Katrina exposes known weaknesses.
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Alabama↗
SEARCH · PubMed Health
Results for “Emergency Medical Service Communication Systems”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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2005 JEMS 200-city survey. A benchmark for the EMS industry.
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Benchmarking↗
Medical assistance during commercial airline flights: analysis of 11 years experience of the Paris Emergency Medical Service (SAMU) between 1989 and 1999.
Emergencies arising during commercial airline flights may have serious consequences. We report the experience of the Paris Emergency Medical Service (SAMU) in providing in-flight assistance to Air France between 1989 and 1999. During this period medical advice was sought 380 times during the carriage of about 350 million passengers. Analysis of the patient files suggests that serious emergencies were rare and that cardiopulmonary resuscitation was required only exceptionally. However the relative frequency of cardiac and neurological emergencies in our analysis supports the necessity of carrying adequate medical equipment and of having direct access to expert medical advice. The results suggest the requirement for a rigorous prospective epidemiological study of in-flight emergencies to evaluate the effectiveness of current practice and possible modifications of equipment and protocols for patient management.
Adolescent↗
EMS ... agenda for the future.
In 1996, the National Highway Traffic Safety Administration and the Health Resources and Services Administration, Maternal and Child Health Bureau published the EMS Agenda for the Future. To date, thousands of copies have been distributed to EMS-knowledgeable people, and those who aspire to be, throughout the United States. This article reviews the findings discussed within the EMS Agenda for the Future. This discussion also assesses the effects of these findings on EMS development.
Emergency Medical Service Communication Systems↗
The medical impact of tornadoes in North America.
North America suffers some of the most severe tornado disasters of any location on the planet. Significant injury and economic impact may result from these storms, particularly in rural areas. Tornadic storms present unique problems for prehospital and Emergency Department personnel. Soft tissue injuries seen after tornadoes are contaminated with polymicrobial flora and may require delayed primary closure. Fractures are a frequent cause of hospital admission and head injury is a frequent cause of death. Advanced warning and proper sheltering actions by a population are the most significant factors in reducing morbidity and mortality. This article reviews the pertinent literature on the medical impact of tornadoes and details the mechanisms of injury, nature of injuries, pre-hospital and ED planning points associated with tornadic storms.
Canada↗
[Bioterrorism and health security in the European Union].
A PROGRAM OF ACTION AND COOPERATION: Since 2001, a series of measures have been taken by the Member States, the European Union and the International authorities to reinforce the preparation and response to biological and chemical terrorist acts. It is essential that the Member States can mutually consult and coordinate their preparation and response as widely as possible. THE ROLE OF THE HEALTH SECURITY COMMITTEE: Together with the health security committee, the European Union has setup a mechanism of consultation and coordination that can be recommend and guide joint action in an emergency, and guarantee the coherence of the counter-actions throughout the Union. This is a committee also constitutes the framework within which the emergency strategies and model-simulations are exchange, and in which assistance in the form of expertise and other resources can be obtained among the Member States. IN THE YEARS TO COME: The future European Centre for the prevention and control of disease, the implantation and functioning of which will start in Sweden in 2005, will play a fundamental part in the harmonisation of the European response to any eventual terrorist acts, whether biological or chemical.
Bioterrorism↗
Communications survey.
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Data Collection↗
Mass-casualty terrorist bombings in Istanbul, Turkey, November 2003: report of the events and the prehospital emergency response.
