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PubMed2003

Trauma care systems in Spain.

Trauma care systems in Spain are provided by the Nacional Health Service in a decentralized way by the seventeen autonomous communities whose process of decentralization was completed in January 2002. Its organisation is similar in all of them. Public sector companies of sanitary emergencies look after the health of citizens in relation to medical and trauma emergencies with a wide range of up to date resources both technical and human. In the following piece there is a description of the emergency response teams divided into ground and air that are responsible for the on site care of the patients in coordination with other public services. They also elaborate the prehospital clinical history that is going to be a valuable piece of information for the teams that receive the patient in the Emergency Hospital Unit (EHU). From 1980 to 1996 the mortality rate per 10.000 vehicles and the deaths per 1.000 accidents dropped significantly: in 1980 6.4 and 96.19% and in 1996, 2.8 and 64.06% respectively. In the intrahospital organisation there are two differentiated areas to receive trauma patients the casualty department and the EHU. In the EHU the severe and multiple injured patients are treated by the emergency hospital doctors; first in the triage or resuscitation areas and after when stabilised they are passed too the observation area or to the Intensive Care Unit (ICU) and from there the EHU or ICU doctors call the appropriate specialists. There is a close collaboration and coordination between the orthopaedic surgeon the EHU doctors and the other specialists surgeons in order to comply with treatment prioritization protocols. Once the patient has been transferred an entire process of assistance continuity is developed based on interdisciplinary teams formed in the hospital from the services areas involved in trauma assistance and usually coordinated by the ICU doctors. There is also mentioned the assistance registry of trauma patients, the ICU professional training in the ATLS and the future guidelines for trauma care in the ICU based on epidemiological studies carried out in both the North Spanish Group and the Southern one to promote development and improvement in several areas.

Accidents, Traffic↗
PubMedDate not supplied

Requiring on-line medical command for helicopter request prolongs computer-modeled transport time to the nearest trauma center.

INTRODUCTION: Rapid transport from scene to closest trauma center requires optimal use of public safety first responder (FR), basic life support (BLS), advanced life support (ALS), and transport resources (ground or air). In some parts of this regional emergency medical services (EMS) system, on-scene ALS requires contact with on-line medical command (OLMC) to obtain authorization for air medical helicopter (AMH) dispatch, because some EMS medical directors believe that this may decrease overutilization of AMH services. HYPOTHESIS: The hypothesis of this study was that requiring prior OLMC for AMH dispatch prolongs mean time to a trauma center versus either FR or BLS request for AMH. METHODS: Computer mapping programs were used to model the most rapid driving time to the closest trauma center from 167 actual AMH responses to the scene of a motor vehicle accident. In an OLMC-ALS model, only OLMC-ALS can request an AMH. In a BLS model, BLS units arrive on the scene and the crew requests simultaneous dispatch of an ALS response and an AMH. In the FR model, on arrival at the scene, a FR requests simultaneous dispatch of a BLS unit, an ALS unit, and an AMH. RESULTS: The OLMC-ALS model resulted in a longer mean value for time to trauma center by an AMH than did the computer model for all ground transport settings. The FR model yielded a shorter mean time for AMH compared with the mean values for time to trauma center for all settings. Differences in mean values for time in urban settings were small (ground: 42 minutes, air: 36 minutes), whereas those for the suburban (ground: 52 minutes, air: 41 minutes), and those for rural (ground: 69 minutes, air: 47 minutes) were significant clinically. For the BLS model, these differences persisted, but were significant clinically only in the rural setting (ground: 68 minutes, air: 53 minutes). CONCLUSIONS: Optimal use of AMH requires balancing the need for early helicopter dispatch to fully exploit its speed advantage with the disadvantage of expensive overutilization. This computer model indicates that the best person to request AMH varies by venue: in urban settings, the OLMC physician should request AMH dispatch; in suburban venues, BLS should request AMH dispatch; and in rural venues, FRs should request AMH dispatch.

