Disaster Reanimatology Potentials: A Structured Interview Study in Armenia I. Methodology and Preliminary Results

1989 ◽  
Vol 4 (2) ◽  
pp. 135-152 ◽  
Author(s):  
Miroslav Klain ◽  
Edmund Ricci ◽  
Peter Safar ◽  
Victor Semenov ◽  
Ernesto Pretto ◽  
...  
Keyword(s):  
Intensive Care ◽  
Life Support ◽  
Medical Personnel ◽  
The United States ◽  
Structured Interview ◽  
Advanced Trauma Life Support ◽  
Mass Casualties ◽  
Medical Systems ◽  
Preliminary Results ◽  
Medical Teams

AbstractIn general, preparations for disasters which result in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgery, and prolonged life support (PLS: intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks. Preliminary results permit the following generalizations: 1) a significant number of victims died slowly as the result of injuries such as external hemorrhage, head injury with coma, shock, or crush syndrome; 2) early search and rescue was performed primarily by uninjured covictims using hand tools; 3) many lives potentially could have been saved by the use of LSFA and ATLS started during extrication of crushed victims. 4) medical teams from neighboring EMS systems started to arrive at the site at 2-3 hours and therefore, A TLS could have been provided in time to save lives and limbs; 5) some amputations had to be performed in the field to enable extrication; 6) the usefulness of other resuscitative surgery in the field needs to be clarified; 7) evacuations were rapid; 8) air evacuation proved essential; 9) hospital intensive care was well organized; and 10) international medical aid, which arrived after 48 hours, was too late to impact on resuscitation. Definitive analysis of data in the near future will lead to recommendations for local, regional, and National Disaster Medical Systems (NDMS).

Disaster Reanimatology Potentials: A Structured Interview Study in Armenia. III. Results, Conclusions, and Recommendations

1992 ◽  
Vol 7 (4) ◽  
pp. 327-337 ◽  
Author(s):  
Ernesto A. Pretto ◽  
Edmund Ricci ◽  
Miroslav Klain ◽  
Peter Safar ◽  
Victor Semenov ◽  
...  
Keyword(s):  
Life Support ◽  
Construction Materials ◽  
Structured Interview ◽  
First Aid ◽  
Interview Study ◽  
Advanced Trauma Life Support ◽  
Mass Casualties ◽  
First Aid Training ◽  
Medical Teams ◽  
Lay Public

AbstractNational medical responses to catastrophic disasters have failed to incorporate a resuscitation component.Purpose:This study sought to determine the lifesaving potentials of modern resuscitation medicine as applied to a catastrophic disaster situation. Previous articles reported the preliminary results (I), and methodology (II) of a structured, retrospective interview study of the 1988 earthquake in Armenia. The present article (III) reports and discusses the definitive findings, formulates conclusions, and puts forth recommendations for future responses to catastrophic disasters anywhere in the world.Results:Observations include: 1) The lack of adequate construction materials and procedures in the Armenian region contributed significantly to injury and loss of life; 2) The uninjured, lay population together with medical teams including physicians in Armenia were capable of rapid response (within two hours); 3) Due to a lack of Advanced Trauma Life Support (ATLS) training for medical teams and of basic first-aid training of the lay public, and scarcity of supplies and equipment for extrication of casualties, they were unable to do much at the scene. As a result, an undetermined number of severely injured earthquake victims in Armenia died slowly without the benefit of appropriate and feasible resuscitation attempts.Recommendations:1) Widespread adoption of seismic-resistant building codes for regions of high seismic risk; 2) The lay public living in these regions should be trained in life-supporting first-aid (LSFA) and basic rescue techniques; 3) Community-wide emergency medical services (EMS) systems should be developed world-wide (tai-lored to the emergency needs of each region) with ATLS capability for field resuscitation; 4) Such systems be prepared to extend coverage to mass casualties; 5) National disaster medical system (NDMS) plans should provide integration of existing trauma-EMS systems into regional systems linked with advanced (heavy) rescue (public works, fire, police); and 6) New techniques and devices for victim extrication should be developed to enable rapid extrication of earthquake casualties within 24 hours.

Resuscitation

2018 ◽  
pp. 225-244
Author(s):  
Tim Raine ◽  
George Collins ◽  
Catriona Hall ◽  
Nina Hjelde ◽  
James Dawson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Early Warning ◽  
Basic Life Support ◽  
Life Support ◽  
Advanced Life Support ◽  
Advanced Trauma Life Support ◽  
Early Warning Scores

This chapter explores resuscitation, including early warning scores, intensive care, peri-arrest, in-hospital resuscitation, Advanced Life Support (ALS), arrest equipment and tests, Advanced Trauma Life Support (ATLS), Paediatric Basic Life Support, Newborn Life Support (NLS), and obstetric arrest.

