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The use of tactical medics by members of hostage and crisis negotiations teams has not been examined in the literature or the field. Usually, negotiations teams are deployed within the confines of the established inner perimeter along with the tactical team and tactical medics. While the likelihood of injuries or performance degrading medical problems for negotiators is less than that expected for Special Weapons and Tactics (SWAT) team members, they may occur and need attention. Additionally, there are other roles that tactical medical personnel can play that are specific to the needs of police negotiators. This article will examine these possible roles.
A mass casualty disaster (MCD) never has occurred in the United States, but such an event remains a fearful possibility. The purpose of this study was to establish baseline information concerning the perceptions relative to the capabilities of the United States to respond to a MCD of persons most likely to involved in the responses to such an event when it does occur.
Methods:
A survey was constructed in 1995 to query the perceptions of persons in authority in federal, state, and local agencies who would participate in the medical responses to a MCD. Participants were asked to select the most likely scenario, a hurricane or earthquake, that could generate 30,000 casualties within their respective region. The survey requested respondent's perceptions as to the timing of the federal responses and the quality and sufficiency of these responses. The survey also sought information about the availability of plans to meet such a catastrophe in the region, and the frequency with which such plans have been exercised.
Responses were grouped by phase of the responses and whether the respondents were employed by federal, state, or local agencies. Descriptive statistics were used to summarize the data. When appropriate, a one-tailed t-test was used to compare the responses of the groups. A p-value = 0.05 was considered statistically significant.
Results:
A total of 104 surveys were distributed of which 88 were completed and returned (85%). Both the federal and state respondents had considerable experienced in this area.
Overall, the federal respondents were more optimistic about the availability, utility, and timely arrival of federal resources to assist regions in meeting the medical needs. In each of the three phases of MCD responses evaluated (medical response, patient evacuation, and definitive care), there was concern that there were insufficient resources to meet the requirements. States and local respondents perceived that initially, they will be on their own for field rescue, life-supporting first-aid, and casualty evacuation. Respondents acknowledged that a combination of local, state, federal, and private resources eventually would be needed to meet the huge demand. Only 31% federal and 26% state/local respondents believed that there will be sufficient combined local, state, federal, and private resources to meet the requirements for the evacuation of casualties to definitive care facilities outside of the region, and another 50% acknowledged the resources would only partially meet these requirements. Sixty-eight percent of state/local respondents believed that there would be insufficient local, state, federal, and private definitive care resources to meet the requirements for definitive care.
Conclusion:
While three years have elapsed since the survey was conducted and there have been some improvements in preparedness and responses, concerns center around the perceived lack of resource capability or lack of ability to get the resources to the MCD scene in time to meet requirements. Such perceptions by experienced professionals warrant further review by those at all levels of government responsible for planning and responding to mass casualty disasters.
In Ontario, Canada, Emergency Medical Care Assistants (EMCAs) have many opportunities for continuing education. However, little is known about how EMCAs learn.
Objectives:
The intent of this study was to explore the distribution of learning styles, preferences for major learning environment characteristics, and the associations between these two factors among the EMCA population in Ontario, Canada.
Methods:
Following review of the literature, a 32-item survey of learning environment characteristics was constructed to measure the respondents' preferences. Using a random number generator, 386 EMCAs were selected for participation. Each received: a) an explanatory cover letter; b) a copy of the Kolb Learning Style Inventory (LSI) questionnaire; c) a second questionnaire consisting of learning environment characteristics; and d) a stamped, return addressed envelope. Completed surveys were scored to determine the respondent's Learning Style. The LSI and Learning Environment survey results were entered into a data base and subjected to Dual Scaling analysis in order to 1) Identify the distribution of learning styles; and 2) Explore associations between styles and environmental characteristics.
Results:
A total of 75 completed surveys were returned, each of the four styles of learning (Converger; Diverger; Assimilator; and Accommodator) were identified in the sample. Dual Scaling analysis indicated a noteworthy association (R(jt) correlation >0.300) between learning style and 10 of the 32 environmental characteristics. The data describe the usefulness of each of the learning styles.
Accommodators believed courses with a strong emphasis on practical applications and working in groups to be very useful, but were less interested in courses with a strong emphasis on theory. Assimilators felt lectures and courses with a strong emphasis on theory very useful, but were less interested in providing input into course objectives. Divergers found that a lot of verbal explanation is useful, but were less interested in working with teachers who act as coaches. Convergers believed that working with teachers who act as coaches is useful. They also preferred courses with a strong emphasis on practical applications, but were less interested in courses with a strong emphasis on theory.
