European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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A case of a person struck by lightning is presented in which treatment consisted of 60 min of resuscitation, followed by a 3 day period of artificial ventilation. Persons who are struck by lightning might benefit from prolonged resuscitation efforts, since patients such as this one, as well as similar cases described in the literature, have survived without major sequelae. In our opinion, on-the-spot advanced life support, hypothermia and a moderate rehydration policy contributed to this patient's successful resuscitation.
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Comparative Study
Helicopters as part of a regional EMS system--a cost-effectiveness analysis for three EMS regions in Germany.
With increasing health care costs the use of rescue helicopters is being questioned on the grounds of expense. No data exist on the cost-effectiveness of the use of rescue helicopters as part of a regional EMS. The end-point of this study was to analyse the cost-effectiveness of a 15 min response time (state regulation) of advanced life support (ALS) equipment provided by helicopter (1,575,000 DM annual costs) versus a ground-based ambulance (1,004,000 DM annual costs) in three EMS systems (50 km radius) with differing demographic and geographic features in Germany. ⋯ In model 2 each region had its existing helicopter withdrawn and replaced with six ALS cars. This made response times longer and increased expenditure. In conclusion, the additional use of rescue helicopters in EMS regions (50 km radius) remains cost-effective up to an ALSC:helicopter cost ratio of 1:6.
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Malignant arrhythmia, which is responsible for most of the out-of-hospital cardiac arrests, is ventricular fibrillation (VF). The best treatment of VF is a controlled electric shock on the chest administered in a short delay. ⋯ The delegation of defibrillation to ambulance crew members however implies a specific teaching, training and a medical control. The Brussels experience shows that semi-automatic external defibrillation by EMT-Ds (SAED) is feasible when criteria for applying SAED in the pre-hospital phase are applicable.
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During the period 1970-1993, 245,251 visits were recorded in the trauma registry of the University Hospital Groningen, The Netherlands. An analysis of injury antecedents revealed five principal causes (ICD-CM): accidental falls (28%), sports and unspecified accident (26%), traffic (19%), cutting and piercing instruments (10%) and violence (4%). The trend analysis across the 24 year period showed that the incidence of injuries due to traffic and accidental falls decreased, while the rate of injuries due to assault increased 2-fold. ⋯ Some discrepancies could be discerned. For example, in traffic injury, most of the victims (66%) concerned were pedestrians and bicyclists and firearms comprised only 1.2% of injuries due to assault. The usefulness of the registry in current community trauma care programmes and the broader perspective of trauma registration in The Netherlands is discussed.
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Comparative Study
Immediate management of the airway during cardiopulmonary resuscitation in a hospital without a resident anaesthesiologist.
The effect of withdrawing the resident anaesthesiologist from the cardiopulmonary resuscitation (CPR) team was audited over a 1-year period in a 407-bed hospital in which nurses had been trained in the use of the laryngeal mask airway (LMA) as a first response airway in CPR. The data were compared to those of the previous year, which are shown in parentheses. ⋯ There were no instances of failure to maintain the immediate airway during the audit period. Initial results suggest that an anaesthesiologist may not be essential for the provision of an immediate airway in patients requiring CPR.