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Ambulance crashes are a significant risk to prehospital care providers, the patients they are carrying, persons in other vehicles, and pedestrians. No uniform national transportation or medical database captures all ambulance crashes in the United States. A website captures many significant ambulance crashes by collecting reports in the popular media (the website is mentioned in the introduction). This report summaries findings fromambulance crashes for the time period ofMay 1, 2007 to April 30, 2009. Of the 466 crashes examined, 358 resulted in injuries to prehospital personnel, other vehicle occupants, patients being transported in the ambulance, or pedestrians. A total of 982 persons were injured as a result of ambulance crashes during the time period. Prehospital personnel were the most likely to be injured. Provider safety can and should be improved by ambulance vehicle redesign and the development of improved occupant safety restraints. Seventy-nine (79) crashes resulted in fatalities to some member of the same groups listed above. A total of 99 persons were killed in ambulance crashes during the time period. Persons in other vehicles involved in collisions with ambulances were the most likely to die as a result of crashes. In the urban environment, intersections are a particularly dangerous place for ambulances. [ABSTRACT FROM AUTHOR]

Summary: Background: Ventricular fibrillation occurs in 10–20% of pediatric cardiac arrests. Survival rates in children with ventricular fibrillation can be as high as 30% when the rhythm is identified and treated promptly. In the last 5 years, recommendations have been made for the use of automated external defibrillators in children between 1 and 8 years of age. Objective: The goal of this study was to determine the awareness of the ILCOR guidelines and statewide protocols concerning AED use in children ages 1–8 among emergency medical providers after new guideline release. Availability of pediatric capable AED equipment was also assessed. Methods: Surveys were distributed to EMS providers in Iowa and Montana within 1 year of the ILCOR advisory statement in 2003 recommending use of AEDs in children ages 1–8, and again approximately 1 year after the 2005 ILCOR guidelines on cardiopulmonary resuscitation were published. In Iowa, there were concentrated efforts to disseminate information about AED use in children, while there were minimal efforts in Montana. Results: Awareness of ILCOR guidelines for use of AEDs in children was low in both states in 2003 (29% in Iowa vs. 9% in Montana, p <0.001). After release of the 2005 guidelines, awareness improved significantly in both states but was still significantly greater in Iowa (83% vs. 60%, p <0.002). In 2003, less than 20% of respondents in both states reported access to pediatric capable AEDs. Availability of pediatric pads and cables increased significantly in 2006 but remained low in Montana (74% in Iowa vs. 37% in Montana, p <0.001). Conclusions: At the present time, publication of new or interim guidelines in the scientific literature alone is insufficient to ensure that new protocols are implemented. An effective and efficient method to disseminate new pediatric out-of-hospital protocols emergency care to become standard of care in a timely matter must be developed. [Copyright &y& Elsevier]

Mass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.

Mass casualty triage is a critical skill. Although many systems exist to guide providers in making triage decisions, there is little scientific evidence available to demonstrate that any of the available systems have been validated. Furthermore, in the United States there is little consistency from one jurisdiction to the next in the application of mass casualty triage methodology. There are no nationally agreed upon categories or color designations. This review reports on a consensus committee process used to evaluate and compare commonly used triage systems, and to develop a proposed national mass casualty triage guideline. The proposed guideline, entitled SALT (sort, assess, life-saving interventions, treatment and/or transport) triage, was developed based on the best available science and consensus opinion. It incorporates aspects from all of the existing triage systems to create a single overarching guide for unifying the mass casualty triage process across the United States.

Public health and the emergency care community must work together to effectively achieve a state of community-wide disaster preparedness. The identification of model communities with good working relationships between their emergency care community and public health agencies may provide useful information on establishing and strengthening relationships in other communities. Seven model communities were identified: Boston, Massachusetts; Clark County, Nevada; Eau Claire, Wisconsin; Erie County, New York; Louisville, Kentucky; Livingston County, New York; and Monroe County, New York. This article describes these communities and provides a summary of common findings. Specifically, we recommend that communities foster respectful working relationships between agency leaders, hold regular face-to-face meetings, educate each other on their expertise and roles during a disaster, develop response plans together, work together on a day-to-day basis, identify and encourage a leader to facilitate these relationships, and share resources.

