Last updated 10th July 2024: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website https://www.cambridge.org/news-and-insights/technical-incident
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
This journal utilises an Online Peer Review Service (OPRS) for submissions. By clicking "Continue" you will be taken to our partner site
https://mc.manuscriptcentral.com/pdm.
Please be aware that your Cambridge account is not valid for this OPRS and registration is required. We strongly advise you to read all "Author instructions" in the "Journal information" area prior to submitting.
To save this undefined to your undefined account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your undefined account.
Find out more about saving content to .
To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Controlled mechanical ventilation using positive and expiratory pressure (PEEP) is a well-established therapeutic measure in intensive care. Its early application has been shown to markedly decrease morbidity and mortality, especially in polytraumatized patients with an acute respiratory distresss syndrome. It therefore seems reasonable to use positive end expiratory pressure as early as possible in the clinical treatment of emergency patients before extensive pulmonary changes have had time to develop completely.
There exists strong sentiment, among emergency medical personnel and physicians alike, that the pneumatic anti-shock garment (PASG) “saves lives.” As a result, controlled studies have been criticized as the “withholding of important therapy.” The purpose of this presentation is to confirm the need for controlled clinical trials of the PASG. Despite an early report that the PASG offered no advantage in terms of the presenting emergency center Trauma Score (TS), similar disparagements have continued, particularly because survival data were not discussed. The present report is a pilot analysis of the effect of the PASG on the prehospital survival of patients arriving at an urban trauma center in the United States. In the study, sixty-eight patients were assigned randomly to control and PASG groups in a prospective investigation involving injured patients with systemic hypotension. The 32 control patients, whose mean initial systolic blood pressure (BP) was 59 ± 32 mm Hg, and the 36 PASG-treated patients, whose mean initial BP was 55 ± 31 mm Hg, were found to be well matched for age, sex, type and location of injuries, initial field TS; response, field management, and transport times; and the total amount of intravenous crystalloid infused. The results demonstrated no significant difference between the control and PASG-treated groups in terms of those pronounced dead on arrival at the trauma center (9/32 vs. 10/36). Further studies are therefore justified to determine how the PASG affects the long-term morbidity and mortality of injury victims, particularly those within certain sub-groups such as penetrating abdominal versus those with penetrating thoracic injuries. This report reaffirms the need for early responsible, scientific scrutiny of prehospital interventions.
This brief examination of casualty patterns suggests that differences may exist in the numbers of immediately dead and critical patients, depending on the nature of the disaster. More data must be collected from future disasters to more accurately define relationships between critical patients and total numbers injured. Such characterization is essential for hospital disaster planning because critical patients require great resources and optimal hospital functioning.
Knowledge of casualty patterns can make disaster planning more practical, disaster drills more realistic, and disasters less disastrous.
Perfluorochemicals (PFCs), which are also known as fluorocarbons or perfluorocarbons, are chemical substances having a high solubility for respiratory gases. At 37 degrees Centigrade pure PFCs can dissolve very large quantities of oxygen and in some instances this may amount to as much as 50 volumes %. These substances are however immiscible with blood and if introduced into the circulation in an unmodified form could cause embolic phenomena. In order to be of use as oxygen carrying blood substitutes, they are therefore emulsified in a solution containing glucose, electrolytes and an osmotic agent.
The Falkland Islands conflict in the South Atlantic once again drew attention to the paramount importance of making adequate plans for the treatment of the sick and wounded, and their subsequent removal from the battle area. The pages of history are littered with accounts of battles, and in some cases wars, being lost because of the inadequate or non-existent plans made to give logistic medical support to the fighting units
There is controversy over the “ideal” electrical energy needed for defibrillation. Furthermore, too massive an electrical shock decreases the possibility of survival by direct damage to an already ailing myocardium and too little energy results in further deterioration of myocardial physiology and metabolism. Therefore, delivery of an erroneous amount of electrical energy decreases the likelihood of successful defibrillation and survival. All 190 defibrillators within 3 medical school hospitals were investigated. Each defibrillator was analyzed at four selected settings ranging from 100-400 Joules (J). Only 29 of 190 defibrillators delivered 100% of the energy selected, while 161 of the 190 (85%) delivered an average of 74% of the energy selected. This discrepancy between selected and delivered energy should be corrected by regulations and standards for manufacturers.
One of the most serious bottle-necks in the discussions concerning the medical disaster relief is the lack of any uniformity of the concept “Disaster.”
In the summary of the International Congress on Disaster Medicine (Mainz 1977) (1) we can read “The definition of a disaster. This question hung over many of the discussions of the Congress. Several speakers drew attention to the fundamental differences between relief services for an air or train crash and those for an earthquake or flood. Armed conflicts can present different problems again which in themselves vary enormously. While numbers of victims were submitted as a basis for one classification, numbers alone are not enough.”
