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Emergency Situations (emergency + situation)
Selected AbstractsU.S. Federal Regulations for Emergency Research: A Practical Guide and CommentaryACADEMIC EMERGENCY MEDICINE, Issue 1 2008Andrew McRae MD Abstract Emergency medicine research requires the enrollment of subjects with varying decision-making capacities, including capable adults, adults incapacitated by illness or injury, and children. These different categories of subjects are protected by multiple federal regulations. These include the federal Common Rule, the Department of Health and Human Services (DHHS) regulations for pediatric research, and the Food and Drug Administration's (FDA) Final Rule for the Exception from the Requirements of Informed Consent in Emergency Situations. Investigators should be familiar with the relevant federal research regulations to optimally protect vulnerable research subjects, and to facilitate the institutional review board (IRB) review process. IRB members face particular challenges in reviewing emergency research. No regulations exist for research enrolling incapacitated subjects using proxy consent. The wording of the Final Rule may not optimally protect vulnerable subjects. It is also difficult to apply conflicting regulations to a single study that enrolls subjects with differing decision-making capacities. This article is intended as a guide for emergency researchers and IRB members who review emergency research. It reviews the elements of Federal Regulations that apply to consent, subject selection, privacy protection, and the analysis of risks and benefits in all emergency research. It explores the challenges for IRB review listed above, and offers potential solutions to these problems. [source] Algorithm of first-aid management of dental trauma for medics and corpsmenDENTAL TRAUMATOLOGY, Issue 6 2008Yehuda Zadik The recommended management of tooth avulsion, subluxation and luxation, crown fracture and lip, tongue or gingival laceration included in the algorithm. Along with a list of after-hour dental clinics, this symptoms- and clinical-appearance-based algorithm is suited to tuck easily into a pocket for quick utilization by medics/corpsmen in an emergency situation. Although the algorithm was developed for the usage of military non-dental health-care providers, this method could be adjusted and employed in the civilian environment as well. [source] Psychosocial response in emergency situations , the nurse's roleINTERNATIONAL NURSING REVIEW, Issue 1 2007Dnurs, F. Hughes rn Background:, It is critical to ensure that nurses have the skills and knowledge to respond effectively and to contribute to the psychosocial recovery of survivors of emergencies, particularly as an increasing proportion of the population is at risk of being exposed to a catastrophe. Over a decade ago it was reported that 16% of the world's population was at risk of experiencing some kind of catastrophic event. That has now risen with a total of 16% vulnerable to flood alone worldwide (Ministry of Health 2005). In the first semester of 2005, there were 174 natural disasters affecting 86 countries, resulting in the deaths of 5967 people, affecting a total of 60 million with an estimated damage of $6.3 billion (US$) (Centre for Research on the Epidemiology of Disasters 2005). Aim:, To describe the nursing contribution to the psychosocial recovery of survivors of emergencies during the emergency preparedness and planning stage and in promoting recovery over the longer term. Methods:, Data for this article was sourced from relevant literature including World Health Organization policy and guidelines regarding mental health in emergencies. Implications for education, training and practice:, It is vital that nurses realize they are too vulnerable to the effects of an emergency situation and that steps can be taken to protect nurses from enduring psychosocial effects. [source] Predictors of Survival 1 Hour After Implantation of an Intra-aortic Balloon Pump in Cardiac SurgeryJOURNAL OF CARDIAC SURGERY, Issue 1 2001Harald Hausmann M.D. From July 1996 to March 2000, 391 patients with intraoperative cardiac lowoutput syndrome who underwent surgery with heart-lung bypass and had an intre-aortic balloon pump (IABP) Implanted were analyzed in a prospective study. Of these 391 patients, 153 (39%) were operated on in an emergency situation, and 238 (61%) patients had elective surgeries. The perioperative mortality was 34% (133 patients). Clinical parameters were analyzed 1 hour after IABP support began. Statistical multivariate analysis showed that patients with an adrenaline requirement higher than 0.5 ,g/kg/min, a left mrial pressure higher then 15 mmHg, output of less than 100 mL/hour, and