Search PubMedSearch

Biomedical subjects

R L Muelleman

Publications and source records attributed to R L Muelleman.

16 recordsLinked to original sources

Measuring response intervals in a system with a 911 primary and an emergency medical services secondary public safety answering point.

STUDY OBJECTIVE: Measurement of interval data is important in the accurate recording of events that occur in an emergency medical services system. Measurement of intervals should be a simple task. However, when two separate clocks are needed to record the beginning and end of an interval, accurate measurement may be difficult. We sought to accurately measure the 911 call receipt-to-vehicle departure and 911 calls receipt-to-patient access intervals in a system with primary and secondary public safety answering points (PSAPs). METHODS: We conducted a descriptive study between January 1 and July 31, 1993. All 911 calls beginning at the primary PSAP, transferred to the EMS secondary PSAP, and ending with patient access times were eligible. Clock-synchronization errors and unavailability of 911 time logs were the criteria for exclusion. We measured the 911 call receipt-to-vehicle departure interval by adding the primary-PSAP and the EMS secondary-PSAP call-processing intervals. The 911 call receipt-to-patient access interval was the absolute difference between the time when the 911 primary-PSAP phone range and the time of patient access recorded by EMS personnel. RESULTS: The data were best described with median and interquartile ranges (IQRs). We found 1,945 calls that met inclusion criteria. Of these, 270 were deleted because of clock errors and 616 for time log unavailability, yielding 1,059 calls for interval determinations. The median 911 call receipt-to-vehicle departure interval was 1.7 minutes (IQR, 1.2 to 2.2 minutes). The median 911 call receipt-to-patient access interval was 8.2 minutes (IQR, 6.4 to 10.5 minutes). CONCLUSION: The 911 call receipt-to-vehicle departure and 911 call receipt-to-patient access intervals can be accurately measured in a system with two separate PSAP computer-aided dispatch clocks. These intervals are variable and often lengthy.

Ambulances

Battered women: injury locations and types.

STUDY OBJECTIVE: To characterize injuries to battered women by comparing their location, type, and severity with those of injuries to women resulting from other mechanisms. METHODS: Cross-sectional study of 9,057 women between the ages of 19 and 65 years who presented for any reason to the emergency departments of 10 hospitals serving inner-city, urban, and suburban populations. RESULTS: A total of 280 injured, battered women were identified during the study period. About 3.1% (95% confidence interval [Cl]. 2.7% to 3.5%) of all women seen in the ED, and 11.2% [95% Cl, 10.0% to 12.4%) of injured women with known mechanisms of injury, were determined to be positive for battering. Battered women were more likely to be injured in the head, face, neck, thorax, and abdomen (P < .001) than were women injured by other mechanisms. Twelve specific injury types were identified that occurred more frequently in battered women. CONCLUSION: Although battered women experience certain injury types more frequently than women injured by other mechanisms, the low positive predictive value of these injuries supports the use of universal screening for domestic violence in all injured women.

Adult

Fatal motor vehicle crashes: variations of crash characteristics within rural regions of different population densities.

OBJECTIVE: While it is known that motor vehicle crash (MVC) fatality rates are inversely related to population density, there has been no description of which crash variables are related to population density. The purpose of this study was to describe crash characteristics of fatal MVCs and to determine which crash characteristics are related to population density. DESIGN: This is a retrospective review of fatal accident reporting system (FARS) records. They represent four different population density regions over a 5-year period in a four-state midwest region. RESULTS: There were 10,932 people in 6,318 vehicles who were involved in 4,970 fatalities. Occupant fatality rates per 100,000 persons were inversely related to population density. The variables related to lower population density were more light and heavy truck types, more frequent alcohol use and higher levels of intoxication, more frequent crashes that are noncollisions on less heavily traveled roads, more frequent crashes on gravel surface types, more frequent occupant ejection, and delayed medical care. CONCLUSION: Rural areas are not homogenous in terms of fatal MVC crash characteristics. By analyzing fatal MVC crash characteristics in regions with different population densities, many crash variables were found to be related to population density. By understanding which characteristics about fatal MVCs are related to population densities, different interventions could be targeted to different rural populations.

