Articles: emergency-medical-services.
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The rural area is not immune to multi-casualty incidents, and the complete rural EMS System reported here includes a plan to deal with one. The Susquehanna Valley Health Care Consortium was developed with this in mind, and addresses the points pertinent to the rural setting, including the large area served, available medical care, prehospital transport, and communications. Six hospitals in five counties participate. New approaches to these problems, which emerged after three field tests, are: participants must be organized for successful triage and resuscitation; crowd and traffic control by police is mandatory; an overall commander is necessary; two-way communication by several methods must be available; an administrator should track all victims; and air evacuation capability should be arranged.
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At the scene of an accident with possible injury to the cervical spine, management should focus on life support and prevention of further injury. On arrival of the patient in the emergency department, three standard x-ray films should be obtained in search of the abnormalities in soft tissues, alignment, and joints that indicate cervical spine injury and a thorough neurologic assessment should be performed. The potential of cord injuries to deteriorate makes careful monitoring of blood gases, urine output, and blood pressure imperative during this period. Early therapy with steroids and mannitol seems to minimize neurologic deterioration.
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Computer-aided telecommunications provide deaf teletypewriter users with 24-hour toll-free access to emergency services. An interface and software link the deaf caller's teletypewriter (TDD) with a microprocessor by reducing and inverting voltage levels between the two devices. This system facilitates rapid transmission of linguistically controlled triage questions to meet the communication needs of deaf patients.