mixed venous saturation (SvO2) of less then 60% had poor outcomes. Using this data, we developed an IABP score to predict survival early after IABP implantation in cardiac surgery. We conclude that the success or failure of perioperative IABP support can be predicted early after implantation of the balloon pump. In patients with low-output syndrome despite IABP support, implantation of a vantricular assist system should be considered. [source] Training Decision Makers , Tactical Decision GamesJOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 4 2000Margaret T. Crichton There is growing recognition of the need to train non-technical skills, especially decision making, for emergency management in high reliability industries as well as in contained environments such as prisons. This article presents a training method, Tactical Decision Games, which appears to provide a good opportunity to practise the non-technical skills that would be required in the management of an emergency situation. Case studies from the UK nuclear power industry and the Scottish Prison Service (SPS) illustrate the adaptability and general application of TDGs for training of emergency response teams in a range of operational settings. [source] Is ECG-guidance a helpful method to correctly position a central venous catheter during prehospital emergency care?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2005J. S. David Background:, Insertion of a central venous catheter (CVC) in an emergency situation is challenging and may be potentially associated with more complications. Because CVC positioning by ECG-guidance may help to decrease the frequency of a malpositioned catheter, we decided to prospectively evaluate the usefulness of positioning a CVC by ECG-guidance during prehospital emergency care. Methods:, Prospective observational study during which all patients requiring CVC placement during prehospital care were included. We compared two periods of 1 year during which CVCs were inserted without and then with the help of ECG-guidance. Results:, Eighty successive patients were included. We observed a significant reduction of incorrectly positioned CVCs with ECG-guidance (13% vs. 38%, P < 0.05) and a decreased number of chest X-rays needed to verify the position of the CVC (40 vs. 54, P < 0.05). Conclusion:, ECG-guidance is a safe and feasible technique which significantly improved the rate of CVCs correctly positioned during prehospital emergency care. [source] Reactive chemicals emergency response and post-event calorimetric testingPROCESS SAFETY PROGRESS, Issue 1 2010David Frurip Abstract A serious upset in process conditions may result in a Reactive Chemicals incident. In such an emergency, procedures must be implemented to prevent injuries, mitigate the event and minimize property loss and/or environmental release as dictated by the required facility Emergency Plan. This article describes the process the Dow Chemical Company uses for engaging Reactive Chemicals experts in an emergency situation. In order to be effective, the Reactive Chemicals expert must have or be provided with in-depth knowledge of the process streams and raw materials involved. The information is crucial for understanding what is happening, what might happen in the immediate future, and what can be done to successfully mitigate the Reactive Chemicals incident. Following the incident, calorimetric experiments are typically performed to confirm or refute the hypotheses of what caused the event; additionally, the experiments provide information as to reactive chemicals hazards that may potentially still exist in the process streams. The aforementioned process will be illustrated by describing an actual event. Useful methods are described and recommended for (a) characterizing and storing reactive chemicals, and (b) responding and mitigating safety incidents with reactive chemicals. The role of a reactive chemicals "expert" during and after a plant emergency is important and potentially critical to the safe handling of an ongoing event and also in determining the root cause of the incident. © 2009 American Institute of Chemical Engineers Process Saf Prog, 2010 [source] Basic Emergency Medicine Skills Workshop as the Introduction to the Medical School Clinical Skills CurriculumACADEMIC EMERGENCY MEDICINE, Issue 2009Wallace Carter Introduction:,Most medical school curricula lack training in basic skills needed in a medical emergency. After the September 11th, 2001 terrorist attacks, junior level medical students at our institution volunteered their time in the emergency department[ or at Ground Zero. They quickly realized they had little or no practical training for an emergency situation. Objectives:,To correct this curriculum deficit, a five hour