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《Prehospital emergency care》2000,4(3):234-237
Objective. To determine whether the lay public expects public safety answering points (PSAPs) to provide prearrival instructions. Methods. Two thousand telephone numbers were randomly generated from all listed residential numbers in a county containing urban, suburban, and rural communities served by 26 enhanced 9-1-1 PSAPs. Only a minority of the PSAPs provided prearrival instructions. Research assistants made two attempts to contact an individual at each telephone number. A survey was administered to any person who answered the telephone provided the person was at least 18 years of age and gave verbal consent. The respondents were asked their age, level of education, and gender. They were also asked what number they would call for first aid or an ambulance and whether they would expect telephone instructions from the dispatcher if a close relative was choking, not breathing, bleeding, or giving birth. Results. One thousand twenty-four individuals were successfully contacted; and 524 (51%) were at least 18 years of age and agreed to participate. The respondents' mean age was 50 (standard deviation 19 years). Sixty-five percent of the respondents were female; and 90% had at least a high school diploma. Only 37% had previously called 9-1-1 (nine-one-one) for an emergency. Ninety-seven percent said they would dial either 9-1-1 (85%) or 9-11 (nine-eleven) (12%) in an emergency. Seventy-six percent (95% CI: 73%-80%) expected prearrival instructions for all four medical conditions. Specifically, prearrival instructions were expected by: 88% for choking (95% CI: 85%-90%), 87% for not breathing (95% CI: 84%-90%), 89% for bleeding (95% CI: 86%-91%), and 88% for childbirth (95% CI: 86%-91%). Ninety-nine of 117 respondents (81%) served by a PSAP that did not provide prearrival instructions expected to receive phone instructions for all four emergencies. Logistic regression revealed that knowing to dial 9-1-1 or 9-11 in an emergency was the only significant predictor of prearrival instruction expectation [p < 0.03, odds ratio 3.4 (95% CI: 1.16-9.78)]. Age, gender, service by a PSAP providing prearrival instructions, and level of education were not predictive. Conclusion. The lay public expects prearrival instructions when calling 9-1-1, although they may not currently receive this service. PREHOSPITAL EMERGENCY CARE 2000;4:234-237 相似文献
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Letvak S 《Issues in mental health nursing》2002,23(3):249-261
While the mentally ill are considered to be vulnerable as a group, those who are mentally ill and reside in rural communities are at a greater disadvantage due to limited access to health care, a scarcity of resources, and traditional cultural belief systems. Social support has been found to have a direct effect on the well-being of families and individuals. Specific strategies are presented which will assist rural health nurses in providing the support systems necessary to help rural residents in managing and coping with stress and mental health problems. 相似文献
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Background: Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utilization, but it is unclear whether this association remains significant when accounting for variations in the severities and types of ambulance contacts. Methods: We merged EMS ambulance contact records in a single California county (n = 88,027) with data from the American Community Survey at the census tract level (n = 300). Using tract as a proxy for neighborhood and negative binomial regression as an analytical tool, we predicted 16 outcomes: any ambulance contacts, ambulance contacts stratified by three intervention severities, and ambulance contacts varied by 12 primary impression categories. For each model, we estimated the incident rate ratios for 10 percentage point increases in tract-level poverty while controlling for geographic patterns in race, citizenship, gender, age, emergency department proximity, population density, and population size. Results: Our study produced three major findings. First, tract-level poverty was positively associated with ambulance contacts (incident rate ratio [IRR] 1.45; 95% confidence interval [CI] 1.34 to 1.57). Second, poverty was positively associated with low severity contacts (IRR 1.48; 95% CI 1.35 to 1.61), medium severity contacts (IRR 1.38; 95% CI 1.28 to 1.49), and high severity contacts (IRR 1.40; 95% CI 1.30 to 1.51). Third, poverty was positively associated with 12 primary impression categories: abdominal (IRR 1.48; 95% CI 1.36 to 1.61), altered level of consciousness (IRR 1.37; 95% CI 1.25 to 1.50), cardiac (IRR 1.28; 95% CI 1.14 to 1.42), overdose/intoxication (IRR 1.59; 95% CI 1.40 to 1.81), pain (IRR 1.56; 95% CI 1.41 to 1.73), psych/behavioral (IRR 1.50; 95% CI 1.34 to 1.67), respiratory (IRR 1.42; 95% CI 1.29 to 1.56) seizure (IRR 1.52; 95% CI 1.38 to 1.68), stroke (IRR 1.14; 95% CI 1.01 to 1.28), syncope/near syncope (IRR 1.23; 95% CI 1.12 to 1.36), trauma (IRR 1.44; 95% CI 1.31 to 1.58), and general weakness (IRR 1.31; 95% CI 1.20 to 1.42). Conclusion: Our study suggests poverty is a positive, strong, and enduring predictor of ambulance contacts at the neighborhood level. The relationship between neighborhood poverty and ambulance utilization should be considered at multiple levels of EMS decision making 相似文献
