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Biomedical subjects

J E Pointer

Publications and source records attributed to J E Pointer.

14 recordsLinked to original sources
PubMed1992

The 1989 Loma Prieta earthquake: impact on hospital patient care.

STUDY OBJECTIVE: To provide an overview of the Loma Prieta earthquake regarding patient care in affected hospitals. DESIGN: A retrospective review of medical records using International Classification of Disease, ninth revision (ICD-9) codes and a personal interview questionnaire. SETTING: Fifty-one hospitals in the six-county area most affected by the earthquake. TYPE OF PARTICIPANTS: Patients seeking care in emergency departments of study hospitals and supervising emergency physicians and ED nurses at the time of the earthquake. MEASUREMENTS: ED census data, complaint and diagnosis, disposition, and operative procedures for patients seen during the study period. MAIN RESULTS: Affected hospitals experienced a 15% increase in ED census during the study period. Minor trauma was the most common patient complaint. Open wound (870-897), contusion (920-924), and fracture (800-829) were the most common ICD-9 diagnostic categories. The percentage of patients presenting to EDs during the study period who were hospitalized increased slightly compared with baseline. Seventy-five percent of operative procedures were earthquake related; 63.7% of these were for fracture reduction. Physicians and nurses had somewhat conflicting opinions on adequacy of ED staffing. A small number of emergency physicians had difficulty in obtaining diagnostic tests on the night of the earthquake. Physicians noted no differences in diagnosis or treatment resulting from the earthquake. CONCLUSION: The Loma Prieta earthquake resulted in minimal negative impact on patient care in hospitals in the study area. The use of the ICD-9 classification deserves further consideration and study to improve the predictive value of disaster illness and injury reporting. The event has provided the stimulus for Bay Area hospitals to further improve plans for patient care during a disaster.

California↗
PubMed1989

Clinical characteristics of paramedics' performance of pediatric endotracheal intubation.

There are little data available on success rates, complications, and efficacy of intubation in the pediatric age group by prehospital personnel. In a 12-month period, paramedics successfully intubated 32 of 36 (88.9%) patients for various indications, with a total of 67 attempts. Seventeen of 36 (47.2%) patients survived to hospital admission. Patient age ranged from newborn to 14 years. Paramedics used the straight blade in 21 of 37 patients (56.8%). The study demonstrates that paramedics can intubate pediatric patients with the same success rate as in adult patients. The data support the inclusion of pediatric endotracheal intubation in the scope of paramedic practice.

Adolescent↗
PubMed1989

Effect of standing orders on field times.

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. Standing orders were allowed for calls that required rapid intervention with little probability of morbidity. The EMS agency conducted a retrospective study to compare times at scene and total prehospital care times before (control group) and after institution of standing orders and 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.

Ambulances↗
PubMed1988

Evaluation of a pulse oximeter in the prehospital setting.

Paramedics field-tested a portable, battery-powered pulse oximeter to determine its applicability and usefulness as an adjunct to prehospital care. The pulse oximeter was attached to 62 consecutive patients who met local criteria for mandatory advanced life support base hospital contact. Arterial hemoglobin saturation (SaO2) levels and changes over time were documented by the pulse oximeter's integral printer and prehospital care reports prepared by paramedics. The pulse oximeter performed reliably in 60 patients (96.7%) by providing continuous SaO2 levels. Fifteen patients (24.2%) had saturations below 91%, and the pulse oximeter detected two (3.2%) otherwise undetected saturations below 80%. In each case, field intervention improved saturation. Pulse oximetry quantifies SaO2 changes correlated with many prehospital interventions: medications, suctioning, precarious gurney transport, oxygen therapy, and ventilatory assistance. The pulse oximeter performs reliably in the field and can be invaluable as an adjunct to patient care. Further prehospital studies are needed to evaluate specific field treatments and techniques, to assess the pulse oximeter's effect on morbidity and mortality, and to analyze the determination of severe hypoxemia in the field.

