Articles: emergency-medical-services.
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Emerg. Med. Clin. North Am. · May 1984
ReviewPrinciples of prehospital care of musculoskeletal injuries.
Prehospital management of musculoskeletal injuries in the traumatized patient is based on the application of a few basic principles in an orderly but expeditious manner. The patient must be assessed for immediate life-threatening conditions involving airway, respiratory, and circulatory functions while the cervical spine is protected. Resuscitative efforts to reestablish and preserve an adequate circulating volume of oxygenated blood must follow, using airways, oxygen therapy, and fluid replacement through MAST trousers and intravenous fluids. ⋯ In the multiply traumatized patient with severe injuries to several organ systems, prehospital care may need to be expedited to provide this patient the in-hospital care required to save his or her life. Appropriate treatment in such life-threatening trauma situations will consist of a rapid primary assessment, airway and cervical spine control, appropriate respiratory and cardiovascular assistance, gross whole body fracture immobilization using a backboard, and immediate transport. For less severely injured patients, primary assessment, resuscitation, stabilization, full secondary assessment, initial definitive care, and immobilization should be completed before transport begins.
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Out-of-hospital cardiac arrests constitute 350,000 cases yearly in the United States and 60,000 in the United Kingdom. Prompt resuscitation (CPR) by lay persons and fast defibrillation by paramedics have had epidemiologic consequences on both sides of the Atlantic. In Seattle there are 20.6 and in Brighton 10.0 long-term life-saves yearly per 100,000 persons. ⋯ Diagnostic procedures like electro-provocation identify high-risk patients. Changes of behavior and diet, new drugs, new operations, and external and implantable automated devices reduce sudden deaths. In the future, automated defibrillation by first responders and trained lay persons (including members of families of high-risk patients) should increase the number of early survivors who become candidates for long-term therapy with drugs, operations, and devices.
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The Riverside Medical Clinic in Riverside , California, recently created an urgent care center which achieved a breakeven point after only four months of operation and has exceeded all expectations ever since. The many areas of concern when implementing an urgent care center program are presented in the article, including choosing the provider group, philosophy of the center, organizational structure, operational plan, developing a marketing program, and possible pitfalls. Not only has the extended-hours medical service offered by the Riverside Medical Clinic Urgent Care Center been an answer to increasing competition, it has added a critical dimension in the clinic's development of a truly integrated medical delivery system.
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The American surgeon · Apr 1984
Historical ArticleLife Saver: a complete team approach incorporated into a hospital-based program.
Both military and civilian settings have shown that a team approach through an excellent prehospital Emergency Medical Services system, an organized regional communication system, access to rapid air evacuation with a "complete" medical team on board, and dedicated trauma resources allows a critically ill or injured patient optimal chances for survival. The Life Saver airborne emergency service, operated by Carraway Methodist Medical Center in Birmingham, Alabama, is a "complete team" concept with a well trained emergency physician and a critical care flight nurse aboard every flight. The physician upgrades the level of care at the scene of an accident, lessens the referring physician's anxiety, maintains an intensive care unit environment during transport and intervenes if a life threatening emergency occurs, which cannot be predicted prior to lift-off. ⋯ Trauma transports accounted for 47.5%, nonsurgical problems 47.8% and nontraumatic surgical patients representing the remaining 4.7%. The in-flight mortality was 0%. This type service is not appropriate for all hospitals to provide, but should be considered by major trauma and cardiac referral centers.