Rescue Unit Research Articles

Kostentragung im Rettungsdienst

Abstract The provision of Emergency Medical Services (EMS) is a highly important as well as a very costly public service. In Germany, liability for costs of EMS is determined by complex legal rules posing considerable difficulties on the people practising in this field of law. Michael Uechtritz and Holger Tobias Weis carry out a comprehensive analysis of the relevant laws, covering public emergency law, private law and (social) insurance law. First of all they systematise the legal situation. The authors identify the primary cost bearer (public bodies and private providers) of EMS. Subsequently they analyse the mechanisms for shifting EMS costs onto patients, causers of emergency operations and / or insurance companies. On the basis of this systematisation, Uechtritz and Weis then deal with the phenomenon of futile rescue operations (“Fehleinsatze”). Futile rescue operations are operations where a dispatched rescue unit renders either incomplete or no rescue services at the site of emergency, e.g. in case...

Aero-Medical Evacuation From the Second Israel—Lebanon War: A Descriptive Study

The second Lebanon war started as a limited operation and progressed to a large-scale campaign. Most of the fighting took place in mountainous villages and small towns inhabited with civilians. The Israeli Defense Forces (IDF) Airborne rescue and evacuation unit is charged with air evacuation of soldiers and civilians in times of peace, limited conflict, and war. We describe this unit's activities in the second Lebanon war, analyzing injury, treatment, and evacuation characteristics Data were collected from flight medical reports, debriefings of aero-medical team members (usually immediately upon return from mission), ground units medical reports and debriefings, and hospital records. 725 IDF soldiers were injured and 117 killed either in Lebanon or near the Israeli-Lebanese border during the war. A total of 338 (46%) were evacuated in 95 airlifts (averaging 4.5 evacuees per airlift) from the fighting zones or the border. Air evacuation used dedicated helicopters with advanced care capacities, and most victims were evacuated straight from the battlefield, as the fighting was ensuing. Many wounded first received advanced medical care upon the arrival of the aero-medical teams. In military operations within civilian populated areas with threats to ground transport, air evacuation can sometimes be the only readily available option. Providing timely ground advanced medical care proved difficult in many instances. Thus, for many, the rescue helicopter was the first point of access to such care. Aero-medical aircrafts and personnel faced threats from gunfire and missiles, causing both delays in evacuation and a high average number of evacuees per airlift. This article proposes ways of coping with situations in which similar rescue and evacuation problems are likely.

Wilderness Rescue and Border Enforcement Along the Arizona Mexico Border—The Border Patrol Search, Trauma and Rescue Unit

To introduce and describe the US Border Patrol (USBP) Tucson Sector Border Patrol Search, Trauma and Rescue Unit (BORSTAR) and to analyze whether the frequency of its activities were associated with the amount of total border patrol law enforcement activities in the area. Descriptive and nonparametric analysis was conducted on data that were obtained on total USBP apprehensions of undocumented immigrants and BORSTAR activities for a consecutive 3-year period. From October 2004 to September 2007 over 1 million apprehensions occurred within the Tucson Sector. During this time, a large number of search, rescue, and medical intervention events occurred. However, only a weak association was found between the frequency of apprehensions and BORSTAR activities. The BORSTAR unit of the Tucson Sector commonly encounters harsh conditions and provides search, rescue, and medical interventions to undocumented immigrants. The frequency of BORSTAR activities is not strongly associated with the volume of USBP law enforcement activities.

Pitfalls in Aeromedical and Ground Crew Engagement: Lessons Learned

Aeromedical (AM) evacuation of trauma victims from action is an integral part of trauma care. The Israeli Air Force Rescue and Evacuation Unit is responsible for nearly all AM evacuations in Israel. We present three recent cases, within 1 year of operation, of engagement process failure during evacuations performed by the Rescue and Evacuation Unit. We then discuss possible pitfalls and lessons learned. In sum, we reveal that successful AM and ground crew engagement can save lives, as long as the engagement process is as short and efficient as possible.