Adult↗
PubMed1987

The advanced life support base hospital audit for medical control in an emergency medical services system.

A large California county uses an audit of its advanced life support (ALS) base hospitals to maintain medical control of prehospital care and to improve the county emergency medical services. The audit is a rigorous, semi-annual evaluation of ALS base hospital performance using objective, written criteria. The county emergency medical service district and the base hospitals have benefited from the data that have resulted from the audits. The base hospital audit is an excellent method of assessing medical control in an emergency medical services system.

California↗
PubMed1986

Emergency physicians' duty to warn and protect: a critique and guidelines.

For ten years, psychotherapists in California have practiced under a court decision which imposed a duty to warn intended victims of violent crimes. Other cases extended the scope of the psychotherapists' duty to warn to an alarming degree. Although there have been no court cases involving emergency physicians, it is reasonable to assume that, under certain circumstances, the duty to warn could be extended to primary care physicians. Emergency physicians should familiarize themselves with applicable case law and should be aware of measures to use to avoid potential civil liability.

Adult↗
PubMed1986

Glucose analysis: indications for ordering and alternatives to the laboratory.

Cost considerations mandate that the emergency physician consider the use of test strips for glucose analysis. Presented are medical criteria for glucose analysis, a description of available test strips and reflectance meters, and data from studies which compare performance and cost of the strips with laboratory methods. Emergency physicians should study the test strips and their indications more comprehensively. In general, glucose test strips provide a clinically acceptable means for blood glucose determinations.

Blood Glucose↗
PubMed1985

The emergency physician and medical control in advanced life support.

A large urban emergency medical services district (EMSD) in California set certification, recertification, and continuing education standards for advanced life support physician medical radio operators. The EMSD attempted to encourage physician participation and to maintain a high level of medical control. The standards have been well received. There is enthusiastic physician support and widespread physician involvement in the advanced life support system.

California↗
PubMed1975

Differential effects of cortical ablation and spreading depression on sensitivity to footshock: implications for the role of the cortex in learning.

Rats were tested for flinch and jump responses to shock under unilateral and bilateral spreading depression (USD and BSD) and unilateral cortical ablation (UCA). Some Ss were tested with insulating boots on the left or right limbs. Under USD and UCA the limbs contralateral to the depressed or ablated hemisphere were as insensitive as when under BSD, and the ipsilateral limbs were almost as sensitive as in the normal condition. The data indicate that lack of transfer typically found in the USD transfer paradigm can be attributed to stimulus factors and not to learning or memory deficits, especially since most studies have used a shock level which does not exceed the jump threshold for a depressed hemisphere.

Animals↗
PubMedDate not supplied

EMS quality assurance: a computerized incident reporting system.

Incident reports are an extremely valuable quality assurance vehicle in Emergency Medical Services (EMS) Systems. Appropriate identification, analysis, and followup of incidents can identify trends and recurrent problems, and change system policy. An urban EMS System utilized a computerized data base program to expedite its handling of a large number of incident reports.

California↗
PubMedDate not supplied

Clinical characteristics of paramedics' performance of endotracheal intubation.

Paramedics intubated 358 of 383 (93.5%) patients over a nine-month period. There were 85 survivors. The intubators used the curved-blade laryngoscope in 304 patients (79.5%). Two of 25 (8.0%) patients who were not successfully intubated lived; 83 of 358 (23.2%) successfully intubated patients survived. Clinically significant complications occurred in 32 patients (8.9%) who were successfully intubated. Paramedics encountered adverse conditions in 126 patients (32.9%). Presenting cardiac rhythm was recorded. There were no significant differences in intubation success rate between survivors and nonsurvivors or as a function of cardiac rhythm. This retrospective study further documents the ability of paramedics to successfully perform endotracheal intubation. The high success rate supports training with live subjects. Further studies of cause and impact of complications, correlation of success with increased survival, and alternative techniques are essential for effective EMS system medical control.

Allied Health Personnel↗