Prehospital and disaster medicine
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Prehosp Disaster Med · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialComparison of delivered volumes and airway pressures when ventilating through an endotracheal tube with bag-valve versus demand-valve.
Use of an oxygen-powered demand-valve to ventilate through an endotracheal tube is considered inappropriate due to concern regarding excessive airway pressures. ⋯ Overall average tidal volumes and minute ventilations were acceptable with both ventilatory devices at both normal and poor compliance for the first, fifth, and 10th minute of continuous ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Proper airway control in trauma patients who have sustained cervical spine fracture remains controversial. ⋯ The choice of airway control in the trauma patient with CSF differs between anesthesiologists and surgeons. However, the method selected does not have an adverse affect on neurological status as long as in-line stabilization is maintained. The methods available are safe, effective, and acceptable. The recommendations of the American College of Surgeons Committee on Trauma for airway control with suspected cervical spine injury are useful. The technique utilized is dependent upon the judgment and experience of the intubator.
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Prehosp Disaster Med · Jan 1994
Adverse events during interfacility transfers by ground advanced life support services.
To identify risk factors for adverse events that occur during interfacility transfers by advanced life support (ALS). ⋯ Interfacility transfers of a heterogeneous group of patients in this series involve a low risk of cardiac arrest. Patients with medication infusions are at higher risk of deterioration and more frequently require ALS intervention en route. The presence of hospital staff had no measurable effect. These findings have implications for the development of ALS transfer protocols.
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Prehosp Disaster Med · Jan 1994
The effect of a quality improvement feedback loop on paramedic skills, charting, and behavior.
A mechanism was initiated for conveying quality improvement (QI) results to paramedics as a means of improving chart documentation in difficult-to-correct areas. This study examines the impact of this QI feedback loop on charting, resuscitation rates from cardiac arrest, endotracheal intubation (ETI) success rates, and trauma scene times. ⋯ The use of QI feedback had little effect on psychomotor skills as the ETI success rate or resuscitation rate, but had a dramatic effect on chart documentation, as evidenced by ETID rate, and behavior, as evidenced by the reduction in prolonged trauma scene times. The use of QI feedback is recommended as a means of correcting charting deficiencies or modifying behavior.
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Prehosp Disaster Med · Jan 1994
Motor vehicle safety, health care, and taxes. National Highway Traffic Safety Administration, U.S. Department of Transportation.
Motor vehicle injuries are a major public health problem. They are a primary cause of: 1) death and injury in the United States; and 2) result in a substantial loss of productive life. These injuries and fatalities have serious social and economic consequences for the injured individual, their families, and society. This report focuses on the portion of health care expense borne by the public and the tax revenue implications of these injuries and fatalities. ⋯ It is obvious that inaction is a costly alternative and that anticipated population gains will require further reductions in injury and fatality rates just to maintain current injury and fatality rates. Fortunately, countermeasures are to be available that can accomplish this. Lack of vigilance that would result in deterioration of safety levels would be even more costly.