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“The Club of Mainz for Improved Emergency and Disaster Medicine Worldwide” was founded in 1976 by ten concerned resuscitologists from seven countries under the leadership of the late Rudolf Frey, who then was Chairman of the Department of Anesthesiology at the Johannes Gutenberg University in Mainz, West Germany. The Club was founded because the potentials of modern resuscitation and life support are not realized in most everyday emergencies and natural and manmade disasters throughout the world. The idea was initiated in discussions between Frey and Safar during the International Symposium on Advanced Emergency Medical Services (EMS) Delivery Systems in Mainz in September 1973.
From the Medic Alert Foundation International, PO Box 1009, Turlock, CA 95381 USA.
Medic Alert Foundation International is dedicated to the thesis that one universally recognized symbol of emergency medical identification will best serve all people. This is why Medic Alert conducts an active program to expand its services internationally.
Volunteer groups in 17 countries presently provide Medic Alert services to over 1.7 million people worldwide. The Foundation's purpose is to give a lifetime of fast reliable protection for a modest, one-time fee. Medic Alert is a non-profit, tax-exempt and charitable organization.
The volunteer organizations in these 17 countries are affiliated with the international headquarters in the United States, but each is autonomous in providing protection to the people of its nation. National boards and staffs actually deliver the total services to their members within their country.
Rudolf Frey, known as “Rolf“ in Europe and “Rudi” in America — a leading star of anesthesiology, emergency medicine and disaster medicine — has ended his life's struggles. He influenced many lives positively. His years were rich with experiences and contributions.
Surgery and anesthesiology were his base specialties. Alone, these fields would have been too narrow for him. He initiated the first professorship of anesthesiology in Germany at the University of Heidelberg in the 1950's; the first autonomous university department of anesthesiology in Germany at the Gutenberg University of Mainz in 1960; the journal Der Anaesthesist, the first textbook of anesthesiology in German; one of the first physician-staffed advanced life support ambulance and ambulance helicopter services in Europe; numerous training programs, symposia and congresses; and the Club of Mainz and its associated monograph series Disaster Medicine, originally published by Springer-Verlag.
The pathology of mixed injuries resulting from simultaneous action of several damaging factors on the organism is still insufficiently known. Peritonitis is the most frequent complication of injuries to the abdominal organs. Co-existence of peritonitis with radiation sickness impairs considerably the results of therapeutic management and prognosis. Surgical treatment is indicated in the latent period of radiation sickness or only in the period of recovery. In the case of diffuse peritonitis, the time of performing the operation is of essential importance for the prognosis. The purpose of the reported investigations was the study of the effect of ionizing radiation before exposure of the organism on the course of diffuse peritonitis and a trial of prolonging with an antibiotic the preliminary stage of the disease in which surgical treatment is effective. Investigations were carried out on 160 male Wistar rats weighing 250g on the average, divided into five groups. Group 1 served as control. In Group 2, the rats were only exposed to radiation.
The American Heart Association is a voluntary health agency with approximately 100,000 members. It has affiliate offices in every state and in major cities throughout the country. The primary objective of the organization is to decrease and eventually eliminate disability and death from cardiovascular disease. This is accomplished through three general areas of program responsibility, namely support of research, community programs, and public and medical education. Its financial support is derived from public voluntary contributions.
There are close to one million deaths in the United States annually from cardiovascular disease, which include over 640,000 heart attack victims. Those of us working in the area of heart disease regard the problem as one of catastrophic proportions, and in fact, “disaster medicine.” With the cause of most cardiovascular diseases unknown, special emphasis is placed on research. However, the American Heart Association also has a responsibility to impart to the medical profession, and the public at large, what knowledge is known. Therefore, a great deal of emphasis is placed on prevention, particularly how it relates to heart attacks.
Our hospital which was initially devoted to deal with specialized branches of medicine, was rapidly transformed into a purely military one when mass casualties of war needed care. The design of the hospital was therefore changed. Operating theaters were shifted to safe underground floors. Intensive care units were placed near the operating theaters, and a large reception-identification area was prepared to receive victims brought by ambulance or helicopter. Quick-sorting of casualties according to priorities was dealt with in the reception area.
(1) Immediate group: This was dealt with on the spot by quick resuscitation measures. (2) Urgent group: These were immediately taken to the intensive care units or to the operating theaters. (3) Expectant group: These were taken to the wards.
