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In early 1975, H.J. Heimlich demonstrated external compression of the diaphragm as a first-aid measure in the event of threatening death by suffocation.
A controversial debate developed in the ensuing years. What speaks in favor of the so-called “Heimlich Maneuver,” which should be applied only when:
• the foreign substance sits too deep or too tight to be removed by other means; and
• the trachea is completely closed by the foreign substance and breathing has ceased entirely,
is the dramatic situation which leaves a helper only a few minutes to save life in view of imminent unconsciousness and threatening hypoxic cardiac arrest.
What speaks against applying the maneuver are possible lesions of the intrathoracic organs (including fractures of the osseous thorax) and ruptures of internal organs, also the application without an existing indication or inadequate mastery of the manipulation.
The objective of this study was to evaluate a school Trauma Awareness (TA) program conducted by the Health Education Center (HEC) of Pittsburgh, Pennsylvania under contract with the Emergency Medical Services (EMS) Institutes. A total of 44 presentations were made before 3545 persons dealing with school children in seven counties of western Pennsylvania. The TA program was undertaken because: l) the leading cause of death among school-age children in the USA during the 1970s was accidents, 60% of which occurred on school premises or going to and from school; and 2) there was a need for improvement of EMS in the local schools.
Shock appears to complicate acute myocardial infarction (AMI) more often during the hot summer in Kuwait, than it does in winter. The aim of this study was to define the forms of shock, investigate its frequency, and evaluate the effects of fluid therapy.
Material and Methods
In a 3 month period during the hot summer of 1980, 21 shock patients (pts.) (18 male, 3 female) with AMI were studied. Their average age was 55 years (yrs.) (range 30–82), all had definite AMI (18 anterior, 3 inferior) and at least 3 known criteria of shock. Observations were made for 24 hours (hrs.) in the CCU, within one hour of admission. Initial hemodynamic pressures were obtained and hemoglobin (Hb), hematocrit (Hct) and serum glutamic oxaloacetic transaminase (SGOT) on blood samples were estimated.
The purpose of first aid remains the same through the ages: to prevent pain, disease and death. But the need is different in different places and at different times.
It should not be forgotten that in large parts of the world the most immediate threat to human life is starvation and malnutrition, together with lack of hygiene and basic medical care. The kind of first aid most needed under such circumstances is food and medicine. The key to a long-term solution is education in self-help. The prosperity and experience of the Western world must, in the future, be used more systematically to booster development towards self-sufficiency in the less developed countries. These are most important aspects that should be dealt with more often. The time frame of this article forces me to concentrate on conditions in the industrial world.
Resuscitation in the prehospital phase is feasible. As intensivists, however, we know that many cases could reach our intensive care units (ICU's) in far better condition if prehospital care were improved. We have learned from feedback on our cases in the unit that we physicians are indeed the best prepared specialists for fast and efficient intervention outside the hospital. Diagnosis and, hence, titrated therapy are more and more transportable and, under acute conditions, it is often safer to transport medicine to the patient, rather than the patient to medicine. Technological problems are no longer an excuse for the doctor to refuse to go to the scene.
An Approach to First Aid Programming: The Yugoslavian Red Cross Society has had the unique opportunity to design, develop and commence implementation of a full National First Aid Service. The program is divided into four areas: (1) first aid skill components of existing programs; (2) student training courses; (3) leadership courses; and (4) public education. The movement toward a National First Aid Service has been rapid. The radical change in delivery systems, principles upon which the program is built, and the overall philosophy are recognized as potential risks but ones well worth taking.
Airway Intubators are obtainable from Williams Airway Intubator Limited, 405–206 7th Avenue S.W., Calgary T2P0W7 Canada
The Airway Intubator serves two purposes: as an oropharyngeal airway and, should the need arise, an endotracheal tube can be passed through the center of the airway intubator into the trachea without the need for further instrumentation.
Sykes, in 1937, described a divided airway made of aluminum; following the introduction of the endotracheal tube, both halves of the airway were removed leaving the endotracheal tube in place. A plastic airway, as designed in the 1970's by Berman, consisted of a tunnel along its whole length so that an endotracheal tube was compelled to follow this pathway.
