A Retrospective Study on Measures Taken to Prevent Over the Embankment Motor Vehicle Crashes in the Hoopa Area of Northern California

This is a retrospective research paper on measures taken to prevent over-the-embankment (OTB) motor vehicle crashes in the Hoopa Area of Northern California. OTB crashes are defined as any motor vehicle crash that results in that vehicle leaving the roadway and continuing down an embankment. The roadways included for the purposes of this study will be limited to those state highways, local roads, and major spur roads within the approximately 50 mile radius which constitutes the Hoopa Health Association emergency medical services response zone. This study demonstrates that the bluff areas are over-represented for fatal and critical injuries from all motor vehicle crashes in the Hoopa Area. It will further show that the nature of these fatalities is primarily major systems trauma. It is meant to reinforce the conclusion that improved rescue operations and response is not the answer for multiple trauma patients, since even under optimal conditions the time needed for response time, rescue time and the time involved in transport to the nearest contract care emergency unit (52 miles) is far too much time to respond to severe systems trauma. The methodology used in this study was reasonably simple, inexpensive and low-tech surveillance used to predict OTB crash clustering. It was implemented by an Emergency Medical Service Coordinator who had also served as a rescuer. The focal points of the surveillance efforts were the bluff areas that presented a major problem for rescuers because of their height and extreme steepness. The author began a program of video taping the areas where the most severe problems were occurring. He would accompany ambulance units, and record road features, embankments, shoulder widths, and slide marks soon after the accidents had occurred. He began the video taping in 1985. In 1985, coincidental to the video taping campaign, Cal-Trans found itself at fault in two substantial lawsuits in the Hoopa Area. The one was for inadequate road width, and the second was for actions taken by a state road crew at the scene of a diesel spill that caused a double fatality in the North Hoopa Bluffs. At approximately the same time, a Cal-Trans employee developed a means for anchoring guard rails underneath the roadway, using cantilevered steel I-Beams set into ditches under the roadbed. This and the lawsuits and the video campaign resulted in a massive campaign to install guardrail on the bluffs and in widening the roads and other roadbed improvements.Based on the ongoing surveillance of data, since the installation of the guardrail, there is a very strong correlation between the date of installation and a downturn in the number of OTB crashes. The existence of the guardrail has not increased or been a factor in head oncrashes. The cantilevered guardrail seem to be holding up well to brushing impacts and falling rocks along the bluffs without any obvious signs of weakening. There are still embankments that are unprotected. There are some dangerous turns where guardrail weren\\u27t installed completely. These areas will continue to be especially hazardous until they are improved. Lack of visibility of a problem often prevents that problem from being addressed or allows it to be set aside. In OTB crashes multiple systems trauma is most often the killer. Seat belts are a good preventive measure to avoid ejection from the vehicle once the accident is in progress. Other factors in the occurrence of OTB crashes are age of driver, speed and road condition, sex of the driver, familiarity with the road. and sensory impairment from drugs, alcohol, and lack of sleep.The author determined that prevention would reduce fatalities far more than efforts to treat trauma after the fact. He also suggests exploration for altering the environment in an effort to prevent accidental injury rather than or in addition to education efforts

Innovative Approaches to Emergency Medical Services Fellowship Challenges

Introduction: Since the development of an Accreditation Council of Graduate Medical Education (ACGME)-accredited emergency medical services (EMS) fellowship, there has been little published literature on effective methods of content delivery or training modalities. Here we explore a variety of innovative approaches to the development and revision of the EMS fellowship curriculum.Methods: Three academic, university-based ACGME-accredited EMS fellowship programs each implemented an innovative change to their existing training curricula. These changes included the following: a novel didactic curriculum delivery modality and evaluation; implementation of a distance education program to improve EMS fellows’ rural EMS experiences; and modification of an existing EMS fellowship curriculum to train a non-emergency medicine physician.Results: Changes made to each of the above EMS fellowship programs addressed unique challenges, demonstrating areas of success and promise for more generalized implementation of these curricula. Obstacles remain in tailoring the described curricula to the needs of each unique institution and system.Conclusion: Three separate curricula and program changes were implemented to overcome specific challenges and achieve educational goals. It is our hope that our shared experiences will enable others in addressing common barriers to teaching the EMS fellowship core content and share similar innovative approaches to educational challenges

