We prospectively evaluated the frequency with which advanced life support (ALS) personnel fail to attempt to measure blood pressure (BP) and/or pulse (P) during prehospital patient assessment. A single in-field observer rode on ALS rescue vehicles from 20 Emergency Medical Services (EMS) agencies throughout Arizona during a one-year study (1/89–12/89). Data were collected from urban, suburban, and rural systems. Statistical evaluation was performed by Chi Square analysis with p <0.05 considered significant.

Among 227 patient encounters, BP and/or P measurements were omitted in 84 cases (37.0%). BP and/or P were omitted in 50.0% of children (age <18 years) compared to 26.5% of adults (p=0.023). Among patients who were transported to a hospital, 19.4% had BP omitted compared to 49.1% of those not transported (p=0.00003). Seven of 58 patients in whom TVs were attempted (12.1 %) had BP omitted compared to 54 of 169 patients without IV attempts (32.0%, p=0.0055). Blood Pressure was omitted in 21.9% of patients transported Code 3 and in 24.2% of patients with Glasgow Coma Scale ≤13. Omission of BP occurred more frequently in non-urban agencies (33.9%) than in urban ones (20.0%, p=0.027).

In a statewide evaluation of prehospital patient assessment, failure to measure vital signs (VS) occurred on a frequent basis. Our data indicate that a concerning lack of attention to the most basic details of patient assessment is common. It is possible that failure to measure VS might even happen more frequently during routine patient encounters without an observer present. Medical control physicians must emphasize to EMS personnel the paramount importance of careful assessment to ensure optimal patient care.

An inverse correlation has been reported between motor vehicle crash mortality rate (MVCMR) and population density. The reasons for this are unknown, but variations in prehospital and hospital resources are a possible explanation.

We performed a retrospective review of the charts of 252 adult, non-traumatic, prehospital cardiac arrest patients treated over a one-year period in order to assess the effectiveness of intravenous (IV) and endotracheal (ET) administration of epinephrine (0.5–1.0 mg) (EPI) in assisting restoration of a spontaneous pulse. Patients initially receiving IV-EPI were more likely to develop a spontaneous pulse earlier than those receiving a similar dose ET (7.3% vs 0.9%; p<0.01. In those patients who received a second dose of EPI, six (2.9%) regained a spontaneous pulse; each had been treated previously with IV-EPI. None who required a third dose of EPI regained a spontaneous pulse. In total, only five (2%) patients survived to discharge. We conclude that, in our system, patients who receive the currently recommended dose of EPI to treat cardiac arrest have a poor prognosis, and that IV-EPI is associated with a higher incidence of return of a spontaneous pulse compared to those treated ET.

The authors, who served as anesthesiologists for 15 months at an International Committee of the Red Cross (ICRC) surgical field hospital in a Cambodian refugee camp, report their anesthesiologic experience with 2,906 patients. In spite of preferential use of regional anesthetic techniques, general anesthesia was required in 68% of the cases. Local infiltration anesthesia was applied in 21% of the cases, conduction anesthesia in 3%, and spinal anesthesia in 8%.

There are several unique aspects of aeromedical transportation that render it vital to the overall management of disaster emergencies. Valuable time can be saved in moving medical expertise, supplies, and equipment into the disaster area as well as in moving victims out of the hazardous area quickly and in large numbers. Chaotic ground traffic at and near the disaster scene as well as environmental obstacles en route often may be avoided. Large numbers of disaster victims can be cared for efficiently en route by proportionately fewer health care personnel than is possible using traditional land carriers due to the concentration of many patients in one aircraft. Patients with similar injuries (e.g., burns) can be routed to and concentrated in centralized institutions that specialize in the care of those specific injuries. The plans for execution of the foregoing should include the use of military troop-transport aircraft that may be converted easily for patient transport. Also, military personnel should be involved, as they are part of a highly organized structure that can be mobilized more easily and swiftly than can most civilian organizations. The United States Air Force aeromedical evacuation policies and management structure is reviewed with attention directed toward additions and adaptations of this system needed to allow it to serve global disaster response. Such a highly evolved system will require a governing body with global reach for purposes of coordination and management. The resources for such a system currently exist but such an organization has yet to be formed.