basic emergency medicine skills / first responder course for students in their first few weeks of medical school was designed. Methods:,The course consists of lectures followed by related skills stations. Lectures include an introduction to the first responder concept, basic airway, breathing, and circulation management, and a rapid, systematic approach to common emergencies. Skills stations teach basic airway management, bag valve mask ventilation, splinting and immobilizing, and moving patients in the field, stressing improvisation. Multiple skills are practiced in a final simulation station using actors with wound moulage and scripted scenarios. Results:,This course, instituted at Weill Cornell Medical School in 2002, has become a mainstay of the first year curriculum. Student evaluations have been uniformly superlative. There is strong student sentiment that this is the most practical course of the first year. Conclusion:,After six years of experience, we have shown it is possible to present a truncated first responder course as part of the first year curriculum. The course generates tremendous interest and awareness regarding emergency medicine. Future research will examine whether skills taught in this course are retained and can be correctly applied later in medical school. [source] Evaluation of the knowledge of the treatment of avulsions in elementary school teachers in Rio de Janeiro, BrazilDENTAL TRAUMATOLOGY, Issue 2 2003Luciana Fernandes Pacheco Abstract ,,,Avulsions are very common in a school setting. Teachers are often requested to help in such emergency situations. A survey consisting of seven simple questions regarding dental avulsion was answered by 60 teachers from five different elementary schools in Rio de Janeiro, Brazil, in order to evaluate their knowledge on the subject and establish a guideline to be followed when an accident of this type happens. A lack of technical information was observed among the teachers; most of them answered intuitively rather than on an informative basis. This study showed the need of a more effective communication between dental professionals and school teachers in order to better handle dental emergencies. [source] SURGICAL INDICATIONS AND PROCEDURES FOR BLEEDING PEPTIC ULCERDIGESTIVE ENDOSCOPY, Issue 2010Nobutsugu Abe Recent important insights into the surgical treatment of bleeding peptic ulcer are reviewed in this article. Although the widespread use of endoscopic treatment and interventional radiology has reduced the number of surgical cases, surgery still plays a pivotal role in managing bleeding peptic ulcer. Failure to stop the bleeding by endoscopy and/or interventional radiology is the most important indication for emergency surgery. An early elective/planned surgery after the initial endoscopic control to prevent life-threatening rebleeding seems justified in patients who have risk factors for rebleeding, although its true efficacy still remains controversial. The surgical procedures in emergency situations should be limited to safe hemostasis. The addition of acid-reduction surgery may be unnecessary as a result of the increasing utilization of proton pump inhibitors. Angiographic embolization may be a less invasive alternative to surgery, and may further enhance endoscopic hemostasis. [source] Stressful but rewarding: Norwegian personnel mobilised for the 2004 tsunami disasterDISASTERS, Issue 3 2009Siri Thoresen Adequate responses to disasters and emergency situations rely, among other factors, on coping abilities in disaster workers and emergency personnel. In this study, different aspects of disaster-related stressors and training/experience were investigated in Norwegian personnel (n = 581) mobilised for the 2004 tsunami disaster. The level of stress reactions, measured nine to ten months after the tsunami, was relatively low in this sample, indicating that the personnel coped well with the challenges of the disaster. The level of intrusive memories was higher in disaster-area personnel (n = 335) than in home-base personnel (n = 246). Stress reactions were significantly associated with witnessing experiences (disaster-area group) and with having to reject victims in need of help (both groups). Specific preparation for the mission was associated with a lower level of stress reactions in disaster-area personnel. Such factors may be considered in training and preparation programmes for disaster workers. [source] Planning Environmental Sanitation Programmes in EmergenciesDISASTERS, Issue 2 2005Peter A. Harvey Environmental sanitation programmes are vital for tackling environmental-related disease and ensuring human dignity in emergency situations. If they are to have maximum impact they must be planned in a rapid but systematic manner. An