Articles: emergency-medical-services.
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Trauma patients requiring intubation at the scene of the accident were entered into a study from June 1985 to June 1987 to determine: 1) the success rate of intubation by flight crews and 2) factors important in managing the difficult airway at the scene. One hundred thirty-six patients were reviewed. The success rate of trauma patients intubated in the field was 92.6%. ⋯ An aeromedical crew (MD, RN, RT) can successfully intubate trauma patients at the scene of the accident. Severe facial injuries with vomiting and blood in the oropharynx are factors in intubation failure. The use of muscle relaxants and sedatives facilitates difficult intubations.
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The French emergency medical system (EMS) is the Service d'Aide Médicale Urgente (SAMU). In case of mass casualties, involving 100 simultaneous victims, SAMU has developed a disaster plan, "The White Plan." This plan is closely correlated to the Red Plan of the Fire Department, to provide advanced life support (ALS) at the incident site, followed in a continuum by medical transport and hospitalization in the appropriate services. ⋯ This objective was approached by adopting a formal protocol designed for each city. In France, the medical organization for the treatment of casualties is operated by anesthesiologists who are qualified to perform ALS, preanesthetic evaluation en route, anesthesia for the multitrauma patient, and postanesthetic resuscitation in a continuum from the accident scene to the ICU.
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Because of discontinuation of base hospital participation, paramedics in a large urban zone of a California emergency medical services (EMS) system serving 1.1 million persons went on emergency standing orders for nearly all calls requiring advanced life support. Subsequently, the base hospital resumed medical control function under limited standing orders. ⋯ There were significant differences in total prehospital care times and at-scene times between the control group and the two standing order groups (P less than .01). There are important implications to EMS systems that use extensive base hospital contact.