Ambulance Attendants Research Articles

The impact of providing help: Emergency workers and cardiopulmonary resuscitation attempts

Although anecdotes suggest that emergency medical technicians often themselves have to cope with severe trauma as a result of their work, almost all empirical work has been concerned with the aftermath of disaster. Fourteen volunteer ambulance attendants were asked about resuscitation attempts in which they had been involved. It was found that many of these evidenced a persistent psychological aftermath. Some of these individuals experienced vivid, involuntary, and uncontrollable thoughts, feelings, and/or mental images concerning their attempt. Perceived control and coping responses were examined, and found to be related to the impact of the resuscitation attempt upon the ambulance personnel. Data from this preliminary investigation indicate the need for further work in the area, and with related populations, such as nonprofessionals who attempt cardiopulmonary resuscitation.

The impact of providing help: Emergency workers and cardiopulmonary resuscitation attempts

AbstractAlthough anecdotes suggest that emergency medical technicians often themselves have to cope with severe trauma as a result of their work, almost all empirical work has been concerned with the aftermath of disaster. Fourteen volunteer ambulance attendants were asked about resuscitation attempts in which they had been involved. It was found that many of these evidenced a persistent psychological aftermath. Some of these individuals experienced vivid, involuntary, and uncontrollable thoughts, feelings, and/or mental images concerning their attempt. Perceived control and coping responses were examined, and found to be related to the impact of the resuscitation attempt upon the ambulance personnel. Data from this preliminary investigation indicate the need for further work in the area, and with related populations, such as nonprofessionals who attempt cardiopulmonary resuscitation.

Local exhaust ventilation and exposure to nitrous oxide in ambulances

Under extreme conditions, ambulance attendants and drivers could be exposed to nitrous oxide administered to transported patients in concentrations causing acute effects. Special arrangements are necessary to prevent such exposure, which is influenced by travelling speed, local exhaust ventilation and the use of an excess gas transfer tube evacuating expired air and overflow gas from the face mask to the outside. The separate eliminative effects of travelling speed and local exhaust varied considerably with the experimental conditions. The excess gas transfer tube reduced the levels of nitrous oxide in the air by 86 to 97% inside the ambulance at different experimental conditions. The combination of excess gas transfer tube and local exhaust resulted in a relatively constant reduction of the airborne nitrous oxide levels by about 98% when the ambulance was at a standstill and 99% when it was running.

An Analysis of Ambulance Accidents in Tennessee

In an effort to improve our program for ambulance crash and related injury prevention, we analyzed 102 consecutive ambulance accidents. Incidents reported included those that resulted in human injury or in which property damage exceeded $200. Multiple logistic regression was used to determine the association between circumstances reported at the time of the accidents and the risk of injury. Twenty-nine accidents contributed to a total of 65 injured victims, with one death. The variable most strongly associated with the probability of an injury-accident was use of a passenger restraint device. Darkness and occurrence at an intersection were variables showing increased risk, but were not statistically significant. The interaction of variables did not have a combined influence on the incidence of injury. The mean delay to hospital care after an accident was 9.4 minutes. Based on our data, we conclude that passenger restraints for both ambulance attendants and passengers should be mandatory, and we suggest that traffic signals be strictly heeded at intersections and speed limits in urban settings be obeyed.

Results of cardiopulmonary resuscitation by ambulance attendants : K. Furubayashi, H. Terada, K. Katsurada, Jpn J Acute Med 1984; 8: 1849–1854

Results of cardiopulmonary resuscitation by ambulance attendants : K. Furubayashi, H. Terada, K. Katsurada, Jpn J Acute Med 1984; 8: 1849–1854

A study of hospital based ambulance systems in Wisconsin.

This study was undertaken to determine the advantages and disadvantages of a hospital-based emergency medical service system with hospital employees serving as emergency medical technicians. This type of service is operating in thirteen hospitals in Wisconsin. A series of interviews was conducted to obtain pertinent information regarding the hospital, emergency medical vehicles, ambulance attendants, finances, communications and personal reactions to the system. The data indicate that hospital-based services using hospital employees can operate with minimal interference to regular patient care, and with apparent advantages to the emergency patients. In the rural, sparsely populated areas which were studied, response times from the hospital-based systems were comparable to other rural systems, and the financial and administrative aspects of the system were reviewed.