BACKGROUND: This paper describes the two mass-casualty, terrorist attacks that occurred in Istanbul, Turkey in November 2003, and the resulting pre-hospital emergency response. METHODS: A complex, retrospective, descriptive study was performed, using open source reports, interviews, direct measurements of street distances, and hospital records from the American Hospital (AH) and Taksim Education and Research State Hospital (TERSH) in Istanbul. RESULTS: On 15 November, improvised explosive devices (IEDs) in trucks were detonated outside the Neve Shalom and Beth Israel Synagogues, killing 30 persons and injuring an estimated additional 300. Victims were maldistributed to 16 medical facilities. For example, AH, a private hospital located six km from both synagogues, received 69 injured survivors, of which 86% had secondary blast injuries and 13% were admitted to the hospital. The TERSH, a government hospital located 1 km from both synagogues, received 48 injured survivors. On 20 November, IEDs in trucks were detonated outside the Hong Kong Shanghai Banking Corporation (HSBC) headquarters and the British Consulate (BC), killing 33 and injuring an estimated additional 450. Victims were maldistributed to 16 medical facilities. For example, TERSH, located 18 km from the HSBC site and 2 km from the the BC received 184 injured survivors, of which 93% had secondary blast injuries and 15% were hospitalized. The AH, located 9 km from the HSBC site and 6 km from the BC, received 16 victims. CONCLUSION: The twin suicide truck bombings on 15 and 20 November 2003 were the two largest terrorist attacks in modern Turkish history, collectively killing 63 persons and injuring an estimated 750 others. The vast majority of victims had secondary blast injuries, which did not require hospitalization. Factors associated with the maldistribution of casualties to medical facilities appeared to include the distance from each bombing site, the type of medical facility, and the personal preference of injured survivors.
Ambulances↗
Challenges of major incident management when excess resources are allocated: experiences from a mass casualty incident after roof collapse of a military command center.
During a military exercise in northern Norway in March 2000, the snow-laden roof of a command center collapsed with 76 persons inside. Twenty-five persons were entrapped and/or buried under snow masses. There were three deaths. Seven patients had serious injuries, three had moderate injuries, and 16 had minor injuries. A military Convalescence Camp that had been set up in a Sports Hall 125 meters from the scene was reorganized as a causality clearing station. Officers from the Convalescence Camp initially organized search and rescue. In all, 417 persons took part in the rescue work with 36 ambulances, 17 helicopters, three ambulance airplanes and one transport plane available. Two ambulances, five helicopters and one transport aircraft were used. Four patients were evacuated to a civilian hospital and six to a field hospital. The stretcher and treatment teams initially could have been more effectively organized. As resources were ample, this was a mass casualty, not a disaster. Firm incident command prevented the influx of excess resources.
Cold Climate↗
The ice storm in eastern Canada 1998 KAMEDO-Report No. 74.
This is a report of the impact of the ice storm that struck eastern Canada on 04-09 January 1998. The storm deposited ice some 100 mm thick on the ground and on the electric power lines and eventually left 1.4 million households and much of the infrastructure without electrical power. Data were obtained through non-structured interviews of those involved. Most of the larger hospitals were equipped with emergency generating equipment and were able to provide most essential services. For most hospitals, non-emergency services were compromised. Many other medical facilities, including clinics had to be shut down, and smaller hospitals were forced to transfer some patients to larger institutions. In addition, hospitals experienced a marked increase in the number of emergency department visits including an increase in the number of persons with injuries, respiratory tract infections, or heart problems. A marked increase in carbon-monoxide intoxication was observed: 50 persons required the use of hyperbaric oxygen and six persons died of CO poisoning. Prehospital services not only experienced a marked increase in the number of emergency responses, but also were utilized to provide transportation of non-ill or injured persons, equipment, and supplies. Home care was interrupted and many patients dependent upon power had to be transported to hospitals. Many hospitals opened their buildings to provide shelter to the families of many of their employees and medical staff. This helped to keep staffing at a better level than if they had to find shelter and essential services elsewhere. The transmission and sharing of information was severely limited due in part to the loss of power and inability to access television. This led to the distribution of misleading or incorrect information. This storm was exemplary of our dependence upon electrical power and that we are not prepared to cope with the loss of electricity.
Attitude of Health Personnel↗
Case law involving base-station contact.
INTRODUCTION: Although general discussion of legal claims against emergency medical services (EMS) have been published, there is no literature that examines legal claims that specifically have involved base-station contact for direct medical control. METHODS: A review of case law through July 1994 was conducted to identify cases that involved radio communications between a prehospital provider and a physician or nurse under the direction of a physician. RESULTS: Only eight cases could be identified. Each case is described in terms of the event, selected pertinent legal issues, and the opinions rendered by the court. CONCLUSIONS: These few cases illustrate some important observations that indicate that there will occur an increase in the detail, role delineation, and clarification of the prehospital providers, medical directors, base-station physicians, and others who provide direct medical control to prehospital EMS providers. These findings have important implications for EMS medical directors.
