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Biomedical subjects

R A De Lorenzo

Publications and source records attributed to R A De Lorenzo.

At least 19 recordsLinked to original sources
PubMed2001

U.S. Army MEDEVAC in the new millennium: a medical perspective.

The U.S. Army Aeromedical Evacuation community (MEDEVAC) possesses a long-standing tradition of excellence in the care and transportation of combat casualties. Recent developments in civilian air medical transport and quantitative review of MEDEVAC operations have identified potential areas for improvement, concentrating on enhanced flight medic standards, training, sustainment and medical oversight of the air ambulance system. These proposed changes are discussed in detail, from the perspective of current emergency medicine and aviation medicine standards of practice. If instituted, these changes would facilitate the emergence of a true air medical transport capability comparable with the civilian community standard.

Aerospace Medicine↗
PubMed2001

Medic for the millennium: the U.S. Army 91W health care specialist.

The new millennium challenges the Army Medical Department to provide good care in a variety of circumstances from peacetime to operations other than war to combat. To provide care in this broad variety of missions, the Army Medical Department needs flexible providers. The new 91W health care specialist enlisted medic is designed to meet this need. By coupling skills in emergency care, evacuation, medical force protection, and primary care with certification in emergency medical technology, the 91W initiative will fill the needs of the Army now and into the new millennium.

Allied Health Personnel↗
PubMed1999

EMS systems: foundations for the future.

Emergency medical services (EMS) occupy a unique position in the continuum of emergency health care delivery. The role of EMS personnel is expanding beyond their traditional identity as out-of-hospital care providers, to include participation and active leadership in EMS administration, education, and research. With these roles come new challenges, as well as new responsibilities. This paper was developed by the SAEM EMS Task Force and provides a discussion of these new concepts as well as recommendations for the specialty of emergency medicine to foster the continued development of all of the potentials of EMS.

Emergency Medical Services↗
PubMed1999

Army aeromedical crash rates.

BACKGROUND: Safety is a principal concern for everyone in aviation, including those in military and civilian aeromedical programs. The U.S. Army flies thousands of helicopter missions each year, including many aeromedical flights. The comparison between Army general and aeromedical aviation crash data provides a benchmark for establishing patterns in aeromedical safety and may be useful for similar programs examining safety profiles. OBJECTIVES: To determine the crash rates of Army aeromedical rotary-wing (helicopter) programs and compare them with crash rates in Army general aviation. METHODS: Retrospective review of safety data from 1987 to 1995. Crashes or mishaps are categorized into three classes: A, B, and C. Class A reflects the most serious mishap and involves loss of life or aircraft destruction, whereas classes B and C represent lesser but still significant mishaps. Crash rates are compared on a year-by-year basis and are reported as events per 100,000 flight hours. Statistical analysis was performed by the z test with Yates' correction, with significance set at p < or = 0.05. RESULTS: During the study period, 13.31 million total flight hours were recorded, with 741,000 aeromedical hours logged. The mean Army general aviation class A crash rate was 1.86 compared with the aeromedical rate of 2.02. The mean general class A to C crash rate was 7.37 compared with the aeromedical rate of 7.44. Between 1992 and 1995, there were 3 years when the Army aeromedical program suffered no class A mishaps. Differences between study groups are statistically significant, but they are interpreted conservatively given the very low incidence of mishaps in both groups. Both rates are comparable with published civilian mishap rates. CONCLUSIONS: There is a very low overall incidence of crashes in both groups. There may be no practical difference between Army general and aeromedical aviation mishap rates. Furthermore, Army crash rates are comparable with published civilian mishap rates.

Accidents, Aviation↗
PubMed1999

Mass casualty triage knowledge of military medical personnel.

During battlefield and mass casualty incidents, triage has been traditionally performed by many different personnel, including medics, nurses, dentists, and physicians. The objective of this study was to determine which military medical providers are most knowledgeable in mass casualty triage. The design was a prospective, written, timed, case-based examination of triage knowledge. Participants were volunteers from the active duty medical (physician), dental, nursing, and enlisted corps of the three military services. Subjects completed a 16-minute written examination consisting of seven cases in each of three simulated mass casualty scenarios: combat; nuclear, biological, and chemical; and humanitarian. Tests were taken anonymously, although demographic data on medical specialty, training, and experience were collected. Participants were instructed to classify the cases using the NATO categories of immediate, delayed, minimal, or expectant. Scores were tabulated according to two grading scales: an absolute scale of number correct, and a weighted scale amplifying gross misclassifications. Median scores between groups were tested pairwise using the Kruskal-Wallis one-way analysis of variance with p < or = 0.05. Statistically significant differences were noted between the highest and lowest scoring groups in each scenario. Our conclusion is that among the subject groups tested, physicians were best at mass casualty triage. Dentists, nurses, and medics scored progressively less well on our examination.

Analysis of Variance↗
PubMed1997

Military and civilian emergency aeromedical services: common goals and different approaches.

Military and civilian organizations in the U.S. operate separate but parallel emergency aeromedical services. Despite common origins, military and civilian approaches and methods have diverged. This article compares and contrasts the capabilities, priorities, safety, equipment, training and personnel of the largest military service, the U.S. Army, to civilian rotary wing (helicopter) emergency aeromedical programs. The different successes of military and civilian emergency aeromedical programs can be considered for use to improve the services of each. In general, Army programs operate larger aircraft and utilize two pilots per aircraft. Safety is a high priority and the Army aeromedical safety record is excellent. The Army also places a high degree of emphasis on crashworthiness and protective gear for the crew. Most civilian air Emergency Medical Service (EMS) programs operate small to moderate-sized aircraft flying with a single pilot. The recent safety record has improved dramatically. Civilian programs may add to their safety by considering two pilots and incorporating the crashworthy and protective advancements made by the military. Civilian programs fly with two highly trained medical technicians, nurses or physicians, equipped with state-of-the-art medical equipment. Army helicopters fly with one lesser-trained medical crewmember and less equipment. Improved combat casualty care and battlefield survival may be possible by increasing both the number and training of the medical attendants on Army aircraft.

