Prehospital and disaster medicine
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Prehosp Disaster Med · Jul 1999
GuidelineRecommendations for uniform reporting of data following major trauma--the Utstein Style: an initiative. International Trauma Anaesthesia and Critical Care Society (ITACCS)
Basic and advanced care of trauma patients always has been an important aspect of prehospital and immediate in-hospital Emergency Medicine, involving a broad spectrum of disciplines, specialties, and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources, and operation. This complex background, at least in part, has hindered the development of a uniform pattern or set of criteria and definitions. This in turn, has rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be evaluated or compared readily with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA, and other International Organisations represented in ILCOR--on Uniform Reporting of Data following Out-of-hospital and In-hospital Cardiac Arrest--the Utstein Style, an international working group of ITACCS, has drafted a document, Recommendations for Uniform Reporting of Data following Major Trauma--the Utstein Style. The reporting system is based on the following considerations: 1) A structured reporting system based on an "Utstein style template" that would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance, and quality of care (and enable groups to challenge performance statistics that did not take account of all relevant information); 2) The Recommendations and Template should encompass both out-of-hospital and in-hospital trauma care; 3) The Recommendations and Template should permit further intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives; and 4) The Template should facilitate studies setting out to improve epidemiological understanding of trauma; for example, such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on "prehospital cardiac arrest". It includes a glossary of terms used in the prehospital and early hospital phase as definitions, time points, and time intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance, and finally, one for the hospital. For clarity, data should be reported as core data (i.e., always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein Template for pre- or in-hospital cardiac arrest, respectively, the present Template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: I. ⋯ Describes the following items: a) Cause of injury e.g., type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc.; b) Severity of Injury--e.g., prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from "1" = head to "9" = external; the physiological disability scale ranges ordinally from "0"; c) Mechanism of injury--recording for transportation incidents etc; e.g., the type of impact, possible restraining devices,
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Prehosp Disaster Med · Jul 1999
Comparative StudyTriage ability of emergency medical services providers and patient disposition: a prospective study.
To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission. ⋯ Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.
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Prehosp Disaster Med · Jul 1999
Predictors of demand for emergency prehospital care: an Australian study.
Determining the predictors of demand for emergency prehospital care can assist ambulance services in undertaking policy and planning activities. ⋯ Demand for ambulance services can be predicted by a number of demographic, medical status, and insurance variables. Age and triage levels are key influences on demand for ambulance services. Ambulance insurance status provides an economic incentive to use ambulance services regardless of the urgency of the medical condition.
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Prehosp Disaster Med · Jul 1999
Comparative StudyGeriatric trauma patients at a suburban level-I trauma center in Japan.
Despite the increases in the aged population in Japan, there are little data on geriatric patients with traumatic injuries. A prospective clinical study was carried out to evaluate the use of the emergency medical services (EMS) system, mechanisms of injury, and prehospital assessment and triage of elderly victims of trauma. ⋯ The data suggest that in geriatric-age patients, direct transfer patients have a lower mortality rate than do indirect transfer patients when controlled for ISS. Therefore, it seems that a different set of triage criteria should be developed and implemented for geriatric-age victims with trauma-induced injuries and that those who meet these more stringent criteria should be transferred directly to a Trauma Center.
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Prehosp Disaster Med · Jul 1999
Comparative StudyDifferences in mortality rates among trauma patients transported by helicopter and ambulance in Maryland.
A comprehensive state-wide emergency medical services and helicopter transport system has been developed in the State of Maryland on the principle that early definitive care improves patient outcomes. The purpose of this study was to determine if empirical data exist to support the theory that air medical transportation services provided by the Maryland State Police (MSP) Aviation Division contribute to an improved trauma patient survival rate in Maryland. ⋯ The State of Maryland has demonstrated a commitment to its citizenry and invested heavily in its public safety air medical service. This study suggests the rapid air transport of victims of traumatic events by specialized personnel in Maryland has a positive effect on the outcome of severely injured patients. Further research is necessary to clarify the causal relationships in order to more fully elucidate the value of this resource.