The Gillette Stadium Experience: A Retrospective Review of Mass Gathering Events From 2010 to 2015.

OBJECTIVE: Mass gathering events can substantially impact public safety. Analyzing patient presentation and transport rates at various mass gathering events can help inform staffing models and improve preparedness. METHODS: A retrospective review of all patients seeking medical attention across a variety of event types at a single venue with a capacity of 68,756 from January 2010 through September 2015. RESULTS: We examined 232 events with a total of 8,260,349 attendees generating 8157 medical contacts. Rates were 10 presentations and 1.6 transports per 10,000 attendees with a non-significant trend towards increased rates in postseason National Football League games. Concerts had significantly higher rates of presentation and transport than all other event types. Presenting concern varied significantly by event type and gender, and transport rate increased predictably with age. For cold weather events, transport rates increased at colder temperatures. Overall, on-site physicians did not impact rates. CONCLUSIONS: At a single venue hosting a variety of events across a 6-year period, we demonstrated significant variations in presentation and transport rates. Weather, gender, event type, and age all play important roles. Our analysis, while representative only of our specific venue, may be useful in developing response plans and staffing models for similar mass gathering venues. (Disaster Med Public Health Preparedness. 2018;12:752-758).

First Rescue Under the Rubble: The Medical Aid in the First Hours After the Earthquake in Amatrice (Italy) on August 24, 2016.

Specific Event Identifiers a. Event Type: Earthquake measuring 6.2 (SD=0.016) on the moment magnitude; b. Event Onset: August 24, 2016 - 03:36:32 CEST (01:36 UTC); c. Location of Event: Central Italy, in the town of Amatrice; d. Geographic Coordinates: latitude (DMS): 42°37'45.77″N; longitude (DMS): 13°17'18.14″E; elevation: 955 meters above sea-level; e. Dates: August 24, 2016 at 4:48 AM; f. Response Type: Medical Relief. ABSTRACT: On August 24, 2016, an earthquake hit the town of Amatrice (Italy). This study aims to document the first medical aid provided to earthquake victims in Amatrice immediately following the earthquake. Patient data were collected and recorded during the first clinical evaluation and before definitive hospitalization. Blood gas tests were performed on survivors extricated from the rubble using the iSTAT (Abbott Point of Care Inc.; Princeton, New Jersey USA) handheld blood analyzer. Performing "victim-side" blood gas tests could provide concrete information to facilitate clinical evaluation and decision making when treating buried victims. After a natural disaster, it is essential to provide effective analgo-sedation to victims. Blasetti AG , Petrucci E , Cofini V , Pizzi B , Scimia P , Pozone T , Necozione S , Fusco P , Marinangeli F . First rescue under the rubble: the medical aid in the first hours after the earthquake in Amatrice (Italy) on August 24, 2016. Prehosp Disaster Med. 2018;33(1):109-113.

Are prehospital deaths from trauma and accidental injury preventable? A direct historical comparison to assess what has changed in two decades.

BACKGROUND & OBJECTIVES: In 1994, Hussain and Redmond revealed that up to 39% of prehospital deaths from accidental injury might have been preventable had basic first aid care been given. Since then there have been significant advances in trauma systems and care. The exclusion of prehospital deaths from the analysis of trauma registries, giv en the high rate of those, is a major limitation in prehospital research on preventable death. We have repeated the 1994 study to identify any changes over the years and potential developments to improve patient outcomes. METHODS: We examined the full Coroner's inquest files for prehospital deaths from trauma and accidental injury over a three-year period in Cheshire. Injuries were scored using the Abbreviated-Injury-Scale (AIS-1990) and Injury Severity Score (ISS), and probability of survival estimated using Bull's probits to match the original protocol. RESULTS: One hundred and thirty-four deaths met our inclusion criteria; 79% were male, average age at death was 53.6 years. Sixty-two were found dead (FD), fifty-eight died at scene (DAS) and fourteen were dead on arrival at hospital (DOA). The predominant mechanism of injury was fall (39%). The median ISS was 29 with 58 deaths (43%) having probability of survival of >50%. Post-mortem evidence of head injury was present in 102 (76%) deaths. A bystander was on scene or present immediately after injury in 45% of cases and prior to the Emergency Medical Services (EMS) in 96%. In 93% of cases a bystander made the call for assistance, in those DAS or DOA, bystander intervention of any kind was 43%. CONCLUSIONS: The number of potentially preventable prehospital deaths remains high and unchanged. First aid intervention of any kind is infrequent. There is a potentially missed window of opportunity for bystander intervention prior to the arrival of the ambulance service, with simple first-aid manoeuvres to open the airway, preventing hypoxic brain injury and cardiac arrest.

