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Emergency Medical Services are an area of special interest in emergency medicine. Many emergency physicians are called upon to direct, train, or manage emergency medical services. Residents training in emergency medicine have a need for a defined curriculum in emergency medical services. Residency training should provide a basic foundation in EMS including on- and off-line medical control, medicolegal aspects, communications, disaster management, and EMS history, structure, and function. The resident must gain experience through on-scene observation, EMT/Paramedic education, medical direction, and quality assurance activities. This paper is one in a continuing series of goals and objectives to direct resident training in off-service rotations. Specific resources, learning objectives, and experiences are suggested.
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PMID:Objectives to direct the training of emergency medicine residents on off-service rotations: emergency medical services. 209 79

Prehospital bystander cardiopulmonary resuscitation (CPR) was studied to determine if it affected the outcome of defibrillation. Four hundred twenty-one consecutive witnessed cardiopulmonary arrests presenting with the initial rhythm of coarse ventricular fibrillation treated by the Milwaukee County Paramedic System from January 1980 to June 1982 were analyzed. Pediatric, trauma, and poisoning patients and those receiving intravenous or endotracheal medications before defibrillation (58) were excluded. Immediate professional bystander CPR (physician, nurse, EMT) and citizen bystander CPR were compared to a control group receiving no bystander CPR until arrival of EMS personnel. A successful defibrillation occurred if defibrillation prior to administration of medication produced an effective cardiac rhythm with pulses. Eighty-eight of the 363 remaining patients (24%) converted with initial defibrillations. While the group receiving professional bystander CPR had a higher successful defibrillation rate than did the no-CPR group (35% vs 22%, P less than .04), citizen bystander CPR and no-CPR groups had similar successful defibrillation rates (24% vs 22%, no significant difference). One hundred eighty-six of the 363 patients (51%) were transported to a hospital with a rhythm and a pulse (a successful resuscitation). Ninety-seven of the 363 patients (27%) were discharged alive from the hospital (a save). Patients who were converted successfully using initial "quick-look" defibrillations were far more likely to be successfully resuscitated (79/88 [90%] vs 107/275 [39%], P greater than .0001) and to be discharged alive from the hospital (54/88 [61%] vs 43/275 [16%], P greater than .0001) than were those who required further advanced cardiac life support techniques.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bystander CPR in prehospital coarse ventricular fibrillation. 648 36

Bruce Grotewiel, EMT-P, director of the Jefferson City Ambulance Service in Missouri, was named 1989 EMS administrator of the year by the National Association of Emergency Medical Technicians (NAEMT). NAEMT bases its decision each year on a combination of community service, service to the EMS profession, and excellence as an EMS administrator. The National Society of EMS Administrators, a division within NAEMT, established the award in 1988. It is sponsored by Fitch and Associates, a Kansas City-based health-care-management consulting firm. Grotewiel became director of the hospital-based service in March 1988, after working as the assistant director for four years. As a result of his efforts, the service has expanded to include 40 EMS providers and seven ALS units, response time has been significantly reduced, and employee compensation and benefits have increased. What does it take to be a top administrator? EMS staff writer LaTresa Costello recently spoke with Grotewiel to find out.
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PMID:What makes an effective administrator?. Interview by LaTresa Costello. 1010 86

Passing an EMT or paramedic course is a considerable achievement, as you have had to acquire a huge and fascinating volume of medical knowledge. But, did the program teach you acting skills? Acting? Whoever said that EMS professionals need to know anything about acting? We submit that you do; prehospital workers can gain many unanticipated benefits by using various acting skills and tactics in the field. One such benefit is the avoidance of the "complacency trap," or the boredom that can develop if you adopt the viewpoint that one crisis is much like another. But, more importantly, you will be more effective at delivering prehospital care, and you'll have a lot more fun on the job.
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PMID:Kaisen. EMS as theater of the streets. Part two. 1011 Jan 86

Contrary to popular opinion, it is possible to make EMS a career. The key is deciding that the field of prehospital care is where you ultimately want to be and planning where you want to go and what you want to do within the field. Follow these tips on becoming an EMT, moving up to paramedic and, finally, deciding whether to become a manager, and find out for yourself that the sky really is the limit.
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PMID:The sky's the limit. How to plan your career in EMS. 1012 91

When Pope John Paul II visited Denver, CO, in August, members of the city's EMS community volunteered to provide coverage at special events. But no one anticipated the tens of thousands of medical emergencies that occurred, overwhelming EMS resources. In this special feature, Dottie Schulte, RN, MS, and Denis M. Meade, EMT-P, offer a behind-the-scenes look at how EMS professionals coped during the unprecedented religious experience.
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PMID:The papal chase. The Pope's visit: a "mass" gathering. 1012 81

In the hundreds, and even the thousands, of hours that are spent in EMS training, none of the time is dedicated to community relations and public information. You have learned how to provide a service, but not how to sell the product. We relate to stories about physicians who were unsuccessful because of a poor "bedside manner." The patient's perception of you has very little to do with your score on the final exam or the terminology used as you explain an illness. You are judged by the same rules by which store clerks, telephone operators, waitresses and all others in the field of public service are gauged everyday. You may never do great things, but you can do small things in a great way. Just calling 911 is not enough to save a life. The very idea that we can get everywhere in the nick of time to snatch victims from the jaws of death is a fallacy. You most be concerned with the training provided for the lay public as you are with your own continuing education. There is no better way to make your service more effective than to train your entire community to save lives. There are many reasons why you should know how to deal with the media. A strong relationship can be formed simply by knowing how to make their job easier. Following the golden rules for news releases and interviews help us all appear more professional. The career of an EMT is in metamorphosis. You have been accepted by the patients you served and your fellow members of the medical community. Now you must continue to evolve as practitioners; your skills must change to meet the demands of modern medicine, and your knowledge base must continue to increase as new information becomes available. The one thing that must remain the same is your total commitment to patient care.
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PMID:Know your public: the importance of the EMS provider in community and media relations. 1017 92

The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew's ability to satisfy a patient's non-medical needs was rated as fair to poor, the average overall score diminished by 37.4%.
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PMID:Customer care. Patient satisfaction in the prehospital setting. 1018 18

A general theoretical approach for the determination of the optimum pulsewidth used for TENS/EMS/FES is presented. Analysis based on the interaction between a step-up transformer-coupled nerve stimulator and an electrode-tissue load modelled as a simple lossy capacitive load results in excellent agreement between the predicted and measured performance. The analysis shows that, by adjusting the pulsewidth (PW) of a push-pull symmetric square waveform such that PW = 4.5 tau, the total charge delivered to the tissue load can be minimised without impacting the efficiency of the nerve stimulation. Additionally, by minimising the charge exchange supported portion of the current pulse, which is primarily responsible for the pH shift and subsequent tissue burning with long-term use, the latter can be reduced to an acceptable level.
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PMID:Pulsewidth optimisation for transformer-coupled transcutaneous current pulse generation. 1019 31

Psychiatric patients present challenges not only to EMS, but in the ED as well. As we have tried to indicate in the case report, the presentation is not always clear-cut. There may not be a definite solution, and each case can be different. As an EMT or paramedic, how should you approach these issues? First, always make sure the scene is safe for you and your team. If you have doubts, contact law enforcement. With regard to patient care, err on the side of safety and what is in the best interest of the patient (which may include restraints). Follow established procedures and guidelines, and always document well. If you have any questions on scene, contact medical control, and document doing so. If there is a question, let the physician decide on competency issues.
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PMID:An EMS approach to psychiatric emergencies. 1053 26


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