Accidents, Traffic

An emergency medicine approach to violence throughout the life cycle. SAEM Public Health and Education Committee.

This document by the SAEM Public Health and Education Committee outlines the public health impact of interpersonal violence as it pertains to acute emergency care. This paper provides an overview of violence through the life cycle (i.e., child abuse, youth violence, intimate violence, and elderly abuse). It also makes specific recommendations regarding the role emergency physicians can play in reducing violence through medical education, research, surveillance, public education, advocacy, and clinical practice.

Aged

Motorcycle helmets and spinal injuries: dispelling the myth.

STUDY OBJECTIVE: To determine the relationship between spinal injuries and helmet use in motorcycle trauma. DESIGN: Retrospective case series. SETTING: Twenty-eight hospitals in four midwestern states--Illinois, Iowa, Nebraska and Wisconsin--representing urban, suburban, and rural settings. PATIENTS AND OTHER PARTICIPANTS: Consecutive sample of motorcyclists treated at the participating centers. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The major variables evaluated were helmet use, ethanol use, and significant head or spinal injuries. RESULTS: 1,153 cases were analyzed. Helmet use was not significantly associated with spinal injuries (odds ratio, 1.12; 95% confidence intervals, 0.79, 1.58) whereas head injury was markedly decreased with helmet use (odds ratio, 0.35; 95% confidence intervals, 0.23, 0.53). Ethanol use was a significant variable in both head (odds ratio, 3.89) and spinal (odds ratio, 2.41) injuries. CONCLUSION: In contrast to a significant protective relationship identified for head injuries, helmet use was not associated with an increased or decreased occurrence rate of spinal injuries in motorcycle trauma.

Adult

Motor vehicle deaths: a rural epidemic.

OBJECTIVE: To determine the magnitude of the discrepancy in injury death rates between urban and rural counties and which types of injury deaths contribute most to this discrepancy. DESIGN: A review of Nebraska death certificates over the period 1985-1989 was undertaken. Counties were divided into four groups according to population. Group I: urban counties (n = 3); group II: counties with a town of greater than 10,000 (n = 9); group III: counties with a total population of greater than 10,000 (n = 19); group IV: counties with a total population of less than 10,000 (n = 62). Age-adjusted death rates for heart disease, cancer, cerebrovascular disease, pneumonia, and injury were tabulated. Injury deaths were further categorized by intentional injury (homicide, suicide), and unintentional injury (motor vehicle-related, falls, drownings, poisoning, farm machinery-related, choking, firearms-related, fire-related and burns). INTERVENTIONS: None. RESULTS: Age-adjusted death rates per 100,000 population (with 95% confidence intervals) in group IV were lower than in group I for heart disease: 209 (193.9-224.1) vs. 227.4 (216.3-238.5); cancer: 135.9 (123.7-148.1) vs. 176.3 (166.6-186.0); cerebrovascular disease: 39.9 (33.3-46.5) vs. 44.6 (39.7-49.5); pneumonia: 19.6 (15.0-24.2) vs. 23.4 (19.8-27.0); and intentional injury deaths: 13.3 (9.5-17.0) vs. 15.1 (12.2-18.0). However, age-adjusted unintentional injury death rates were 54.2% higher in group IV than in group I: 42.7 (35.9-49.5) vs. 27.7 (23.8-31.6). Motor vehicle-related death rates were 93% higher: 23.3 (18.2-28.4) vs. 12.1 (9.5-14.7); and farm machinery-related deaths were 1250% higher: 2.7 (1.0-4.4) vs. 0.2 (-0.1-0.5). CONCLUSION: Age-adjusted unintentional injury death rates are higher in the rural counties of Nebraska, even though death rates for the four other leading causes of death (heart disease, cancer, cerebral vascular disease, and pneumonia) and intentional injury are lower. Although farm machinery-related deaths have the largest percentage difference between rural and urban counties, motor vehicle-related deaths are the major contributor to the unintentional injury death rate discrepancy in rural Nebraska.

