashid, Omar M; Mullinax, John E; Pimiento, Jose M; Meredith, Kenneth L; Malafa, Mokenge P

2015-07-01

Resection of malignancies in the head and uncinate process of the pancreas (Whipple procedure) using a robotic approach is emerging as a surgical option. Although several case series of the robotic Whipple procedure have been reported, detailed descriptions of operative techniques and a clear pathway for adopting this technology are lacking. We present a focused review of the procedure as it applies to pancreatic cancer and describe our clinical pathway for the robotic Whipple procedure used in pancreatic cancer and review the outcomes of our early experience. A systematic review of the literature is provided, focusing on the indications, variations in surgical techniques, complications, and oncological results of the robotic Whipple procedure. A clinical pathway has been defined for preoperative training of surgeons, the requirements for hospital privileges, patient selection, and surgical techniques for the robotic Whipple procedure. The robotic technique for managing malignant lesions of the pancreas head is safe when following well-established guidelines for adopting the technology. Preliminary data demonstrate that perioperative convalescence may exceed end points when compared with the open technique. The robotic Whipple procedure is a minimally invasive approach for select patients as part of multidisciplinary management of periampullary lesions in tertiary centers where clinicians have developed robotic surgical programs. Prospective trials are needed to define the short- and long-term benefits of the robotic Whipple procedure.

Emergency management and infection control in a radiology department during an outbreak of severe acute respiratory syndrome.

PubMed

Lin, Y C; Dong, S L; Yeh, Y H; Wu, Y S; Lan, G Y; Liu, C M; Chu, T C

2005-07-01

The World Health Organization classified Taiwan as a serious epidemic-stricken area when the extent of severe acute respiratory syndrome (SARS) in Taiwan became clear. As of 11 July 2003, 671 probable SARS cases had been identified in Taiwan and 7 healthcare workers had died from the disease. Radiographers were easily infected by SARS because they had close contact with suspected or probable cases while conducting chest X-ray examinations. Three radiographers had been infected by the end of May 2003. Because of the impact of SARS on the Radiology Department, the department established a SARS emergency infection control team and re-designed the department's infection-control and emergency-management procedures based on the concept of risk-grade protection. This effort included installing a radiographic room at the fever-screening station, re-allocating human resources in the Radiology Department, training the department staff in infection control, and drafting new operational procedures for radiographers conducting X-ray examinations on SARS patients. The goal of this program was to reduce the infection rate and distribute materials efficiently in the department. This article introduces the emergency-management procedure of the Radiology Department during the SARS outbreak and the infection-protection experience of the department staff.

10 CFR 590.403 - Emergency interim orders.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DEPARTMENT OF ENERGY (CONTINUED) NATURAL GAS (ECONOMIC REGULATORY ADMINISTRATION) ADMINISTRATIVE PROCEDURES WITH RESPECT TO THE IMPORT AND EXPORT OF NATURAL GAS Opinions and Orders § 590.403 Emergency interim... and issue an emergency interim order authorizing the import or export of natural gas. After issuance...

School Emergency Planning Guide.

ERIC Educational Resources Information Center

Benedetto, Harry J.

This guide was prepared to assist Pennsylvania schools and communities in the development of comprehensive emergency plans. Procedures for identifying and responding to potential community and school emergency situations are presented. A plan for developing and organizing mass care centers utilizing school and community facilities and resources is…

44 CFR 1.8 - Regulations review.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Regulations review. 1.8 Section 1.8 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL RULEMAKING; POLICY AND PROCEDURES General § 1.8 Regulations review. (a) As part...

49 CFR 192.615 - Emergency plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... effective response to a notice of each type of emergency, including the following: (i) Gas detected inside... they are knowledgeable of the emergency procedures and verify that the training is effective. (3... public officials to: (1) Learn the responsibility and resources of each government organization that may...

49 CFR 192.615 - Emergency plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... effective response to a notice of each type of emergency, including the following: (i) Gas detected inside... they are knowledgeable of the emergency procedures and verify that the training is effective. (3... public officials to: (1) Learn the responsibility and resources of each government organization that may...

49 CFR 192.615 - Emergency plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... effective response to a notice of each type of emergency, including the following: (i) Gas detected inside... they are knowledgeable of the emergency procedures and verify that the training is effective. (3... public officials to: (1) Learn the responsibility and resources of each government organization that may...

49 CFR 192.615 - Emergency plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... effective response to a notice of each type of emergency, including the following: (i) Gas detected inside... they are knowledgeable of the emergency procedures and verify that the training is effective. (3... public officials to: (1) Learn the responsibility and resources of each government organization that may...