Introduction: Although the hemodynamic superiority of open chest cardiopulmonary resuscitation has long been recognized, its advantages with respect to the brain have only recently been investigated. Yashon demonstrated the ability of open chest CPR to maintain EEG activity during prolonged resuscitation. Alifimoff showed improved cerebral reco-very in dogs after open chest CPR. Byrne has demonstrated that internal cardiac massage can provide nearly normal cerebral blood flow in dogs as opposed to the 30% of normal seen during standard CPR, which consists of 60 chest compressions per min with a ventilation interposed after every fifth compression and 50% compression duration.
The Netherlands, due to its density of population (415 residents per square kilometer) has ambulance services organized under municipal and district health departments (emergency services) or private services (routine transportation). The law requires that each patient be reached by an ambulance within 15 minutes everywhere in the country.
Emergency services are generally performed by the health departments, whereas more routine patient transport is carried out by private firms. In the Netherlands, it is usual that emergency complaints are first directed to the family physician who makes further decisions concerning the use of ambulance services. All ambulance services are coordinated from central district ambulance posts.
Our ability to manage disaster relief activities at regional, national or international levels of socio-political organization has, according to many analysts, not kept pace with the knowledge and technical capability presently available to contend with disasters. In a report released in 1977 a panel of experts assembled by the United Nations Association characterized disaster relief efforts as being routinely mismanaged. For example, the panel described what has been considered one of the better organized disaster relief efforts (the 1976 earthquake in Guatamala) in the following way.
I would hope that there is no question regarding the need for physician leadership in an EMS system; and that the question, if there is any, concerns the amount required, where it is to be applied, and its quality. EMS, I would remind you, stands for emergency medical services. Medical delivery systems, in my opinion, require physicians for their design and implementation. That does not mean that all the services have to be delivered by physicians, but they need physician leadership.
If this outlines the area of physician authority, then there is by definition a concomitant responsibility—authority without responsibility would be tyranny. The responsibility should provide an appropriate level of medical care that is current in concept, appropriate to the needs, considerate of the resources available, and coherent with the overall health care system. It must not be just an isolated EMS system.
Investigation of High Frequency Jet Ventilation (HFJV) for cardiopulmonary resuscitation (CPR) was initiated to determine whether HFJV may be used as an alternative to conventional intermittent positive pressure ventilation (IPPV) and also to determine whether HFJV may be employed in CPR if cardiac arrest should occur during use of HFJV.
The novel method of HFJV has several advantages over conventional ventilation, namely low airway pressure, no hemodynamic impairment and no need for muscle paralysis. Transtracheal HFJV offers in addition cricothyroid membrane puncture as a fast alternative to tracheal intubation in cases of difficult airway control. It is able to prevent aspiration, and allows direct intrapulmonary drug administration.
On September 26, 1980, at 22:19, a bomb exploded at the main entrance to the Oktoberfest in Munich. The bomb, which had been put together by an apparently politically motivated individual, had planted at waist level in a litter bin. Reconstruction from the fragments found at the site and in the bodies of the victims indicated that the bomb was made from a British mortar projectile, manufactured in 1954, which had been modified to ensure particularly intensive fragmentation. The area affected by the explosion was the size of a soccer field. The effects of the explosion were extremely severe (Figures 1-3): 13 fatalities and approximately 225 nonfatal casualties, of which approximately 50 were severely injured.
Thanks to quick, accurate reporting of this major disaster to the Munich Emergency Control Center, which acts as the central coordinating point in case of emergencies, a contingency plan was put into action, which had proved to be effective for disasters involving more than 35 injured. This plan calls for the dispatching of 5 ambulances staffed with physicians, all other available ambulances and the alerting of all hospitals which may have to receive casualties.
Recent advances in the resuscitation and stabilization skills of prehospital emergency care providers have done much to improve the quality of immediate care provided to suddenly ill or injured patients. Although much of the innovation and leadership in this area has been provided by emergency department physicians, most of them still lack an adequate appreciation of the circumstances under which these skills are executed. While many physicians participate in prehospital care teaching and evaluation of the system, most have not gained personal experience in those aspects of care foreign to hospital environment. They are particularly unacquainted with the intricacies of rescuing patients from automobile accidents and similar entrapments. It is not unusual, however, for an accident victim to spend half of the time required for the prehospital phase of emergency medical care undergoing extrication, and in many cases this must be done before full advanced life support measures may be initiated.