Air Ambulances↗
PubMed1982

The MGM Grand Hotel fire: lessons learned from a major disaster.

Most community disaster plans are formulated to respond to disasters of moderate size. The MGM Grand Hotel fire in Las Vegas, because of its magnitude, had the potential to overwhelm completely the local medical resources. It did not, because of innovative responses to unforeseen problems based on sound disaster planning. Fortunately, disasters on the magnitude of this fire are rare, and few communities have ever faced the problem of dealing with thousands of casualties. The important lessons learned about perimeter control, command functions, helicopter evacuation, crowd control, and transportation priorities will benefit disaster planners in other communities.

Disasters↗
PubMed1997

[Emergency medical service response to major incidents. A study of 21 cases].

UNLABELLED: Major incidents are high-profile events where many lives are at stake. The response of the health-care-related agencies has to be well-planned and co-ordinated, thus retaining the public's confidence in the emergency services whilst efficiently responding to those in need. The communication between supervising officers such as medical incident officer (MIO) and ambulance incident officer (AIO) with the ambulance personnel is vital for the proper employment of doctors and ambulance teams at the incident scene. In Germany the experience gained at such events has not yet been collected into a single coherent and comprehensive analysis. This study investigates the delivery of ambulance vehicles and personnel at major incidents. Was appropriate emergency treatment and transport for each seriously injured patient possible? Were the communication structures between the supervising officers and the ambulance teams sufficient to provide effective co-ordination and utilisation of the teams at the scene? METHODS: A major incident was defined as any incident with more than ten casualties. All central ambulance controls (CAC) in the five federal states Rhineland-Palatinate, Bavaria, Saarland, Hessen, and Baden-Württemberg were asked by telephone and mail if a major incident had occurred in their area from September 1992 to September 1994. In cases of major incidents in other federal states of West Germany during that period, the appropriate CAC was contacted to collect data. A standardised questionnaire was send to the CACs. The data were split into chronological periods of responses to major incidents. RESULTS: Twenty-one major incidents were included in the study, 11 of them road accidents. The mean time to arrival of physician-staffed ambulances at the scene was calculated as 20 min after alerting of the CAC. In 90% of all cases enough physicians were available to treat each seriously injured patient (NACA score 3-6). In 9 cases a MIO and an AIO were sent out. Their mean time to arrival at the scene was 25 min after alerting of the CAC. In 19 cases (90%) enough ambulance vehicles were provided to rapidly distribute all casualties. With one exception, this was also true for the use of helicopters. Onsite communication of the ambulance staff was always by direct personal contact. In 38% of all incidents the arriving ambulance staff had difficulties in contacting senior officers, and thus, nobody defined their roles and responsibilities. CONCLUSIONS: Quality assurance in emergency medicine can only be achieved by research and documentation. Analysis of the data for this study revealed a severe documentation gap. Only in Bavaria did a one-page documentation form for major incidents exist. For a comprehensive analysis of the health-care-related response to major incidents, a standardised and detailed documentation form should be introduced. According to the data from this study, ambulance staff and vehicles can be quickly and sufficiently provided for the vast majority of major incidents in Germany. For the optimal use of these resources, however, communication skills and knowledge and understanding of on-side supervision structures such as the MIO and AIO need to be promoted.

Accidents, Traffic↗
PubMed1991

Prehospital diagnosis and treatment of acute myocardial infarction: a north-south perspective. The Cincinnati Heart Project and the Nashville Prehospital TPA Trial.