Trauma

2018 ◽  
Author(s):  
David A. Young
Keyword(s):  
Cause Of Death ◽  
Life Support ◽  
Motor Vehicle ◽  
The United States ◽  
Motor Vehicle Accidents ◽  
Advanced Trauma Life Support ◽  
Traumatic Injuries ◽  
Vehicle Accidents ◽  
One Year ◽  
Uncontrolled Bleeding

Traumatic injuries are the most common cause of death within the United States for children above one year of age Most traumatic injuries in children are a result of motor vehicle accidents, child abuse (or nonaccidental trauma), drowning, thermal injury, or falls. Motor vehicle accidents are the leading cause of death for children above the age of one year. Strategies of Advanced Trauma Life Support (ATLS) utilize a standardized approach to promptly identify and manage life-threatening traumatic injuries. These strategies include recognition of cardiopulmonary disorders, volume resuscitation, and prevention of additional injuries including to the cervical spine. A management plan for severe and uncontrolled bleeding is critically important to have established when caring for children with traumatic injuries. Many strategies have been developed to manage severe and uncontrolled bleeding including the use of massive transfusion protocols, damage control surgery, and hemostatic agents.

Current Practices for Withdrawal of Life Support in Intensive Care Units

2010 ◽  
Vol 19 (6) ◽  
pp. 532-541 ◽  
Author(s):  
Karin T. Kirchhoff ◽  
Jennifer A. Kowalkowski
Keyword(s):  
Intensive Care ◽  
Nursing Education ◽  
Intensive Care Units ◽  
Life Support ◽  
Quality Care ◽  
The United States ◽  
Health Care Team ◽  
Intensive Care Nurses ◽  
Care Plans

BackgroundNurses are present at the bedside of patients undergoing withdrawal of life support more often than any other member of the health care team, yet most publications on this topic are directed at physicians.ObjectivesTo describe the training, guidance, and support related to withdrawal of life support received by nurses in intensive care units in the United States, how the nurses participated, and how the withdrawal of life support occurred.MethodsA questionnaire about withdrawal of life support was sent to 1000 randomly selected members of the American Association of Critical-Care Nurses, with 2 follow-up mailings.ResultsResponses were received from 48.4% of the nurses surveyed. Content on withdrawal of life support was required in only 15.5% of respondents’ basic nursing education and was absent from work site orientations for 63.1% of respondents. Nurses’ actions during withdrawal were most often guided by individual physician’s orders (63.8%), followed by standardized care plans (20%) and standing orders (11.8%). Nurses rated the importance of emotional support during and after the withdrawal of life support very highly, but they did not believe they were receiving that level of support. Most respondents (87.5%) participated in family conferences where withdrawal of life support was discussed. After physicians, nurses were most influential concerning administration of palliative medications. Patients’ families were present during withdrawal procedures between 32.3% and 58.4% of the time.ConclusionsTo improve their practice, intensive care nurses should receive formal training on withdrawal of life support, and institutions should develop best practices that support nurses in providing the highest quality care for patients undergoing this procedure.

Epidemiology of Intensive Care

1992 ◽  
Vol 8 (3) ◽  
pp. 395-407 ◽  
Author(s):  
Lis Dragsted ◽  
Jesper Qvist
Keyword(s):  
Intensive Care ◽  
Western Europe ◽  
Life Support ◽  
Admission Rate ◽  
Severity Of Illness ◽  
The United States ◽  
Normal Functional ◽  
One Year ◽  
Uniform Nomenclature ◽  
And Function

AbstractIt is difficult to study the epidemiology of ICUs, as they lack a uniform nomenclature and/or classification. The organization and distribution of intensive care medicine depend on the size and function of the hospital. The patients in ICUs are predominantly men, with a high proportion of elderly patients (≥70 years) constituting 25–30% of the total. Case-mix, severity of illness and outcome differ from one unit to another, and can be compared only if the patients are classified with a common classification system. Most survivors of intensive care seem to return to normal or near normal functional level within one year. Compared to Western Europe, the United States has more ICU beds and a nearly ten times higher admission rate to intensive care. These variations can be seen as a result of a fundamental difference in the attitudes toward withdrawing or withholding life support.

Thermal Injuries

2015 ◽  
Author(s):  
Tatiana Havryliuk ◽  
Ryan Paterson
Keyword(s):  
Life Support ◽  
Chemical Exposure ◽  
The United States ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Initial Assessment ◽  
Advanced Trauma Life Support ◽  
Burn Patients ◽  
Medical Facilities ◽  
Thermal Injuries

In the United States, an estimated 450,000 patients with burns are treated in medical facilities annually. On assessment of burn patients, Advanced Trauma Life Support protocols should be followed because these patients often suffer from concomitant trauma; chemical exposure and airway compromise should also be considered in the initial assessment. Mortality from burn injuries increases with the patient’s age, the extent of the burn, and the presence of inhalation injury. This review covers the epidemiology, pathophysiology, assessment and stabilization, diagnosis, treatment and disposition, and outcomes of patients with burn injuries. Figures show the structure of the skin, and photographs of partial-thickness and full-thickness burns. Tables list burn classification by depth, indications for intubation, American Burn Association 2010 guidelines for calculating IV fluid resuscitation, indications for escharotomy in patients with circumferential trunk and extremity burns, and indications for burn center referral. This review contains 3 highly rendered figures, 5 tables, and 33 references.

