Emergency Medicine Commons^™

Incident Medical Operations At The Sr530 (Oso, Wa) Slide, Richard N. Bradley

Richard N Bradley

No abstract provided.

Bystander Performance Using Automated External Defibrillators During Simulated Cardiac Arrest, Richard N. Bradley, Lynda M. Schoenstein, Wesley H. Hamilton, Mark R. Boyle

Richard N Bradley

Objective: Automated external defibrillators (AEDs) are becoming widely available to the public. This study examined the hypothesis that less than 75% of the general population can defibrillate using an AED in less than three minutes.

Methods: This was a survey of the behavior of individuals over age 12 in a major airport on Jan. 2–3, 2003. After obtaining consent, an investigator told the subject that he/she was walking down the concourse and saw a person collapse. The subject demonstrated his/her response, using only a telephone and an AED simulating ventricular fibrillation. Data were analyzed using a one-sample test of proportions. …

Harris Health System Ems Protocols And Standing Delegation Orders, Richard N. Bradley

Richard N Bradley

As the EMS Medical Director for Harris Health System-EMS, I have approved these Protocols and Standing Delegation Orders to provide a treatment plan for the various types of injuries and illnesses that may commonly occur. These Protocols and Standing Delegation Orders are not intended to replace on-line Medical Control by a qualified physician, but rather to provide standing orders for specific interventions prior to the point that establishing control with a qualified physician becomes mandatory.

Authorized personnel are those basic and/or advanced life support trained HARRIS HEALTH SYSTEM-EMS personnel who have been approved in writing by the Medical Director in …

American Red Cross Sac Advisory On Obstructed Airway-Adults, Richard N. Bradley, Stamatios Lerakis

Richard N Bradley

INTRODUCTION: There were 4,700 deaths due to choking in the United States in 2012. This study was a structured literature review with the objective of determining whether in adults, either conscious or unconscious, with acute foreign body airway obstructions, if any specific resuscitation technique, compared to other techniques, leads to different outcomes.

METHODS: We developed an a priori search definition, and searched PubMed, Google, and OneSearch@IU. We sought additional articles by reviewing the reference lists of articles that we included. We included articles if they addressed original research of treatment of foreign body airway obstruction in adults. We excluded articles …

American Red Cross Scientific Review On Obstructed Airway-Adults, Richard N. Bradley, Stamatios Lerakis

Richard N Bradley

INTRODUCTION: There were 4,700 deaths due to choking in the United States in 2012. This study was a structured literature review with the objective of determining whether in adults, either conscious or unconscious, with acute foreign body airway obstructions, if any specific resuscitation technique, compared to other techniques, leads to different outcomes.

METHODS: We developed an a priori search definition, and searched PubMed, Google, and OneSearch@IU. We sought additional articles by reviewing the reference lists of articles that we included. We included articles if they addressed original research of treatment of foreign body airway obstruction in adults. We excluded articles …

National Emergency Cardiovascular Care Education Models: Where Do We Go From Here?, Richard N. Bradley

Richard N Bradley

The last decade could easily be called the "Renaissance Period" of CPR education. Self-learning, video-mediated instruction, virtual education and many other strategies have been employed, but what is on the horizon? The presenter will discuss challenges in defining the meaning of BLS and ACLS certification and issue a call for a national summit to define the minimum criteria for emergency cardiac care certification.

The Scientific Foundations Of The American Red Cross Cpr Training Standards, Richard N. Bradley

Richard N Bradley

The CPR (cardiopulmonary resuscitation) training and certification standards established by the ARC (American Red Cross) are based on a scientific review of the best available published literature. Minimal difference are present between the ARC and other national training organizations. These differences result from differing organizational opinions on the best way to implement standards from limited scientific evidence.

