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E J Craren

Publications and source records attributed to E J Craren.

8 recordsLinked to original sources
PubMed1988

Cost-effectiveness of defibrillation by emergency medical technicians.

Effective emergency systems using emergency medical technicians (EMTs) trained to defibrillate or paramedics can save more lives from out-of-hospital cardiac arrest due to ventricular fibrillation than can emergency systems staffed with basic EMTs who cannot defibrillate. This article focuses on the cost-effectiveness of systems staffed with each type of EMT. Data were collected from all 50 states and from the District of Columbia to determine the number of hours and estimated cost of initial training for the three types of EMTs in the United States in 1986. The median initial training hours for basic EMTs, EMTs trained in defibrillation, and paramedics were 110, 129, and 700, respectively. Median costs for initial training at each EMT level were +123, +150, and +1580/student. According to published survival data for emergency medical systems staffed with EMTs at each level, the total initial training personnel and equipment cost per life saved from ventricular fibrillation was +7687, +2126, and +2289 for systems staffed by the respective EMTs. The initial cost per life saved from ventricular fibrillation is more than three times greater in systems staffed by basic EMTs than in systems staffed by EMTs trained in defibrillation or paramedics. From a medical and a cost-effective standpoint, all communities served by basic EMTs should consider upgrading them to at least the defibrillation-trained EMT level.

Allied Health Personnel↗
PubMed1985

Ineffectiveness of the trauma score and the CRAMS scale for accurately triaging patients to trauma centers.

Both the Trauma Score (TS) and the CRAMS scale have been advocated for field triage of trauma victims to trauma centers. To determine which scale best serves this purpose, both scores were calculated by computer for 5,130 trauma cases in our statewide computer file of ambulance rescue runs from 1981 through 1983. A total of 3,231 patients (63%) were treated in the ED and released; 1,857 (36.2%) were admitted to the hospital (202 of whom were transferred directly from the ED to the operating room [OR] for immediate operation); and 42 (0.8%) were DOA or died in the ED. Major trauma was defined as a TS of 12 or less or a CRAMS scale of 8 or less. Both scales correctly identified as major trauma all patients who were DOA or died in the ED. The TS identified as major trauma more patients admitted to the hospital than did the CRAMS scale (33% vs 21%; P less than .0001). The TS identified as major trauma more patients transferred from the ED to the OR than did the CRAMS scale (37% vs 21%; P less than .002). Both scales failed to identify as major trauma almost two out of three patients brought directly from the ED to the OR. The paramedics', or emergency medical technicians' qualitative judgements about injury severity, reflected in their coding injuries as life- or limb-threatening, was almost as good (more than 90% sensitive and specific) as either score (100% sensitive and specific) in identifying patients who died, and was better in identifying patients sent from the ED to the OR.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis-Related Groups↗
PubMed1985

Impact of improved emergency medical services and emergency trauma care on the reduction in mortality from trauma.

From 1972 to 1982 there was a 23.9% decline in the number of deaths due to trauma in Nebraska. During this time, an improved emergency medical services (EMS) system was being implemented, including training of EMT's and paramedics, physician education in advanced trauma life support (ATLS), establishment of three helicopter transport services, and designation of trauma centers in the two most populous (of six) EMS regions. Highway safety programs alone could not account for the decline in trauma deaths, since there was almost as great a fall in nonvehicular (21.4%) as vehicular (26.4%) trauma deaths. The much larger decline in prehospital (28.3%) than in-hospital (17.3%) trauma deaths suggested a relationship between the improving EMS system and decreased mortality from trauma. We found that growth of the EMS system, as measured by the cumulative number of EMT's trained, correlated strongly with the decline in prehospital (r = 0.95; p less than 0.001), in-hospital (r = 0.84; p less than 0.001), total (r = 0.95; p less than 0.001), vehicular (r = 0.86; p less than 0.001), and nonvehicular (r = 0.93; p less than 0.001) trauma deaths. Our findings suggest that improvements in the statewide EMS system along with better hospital care have caused a significant decline in the number of trauma deaths over a 14-year period.

Accidents, Traffic↗
PubMed1984

Limitation on effectiveness of rapid defibrillation by emergency medical technicians in a rural setting.

First-responding emergency medical technicians (EMTs) trained to defibrillate have been shown to increase survival from prehospital ventricular fibrillation (VF) almost fourfold in Washington's King County. Using Nebraska ambulance rescue run data from 1982 and published information relating ambulance response time to the likelihood that a patient would be in VF, we constructed a model to analyze the difference in expected results for EMT defibrillation among communities of varying population. The model predicts that EMTs in urban Nebraska (mean population 242,000) will use the defibrillator once every six weeks. EMTs in intermediate cities (mean population 22,300) will defibrillate once a year. In rural Nebraska (mean population 1,500), the defibrillator will be used once every 5.6 years. Despite these figures, the model predicts relatively low cost per life saved (ranging from $566 in urban areas to $4,785 in rural Nebraska). The major problem with EMT defibrillation in rural areas is maintenance of skills and continuing education.

Education, Continuing↗
PubMed1984

EMS by the numbers.

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Emergency Medical Services↗