Prehospital deaths from trauma: Are injuries survivable and do bystanders help?

BACKGROUND AND OBJECTIVES: Deaths from trauma occurring in the prehospital phase of care are typically excluded from analysis in trauma registries. A direct historical comparison with Hussain and Redmond's study on preventable prehospital trauma deaths has shown that, two decades on, the number of potentially preventable deaths remains high. Using updated methodology, we aimed to determine the current nature, injury severity and survivability of traumatic prehospital deaths and to ascertain the presence of bystanders and their role following the point of injury including the frequency of first-aid delivery. METHODS: We examined the Coroners' inquest files for deaths from trauma, occurring in the prehospital phase, over a three-year period in the Cheshire and Manchester (City), subsequently referred to as Manchester, Coronial jurisdictions. Injuries were scored using the Abbreviated-Injury-Scale (AIS-2008), Injury Severity Score (ISS) calculated and probability of survival estimated using the Trauma Audit and Research Network's outcome prediction model. RESULTS: One hundred and seventy-eight deaths were included in the study (one hundred and thirty-four Cheshire, forty-four Manchester). The World Health Organisation's recommendations consider those with a probability of survival between 25-50% as potentially preventable and those above 50% as preventable. The median ISS was 29 (Cheshire) and 27.5 (Manchester) with sixty-two (46%) and twenty-six (59%) respectively having a probability of survival in the potentially preventable and preventable ranges. Bystander presence during or immediately after the point of injury was 45% (Cheshire) and 39% (Manchester). Bystander intervention of any kind was 25% and 30% respectively. Excluding those found dead and those with a probability of survival less than 25%, bystanders were present immediately after the point of injury or "within minutes" in thirty-three of thirty-five (94%) Cheshire and ten of twelve (83%) Manchester. First aid of any form was attempted in fourteen of thirty-five (40%) and nine of twelve (75%) respectively. CONCLUSIONS: A high number of prehospital deaths from trauma occur with injuries that are potentially survivable, yet first aid intervention is infrequent. Following injury there is a potential window of opportunity for the provision of bystander assistance, particularly in the context of head injury, for simple first-aid manoeuvres to save lives.

Primers auxilis 2015 / No disponible

No disponible

Valoración de los conocimientos en primeros auxilios en combate que tienen los soldados españoles / Appreciating knowledge in first aid in combat with the Spanish soldiers

Los militares en misiones internacionales están expuestos a múltiples riesgos que ponen en peligro sus vidas. Tener conocimientos de primeros auxilios y habilidad en el manejo del herido grave, pone al alcance del soldado las herramientas necesarias para brindar la primera asistencia a un herido. Es imprescindible asegurar en primer lugar el escenario del incidente antes de exponernos o comprometer al resto de la patrulla. OBJETIVO GENERAL: Evaluar el nivel de conocimientos en primeros auxilios que tienen los soldados participantes en el estudio. Objetivos específicos: 1º- Valorar si los soldados del Batallón creen estar preparados para prestar los primeros auxilios a un compañero herido en combate. 2º- Analizar si tienen en cuenta la seguridad del escenario donde ocurrió el suceso antes de socorrera las víctimas. 3º- Comprobar si son capaces de identificar una hemorragia externa grave y una situación de paro cardiorrespiratorio, y poder brindar los primeros auxilios. MATERIAL Y MÉTODO: Estudio cuantitativo, descriptivo de carácter prospectivo y transversal. Sobre una muestra de 269 soldados de los cuales, 178 realizan una encuesta que nos aportalos datos necesarios para evaluar los conocimientosy habilidades en primeros auxilios y valorar la seguridad del escenario. RESULTADOS: Los resultados nos aportan los datos suficientes para valorar el nivel de conocimientos que tienen en primeros auxilios, si disponen de las habilidades necesarias, si creen estar capacitados para socorrer a este tipo de herido y por último si controlan adecuadamente la seguridad del escenario. CONCLUSIONES: Los soldados del Batallón creen disponer de los conocimientos necesarios para realizar el control de la zona de siniestro, de los conocimientos necesarios para brindar los primeros auxilios a un herido en combate y se creen capacitados para ello