appropriate planning process comprises five key stages: rapid assessment and priority setting; outline programme design; immediate action; detailed programme design; and implementation. The assessment should be based on carefully selected data, which are analysed via comparison with suitable minimum objectives. How the intervention should be prioritised is determined through objective ranking of different environmental sanitation sector needs. Next, a programme design outline is produced to identify immediate and longer-term intervention activities and to guarantee that apposite resources are made available. Immediate action is taken to meet acute emergency needs while the detailed programme design takes shape. This entails in-depth consultation with the affected community and comprehensive planning of activities and resource requirements. Implementation can then begin, which should involve pertinent management and monitoring strategies. [source] Humanitarian Crises: What Determines the Level of Emergency Assistance?DISASTERS, Issue 2 2003Donor Interests, Media Coverage, the Aid Business This paper proposes a basic hypothesis that the volume of emergency assistance any humanitarian crisis attracts is determined by three main factors working either in conjunction or individually. First, it depends on the intensity of media coverage. Second, it depends on the degree of political interest, particularly related to security, that donor governments have in a particular region. Third, the volume of emergency aid depends on strength of humanitarian NGOs and international organisations present in a specific country experiencing a humanitarian emergency. The empirical analysis of a number of emergency situations is carried out based on material that has never been published before. The paper concludes that only occasionally do the media play a decisive role in influencing donors. Rather, the security interests of Western donors are important together with the presence and strength of humanitarian stakeholders, such as NGOs and international organisations lobbying donor governments. [source] Review of Policies and Guidelines on Infant Feeding in Emergencies: Common Ground and GapsDISASTERS, Issue 2 2001Andrew Seal Recent crises in regions where exclusive breastfeeding is not the norm have highlighted the importance of effective policies and guidelines on infant feeding in emergencies. In 1993, UNICEF compiled a collection of policy and guideline documents relating to the feeding of infants in emergency situations. In June 2000 Save the Children, UK, UNICEF and the Institute of Child Health undertook a review of those documents, updating the list and identifying the common ground that exists among the different policies. The review also analysed the consistency of the policy framework, and highlighted important areas where guidelines are missing or unclear. This article is an attempt to share more widely the main issues arising from this review. The key conclusions were that, in general, there is consensus on what constitutes best practice in infant feeding, however, the lack of clarity in the respective responsibilities of key UN agencies (in particular UNICEF, UNHCR and WFP) over issues relating to co-ordination of activities which affect infant-feeding interventions constrains the implementation of systems to support best practice. Furthermore, the weak evidence base on effective and appropriate intervention strategies for supporting optimal infant feeding in emergencies means that there is poor understanding of the practical tasks needed to support mothers and minimise infant morbidity and mortality. We, therefore, have two key recommendations: first that the operational UN agencies, primarily UNICEF, examine the options for improving co-ordination on a range of activities to uphold best practice of infant feeding in emergencies; second, that urgent attention be given to developing and supporting operational research on the promotion of optimal infant-feeding interventions. [source] Topics of Special Interest in an Emergency Medicine Course for Dental Practice TeamsEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2004S. Weber Considering increasing life expectancy and population comorbitity, not only dentists but also nursing staff should gain knowledge and skills in treatment of patients in acute life-threatening situations. In cooperation with the State Dental Council, a 1-day course in the management of medical emergencies based on the ERC ALS guidelines was held for primary care dental practice teams. Following a short lecture series (2 hours), a systematic skills-training session (6 hours) was performed in small groups, addressing the following subjects: BLS, airway management and