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Optimal, initial medical care given at the disaster site to victims of civil disasters requires an organized, pre-planned, disaster-site medical support system. Such a system has been developed in Singapore.
On notification of a serious civil disaster, the Coordinating Health Agency (CHA) initially dispatches up to three medical teams. Each team consists of two doctors, four nurses, and an allotment of pre-packaged medical supplies. A Disaster-site Medical Command (DSMC) head-quarters (HQ) is established, consisting of a Medical Commander (MC), a Deputy Medical Commander (Dy MC), three hospital staff, and a clerk. The MC conducts an initial assessment of the disaster site and then deploys medical teams and establishes the headquarters. The MC also informs the CHA (via cellular telephone) of the situation at the disaster site and when deemed necessary requests further medical assistance.
The MC has two-way radio contact with all medical teams. The medical teams relay information regarding the casualty situation, requirements for ambulances, stretchers, and medical supplies. Direct channel communication with the CHA enables the MC to direct ambulance transport of patients from the disaster site. The MC also has operational control over other paramedical teams from the Fire Service, the Singapore Red Cross, and the Singapore Armed Forces. Prior to transportation to the hospital, the medical teams only carry out trauma resuscitative procedures such as maintenance of airway, ventilation, and circulation.
This system is expected to provide a coordinated and rapid medical response to a civil disaster situation.
The purpose of this study was to determine whether shorter prehospital scene time (ST) is associated with an increased survival rate in non-traumatic, out-of-hospital, cardiac arrest (CA) in a medium-sized, metropolitan EMS system. Information was retrieved for all adult victims (age ≥18 years) of CA treated and transported by a metropolitan fire department over a 16month period (6/87–9/88). Data were retrieved from the fire department's database, hospital records, and death certificates. Statistical analysis of continuous variables was performed using the two-tailed, Student's t-test and non-parametric evaluations were performed by square analysis with p<0.05 considered significant. Two hundred ninety-eight cases were recorded of which 293 patients (98.3%) had documented ST (study group). Seventy-nine patients (27.0%) had ST <12 minutes, while 214 (73.0%) had ST≥12 minutes. Patients with ST <12 minutes were more likely to have return of spontaneous circulation in the field (26.6% vs. 15.9%, p<0.05) and also were more likely to survive than were patients with ST ≥12 minutes (13.9% vs. 6.5%, p<0.05). Mean ST for survivors was significantly less than for non-survivors (12.8 vs. 15.3 min., p<0.05).
We conclude that, in our system, adult victims of CA with ST <12 minutes are more likely to survive than are patients with longer ST. In addition, the mean ST for survivors is shorter than for non-survivors. It remains unclear whether shorter ST actually has an impact on survival or is merely a reflection of a sub-group with rapid resuscitation and consequently a higher likelihood of survival. Future investigations are needed to determine whether shorter ST actually impacts the likelihood of survival from CA.
To investigate the relationship between age and Advanced Life Support (ALS) utilization.
Population:
All patients from 1 January 1987 to 31 December 1988 transported by ALS ambulances within Lebanon County, a rural/urban county of 112,000.
Methods:
All runs resulting in patient treatment by ALS personnel were tallied at five-year age intervals and sub-grouped by trauma- and non-trauma-related calls. Utilization rates for each age group were obtained by dividing the calls by the population of each group. Correlation with age was tested by Spearman's rank correlation. Treatment rates for age groups were calculated for the six most frequent medical etiologies. To illustrate the effect of age distributions, age rates were applied to projected state and national population distributions.
Results:
There was a significant correlation with age for all transports (p < .01; r=.93) and for those not related to trauma (p<.01; r=.98). Correlation was not detected for trauma-related responses (p>.10; r=.19). Non-trauma-related case incidence varied among age groups, ranging from 1.1/1,000 for age five through nine years to 89/1,000 for age 80–84 years. Congestive heart failure, cardiac ischemia, syncope, myocardial infarction, and cardiac arrest evidenced increased incidence with age. Seizure did not. Older populations had a higher projected utilization of ALS services than did the younger age groups.
Conclusion:
Non-trauma ALS utilization is highly dependent on the age of the patient. Due to projected aging of the population and increased utilization of ALS by the elderly, projected utilization will increase at a rate faster than will the population. Age:rate data can be combined with population projections to estimate future need.
Resuscitology is the science of reanimation from apparent death or from unconsciousness. Prior to the last quarter of this century, resuscitation was steeped in myth, supported only by anecdote, and founded on unphysiologic principles. The development of new, scientifically based, modern concepts and practice of cardiopulmonary resuscitation (CPR) injected great hope into improving the chances for survival and quality of life for cardiac patients.
Recent reports indicate that there are nearly 70,000 “successful” cardiac resuscitations annually. However, it is estimated that only 10% are able to resume their former lifestyles. It is anticipated that with the expansion of prehospital emergency medical services, this proportion will increase. These facts have stimulated intense research aimed at elucidating the pathophysiology of cellular death with the goal of protecting the brain during cardiac arrest.
Report forms are used by Emergency Medical Services (EMS) systems for documentation of services provided and for self-analysis of EMS functions. Although the EMS Systems Act of 1973 originally intended for the development and implementation of a uniform EMS report form, items recorded on EMS forms vary throughout the United States. We review the governmental sponsored development of a recommended minimum data set (MDS) for EMS forms performed in 1974, and discuss areas of needed investigation regarding data set development and usage. The concepts used to develop the recommended MDS provide a useful resource for review of the purpose and content of one's own EMS report form. However, future data set development and applications should use outcome measure guided data set selection, on-line validation of data item accuracy and recordability, psychometric analysis of the process of form completion, and incorporation of new data entry and storage technology.