Cardiopulmonary Resuscitation (CPR) Basic and Advanced Life Support (BLS, ALS) Self-Training Systems (STS) for Paramedical and Medical Personnel

1985 ◽  
Vol 1 (S1) ◽  
pp. 96-99
Author(s):  
M. Scott ◽  
P. Safar ◽  
P. Berkebile ◽  
A. Sladen ◽  
J. McClintock ◽  
...  
Keyword(s):  
Life Support ◽  
Advanced Life Support ◽  
Medical Personnel ◽  
Training System ◽  
Learning Ability ◽  
Respiratory Care ◽  
Mass Casualties ◽  
Training Systems ◽  
Film Viewing ◽  
Lay Public

Resuscitation and acute respiratory care must be taught to all personnel involved in the management of everyday emergencies and mass casualties. Personnel range from the lay public to physician specialists. In deciding who should be taught what and how one must consider the limitations of learning ability of trainees and of resources. Mouth-to-mouth ventilation can be learned by laymen merely from viewing pictures, but better with manikin practice to perfection. CPR steps A-B-C can be effectively taught to non-physicians including laymen with instructor-coached manikin practice to perfection. but also with self-practice coached by audiotape, and to some extent even by frequent film viewing only without manikin practice. In 1972, A. Laerdal invented a CPR steps A-B-C self-training system consisting of a recording manikin, flipcharts and the coaching audiotape. We added a demonstration film to be shown before manikin practice.

Surgical Simulation: An Emerging Technology for Training in Emergency Medicine

1997 ◽  
Vol 6 (2) ◽  
pp. 147-159 ◽  
Author(s):  
Scott L. Delp ◽  
Peter Loan ◽  
Cagatay Basdogan ◽  
Joseph M. Rosen
Keyword(s):  
Virtual Environment ◽  
Computer Model ◽  
Life Support ◽  
Surgical Simulation ◽  
Medical Training ◽  
Medical Personnel ◽  
Advanced Trauma Life Support ◽  
Training Experience ◽  
Training Environment ◽  
Wound Debridement

The current methods of training medical personnel to provide emergency medical care have several important shortcomings. For example, in the training of wound debridement techniques, animal models are used to gain experience treating traumatic injuries. We propose an alternative approach by creating a three-dimensional, interactive computer model of the human body that can be used within a virtual environment to learn and practice wound debridement techniques and Advanced Trauma Life Support (ATLS) procedures. As a first step, we have developed a computer model that represents the anatomy and physiology of a normal and injured lower limb. When visualized and manipulated in a virtual environment, this computer model will reduce the need for animals in the training of trauma management and potentially provide a superior training experience. This article describes the development choices that were made in implementing the preliminary system and the challenges that must be met to create an effective medical training environment.

Facial Gunshot Wounds

2019 ◽  
Vol 35 (06) ◽  
pp. 578-583 ◽  
Author(s):  
Angela S. Volk ◽  
Tom Shokri ◽  
Mofiyinfolu Sokoya ◽  
Yadranko Ducic ◽  
Larry H. Hollier
Keyword(s):  
Life Support ◽  
Suicide Attempts ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Gunshot Wounds ◽  
The United States ◽  
Tissue Loss ◽  
Advanced Trauma Life Support ◽  
Unique Challenge ◽  
Temporary Closure

AbstractCraniomaxillofacial gunshot injuries, resulting from assault, suicide attempts, and accidental trauma, represent a major public health dilemma in the United States. Due to the extent of injury and resulting osseous and soft tissue loss, facial gunshot wounds pose a unique challenge to the reconstructive surgeon. Initial management should use advanced trauma life support principles with the goal of patient stabilization. Acute operative management should center around wound decontamination, debridement, and temporary closure. Historically, definitive surgical management focused on delayed reconstruction secondary to high rates of wound infections, necrosis, and ischemia. With improvements in imaging modalities, the advent of virtual surgical planning, and the popularization of microvascular free flaps, contemporary methods have shifted toward earlier more definitive reconstruction. Autologous free tissue transfer has resulted in a decrease in hospital stay and the number of overall surgeries. Importantly, due to the variability in injury pattern and complexity in reconstruction, a systematic approach toward intervention is needed to mitigate complications and optimize overall functional and aesthetic outcomes.

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