Adesão às precauções padrão pela equipe do atendimento pré-hospitalar móvel de Belo Horizonte, Minas Gerais, Brasil

This was a cross-sectional study of workers in the pre-hospital care team in Belo Horizonte, Minas Gerais State, Brazil, aimed at evaluating adherence to precautions. The study instrument included questions on knowledge, attitudes, and facilitating factors for adherence to standard precautions. Adherence was verified by percentage of adequacy: > 75% correct answers. Drivers showed the lowest degree of knowledge and physicians the highest. In self-reported answers, none of the workers demonstrated adequate use of face masks, goggles, or personal protective equipment (PPE), and drivers reported inadequate attitudes on all the items. In the univariate analysis, job position, gender, and specific rescue unit were associated with adoption of precautions. Meanwhile, in the multivariate analysis, only job position was related (drivers and nurse technicians/aides). The most frequently cited facilitating factors for improvement of adherence were: training focusing on infections, occupational risks, and use of PPE; periodic team meetings; and creation of a central unit for cleaning, disinfecting, and sterilizing equipment and materials. Workers in the pre-hospital care service demonstrated attitudes that were compatible with knowledge, but professional class affected knowledge on standard precautions and self-reported adequate attitudes.

Planning Rescue Services with Non-Stationary Rescue Units

Geographical accessibility is fundamental when planning rescue services. At present there are several programs for computing the accessibility of stationary rescue units. This study suggests a method for evaluating geographic accessibility in scenarios containing also non-stationary units. The method supports the planning process by matching the risk of an incident occurring with the rescue units’ capabilities and accessibility. The method is implemented in the computer program Rescue Unit Planner. The result of the analysis is presented in thematic maps and graphs as level of coverage, mean response time and concentration. The method and the computer program have been evaluated in two case studies: one urban area in southern Sweden and one rural area in northern Sweden. The case studies show that that this method can be useful in the rescue service planning process.

외근직 소방공무원의 직무유형에 따른 요통발생의 차이

The purpose of this study was to analyze the effect of fire fighters' duty type on occurrence and severity of low back pain. Data were collected with questionnaire to 450 fire fighters working at 119 safety center and rescue unit of 30 fire stations in Gyeonggi-do. Finally the study was analyzed for 360 persons among them. The risk of experiencing of lower back pain occurred in the order of Rescue[odds ratio(OR) 3.36, 95% confidence interval(95% CI) 1.18-9.52], Vehicle operation(OR 2.63, 95% CI 1.26-5.50), First aid(OR 2.18, 95% CI 1.03-4.59), and Putting out a fire. The risk on severity of lower back pain occurred in the order of Vehicle operation(OR 4.00, 95% CI 1.57-9.80), First aid(OR 1.88, 95% CI 1.00-4.81), Putting out a fire, and Rescue. These result suggest that duty type of fire fighters may be a prognostic factor for occurrence and severity of low back pain. The potential implications of these findings are discussed about different approach for primary and secondary prevention by duty type of fire fighters.

A model for the development of volunteer resources: The East Hampton ocean rescue unit

This article is an illustration of a success story involving the development of the first all-volunteer lifeguard ocean rescue unit in the North east United States.Developing and managing volunteers is one of the most pressing topics being taught throughout the emergency management field. Successful programs often elude Local Communities; this article spotlights a model for success.

New Orleans EMS Rescue Unit

New Orleans EMS Rescue Unit

Leeway Prediction of Oceanic Disastrous Target via Support Vector Regression

This paper demonstrates an application of support vector machine (SVM) to the oceanic disasters search and rescue operation. The support vector regression (SVR) for system identification of a nonlinear black-box model is utilized in this research. The SVR-based ocean model helps the search and rescue unit by predicting the disastrous target’s position at any given time instant. The closer the predicted location to the actual location would shorten the searching time and minimize the loss. One of the most popular ocean models, namely the Princeton ocean model, is applied to provide the ground truth of the target leeway. From the experiments, the results on the simulated data show that the proposed SVR-based ocean model provides a good prediction compared to the Princeton ocean model. Moreover, the experimental results on the real data collected by the Royal Thai Navy also show that the proposed model can be used as an auxiliary tool in the search and rescue operation.