Emergency Medical Services— The Bottom Line

As emergency medical systems have developed in recent years, they have functioned under a number of presumptions. Chief among these is the conviction that the time, work, and money involved in the development of such systems reap tangible benefits for society in terms of lives saved and prolonged. It has also been presumed by those active in the field that the effectiveness of emergency medical services (EMSs) is directly related to the speed with which such services can be provided in times of crisis. Such a presumption is only the logical extension of battlefield experience, which proved that rapid stabilization of the conditions of severely wounded patients before evacuation for definitive care resulted in notable decreases in morbidity and mortality. When physicians used to such sophisticated battlefield intervention began returning from Vietnam to practice in their native country, they found relatively primitive emergency-response systems. Ambulance attendants required less formal training

State laws for ambulance attendants and advanced emergency medical technicians

The establishment of ambulance personnel licensing standards is studied. Since 1970, 18 states have enacted or amended statutes regulating ambulance services and 25 have set requirements for attendants. Another 13 states have recently developed regulations pertaining to Advanced Emergency Medical Technicians (EMT-A). Various levels of EMT training are described. It is noted that recertification or refresher training is being made a statutory requirement in most recently enacted laws. Standards for training, certification and activities of EMT-As are discussed, as are the functions which may be performed. Medical-legal questions pertaining to civil liability are examined, as are the needs for licensing reciprocity arrangements to permit geographic mobility. Activities of EMTs are discussed with special attention given to restrictions under various state laws, and the delegation of medical tasks as well as the question of immunity from liability are considered.

Mobile coronary care provided by ambulance personnel.

Mobile coronary care has been provided in Brighton by ambulance personnel without immediate help from physicians or nurses. No additional vehicles or staff were required. The capital cost of the experiment was therefore small and additional running costs were negligible. The results have been monitored by retrospective analysis of electrocardiograms recorded in the ambulance and stored on magnetic tape. In the first 12 months of operation to July 1972, 1,082 patients with suspected cardiac emergencies were carried in two vehicles. Subsequent analysis showed that 76% of these patients had acute symptoms from ischaemic heart disease or had circulatory arrest. Eighty-six per cent. of arrhythmias were diagnosed correctly by the ambulance attendants. Though only eight cases of primary ventricular fibrillation occurred during or shortly before transit all were successfully reversed, and five of these patients subsequently left hospital alive. Other benefits of the scheme have included an appreciable reduction in the median delay between onset of presenting symptoms in patients with acute myocardial ischaemia and their admission to hospital.

Cardiac defibrillation by ambulance attendants

Cardiac defibrillation by ambulance attendants

Cardiac Defibrillation by Ambulance Attendants

Defibrillation by ambulance attendants was the goal of the Oregon Coronary Ambulance Project organized in 1969 by the Oregon State Board of Health in cooperation with a private ambulance company, a community hospital, and the county medical society. Highly motivated ambulance personnel were trained so that they achieved a high degree of accuracy in the interpretation of life-threatening electrocardiographic arrhythmias, and by persistent vigorous cardiopulmonary resuscitation combined with defibrillation were able to salvage seven out of 14 patients, without telemetry, all of whom were subsequently discharged from the hospital. The feasibility of incorporating this service on a practical basis into the community medical system with conservation of medical manpower and at a low cost to the patient was demonstrated.

Cardiac defibrillation by ambulance attendants

Defibrillation by ambulance attendants was the goal of the Oregon Coronary Ambulance Project organized in 1969 by the Oregon State Board of Health in cooperation with a private ambulance company, a community hospital, and the county medical society. Highly motivated ambulance personnel were trained so that they achieved a high degree of accuracy in the interpretation of life-threatening electrocardiographic arrhythmias, and by persistent vigorous cardiopulmonary resuscitation combined with defibrillation were able to salvage seven out of 14 patients, without telemetry, all of whom were subsequently discharged from the hospital. The feasibility of incorporating this service on a practical basis into the community medical system with conservation of medical manpower and at a low cost to the patient was demonstrated.