44 CFR 13.20 - Standards for financial management systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... attendance records, contract and subgrant award documents, etc. (7) Cash management. Procedures for... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Standards for financial management systems. 13.20 Section 13.20 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT...

44 CFR 13.20 - Standards for financial management systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... attendance records, contract and subgrant award documents, etc. (7) Cash management. Procedures for... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Standards for financial management systems. 13.20 Section 13.20 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT...

44 CFR 13.20 - Standards for financial management systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... attendance records, contract and subgrant award documents, etc. (7) Cash management. Procedures for... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Standards for financial management systems. 13.20 Section 13.20 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT...

76 FR 39843 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-07

...: National Institute of Standards and Technology (NIST). Title: Usage of Elevators for Occupant Evacuation...- story buildings in the United States during fire emergencies. This research aims to summarize emergency... emergency procedures for multi-story buildings) from existing buildings in the United States, including...

The three Rs of fire safety, emergency action, and fire prevention planning: promoting safety at the worksite.

PubMed

Thompson, Marcella R

2003-04-01

Fire safety is of paramount importance for everyone. In many workplaces, the occupational health nurse's scope of practice encompasses safety related activities. Included within this role is the responsibility for fire safety, emergency action, and fire prevention planning. The Three Rs of fire safety, emergency action, and fire prevention plans are rules, responsibilities, and resources. Myriad building and fire safety codes, regulations, and standards exist with which an employer must comply. An employer's responsibility for installing, testing, inspecting, and maintaining fire safety related equipment is extensive. Emergency action and fire prevention planning begins with conducting a detailed physical survey and preparing site maps. It includes making key policy decisions, writing procedures, and training employees in those procedures by practicing and executing site drills. The best resources available for emergency planning are the local fire department and the property insurer. Planning ahead means an efficient emergency response if disaster strikes. It saves lives, limits property damage, and preserves the environment.

Astronaut Scott Parazynski in hatch of CCT during training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Scott E. Parazynski, STS-66 mission specialist, poses near the hatchway of the crew compartment trainer (CCT) (out of frame) in JSC's Shuttle mockup and integration laboratory. Crew members were about to begin a rehearsal of procedures to be followed during the launch and entry phases of their flight. That rehearsal was followed by a training session on emergency egress procedures.

Emerging Opportunities for School Psychologists to Enhance our Remediation Procedure Evidence Base as We Apply Response to Intervention

ERIC Educational Resources Information Center

Skinner, Christopher H.; McCleary, Daniel F.; Skolits, Gary L.; Poncy, Brian C.; Cates, Gary L.

2013-01-01

The success of Response-to-Intervention (RTI) and similar models of service delivery is dependent on educators being able to apply effective and efficient remedial procedures. In the process of implementing problem-solving RTI models, school psychologists have an opportunity to contribute to and enhance the quality of our remedial-procedure…

Ketamine-a returning option for procedural sedation and analgesia in adults.

PubMed

O'Malley, Patricia Anne

2014-01-01

I am a clinical nurse specialist in a busy trauma center. Increasingly, we are using ketamine for procedures and pain management in adults. I thought ketamine was appropriate only for pediatric patients. Why has ketamine emerged again for adults? Also, we have seen a few cases of ketamine abuse over the past 3 months. Is ketamine abuse becoming more prevalent?

Astronaut Scott Parazynski during egress training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Scott E. Parazynski looks at fellow STS-66 mission specialist Joseph R. Tanner, (partially visible in foreground) during a rehearsal of procedures to be followed during the launch and entry phases of their scheduled November 1994 flight. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

Teaching Manual Signs to Adults with Mental Retardation Using Matching-to-Sample Procedures and Stimulus Equivalence

ERIC Educational Resources Information Center

Elias, N. C.; Goyos, C.; Saunders, M.; Saunders, R.

2008-01-01

The objective of this study was to teach manual signs through an automated matching-to-sample procedure and to test for the emergence of new conditional relations and imitative behaviors. Seven adults with mild to severe mental retardation participated. Four were also hearing impaired. Relations between manual signs (set A) and pictures (set B)…

Financial Analysis of Hastily-Formed Networks

DTIC Science & Technology

2006-09-01

well as support the goals of the new National Strategy, by developing new plans and procedures to improve the coordination, communications and...Strategy, by developing new plans and procedures to improve the coordination, communications and operations between DoD and other entities when...Strike Group xviii DoD Department of Defense DRDO Defense Research Development Organization EMT Emergency Medical Technician ESG Expeditionary

STS-39 MS Hieb floats in single person life raft in JSC's WETF Bldg 29 pool

NASA Technical Reports Server (NTRS)

1990-01-01

STS-39 Mission Specialist (MS) Richard J. Hieb, wearing launch and entry suit (LES) and launch and entry helmet (LEH), floats in single person life raft after landing in JSC's Weightless Environment Training Facility (WETF) Bldg 29 pool. During emergency egress bailout procedures, Hieb practiced procedures necessary for a water landing. Divers monitor Hieb's activity.

