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PubMedDate not supplied

Emergency medical services in the reconstruction phase following a major earthquake: a case study of the 1988 Armenia earthquake.

STUDY OBJECTIVE: To use the clinical activities of an ambulance service as a tool to assess the residual and unmet medical needs of a city in the aftermath of a major earthquake and to apply that assessment to the development of a training curriculum for the prehospital personnel. METHODS: The researchers conducted structured interviews with health care workers at all levels of the emergency health care delivery system in Gyumrii, Armenia, and carried out a retrospective frequency analysis of 29,010 ambulance runs for an 11-month period from February through December 1992. Runs first were assigned into the broad categories of: 1) Adult Medical; 2) Pediatric Medical; or 3) Trauma, and then, according to diagnosis. The runs then were classified further as: 1) Primary Care; 2) Basic Life Support (BLS); or 3) Advanced Life Support (ALS). RESULTS: Adult Medical calls represented 24,684 (85%), Pediatric Medical calls 459 (1.6%), and Trauma calls 3,867 (13%). Only 12% of all ambulance calls resulted in transport to a medical facility, although this percentage was higher in children. Thirty percent of Adult Medical patients were diagnosed by the emergency medical providers as having exclusively a psychiatric problem. CONCLUSION: In the late aftermath of a devastating earthquake, the ambulance service in Gyumrii, Armenia has been delivering a substantial proportion of non-emergency, primary care services. They have adopted this unconventional role to compensate for the deficit in health care facilities and personnel created by the disaster. The training program that the investigators developed reflected the actual work activities of the prehospital personnel demonstrated in their assessment.

Adult↗
PubMed1987

The basically advanced provider.

There do exist several ALS techniques that could be performed by BLS personnel. With the proper training, EMTs can assist the paramedic with duties that can speed aid to the patient.

Allied Health Personnel↗
PubMed1988

CPI revision provides more accuracy in the medical care services component.

This revision, as in the past, enabled the Bureau to update medical care service expenditure weights in the CPI, including a more complete allocation of health insurance premiums. Instead of keeping the portion of premiums that go to benefits under health insurance, the expenditure weight for each benefit category has been added to the appropriate out-of-pocket expense. The unpublished health insurance item represents only the retained earnings portion of premiums paid by households. The specific item categories included in medical care services have also been updated and expanded. A study conducted during the developmental phase of the revision indicated that the Bureau should expand the eligible priced rates for physicians in the CPI to include not only the "self-pay" rate, but also other categories of payment as well. Another study indicated that the direct pricing of health insurance is not feasible because of the difficulty of factoring out from premium changes the effect of utilization levels and modified coverage. In pricing medical care service items, as with other item categories in the CPI, BLS attempts to exclude from price movement the effect of quality changes. However, some quality changes are difficult to assess or are not readily identified, for example, a change in the ratio of nurses to patients, and such changes may be reflected as part of the price change movement in the CPI.

Abstracting and Indexing↗
PubMed1999

EMS incident management: emergency medical logistics.

If you had to get x amount of supplies to point A or point B, or both, in 10 minutes, how would you do it? The answer lies in the following steps: 1. Develop a logistics plan. 2. Use emergency management as a partner agency for developing your logistics plan. 3. Implement a push logistics system by determining what supplies/medications and equipment are important. 4. Place mass casualty/disaster caches at key locations for rapid deployment. Have medication/fluid caches available at local hospitals. 5. Develop and implement command caches for key supervisors and managers. 6. Anticipate the logistics requirements of a terrorism/tactical violence event based on a community threat assessment. 7. Educate the public about preparing a BLS family disaster kit. 8. Test logistics capabilities at disaster exercises. 9. Budget for logistics needs. 10. Never underestimate the importance of logistics. When logistics support fails, the EMS system fails.

Decision Making, Organizational↗
PubMed2000

Cardiac arrest witnessed by emergency medical services personnel: descriptive epidemiology, prodromal symptoms, and predictors of survival. OPALS study group.