Catastrophic Incident Search And Rescue Lessons From The 2013 Colorado Floods, Thomas Miner, Richard N. Bradley

Richard N Bradley

The response to the Colorado floods is a textbook example of how to respond to catastrophic disasters Responders from hundreds of different organizations came together to form a single coordinated, unified command structure that resulted in the rapid and effective evacuation and rescue of hundreds of people in just three days. Local responders performed hundreds of highly dangerous rescues during the height of the storm. They established incident command at the county level using type 3 incident command teams. When they realized they were facing an unprecedented storm with catastrophic damage they asked for help and state and federal responders …

Ethical Questions In Emergency Medical Services: Controversies And Recommendations, Torben K. Becker, Marianne Gausche-Hill, Andrew L. Aswegan, Eileen F. Baker, Kelly J. Bookman, Richard N. Bradley, Robert A. De Lorenzo, David J. Schoenwetter

Richard N Bradley

EMS providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of ethical questions at the scene, it is important to establish protocols and policies, when possible, to address these high risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by emergency medical services (EMS) personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider …

Cardiopulmonary Resuscitation With Rescue Breathing Is Superior To Hands-Only Cardiopulmonary Resuscitation For Children And Infants: Results Of A Systematic Review, Joseph W. Rossano, Richard N. Bradley

Richard N Bradley

Introduction

Evidence supports teaching hands-only CPR for the initial treatment of cardiac arrest in adults. Unlike adults, however, children and infants with cardiac arrest are more likely to have non-cardiac causes.

Hypothesis: The objective of this project was to conduct a structured literature review to answer the question, “In children and infants with cardiac arrest treated in an out-of-hospital setting, does compression-only CPR, alone or with supplemental oxygen, compared to CPR with rescue breathing lead to improved outcomes?”

Results

Sixty-nine records were identified and screened. Fifty-four of these did not meet inclusion/exclusion criteria, leaving fifteen full-text articles that we assessed …

Existing Research Is Inadequate For The Development Of Guidelines For The Basic Lifesupport Management Of Airway Obstruction In Adults: Results Of A Systematic Review, Richard N. Bradley, Joseph W. Rossano, Siobán Kennedy

Richard N Bradley

Introduction

There has been considerable controversy and several changes in guidelines for the basic life support (BLS) management of choking since the introduction of the Heimlich procedure in 1974.

Hypothesis: The objective of this project was to conduct a structured literature review to answer the question, “For adults, either conscious or unconscious, with obstructed airway, does any specific resuscitation techniques compared to currently recommended techniques, lead to different outcomes?”

Results

We identified 475 records after duplicates were removed; we screened all of these and excluded 454. This left 22 full-text articles which we assessed for eligibility; we excluded 19 of …

The Impact Of Health Care Reform On Emergency Medical Services, Richard N. Bradley, Sabina A. Braithwaite

Richard N Bradley

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. The reforms introduced through PPACA present a paradigm shift in the future delivery model of all health care, including Emergency Medical Services (EMS). Changes embodied in this law offer a variety of opportunities to improve the delivery of care in urgent and emergent medical situations in the out-of-hospital setting. PPACA offers a number of avenues for EMS to engage at a much higher level as professional members of the health care team going forward. Certain components of the law stand to facilitate and …

Arc Sac Advisory Pulse Check For Cardiac Arrest, Sarah Clarke, Richard N. Bradley, Siobán Kennedy

Richard N Bradley

One good quality study (LOE 4) supports omitting a pulse check after defibrillation for patients in cardiac arrest.

One fair quality study (LOE 4) opposes the performance of simultaneous as opposed to sequential pulse and breathing check to determine cardiac arrest.

There is insufficient evidence to support a recommendation on the preferred method for the initial determination of cardiac arrest.

CPR courses should specifically teach the recognition of agonal breathing and the understanding that agonal breathing is not normal breathing and that it indicates the need for CPR.