With the advent of plastic endotracheal tubes with a relatively fixed radius of curvature, the airway intubator has been more successful than its predecessors, both as an oropharyngeal airway and as a means of intubating the trachea.
The International Civil Defense Organization (ICDO) is helping a large proportion of the Third World Countries where Civil Protection is considered, promoted and organized as a State Service, an obligation of the Authorities toward the population to save it from the devastating effects of a natural or technological disaster or the after-effects of a serious accident. The absence of the industrialized countries within the ICDO has not prevented the poor countries from developing a protection and safety system within the Technical Cooperation Program of ICDO, by their own efforts and with their own resources. The system is based on intervention units, which although sometimes in their embryonic stages, are already capable, however, of administering emergency first aid. Hence the keen interest of those countries in resuscitation techniques.
In essence, the United Nations Organization was born out of disaster to avert disaster. Be they the work of nature or of man, catastrophic emergencies are not rare occurrences and all studies indicate that they are increasing in frequency and severity.
Within the international community, the UN and its component organizations is only one of the three principal partners in disaster relief. The other are the Non-Governmental Organizations (NGO) – including the Voluntary Agencies (VOLAGS) – and the bilateral donor countries. Collaboration among these sectors is vital if international action is to be effective.
This article deals with the UN System only, and in particular with the role of the World Health Organization (WHO) in disaster relief and preparedness.
In fluid therapy, colloid plasma substitutes are especially suitable for emergencies and mass disasters because they can be obtained in unlimited quantities and can be used immediately.
The initial volume effect is greater than that of Gelatin or HES 40 but is much weaker than 10% Dextran 40. In this respect, HES 200/0.5 is comparable with 6% Dextran 70. The volume effect of HES 200/0.5 lasts for about 3 hrs and thus is comparable to Gelatin, HES 40 or 10% Dextran. Six percent Dextran 70, however, lasts for 6–8 h. Ten percent HES 200/0.5 is more easy to regulate.
Hydroxyethyl starch does not influence the coagulability to the extent that can occur with Dextran.
Anesthesia in disaster medicine, especially as practiced in developing countries, is fundamentally different from the anesthesia that is practiced during normal situations. Anesthetic procedures suitable for disaster situations must often take place under minimal conditions of instrumental availability and in a setting of less than modern technology. Such conditions, of course, limit the use of inhalatory anesthetics.
The key factor present in disaster situations is the disturbed relationship between the number of injured, on the one hand, and the available resources to treat them, on the other. This includes medical personnel—both professional and para-professional. This has been substantiated by the earthquakes in Iran, Guatemala, China and Turkey. The earthquake which occurred in Tabas, Iran in December 1978, for example, lasted only thirty seconds, but left behind more than 20,000 dead and countless thousands of injured.
The quick re-establishment of communications is vital to all disaster relief operations, but simple effective means of doing so are usually lacking. The unpredictability of the type, time, and location of catastrophic or disaster events requires a communications capability which is mobile, versatile, and dependable under all conditions of weather and terrain. Similar needs are essential for emergency medical services and search and rescue operations. These are problems without national boundaries.
The title of my paper, Area Disaster Planning in the UK, is perhaps grandiose. However, while the need for disaster planning at hospital level is well-recognized, few studies have been published on the results of getting a number of hospitals in a metropolitan area to co-operate in planning on a larger scale.
Following a series of railway accidents, the Ministry of Health in the UK issued a memorandum in 1954 to hospitals in the National Health Service on the arrangements hospitals should make for dealing with major accidents. The main points of this memorandum were that ambulance authorities should be told which hospitals in an area were able to receive casualties; that suitable hospitals should send a senior doctor to the site together with mobile medical teams; and that one doctor at a hospital should be in charge of all the medical arrangements.
The development of emergency medical services (EMS) systems in the United States, incorporating various levels of sophistication in prehospital care and echelons of capability in hospital resource availability, has brought new connotations to the word “triage” (sorting).
Heretofore, triage consisted entirely of estimating treatment needs so that prioritized transfer of patients could be made to hospitals. The decision is no longer binary, since the introduction of Trauma Centers requires the triage decision maker to not only decide which patient first, but also which patient to which hospital. Clear cut decision rules for this process applied to routine civilian emergency medical practice have yet to emerge.
