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Prehospital pediatric trauma care is an important part of the EMS system. Review of 458 pediatric ALS trauma responses over two years treated in an urban, tiered ALS system revealed a male predominance. Violence (gunshot, stab, or assault) accounted for 46% of injuries, followed by vehicular accidents (occupant or pedestrian), with 35%. Important ALS resuscitation interventions were commonly performed en route, with a high degree of success (IVs = 93%, intubation = 79%), and did not greatly prolong field times (9 min BLS vs 11.7 min ALS). ALS procedure success rates and field times reported here are lower than previously described. Benchmark standards for the prehospital care of pediatric trauma are proposed.
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PMID:The prehospital treatment of pediatric trauma. 160 98

Time is an essential element for successful CPR. Two time factors are particularly important: the duration of complete CA and the time to advanced life support. According to a registration protocol, these time factors, together with other variables and outcome were recorded in 3083 CA cases, treated by the NICU teams of 7 major Belgian hospitals. The mean duration of complete CA is 10.3 min for CPR failure (79%); 5.3 min for initial CPR success (21%); 3.4 min for long-term CPCR success (7%). The mean time to ALS is 19.7 min for CPR failure; 14.6 min for initial CPR success: 12.7 min for long-term CPCR success. Both duration of CA and time to ALS are independently related to outcome; the mean duration of BLS is less than 10 min and not significantly related to outcome. Response time of BLS and ALS are increasingly important in their 'rapid response' failure zone (time to ALS more than 8 min, time to BLS more than 4 min). The tiered MICU system, with nurse paramedics before physicians, has equal time to ALS and comparable outcome results to the non-tiered MICU system. According to our present experience, the following time goals are proposed for Belgian EMS-MICU systems: duration of CA less or equal to 4 min (introduction time less than or equal to 1 min and response time of BLS less than or equal to 3 min) and time to ALS less than or equal to 9 min. These time goals stand, in Belgium for perfection of public training in CPR and for spreading of a higher number of MICU teams countrywide.
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PMID:Influence of time intervals on outcome of CPR. The Cerebral Resuscitation Study Group. 255 Oct 17

Several time intervals, with important influence on the outcome of CA and CPR, are determined by the local EMS-MICU characteristics: time to introduction in the EMS, response time of BLS, duration of BLS before ALS. These time factors have been studied in 2779 out-of-hospital CA cases, treated by the MICU in teams of 7 major Belgian hospitals. The analysis compares the time intervals in the following pre-CPR conditions: the age of the patient; the previous health status of the patient; the disease underlying the CA; the site where CA occurs; the witnessing of the CA; the type of CA; the MICU center, responding to the CA. The mean introduction time is 4.6 min, the mean response time of BLS is 5.1 min, the mean duration of BLS before ALS is 11 min. Introduction in EMS should be improved in CA due to intoxication, drowning, SIDS and respiratory disease, and overall when CA occurs at home.
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PMID:Influence of pre-CPR conditions on EMS response times in circulatory arrest. The Cerebral Resuscitation Study Group. 255 Oct 19

The Hyatt Regency skywalk collapse (July 17, 1981) provided the emergency medical services system of Kansas City, Missouri, with its greatest challenge ever. Utilizing an EMS-based, centralized, city-wide disaster plan, the rescue operation encountered 113 dead and 188 multiply traumatized patients. The rescue operation could be divided into three areas: initial response, onset triage, and delayed extrication. Success of the operation was credited to several factors, including the centralized urban location of the collapse, short patient transport times, centralized ambulance dispatch, availability of ALS vehicles and personnel to the scene, and mutual aid response. Short-comings of the rescue that became apparent on critical review of the response included poor communications at the scene, lack of physician bystander control, and the need for identification of key personnel at the site. Success in responding to the health care needs of a disaster included a flexible and well-organized disaster response plan as well as the support of a health care system capable of picking up the pieces of the psychological aftermath.
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PMID:The Hyatt Regency skywalk collapse: an EMS-based disaster response. 662 60

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.
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PMID:Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council. 756 46

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of the King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.
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PMID:Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein Style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council. Writing Group. 767 87

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, recommendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.
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PMID:Recommended guidelines for uniform reporting of pediatric advanced life support: the Pediatric Utstein Style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council. 856 Jan 9

Outcome after prehospital cardiac arrest was examined in the EMS system of Bonn, a midsized urban community, and presented according to the Utstein style. The data were collected from January 1st, 1989 to December 31st, 1992 by the Bonn-north ALS unit, which serves 240,000 residents. Fifty-six patients suffered from cardiac arrest of non-cardiac aetiology and were excluded; 464 patients were resuscitated after cardiac arrest of presumed cardiac aetiology (incidence of CPR attempts: 48.33 per year/100,000 population). The collapse was unwitnessed, bystander witnessed or EMS personnel witnessed in 178, 214 or 72 patients, respectively. In these subgroups discharge rates and 1-year survival accounted for 7.3% (4.5%), 22.9% (15.9%) and 16.7% (11.1%), respectively. Thirty-four patients were discharged without neurological deficits (cerebral performance category 1: CPC 1), 22 and nine patients scored CPC 2 or CPC 3, respectively. Nine patients were comatose (CPC 4) when they were discharged and remained in this state until they died. Of the 50 1-year survivors 35 lived without neurological deficit, eight demonstrated mild (CPC 2) and five severe (CPC 3) cerebral disability at 1-year after resuscitation, and, finally, two patients remained comatose for more than 1 year. The Utstein template recommends the selection of patients who were found in VF after bystander witnessed collapse. In our cohort 118 patients met these criteria. Of them 41 (35%) could be discharged from hospital and 28 (24%) lived more than 1 year. The comparison of our data with those from double-response EMS systems of other communities revealed that, in midsized urban and suburban communities the highest discharging rates could be achieved. Our study demonstrated that survival depends crucially on short response intervals and life support which will be performed by well-trained emergency technicians, paramedics and physicians.
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PMID:One-year survival after out-of-hospital cardiac arrest in Bonn city: outcome report according to the 'Utstein style'. 904 96

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

"Sorry, we're not hiring." This is becoming a common refrain for those of you searching in today's EMS job market. JEMS has received numerous letters from people frustrated by their inability to find employment following training. A spot-check of organizations and employers around the country suggests that, indeed, EMS positions are scarce. The waiting time for employment in many large urban services can be from six months to two years or more, and one director from a busy midwestern ALS service said he was receiving approximately 75 to 100 applications for every paramedic opening.
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PMID:When jobs are scarce. 1014 99


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