The EMT-paramedic in an emergency system.
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Biomedical subjects
Publications and source records attributed to W F McManus.
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An Emergency Medical Services (EMS) system with the capabilities of rapid response, patient extrication, basic life support, advanced life support, radio communication, and transportation provides appropriate care for a wide spectrum of injured and acutely ill patients. The validity of the selective dual response system in demonstrated by: 1) rapid provision of basic life support, 2) appropriate availability of advanced life support, 3) conservation of educational and fiscal resources, and 4) the enchancement of knowledge and manipulative skill expertise of relatively few, but busy, EMT-paramedics who are provided close medical supervision and support.
Reliable criteria exist to assess emergency medical technician (EMT)-paramedic team and individual competence. In addition to written and oral examiniation, reliable individual manipulative skill data, and on-scene observation of emergency care by responsible physicians, EMT-paramedic team competence may be assessed by using tracer conditions that reflect patient outcome converted to a standard base population per unit time. Using standard definitions of "resuscitation" and "save," and the pulseless, nonbreathing patient as tracer, 75 (31%) of 241 patients were resuscitated and 34 (14%) were saved. Team manipulative skill competence may also be determined by an appropriate tracer.
Nineteen pregnant women with burn areas ranging from 6 to 92% of the total body surface area were treated at the US Army Institute of Surgical Research between 1951 and 1974. A review of these cases led to the following observations and conclusions: 1) Pregnancy does not alter the maternal outcome after thermal injury. 2) Maternal survival is usually accompanied by fetal survival. 3) If the gravida's injury is lethal, the pregnancy will usually terminate spontaneously prior to her death. 4) Obstetric intervention is indicated only in the gravely ill woman whose complications (hypotension, hypoxia, or sepsis) jeopardize the life of the fetus. 5) A better understanding of the complications of major burns and the care available in modern burn units should improve the prognosis for burned pregnant patients.
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The frequency of thromboembolic complications in burn patients has been estimated to range from 0.4% to 7%. The clinical significance of these events is often debated and has prompted some centers to adopt the routine prophylactic use of low dose heparin prophylaxis. A 10 year review of 2,103 burn patients treated at this institution was undertaken. Twenty-five (1.2%) patients, with a mean age of 40.0 years and an average burn size of 49.3% total body surface area (TBSA), were identified as having significant pulmonary thromboembolism (PTE). In only 3 (0.14%) patients was the thromboembolism considered to be a cause of death. Nineteen (0.9%) patients, with an average age of 36.7 years and a mean burn size of 48.3% TBSA, developed clinically evident deep venous thrombosis (DVT); however, in only 1 (0.05%) patient did the disease progress to fatal PTE. A review of the literature reveals a 0.6% to 5% incidence of complications related to low dose heparin therapy which includes bleeding, thrombocytopenia, and arterial thrombosis. We feel that the infrequency of clinically significant PTE and DVT in burn patients and the comparable or greater rate of complications associated with heparin prophylaxis mitigate against the routine use of low dose heparin therapy except in patients at high risk for these events.