In international missions the military are exposed to multiple risks putting their lives in danger. Having first aid knowledge and skills in the treatment of serious injuries, gives soldiers the necessary tools to provide first aid to a wounded person. First of all it is essential to assure the safety of the scene of the incident before exposing ourselves or others to possible danger. General objective: Assess the level of first aid knowledge that the soldiers taking part in the studio have. Specific objectives: 1. Check if the battalion of soldiers believes they are ready to provide first aid to a partner injured whilst in combat. 2. Analyse if they take into consideration the safety of the incident location before helping the victims. 3. Check if they are trained to identify a serious external haemorrhage and a situation of cardiorespiratory arrest to be able to provide first aid. Material and method: A quantitative study, and prospective and transversal descriptive. With a sample of 269 soldiers, of which 178 of them complete a survey that provides the necessary data to evaluate first aid knowledge and abilities and the checking the safety of the scene. Results: The results provide sufficient information to evaluate the soldiers’ level of first aid knowledge, whether or not they have the necessary skills, if they believe that they are capable of dealing with these kinds of wounds, and if they control correctly the security of the scene. Conclusions: The battalion of soldiers believe they have all the necessary knowledge to correctly control the scene of the accident, the necessary knowledge to provide first aid to soldier wounded in combat, and they believe are capable providing first aid

¿Mejora el torniquete la supervivencia del combatiente en zonas en conflicto? / Does the tourniquet improve the survival of the fighter in conflict zones?

ANTECEDENTES: El uso de los torniquetes ha estado presente en los conflictos bélicos como elemento terapéutico para el control de la hemorragia externa en miembros, no obstante, su empleo ha estado rodeado de controversias y supersticiones, a pesar de su probada utilidad. La presente revisión evalúa los beneficios que aporta el torniquete en la atención a los heridos en los modernos conflictos bélicos. El uso pre-hospitalario del torniquete es una medida generalizada y protocolizada en el contexto militar, y está fundamentada en estudios científicos y en una experiencia clínica correspondiente al uso de estos dispositivos en ZO. OBJETIVOS: Analizar mediante la revisión de las referencias encontradas los beneficios y los inconvenientes que ofertan estos dispositivos y si realmente mejoran la supervivencia del combatiente con hemorragia externa en miembros. MATERIAL Y MÉTODOS: Revisión bibliográfica de diversos estudios clínicos efectuados en diversas Zonas de Operaciones (ZO) de los últimos once años. RESULTADOS: el análisis de diversos estudios han demostrado que el uso precoz del torniquete en el campo de batalla, supone una mejora en los ratios de supervivencia y una disminución de la morbimortalidad, del consumo de hemoderivados y por lo tanto, de los costes económicos en el tratamiento de este tipo de heridos. Esta revisión bibliográfica pretende demostrar que el empleo precoz del torniquete en ZO aumenta la supervivencia de los heridos que presentan hemorragia externa en combate

