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Biomedical subjects

L M Jacobs

Publications and source records attributed to L M Jacobs.

80 records · Page 5Linked to original sources
PubMedDate not supplied

The integration of a helicopter emergency medical service in a mass casualty response system.

Since 1985, the state of Connecticut has been served by a hospital-based, advanced life support (ALS) helicopter air medical service. The service is stationed at a 1,000-bed, Level 1, trauma center that is responsible for its operation. Connecticut statute requires the hospital to file operations reports with the Office of Emergency Medical Services, which reports to the Connecticut Department of Public Health. Operations include response to requests for transportation of severely ill or injured patients from the scene of an incident, and patient transport from one hospital to a higher level, definitive-care hospital. This service also was charged to develop a disaster response plan to be integrated into the overall state plan for disaster responses. The helicopter disaster response involves all six New England states and three hospital-based emergency medical helicopter programs that operate in the New England states. This approach has allowed for joint planning and multi-agency, simulated drills. The helicopter emergency medical service has responded to 15 simulated emergencies (drills) and seven actual mass casualty incidents from May, 1985 to June, 1989. In Connecticut, the planning process conducted by the Department of Public Health and the Office of State EMS produced a coordinated, multi-jurisdictional, mass-casualty response plan.

Aircraft↗
PubMedDate not supplied

The prevalence of occupational injuries in EMTs in New England.

OBJECTIVE: To characterize the prevalence and morbidity of injuries to emergency medical technicians EMTs) in New England [United States]. DESIGN: A survey was mailed to a 2% random sample of all registered EMTs in the six New England States. The identity of the EMTs remained anonymous, and a second mailing was used to improve return rate. The EMTs were requested to recall events that occurred during the previous six months. RESULTS: A total of 439 of the 786 (56%) surveys were returned representing 13,875 hours of duty time in the six-month period. Seventy-one percent of the EMTs were male with a mean age of 35 years. Sixty-six percent were basic-EMTs. Injury attack rates (number of injuries/100 EMTs/6 months) were: stress, 11.2; back, 10.5; extremity, 9.8; assault, 8.4; ambulance collision, 4.1; hearing loss, 2.5; and eye injury, 1.4. Twelve percent of the EMTs were injured more than once in the six-month period. The paramedics more frequently were involved in ambulance collisions, suffered from stress, and were less likely to injure their back. There were minor interstate differences. Disability due to back injury affected 2.5% of those surveyed, four EMTs lost duty time secondary to an assault, and 0.5% of the EMTs were out of work due to stress. CONCLUSIONS: This survey begins to characterize the occupational risks of EMTs. The prevalence of back injuries, assault, stress, and extremity injuries seems to be too high. Educational programs and preventive interventions should be designed to minimize back injuries, stress, and assault. There is a need for more research nationwide in order to better characterize these injuries.

Accidents, Occupational↗
PubMedDate not supplied

A 12-year experience with prehospital cricothyrotomies.

INTRODUCTION: Maintaining cricothyrotomy skills is difficult for air medical crewmembers because the procedure is performed infrequently. The purposes of this study were to review our program's experience with cricothyrotomies and use this pilot study to guide an industry-wide study. METHODS: We conducted a retrospective review of all cricothyrotomies performed by our flight crew during the past 12 years. The flight logs were reviewed for patient demographics, scene information, clinical data, and procedure data. RESULTS: During this period, 8833 patients were transported: 1589 required intubation (18%), and eight of the 1589 required a cricothyrotomy (0.5%). Five nurses (14% of the total employed during the study) and one physician attempted this procedure. All patients had at least one intubation attempt before the cricothyrotomy (average 3.6, range 1-6 attempts). Six (75%) patients had airway edema, four (50%) had an unstable trachea, and one patient (12.5%) had an airway obstruction. Five (62.5%) of the cricothyrotomy attempts were successful. The remaining three patients were managed with bag-valve mask ventilation. Three patients arrived at the receiving hospital with a perfusing rhythm. CONCLUSION: Cricothyrotomy, rarely performed by our flight crews, is successful in 62.5% of cases. These preliminary data suggest current training practices should be re-evaluated. An industrywide survey is planned to determine the optimal training program.

Air Ambulances↗
PubMedDate not supplied

Emergency department autotransfusion for trauma victims.

In the initial treatment of serious trauma victims, a valuable source of blood is often overlooked: the patient's own blood, shed into the chest cavity as a result of blunt or penetrating injury. This blood can often be salvaged and made available for immediate reinfusion as an autologous whole blood transfusion, or autotransfusion. In the past decade, clinical experience in many hospitals has confirmed the safety of this method, and a commercial system suitable for use in the emergency department is now available.

ABO Blood-Group System↗
PubMedDate not supplied

Helicopters: extending the prehospital transportation system.

Early efforts to upgrade the prehospital care system were directed toward improved communications, training, education, and ground transport. Increased sophistication within these components of the integrated emergency medical services system prompted the need for categorizing and formally designating trauma centers. With the designation of comprehensive trauma centers to serve not only local areas but macroregional trauma needs, the requirements for faster transport in a medically controlled environment to cover greater distances became evident. Thus, the helicopter has emerged as the appropriate prehospital transport vehicle to fulfill such needs. What remains is the stimulus and mechanism to fully integrate all of these components into a medically controlled, cost-effective, regionally coordinated system.

Aircraft↗
PubMedDate not supplied

Evaluation of battery-operated monitor/defibrillators used in prehospital care.

During the past two decades, prehospital medical care has become more sophisticated, resulting in devices that are routinely used in the hospital being adapted for use in the field. One such device is the ECG machine, which has undergone extensive technological and performance modifications so it may better serve the large number of patients requiring electrocardiographic monitoring and cardioversion in stressed environments.

Electric Countershock↗