For more than 20 years, our company has had the pleasure of working closely with medical authorities and active first aid organizations in many countries for the teaching and practice of life-support. The access thus gained by experience in the field permits me to present the following status report of CPR teaching of the populations in North America and Western Europe.
History
Before 1960, little or no life-supporting treatment was given to the seriously injured or acutely ill prior to arrival at the hospital. First aid was largely limited to dressing wounds and splinting broken limbs. The ambulance at that time merely served as a means of fast transportation.
The goal of critical care medicine is to provide specific care to the patient in whom one or more vital systems are threatened or deficient. The methods of critical care medicine are monitoring, support or temporary substitution of vital systems, and the application of titrated therapy. The specific objective of each link in the chain of medical facilities involved with the critical patient deserves to provide the same expertise and should act according to the same protocol.
The different links of the chain are these: (l)recognition of the critical condition; (2) emergency call; (3) care on the spot of the emergency; (4) care during transport; (5) further diagnostic and therapeutic work in the emergency department; and finally (6) if indicated, continued intensive care.
The effectiveness even of the best organized emergency medical services (EMS) system depends on the level of knowledge and the abilities of those persons who are the first at the scene. Only on few occasions will that be a physician specialist in resuscitology. So it seems necessary to educate and train laymen, medical students, and physicians in life saving methods. This should be done in a uniform way concerning organization and contents. In the German Democratic Republic (GDR), we try to perform this task on a nationwide basis.
On March 28,1979, a near nuclear catastrophe occurred at Three Mile Island (TMI) near Harrisburgh, Pennsylvania, USA. I was at that time Pennsylvania's Secretary of Health. It was an accident that just “could not happen.” After all, nuclear power plants were built so safely that they could not possibly affect public health.
As a physician, lam compelled to say that I am unalterably opposed to nuclear warfare. I am sure that most physicians would agree that there can be no adequate preparedness for the devastating medical consequences of nuclear war. Prevention of nuclear war is the only reasonable medical response to the hazards posed by nuclear weapons.
By contrast, many of you may not share my position on nuclear power. Nuclear power can be made relatively safe if we do not ignore the public health lessons of the past. I belive that physicians need to increase and update their understandings of the medical consequences of radiation accidents and be trained to triage and to treat blast, radiation, and burn injuries.
The River Ogunpa flood disaster was an event which created difficulties from every conceivable angle and provided many of the problems to be experienced in disaster management generally. It should be emphasized that every state hospital should have a disaster plan so that one could assume that it is adequately prepared for major accidents. Some of the teaching hospitals in Nigeria have disaster plans. However, the mere presence of a paper plan did not guarantee that it was up to date, comprehensive and understood by all staff concerned, in some of the major disasters which recently occurred in Nigeria. This article highlights some of the major natural and man-made disasters in our country, the magnitude of the damage done, factors affecting the response of the nation to the disasters, as well as some of the major deficiencies in our disaster plans.
Tertiary care for critically ill children requires a safe, efficient transport modality designed for the pediatric patient. This system should be capable of delivering mobile intensive care en route after resuscitation and stabilization at the sending hospital.
In July 1979, a Pediatric Emergency Transport Service (PETS) was organized at The Children's Hospital, Denver, to provide physicians of the Rocky Mountain-Plains Region with the capability of triaging pediatric nonneonatal patients to three Denver Pediatric Intensive Care Units (PICU's). The components of the system included: (1) a transport team comprising of a medical attending-director, twelve transport physicians including nine pediatricians, two anesthesiologists and one surgeon, six pediatric transport nurses, six pediatric transport respiratory therapists, and four emergency medical technicians; (2) a communication dispatch system; (3) an answering service with Wide Area Telecommunications Service capability; (4) an equipment depot within the PICU at The Children's Hospital; (5) a complete dispatch log; (6) a continuing education and information system for the team, providers, consumers and health planners; (7) a cost and administrative center with established billing procedures and support services; (8| management, drug and equipment protocols, and (9) specifically designed air and ground ambulances which are owned and/or leased by The Children's Hospital.