The literature of disaster planning and management makes frequent reference to disaster drills and exercises as a fundamental training tool. Such exercises have been variously described as ranging from full-scale, all-day events involving many agencies and resources to table-top simulations using models and prepared scenarios. Because of this large gamut of disaster training activities, often it is difficult for trainers to select the most appropriate model. The purpose of this paper is to place various types of disaster training exercises in a hierarchial order based on fundamental educational principles.

The existence of endogenously produced, digoxin-like factor(s) is clear. The implications of die presence of this circulating substance are substantial for the practice of emergency medical care. Clearly, EDLF plays an important role in the generation of dysrhythmias associated with an AMI. Treatment with AA could become routine early in the course of management of some patients with AMI and in die treatment of some forms of hypertension

This article presents the concepts of a computerized information system and its potential applications to Emergency Medical Services (EMS). It is an informational article intended to provide administrators clear concepts of how computers may be best used to provide information in integrated networked systems for EMS needs. It addresses the function of a system, processes of computerizing a department, planning, and provides an overview of computer hardware.

Workers, managers, occupational health and safety inspectors, and the general community can be trained to detect and promote action by the use of sentinel markers for detecting industrial disasters. A sentinel marker is a pre-disaster warning sign of impending failure in prevention. Administration sentinel markers are: weak occupational health and safety programs; lack of spontaneous access to top management; failure to accept responsibility for sub-contractors; absence of written disaster plans and drills for emergency response in the factory and in the adjacent community; non-investigation of prodromal leaks, exposures, spills, or injuries; punishment of “trouble-some” individuals (“whistleblowers”) reporting prodromal events; non-use or misuse of data on illness, injury, and absenteeism; and sub-optimal work conditions and supervision of shift workers. Information sentinel markers are: absence of worker and community right-to-know programs; non-use of data on earlier mishaps from similar technologies; and failure to provide toxicologic data to hospitals in the pre-disaster phase. Technological sentinel markers include the absence of fail-safe controls, interlocks, and automated alarm systems driven by real-time monitoring. Transportation sentinel markers include sub-optimal vehicle standards, alcohol and drug abuse, and fatigue in drivers. Preventive programs based on identification of all sentinel markers by workers and others outside a narrow spectrum of specialists are suggested to be more effective than are selective actions based on risk assessment analysis.

The growth and development of emergency medical services (EMS) has been both impressive and extensive since the late 1960s. Since that time, there has been much discussion and debate regarding the level and quality of care that patients receive from the EMS system. In the United States, this has resulted in a wide variety of emergency medical technician (EMT) certification levels that determine which personnel administer an extensive range of medications, procedures, and medical protocols. Because of these differences, the care a patient receives varies not only from state to state but from community to community. Even though there are many different EMS system configurations, EMS professionals generally believe die level of care they provide in their local community is effective. It is unfortunate that very often, opinions about EMS system effectiveness are not based on studies of EMS system performance or patient outcome data, but upon subjective assessments of ongoing activities by those individuals providing the services.

An emergency medical service (EMS) system is part of a broad health care system which no longer can be concerned exclusively with patient transportation. Integration of prehospital and in-hospital emergency care must be achieved to provide quality patient care. This article suggests modifications in the Joint Commission on Accreditation of Healthcare Organization's (JCAHO) 10-Step Model indicators that should help in an evaluation of the issues associated with the diversion of patients from Emergency Departments. The JCAHO model is one that can be used to help integrate prehospital and inhospital care.

Once ignored by health care and management theorists, emergency medical service (EMS) has begun to attract attention to its traditional policies and practices. Long-standing notions about job qualifications, job responsibilities, organizational structure, and operations control are being challenged by alternative approaches such as System Status Management (SSM), Computer-Aided Dispatch (CAD), and Emergency Medical Dispatch (EMD). One important characteristic of these new models is their emphasis on the role of the communications center in controlling operations. Convincing arguments for these systems have been advanced, and they have been implemented successfully in many areas.

Despite these developments, variations of the traditional model which minimizes the importance of the communications center and emphasizes control by field supervisors still characterize many, if not most, EMS systems in the United States. While this probably is due to a natural resistance to change and local political concerns, data supporting the new systems unfortunately are only anecdotal. Except for superficial comparisons, the traditional and alternative approaches have not been examined in light of accepted management theory and principles. Therefore, this paper will analyze the communications center and operations control from a theoretical standpoint to determine where in an EMS organization, control is exercised most naturally, and how these findings could impact on management effectiveness.

When a multiple patient incident occurs in a remote location, significant challenges are presented to the Emergency Medical Services (EMS) system. Emergency medical services systems need to have the capability to respond effectively to major incidents anywhere within the service area.

On 2 September, 1988, some time after 1400H, a Gray Line of Alaska tour bus overturned at milepost 132 on the Taylor Highway in the interior region of Alaska. The bus rolled from a soft shoulder down a hill as it attempted to pass a large truck going the opposite direction. The accident location was 220 air miles east of Fairbanks, a city of about 60,000 population.