The problems faced by three government disaster response teams of Ankara city during the Marmara earthquake ??? 1999 response

The objectives of this study were to determine the organization/system and personal problems faced by the personnel of Ankara greater municipality Firebrigade Department (firemen), Ankara Emergency Aid and Rescue Services (ambulance personnel), Civil Defence General Directorate's Ankara Search and Rescue Unit (rescuers), who participated in the 1999 Marmara earthquake. A total of 1132 individuals were in the universe of the study; the total rate of participation was 95.1% (1076 individuals). This study was a cross-sectional survey, in which self-administered questionnaires were used. The study was conducted in May, June and July of 2001. Overall, 33.1% of the personnel of three government disaster response teams (356 individuals) said that they participated in the Marmara earthquake - 1999 response. The leading most important organization/system problem they faced during the Marmara earthquake was coordination (30.8%) according to the firemen, disaster management (31.4%) according to the rescuers, and coordination (41.6%) according to the ambulance personnel. The personal problems faced during the Marmara earthquake by the firemen were food problems (56.4%), accommodation problems (62.8%), safety problems (28.2%) and health problems (71.8%); according to the rescuers they were food problems (77.1%), accommodation problems (48.6%), safety problems (74.3%) and health problems (51.4%), and according to the ambulance personnel they were food problems (47.7%), accommodation problems (58.0%), safety problems (31.7%) and health problems (26.7%). Among the organization/system problems faced by the personnel of three government disaster response teams in the Marmara Earthquake of 1999, coordination problems were the major concern. The personnel also had some personal problems such as food, accommodation, safety and health.

Pausing for Rest, Next to the Remnants of a New York City Fire Department Rescue Unit

Pausing for Rest, Next to the Remnants of a New York City Fire Department Rescue Unit

Pausing for Rest, Next to the Remnants of a New York City Fire Department Rescue Unit

Pausing for Rest, Next to the Remnants of a New York City Fire Department Rescue Unit

Black Hawk Down: A Story of Modern War

You won’t be able to put Black Hawk Down aside. It is a true story that reads like fiction: 1 part military history, 1 part adventure narrative, and all adrenaline. Mark Bowden's work on the 2-day gun battle in Mogadishu, Somalia, in 1993 was praised by the soldiers, the US military, and critics alike. In fact, it was a National Book Award finalist. On October 3, 1993, Task Force Ranger along with a unit of Delta Force stormed the city of Mogadishu, Somalia, to capture 2 warlords responsible for widespread famine and genocide. What was to be a 1-hour mission became a 1-day gun battle. The soldiers found a city of militia that lay ready to fight back; it culminated with the downing of 2 Black Hawk helicopters (including a search and rescue unit), 18 dead US soldiers, 70 GIs wounded, and scenes of US soldiers being dragged through the streets the next morning, as shown on CNN. Now required reading by military academies, this text is a page turner; it's a must-read for wilderness medicine enthusiasts involved in any sort of military or similar mass casualty situation or readers looking for one of the finest pieces of military journalism available. The wilderness medicine lessons are plentiful and horrific. The Ranger unit was well prepared with a multidisciplinary search and rescue Black Hawk crew, complete with rangers, parajumpers, and physicians’ assistants. Then, when the search and rescue helicopter is shot down, the scenes become dire. The most dramatic is that of a physician's assistant performing a femoral artery cutdown in the field to stop the bleeding from a grenade wound. The gruesome tale culminates with the triage physician at the ranger base: he sends critical patients by air to a nearby NATO hospital, keeps the walking wounded at his field medical tent, and takes the mortally injured to a holding area to die. Politics of the war in general are minimized, as is the Somali point of view (conservative estimates of Somali death and injured were catastrophic, upwards of 1000). But Bowden gets inside the minds of the men of Task Force Ranger and highlights their patriotism, camaraderie, trust, faith, responsibility, and dedication.

Stress-associated endoplasmic reticulum protein 1 (SERP1)/Ribosome-associated membrane protein 4 (RAMP4) stabilizes membrane proteins during stress and facilitates subsequent glycosylation.

Application of differential display to cultured rat astrocytes subjected to hypoxia allowed cloning of a novel cDNA, termed stress-associated endoplasmic reticulum protein 1 (SERP1). Expression of SERP1 was enhanced in vitro by hypoxia and/or reoxygenation or other forms of stress, causing accumulation of unfolded proteins in endoplasmic reticulum (ER) stress, and in vivo by middle cerebral artery occlusion in rats. The SERP1 cDNA encodes a 66-amino acid polypeptide which was found to be identical to ribosome-associated membrane protein 4 (RAMP4) and bearing 29% identity to yeast suppressor of SecY 6 protein (YSY6p), suggesting participation in pathways controlling membrane protein biogenesis at ER. In cultured 293 cells subjected to ER stress, overexpression of SERP1/RAMP4 suppressed aggregation and/or degradation of newly synthesized integral membrane proteins, and subsequently, facilitated their glycosylation when the stress was removed. SERP1/RAMP4 interacted with Sec61alpha and Sec61beta, which are subunits of translocon, and a molecular chaperon calnexin. Furthermore, Sec61alpha and Sec61beta, but not SERP1/RAMP4, were found to associate with newly synthesized integral membrane proteins under stress. These results suggest that stabilization of membrane proteins in response to stress involves the concerted action of a rescue unit in the ER membrane comprised of SERP1/RAMP4, other components of translocon, and molecular chaperons in ER.