STUDY OBJECTIVE: The Utstein guidelines recommend that emergency medical services (EMS)-witnessed cardiac arrests be considered separately from other out-of-hospital cardiac arrest cases. The objective of this study was to assess EMS-witnessed cardiac arrest and to determine predictors of survival in this group. METHODS: This prospective cohort included all adults with an EMS-witnessed cardiac arrest in the 21 communities of the Ontario Prehospital Advanced Life Support (OPALS) study. Systems provided a basic life support with defibrillation (BLS-D) level of care. Case and survival definitions followed the Utstein style. Descriptive and univariate methods (chi(2) and t test) were used to characterize EMS-witnessed cardiac arrest. Multivariate logistic regression was undertaken to assess predictors of survival to hospital discharge. RESULTS: From January 1, 1991, to December 31, 1996, there were 9,072 cardiac arrest cases in the study communities. Of these, 610 (6.7%) were EMS-witnessed. The majority had preexisting cardiac or respiratory disease (81.5%) and experienced prodromal symptoms before EMS personnel arrived (91.4%). An initial rhythm of pulseless electrical activity was present in 50.1% of the patients, ventricular fibrillation/ventricular tachycardia in 34.2%, and asystole in 15.7%. Survival to discharge was 12.6%. Multivariate analysis identified the following as independent predictors of survival (odds ratio with 95% confidence intervals [CIs]): nitroglycerin use before EMS arrival: 2.3 (95% CI 1.2 to 4.5), prodromal symptoms of chest pain: 2.5 (95% CI 1.4 to 4.5) or dyspnea: 0.5 (95% CI 0.3 to 1.0), and unconsciousness on EMS arrival: 0.5 (95% CI 0.2 to 0.9). Patients with chest pain were more likely than dyspneic patients to experience ventricular fibrillation/ventricular tachycardia (62% versus 17%, P<.0001), and were 5 times more likely to survive (30.6% versus 6.3%, P<.0001). CONCLUSION: EMS-witnessed cases are clearly an important subset of out-of-hospital cardiac arrest and are characterized by 2 distinct symptom groups: chest pain and dyspnea. These symptoms are important predictors of survival and may also help determine underlying mechanisms before patient collapse. A later phase of the OPALS study will prospectively evaluate the impact of out-of-hospital advanced life support on the survival of victims of EMS-witnessed cardiac arrest.

Adult↗
PubMed2000

Expression of neurotrophin receptors in normal and malignant B lymphocytes.

In order to define a cellular model suitable for studying, in vitro, the molecular properties and functions of neurotrophin receptors in human lymphocytes, TrkA, TrkB, TrkC and p75(NTR) expression was investigated in a panel of EBV immortalized lymphoblastoid (LCL) and Burkitt lymphoma-derived cell lines (BLs) compared to primary B lymphocytes by RT-PCR and flow cytometric analysis. Our data show that trkA and trkB are transcribed in most B cell lines of normal and malignant origin. For several of them, we also gained first evidence of trkC expression in B cells. All cell lines and primary B cells lack p75(NTR) expression. These data suggest that neurotrophin receptors expression in the B cell lines correlates to some extent with the phenotypic maturation stage and endogenous viral activity levels. Our data suggest that TrkA and TrkB, once activated, provide a partial rescue from apoptosis, whereas TrkC stimulates the progression through the cell cycle without affecting cell survival. Finally, the identification of a number of cell lines showing single expression of one of the Trk receptors has disclosed the availability of a cellular tool for further studies on their function, and mechanisms of signal transduction in the B cell moiety in the absence of p75(NTR).

Animals↗
PubMed2000

The cost of productivity losses associated with allergic rhinitis.

