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Biomedical subjects

R A Narad

Publications and source records attributed to R A Narad.

12 recordsLinked to original sources
PubMed1992

Health risks associated with residential exposure to extremely low frequency electromagnetic radiation.

Extremely low frequency electromagnetic radiation has received considerable attention recently as a possible threat to the health of persons living near high tension electric power lines, distribution substations, and even in close proximity to common household electric appliances. Results of epidemiological and laboratory research are examined to assess risks associated with magnetic fields generated by extremely low frequency electromagnetic sources. Health risks associated with such fields include a wide variety of ills ranging from disruption of normal circadian rhythms to childhood cancers. Risk assessment has been particularly difficult to determine in light of an ostensible lack of a dose-response relationship. Current media sensation fueled in part by an equivocal position adopted by the United States Environmental Protection Agency has contributed to the controversy. Recommendations for prudent avoidance of possible dangers are presented along with policy implications concerning health risks associated with magnetic fields.

Environmental Exposure↗
PubMed1990

Emergency medical services system design.

The delivery of emergency health services requires the participation of a number of autonomous organizations which operate with high degrees of interdependence. To provide appropriate care, these organizations must be organized into a functional system. This requires a central planning and coordinating organization to plan the system and to coordinate the various providers. The system plan must consider the needs of the patients and the roles and responsibilities of system participants.

Emergency Medical Services↗
PubMedDate not supplied

Economic regulation of ambulance services in California.

OBJECTIVE: This study was intended to identify economic regulatory programs used by California counties (including ambulance franchising and rate setting), to inventory their foci and application, and to identify differences around the state. By studying the variety of programs used in one state, this study establishes a framework for evaluation of state and local regulatory programs elsewhere. METHODS: This study surveyed all California local EMS agencies (LEMSAs); these are California's equivalent of regional EMS organizations. The survey achieved a 100% response rate, and all data involve population parameters obviating the need for inferential statistics. RESULTS: Seventy-three percent of California counties use economic regulations. Large-population counties and those that operate their own LEMSAs are more likely to use economic regulations than are small counties and those that participate in multicounty EMS agencies. Despite a preference for competition in the authorizing statute, most franchises were granted without competition to existing providers. The majority of franchises in the state were granted to public services. Most ambulance rate setting occurs outside of a competitive process. CONCLUSIONS: Economic regulations that were intended to provide a structured marketplace are often being used to protect existing providers, particularly public services, from competition. The growing interest by fire departments in entering the market for emergency ambulance service, along with the existing bias toward them in granting of franchises, does not bode well for use of the competitive process. The growth of managed care may change or eliminate the need for economic regulations but, if they are to continue, more state oversight should be considered.

Ambulances↗
PubMedDate not supplied

Coordination of the EMS system: an organizational theory approach.

Emergency medical services (EMS) systems include autonomous organizations with high degrees of interdependence. The need to coordinate system participants has long been recognized but seldom achieved. This can be explained by organizational theory--specifically, the study of the relationships among organizations. Existing models identify the total system's functions, but fail to explain roles and relationships among the system's participants. Coordination among organizations is more difficult than coordination within an organization because of lack of an authority structure. The EMS system can be described as "a functionally interdependent system," consisting of multiple autonomous organizations with high degrees of interdependence in their technical functions. Communities have five potential management approaches, varying according to their aggressiveness. These are laissez-faire, where even voluntary coordination efforts are not tried; voluntary cooperation efforts, such as coordinating councils; external planning agencies without regulatory control; "framework organizations" with regulatory control over the system participants; and bureaucratization, placing the system participants within a single organizational hierarchy. The "multicratic organization" is a model for management of multiorganizational systems. A "system lead agency" plans joint activities and manages relationships among system participants in the way that the management of a uniorganization integrates departments. A lead agency is usually a unit of government or organized pursuant to government action, but a managed care organization can also fill this role. In extreme application of the model, the system is viewed as a framework and temporary modules are attached. Their interests are limited, as needed, to optimize the entire system. The lead agency sets policies affecting relationships of modules and policies crossing organizational boundaries.

Decision Making, Organizational↗
PubMedDate not supplied

The public vs private debate: separating facts from values.

The choice between public and private emergency ambulance services is generally based on histological experience within the community. No empirical evidence exists that supports an argument that either public or private emergency ambulance services are better, per se. On a macro level, this debate is based on the question of the role of government and the role of the marketplace in the delivery of public services and medical care, and the comparative efficiencies of public and private organizations. On a micro or community level, these philosophical concerns are supplemented with issues relating to protection of individual jobs and investments, upholding of community tradition, and maintenance of existing relationships. Other specific values that are considered include the role of profit and equity--fairness of coverage. A rational choice would be based on consideration of efficiency and effectiveness. The effectiveness of an emergency medical services system is primarily based on its ability to provide patients with the level of care that they need within a clinically appropriate time. Efficiency is the ratio between inputs and outputs. One factor that can increase efficiency is the availability of excess production capacity that can be used to provide emergency ambulance service, with a low marginal cost of adding this to the other functions. A rational model is intended to change the level of the debate to one that is less based on values, but it is impossible for a community to select an ambulance provider in a value-free environment.