The world population is becoming increasingly reliant upon nuclear fission for the generation of electric power. In the wake of this activity, there have been two major accidents: Three Mile Island (TMI), near Harrisburg, Pennsylvania, United States, in 1979; and Chernobyl, near Kiev, Ukraine, Soviet Union, in 1986. It is noteworthy that both of these accidents were related to human error and not to malfunction of the emergency back-up systems. So far, nuclear energy production plant accidents have occurred when either the data were misinterpreted or systems misguided by human function.

The major problem associated with a nuclear energy generating plant accident is the release of radiation. Even though the medical facilities may not be destroyed physically, they may be rendered useless because of contamination by radiation. Unfortunately, in the event of such an accidental release of radiation, all of the health-care facilities in the area will be contaminated. Therefore, all patients in hospitals and nursing homes will need to be evacuated to facilities outside of the contaminated area and not just relocated within the contaminated area.

Aspects of internal contamination with radionuclides are reviewed. The possible association of this kind of accident with radiation and conventional accidents is addressed. The most important mishaps in the initial diagnosis, the need for prompt treatment, and a well-prepared plan to cope with radioisotopes at the workplace are discussed. The metabolic behavior and specific treatment for radionuclide contamination is reported.

If the tower of Babel was a language disaster, disaster itself has a language. Whether act of God or act of man, disaster often calls for multinational assistance. The many governments, agencies, professions, and individuals from different parts of the world, representing different languages, specialties, religions, and cultures, yet all imbued with one and the same spirit of providing succor to the helpless, converge on the stricken land to help the victims, who are themselves of different language and background.

It is a sunny day in Moscow. I am participating in an excellent meeting on Disaster Medicine. While sitting at the breakfast table eating red caviar and sturgeon, somebody started to talk of the scarce value attributed to qualitative research since it cannot be statistically evaluated. I do not recall the unfortunate statement I made that induced Dr. Birnbaum to say, “You are going to write a paper for our journal on this topic.” I did not know what to reply and thus started the day in a very troubled mood. In a status of “reverie” (almost dozing) during a presentation in the morning session, a title spontaneously presented itself for what I still do not know I am going to write—Can You Average Cheshire Cat Smiles? Perhaps the further development of this free writing will explain the title or will serve to float, as if a koan, for our meditation and interpretation.

Report forms are used by Emergency Medical Services (EMS) systems for documentation of services provided and for self-analysis of EMS functions. Although the EMS Systems Act of 1973 originally intended for the development and implementation of a uniform EMS report form, items recorded on EMS forms vary throughout the United States. We review the governmental sponsored development of a recommended minimum data set (MDS) for EMS forms performed in 1974, and discuss areas of needed investigation regarding data set development and usage. The concepts used to develop the recommended MDS provide a useful resource for review of the purpose and content of one's own EMS report form. However, future data set development and applications should use outcome measure guided data set selection, on-line validation of data item accuracy and recordability, psychometric analysis of the process of form completion, and incorporation of new data entry and storage technology.

Resuscitology is the science of reanimation from apparent death or from unconsciousness. Prior to the last quarter of this century, resuscitation was steeped in myth, supported only by anecdote, and founded on unphysiologic principles. The development of new, scientifically based, modern concepts and practice of cardiopulmonary resuscitation (CPR) injected great hope into improving the chances for survival and quality of life for cardiac patients.

Recent reports indicate that there are nearly 70,000 “successful” cardiac resuscitations annually. However, it is estimated that only 10% are able to resume their former lifestyles. It is anticipated that with the expansion of prehospital emergency medical services, this proportion will increase. These facts have stimulated intense research aimed at elucidating the pathophysiology of cellular death with the goal of protecting the brain during cardiac arrest.