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This study explores the value of Emergency Medical Services (EMS) experience for students applying to medical school. Methods: Surveys were sent to 67 medical schools in the eastern United States and Canada. Using a five-point Likert scale, the survey asked the respondent to rate the amount of consideration given to Emergency Medical Technician (EMT) or paramedic experience when making admissions decisions (1 = very little to 5 = strong), and to describe the influence of that experience (1 = very negative to 5 = very positive).
Results:
Usable responses were received from 21 schools. The median rating for the consideration given to EMS experience was “some consideration” for both EMT and paramedic experience, with 85.7% of respondents assigning that rating or higher. The median rating for the influence of that experience was “somewhat positive” for both EMT and paramedic experience. Only 14.3% of the returned surveys rated EMS experience as “neutral”, and no respondent reported EMS experience as a “negative”.
Conclusion:
EMS experience receives at least some consideration during the admissions process at most of the responding institutions in the United States and Canada. Experiences at either the EMT or Paramedic level are viewed similarly. None of the responding institutions viewed EMS experience negatively.
A mass-casualty situation (MCS) usually is short in duration and resolves itself. To minimize the risks to patients during MCS, planning is essential. This article summarizes the preparations needed at the hospital level, for a local MCS involving numerous trauma victims arriving to the Emergency Department at a short notice. Experiences and conclusions related to the implementation of the Israeli strategy in one hospital that combines the responsibilities of both the military and civilians are summarized.
The Ministry of Health distributes the master MCS plan to each hospital where a local committee adapts it to the specific situation in a format of standing orders. After its approval by the Ministry of Health, an annual inspection is conducted to check the ability of the staff to manage a MCS. A full-scale drill is conducted every second year during which each site's readiness level and the continuity of the flow of care are tested.
In building the strategy for treating trauma victims during a MCS, a few assumptions were taken into account. The goal of treatment in a MCS is to deliver an acceptable quality of care while preserving as many lives as is possible. In theory, the capacity of the hospital is its ability to manage a load of patients in the range of 20% of the hospital bed capacity. Planning and drilling are the ways to minimize deviations from the guidelines and to avoid management mistakes. Special attention should be paid to problems related to the initial phase of receiving the first message, outside communication, inside hospital communication, and staff recruitment. Other issues include: free access to the hospital; opening a public information center; and dealing with the media and very important persons (VIPs).
A new method for creating the needed MCS plan in the hospital is suggested. It is based upon knowledge of management techniques that used multi-level documents, which are spread via Intranet between the different key figures. Using this method, it is possible to keep the strategy, the source documentation, and reasons for choosing it, as well as immediate release of checklists for each functions. This detailed, time consuming work is worthwhile in the long run, when the benefits of easy updating and better preparedness are apparent.
On 21 September, 1999, an earthquake measuring 7.3 on the Richter scale, struck central Taiwan near the town of Chi-Chi. The event resulted in 2,405 deaths and 11,306 injuries. Ad hoc emergency medical assistance teams (EMATs) from Taiwan assumed the responsibility for initiating early assessments and providing medical care.
Objective:
To determine whether the EMATs served a key role in assisting critically injured patients through the assessment of number and level of hospitals responding, training background, timeliness of response, and acuity of patient encounters.
Methods:
Local and national health bureaus were contacted to identify hospitals that responded to the disaster. A comprehensive questionnaire was piloted and then, sent to those major medical centers that dispatched EMATs within the first 72 hours following the quake. In-depth interviews also were conducted with team leaders.
Results:
A total number of 104 hospitals/clinics responded to the disaster, including nine major medical centers and 12 regional hospitals. Each of the major medical centers/regional hospitals that dispatched EMATs during the first 72 hours following the quake were surveyed. Also, 20 individual team leaders were interviewed. Seventy-nine percent of the EMATs from the hospitals responded spontaneously to the scene, while only 21% were dispatched directly by national or local health authorities. Combining the phases of the disaster response, it is estimated that only 7% of EMATs were providing on-site care within the first 12 hours following the earthquake, 17% within <18 hours, and 20% within <24 hours. Thus, 80% of these EMATs required >24 hours to respond to the site. Based on a ED I-IV triage system (Level-I, highest acuity; Level-IV, lowest acuity), the vast majority of patient encounters consisted of Level-III and Level-IV patients. Fewer than 16% of teams encountered >10 Level-I patients, and <28% of teams evaluated >10 Level-II patients.
Conclusions:
1. The response from EMATs was impressive, but largely uncoordinated in the absence of a pre-existing dispatching mechanism.
2. Most of the EMATs required >24 hours to reach the disaster sites, and generally, did not arrive in time to affect the outcome of victims with preventable deaths. Therefore, there is an urgent need to strengthen local prehospital care.
3. A central governmental body that ensures better horizontal and vertical integration, and a comprehensive emergency management system is required in order to improve future disaster response and mitigation efforts.