Emergency medical services

When NASA was established in 1958, it was known that space flight would require efforts beyond those of NASA to ensure the health and safety of our astronauts. On 10 Aug. 1958, a Secretary of Defense memorandum was signed that assigned the first Department of Defense (DOD) Manager to provide support to NASA for Project Mercury. This established a chain of command through the Joint Chiefs of Staff to the Secretary of Defense. The current charter is dated 19 Mar. 1986 and assigns the DOD Manager responsibilities to the Commander and Chief, US Space Command. The DOD Managers charter has many support areas and among them are recovery of astronauts and medical support. Today these efforts support the Space Shuttle and Space Station Programs. Briefly, the program works with each organization tasking the other through a requirements document. Level of care, communications, and recovery requirements are established; NASA and the DOD provide the capability to meet them. NASA is also responsible for the specialized training and equipment needed to meet these requirements. A Shuttle launch a KSC requires an Emergency Medical Services (EMS) coordinator on console to facilitate communications, ensure proper coverage, and coordinate with area hospitals. A contingent of NASA medical personnel are assembled to provide triage and medical support capabilities. The DOD provides medical evacuation (MEDEVAC) helicopters with surgeons and pararescue specialists (PJ's) or emergency medical technicians (EMT's). Each helicopter is equipped with at least one doctor and one PJ/EMT per astronaut crew member. Transoceanic abort landing (TAL) sites and end of mission (EOM) sites have similar structures, with TAL sites utilizing fixed wingg aircraft for MEDEVAC. The DOD also supports contingency planning for the support and return of crew members from the Space Station Freedom. Much of this support has been directed at the recovery of crew members following the landing of an Assured Crew Return Vehicle

The Pediatric Emergency Care Applied Research Network: a history of multicenter collaboration in the United States.

In this article, we review the history and progress of a large multicenter research network pertaining to emergency medical services for children. We describe the history, organization, infrastructure, and research agenda of the Pediatric Emergency Care Applied Research Network (PECARN), and highlight some of the important accomplishments since its inception. We also describe the network's strategy to grow its research portfolio, train new investigators, and study how to translate new evidence into practice. This strategy ensures not only the sustainability of the network in the future, but the growth of research in emergency medical services for children in general

Emergency Medical Services (EMS)

This history for the Emergency Medical Services program was written to commemorate DMACC\u27s 50th anniversary celebration during the 2015-16 academic year

School of Continuing Studies Launches New Degree Program for Emergency Medicine Professionals

Starting this fall, RWU to offer new program aimed to help expand career opportunities for students and professionals in the emergency medical services field

Prehospital nursing students' experiences of patient safety culture in emergency medical services-A qualitative study

Aims and Objectives To describe prehospital nursing students' experiences of patient safety culture in emergency medical services during their internship. Background Patient safety culture in the emergency medical services is a complex phenomenon including more than organisational policies and practices and professionals' technical skills. Design The descriptive qualitative approach used the Sharing Learning from Practice to improve Patient Safety Learning Event Recording Tool, which includes both open-ended and structured questions. Methods Purposeful sampling was used, and data were collected from graduating prehospital nursing students (n = 17) from three Finnish Universities of Applied Sciences. Open-ended questions were reviewed using thematic analysis, and frequencies and percentages were derived from structured questions. COREQ guidelines were used to guide this study. Results Four themes were identified during the thematic analysis: environmental and other unexpected factors in emergency medical services, working practices and professionalism in emergency medical services, teamwork in emergency medical services and feelings related to patient safety events in emergency medical services. Patient safety events described by students were seldom reported in the healthcare system or patient files. According to the students, such events were most likely related to communication, checking/verification and/or teamwork. Conclusions This study shows that prehospital nursing students can produce important information about patient safety events and the reasons that contributed to those events. Therefore, emergency medical services organisations and managers should use students' observations to develop a patient safety culture in emergency medical services. Relevance to clinical practice Understanding how prehospital nursing students have experienced patient safety culture during their internships on ambulances can support educational institutions, together with emergency medical services organisations and managers, to improve policies for students to express patient safety concerns as well as patient safety successes.Peer reviewe

Effects of Emergency Medical Service Funding Policies in Kentucky

Emergency medical services is a complicated component in local Kentucky governments. Emergency Medical Services (EMS) operated and managed by local government have various funding mechanisms and each have different methods of reporting. This paper reviews the various ways EMS is funded in Kentucky along with the impact these different funding strategies have on quality and delivery of emergency medical services

Emergency medical services in Iceland

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