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Biomedical subjects

R R Bass

Publications and source records attributed to R R Bass.

10 recordsLinked to original sources
PubMed1999

Update on trauma system development in the United States.

BACKGROUND: Two previous reports, in 1987 and 1993, have tracked trauma system development in the United States. This report updates the current status of trauma systems in the United States. METHODS: All state emergency medical service directors (including the District of Columbia) were surveyed regarding the existence of trauma systems in their states, including the presence of eight essential criteria of trauma system development that have been the focus of the two previous studies. Data were analyzed and compared with results previously published in the two reports. RESULTS: Five states met all eight essential development criteria, 28 states met six or seven criteria, and another 10 states met between one and five criteria. In the 1993 study, 18 states met six or more criteria. In 1987, 22 states reported meeting four or more criteria. CONCLUSION: There has been significant progress, when compared with 1987 and 1993 evaluations in the number of states reporting the presence of trauma systems and meeting six or more key criteria. Recent progress may be due to federal assistance for trauma system development available from 1991 until 1995.

Data Collection↗
PubMed1997

Current state of the art in the management of patients with acute myocardial infarction and ischemia within the Maryland Emergency Medical Service system.

Maryland has a pioneering and sophisticated system of prehospital emergency medical care. Approximately 44,000 patients with chest pain and/or acute myocardial infarction were transported last year by emergency medical service (EMS) providers who also responded to approximately 5,000 out-of-hospital cardiac arrests. Funding has recently been prioritized to enable EMS providers to be trained and equipped with automated external defibrillators. Future consideration may be given to purchasing defibrillators with integrated 12-lead electrocardiographic capability. These devices have been shown to reduce the time required to initiate thrombolytic therapy once in the emergency department. There are presently no data in the United States that support the prehospital administration of thrombolytics.

Chest Pain↗
PubMed1986

Clinical trials of the pneumatic antishock garment in the urban prehospital setting.

As a result of experimental data and favorable clinical impressions, the pneumatic antishock garment (PASG) has gained widespread acceptance as a reasonable standard of care in emergency medical services (EMS) systems. It is currently legislated as required equipment for medical rescue vehicles in two-thirds of the United States. But despite a decade of widespread use, prospective, randomized, controlled trials that demonstrate the efficacy of the PASG have not been published. Furthermore, certain complications have been reported and concerns have been raised about the use of the PASG under certain circumstances, such as penetrating thoracic injury. In the fall of 1983, the City of Houston EMS system embarked on a long-term prospective evaluation of PASG use in hypotensive victims of injury in the urban prehospital setting. All victims of injury whose systolic blood pressure was 90 mm Hg or less when they initially presented to paramedics in the field were entered into the study. All patients received the identical treatment protocol, with the sole exception of PASG application and inflation to full pressure prior to intravenous catheterization on an alternate day basis. Prospectively collected demographic data have demonstrated that the two resulting groups of PASG and no-PASG patients are well matched in terms of age, sex, injury type, anatomic location of the injury, initial field trauma score, injury severity score and probabilities of survival, as well as the amounts of IV fluids infused in the prehospital setting and the response, scene, and transport times.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1983

Thigh compartment syndrome without lower extremity trauma following application of pneumatic antishock trousers.

Reported are two cases of thigh compartment syndrome following application of a pneumatic antishock trouser suit. Both patients developed compartment syndromes after prolonged antishock suit use in the absence of any apparent leg trauma. We recommend that suit compartment pressures be no more than required to restore adequate blood pressure. The duration of application should be no longer than is clinically necessary. Patients with prolonged application (greater than 120 minutes) should be closely monitored for the development of compartment syndromes.

Adult↗
PubMed1983

Anal eroticism: two unusual rectal foreign bodies and their removal.

We have described two cases involving unusual rectal foreign bodies and their subsequent removal. Suggestions are included to aid in the removal of colorectal foreign bodies, as well as references to provide for the appropriate management of these cases in the emergency department. Primary care providers need to be aware of the issue of colorectal foreign bodies as a clinical entity and the fact that their occurrence is expected to continue to rise dramatically. Patient education of the dangers inherent in the insertion of objects into the colorectal area should be more prevalent. At the very least, all physicians need to be aware of anal eroticism and the necessity to take a careful medical history.

Adult↗
PubMed1982

The esophageal obturator airway: a reassessment of use by paramedics.

A study was undertaken to determine the incidence of failures and complications of EGTA. The life history of 31 airways was followed. Ten failed prior to 5 usages. Paramedics successfully intubated 88% of the patients but experienced difficulties maintaining adequate airways in 15%. While the EGTA is a valuable tool in prehospital care, its utilization to the exclusion of endotracheal intubation should be carefully considered.

Allied Health Personnel↗
PubMedDate not supplied

Change the scope of practice of paramedics? An EMS/public health policy perspective.

OBJECTIVE: To analyze the potential for expanding the scope of practice of paramedics from public health, health planning, and health policy perspectives, utilizing data covering more than 42,000 emergency patients. METHODS: The authors conducted a retrospective study of 42,918 patients seen in two Baltimore emergency departments over a six-month period, 5,259 of whom were transported by emergency ambulance. The authors constructed epidemiologic profiles of in-hospital and prehospital patients, and merged ambulance data with discharge diagnoses. RESULTS: The 42,918 patients had a total of 2,118 different discharge diagnoses. The ten most frequent diagnoses of ambulance-transported patients were convulsions, injuries, asthma, congestive heart failure, chest pain, syncope and collapse, otitis media, abdominal pain, cardiac arrest, and respiratory abnormality. The ten most frequent diagnoses for all ED patients were otitis media, asthma, finger and nonspecific injuries, upper respiratory infections, chest pain, bronchitis, pharyngitis, gastroenteritis, nonspecific viral infections, and urinary tract infections. Infections accounted for 31.6% of the top 50% of diagnoses by volume, followed by injuries (24%) and cardiovascular cases (16.5%). However, 26.9% of ED patients received an assessment and diagnosis of general symptoms (no procedure). CONCLUSIONS: The high number of diagnoses and the frequency of infections as a primary complaint in this patient sample reconfirm the primacy of the physician in prioritizing patients and assigning treatment pathways. The authors suggest a methodology that may allow properly trained medics to alter some of their role as physician extenders, but suggest that system planners must first ensure that any changes not reduce the public health benefits that each EMS system already provides.

Adolescent↗
PubMedDate not supplied

A medically wise approach to expanding the role of paramedics as physician extenders.

The authors examined a portion of the complex issue of the scope of practice of paramedics in light of the epidemiologic profile of emergency patients seen at two Baltimore hospitals. They suggest that the same approach could and should be used to help decide on the scope of work of prehospital personnel in any jurisdiction. The findings lead the authors to urge caution toward any potential changes to the work done by medics, because of the enormous breadth of presenting patient conditions. The authors suggest that the epidemiologic profile witnessed in Baltimore would require increased direct physician input on patient destination decisions for all medics who would be working under an expanded scope of functions, and the paper suggests a mechanism for accomplishing this goal. Finally, while there may be compelling economic reasons to change what medics do in the field, this article cautions health care managers to design changes, based on solid evidence, that will have a positive public health impact, and then work to evaluate the character of the impact after changes are implemented.

Algorithms↗