Emergency Medical Service Communication Systems↗
Prehospital communications during the Loma Prieta earthquake.
INTRODUCTION: On 17 October 1989, the Loma Prieta Earthquake shook the San Francisco Bay area, home to more than 6 million people. This study examined the effectiveness and function of emergency medical services (EMS) communications after this event. METHODS: The six Bay area counties most affected by the Loma Prieta Earthquake were surveyed using a 156-part questionnaire. This study examined the functioning of the primary 9-1-1 county dispatch centers. Paramedics involved in a set of defined activities during the period after the earthquake also were surveyed. Emergency medical services directors also were questioned by telephone using an interview tool developed for this purpose. All areas concerning disaster response were not queried. Ten specific areas were considered, including: 1) preparation for disaster; 2) the impact of the earthquake; 3) reconnaissance; 4) call volume; and 5) others. RESULTS: Coordination among the various agencies responsible for disaster response and mitigation needs more study. Uniform response plans for medical mutual aid need development. Government support similar to police and fire department arrangements for mutual aid are not in place. Additional planning and training for disasters at all levels need reassessment. The communication-center personnel indicated that they did not call for more resources, but instead accepted volunteers at dispatch centers and extra assistance. Once engaged, however, most communications centers (CCs) had great difficulty tracking and controlling all the units under their jurisdiction. In some large urban counties, some ambulances were idled awaiting calls but lost their communications centers, while other ambulance personnel were trying to handle multiple patients and requests for services. CONCLUSIONS: Significant help from a state or federal agency likely will be unavailable for a substantial period after a catastrophic regional event. Important coordination among EMS agencies for disaster response is poor or absent. Although fatalities and casualties were limited compared to what could have occurred, great confusion reigned for varying periods of time after the earthquake. Communications among local agencies, counties, and the state were problematic. Information flow to hospitals was cited frequently as a problem, making it difficult for hospitals to prepare adequately. Medical mutual-aid help was disorganized and inadequately controlled. The training of personnel and the method of recall for disaster response need to be examined.
Disaster Planning↗
Out-of-hours emergency dental services--development of one possible local solution.
This paper describes the development of a local solution to the problem of the provision of out-of-hours dental care in Newcastle and North Tyneside in the north east of England. Focus groups were used to review the current provision of, and problems with, dental out-of-hours emergency provision. A consensus conference involving both general dental and medical practitioners, was subsequently used to develop possible alternative methods for the provision of out-of-hours emergency dental services. A centralised service delivered from a secure location in conjunction with general medical practitioners was developed which was dependent on a nurse-led triage. The linkage with NHS Direct may be an opportunity, in some locations, to integrate dental services more fully with other out-of-hours primary care services. The method described allowed a solution to be generated by practitioners themselves, thus giving ownership and acceptance to the chosen option.
Consensus Statements as Topic↗
The Armenian earthquake of 1988: a milestone in the evolution of nephrology.
A dreadful earthquake struck a densely populated region of Armenia on December 7, 1988. All principal determinants of structural damage and crush injury converged to magnify the dreadful outcomes of this otherwise modest earthquake, which registered 6.9 on the Richter scale. Two circumstantial events focused unprecedented world attention on this natural disaster. First, the news media, assembled to cover the historic visit of Mikhail Gorbachev to the United States, were suddenly deprived of the news they had gathered to cover when Gorbachev interrupted his visit to examine the disaster personally. As a result, the world news media channeled their collective force on covering the tragic events in Armenia. Second, an official Soviet request for dialysis assistance was delivered at the opening session of the annual meeting of the American Society of Nephrology in San Antonio on Sunday, December 11, 1988. As a result, the entire nephrology community was suddenly engulfed in the mounting worldwide enthusiasm to provide humanitarian aid. The subsequent efforts of the National Kidney Foundation and the International Society of Nephrology prompted the discipline to examine, evaluate, and establish a role for nephrologists in preparedness and response to natural disasters.
Acute Kidney Injury↗
Introduction: Disaster management and communications as viewed from 2003--taking the long view.
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Armenia↗
Work-related stress in an emergency medical dispatch center.