BACKGROUND: The use of tourniquets has been in the wars as a therapeutic element to control the external bleeding, however, their use has been surrounded by controversy and superstitions, despite its proven utility. This review assesses the benefits of the tourniquet in care of the wounded soldiers in modern warfare. Pre-hospital use of the tourniquet is widespread and notarized as in the military context, and is based on scientific studies and clinical experience for the use of these devices in ZO. OBJECTIVES: To analyze by reviewing the references found the benefits and drawbacks that offer these devices and whether it improves survival fighterwith external bleeding members. Material and METHOD: Literature review of several clinical studies in various combat areas of the last eleven years. RESULTS: The analysis of several studies have shown that early use of the tourniquet on the battlefield, an improvementin survival rates and decreased morbidity and mortality, consumption of blood and therefore the economic costs treatment of such injuries. This literature review aims to demonstrate that early use of tourniquet ZO increases the survival of the casualty who have external bleeding in combat

Mass gathering medical care: to calculate the Medical Usage Rate of Galway Races.

Medical Usage Rate (MUR) of Galway Races: The Galway Races is the most popular horse-racing festival in Ireland. It takes place for a week starting from the last Monday in July. The races are held at Ballybrit race course in Galway. During the 7 days of racing, about 180,000 people attend. The average temperature in Galway around that time of the year is around 15-200C. The aim of this study is to calculate the MUR of Galway Races and to develop a model to predict the MUR for Galway Races in future. The MUR of Galway Races is calculated by looking retrospectively at the medical records of the last 11 years of Galway Races from 1997 to 2007. The Galway Races has a MUR of 3.67 patient per ten thousand. Based on the figures for last 10 years, the predictive MUR for Galway Races 2008 calculated before the races and actual figures in 2008 races is comparable.

Maletines usados en DCCU móviles Sevilla / No disponible

Todos los vehículos de transporte sanitario deben cumplir la normativa contenida en el Real Decreto 619/1998, de 17 de abril, por el que se establecen las características técnicas, el equipamiento sanitario y la dotación de personal de los vehículos de transporte sanitario por carretera. Los DCCU móviles se definen como equipo de profesionales compuestos por un médico, enfermero/a y técnico de transporte sanitario o celador-conductor y los recursos materiales, encargados de la atención y asistencia en el ámbito extrahospitalario de toda aquella patología de inicio súbito o inesperados, o agudización de una patología previa, que causa disconfort a cualquier persona por estar en ella implicada su salud, basando esta atención en los beneficios que demuestra la evidencia científica, así como en el trato personal, humano y de respeto. En este artículo se enumera la dotación o equipamiento sanitario mínimos con los que ha de contar en los maletines usados en los DCCU móviles de Sevilla así cómo su distribución física(AU)

All vehicles must comply with health regulations contained in Royal Decree 619/1998, of April 17, laying down the technical, medical equipment and staffing of medical transport vehicles on the road. The DCCUMobile defined as a professional team comprising a doctor, nurse ay technical or medical transport driver and guard-material resources, responsible for the care and assistance in the area outside of the entire pathology of sudden or unexpected onset or worsening a preexisting disease, which causes discomfort to any person for being involved in it their health, focusing attention on the benefits that scientific evidence shows, as well as the personal, humane and respectful. This article lists the minimum manning or sanitary facilities with which it has to count the cases used in DCCU Mobile Sevilla and its physical distribution(AU)

Programa de Reanimación Cardiopulmonar Orientado a Centros de Enseñanza Secundaria (PROCES): conclusiones tras 5 años de experiencia / Cardiopulmonary resuscitation program for secondary schools (PROCES): conclusions after 5 years