The development of a water rescue unit in an urban EMS system.

A river rescue unit was developed in Pittsburgh in March 1986. From its time of inception through December 31, 1987, the unit responded 572 times (325 times in 1987); this included 144 medical calls. Many of the other calls were police related, false alarms, routine patrols, or public service calls. We present a description of the service, type of training necessary, costs involved, and administrative aspects of running a marine emergency medical services system and its integration into an urban EMS system.

Search Area Determination and Search Unit Deployment

In any maritime emergency where time elapses from the start of the incident to the arrival of rescue units it is necessary to establish the most probable survivor area. The procedure for establishing a most probable area is known as search area determination and requires the calculation of one position from another, known respectively as the datum point (DP) – the most probable position of survivors – and the last known position (LKP) – the incident position with recourse to the effects of tide and wind. Under the present manual methodology of the search and rescue planning system (USCG 1973), the DP is given an error treatment comprising drift initial position and search and rescue unit navigational (SRU) errors. Error calculations produce a search area radius (R) which is ‘boxed’ and referenced by four corner coordinates given in latitude and longitude.

Preparing for scenes: A team approach to scene control

Helicopter transport has given rescue units a new, sophisticated support system unmatched by any other development in the past 10 years. Life Flight is the first helicopter service of its kind in this area (Nebraska), having been in operation since June 1979. Currently, flights directly to the scene of an accident at the request of a rescue unit account for approximately 15 percent of our transports. Our Life Flight staff has the luxury of enjoying a close, professional relationship with rescue departments within our service area. More times than not our scene transports are well organized and beneficial to the patients involved. We have found that organized, efficient air transport from the scene does require some prior knowledge of what the emergency medical system has to offer and how it works. Rescue squad members should be familiar with your service and your in order to be of optimum assistance to you, and you should be familiar with their routine in order to assist them.

Appropriate Emergency Care

To the Editor.— As chief of surgery of a moderately-sized (50,000+ members), urban health maintenance organization (HMO), I would like to respond to the letter from Dr Richard F. Kunkle. 1 Our policy as an HMO, clearly stated to all community emergency rooms, is that in life-threatening emergencies we expect that emergency care will be rendered irrespective of the patient's HMO affiliation, insurance coverage, or method of payment. Our policy is similarly stated to our patients. The reverse side of the plastic identification card issued to all members states in boldfaced type: Life Threatening Emergencies: Call your local rescue unit or go to the nearest emergency room. Notify FHP within 48 hours to ensure payment for emergency expenses. ATTENTION PROVIDER: FHP will cover the cost of emergency care required to prevent death or disability for eligible members. Please provide necessary care and notify FHP immediately to verify membership and obtain

On-Site Management and Treatment of Motor Car Racing Casualties

In 1964, the medical team at motor car races consisted of 2 physicians, including the author, several first aid workers, and 2 nurses. Only one physician stood at the trackside and sophisticated equipment was non-existant. Nevertheless, it was possible to resuscitate drivers who had suffered a cardiac arrest at the moment of impact, by simple cardiopulmonary resuscitation (CPR). In 1965, the Grand Prix mobile hospital was added. This was a Juggernaut container lorry containing a well-equipped operating room and scrub up area. It was found to be of little use in the UK, although the idea behind it was well intentioned. The problem with the unit was one of mobility. It was certainly true that the hospital could be taken from London to Paris, but it was far too big to be driven from the car park to the injured driver at the side of the track. In 1968, theBritish Racing and Sports Car Club (BRSCC) introduced the first rescue unit. This short wheel base vehicle was presented to the club by Ford as a service to motor sport. It contained all necessary fire-fighting, cutting and medical equipment. It was to reach the scene of any accident within 3 minutes. In that way a driver whose heart had stopped at the moment of impact could be resuscitated before his brain suffered irreparable damage. Apart from firemen, the rescue unit carried a physician, usually an anaesthetist skilled in resuscitation. As a result, the standard of care around the circuit became standardized after the first few minutes.