OBJECTIVE: To measure the cost of absenteeism and reduced productivity associated with allergic rhinitis. METHODS: The National Health Interview Survey (NHIS) was used to obtain information on days lost from work and lost productivity due to allergic rhinitis. Wage estimates for occupations obtained from the Bureau of Labor Statistics (BLS) were used to calculate the costs. RESULTS: Productivity losses associated with a diagnosis of allergic rhinitis in the 1995 NHIS were estimated to be $601 million. When additional survey information on the use of sedating over-the-counter (OTC) allergy medications, as well as workers' self-assessments of their reduction in at-work productivity due to allergic rhinitis, were considered, the estimated productivity loss increased dramatically. At-work productivity losses were estimated to range from $2.4 billion to $4.6 billion. CONCLUSION: Despite the inherent difficulty of measuring productivity losses, our lowest estimate is several times higher than previous estimates of the indirect medical costs associated with allergic rhinitis treatment. The most significant productivity losses resulted not from absenteeism but from reduced at-work productivity associated with the use of sedating OTC antihistamines.

Absenteeism↗
PubMed2000

[Observing an SSU Em 118 dispatch center for continuous quality improvement. The case of SSUEm 118 Varese].

The present paper highlights quality aspects of the management of an Emergency Health Service Center (SSUEm 118, Varese) in order to identify the corrective measures required in a service that is increasingly close to the citizens real needs and expectations. Data were collected retrospectively on a total 54,301 calls for assistance in the period October 1997-March 1999 from an area covering some 1,300 sq.km with a population of 1,150,000 residents. That resident population was dramatically increased on a daily basis by heavy vehicle traffic particularly on the motorways to the area's many factories and to the Intercontinental Airport Malpensa 2000. The survey employed 7 anaesthetists and resuscitation staff, 14 nurses and 8 Italian Red Cross works from the Emergency Center. The researchers analysed the following phases: call reception and telephone conversation: ambulance dispatch, patient transportation and the alerting of the hospital of destination. The ServFMEA method was used for Quality Control with appropriate dispatch and the conduct and timing of the ambulance service in the Varese SSUEm 118 area. The data collected allowed for a detailed analysis of the accuracy of the information provided over the telephone (over-triage 58%, undertriage 2%), the usefulness of the telephone filter, the colour coding (correct in 40% of cases), pick-up times (5'40" on average) which were related to problems inherent in the ambulance call-out and the way ambulances reached the emergency (BLS 99%, ALS 1%, Air rescue < 1%). It was concluded that Varese SSUEm 118 was effectively and efficiently run in its first 18 months and results were improved as far as they could be given the inadequate funding of the Italian Heatlh Service.

Emergency Service, Hospital↗
PubMed2000

[Development and organization of the Education Center at the Institute of Emergency Medical Services in Sarajevo].

This paper presents an experience of the Educational Centre of EMSC Sarajevo in the postgraduate training of the various profiles of medical personnel (medical doctors and medical technicians) that are employed in the emergency services of the pre-hospital and hospital type in Bosnia and Herzegovina. A period of the last four years (1996-2000) when the Educational Centre was restructured, becoming a one of the most active services in the medical sector of the EMSC Sarajevo has been emphasised in particular. Educational Centre of EMSC was participating in a number of international projects related to the education. Forty-five (45) courses of the various levels and with different programs: BLS, ALS, ACLS, ACLS-instructor course, ATLS, EMT-course, EMT-advanced, EMT-instructor and EMT-dispatcher course were carried out in the mentioned period. Seven thousand eight hundred and twelve (7812) hours of theoretical teaching and practical training were provided for the 570 candidates who successfully completed training in various programs. First aid training for civilian population was also conducted. Twenty one first.aid courses were carried out and successfully achieved by 324 candidates. On this way, 196 hours of theoretical teaching and practical training were realised. In order to make first aid training popular, 160 children from pre-school institutions (kindergartens) of Sarajevo Canton were also introduced to first aid principles. It has been pointed out that well equipped and trained team for the urgent medical intervention with a necessary team work is a crucial factor for the successful treatment of emergency that means a patient in life threatening situation.

Academies and Institutes↗
PubMed2001

[Education of basic/advanced life support and emergency medicine for anesthesiologists: a survey of chairpersons at university department and newly board certified anesthesiologists].

