Articles: emergency-medical-services.
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Physician involvement in the provision of both direct and indirect medical control to emergency medical providers is critical to the effective operation of an emergency medical services (EMS) system. We conducted a survey of all accredited emergency medicine residency programs in the United States to determine the content of EMS instruction provided to these physicians-in-training. ⋯ The importance placed on EMS during residency training is variable. EMS is the domain of emergency medicine, and adequate training of residents for these responsibilities is imperative.
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To assess how soon rural emergency departments (EDs) call for helicopters to transport seriously injured patients, the records of all trauma victims (excluding isolated CNS trauma) transported by an emergency helicopter service from referring hospitals to a trauma center over an 18-month period were studied. Admission time to the referring ED was compared with the exact time a call for the helicopter was received and a time-to-request interval (TTR) was calculated. A total of 64 cases were studied. ⋯ Children (aged less than or equal to 16 years) had an average TTR of 34.1 minutes compared with 76.4 minutes for adults (aged greater than 16 years). Of the variables examined, patient age was the only factor significantly associated with TTR. These observations suggest that, except in children, there frequently is a lengthy time interval between the time trauma patients arrive at EDs in rural eastern North Carolina and the time an emergency helicopter service is called to transport them to a trauma center.
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In 1986 and 1987 the department of orthopaedic surgery at the Central Hospital of Esbjerg dealt with 135 medical problems by radio-telephone contacts to persons at sea. Of these, 28% needed a chartered helicopter. This eguals one third of all chartered helicopter evacuations from Danish waters. 77% of the evacuations were from fishing boats and the rest from offshore structures or other kinds of ships. The mechanism of trauma and the diagnosis agreed with the findings in an earlier Danish publication.
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This study is concerned with the value of basic CPR (manual ventilation and closed chest cardiac massage) initiated within 5 min in delaying brain damage after cardiac arrest in adult patients at ambient temperature. In 88 cases of cardiac arrest, basic CPR was initiated within 5 min of collapse by trained ambulance personnel. Basic CPR was continued during transport to the hospital in ambulances not equipped with defibrillators. ⋯ All 11 patients eventually discharged from the hospital without apparent brain damage arrived at the hospital within 10 min of cardiac arrest. A significant number of patients arriving later could be resuscitated acutely but later died unconscious or were discharged with severe brain damage. We conclude that basic CPR, including bystander CPR initiated within 5 min of cardiac arrest is likely to be of long-term value only if definitive advanced life support can be provided within 10 min after the patient's collapse.