STUDY OBJECTIVE: Stress is an emergent occupational problem in modern societies. Among workers, medical practitioners are particularly exposed. However, data objectifying stress levels during work time are scarce. The aim of this study was to establish diurnal salivary cortisol levels in a highly stressful work environment, the medical dispatch center of an emergency care unit. METHODS: Eight emergency medical dispatchers agreed to be sampled every 2 hours from 9 AM to 7 PM during a usual day of work. Eight matched control subjects sampled during their leisure time were used as a control group. RESULTS: Whatever the time of the day, emergency medical dispatchers showed significantly increased cortisol levels during their work time compared with levels found in the control group. There was a significant difference in the amount of daytime cortisol secretion between control subjects and emergency medical dispatchers (0.345 nmol/L; 95% confidence interval [CI] 0.04 to 0.93 nmol/L), with a mean daytime augmentation of 22.8% in emergency medical dispatchers compared with that in control subjects. In addition, among emergency medical dispatchers, the subjective perception of emotional stress was positively correlated with total cortisol concentrations per day (r =0.78; 95% CI 0.39 to 1). CONCLUSION: Our data show that work tasks of emergency medical dispatchers led to a hypersecretion of cortisol. Because the damaging effects of persistent cortisol increases on health and cognitive functions are well recognized in human beings, it seems necessary to rapidly identify stressful work situations and targets for organizational improvements to minimize stress in these situations.
Acute Disease↗
Emergency department contributors to ambulance diversion: a quantitative analysis.
STUDY OBJECTIVE: We determine the relationship between physician, nursing, and patient factors on emergency department use of ambulance diversion. METHODS: Data were collected at 1 ED in Toronto, Ontario, Canada, on the duration of ambulance diversion during consecutive 8-hour intervals from January to December 1999 (intervals=1,095). By using time series methods, the association between ambulance diversion and nurse hours, physician on duty, and boarded patients was determined. Covariates included patient volume, assessment time, and boarding time. RESULTS: A total of 37,999 patients were treated in the ED over the study period (2% major trauma, 16% ambulance arrivals, and 22% admitted). Nurse hours per interval averaged 60. A mean of 3.2 admitted patients were boarded in the ED each interval. For admitted patients, the time from registration to admission order and from admission order to ED departure averaged 5.2 and 3.5 hours, respectively. There was no ambulance diversion during 170 (15.5%) intervals, whereas 17 (1.5%) intervals were continuously on diversion. In time series analyses, ambulance diversion increased with the number of admitted patients boarded in the ED (6.2 minutes per patient; 95% confidence interval [CI] 2.6 to 9.8 minutes), the number admitted per interval (4.6 minutes per patient; 95% CI 0.1 to 9.1 minutes), assessment time (9.9 minutes per hour; 95% CI 3.3 to 16.5 minutes), and boarding time (11.3 minutes per hour; 95% CI 5.6 to 17.0 minutes). Thirteen of 15 emergency physicians were not associated with ambulance diversion, 1 was associated with reduced use (-36.3 minutes; 95% CI -65.2 to -7.5 minutes), and 1 was associated with increased use (47.6 minutes; 95% CI 4.5 to 90.6 minutes). ED nurse hours were not associated with diversion. Ambulance-delivered patient volume was associated with diversion (5.2 minutes per patient; 95% CI 2.7 to 7.8 minutes), but walk-in patients and patients with major trauma were not. CONCLUSION: Admitted patients in the ED are important determinants of ambulance diversion, whereas nurse hours and most emergency physicians are not. Reducing the volume of walk-in patients is unlikely to lessen the use of diversion.
Ambulances↗
Command and control in emergency services operations: a social network analysis.
There is increasing interest in the use of social network analysis as a tool to study the performance of teams and organizations. In this paper, processes of command and control in the emergency services are explored from the perspective of social network theory. We report a set of network analyses (comprising visualization, a selection of mathematical metrics, and a discussion of procedures) based on the observation of six emergency service incidents: three fire service operations involving the treatment of hazardous chemicals, and three police operations involving immediate response to emergency calls. The findings are discussed in terms of our attempts to categorize the network structures against a set of extant command and control network archetypes and the relationship between those structures; comments on the qualities the networks display are put into the contexts of the incidents reported. We suggest that social network analysis may have a valuable part to play in the general study of command and control.
Efficiency, Organizational↗