Articles: emergency-medical-services.
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Comparative Study
A comparison of four methods of testing emergency medical technician triage skills.
Triage skills are requisite for all providers of prehospital care. Methods of assessing the acquisition of triage skills vary in complexity and expense. In this study, 61 prehospital care providers classified 20 cases, divided into four groups of five cases each: moulaged live trauma victims, nonmoulaged live trauma victims, nonmoulaged manikin trauma victims, and written scenarios. ⋯ Analysis of variance revealed statistically significant differences among the four methods in both mean tagging scores (F3,235 = 8.63, P less than .0001) and mean ranking scores (F3,232 = 6.09, P less than .001). Multiple comparisons using Scheffe's test revealed that the mean tagging and ranking scores for moulaged live victims and written scenario methods were comparable and that both were significantly superior to the scores of the two other methods. However, a qualitative evaluation revealed that the providers greatly preferred triage of moulaged live victims to the other three methods.
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Prog. Clin. Biol. Res. · Jan 1989
Randomized Controlled Trial Comparative Study Clinical TrialUse of a 7.5% NaCl/6% Dextran 70 solution in the resuscitation of injured patients in the emergency room.
Animal studies and preliminary field patient trials suggest that hypertonic saline solutions can achieve resuscitation of hypovolemic shock with extremely small volumes. In the study reported here, we evaluated the effects of a hypertonic 7.5% NaCl/6% Dextran 70 (HSD) solution in the resuscitation of patients in the emergency room. Thirty-two patients were randomized into a prospective, randomized, placebo-controlled, double-blinded trial in which 250 ml of either HSD or, as a control, lactated Ringers (LR) was used as the initial fluid for resuscitation of patients with systolic blood pressures of 80 mmHg or less. ⋯ With the exception of one patient, the highest sodium concentration was 156 mEq/l, the highest chloride concentration was 126 mEq/1, and the highest osmolality was 401 mOsm/kg, and this value was obtained in a patient in the control LR group. Osmolality correlated far better with blood alcohol levels (Spearman's rank correlation coefficient = 0.81) than with any other variable, including sodium and chloride concentrations. The HSD solution was safe to use.(ABSTRACT TRUNCATED AT 250 WORDS)
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In-flight medical emergencies were evaluated among passengers arriving at Los Angeles International Airport (LAX) from October 1985 through March 1986. All emergency department, LAX first-aid station, and paramedic records were examined. There were 8,735,000 passenger arrivals at LAX during the study period; 260 passengers (0.003%) developed medical complaints in flight, and of these 260, 115 (44.2%) had symptoms that lasted for more than one hour. ⋯ Most of the illnesses encountered did not require advanced medical treatment. We conclude that while in-flight medical illnesses occur more frequently than believed by airlines, true emergencies are rare. The rarity of true in-flight medical emergencies coupled with low physician availability bring into question the benefit of any comprehensive medical kit on airliners.
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National attention has been directed to the problem of "dumping" of uninsured patients upon public hospitals. Federal law addresses only transfers of emergency room patients without regard to possible financial motivation. ⋯ Both the hospital and the physician responsible for the care of a patient who is transferred in violation of the law may be subject to Medicare sanctions, including termination or suspension from participation and fines up to $50,000 for each occurrence. Proposed regulations affirm that private practitioners who provide uncompensated emergency room services under an oral agreement may be subject to sanctions in the event of a violation.
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Data about the number and treatment of trauma-patients are, certainly in our country, very rare. In this study we showed that such a registration with grading of the severity of the injuries following the ISS-Score is feasible and useful. Further and more extensive registration seems necessary in order to obtain a better insight in epidemiology and treatment of trauma patients in our country.