ventilation, intravenous techniques, manual and automated external defibrillation, ALS and resuscitation routine in a typical dental practice setting. For all skills-training sessions, life-like manikins and models were utilized and the emergency scenarios were simulated by the use of a universal patient simulator (SimMan®, MPL/Laerdal). At the end of the course, an evaluation questionnaire was completed by all candidates to find out in which emergency situations the dental practice teams now felt well trained or incompetent. In the first course with 32 participants, 13 were dentists and 19 were dental nurses. In the evaluation results, 53% of both, dentists and nurses, stated to be competent in cardiac arrest situations. 95% of the nurses, but only 69% of the dentists, thought that an automated external defibrillator should be available in the dental practice. 26% of the dentists felt unable to treat patients with anaphylactic reactions adequately, whereas 37% of the nurses felt incompetent in respiratory emergencies. [source] Scandinavian clinical practice guidelines on general anaesthesia for emergency situationsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010A. G. JENSEN Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1,1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia. [source] Security Zones and New York City's Shrinking Public SpaceINTERNATIONAL JOURNAL OF URBAN AND REGIONAL RESEARCH, Issue 1 2010JEREMY NÉMETH Abstract Urban scholars lament the loss of public space due to heightened security and behavioral controls borne of economic priorities and anti-terror concerns after September 11th 2001. Owners and managers of government buildings, banks and courthouses have closed streets and fitted the surrounding space with concrete barriers, bollards and moat-like structures to prevent potential terror attacks. These are reasonable protections in emergency situations, but, as threat levels fall, these zones fail to incorporate a diversity of users, privatizing the space for those with security clearance. The ubiquity of these zones encourages us to consider them as a new type of land use. To test this statement, we describe the results of site visits to two high-profile New York City neighborhoods (one with numerous civic buildings, the other populated with corporate headquarters). Using a simple tool we developed, we find that 27% of aggregate non-building area in the two districts is now in a security zone. Interestingly, the percentage of space within each district that can be classed as a security zone is reasonably similar, providing insight into the way in which terror targets are internally and externally defined and justified. We argue that this new type of land use is an important and permanent feature of twenty-first century global cities. Résumé Les chercheurs en sciences urbaines regrettent la perte d'espace public, incriminant souvent les contrôles accrus de sécurité et de comportement suscités par des priorités économiques ou des préoccupations anti-terroristes depuis le 11 septembre 2001. Propriétaires et gestionnaires de bâtiments publics, banques et tribunaux ont fermé des rues et équipé l'espace environnant d'obstacles en béton, de plots et de quasi-fossés afin de parer aux attaques terroristes potentielles. Ces protections sont normales en situations d'urgence, mais lorsque la menace décroît, les zones concernées ne parviennent pas à diversifier leurs usagers, l'espace étant réservé aux détenteurs de droits d'accès. L'ubiquité de ces zones pousse à les considérer comme un nouveau type d'occupation des sols. Pour vérifier cette affirmation, nous présentons les résultats de visites dans deux quartiers éminents de New York, l'un regroupant de nombreux bâtiments publics, l'autre une multitude de sièges sociaux. Au moyen d'un outil simple développé par nos soins, nous constatons que 27% de la surface cumulée non bâtie dans les deux secteurs sont désormais dans une zone sécurisée. Il faut noter que, dans chaque secteur, la proportion de l'espace qui peut être classé en zone sécurisée est relativement similaire, donnant un éclairage sur la façon dont les cibles terroristes sont définies et justifiées sur les plans intérieur et extérieur. Selon nous, ce nouveau type d'occupation des sols constitue un caractère important et permanent des villes planétaires du xxie siècle. [source] Psychosocial response in emergency situations , the nurse's roleINTERNATIONAL NURSING REVIEW, Issue 1 2007Dnurs, F. Hughes rn Background:, It is critical to ensure that nurses have the skills and knowledge to respond effectively and to contribute to the psychosocial recovery of survivors of emergencies, particularly as an increasing proportion of the population is at risk of being exposed to a catastrophe. Over