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Biomedical subjects

L M Jacobs

Publications and source records attributed to L M Jacobs.

At least 73 records · Page 4Linked to original sources
PubMed1984

Prehospital advanced life support: benefits in trauma.

The Boston Emergency Medical Service system was studied to determine the effects of Advanced Life Support (ALS) prehospital trauma care compared to Basic Life Support (BLS) treatment. The severity of injury and clinical status of patients was defined and monitored using the Trauma Score (TS) described by Champion. The TS on arrival at the hospital increased significantly more for patients receiving field ALS care than for patients transported by BLS ambulances (p = 0.01). ALS resuscitation had most influence on patients with TS 4-13 and did not delay transport time. Furthermore, a positive change in prehospital TS was significantly related to an increased chance of long-term survival for any given severity of injury (p = 0.0002). From these data we conclude that the TS is useful for prehospital triage and that appropriate field ALS resuscitation results in more favorable outcomes following major trauma.

Adult↗
PubMed1984

Prehospital trauma care.

The past two decades have been a period of increased concern over the improvement of prehospital emergency medical care. Training of basic and advanced EMTs to a level of professionalism that includes a distinct body of knowledge and the use of assessment and management skills is only one component of the prehospital system. Communications systems, transportation deployment plans, and improved links with hospitals have contributed to the refinement of emergency medical systems. The management of the trauma victim is an organized plan of controlling the airway, restoring breathing, and supporting ventilation, followed by a secondary survey of the less life-threatening problems. The role of EMTs or paramedics, therefore, is to assess, manage, extricate, and transport.

Abdominal Injuries↗
PubMed1983

Endotracheal intubation in the prehospital phase of emergency medical care.

One hundred seventy-eight endotracheal intubations by paramedics were reviewed prospectively during a nine-month period; 149 patients (83.7%) had medical conditions, and 29 (16.2%) had trauma. The endotracheal tube was successfully placed in 172 (96.6%); in four patients (2.2%), attempts were unsuccessful, and in two patients (1.1%), the attempt was aborted. There were no incidences of reported complications. We conclude that endotracheal intubation can be accomplished successfully outside the hospital by paramedical personnel. Comprehensive training and continuous medical control of paramedics' activities seem to be essential requirements for its success.

Adolescent↗
PubMed1983

Hepatitis B exposure in emergency medical personnel. Prevalence of serologic markers and need for immunization.

To assess the occupational risk of hepatitis B infection in emergency medical personnel, a seroepidemiologic survey of 87 emergency medical technicians and paramedics was conducted. Serologic markers indicating exposure to hepatitis B virus were detected in 18 percent. The prevalence of markers was associated with race (p = 0.006), with a relative risk of 3.5 (95 percent confidence interval 1.42 to 8.63) for nonwhites. Seropositivity was not associated with age, sex, previous clinical hepatitis, or blood transfusion. There was a suggestion that duration of employment as an emergency medical technician was related to the prevalence of hepatitis B markers (p = 0.11). Efforts to control the risk of hepatitis B infection in this profession are complicated by unique problems with post-exposure prophylaxis and uncontrolled exposure to blood. Immunization with hepatitis B vaccine would be the optimal strategy to reduce infection in this high-risk occupation.

Adult↗
PubMed1983

Emergency medical personnel training: I. An historical perspective.

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

Allied Health Personnel↗
PubMed1983

Emergency medical personnel training: II. Components of training.

Nationwide Emergency Medical Technician (EMT) training programs at both basic and advanced levels are in flux, confronting similar challenges in design and implementation. There currently exist the 81-hour Department of Transportation course of instruction as the basis for EMT-Ambulance (EMT-A) certification and the National Standard Training Curriculum (NSTC) 15-module course for training the EMT-Paramedic (EMT-P). The National Registry of EMTs has established examination and recertification guidelines as well as requirements for both levels of training. The two national training courses reflect a difference in disease focus (ie, trauma vs cardiac) and thus a difference in care rendered by the two EMT levels. Variations in both EMT-A and EMT-P training programs at the state level in areas such as length of training and requirements for certification point out a need for greater consistency in training of emergency medical personnel. Evaluation of current training programs based on the NSTC has resulted in updating the EMT-P curriculum. The proposed curriculum includes new course material with behavioral and performance objectives. An ongoing system of training, evaluation, and incorporation of new techniques found clinically relevant is recommended.

Allied Health Personnel↗
PubMed1981

Congruency in physician-EMT assessment.

The transport of 488 patients by Department of Health and Hospital (DHH) ambulances during a three-week period was studied in an effort to determine the operational effectiveness of the Point of Entry (POE) Plan in Boston. The Plan is based on an assumption that EMTs can correctly assess patients' medical problems. Comparisons of the physicians' diagnoses and the EMTs' assessments were made to establish the level of congruency for each of the seven care categories delineated. Several secondary univariate analyses were performed for their association with accuracy in patient assessment. Appropriate ambulance utilization also was reviewed based on the diagnosis and the circumstances of the incident. Findings supported the effectiveness of the assessment and transportation of emergency patients in the Boston emergency medical services system.