Cholera, which was unknown in Africa south of the Sahara, became an identifiable disease in South Africa in 1919. In the 1970's, 5 cases were diagnosed in people coming into South Africa from countries to the north. Instructions regarding Cholera surveillance were circulated in 1979 following an outbreak in Maputo. There was no evidence of any case of cholera acquired in South Africa before September 1980. Within 12 days, there were 23 proven cases of Vibrio cholera, El Tor biotype, among Africans who obtained drinking water from an irrigation canal off the Crocodile River midway between Nelspruit and Kaapmuiden. Five hundred forty-six cases had been identified by the end of February 1981 and more are expected.
On 13 October 1980, a team of health officials collected at Nelspruit to coordinate measures to contain the epidemic. They included chlorination of the irrigation canal, water surveillance of local rivers by sampling or leaving Moore pads in situ, increasing the number of staff and strengthening equipment at local laboratories, educating local medical and nursing staff in patient management and providing adequate stocks of intravenous fluids and tetracycline. Patients' contacts were traced, their homes inspected, their water supply sources and means of sewage disposal checked and the public educated in cholera prevention. There were regular press statements, radio talks, television programs and the broadcasting of educational leaflets to warn the population to take precautions. It was decided not to hold a mass immunization campaign nor to administer preventive antibiotics.
Disaster plans in response to a nuclear crisis involve extended forays into uncertainty. Controversy arises over whether or not a nuclear disaster or war might ever occur. Estimates of destructive parameters vary widely. Planning must take into account a wide range of issues, from the nature of radiation injury to the survival capacity of social systems. From the standpoint of analyzing possibilities for emergency response, we will discuss: l) medical effects of radiation; 2) severe core meltdown at a nuclear power plant; and 3) a scenario for a nuclear bomb explosion over one city in the USA, in the setting of a strategic nuclear exchange.
Several thousand distinct medical devices exist and for each one the user usually has a choice from among a number of manufacturers. The process whereby a clinician or hospital purchasing agent makes a selection from a number of competing brands may be based on anything from, on the one extreme, little more than an emotional attraction to a particular brand name to, at the other end of the spectrum, a fully enlightened choice after an inhouse evaluation together with extensive additional information. This paper will describe, with concrete examples drawn from the ensemble of equipment used in the fields of resuscitation and critical care, how Emergency Care Research Institute evaluates such devices, investigates hazards associated with these instruments, and communicates this information to users.
In September 1980 at the International Aeromedical Evacuation Congress held in Munich, West Germany, the International Society of Emergency Medical Services (ISEMS) was formed. The purpose of this new society is to develop, promote, and improve EMS throughout the world. The founding members came from sixteen nations and represented such regions as Africa, the Americas, Europe, and the Middle East.
This new organization, ISEMS, provides a permanent, ongoing focal point for studies and serves as a global clearinghouse for EMS technical assistance, training, management, and evaluation. The Society remains on an international level, and its eligible membership consists of all persons who participate in EMS throughout the world. The publication of a scientific journal for all EMS personnel is planned. Through ISEMS, International Centers of Excellence will be established to provide technical assistance to countries for improvement of their EMS programs; training seminars and educational programs will also be sponsored. In addition, annually sponsored meetings in key cities in various countries of the world are planned.
A standardized approach to advanced cardiac life support (ACLS) improves the morbidity and mortality from cardiac arrest. Physicians should receive formal training, certification, and periodic recertification in ACLS. This paper describes the system we have developed to provide all the medical graduates of our university with training and American Heart Association (AHA) certification in ACLS.
Method
The course takes place during the third year of medical school in four afternoons during the students' medical clerkship. The students are required to take this course and are freed from all other commitments during these afternoons. Several weeks before the course, the students are given a brief introductory lecture, registered, and strongly encouraged to read the AHA manual for providers of advanced cardiac life support.
The time has come when it may be asserted quite categorically that a new medical science, the theoretical foundation of reanimation, has emerged on the medical scene. At the International Congress of Traumatology held in Budapest in 1961, I proposed to call this new science reanimatology. My suggestion was based on the medical tradition of using the Latin roots of words. I am pleased that not only this term but also its notion are being increasingly used by experts in the field.
The League of Red Cross Societies is the international federation of the 130 National Red Cross and Red Crescent Societies, which together have a membership of more than 230,000,000. The League is one of the three components of the International Red Cross, the others being the International Committee of the Red Cross (ICRC) and the National Red Cross/Red Crescent Societies.
The ICRC acts as a neutral intermediary in humanitarian matters during international conflicts, civil wars and internal disturbances, providing protection and assistance to victims, prisoners of war and civilian detainees. The League objective is to facilitate, encourage and promote the humanitarian activities of its member societies and thus contribute to the promotion of peace in the world.