To determine how the education of basic life support (BLS)/advanced cardiac life support (ACLS) and emergency medicine for anesthesiologists is conducted, we performed a survey of chairpersons at university departments and newly board certified anesthesiologists in 1999. Basic and advanced life support courses for residents were provided in more than half of the anesthesiology departments that responded to this survey. However, approximately only 10% of the respondents had regular BLS/ACLS courses for residents. On the other hand, more than 80% of respondents considered a rotation in emergency medicine desirable as a part of anesthesia training. To improve the resuscitation skills of anesthesiologists, an urgent need to establish regular BLS/ALS courses and educational programs in emergency medicine in anesthesia training does exist.

Anesthesiology↗
PubMed2001

Heart-to-heart talk. Roundtable discussion.

This past August the American Heart Association (AHA) released a major revision of its recommendations for emergency cardiovascular care (ECC). The 2000 guidelines simplify CPR techniques for the layperson and strongly promote the use of community early defibrillation. What repercussions can we expect from these changes? We asked five experts to join a roundtable discussion of the BLS aspects of these new guidelines. Their conversation follows.

Cardiopulmonary Resuscitation↗
PubMed1996

Charge balance--a theoretical basis for modulating pH fluctuations in plant nutrient delivery systems.

Existing control systems for pH and nutrient supply in hydroponic space plant growth units and bioregenerative life support (BLS) systems require acid and base additions to correct plant-induced charge imbalances in the nutrient solution. Plant growth is dependent on nutrient availability, and the active uptake of ions by roots changes the pH of the nutrient solution. This change in pH is an integrated response to nutrient and organic ion influx/efflux by the plant. Plant nutrient requirements, as a function of crop development and driven by specific environmental conditions, influence the magnitude of the charge balance requirement. Nitrogen is the dominant nutrient taken up by plant species. If the daily crop nutrient (N) requirement at each developmental stage is known, and the daily addition of nutrients (relative addition rate = RAR) to the plant growth system is calculated, controlling the daily addition of ammonium (NH4+) and nitrate (NO3-) offers a mechanism whereby pH fluctuations in the nutrient solution could be largely minimized and controlled, reducing acid or base additions to the system.

Anions↗
PubMed2001

Characteristics of patients at a Taipei summer rock concert festival.

BACKGROUND: Rock concerts are popular mass gatherings in Taiwan. Millions of fans participate in rock concerts in Taiwan each year. However, there were no reports on the characteristics of the patients seen in rock concerts in Taiwan. METHODS: Medical care for a summer rock concert festival held in an outdoor stadium in Taipei was coordinated by emergency physicians of a medical center. About 50,000 attendees participated in the two-night concert. Three stations were set up to provide advanced medical care. A standardized form was used to collect information about patients. RESULTS: A total of 28 cases visited the medical stations, fourteen cases each day. They were aged from 13 to 40 years, with an average of 20.8 +/- 6.4. Twenty-one cases were female and seven were male. Twenty-two (79%) were spectators, five (18%) were on-duty staff, and one was a by-stander. Based on an estimation of totally 50,000 participants in the stadium for this two-night festival, the medical use rate was roughly 5.6 PPTT (patients per ten thousand attendees). The most common major problem was fainting which accounted for 13 cases (46%). Of these 13 cases, three cases (23%) lost consciousness and 12 cases (92%) were female. Sixteen cases (57%) were classified as requiring ALS (advanced life support) and 12 cases (43%) as requiring BLS (basic life support). Most cases improved and were discharged after onsite treatment. Only one case was transferred by ambulance due to persistent chest pain. However, she recovered several hours later. CONCLUSIONS: By this preliminary data, first reported in Taiwan, we found that the most common problem was fainting. More than half of the cases seen at the concert required advanced life support. A well-designed emergency medical service (EMS) system is mandatory to provide services for these events.

Adolescent↗
PubMed2001

ACLS.

It must be emphasised that the published International Guidelines 2000 contain an in-depth presentation of the scientific evidence behind advanced life support. The exact interpretation of this evidence, and the algorithms adopted by a national resuscitation council will depend upon various factors such as local interpretation of the evidence, local practice and availability of drugs. The ERC is publishing its own summaries of the guideline changes and the sequences of action for both BLS and ALS and these papers are recommended for further reading.