Collapsible Airway for Mouth-to-Mouth Resuscitation

ABSTRACT To the Editor.— Mouth-to-mouth resuscitation has become the prime method used by those attempting to revive patients near death from drowning, electrocution, asphyxiation, or cardiac arrest. Although simple and effective, this method is objectionable in some aspects. Rescuers hesitate to use it because of the all-too-frequent presence of unpleasant secretions on the lips of victims. They also fear contact with disease-causing organisms. Failures of the method can often be attributed to the inability to depress the patient's tongue and thereby create a clear passageway for the flow of expired air in and out of the patient's lungs.Various types of airways have been used to overcome the objections and shortcomings listed above, but most are available only in hospitals and rarely in the physician's bag. Their size precludes widespread use by firemen, policemen, boy scouts, lifeguards, soldiers, utility employees, ambulance attendants, nurses, and physicians. Lives have been lost that might

Defibrillation by ambulance attendants

Defibrillation by ambulance attendants

Recommendations for improving emergency medical services.

<h3>EMERGENCY FIRST AID AND MEDICAL CARE</h3><h3>First Aid</h3> Extension of basic and advanced first aid training to greater numbers of the lay population. Preparation of nationally acceptable texts, training aids, and courses of instruction for rescue squad personnel, policemen, firemen, and ambulance attendants. Adoption at the state level of general policies and regulations pertaining to ambulance services. Adoption at district, county, and municipal levels of ways and means of providing ambulance services applicable to the conditions of the locality, control and surveillance of ambulance services, and coordination of ambulance services with health departments, hospitals, traffic authorities, and communication services. Pilot programs to determine the efficacy of providing physician-staffed ambulances for care at the site of injury and during transportation. Initiation of pilot programs to evaluate automotive and helicopter ambulance services in sparsely populated areas and in regions where many communities lack hospital facilities adequate to care for seriously injured persons.

A Community Hospital Immunization Program

W ITH THE ADVENT of modern vaccines, diseases such as smallpox, poliomyelitis, and diphtheria are now essentially preventable. Although a confirmed indigenous case of smallpox has not been reported in the United States since 1949 according to the Surveillance Section of the Public Health Service's Communicable Disease Center, cases of diphtheria and poliomyelitis continue to occur. In 1965, 160 cases of diphtheria and 59 of poliomyelitis were reported to the Communicable Disease Center (1). Persons with such illnesses, especially prior to diagnosis, obviously present a serious threat to others. Certain persons within the community who are especially subject to exposure to communicable diseases are considered members of high-risk groups. Foremost among these are physicians, dentists, nurses, hospital personnel, and ambulance attendants (2). Persons with irregular or limited exposure to patients, such as laundry handlers, cooks, and hospital carpenters, have also contracted disease as a result of their indirect contact with hospitalized patients. This threat to others from persons with communicable diseases was demonstrated in Great Britain in 1961-62 when several people with smallpox, accidently admitted into the country, infected 62 other persons, resulting in 26 deaths. Of these, 40 cases and 21 deaths occurred in 3 physicians, 1 nurse, 2 hospital visitors, 33 hospital patients, and 1 hospital employee (3). Analysis of 11 serious outbreaks, of smallpox following importation into Europe since December 1961 reveals that 96 of 222 indigenous cases and 29 of 39 deaths occurred among persons known to have acquired the disease directly through hospital contact (4). When a patient suspected of having smallpox was recently admitted to a Washington, D.C., hospital, health officials were reawakened to the vast problems involved when such a disease is introduced into a susceptible population (5). For this reason the American Medical Association, the American Hospital Association, and the Public Health Service recommend that hospital personnel keep current their immunizations against smallpox (personal communication, J. D. Millar, Smallpox Surveillance Section, Communicable Disease Center, March 1965). Hospital personnel may also be considered vulnerable to other infectious diseases, such as Dr. Sells, formerly epidemic intelligence service officer, Kansas City Field Station of the Public Health Service's Communicable Disease Center, is now a resident in pediatrics at the Children's Orthopedic Hospital and Medical Center, Seattle, Wash. Dr. Lyman is health director of the Omaha-Douglas County Health Department in Omaha, Nebr., and Mr. Kirby, formerly immunization project coordinator, assigned to the Omaha-Douglas County Health Department by the Public Health Service, is presently assigned to the California State Department of Health.