Articles: emergency-medical-services.
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For many people who deal with medical emergencies--some human resource managers, emergency team administrators, CPR and first aid instructors, EMTs, nurses and physicians--the topic of oxygen use by nonmedical responders at the workplace is poorly understood. Workplace emergency response administrators may find it helpful to become familiar with the current emergency medical literature and learn that the previous literature may no longer apply. Furthermore, fear that use of emergency oxygen by nonmedical responders is "playing doctor," and will lead to some imagined uncontrollable catastrophe is based on statistically and medically unfounded misinformation. ⋯ Refusing to allow appropriately trained nonmedical responders to use reliable emergency oxygen when it is available is a potentially grave error and makes emergency care in the workplace less efficient and valuable. There are many cases of workplace injury or illness in which oxygen use is not only appropriate but may help save a patient's life. Ensuring that the proper emergency oxygen equipment is available where appropriate and properly training personnel are responsible for first aid can, in some cases, lessen the severity of workplace illness and injury incidents.
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Owing to different cultural backgrounds, epidemiological disease patterns as well as economic status, it is important to collect local data regarding Emergency Medical Services (EMS), in order to direct our planning and to establish an appropriate EMS policy. This study was conducted from 1 July 1991 through 30 June 1992. During the 109 days of the study, 12502 prehospital records from Taipei city's 119 ambulances were collected and analyzed. ⋯ The results provided the following information: 1) in 7.41% of the ALS cases, ECG monitoring accounted for 3.13%, CPR for 3.55%, and IV injections for 0.73%; 2) cases needing the use of an ambulance accounted for 16.26% of the total; 3) the response time was 4.89 minutes on average; 4) time spent on the scene was 3.78 minutes; 5) the transportation time was 9.76 minutes; and 6) the percentage of abuse was 29.09%. Based on these results we recommend the following: 1) in enacting the EMS law, the policy stipulating that one ambulance should be expected to serve a population of 50 thousand should be modified because of limited daily emergency calls; and 2) education of the lay public is needed to prevent ambulance abuse. These are the main issues that need to be focused on in the development of our EMS system.
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Comparative Study
Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience.
All patients with primary cardiac disease presenting with out-of-hospital sudden cardiac death (OH-SCD) to a provincial hospital were reviewed retrospectively over a 5-year period from 1985 to 1989. This coincided with the introduction of out-of-hospital defibrillation (OH-DEFIB) by ambulance officers. Of 215 patients, 17 (9%) survived to leave hospital alive, 15 of whom underwent OH-DEFIB. ⋯ A total of 155 (72%) had a known cardiac history, with the majority (74%) of arrests occurring at home. Of 134 witnessed arrests, only 46 (34%) underwent bystander-initiated cardiopulmonary resuscitation (CPR). A programme in CPR aimed at relatives of known cardiac patients, and the adoption of a paramedic protocol which improves oxygenation at the time of arrest are recommended.
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A review of 452 trauma deaths in Hillsborough County, Florida, in 1984 documented that 23% of non-CNS trauma deaths were preventable and occurred because of inadequate resuscitation or delay in proper surgical care. In late 1988 Hillsborough County organized a County Trauma Agency (HCTA) to coordinate trauma care among prehospital providers and state-designated trauma centers. The purpose of this study was to review county trauma deaths after the inception of the HCTA to determine the frequency of preventable deaths. ⋯ The preventable death rate has decreased to 7.0% with system care. The causes of preventable deaths have changed from delayed or inadequate intervention to postoperative care errors.