Prehospital and disaster medicine
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Prehosp Disaster Med · Oct 1999
Randomized Controlled Trial Multicenter Study Clinical TrialA safety assessment of diaspirin cross-linked hemoglobin (DCLHb) in the treatment of hemorrhagic, hypovolemic shock.
To determine the safety and possible efficacy of diaspirin cross-linked hemoglobin (DCLHb) in the treatment of patients in Class II-IV hemorrhagic, hypovolemic shock. ⋯ Administration of 50 to 200 mL of DCLHb to patients in hemorrhagic, hypovolemic shock was not associated with evidence of end organ toxicity or significant adverse events. Further studies involving larger doses and, perhaps, earlier administration of DCLHb are warranted.
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Prehosp Disaster Med · Oct 1999
Job stressors and job satisfaction in a major metropolitan public EMS service.
Behavioral and social science research suggests that job satisfaction and job performance are positively correlated. It is important that EMS managers identify predictors of job satisfaction in order to maximize job performance among prehospital personnel. ⋯ Quality of career choice and interactions with physicians are predictive of global job satisfaction within this urban emergency medical service (EMS). Future studies should examine specific characteristics of the physician-paramedic interface that influence job satisfaction and attempt to generalize these results to other settings.
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Prehosp Disaster Med · Oct 1999
Racial and ethnic patterns in the utilization of prehospital emergency transport services in the United States.
This descriptive research used a large, urban population-based data set for prehospital, emergency medical transports to examine racial/ethnic patterns of access and utilization for several broad categories of emergency medical transport services. ⋯ Age- and gender-standardized rates for emergency medical transport were found to be lowest for non-Hispanic, whites, moderately higher for Hispanics, and substantially higher for African-Americans, who experienced transport rates nearly three times higher than were the rates for non-Hispanic whites. Further research is required to establish the extent to which racial/ethnic differences observed in this geographically restricted study reflect variations between racial/ethnic groups in the underlying need for services.
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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.