Medical Direction Of Wilderness And Other Operational Emergency Medical Services Programs, Craig R. Warden, Michael G. Millin, Seth C. Hawkins, Richard N. Bradley

Richard N Bradley

Within a healthcare system, operational emergency medical services (EMS) programs provide prehospital emergency care to patients in austere and resource-limited settings. Some of these programs are additionally considered to be wilderness EMS programs, a specialized type of operational EMS program, as they primarily function in a wilderness setting (eg, wilderness search and rescue, ski patrols, water rescue, beach patrols, and cave rescue). Other operational EMS programs include urban search and rescue, air medical support, and tactical law enforcement response. The medical director will help to ensure that the care provided follows protocols that are in accordance with local and state …

Environmental Toxins: Biological, Chemical And Radiological Terrorism, Richard N. Bradley

Richard N Bradley

Children have greater risk of harm than adults after exposure to chemical, biological or radiological weapons, as may be seen following some acts of terrorism. This chapter reviews potential chemical agents, separating them into four categories: nerve agents, blister agents, cyanides, and choking agents. It reviews both recognition and treatment. The chapter also reviews symptoms, modes of transmission and treatment for the following biological agents: smallpox, plague, tularemia, anthrax, botulism, and viral hemorrhagic fevers.

International Strategy For Disaster Reduction – World Health Organization 2008-09 Campaign On Safer Healthcare Facilities, Richard N. Bradley

Richard N Bradley

Many recent emergencies highlight the need for hospitals that are safer and more resistant to disasters. The International Strategy for Disaster Reduction, an instrument of the United Nations General Assembly, and the World Health Organization have addressed the need for safer and more disaster-resistant healthcare facilities by making this priority the theme of their 2008 – 2009 biennial World Campaign on Disaster Reduction.

Shelter Care, Richard N. Bradley

Richard N Bradley

Unless exclusively serving an adult population, shelters must ensure that the physical and mental health needs of children are appropriately addressed, and that children remain with their families or caregivers to the maximum extent possible.

Smallpox, Richard N. Bradley

Richard N Bradley

Description Viral infection of the human respiratory tract. Causes Infection by variola virus. Risk Factors Exposure to a biological warfare or bioterror attack or contact with an infected person. Symptoms

Fever, cough and body aches, followed by a spotted, bumpy rash.

Diagnosis

Confirmed by testing blood or the fluid from the blisters.

Treatments

None currently approved but experts are testing some medications.

Pathogenesis

The virus enters and multiplies in the respiratory passages.

Prevention

Avoid those with the disease. During an outbreak a vaccine is available that will prevent the disease or lessen its severity.

Epidemiology

Completely eradicated from nature, but …

Educating The Public About Stroke: Role In Improving Outcomes, Richard N. Bradley

Richard N Bradley

Acute stroke affects large numbers of people worldwide. It causes significant morbidity and mortality. Data support the hypothesis that the public is not familiar with either the risk factors or the signs of stroke. Educating the public about stroke may result in a lower incidence of the disease as individuals modify their risk factors, and in improved outcomes as a result of reductions in delays to treatment. There is clear and convincing evidence that reducing delays to treatment of patients with acute stroke results in improved outcomes. Public education programs should be broad-based, tailored to individual audiences, and carry a …

Untrained Volunteers Are Marginally Effective In Delivering Public Access Defibrillation, Richard N. Bradley, Lynda J. Schoenstein, Mohhamad Alshanti

Richard N Bradley

Study objectives: This study analyzed the behavior of untrained volunteers when presented with a simulated cardiac arrest and an automated external defibrillator (AED). The primary hypothesis of this study was that volunteers could, with no advance training, operate an AED to deliver a defibrillation to a mannequin in 3 minutes or less at least 75% of the time. The secondary hypothesis was that this population would perform all of the tasks considered essential in AED use (establish unresponsiveness, check for breathing, give 2 rescue breaths, check for pulse, apply electrodes correctly, clear patient, activate emergency medical services (EMS) response, and …

Chemical & Biological Weapons Reference Chart, Richard N. Bradley

Richard N Bradley

Health Care Providers' Quick Reference Chart to Biological and Chemical Weapons. Includes symptoms and treatment for Nerve Agents (Tabun, Sarin, Soman, and VX), Cyanides, Vesicants (Blister Agents including Mustard and Lewisite), Pulmonary Intoxicants (including chlorine and phosgene), and Riot Control Agents (pepper spray and Mace). Also includes information on detection and treatment for Biological Agents, including Anthrax, Cholera, Plague, Tularemia, Q Fever, Smallpox, Viral encephalitides, Viral hemorrhagic fevers, Botulism, Staphlococcus enterotoxin B, and Ricin.