a decade ago it was reported that 16% of the world's population was at risk of experiencing some kind of catastrophic event. That has now risen with a total of 16% vulnerable to flood alone worldwide (Ministry of Health 2005). In the first semester of 2005, there were 174 natural disasters affecting 86 countries, resulting in the deaths of 5967 people, affecting a total of 60 million with an estimated damage of $6.3 billion (US$) (Centre for Research on the Epidemiology of Disasters 2005). Aim:, To describe the nursing contribution to the psychosocial recovery of survivors of emergencies during the emergency preparedness and planning stage and in promoting recovery over the longer term. Methods:, Data for this article was sourced from relevant literature including World Health Organization policy and guidelines regarding mental health in emergencies. Implications for education, training and practice:, It is vital that nurses realize they are too vulnerable to the effects of an emergency situation and that steps can be taken to protect nurses from enduring psychosocial effects. [source] Ionic Basis of Pharmacological Therapy in Brugada SyndromeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2007MANLIO F. MÁRQUEZ M.D. An implantable cardioverter-defibrillator is considered the only effective therapy to terminate ventricular arrhythmias in symptomatic patients with Brugada syndrome. However, it does not prevent future arrhythmic episodes. Only antiarrhythmic drug therapy can prevent them. There have been several reports of a beneficial effect of oral quinidine in both asymptomatic and symptomatic patients. Other possible beneficial oral agents could be Ito blockers. Intravenous isoproterenol has been reported to be especially useful in abolishing arrhythmic storms in emergency situations. Also, isolated case reports on the usefulness of cilostazol, sotalol, and mexiletine have been described. The present article reviews the mechanisms by which these drugs may act and their possible role in the pharmacotherapy of this disease. [source] Evaluation of stratus® CS Stat fluorimetric analyser for measurement of cardiac markers Troponin I (cTnI), creatine kinase MB (CK-MB), and myoglobinJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 6 2001Bénédicte Bénéteau-Burnat Abstract Myoglobin, CK-MB, and Troponin I (cTnI) are cardiac muscle necrosis markers that are useful for detecting acute myocardial infarction (AMI). The Stratus® CS (Dade Behring, Inc.) is a discrete fluorimetric immunoassay analyser designed for the determination of the three cardiac markers from a single sample of whole blood or plasma. Overall analytical performances of the Stratus® CS provided by Dade Behring were evaluated according to the French Society of Clinical Biology guidelines. Within-run imprecision (n = 20) for the three parameters at three levels gave values under 5%, whereas CVs for between-run imprecision (n = 20) were under 6%. The sensitivities were 0.03 ,g/L for cTnI and 0.4 ,g/L for CK-MB. Linearities extended from 0,50 ,g/L for cTnI, 0,140 ,g/L for CK-MB, and 1,900 ,g/L for myoglobin. The results, particularly those obtained on whole-blood samples, correlated well with those obtained on Stratus® II. We did not find any interference with haemolysis, icterus, or lipemia. The system was very easy to use, and fulfills the requirements for the analysis of the three cardiac markers in patients with acute chest pain in emergency situations. J. Clin. Lab. Anal. 15:314,318, 2001. © 2001 Wiley-Liss, Inc. [source] Modelling emergency decisions: recognition-primed decision making.JOURNAL OF CLINICAL NURSING, Issue 8 2006The literature in relation to an ophthalmic critical incident Aims., To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. Background., This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. Design., Systematic literature review with critical incident reflection. Methods., Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996,2004) followed by the ,snowball method'. Studies were selected in accordance with preset criteria. Results., A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. Conclusions., Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making (Fig. 2). Figure 2. ,Influences and processes of RPD making. Relevance to clinical practice., Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety. [source] Exploring the potential of video technologies for collaboration in emergency medical care: Part II.JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, Issue 14 2008Task performance We conducted an experiment with a posttest, between-subjects design to evaluate the potential of emerging 3D telepresence technology to support collaboration in emergency health care. 3D telepresence