Acute Disease↗
PubMed1980

The 23rd specialty.

Explore the source record for details and available documents.

Emergency Medicine↗
PubMed1979

An emergency medical system approach to disaster planning.

The increasing prevalence of terrorist attacks and natural disasters has mandated that more emphasis be placed on emergency disaster planning. The report focuses on the 1976 Courthouse bombing in Boston, which generated 20 casualties. Ambulance response by Boston's Emergency Medical Service system was made in 2.5 minutes and all victims were transported from the scene within 20 minutes. Successful management of this incident employed several important principles of disaster planning. These include the initial medical response, staging at the scene, and hospital notification. Additionally, the concept of triage as an integral part of disaster planning is explained with examples of the on-site medical stabilization and treatment of casualties. The importance of these concepts in practice and the necessity of close coordination of ambulance response and the responses of other emergency agencies, i.e., Police and Fire, were clearly demonstrated in the disaster which resulted from the Courthouse bombing.

Adult↗
PubMedDate not supplied

Clinical management of blunt trauma patients with unilateral rib fractures: a randomized trial.

Optimal pain management is essential in blunt trauma patients sustaining significant chest trauma. The purpose of this randomized prospective trial was to measure the difference in pulmonary function in nonintubated patients with unilateral multiple rib fractures receiving two modalities of pain relief: systemic narcotic medications alone or local anesthetics given by intrapleural catheter (IPCs). Forty-two patients were randomized to receive systemic narcotic medications or IPCs for pain control. The patients with IPCs statistically had more compromised pulmonary function as measured by forced vital capacity (FVC) on admission; however, they tended toward a greater objective improvement of FVC on discharge. When analyzing a cohort of severely impaired patients (initial FVC < 20%), half of the systemic medication patients compared to only 10% of the IPC group failed and required another mode of therapy. Catheter complications were minor and did not contribute to overall morbidity. The IPC patients had fewer failures than the systemic medication patients.

Analgesia↗
PubMedDate not supplied

The effect of quality assurance on flight nurse documentation.

This study was developed to evaluate if a structured quality assurance program has an effect on nursing documentation. A randomized, retrospective audit of records was conducted from 1985 to 1989, and in November 1987, a structured QA program was initiated for flight nurses. Each chart was audited for completeness of 69 elements from seven categories: administrative information, patient history, physical exam, management plan, vital signs, medications and intravenous access. A comparison of audit results was conducted before and after the QA program was initiated. A total of 224 charts were audited, 123 before the QA program and 101 after. There was statistically significant improvement in 4 of 13 administrative, 5 of 7 history, 21 of 31 physical exam, 2 of 6 management, 2 of 2 vital signs, 0 of 4 medication, and 0 of 6 intravenous access elements. Twenty-five of 35 categories that did not show improvement had initial completion rates greater than 90 percent. The significant improvement in documentation by flight nurses after a formal QA program was initiated lead the authors to conclude that QA benefits air medical programs by providing a mechanism to improve documentation.

Aircraft↗
PubMedDate not supplied

Recidivism in a helicopter emergency medical service.

This study was designed to determine the frequency of recidivism (patients using a service more than once for the same or different disease episodes) in a helicopter emergency service, with the premise that high levels of recidivism may constitute grounds for improving quality of care or patient education programs. A retrospective chart review was performed on records from June 1985 to September 1990. Patients were included if they required helicopter transport on more than one occasion for either different disease episodes (true recidivists) or for multiple transports during a single hospital admission. Twenty-one (0.6%) of the 3,543 patients transported were true recidivists and 20 (0.6%) patients required secondary transport during the same admission. Of the latter group, 17 secondary transports were within 24 hours of admission. This study showed that recidivism in this helicopter emergency service is low. Patients who were air transported more than once for the same illness or injury within a 24-hour period occurred in less than 1% of transports, well within the helicopter program's pre-established less than 2% threshold.

Aircraft↗
PubMedDate not supplied

Integrating emergency medicine residents into a well-established helicopter program.

INTRODUCTION: The institution of an emergency medicine residency in a university-affiliated Level 1 trauma center in July 1993 provided a challenge to develop a curriculum and on-line learning experience for emergency medicine residents in a well-established helicopter program. The purpose of this study was to survey flight crew members, emergency medicine at tending physicians, and emergency medicine residents on the anticipated roles and educational experience of integrating the emergency medicine residents from a new emergency medicine residency into the flight crew of a well-established helicopter program. METHODS: A survey consisting of multiple choice, Likert scale, and open-ended questions was distributed to flight crew members (RN, RT, pilots, communication specialists, EM attendings, and EM residents [n=72]). RESULTS: 92% of surveys were returned. These surveys identified specific issues of concern and those areas believed to be of academic importance for the emergency medicine residents. CONCLUSIONS: The results of this study allowed for the creation and implementation of a progressive flight experience for EM residents that incorporates increasing responsibility on the flight crew as experience is gained.

Air Ambulances↗