Conclusion:
The findings in this study, provide some additional insight into the connections between learning style and elements of the learning environment, and their application may contribute to operationalizing learning theory.
Theoretically, simulation of disastrous situations has many advantages in that it prepares hospital staff to cope with the real scenario. It is a challenge to create the database and custom-making a friendly software while still keeping it representative of a real situation. This article describes experience with developing and implementing the use of simulation software as a drilling technique used by Israeli hospitals.
Methods:
The application was developed using SIMAN/ARENA software. Knowledge and a database for a basic multi-casalty incident (MCI) were developed in the pilot phase. It contains detailed description of the casualties which can be compared with the real hospital capabilities (staff and infrastructure). A consensus committe decided the crucial model issues and estaalished the thresholds for quality performance indicators. Interfaces to the each hospital's information management systems (IMS) were developed and the various output documents of each exercised step were updated. Before drilling, the hospital managerial staff received notice and had to prepare the data on the anticipated resources required The simulation staff, as well as representatives from the hospitals, then conducted the limited scale drill (LSD).
Results:
During the LSD, the trained hospital staff were given two types of input: 1) copies of reports on patients entering the stations and had to enter them into its IMS; and 2) timed telephone notifications of problems in each station. During a 90 minutes drill, there were about 15 timely reports and 20 telephone problems. The evaluation of the LSD were based mainly on the following: 1) observing the staff solving various problems; 2) constructing a detailed picture of the situation; and 3) measuring the effectiveness of the hospital IMS. The drill ended with a discussion. Lessons are drawn from each drill in order to find methods for optimizing the conduct of the hospital. An animation tool proved to be useful in describing bottle necks in emergency room, diagnostic department, and operating rooms.
Conclusion:
Simulation techniques and a preparatory limited scale drill have advantages in evaluating and improving preparedness of hospitals for managing an MCI before a full scale drill is carried out.
Ambulance regulation in California is the responsibility of numerous agencies on the state and local levels.
Objective:
By identifying and analyzing the variety of programs used in one state, this study establishes a framework for evaluation of state and local regulatory programs elsewhere.
Methods:
This study surveyed all California local EMS agencies (LEMSAs: California's equivalent of regional EMS organizations) to identify the types of regulatory programs used, the foci of these programs (e.g., equipment and personnel), and their application (e.g., public and private providers). All data acquired were analyzed using population parameters rather than inferential statistics.
Findings:
A response rate of 100% was obtained. Among the regulatory tools used are ordinances, contracts, and franchises. Regulatory standards vary widely as do their applications. Large counties and those that operate their own LEMSA have more extensive regulatory programs than do smaller counties and those who participate in multicounty agencies. Many of the enforcement mechanisms available are weak.
Conclusion:
This study suggests several policy implications for California and other states. The wide variation in the types of regulatory programs and the standards that are used suggest that the purpose and impact of regulatory programs should be studied further. The decentralization of the ambulance regulatory program and the lack of integration of ambulance regulations into EMS system planning also raise policy questions. In addition, the role of multicounty EMS agencies, as it relates to regulation of ambulance services, should be reviewed.
This study addresses the paucity of literature on death education offerings in emergency medical services schools. The study examines the cadre of death education instructors in paramedic training programs. Examining death education offerings in paramedic programs can provide insight into how well emergency medical services personnel are prepared when encountering bereaved persons on death related responses.
Methods:
In an exploratory study, information was gathered from paramedic programs on the instructors who teach death-related education. A self-administered survey was sent to each (n = 537) paramedic programs in the USA. The survey solicited the number of instructors teaching death education, their backgrounds, and their formal training in death-related instruction.
Results:
The response rate was 45.4%. The majority of programs (78%) reported using a paramedic as the primary instructor to teach death-related content. Nurses (66%) and physicians (32%) also were utilized frequently. More than two-thirds (68%) of the responding programs utilize faculty members who have had no formal training in death and dying. Only one-third of the programs utilizes a multidisciplinary staff Less than 40% of responding programs teach all of their death-related curricula with instructors who are trained in death education.
Conclusion:
This study indicates that the majority of paramedic programs are not utilizing an instructor cadre that is formally trained in death education, nor are they using a multidisciplinary staff. Reasons for using these instructors to teach death education in paramedic programs are discussed.