[Neurologist and emergency neuroendovascular revascularization -training programs for endovascular procedures-].

PubMed

Imai, Keisuke; Hamanaka, Masashi; Yamada, Takehiro; Yamazaki, Hidekazu; Yamamoto, Atsushi; Tsuto, Kazuma; Takegami, Tetsuro; Umezawa, Kunihiko; Ikeda, Eito; Mizuno, Toshiki

2014-01-01

Emergency neuroendovascular revascularization is a reperfusion therapy for acute stroke. The operator for this therapy has to obtain a license as a specialist in endovascular procedures. For neurologists wishing to acquire this license, there are two kinds of training programs: full-time training and concurrent training. Full-time training was chosen by the first author of this review, while concurrent training will be performed by staff in the author's department. The advantage of full-time training is the acquisition of a lot of experience of various diseases that are treated with endovascular procedures and managed in the periprocedural period. However, full-time training has the disadvantages of a requirement to discontinue medical care of neurological diseases except for stroke and employment at a remote institution. The advantages and disadvantages of concurrent training are the reverse of those of full-time training. Neither training system can succeed without cooperation from Departments of Neurology in neighboring universities and the institutional Department of Neurosurgery. It is particularly important for each neurologist to establish a goal of becoming an operator for recanalization therapy alone or for all fields of endovascular procedures because training will differ for attainment of each operator's goal.

Task analysis method for procedural training curriculum development.

PubMed

Riggle, Jakeb D; Wadman, Michael C; McCrory, Bernadette; Lowndes, Bethany R; Heald, Elizabeth A; Carstens, Patricia K; Hallbeck, M Susan

2014-06-01

A central venous catheter (CVC) is an important medical tool used in critical care and emergent situations. Integral to proper care in many circumstances, insertion of a CVC introduces the risk of central line-associated blood stream infections and mechanical adverse events; proper training is important for safe CVC insertion. Cognitive task analysis (CTA) methods have been successfully implemented in the medical field to improve the training of postgraduate medical trainees, but can be very time-consuming to complete and require a significant time commitment from many subject matter experts (SMEs). Many medical procedures such as CVC insertion are linear processes with well-documented procedural steps. These linear procedures may not require a traditional CTA to gather the information necessary to create a training curriculum. Accordingly, a novel, streamlined CTA method designed primarily to collect cognitive cues for linear procedures was developed to be used by medical professionals with minimal CTA training. This new CTA methodology required fewer trained personnel, fewer interview sessions, and less time commitment from SMEs than a traditional CTA. Based on this study, a streamlined CTA methodology can be used to efficiently gather cognitive information on linear medical procedures for the creation of resident training curricula and procedural skills assessments.

33 CFR 203.61 - Emergency water supplies due to contaminated water source.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (5) Loss of water supply is not a basis for assistance under this authority. (6) Water will not be... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Emergency water supplies due to... PROCEDURES Emergency Water Supplies: Contaminated Water Sources and Drought Assistance § 203.61 Emergency...

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…

78 FR 50136 - Notice of Information Collection Under Emergency Review: Medical History and Examination for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-16

... DEPARTMENT OF STATE [Public Notice 8421] Notice of Information Collection Under Emergency Review... emergency OMB approval. SUMMARY: The Department of State has submitted the information collection request... emergency review procedures of the Paperwork Reduction Act of 1995. The purpose of this notice is to allow...

40 CFR 267.57 - What must the emergency coordinator do after an emergency?

Code of Federal Regulations, 2014 CFR

2014-07-01

... OPERATING UNDER A STANDARDIZED PERMIT Contingency Plan and Emergency Procedures § 267.57 What must the..., or any other material that results from a release, fire, or explosion at the facility. (b) The... completed. (2) All emergency equipment listed in the contingency plan is cleaned and fit for its intended...

49 CFR 193.2509 - Emergency procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... types and places of emergencies other than fires that may reasonably be expected to occur at an LNG... (a) of this section and each fire emergency, each operator must follow one or more manuals of written... emergency evacuation plan, which sets forth the steps required to protect the public in the event of an...

49 CFR 193.2509 - Emergency procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... types and places of emergencies other than fires that may reasonably be expected to occur at an LNG... (a) of this section and each fire emergency, each operator must follow one or more manuals of written... emergency evacuation plan, which sets forth the steps required to protect the public in the event of an...