Objetivo: Describir la experiencia adquirida tras 5 años de realizar formación en reanimación cardiopulmonar básica (RCP-b) a alumnos de enseñanza secundaria obligatoria(ESO), el porcentaje de aprendizaje satisfactorio inmediato y transcurrido un año desde la finalización del programa y los factores asociados a un buen aprendizaje. Método: El programa utilizado para este fin fue el Programa de Reanimació Orientat a Centres d’Ensenyament Secundari (PROCES). Se incluyeron a todos los alumnos que han completado el curso desde 2002 a 2007. Como instrumento de medida del aprendizaje satisfactorio se utilizó un test con 10 preguntas teóricas y 10 preguntas prácticas, el cual se contestó antes de realizar el PROCES e inmediatamente y un año después de concluirlo. Se estudió la influencia en el rendimiento de variables independientes relacionadas con el centro (titularidad, renta del barrio en el que se ubica), con el curso(curso curricular en el que se realiza, personal que desarrolla las clases prácticas) y con el alumno (edad, sexo, intención de estudiar ciencias de la salud, asignaturas pendientes de cursos previos y realización previa de un curso de socorrismo).Resultados: Durante estos 5 cursos académicos, han realizado el PROCES 1.501 alumnos. De ellos, 1.128 completaron el test antes y después del PROCES y 428 al cabo de un año. El porcentaje de aprendizaje satisfactorio inmediato fue del 58%, en tanto quela persistencia del mismo al cabo de un año fue del 42%. El estudio multivariado demostró que los centros privados, los centros situados en distritos de baja renta per cápita, el desarrollo del PROCES íntegramente por profesores del centro y la ausencia de asignaturas pendientes de cursos previos por parte del alumno se relacionaron de forma independiente con un mejor rendimiento inmediato, en tanto que sólo los dos últimos factores guardaron una relación significativa con la persistencia del aprendizaje. Conclusión: El PROCES, en manos de médicos especialistas en urgencias y emergencias, es una herramienta excelente para difundir los conocimientos en RCP entre los alumnos de ESO. Su afianzamiento durante los próximos años, así como su incorporación al currículo, pasa necesariamente por una apuesta clara y decidida de las administraciones públicas implicadas (AU)

Objective: To describe 5 years' experience in providing training in basic cardiopulmonary resuscitation (CPR) for students in Spanish obligatory secondary school education, including the percentage of satisfactory learning immediately after training and 1 year later; and to analyze factors associated with satisfactory learning. Methods: The trainers applied the CPR program developed for secondary schools (PROCES). All students who took the course from 2002 through 2007 were included. Learning was assessed with a test containing 10 items on theory and10 on practice; the test was administered immediately before and after the course and again a year later. We also studied the influence of independent variables related to school (public vs private, neighborhood per capita income),course (the grade when the CPR course was taken by a student, instructors giving the practical classes), and student(age, gender, intention to study a health science, courses failed in previous years, and whether a life-saving course had ever been taken).Results: A total of 1501 students took the PROCES course over 5 academic years. The test was taken immediately before and after the course by 1128 students; it was taken again a year later by 428 students. Fifty-eight percent had satisfactory test scores immediately after the course; 42% had satisfactory scores a year later. Multivariate analysis showed that private schools, those in neighborhoods with a low per capita income, those in which the PROCES course was given entirely by instructors belonging to the school, and not carrying failed subjects from previous years were the independent variables associated with better performance just after the course. However, only the last 2 factors were significantly related to maintenance of learning. Conclusion: The PROCES course in the hands of specialists in urgency and emergency medicine is an excellent tool for creating a broader base of CPR knowledge among secondary school students. Maintaining and extending the program over the coming years, as well as integrating it into the school curriculum, are matters that require clear commitment from the relevant public administrations (AU)

Moving beyond personnel and process: a case for incorporating outcome measures in the trauma center designation process.