Advanced Cardiac Life Support↗
PubMedDate not supplied

Placental weight and birth characteristics of healthy singleton newborns.

To determine the relationship of placental weight and birth characteristics of healthy Chinese singleton newborns, 552 consecutive singleton near-term and uncomplicated pregnancies were enrolled in a retrospective study from October 2000 to April 2001. Maternal age, infants' gender, gestational age, placental weight (PW), birth weight (BW), birth length (BL), cord length, ponderal index, and appearance of meconium-stained amniotic fluid or a nuchal cord were recorded and analyzed. Our results show that the mean value of BW was 3235 +/- 17 g, birth length was 48.8 +/- 0.1 cm, PW was 646.2 +/- 0.3 g, BW/BL was 66.2 +/- 0.3, BW/PW was 5.1 +/- 0.1, and ponderal index was 2.8 +/- 0.0, respectively. Male neonates had significantly larger BWs (p<0.05) and BLs (p<0.01) than did female neonates. However, there was no significant difference in PW between male and female neonates. PW was positively correlated with BW (r=0.413, p<0.01), BL (r=0.305, p<0.01), BW/BL (r=0.397, p<0.01), and cord length (r=0.264, p<0.01). The PW of studied infants showed no significant difference when grouped by gestational age, maternal age, presence of meconium stained amniotic fluid, or presence of a nuchal cord. Of the studied healthy neonate, 81.9% and 69.4% had no meconium-stained amniotic fluid or nuchal cord, respectively. There were no significant differences in PW or BW/PW between neonates with the presence or absence of meconium-stained amniotic fluid or a nuchal cord. These results indicate that PW has a significant role in fetal growth in terms of weight, body length, and cord length. Furthermore, it has no significant role in the presence of meconium-stained fluid or a nuchal cord in healthy neonates.

Birth Weight↗
PubMed2002

WEB-WAP based telecare.

We have developed two telecare applications based on mobile telephony (WAP) and WEB. The first can be used to request Basic Life Support (BLS) guidelines any time by using a WAP device and to teach people and non-professionals involved in health care emergency situations. The second is a WEB-WAP based tool for medical data retrieval and at-home health care monitoring of chronically ill patients with congestive heart failure (CHF) or diabetes. Medical education content related to these diseases is available on the WEB and on the WAP device. The WAP application uses the features found in the last generation of mobile phones such as better multimedia information presentations, better interactivity capabilities, and enhanced ease of use. Based on these two applications, a promising platform is offered for developing applications in health care, home care, medical monitoring and health education ensuring continuity of care. In the paper we present the preliminary results of a pilot test at Thessaloniki University (Greece) where the WEB-WAP based tool is used to monitor patients with diabetes or CHF.

Chronic Disease↗
PubMed2002

Altropane (Boston Life Science).

Boston Life Sciences (BLS) is developing Altropane as a potential radio-imaging agent to be used with single photon emission tomography (SPECT), for the early diagnosis of Parkinson's disease (PD) and attention deficit hyperactivity disorder (ADHD) [329661]. Altropane is currently in phase III clinical trials for PD and phase II clinical trials for ADHD.

Animals↗
PubMed2002

Occupational disease in Connecticut, 2000.

BACKGROUND: Occupational illnesses in Connecticut are tracked to better understand patterns and trends by industry, cause, and time, which allows for interventions such as cluster investigations and education. METHODS: Data were collected for occupational illnesses from three data sources: the Connecticut Bureau of Labor Statistics (BLS) annual survey, workers' compensation reports, and physician reports. FINDINGS: There were 6,396 reports of occupational illness in Connecticut in 2000. Reports increased sharply based on two of the three databases. Reports were dominated by musculo-skeletal disorders (MSD), followed by lung conditions. Manufacturing, the State of Connecticut, and municipalities tended to have the highest number of cases and rates. Acute respiratory conditions were the most common lung condition, followed by occupational asthma and asbestos-related conditions. CONCLUSION: Occupational illnesses are very prevalent in Connecticut and appear to be increasing. Improved diagnosis and reporting are needed to improve patient care and to direct preventive efforts.

Connecticut↗