Prehospital and disaster medicine
-
Prehosp Disaster Med · Feb 2012
The ethics of resuscitation: how do paramedics experience ethical dilemmas when faced with cancer patients with cardiac arrest?
Research on prehospital emergency work traditionally has focused on medical issues, but paramedics often have to make ethical choices. The goal of this exploratory study was to understand how paramedics experience difficult ethical dilemmas regarding resuscitation of cancer patients. ⋯ The findings of this qualitative, exploratory study suggest that ethical concepts and analyses of double pressure situations should have an important role in education and training designed to prepare emergency personnel for difficult life and death choices. More research is needed to shed light on how ethical dilemmas arise in prehospital work.
-
Prehosp Disaster Med · Feb 2012
Prehospital trauma system reduces mortality in severe trauma: a controlled study of road traffic casualties in Iraq.
In low-resource communities with long prehospital transport times, most trauma deaths occur outside the hospital. Previous studies from Iraq demonstrate that a two-tier network of rural paramedics with village-based first helpers reduces mortality in land mine and war-injured from 40% to 10%. However, these studies of prehospital trauma care in low-income countries have been conducted with historical controls, thus the results may be unreliable due to differences in study contexts. The aim of this study was to use a controlled study design to examine the effect of a two-tier prehospital rural trauma system on road traffic accident trauma mortality. ⋯ Where prehospital transport time is long, a two-tier prehospital system of trained paramedics and layperson first responders reduces trauma mortality in severe RTA injuries. The findings may be valid for civilian Emergency Medical Services interventions in other low-resource countries.
-
Prehosp Disaster Med · Feb 2012
The evaluation of research methods during disaster exercises: applicability for improving disaster health management.
The objective of this study was to investigate whether disaster exercises can be used as a proxy environment to evaluate potential research instruments designed to study the application of medical care management resources during a disaster. ⋯ Research instruments can be evaluated and improved when tested during a disaster exercise. Lack of data recovery hampers disaster research even in the artificial setting of a national disaster exercise. Providers at every level must be aware that proper data collection is essential to improve the quality of health care during a disaster, and that predisaster cooperation is crucial to validate patient outcomes. These problems must be addressed pre-exercise by stakeholders and decision-makers during planning, education, and training. If not, disaster exercises will not meet their full potential.
-
Prehosp Disaster Med · Feb 2012
Balancing between closeness and distance: emergency medical services personnel's experiences of caring for families at out-of-hospital cardiac arrest and sudden death.
Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects between 236,000 and 325,000 people in the United States each year. As resuscitation attempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services (EMS) personnel often face the needs of bereaved family members. ⋯ Ethical caring competence is needed in the care of bereaved family members to avoid additional suffering. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Support in dealing with personal discomfort and clear guidelines on family support could benefit EMS personnel.
-
Prehosp Disaster Med · Feb 2012
Increased situation awareness in major incidents-radio frequency identification (RFID) technique: a promising tool.
In mass-casualty situations, communications and information management to improve situational awareness is a major challenge for responders. In this study, the feasibility of a prototype system that utilizes commercially available, low-cost components, including Radio Frequency Identification (RFID) and mobile phone technology, was tested in two simulated mass-casualty incidents. ⋯ The tested prototype system was quick, stable, and easy to use, and proved to work seamlessly even in harsh field conditions. It surpassed the paper-based system in all respects except simplicity of use. It also improved the general view of the mass-casualty situations, and enhanced medical emergency readiness in a multi-organizational medical setting. The tested technology is feasible in a mass-casualty incident; further development and testing should take place.