DRIVING SAFETY IN THE EMERGENCY MEDICAL SERVICES AND TRAINING OF THE AMBULANCE DRIVERS

Ambulanslar; hastane dışında olay yerinden hasta ve/veya yaralı taşımaya uygun özel ekip ve ekipmanla donatılmış, kendine özgü uyarıcı sitemleri ve haberleşme aygıtları bulunduran özelleşmiş araçlardır. Çeşitli yasa ve yönetmelikler ile ambulanslar sınıflandırılmış ve standartları oluşturulmaya çalışılmıştır. Ambulanslarda, hasta ve yaralılara Temel ve İleri Yaşam Desteğinin sağlanabilmesi için gerekli ekip, ekipman ve acil ilaçlar bulunur. Ambulanslar Komuta Kontrol Merkezleri tarafından aktive edilir ve çağrıyı alan ekip olay yerinde hasta ve yaralılara temel ve ileri yaşam desteği vermekle sorumludurlar. Ancak; ambulansların kendileri diğer taşıtlara oranla daha sık olarak kazaya karışmakta yada kaza nedeni olmaktadır. Acil araç operasyonda iken trafik kurallarıyla ilgili bazı ayrıcalıklara, hız limitlerini aşmaya yetkili olmakla birlikte bütün bu yetkiler güvenlik sınırları içinde kullanılmalı; temel hedef personelin, hastanın ve diğer kişilerin güvenliği olmalıdır. Her çağrı rutin olarak "acil" kabul edilmemelidir. Ambulansların karıştığı kazalarda; kavşaklarda yavaşlamama, ışık ve kural ihlalleri, ani manevralar, yakın izleme gibi karakteristik özellikler dikkat çekmektedir. Ambulans sürücülerine trafikteki rol ve sorumluluklarını kapsayan eğitimlerin verilmesi gerekmektedir. Bunun için acil birimlerin güvenli sürüş teknikleri ile ilgili bir eğitim programı olmalı, bu eğitim programının ayrıntılı müfredatı, eğitim ekipmanları ve lisanslı eğitimcileri bulunmalıdır. Eğitimin kavramsal çerçevesi akademisyenlerin katkısı ile hazırlanmalı, meslek derneği temsilcilerinden görüş alınmalıdır. Ayrıca acil araçlarda sürücülük yapacak kişilerin eğitimleri gereği acil tıbbi bakım protokolleri ve ambulansın donanımını bilen tekniker (paramedik) ve/veya Acil Tıp Teknisyenleri içinden seçilmesi, acil araç ilişkili kazaların oranını azaltabilir. Ambulances are specialized vehicles supplied with appropriate crew and equipment to transport the ill and injured from the field to healthcare facilities, and with communication devices, sirens, lights etc. Various regulations and legal documents have been published to classify and standardize ambulances. Medical supplies necessary in an ambulance include all emergency drugs and equipment needed to be used in basic and advanced life support for both trauma and cardiac care. The vehicles are directed by dispatcher centers and the ambulance receiving the call is in charge of delivering basic and advanced life support as appropriate in the field. However, there is concrete evidence that these life-saving vehicles are involved in car accidents themselves, even more commonly than any other type of vehicles. Although there are certain privileges defined for ambulances in emergency operations which allow them to violate speed limits and some other strict rules in traffic, these exceptions are to be used cautiously within safety limits. Safety of the crew and the victims along with emergency medical vehicle should always take the priority. Only a minority of the calls are real ‘emergencies'. Failure to slow down in corners, violations of traffic lights and other rules, sudden maneuvers, following the next vehicle too closely are some of prominent features in the accidents in which the ambulances are engaged. Ambulance drivers should receive appropriate training with special regard to their role and responsibilities in the traffic. This mandates specific training programmes adopted by emergency medical services units regarding driving safety including core curriculum, equipment needed for training and licensed trainers. Conceptual framework should be delineated by academicians, and professional associations must be consulted. Paramedic and emergency medical technicians who are trained on emergency care protocols and use of ambulances should be the first choice to be employed as drivers of emergency medical vehicles in order to alleviate the rate of untoward events involved by these vehicles

Value Creation in Project Cargo Logistics: A Delphi Study

Project cargo logistics, with its idiosyncratic logistics processes and transportation of large, heavy and high-value cargoes, is a developing industry in Turkey. Value creation for project cargo transportation plays a critical role in gaining competitiveness in such a unique industry. Hence, the duties of related parties, the main value creation enablers, value creation outcomes and the barriers restricting such value creation should be explored. This paper sets out to provide an understanding on value creation concept of project cargo logistics. Its purpose is to identify the critical enablers of value creation as well as the main outcomes of value creation. An exploratory Delphi study with two rounds is employed. Key enablers include the partner-related and project cargo logistics operations-related dimensions. Critical outcomes have been classified as operational efficiency, service effectiveness and technology adoption/innovation. Findings can assist both operators and governmental bodies in aligning their services and procedures within the value creation perspective

Degradation of Reactive Red 194 and Reactive Yellow 145 azo dyes by O3 and H2O2/UV-C processes

Reactive Red 194 (RR194), Reactive Yellow 145 (RY145) azo dyes and synthetic textile dye-bath effluent were treated with O3 and H2O2/UV-C processes. The operating parameters such as dye concentration, hydrogen peroxide concentration and pH values were evaluated to find the optimum conditions for the H2O2/UV-C processes. It was observed that while H2O2/UV-C process was more pH dependent in decolorization and dearomatization reactions, ozonation was less selective and more effective in both decolorization and dearomatization reactions. Results indicated that the decolorization and dearomatization rate of each dye are well defined by pseudo-first order reaction kinetics. In general, decolorization reactions were faster than dearomatization reactions in both systems, though ozonation had faster reaction rates in both decolorization and dearomatization compared to the corresponding reaction rates taking place during the application of the H2O2/UV-C process. According to decolorization efficiency it can be inferred that effect of OH radical scavengers (e.g. CO32-, Cl-) present in the synthetic dye-bath as well as radical formation promoter (e.g. OH-) was probably hidden due to complexity of the synthetic dye-bath matrix. © 2009 Elsevier B.V. All rights reserved.This work was supported by Research Grant FEF2004D9 and FEF2007BAP10 from Cukurova University