The term mitigation is often mistaken for litigation, and they are not entirely divorced. What we really mean by mitigation is reducing impact. The activity of early warning and the activities of preparedness planning as well as many other pre-disaster activities certainly have that effect. However, in the engineering, architecture, and planning sense, what we mean by mitigation is the reduction of impact of natural phenomenon primarily on buildings and facilities used by people. For that reason we will be focusing primarily on building related disasters; that is, disasters which effect people through building or constructed facility failures. Those failures are primarily related to the natural hazards of earthquakes, floods, and winds, a somewhat different selection from those which you deal with in terms of emergency medical services.
In Emergency Medicine the need for information is vital.
Our experience is mainly concentrated in the use of computers in the Intensive Care Unit (ICU), the Laboratory and the Anti-Poison Center. We have gained experience with several different types of computers: Personal computers, interfaced with analytical instruments and equipped for graphic representation, have been used in the ICU and the Laboratory. In the Anti-Poison Center terminals connected to a main frame with virtually an unlimited memory and capacity allows the storage of a large amount of data and the performance of complex permutations.
The first emergency department in Hungary was established in Hetenyi Geza County Hospital in 1976. It was organized as part of a research program commissioned by the Ministry of Health. Initially, the hospital had 1400 beds which have now increased to 2,000.
The Emergency Department is located on the ground floor of a new building and occupies 1,100 square meters of surface. The operation of the department is divided into three main areas.
I plan to cover several subjects. First I will speak briefly about a definition of law, although I am fairly certain this kind audience understands a good deal about law. I will then indicate my basic thesis. After that I will review some disaster legislation of two states in the United States that addresses legal considerations relevant to events that occur during major disaster situations. Following that I will make some proposals about how some of the concern about the legal issues can be alleviated, particularly on a worldwide basis. Finally, I hope to provide you with a frame of reference for further consideration of legal matters.
Dangerous situations, violent incidents and accidents are part of our existence, are part of the reality and the conditions under which we exist as human beings. We can do much to limit the possibilities of accidents happening, but we cannot avoid them. It is a fact that we must ascertain and accept that accidents happen. It is not a question of “IF” but “WHEN”.
Within aviation we also have to face the fact that dangerous and stressful situations occur—and when accidents occur within the field of aviation, the consequences are often grave.
A tremendous impact can be made on prehospital care by Emergency Department nurses, and whether that impact is positive or negative depends on the groundwork that has been laid for the prehospital program. If the program is based on the team concept, with all members having the same goal to provide the highest level of patient care possible, then nursing can have a very positive impact. The key phrase is “include nursing,” in all aspects of the program planning and operation. If nurses are excluded, they can hardly be expected to be part of the team, when they haven't even been told the game plan. A survey of Emergency Department nurses from hospitals that range from University teaching facilities to small rural hospitals was conducted. The survey focused on two areas; the first dealt with the degree of nursing involvement in the prehospital program, and the second addressed nurses' attitudes toward the program.
I want to first talk about search and rescue as it occurred in Mexico City; secondly, about what we learned in Mexico City; where are we going from there; what are some of the things that are happening and should be happening in major disaster management, especially as it deals with search and rescue.
There are four main phases in search and rescue. Those four phases are: First, you have to locate the victims; second, you have to reach the victims; third, you need to stabilize those victims; and fourth, you need to evacuate them. I'm going to deal primarily with locating the victims because that was my main responsibility, coordinating the search aspect in Mexico City.
Throughout history complications of military trauma and in particular infection, have been responsible for countless deaths and other serious morbidity. In fact in major conflicts in the not too distant past, deaths from infection of battle wounds have almost equalled the number of deaths from the enemy action itself. It is obviously a tragic and avoidable situation and one that surgeons can be directly instrumental in removing.
Unfortunately, we are guilty of not learning from the lessons of history. Every major conflict brings either a new surgical technique or therapeutic aid which tempts surgeons and physicians alike to ignore simple principles of military surgery, and by their treating these wounds incorrectly, creates a whole new chapter of iatrogenically induced mortality.
Because of its relatively sophisticated infrastructure and the direct and indirect assistance rendered to neighboring states, this paper concentrates on South Africa and those factors which influence the development of Emergency Medical Services on the sub-continent.
Renowned for its scenic beauty, its natural resources, wild life, flora and generally attractive climate, South Africa is a country about two thirds the size of the European Economic Community and approximately one eighth the size of the United States with a population of over 25 million. The current worldwide interest in its internal affairs underlines its mixture of first and third world status and the unique complexity of its society.
The needs of the poorer sections of the community, the usual diseases prevalent among the more affluent, coupled with one of the world's worst road accident records stimulate demands for good Emergency Medical Services.