Air Ambulances↗
PubMed1997

Improving combat casualty care and field medicine: focus on the military medic.

As military medicine in general copes with a rapidly changing world environment, so too must the backbone of the medical force, the enlisted medic. To meet these challenges, the training and utilization of military medics must match new and different missions. This paper will explore innovative approaches to training and preparing for combat casualty care and field medicine. The focus will fall on the education, evaluation, operations, patient-care skills, equipment, and telemedicine potential of the military medic. Future directions for study and development will be suggested. Exploration of the following may improve the capability of the military medic: (1) improved training to include advanced-level skills and interventions for combat casualty care and broader exposure to the casualties expected in operations other than war; (2) annual educational and periodic proficiency evaluation requirements; (3) strengthened medical control at all echelons; and (4) carefully selected additional equipment and technologies to enhance medical capabilities.

Allied Health Personnel↗
PubMed1996

Optimal positioning for cervical immobilization.

STUDY OBJECTIVE: We hypothesized that optimal positioning of the head and neck to protect the spinal cord during cervical spine immobilization can be determined with reference to external landmarks. In this study we sought to determine the optimal position for cervical spine immobilization using magnetic resonance imaging (MRI) and to define this optimal position in a clinically reproducible fashion. METHODS: Our subjects were 19 healthy adult volunteers (11 women, 8 men). In each, we positioned the head to produce various degrees of neck flexion and extension. This positioning was followed by quantitative MRI of the cervical spine. RESULTS: The mean ratio of spinal canal and spinal cord cross-sectional areas was smallest at C6 but exceeded 2.0 at all levels from C2 to T1 (P < .05). At the C5 and C6 levels, the maximal area ratio was most consistently obtained with slight flexion (cervical-thoracic angle of 14 degrees) (P < .05). For a patient lying flat on a backboard, this corresponds to raising the occiput 2 cm. More extreme flexion or extension produced variable results. CONCLUSION: In healthy adults, a slight degree of flexion equivalent to 2 cm of occiput elevation produces a favorable increase in spinal canal/spinal cord ration at levels C5 and C6, a region of frequent unstable spine injuries.

Adult↗
PubMed1994

On the ground at the U.S. Air Show.

Careful planning and organization at mass gatherings are essential if adequate medical care is to be ensured. The U.S. Air Show in Dayton, Ohio, attracts thousands of spectators annually and requires that dozens of EMS agencies and hundreds of first responders, EMTs, paramedics, nurses and physicians join forces to provide EMS coverage.

Accidents, Aviation↗
PubMed1993

Retropharyngeal abscess in an afebrile child.

A case of retropharyngeal abscess in a child is reported. The patient was nontoxic appearing, afebrile, and had minimal symptoms. The case is used to highlight the high index of suspicion that may be necessary to diagnose the condition. Diagnostic approaches, emergency treatment, and disposition of patients are discussed.

Abscess↗
PubMed1993

A proposed model for a residency experience in mass gathering medicine: the United States Air Show.

STUDY OBJECTIVE: Mass gathering medicine is an increasingly important responsibility for emergency physicians. A formal experience in mass gathering medicine can introduce emergency medicine residents to this aspect of community medicine. DESIGN: Educational model based on field experience and retrospective chart review from 1981 through 1991. SETTING: The US Air Show is a summer event that attracts an average of 223,000 spectators annually. Medical care is provided by physicians, nurses, and technicians operating within an organized system of care. Emergency medicine resident physicians (first-, second-, and third-year) evaluate and treat patients appropriate for the resident's level of responsibility. Residents provide immediate medical control and are integrated into the event disaster plan. On-site attending physician supervision is available at all times. Didactic instruction and event orientation are integrated into the residency curriculum. Residents participate in the planning stages of the event. RESULTS: During the study period, 2,091 patients were seen. The most common presenting problems were heat illness (28%), blisters and scrapes (25%), headaches (23%), fractures and lacerations (9%), and eye injuries (5%). One hundred forty-eight patients (7%) required transportation to the hospital. Approximately 16 residents participate each year and treat an average of 13.7 patients during their four-hour shift. A resident training model for a mass gathering experience is proposed to include adequate crowd size to generate useful patient volumes; a regularly scheduled event; organized medical and disaster preparations meeting local or published standards; didactic instruction on history, principles, and current issues; on-site attending supervision; degree of responsibility appropriate for training level; participation in planning and organizing the event; and postevent debriefing. CONCLUSION: A residency experience and training program in mass gathering medicine can introduce the principles of planning and providing care for crowds attending large public events.

Curriculum↗
PubMed1991

Bilateral vocal cord hematomas associated with shoulder harness use.

A case of bilateral vocal cord hematomas caused by a shoulder harness injury is presented. The patient was restrained by a three-point belt system and was involved in a front-end collision. She presented with mild facial and chest injuries and a contusion of the neck. One hour after injury she began to complain of hoarseness without airway compromise. Fiberoptic laryngoscopy showed bilateral true vocal cord hematomas. The patient had an uneventful hospital course and a full recovery. The importance of the mechanism of injury and associated injuries is discussed.

Accidents, Traffic↗
PubMed1991

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

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

Accidents, Traffic↗