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Biomedical subjects

J R Krohmer

Publications and source records attributed to J R Krohmer.

At least 19 recordsLinked to original sources
PubMed1998

Can melatonin improve adaptation to night shift?

This study was undertaken to determine whether melatonin (N-acetyl-5 methoxytryptamine) is effective in helping emergency medical services (EMS) personnel who work rotating night shifts reset their biological clocks and minimize circadian rhythm disruption. A double-blinded, randomized, crossover study was performed using 22 volunteers. Participants were working a span of consecutive night (2300 to 0700 hours) shifts and received either a melatonin capsule (6 mg) or placebo to be taken before each of the consecutive day sleeps. Each participant completed a total of 4 spans of consecutive night shifts (2 melatonin, 2 placebo). Collected data included daily sleep diaries, quantification of alcohol/caffeine consumed, and drug side effects. Assessment of sleep quality, posttreatment mood, and workload ratings were measured daily by 10-cm visual analog scale (VAS). Analysis of sleep diaries found no significant difference (P > .05) between the two treatments with respect to mean sleep latency, duration, and efficiency, and subjectively rated sleep quality. Similarly, no significant benefits were noted between the median VAS scores for daily posttreatment mood or workload ratings. Adverse effects were rare; one patient taking melatonin reported a prolonged sedative effect. Despite recent interest in melatonin for treatment of circadian-based sleep disorders, no clinical benefits were noted in EMS personnel working rotating night shifts.

Adaptation, Physiological↗
PubMed1997

Photograph documentation of motor vehicle damage by EMTs at the scene: a prospective multicenter study in the United States.

The purpose of this study was to determine if emergency medical service (EMS) personnel could take instant photographs of motor vehicle damage at crash scenes depicting the area and severity of damage of the crash under adverse weather conditions, in different lighting, and quickly enough so as not to interfere with patient care. This prospective multicenter trial involved 35 ambulances responding to motor vehicle crash scenes in rural, suburban, and urban areas in five centers in four states. Emergency medical technicians (EMTs) reported their experience implementing a protocol for use of an instant camera to photograph vehicle damage at crash scenes. Time reported by EMTs to take the photographs was 1 minute or less in 204 of 288 (70.9%) of motor vehicle crashes and 2 minutes or longer in 12 of 288 (4.2%) of motor vehicle crashes. From one EMS agency in the study, 48 scene times during which photographs were taken were, on average, 1.5 minutes shorter than 48 scene times immediately before implementation of on-scene crash photography. Photographs were taken in different weather and lighting conditions. EMTs reported they were able to determine both area and severity of damage in 260 of 290 (92.5%) crash photographs, but they were unable to determine area and severity of damage in only 2 of 290 (0.7%) crash photographs.

Accidents, Traffic↗
PubMed1994

Guidelines for the prehospital use of thrombolytic agents.

Recognizing that prehospital thrombolytic therapy may provide benefit to certain subsets of patients, the routine prehospital use of thrombolytic agents should be discouraged pending further scientific delineation and documentation of those subgroups. ACEP encourages further investigation to document feasibility, efficacy, cost-effectiveness, and safety of use of these agents in this environment. Detailed education is needed in such areas as contraindications and the mechanics of drug administration. Online medical direction is paramount to the successful use of these agents in the prehospital setting.

Clinical Protocols↗
PubMed1993

Comparison of motor vehicle damage documentation in emergency medical services run reports compared with photographic documentation.

STUDY OBJECTIVE: To determine whether emergency medical services (EMS) run reports adequately document vehicle damage when compared with vehicle photographs by using a traffic accident scoring system. DESIGN: A prospective study consisting of three phases: photographing motor vehicle collisions and collecting their respective EMS run reports, traffic accident damage score development, and comparison of photographs to the run reports by emergency medical technicians using the traffic accident damage score. SETTING: Data were collected in North Carolina and Ohio from motor vehicle crashes to which nine different EMS squads responded during a three-year period. TYPE OF PARTICIPANTS: EMS squads ranged from basic to paramedic levels of training. MEASUREMENTS AND MAIN RESULTS: Three emergency medical technicians were unable to determine the area of vehicle damage in 48% and the severity of damage in 61% of the EMS run reports. In contrast, there were no instances in which all three emergency medical technicians were unable to determine both area and severity of damage from the photographs. CONCLUSION: Most EMS run reports do not document vehicle damage adequately.

Accidents, Traffic↗
PubMed1989

Influence of emergency medical services systems and prehospital defibrillation on survival of sudden cardiac death victims.

This article reviews the influence of emergency medical systems and prehospital defibrillation on survival of sudden cardiac death. The historical perspective and epidemiologic considerations of prehospital sudden cardiac death are highlighted. Factors predictive of successful resuscitation and impact of community activity on sudden death are discussed. Influences of emergency medical services on outcome of prehospital cardiac arrest are reviewed, with emphasis on the role of dispatchers, emergency medical technicians, and paramedics. The recent emergence of prehospital automatic defibrillation by emergency medical technicians, first responders, and lay persons is discussed in depth, as it has great potential to positively influence outcome of prehospital sudden cardiac death.

Death, Sudden↗
PubMed1988

The effects of antishock trouser inflation during hypothermic cardiovascular depression in the canine model.