Intravenous thrombolytic therapy improves left ventricular function and reduces mortality in patients with acute myocardial infarction (AMI). In European and Middle Eastern trials, prehospital delivery of thrombolytic agents by physician-directed mobile intensive care units has been successful. This report describes two independently conceived and performed trials that used cellular telephone transmission of 12-lead ECGs to deliver recombinant tissue plasminogen activator (r-tPA) in the field to patients with AMI. In the Nashville Prehospital TPA Trial, 85 patients with chest pain were evaluated in the field for possible administration of r-tPA over a 6-month period. Three of 85 patients (3.5%) were found to be actual candidates for r-tPA treatment in the field. In phase II (dry-run phase) of the Cincinnati Heart Project, 374 patients were evaluated in the field with 14 documented cases of AMI (3.7%) before r-tPA was placed in ambulances for administration by paramedics. In phase III (active with r-TPA in ambulances), over a 1-year period 103 patients were evaluated with six (5.8%) documented cases of AMI. Three of five r-tPA field treatment decisions by emergency physicians using transmitted 12-lead ECGs were accurate (60%). When patients in phases II and III were combined, only 20 of 477 total patients (4.2%) were documented to have AMI. A decline in paramedic skills was noted because of the infrequent administration of the thrombolytic agent. Combining the Nashville and Cincinnati experiences, only 27 of 562 total patients with chest pain (4.8%) were candidates for prehospital thrombolysis. We conclude that few patients evaluated in the prehospital setting are actual candidates for thrombolytic therapy. Substantial allocation of financial and human resources for prehospital delivery of intravenous thrombolytic therapy does not appear warranted.

Adolescent↗
PubMed1983

A decade at the roadside.

The Mid-Anglia General Practitioner Accident Service (MAGPAS) was formed ten years ago, following the example set by Dr Ken Easton OBE and his Road Accident After Care Scheme in the North Riding of Yorkshire. The following paper outlines the operational details of MAGPAS and analyses the statistics compiled from the accident report forms returned by the participating doctors over the past five years.

Accidents, Traffic↗
PubMed1995

Delay times in the administration of thrombolytic therapy: the Brighton experience.

We reviewed the effectiveness of a strategy involving paramedic ambulances and community education to reduce the delay to thrombolytic therapy in patients admitted with acute myocardial infarction, by analysing delay times recorded during routine treatment. Rapid identification and treatment of patients with acute myocardial infarction who were eligible for thrombolysis was carried out in the Accident and Emergency and Cardiac Care Units. Two hundred seventy-four patients were admitted with acute myocardial infarction over an 18-month period and treated with anistreplase (168) or streptokinase (106). The following median times were recorded: symptom onset to administration of thrombolytic therapy, 142 min (range 43-980 min); symptom onset to ambulance arrival, 60 min; ambulance with patient to arrival in hospital, 35 min; time to treatment in hospital ('door to needle time'), 25 min; in-hospital delays were notably shorter for patients given anistreplase as opposed to streptokinase. Shortened delays for the delivery of thrombolytic therapy can be achieved by a strategy involving public education, the availability of resuscitation ambulances, and close liaison with the Accident and Emergency Department.

Ambulances↗
PubMed1986

Identification of cardiac arrest by emergency dispatchers.

Prompt identification of cardiac arrest by emergency dispatchers can save valuable time and increase the likelihood of successful resuscitation. The authors reviewed 516 cardiac and 146 non-cardiac calls to identify features of a probable cardiac arrest call. The results indicate that information about sex, location, and activity is of little use in the identification of cardiac arrest. When the patient is over 50 years old and the caller is emotional, the possibility of cardiac arrest is high, suggesting that questions about consciousness and breathing should be asked immediately. Additional information can be obtained or telephone cardiopulmonary resuscitation (CPR) instructions can be given after dispatch of an emergency vehicle.

Age Factors↗
PubMed1988

Cellular telephone communication between hospitals and ambulances.

Cellular telephones provide a new means of wireless telephone communication. In an experimental design study comparing the clarity of receiving and transmitting communications with cellular telephones versus conventional emergency medical radio/microwave equipment, cellular telephones proved to be superior in all aspects of clarity and ease. Cellular telephones have numerous cost and equipment advantages over radio equipment and should replace conventional radio/microwave equipment for emergency medical communication in areas where reliable cellular telephone networks are available. This will improve an important facet of prehospital emergency care.