technology has the potential to provide richer visual information than do current 2D video conferencing techniques. This may be of benefit in diagnosing and treating patients in emergency situations where specialized medical expertise is not locally available. The experimental design and results concerning information behavior are presented in the article "Exploring the Potential of Video Technologies for Collaboration in Emergency Medical Care: Part I. Information Sharing" (Sonnenwald et al., this issue). In this article, we explore paramedics' task performance during the experiment as they diagnosed and treated a trauma victim while working alone or in collaboration with a physician via 2D videoconferencing or via a 3D proxy. Analysis of paramedics' task performance shows that paramedics working with a physician via a 3D proxy performed the fewest harmful interventions and showed the least variation in task performance time. Paramedics in the 3D proxy condition also reported the highest levels of self-efficacy. Interview data confirm these statistical results. Overall, the results indicate that 3D telepresence technology has the potential to improve paramedics' performance of complex medical tasks and improve emergency trauma health care if designed and implemented appropriately. [source] Ephedrine in the cat lung vasculatureACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2003A. M. Fields Background:, Ephedrine is one of the most commonly used non-catecholamine sympathomimetic agents. It is used in operating rooms and critical care settings worldwide. While it has many side effects, its ability to rapidly raise blood pressure makes it an ideal agent to maintain homeostasis as well as in emergency situations. While its effects are known to be mediated by an ,-mediated mechanism, the exact , subtype is unknown. In addition, no studies using ephedrine have been performed in the pulmonary vascular bed of the cat. Methods:, The effects of phentolamine, a non-selective ,-receptor blocker, and prazosin, an ,1 -selective antagonist, were investigated on pulmonary arterial responses to ephedrine, phenylepherine, norepinephrine, and U-46619. Lobar arterial perfusion pressure was continuously monitored, electronically averaged, and recorded with constant flow in the isolated left lower lobe vascular bed of the cat. Results:, Phentolamine and prazosin significantly reduced vasoconstrictor pulmonary perfusion pressure increases induced by ephedrine. Conclusion:, Ephedrine has significant vasopressor activity in the pulmonary vascular bed of the cat meditated predominantly by ,1 adrenergic receptor activation. [source] LMA SupremeTM insertion by novices in manikins and patientsANAESTHESIA, Issue 4 2010B. W. Howes Summary The LMA SupremeÔ has been suggested for use in emergency situations by medical personnel with no experience in endotracheal intubation. We evaluated the LMA Supreme when inserted by non-anaesthetists, firstly in a manikin and then in patients. Fifty airway novices inserted a LMA Supreme in a manikin without any complications so we proceeded to the patient phase. Fifty airway novices inserted the LMA Supreme in anaesthetised patients undergoing elective surgery. First time insertion success rate was 86% and overall insertion success rate was 100%. Mechanical ventilation was successful in all cases. Median (IQR [range]) time to establish an airway was 34 s (26-40 [18,145] s). Median (IQR [range]) pharyngeal seal pressure was 23 cmH2O (19-28 [13,40] cmH2O). There were no important complications. Results are consistent with previous studies of use of the LMA Supreme by airway experts. We conclude that the LMA supreme is suitable for use by airway novices. Further research is needed before it may be recommended for cardiopulmonary resuscitation and emergency airway use. [source] The Emergency of Climate Change: Why Are We Failing to Take Action?ANALYSES OF SOCIAL ISSUES & PUBLIC POLICY, Issue 1 2009Cynthia M. Frantz Latane and Darley developed a five-stage model to understand why people do and do not help other people in emergency situations. We extend their five-stage model to explore why people do and do not take action against climate change. We identify the factors that make climate change difficult to notice and ambiguous as an emergency; we explore barriers to taking responsibility for action; and we discuss the issues of efficacy and costs versus benefits that make action unlikely. The resulting analysis is useful on two levels. For educators and policy makers, the model suggests the most efficacious approaches to galvanizing action among U.S. citizens. For social scientists, the model provides a valuable framework for integrating research from diverse areas of psychology and suggests