HYPOTHESIS: Similarly designated trauma centers do not achieve similar outcomes. DESIGN: Outcomes study. SETTING: Academic research. PARTICIPANTS: Forty-seven American College of Surgeons-verified level I trauma centers that contributed more than 1000 patients to the National Trauma Data Bank (from January 1999 to December 2003) were identified. MAIN OUTCOME MEASURES: Patients were classified into the following 3 injury severity groups using a combination of anatomical and physiological measures: mild (Injury Severity Score [ISS] of <25 with systolic blood pressure [SBP] of >/=90 mm Hg [n = 184 650]), moderate (ISS of >/=25 with SBP of >/=90 mm Hg or ISS of <25 with SBP of <90 mm Hg [n = 22 586]), and severe (ISS of >/=25 with SBP of <90 mm Hg [n = 4243]). The mean survival for each group was calculated. Individual centers were considered outliers if their patient survival was statistically significantly different from the mean survival for each severity group. RESULTS: The mean survival of patients with mild, moderate, and severe injuries was 99%, 75%, and 35%, respectively. For mild injuries, survival at 5 centers (11%) was significantly worse than that at their counterpart centers. With increasing injury severity, the percentages of outcome disparities increased (15% of centers for moderate injuries and 21% of centers for severe injuries) and persisted in subgroups of patients with head injuries, patients sustaining penetrating injuries, and older (>55 years) individuals. CONCLUSIONS: When treating patients with similar injury severity, similarly designated level I trauma centers may not achieve similar outcomes, suggesting the existence of a quality chasm in trauma care. Trauma center verification may require the use of outcome measures when determining trauma center status.

Simulation of in-hospital pediatric medical emergencies and cardiopulmonary arrests: highlighting the importance of the first 5 minutes.

OBJECTIVES: Outcomes of in-hospital pediatric cardiopulmonary arrest are dismal. Recent data suggest that the quality of basic and advanced life support delivered to adults is low and contributes to poor outcomes, but few data regarding pediatric events have been reported. The objectives of this study were to (1) measure the median elapsed time to initiate important resuscitation maneuvers in simulated pediatric medical emergencies (ie, "mock codes") and (2) identify the types and frequency of errors committed during pediatric mock codes. METHODS: A prospective, observational study was conducted of 34 consecutive hospital-based mock codes. A mannequin or computerized simulator was used to enact unannounced, simulated crisis situations involving children with respiratory distress or insufficiency, respiratory arrest, hemodynamic instability, and/or cardiopulmonary arrest. Assessment included time elapsed to initiation of specific resuscitation maneuvers and deviation from American Heart Association guidelines. RESULTS: Among the 34 mock codes, the median time to assessment of airway and breathing was 1.3 minutes, to administration of oxygen was 2.0 minutes, to assessment of circulation was 4.0 minutes, to arrival of any physician was 3.0 minutes, and to arrival of first member of code team was 6.0 minutes. Among cardiopulmonary arrest scenarios, elapsed time to initiation of compressions was 1.5 minutes and to request for defibrillator was 4.3 minutes. In 75% of mock codes, the team deviated from American Heart Association pediatric basic life support protocols, and in 100% of mock codes there was a communication error. CONCLUSIONS: Alarming delays and deviations occur in the major components of pediatric resuscitation. Future educational and organizational interventions should focus on improving the quality of care delivered during the first 5 minutes of resuscitation. Simulation of pediatric crises can identify targets for educational intervention to improve pediatric cardiopulmonary resuscitation and, ideally, outcomes.

Changing concepts of life-saving procedures in 19th century Polish popular first-aid publications.

Throughout Europe, before the era of health insurance, access to professional medical help in an emergency was limited, for the vast majority of people, especially for those living outside big cities. This did not improve in the nineteenth century, even though the number of physicians grew rapidly. The industrial revolution added a range of previously unknown threats and, with the dramatic rise in population, many more people could not afford medical help. Therefore, the need for popular, easy-to-understand instructions on first aid became urgent. In Poland, such publications were especially needed because of the country's political situation, which resulted in restricted access to university medical education. During the nineteenth century, approximately 50 works on first aid were published in Polish, with almost 90% addressed to non-physicians. Evaluation of the contents of these books and the instructions which they contained gives a good insight into the evolution that first aid concepts underwent in the nineteenth century. These range from changes in the most urgent threats (from epidemic disorders to industrial accidents and combat injuries) and the accelerating development of medical knowledge (especially the asepsis / antisepsis concept), to the changing spectrum of readers (with growing numbers of those who could read but were otherwise poorly educated).