The purpose of this study was to investigate the value and to identify any deleterious effects of antishock trouser use during hypothermic cardiovascular depression. Thirteen mongrels were made hypotensive by cooling to a core temperature of approximately 27 degrees C. Eight dogs had antishock trousers inflated for one hour and five dogs served as controls. Metabolic and hemodynamic variables were measured at regular intervals during cooling, during trouser inflation, and after trouser deflation. No study animal experienced ventricular fibrillation. Neither central temperature, pH, or serum potassium nor mean arterial BP or systemic vascular resistance were significantly affected by trouser inflation or deflation. Antishock trouser use during the early phase of hypothermia before rewarming does not appear to result in a central bolus of cold, acidotic, hyperkalemic blood or the precipitation of ventricular fibrillation. There appears to be no significant hemodynamic benefit of antishock trouser use early in the management of hypotension caused by moderate hypothermia.

Animals↗
PubMed1987

Intravenous fluid flow beneath inflated antishock trousers in a canine hemorrhagic shock model.

A study was performed to determine the percentage of fluid that enters the central circulation following infusion in a peripheral vein beneath an inflated pneumatic antishock garment (PASG) during hemorrhagic shock in a canine model. Seven mongrel dogs were bled acutely to a systolic blood pressure of 50 to 60 mm Hg. The PASG then was inflated. One to two microcuries of Technetium-99-labeled macroaggregated albumin was infused into a peripheral vein in the hind leg, followed by a 10-mL/kg fluid bolus. The albumin particles that reached the central circulation were trapped in the pulmonary capillary bed. Following infusion, a full body scan was performed. The percentage of injected fluid entering the central circulation was calculated by comparing the total body counts to counts localized to the thorax. Average mean arterial pressure was 111 mm Hg prior to bleeding, 47 mm Hg prior to shock trouser inflation, and 66 mm Hg after inflation. The percentage of injected Technetium-99-labeled albumin that reached the central circulation ranged from 80.5% to 99.6%, with a mean of 91.3%. We conclude that a significant percentage of IV fluids infused beneath inflated PASG will reach the central circulation.

Animals↗
PubMedDate not supplied

To report or not to report: emergency services response to elder abuse.

PURPOSE: Prehospital emergency medical services (EMS) personnel, as initial responders to calls for assistance, are in an ideal position to identify abused or neglected elderly. A survey of prehospital personnel in Michigan was conducted to determine the scope of this problem, levels of awareness, and willingness to report cases of elder abuse. METHODS: The study population was a random sample of 500 prehospital personnel throughout one state. A blinded, self-administered survey was completed by emergency medical technicians (EMTs) and paramedics outlining their practice characteristics, prevalence of abuse in their community, and training available specific to elder abuse. Attitudes concerning the understanding and reporting of geriatric abuse were measured using a Likert-type scale. RESULTS: A total of 156 surveys (31%) was completed; 68% of the respondents were paramedics. Respondents had an average of 8.7 years (range: 9 months-30 years) of prehospital emergency-care experience, and evaluated an average of 11 patients (range: 1-59) older than 65 years of age each week. Seventy-eight percent had seen a suspected case of elder abuse or negligence during their careers; 68% had seen a case during the past 12 months (mean: 2.3 cases/yr; range: 0-24 cases/yr). However, surveyed personnel reported only 27% of suspected cases to authorities last year (mean: 0.62 cases/yr). Reasons for not reporting included 1) unsure which authorities take reports; 2) unclear definitions; 3) unaware of mandatory reporting laws; and 4) lack of anonymity. Ninety-five percent of respondents stated that training related to elder abuse was not available through their EMS agency. CONCLUSION: Paramedics and EMTs lack complete understanding of their role in the identification and reporting of elder abuse. This information should be emphasized during EMS training and reinforced through continuing education.

Aged↗
PubMedDate not supplied

In-field extremity amputation: prevalence and protocols in emergency medical services.

OBJECTIVE: To determine current experience, attitudes, and training concerning the performance of in-field extremity amputations in North America. DESIGN: Cross-sectional, epidemiological survey. PARTICIPANTS: Emergency medical services (EMS) directors from the 200 largest metropolitan areas in North America and attendees at the 1992 Mid-Year National Association of EMS Physicians Meeting. INTERVENTIONS: The survey consisted of five questions focusing on demographic and operational data, the frequency of occurrence of the performance of in-field amputations, personnel responsible for performing the procedure, existing written protocols for the procedure, and the scope of training provided. RESULTS: A total of 143 surveys was completed. Eighteen respondents (13%) reported a total of 26 in-field extremity amputations in the past five years. The most common cause for the injuries requiring amputations was motor-vehicle accidents. In the majority of cases (53.2%), trauma surgeons were responsible for performing the amputation, followed by emergency physicians (36.4%). Of respondents, 96% stated that there was no training available through their EMS agencies related to the performance of in-field extremity amputations. Only two EMS systems had an existing protocol regarding in-field amputations. CONCLUSIONS: The results suggest a need for established protocols to make the procedure easily accessible when needed, especially in large metropolitan EMS systems. This information should be emphasized during EMS training and reinforced through continuing education.

Accidents, Occupational↗