Introduction: Disaster preparedness is an area of major concern for the medical community that has been reinforced by recent world events. The emergency healthcare system must respond to all types of disasters, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored., Problem: This study sought to answer several questions, including: (1) What are rural emergency medical services (EMS) organizations training for, compared to what they actually have seen during the last two years?; (2) What scale and types of events do they believe they are prepared to cope with?; and (3) What do they feel are priority areas for training and preparedness?, Methods: Data were gathered through a multi-region survey of 1801 EMS organizations in the US to describe EMS response experiences during specific incidents as well as the frequency with which these events occur. Respondents were asked a number of questions about local priorities., Results: A total of 768 completed surveys were returned (43%). Over the past few years, training for commonly occurring types of crises and emergencies has declined in favor of terrorism preparedness. Many rural EMS organizations reported that events with 10 or fewer victims would overload them. Low priority was placed on interacting with other non-EMS disaster response agencies, and high priority was placed on basic staff training and retention., Conclusion: Maintaining viable, rural, emergency response capabilities and developing a community-wide response to natural or man-made events is crucial to mitigate long-term effects of disasters on a local healthcare system. The assessment of preparedness activities accomplished in this study will help to identify common themes to better prioritize preparedness activities and maximize the response capabilities of an EMS organization.

Context: Many American Indian nations, tribes, and bands are at an elevated risk for premature death from unintentional injury. Previous research has documented a relationship between alcohol-related injury and subsequent injury death among predominately urban samples. The presence or nature of such a relationship has not been documented among American Indians living in the northern plains., Purpose: The purpose of this study was to identify and characterize any association between prior injury and/or alcohol use contacts with the Indian Health Service (IHS) and subsequent alcohol-related injury death that may suggest opportunities for mitigation., Methods: Death certificates of American Indians who died from injury (ICD-9-E 800-999) in a rural IHS area over 6 consecutive years were linked to IHS acute-care facility records and toxicology reports. Deaths and prior IHS contacts were stratified by alcohol use as a contributing factor. Of the 526 injury deaths involving American Indians in the IHS area studied, 411 (78%) were successfully linked to IHS records. One hundred fifty-two of these cases met the inclusion criteria, with an additional 98 cases identified as a comparison group., Findings: No differences in alcohol use at time of death between groups with and without prior health care contact (for injury or alcohol) could be determined (81% vs 73%). A significant relationship was found between previous visits for acute or chronic alcohol use and subsequent alcohol-related fatalities (P =.01)., Conclusions: Based on these findings, injury-prevention activities in the population studied should be initiated at the time of any health-system contact in which alcohol use is identified. Intervention strategies should be developed that convey the immediate risk of death from injury in these patients.

Objective: Results of prehospital pediatric continuing education using train-the-trainer and CD-ROM training methods were compared to each other and to a control group. The null hypothesis was that no differences would be found in pretraining and posttraining measurements of knowledge and performance by either training method., Methods: This was a prospective trial involving 12 sites. Random selections were made from ambulance service lists provided by 3-state emergency medical services (EMS) agencies. Preintervention and postintervention (12-month) measurements included a written examination and 2 performance scenarios videotaped for independent panel evaluation. Training was either an interactive CD-ROM or standard classroom instruction using a train-the-trainer model. Mean differences in written, performance, and combined scores were analyzed., Results: Differences were noted in the combined and performance scores for the CD-ROM intervention group. No differences were noted in written measurements between or among the groups., Conclusion: In this small sample, interactive CD-ROM training shows promise for improving performance. The research design, with additional guards against sample size attrition, may provide a model for multisite EMS education research.

The pathology of cardiac disease includes genetic, physical, biochemical, psychological, social, and environmental vectors. Factors contributing to suicide have been identified in these same areas. Survival from an acute cardiac event requires a systematized and multisectoral response. Communities that do not have systematized response capabilities to acute cardiac events have poorer survival outcomes. Suicide prevention and control may also be responsive to an integrated community response system. This paper examines the development of a community cardiac care model, explores potential parallels for a community suicide prevention and control model, and outlines a general systems theory framework for a suicide prevention and control system.