Articles: emergency-medical-services.
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Dtsch. Med. Wochenschr. · May 1991
Comparative Study[Prognostic significance of prehospital phase in acute myocardial infarct. Results of the Augsburg Myocardial Infarct Registry, 1985-1988].
Data collected by the Augsburg Infarct Register during 1985-1988 were analysed. There were 3,729 cases of acute myocardial infarct (2,672 men and 1,057 women; mean age 62.8 [25-74] years). Before hospitalization cardiac arrest had occurred in 1,401 persons (38%); resuscitation attempts were made in 494 of them (34%). ⋯ This caused decisive delays. The thrombolysis rate was 24%, if the pre-hospital interval was under 6 hours (mortality rate 6% with, 12% without thrombolysis). The prognosis of acute myocardial infarction could be improved by specific instructions to high-risk patients and their relatives and by widening emergency care provisions.
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The beginnings of organized emergency care can be traced through military history dating back to the Middle Ages. In 1769, the first civilian rescue society was established to look after shipwrecked persons. Sociological and technical requirements of the late 19th century led to the formation of different rescue associations and to writing of regulations for rescue and ambulance services. ⋯ Today the rescue service functions to bring a physician, often an anesthesiologist, to the victim as quickly as possible. Modern rescue laws fix a lead time of 5 to 15 minutes for a professional rescue service to reach the scene. The medical equipment and qualifications of personnel treating life-threatening trauma and diseases have improved, and in this context, the role of the anesthesiologist is important.
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This article describes the National Park Service wilderness emergency medical services (EMS) system, as implemented at Sequoia-Kings Canyon National Park. EMS records on all 434 patients in the period from August 1, 1986, to July 31, 1987, were reviewed. Most patients had minor problems. ⋯ Differences between the times and problems with skills maintenance. Differences between the patients treated by a wilderness system and those seen in most urban systems may make it appropriate to release a greater portion of patients without ambulance transport. In a system with long response and transport times, use of personnel with different training than in the urban setting becomes necessary.
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One hundred fourteen emergency medical services agencies and 76 police chiefs throughout the United States were prospectively surveyed to ascertain the current utilization of police personnel within the prehospital care system. More than three fourths (77%) of the surveys mailed were completed. Respondents indicated the following: (1) a majority (92%) of police personnel were trained in cardiopulmonary resuscitation and basic first aid, (2) only half (57%) of police were trained in moving or transporting patients, and (3) few (36%) police were provided ongoing training in emergency pediatric medical skills. ⋯ The data indicate that, right or wrong, police personnel are actively involved in their prehospital care system at present. In many instances, their help may be needed. Further thought should be given toward defining an exact emergency medical services role for police personnel and toward providing adequate initial and ongoing basic medical training for these individuals.