Prehospital and disaster medicine
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Prehosp Disaster Med · Jan 1997
Comparative StudyComparison of a colorimetric end-tidal CO2 detector and an esophageal aspiration device for verifying endotracheal tube placement in the prehospital setting: a six-month experience.
Hand held, colorimetric, end-tidal CO2 detector devices are being used to verify correct endotracheal tube (ETT) placement. The accuracy of these devices has been questioned in situations of cardiac arrest. The use of the esophageal detector device (EDD) is an easy alternative for detection of ETT placement, and may be more accurate in situations of cardiac arrest. ⋯ The EDD was accurate in all cases of orotracheal intubation, and was easier to use than was end-tidal CO2 detector device. It was preferred by 75% of participating EMS providers. In cases in which the ETT may be above the vocal cords, caution must be used with interpreting the results obtained by use of the EDD.
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The purpose of this project was to improve the identification, treatment, and referral of domestic violence victims by prehospital care providers (Emergency Medical Technicians (EMTs) and paramedics) and emergency department personnel. The training focused on the definition of domestic violence, procedures to use when questioning patients about abuse, Utah's mandatory reporting law, and the referral of victims to community resources. ⋯ Although providers felt confident asking questions about abuse, the providers did not question patients unless they suspected domestic violence was the cause of the injury. Further training needs to be offered to staff to encourage regular screening for all adult patients.
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Prehosp Disaster Med · Jan 1997
Portable, but suitable: devices in prehospital care might be hazardous to patient or to aviation safety.
Devices used for support of patients requiring air rescue or conveyance are subjected to severe environments that may affect their ability to function when needed or may affect other systems within the transporting vehicle. ⋯ The devices used in various aircraft influence certain vital maneuver systems of the craft. Studies on portable ventilators, a suction device, and tracheal tubes showed that, under specific conditions, the equipment was safe to patients and was not hazardous to the aviation safety. However, under certain conditions commonly encountered during air rescue operations, the equipment became dysfunctional or presented safety hazards to the aircraft, and, hence, the crew. The Swedish Air Force has adopted three different criteria constellations: 1) operative; 2) storing; and 3) transport environment.
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Osborne and Gaebler's Reinventing Government has sparked discussion amongst elected officials, civil servants, the media, and the general public regarding advantages of privatizing government services. Its support stems from an effort to provide services to municipalities while reducing taxpayer expenditure. Many echo the sentiment of former New York Governor Mario Cuomo, who said, "It is not government's obligation to provide services, but to see that they're provided." Even in the area of public safety, privatization has found a "market." In many localities, privatizing Emergency Medical Services (EMS) is a popular and successful method for providing ambulance services. ⋯ The purpose of this paper is to present several important concepts and considerations that public officials, medical directors, and the public must be aware of when contemplating the possibility of privatizing their Emergency Medical Services. A review of the general concepts of privatization and issues of accountability will be presented, referencing policy experts, followed by an examination of how advocates of privatization might see these issues as they relate to providing EMS. The conclusion will present prescriptions for both municipal and commercial ambulance providers.