To use the clinical activities of an ambulance service as a tool to assess the residual and unmet medical need of a city in the aftermath of a major earthquake and to apply that assessment to the development of a training curriculum for the prehospital personnel.

The researchers conducted structured interviews with health care workers at all levels of the emergency health care delivery system in Gyumrii, Armenia, and carried out a retrospective frequency analysis of 29,010 ambulance runs for an 11-month period from February through December 1992. Runs first were assigned into the broad categories of: 1) Adult Medical; 2) Pediatric Medical; or 3) Trauma, and then, according to diagnosis. The runs then were classified further as: 1) Primary Care; 2) Basic Life Support (BLS); or 3) Advanced Life Support (ALS).

Adult Medical calls represented 24,684 (85%), Pediatric Medical calls 459 (1.6%), and Trauma calls 3,867 (13%). Only 12% of all ambulance calls resulted in transport to a medical facility, although this percentage was higher in children. Thirty percent of Adult Medical patients were diagnosed by the emergency medical providers as having exclusively a psychiatric problem.

In the late aftermath of a devastating earthquake, the ambulance service in Gyumrii, Armenia has been delivering a substantial proportion of non-emergency, primary care services. They have adopted this unconventional role to compensate for the deficit in health care facilities and personnel created by the disaster. The training program that the investigators developed reflected the actual work activities of the prehospital personnel demonstrated in their assessment.

From its beginnings, the provision of emergency medical services in the United States has been a male-dominated occupation. The objective of this exploratory study was to determine if and how such issues might influence partner preferences of male and female emergency medical technicians (EMTs).

Initially, unstructured interviews were conducted with 10 EMS workers enrolled in a paramedic training program in order to see whether and how such issue might affect partner preferences. From the data obtained during these interviews, a questionairre was developed and distributed to participants in an annual meeting of Louisiana Association of Nationally Registered EMTs. Participation was voluntary and uncompensated.

A total of 49 EMTs (22 women, 27 men) completed the questionairre. The major gender-related issues could be class fied into three dimensions: 1) physical strength; 2) assumption of authoritative roles; and 3) structural (organizational) preparedness to implement gender-friendly working environments. In general, the gender of a partner now “makes no difference”.

Overall, the EMS work worlds are reflective of the larger society of which they are a part. Now is the time for EMS systems to examine the gendered nature of their organization and of the issues of gendered expectations prevalent in EMS work. Future research should document the changes now due in the field of emergency medical services.

To determine the effect of a return of spontaneous circulation (RO SC) on survival to hospital discharge as compared to other established predictors of survival.

A retrospective case review of all out-of-hospital primary cardiac arrests from 01 January, 1992 to 31 December 1994 was conducted. The relative values of age, race, gender, presenting cardiac rhythm, witnessed event, initiation of CPR by bystanders, response time intervals, and return of spontaneous circulation (ROSC) in an Utstein-template database were tested as predictors of survival of patients who had suffered a cardiac arrest in the out-of-hospital setting. The ROSC was defined as return of spontaneous circulation prior to and present upon arrival at the emergency department. Predictors were evaluated for statistical significance using a logistic regression analysis (p < 0.05). Odds ratios (OR) and 95% confidence intervals (CI) with positive and negative predictive values (PPV, NPV) were calculated.

Of 832 patients with primary cardiac arrest, 153 (18.4%) had ROSC and 67 (8.1%) survived to hospital discharge. Comparing survivors to nonsurvivors, the mean values for age were 64 to 67 years, with 59.7% to 36.1% being witnessed, 35.8% to 23.9% having bystander CPR initiated, 88.1% to 48.4% having ventricular fibrillation (V-fib) and 82.1% to 64.0% having ROSC. An initial electro-cardiographic rhythm of V-fib (p = 0.009; OR = 2.2; CI = 1.2-3.9), and ROSC (p < 0.0001; OR = 5.2; CI = 3.6-7.5) are statistically significant predictors of survival to hospital discharge. The PPV was 13.8% for V-fib and 35.9% for ROSC, and the NPV was 98.0% for V-fib and 98.2% for ROSC.

Presenting V-fib and out-of-hospital ROSC are significant predictors of survival from cardiac arrest. Failure to obtain ROSC in the out-of-hospital setting strongly suggests consideration for terminating resuscitation efforts.

Ambulance regulation in California is the responsibility of numerous agencies on the state and local levels.

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.

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.

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.

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.

In Ontario, Canada, Emergency Medical Care Assistants (EMCAs) have many opportunities for continuing education. However, little is known about how EMCAs learn.

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.

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.

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.

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.

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.

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.

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.

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.

To use the clinical activities of an ambulance service as a tool to assess the residual and unmet medical needs of a city in the aftermath of a major earthquake and to apply that assessment to the development of a training curriculum for the prehospital personnel.

The researchers conducted structured interviews with health care workers at all levels of the emergency health care delivery system in Gyumrii, Armenia, and carried out a retrospective frequency analysis of 29,010 ambulance runs for an 11-month period from February through December 1992. Runs first were assigned into the broad categories of: 1) Adult Medical; 2) Pediatric Medical; or 3) Trauma, and then, according to diagnosis. The runs then were classified further as: 1) Primary Care; 2) Basic Life Support (BLS); or 3) Advanced Life Support (ALS).