Ambulances↗
PubMedDate not supplied

Regulation of ambulance response times in California.

OBJECTIVES: To identify regulatory programs for ambulance response times used by California counties, to inventory their foci and application, and to identify differences around the state. By studying the variety of programs used in one state, this study establishes a framework for evaluation of state and local regulatory programs elsewhere. METHODS: This study surveyed all California local EMS agencies (LEMSAs), California's equivalent of regional EMS organizations. The survey achieved a 100% response rate and all data involve population parameters obviating the need for inferential statistics. RESULTS: Fifty-seven percent of California counties regulate response times. Large-population counties and those that operate their own LEMSAs are more likely to use response time regulations than are small counties and those that participate in multicounty EMS agencies. Most of the counties with response time standards measure from dispatch to arrival at the scene and most use a fractile measurement to determine compliance. Many of the ambulance enforcement programs in California have enforcement mechanisms that are unlikely to promote compliance. CONCLUSIONS: Response time regulations are intended to improve the effectiveness of prehospital care. Few counties use standards that comply with recommended state standards. A large number of counties are unable to determine how well ambulance services actually comply with the standards and are not in a position to enforce them. The use of these regulatory programs is questionable based on their application.

Ambulances↗
PubMedDate not supplied

A decentralized trauma system design for a rural area.

Most trauma-care systems are based on an urban model in which patients are found in sufficient proximity to the trauma center to allow preferential triage. The roles of other hospitals in the community are limited. In rural areas, patients may be remote from the trauma center and may require initial stabilization at a closer, nontrauma "center" designated hospital. An inclusive trauma system design is more appropriate in such situations. The Emergency Department Approved for Trauma (EDAT) is a program implemented in a rural area of northeastern California that establishes minimum standards for nontrauma center designated hospitals in remote areas. It integrates these hospitals into the trauma system through transfer guidelines and agreements and participation in systemwide quality assurance/improvement programs. The EDAT program promotes both improved initial treatment of rural trauma patients and appropriate transfer of patients to designated trauma centers.

California↗
PubMedDate not supplied

An inventory of ambulance service regulatory programs in California.

INTRODUCTION: Ambulance regulation in California is the responsibility of numerous agencies on the state and local levels. OBJECTIVE: By identifying and analyzing the variety of programs used in one state, this study establishes a framework for evaluation of state and local regulatory programs elsewhere. METHODS: This study surveyed all California local EMS agencies (LEMSAs: California's equivalent of regional EMS organizations) to identify the types of regulatory programs used, the foci of these programs (e.g., equipment and personnel), and their application (e.g., public and private providers). All data acquired were analyzed using population parameters rather than inferential statistics. FINDINGS: A response rate of 100% was obtained. Among the regulatory tools used are ordinances, contracts, and franchises. Regulatory standards vary widely as do their applications. Large counties and those that operate their own LEMSA have more extensive regulatory programs than do smaller counties and those who participate in multicounty agencies. Many of the enforcement mechanisms available are weak. CONCLUSION: This study suggests several policy implications for California and other states. The wide variation in the types of regulatory programs and the standards that are used suggest that the purpose and impact of regulatory programs should be studied further. The decentralization of the ambulance regulatory program and the lack of integration of ambulance regulations into EMS system planning also raise policy questions. In addition, the role of multicounty EMS agencies, as it relates to regulation of ambulance services, should be reviewed.

Ambulances↗
PubMedDate not supplied

Emerging organizational structures in the ambulance industry in the United States.

This analysis seeks to identify emerging forms of organizations in emergency medical services (EMS) in the United States, to provide examples of them, to relate them to changes in healthcare generally, and to apply a classification scheme. Public policy issues related to these new forms of organizations and lessons from other areas of the healthcare system are identified. Recent changes in the healthcare system in the United States have been marked by modifications in the structure of organizations that provide and pay for health services. New forms of organizations and alliances among existing organizations have emerged in an effort to improve the efficiency of the services provided and to improve organizations' market positions. Reflecting increased competition within EMS and the demands of the changing health-care delivery system, several types of organizations have begun to emerge in EMS that resemble those occurring in health care generally. These include forms of horizontal integration, such as consolidated ambulance services and various models of ambulance service networks; and forms of vertical integration, such as demand management programs and public-private joint ventures. The ultimate end might be complete integration with a carve-out of all non-scheduled care. Although changes in EMS organizations result largely from marketplace decisions by sellers and purchasers, this does not mean that there is no public policy role. While new organizational forms may increase the ambulance industry's efficiency, public policy makers must be concerned about quality and access as well. Some policy responses will promote marketplace changes, others will accept them generally, but will seek to correct problems, and a third group will attempt to restrain the market.

Ambulances↗