fruitful avenues for future empirical research. [source] From hypothetical scenario to tragic reality: A salutary lesson in risk communication and the Victorian 2009 bushfiresAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2010Robin Burns Abstract Objective: To investigate the ways that the risk of a bushfire emergency and communication strategies are perceived by different community segments. Methods: A brief questionnaire preceded focus group discussion of a bushfire scenario with four communications from different sources. Groups were recruited to represent different community segments within a bushfire-prone peri-urban Shire in Victoria. Results: Four groups (28 participants) were recruited. Bushfire experience was highest in the over 40-year-olds, who would use a variety of information sources, preferred to receive information from trusted local sources, such as emergency services and the council, and were more likely to be a member of a local organisation than the under 40s. Younger people used television, local papers, and friends, family and neighbours as information sources. Young parents felt disempowered through lack of local knowledge, and trusted government departments less than older residents. All wanted clear, current, specific local information about ground conditions and actions to be taken during a fire outbreak. Conclusions/implications: Knowledge of and preparedness for bushfire is unequally spread throughout a bushfire community. There is a need in public health risk and emergency situations to focus on community development, information and consultation. [source] Development of the Video Assessment of Propensity to Use Emergency Restraints Scale (VAPERS): Results of the VAPERS Study GroupACADEMIC EMERGENCY MEDICINE, Issue 6 2007Darryl Macias MD Background:Emergency physicians (EPs) may disagree on when or whether patients need restraints. There is no good objective measure of the likelihood of EPs to restrain patients. Objectives:To 1) develop a scale to determine the likelihood that an EP would restrain a patient, 2) develop subscale scoring, and 3) determine a shortened version that correlates highly with the full scale. Methods:This was a prospective cross sectional study. The Video Assessment of Propensity to use Emergency Restraints Scale (VAPERS), consisting of 17 scenarios utilizing actors, was videotaped to produce a research video assessment tool. The VAPERS was designed by development experts to reflect the spectrum of patients who are considered for restraint in an emergency department. The VAPERS was piloted among a 22-member pilot panel of EPs (faculty and residents). The pilot panel was asked to determine the degree to which each video patient possessed the following patient characteristics: medical instability, trauma, belligerence, agitation, and altered mental status. Each "degree of characteristic" was measured on a separate 100-mm visual analog scale. Participants were then asked whether or not they would restrain each patient and whether the patient exhibited the potential to harm him- or herself or others. VAPERS subscales were developed for the likelihood to restrain patients with each of the patient characteristics. Spearman correlations were used for all comparisons. Linear regression was used to determine which patient characteristics were most related to likelihood to restrain and to develop a reduced scale to predict the overall likelihood to restrain. Results:The overall VAPERS score ranged from 0 to 100, with a median of 50 (interquartile range [IQR], 24,88). The visual analog scale results of how likely each video patient possessed specific characteristics were as follows: medical instability ranged from 0 to 100 (median, 32; IQR, 12,64), trauma ranged from 0 to 69 (median, 0; IQR, 0,31), belligerence ranged from 20 to 93 (median, 28; IQR, 14,63), agitation ranged from 3 to 84 (median, 52; IQR, 23,72), and altered mental status ranged from 1 to 93 (median, 29; IQR, 16,69). Linear regression indicated that two characteristic variables (danger to self and degree of agitation) in the video scenarios were highly correlated (0.87) with overall likelihood to restrain. Based on the results, the authors developed a shortened video assessment tool consisting of five of the original videos that were highly correlated (R= 0.94) with the full VAPERS scale on overall likelihood to restrain. Conclusions:The VAPERS scale covers a wide range of important variables in emergency situations. It successfully measured likelihood to restrain in this pilot study for overall situations, and for subgroups, based on patient characteristics. A shortened five-video VAPERS also successfully measured the overall likelihood to restrain. [source] | |||||||||||||||||||||||||