[Towards the problem of necessity to reduce the medical evacuation stages in conditions of local wars and armed conflicts]. / K voprosu o neobkhodimosti sokrashcheniia étapov meditsinskoi évakuatsii v usloviiakh lokal'nykh voin i vooruzhennykh konfliktov.

The article is devoted to the review of modern opinions concerning the experience of military operation medical support in conditions of local wars and military conflicts. On the base of analysis of medical assistance rendered to the wounded and casualties in Republic of Chechnya the advantages and defects of different approaches are discussed. The experience in rendering assistance to the casualties in the Armed Forces of NATO countries during the local wars for the last decades is discussed. It is shown that the optimal variant of organization of treatment-and-evacuation measures during the local armed conflicts and wars is the two-stage scheme of evacuation: the first medical aid--the qualified (specialized) medical aid.

[The future of electrical defibrillators for the heart]. / Die Zukunft der elektrischen Defibrillation des Herzens.

The aim of electric defibrillation of the heart is to salvage a greater percentage of victims of cardiac arrest in the future. An initial decisive pathway towards this goal is to get a defibrillator to the victim as quickly as possible and apply an electric shock. This has now been implemented on a large scale--by means of the widespread propagation of (semi-)automatic external defibrillators (AED) and their PAD (Public Access Defibrillator) variant for use by laypersons. This is an initial necessary prerequisite which, however, is not sufficient to have a real impact on saving lives. For experience has shown that, despite the early use of AEDs, an appreciable proportion of the victims cannot be saved. The intention is to improve this situation by increasing the efficacy and reducing the harmful downside of the defibrillation waveforms applied. The solution is optimally dimensioned biphasic waveforms with high efficacy at low energy levels. In this connection, it is shown that the efficacy of high-energy defibrillation shocks is exceeded by their injurious effects, thus thwarting life-saving defibrillation. Examples of new waveforms of particularly high efficacy are presented. It is shown how such impulses should be physiologically dimensioned, and clinical results of cardioversion (atrial defibrillation) and initial out-of-hospital results of emergency defibrillation are discussed. In addition, new approaches for future waveforms enabling pulsed pulse-pause-modulated biphasic shocks are described. In this way, waveforms with a physiologically optimal effect on the heart can be produced which were previously impossible with portable defibrillators. Waveforms that have already been tested or are still in the research stage, justify hopes that improved survival of cardiac arrest victims may be expected. These new waveforms may also be of benefit in other types of defibrillators (e.g. cardioversion or implanted defibrillators).

Emergency medical services dispatcher identification of stroke and transient ischemic attack.

OBJECTIVE: Certain forms of stroke can be treated if access to medical care is expeditious. Since many stroke victims first enter medical care through emergency medical services (EMS) access, minimizing delays in the EMS system may translate to improved neurologic outcome. Because EMS dispatchers determine the response priority for these calls, dispatchers should be able to recognize the signs and symptoms of stroke based on their brief phone interviews. The authors studied the abilities of dispatchers in a major urban area to correctly identify stroke and transient ischemic attack (TIA) in victims who access 911 and describe what is communicated in the 911 call. METHODS: A retrospective review was conducted of the medical records of patients treated for stroke or TIA at two urban hospitals during 1996. The tape-recorded 911 calls from patients using EMS were transcribed and analyzed. Information regarding dispatcher classification and triage of these calls was collected and described. RESULT: The records of 182 patients with acute stroke or TIA were reviewed. Fifty-three percent of patients used EMS. Dispatchers coded 31% of their 911 calls as stroke. The word "stroke" was used without prompting by 51% of callers, yet fewer than half of these calls were coded as stroke by dispatchers. Many callers reported symptoms characteristic of stroke, including impaired communication (36%), weakness (30%), and decreased ability to stand or walk (25%). Only 41% of ambulances were sent at high priority. CONCLUSION: People who activate EMS for stroke frequently use the word "stroke" and/or describe symptoms compatible with stroke in their calls. EMS dispatch protocols should be sensitive for these symptoms to ensure more accurate and timely ambulance dispatch.