Ambulances↗
PubMed1990

Efficiency and cost-effectiveness of advanced EMS in West Germany.

A model study was performed by an economist in Lower Frankonia (a mostly rural area of West Germany with several urban centers) to examine the efficiency and cost-effectiveness of the emergency medical service that included prehospital physician presence. To perform this examination about $3.5 million were spent to improve organization and communication within the local emergency medical service, to purchase additional equipment and further emergency vehicles, and to install prehospital emergency physician service. The median response time was lowered to 6 minutes. This report surveys whether these reforms and extra fundings were beneficial and cost-efficient.

Cost-Benefit Analysis↗
PubMed1985

An alarm procedure.

Each disaster procedure is initiated by an alarm scheme, alerting all involved personnel, directly or indirectly in this procedure. Certain mathematical principles can be applied to calculate the number of people who can be reached within a fixed period of time, or to calculate the time needed to alert a fixed number of people. With this methodology a formidable amount of people can be reached within a few minutes. The advantages and disadvantages are further described.

Disaster Planning↗
PubMedDate not supplied

Microcomputer-assisted transmission of disaster data by cellular telephone.

Voice communication of information during disasters is often inadequate. In particular, simultaneous transmission by multiple callers on the same frequency can result in blocked transmissions and miscommunications. In contrast, nonvoice transmission of data requires less time than does voice communication of the same data, and may be more accurate. We conducted a pilot study to test the feasibility of a microcomputer assisted communication (MAC) network linking the disaster scene and the command hospital. The radio chosen to transmit data from the field disaster site to the command hospital was a cellular telephone connected to the microcomputer by modem. Typed communications between the microcomputer operators enabled dialogue between the disaster site and the hospitals. A computer program using commercially available software (Symphony by Lotus, Inc.) was written to allow for data entry, data transmission, and reports. Patient data, including age, sex, severity of injury, identification number, major injuries, and hospital destination were successfully transmitted from the disaster site command post to the command hospital. This pilot test demonstrated the potential applicability of MAC for facilitating transmission of patient data during a disaster.

Computer Communication Networks↗
PubMedDate not supplied

Prehospital misidentification of tachydysrhythmias: a report of five cases.

Identification and treatment of tachydysrhythmias is an important element of prehospital care. Five cases of prehospital misidentification of tachydysrhythmias are presented to highlight the challenges and pitfalls of field management. The literature is reviewed and discussed in light of new therapies and technology. Guidelines for patient subgroups potentially benefitting from on-line medical control and biotelemetry are explored.

Adult↗
PubMed2006

Experiences of adding nurses to increase medical competence at an emergency medical dispatch centre.

INTRODUCTION: Prehospital care begins when the call is placed to the emergency medical dispatch (EMD) centre and ends when the patient is cared for at the emergency department. The highly technical and specialized character demands advanced medical competence. Communication problems, serious and unpredictable situations can often occur during the emergency calls. A two-year intervention study involved the addition of registered nurses to an EMD-centre team to increase medical competence. AIM: To describe registered nurses' and emergency-operators' experiences of working together at an EMD-centre after adding registered nurses to increase medical competence. METHODS: Qualitative content analysis was used to analyse the text from interviews with four registered nurses and 15 emergency-operators involved in the intervention. RESULTS: Initial frustration and scepticism changed to more positive experiences that resulted in improved cooperation and service. The registered nurses had difficulties dealing with the more urgently acute calls, while the emergency-operators had difficulties with the more complicated, somewhat diffuse cases. The two professions complemented each other. CONCLUSION: Combining the registered nurses' and emergency-operators' knowledge and experience at an EMD-centre can perhaps improve the prehospital care for those requiring emergency medical care.

Adaptation, Psychological↗