Accidents, Traffic

Decoding the E-code.

Injury is a major public health problem. E-coding is an important epidemiologic tool that would allow for quantitative estimates of injury morbidity and mortality. This information could then be used to develop and evaluate injury control interventions. E-coding has been successfully implemented at the county level in Nebraska and efforts should be supported to expand this effort statewide.

Adult

Motorcycle crash injuries and costs: effect of a reenacted comprehensive helmet use law.

STUDY OBJECTIVES: To document the effect of a reenacted comprehensive helmet use law on injuries and fatalities. DESIGN: Retrospective before-and-after analysis. SETTING: Two urban counties representing 40% of Nebraska's population. PARTICIPANTS: Six hundred seventy-one patients reported as injured to the Nebraska Department of Roads in the period from one year before through one year after the reenactment on January 1, 1989. RESULTS: The helmet use law was temporally associated with a 26% decrease in the reported rate of motorcycle crashes in Nebraska compared with five other midwestern states. There were sharp declines in the number (and rates) of reported injured, hospital transports, hospital admissions, severe nonhead injuries, severe head injuries, and deaths. Serious head injuries (Abbreviated Injury Score, 3 or higher) decreased 22%. The percentage of injured motorcyclists with serious head injuries was significantly lower among the helmeted motorcyclists (5%) than among the unhelmeted cyclists (14%) for the two years combined. CONCLUSION: The reenactment of a helmet use law resulted in fewer crashes, fatalities, and severe head injuries.

Abbreviated Injury Scale

Hemodynamic and respiratory effects of thyrotropin-releasing hormone and epinephrine in anaphylactic shock.

Thyrotropin-releasing hormone (TRH) has been shown to increase mean arterial pressure during anaphylactic shock. The hemodynamic mechanism of action and the effect of TRH on the respiratory system during anaphylactic shock are not known. A rabbit model of anaphylaxis was used to determine the effect of TRH, epinephrine (EPI), and normal saline (NS) on various cardiovascular and respiratory parameters during anaphylactic shock. Anaphylactic shock was induced by antigen challenge in 31 sensitized animals. After a 25% decrease in mean arterial pressure, they were randomly treated with TRH (2 mg/kg), EPI (0.005 mg/kg), or NS (10 mL/kg). Blood was drawn at baseline and at the end of the experiment for laboratory analysis. Cardiac and respiratory parameters were monitored continuously and measured at baseline, at onset of shock (time zero), and at time intervals for 30 minutes. Animals were treated with repeated doses during the first 15 minutes as needed to maintain mean arterial pressure above shock level. Five of ten TRH-, five of 11 EPI-, and six of ten NS-treated animals survived. The TRH-treated group required fewer doses than the other groups and had increased heart rate, mean arterial pressure, peripheral vascular resistance, respiratory rate, and minute ventilation as well as decreased stroke volume index and lung compliance compared with the NS-treated group. EPI treatment resulted in increased minute ventilation and decreased pulmonary airway resistance compared with NS treatment. The EPI group also had a higher postsurvival epinephrine level than the other groups. No difference in right atrial pressure, cardiac index, acid-base status, pO2, A- a gradient, lung weight, lactate, or norepinephrine levels was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance

Blood pressure effects of thyrotropin-releasing hormone and epinephrine in anaphylactic shock.

To compare the effects of a single dose of thyrotropin-releasing hormone (TRH), epinephrine, and control (normal saline) on mean arterial pressure (MAP) and survival over a one-hour observation period, we carried out a randomized, blinded study using a rabbit model of anaphylaxis. Epinephrine resulted in an increased MAP over normal saline and TRH at one minute after treatment (P less than .001). TRH resulted in an increased MAP over normal saline at two minutes (P less than .017) and over epinephrine at four minutes (P less than .011) after treatment. No differences in MAP were detected beyond four minutes after treatment. There was no difference in survival between treated and control animals (alpha less than .168). Although no difference in survival existed, TRH had a slower onset, but more sustained effect on MAP than did epinephrine and normal saline.

Anaphylaxis