The purpose of this clinical study was to compare the prehospital use of fully automatic defibrillators versus semi-automatic defibrillators.

A prospective study of 200 patients was conducted to evaluate the use of pulse oximetry as an adjunct to clinical monitoring of critically ill patients transported by rotary-wing aircraft with non-pressurized cabins. Thirty-four subjects (17%) were found to have significant hemoglobin desaturation of less than 90%, as defined by pulse oximetry (SpO2). Data were recorded continuously for later review. Desaturation often was noted prior to alterations in vital signs or clinical appearance. In 32 of the 34 hypoxemic subjects (94%), therapeutic interventions corrected the low SpO2. The use of pulse oximetry permitted measures for cardiorespiratory support to be instituted and assessed more rapidly than otherwise would have been possible. The availability of a continuous record of SpO2 facilitated detailed review of case management. It is concluded that the use of pulse oximetry is a practical and valuable adjunct for monitoring critically ill patients transported by rotary-wing aircraft.

Application of pressure infusion bags may increase intravenous (IV) flow rates three-fold. Commercially available pressure infusers, manual squeezing of the IV fluid bag, inflating a blood pressure (BP) cuff around the bag, and kneeling on the bag have been used by prehospital personnel attempting to augment fluid infusion rates. To test the efficacy of each these methods, seven experienced paramedics were asked to employ each method in turn trials using a 1-liter bag of saline though a 14-gauge, 5.7cm catheter and a standard administration set. Gravity flow from 80cm served as the control.

Pressure infusers generated flow rates of 257±54 ml/min and 296±53 ml/min when inflated to 300 mmHg and maximum pressure respectively. This rate was 2–2.5 times that of gravity flow (123±2 ml/min) and significantly greater than those rates obtained by any other method (p<.0005). Manually squeezing the bag also was significantly better than was gravity flow with flow rates of 184±6 ml/min and 173±40 ml/min achieved by each of two different squeezing methods (p<.01). Neither blood pressure (BP) cuff application and inflation (135±28 ml/min) nor kneeling on the bag (125±36 ml/min) was better than gravity alone.

These results indicate that pressure infusers should be used to the exclusion of other field methods of supplying infusion pressure. If pressure infusers are not available, manually squeezing the bag is the only alternative acceptable in the field.

There are limited data available and no recognized standards or guidelines for providing emergency medical care at large public event The organizational planning of emergency medical care for the 1987 San Antonio Papal Mass was reviewed. Medical care was provided using a multi-tiered system. The San Antonio EMS system played a leading role in the design, administration, and implementation of this medical care.

An analysis of the types and frequencies of emergency medical problems encountered by health care providers is detailed. The total attendance was approximately 100,000, 1.5% (1553) required medical attention, and 241 were evaluated on-site by physicians. The majority of medical problems encountered were managed by non-physician, health care providers.

Severe environmental conditions with a heat index exceeding 102°F were responsible for 174 cases (72%) of heat-related illness. A total of 55 patients required transport to local emergency department. There were no cardiopulmonary arrests, major injuries, or deaths.

Since 1985, the state of Connecticut has been served by a hospital-based, advanced life support (ALS) helicopter air medical service. The service is stationed at a 1,000-bed, Level I, trauma center that is responsible for its operation. Connecticut statute requires the hospital to file operations reports with the Office of Emergency Medical Services, which reports to the Connecticut Department of Public Health. Operations include response to requests for transportation of severely ill or injured patients from the scene of an incident, and patient transport from one hospital to a higher level, definitive-care hospital.

This service also was charged to develop a disaster response plan to be integrated into the overall state plan for disaster responses. The helicopter disaster response involves all six New England states and the three hospital-based emergency medical helicopter programs that operate in the New England states.

This approach has allowed for joint planning and multi-agency, simulated drills. The helicopter emergency medical service has responded to 15 simulated emergencies (drills) and seven actual mass casualty incidents from May, 1985 to June, 1989. In Connecticut, the planning process conducted by the Department of Public Health and the Office of State EMS produced a coordinated, multi-jurisdictional, mass-casualty response plan.

Ongoing monitoring of the availability of hospital critical care resources is necessary to assure patients in the emergency medical services (EMS) system reach appropriate care. In this densely populated area Multnomah County, Oregon, ambulances have been diverted by radio from several hospitals before finding one that would accept the patient. Dispatch centers and base-stations had no reliable method to monitor the availability of hospital resources. Data were not available for use in establishing policy.

In response, this community developed an on-line, computerized system known as Computerized Hospital On-Line Resources Allocation Link (CHORAL) that visually displays the resource status of all hospitals to the 911 center, base-station, and participating hospitals. A change of status requires simple keystrokes for entry into the computer which in turn is transmitted automatically to all other CHORAL computers.

Six patient care resources are monitored: Adult Ward (AW); Computerized Axial Tomography Scan (CT); Critical Care (CC); Labor and Delivery (LD); Pediatric (PEDS); and Psychiatric Secure Beds (PSB). Paramedics use protocol to determine if a particular patient fits one of these categories. Availability is relayed to paramedics by the 911 center and the base-station. During the first three months of system operation, there were 337 diversions representing 4,527 hours among 10 of the 12 participating hospitals. The most common resource resulting in diversion was PSB, which was unavailable for 2,195 hours (48.5%). Unavailability of CT resulted in the lowest number of diversions (1.3%, 60.3 hours). Using this system, the paramedics know the resource status of destination hospitals immediately, resource information monitored at base-stations and 911 centre is accurate, and data are available for use in establishing policy.

Some disasters produce circumstances that require the emergency removal of some or all of the citizens from a geographic area. Emergency or mass evacuation can be divided into immediate evacuation, in which the citizens are given no warning of their need to evacuate, and potential evacuation, in which citizens are given time (usually a day or two) to evacuate. The mass evacuation aspect of disaster planning frequently is neglected, but must be planned in detail. An essential ingredient of a plan is the designation of a person who has the authority to order an evacuation and that that person or an authorized alternate, is available instantly 24 hours a day. The plans should identify likely scenarios which could require emergency evacuation for a given community requiring, means of communicating with the citizens, evacuation routes, evacuation mechanisms, and shelter arrangements. All plans need to take into account human behavior during such a stressful situation.

The resuscitator bag has been considered the standard for prehospital, ventilatory managment. Recently, the Berg Resuscitation Apparatus (BRA) was developed as an alternative. Two devices were compared for their ability to deliver adequate tidal volumes and efficacy during simulated, single-rescuer CPR In the first phase, emergency care providers ventilated a test lung using a resuscitator bag, BRA, and demand valve. No significant differences between methods were found. During the second phase of the study, subjects performed single-rescuer CPR on a resuscitation mannikin for two minutes, using the bag-valve-mask and the BRA with a mask. The BRA delivered a volume of 0.81±0.26 liters compared to 0.35±0.19 liters using the resuscitator bag. The BRA allows ventilation to be performed as does the traditional equipment. When used in single rescuer CPR, it appears to provide a substantial increase in the tidal volumes delivered.

The Metag triage label system was assessed during a major incident exercise at an international airport. The exercise simulated a crash of a plane carrying 40 passengers within the airport boundaries. A secondary incident also was staged involving an explosion resulting in a fire with three victims injured. The exercise involved the airport, fire, police, ambulance, and medical services of three counties—Leicestershire, Derbyshire, and Nottinghamshire. Use of the labels enabled evaluation of the triage process, early medical intervention for victims, and completion of the cards.