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Background: Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so often rely on weak measures of neighborhood (e.g., postal zip code), limit the analysis to particular ambulance encounters (e.g., cardiac arrest responses), and do little to account for variations in dispatch priority or intervention severity. Methods: We merged EMS ambulance contact records in a single California county (n = 87,554) with tract-level data from the American Community Survey (n = 300). After calculating tract-level median ambulance response time (MART), we used ordinary least squares (OLS) regression to estimate a conditional average relationship between neighborhood poverty and MART and quantile regression to condition this relationship on 25th, 50th, and 75th percentiles of MART. We also specified each of these outcomes by five dispatch priorities and by three intervention severities. For each model, we estimated the associated changes in MART per 10 percentage point increase in tract-level poverty while adjusting for emergency department proximity, population density, and population size. Results: Our study produced three major findings. First, most of our tests suggested tract-level poverty was negatively associated with MART. Our baseline OLS model estimates that a 10 percentage point increase in tract-level poverty is associated with almost a 24 s decrease in MART (?23.55 s, 95% confidence interval [CI] ?33.13 to ?13.98). Results from our quantile regression models provided further evidence for this association. Second, we did not find evidence that ambulances are relatively late to poorer neighborhoods when specifying MART by dispatch priority. Third, we were also unable to identify a positive association between tract-level poverty and MART when we specified our outcomes by three intervention severities. Across each of our 36 models, tract-level poverty was either not significantly associated with MART or was negatively associated with MART by a magnitude smaller than a full minute per estimated 10 percentage point increase in poverty concentration. Conclusion: Our study challenges the commonly held assumption that ambulances are later to poor neighborhoods. We scrutinize our findings before cautiously considering their relevance for ambulance response time research and for ongoing conversations on the relationship between neighborhood poverty and prehospital care. 相似文献
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HYPOTHESIS: Privately transported, major trauma patients made up approximately 4% of the total trauma patients population at a major, regional trauma center which treats over 90% of all major trauma victims in the geographic area. This study was undertaken to evaluate the patient profile of those individuals who did not access 9-1-1 for transport to a trauma center, including their reasons for such non-use. METHODS: Data on all major trauma occurring within Dade County, Florida, were collected by the county trauma registry. RESULTS: In the last six months of 1989, 1,672 patients were entered into the trauma registry. One-thousand-six-hundred-thirteen (1,613) were transported by professional ground or air services, 59 by private vehicle. For those patients transported directly from the Emergency Department to the Operating Room, only 35% of private vehicle patients entered surgery within 90 minutes of presentation compared to 57% of those who gained access to the 9-1-1 system and used emergency medical services (EMS). One-half of those patients who did not use 9-1-1 did not have telephone access. Patient acuity was similar for those transported by private vehicle compared to those transported by basic or advanced life support units. Private vehicle transport often delayed patient triage and assessment. Thus, for a number of lower income patients, 9-1-1 access was difficult. CONCLUSION: Underestimation of the severity of the injury or fear of delay in rescue response were prominent reasons for non-use of 9-1-1. While educational efforts should concentrate on decreasing inappropriate 9-1-1 use for non-emergencies, the causes of underutilization should not be ignored. 相似文献
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Anthony J. Billittier E. Brooke Lerner William Tucker Jennifer Lee 《Prehospital emergency care》2013,17(3):234-237
Objective. To determine whether the lay public expects public safety answering points (PSAPs) to provide prearrival instructions. Methods. Two thousand telephone numbers were randomly generated from all listed residential numbers in a county containing urban, suburban, and rural communities served by 26 enhanced 9-1-1 PSAPs. Only a minority of the PSAPs provided prearrival instructions. Research assistants made two attempts to contact an individual at each telephone number. A survey was administered to any person who answered the telephone provided the person was at least 18 years of age and gave verbal consent. The respondents were asked their age, level of education, and gender. They were also asked what number they would call for first aid or an ambulance and whether they would expect telephone instructions from the dispatcher if a close relative was choking, not breathing, bleeding, or giving birth. Results. One thousand twenty-four individuals were successfully contacted; and 524 (51%) were at least 18 years of age and agreed to participate. The respondents' mean age was 50 (standard deviation 19 years). Sixty-five percent of the respondents were female; and 90% had at least a high school diploma. Only 37% had previously called 9-1-1 (nine-one-one) for an emergency. Ninety-seven percent said they would dial either 9-1-1 (85%) or 9–11 (nine-eleven) (12%) in an emergency. Seventy-six percent (95% CI: 73%–80%) expected prearrival instructions for all four medical conditions. Specifically, prearrival instructions were expected by: 88% for choking (95% CI: 85%–90%), 87% for not breathing (95% CI: 84%–90%), 89% for bleeding (95% CI: 86%–91%), and 88% for childbirth (95% CI: 86%–91%). Ninety-nine of 117 respondents (81%) served by a PSAP that did not provide prearrival instructions expected to receive phone instructions for all four emergencies. Logistic regression revealed that knowing to dial 9-1-1 or 9–11 in an emergency was the only significant predictor of prearrival instruction expectation [p < 0.03, odds ratio 3.4 (95% CI: 1.16–9.78)]. Age, gender, service by a PSAP providing prearrival instructions, and level of education were not predictive. Conclusion. The lay public expects prearrival instructions when calling 9-1-1, although they may not currently receive this service. 相似文献
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《The American journal of emergency medicine》1995,13(2):188-195
The sooner a person who is experiencing symptoms and signs of an acute myocardial infarction (AMI) (including out-of-hospital cardiac arrest) receives medical treatment, the greater his or her chances of survival and limitation of infarct size. A universal 9-1-1 emergency telephone system makes it possible for AMI patients or those around them to easily and quickly call for help and for emergency medical services (EMS) personnel to rapidly and accurately locate the patient. This article by the Access to Care Subcommittee of the National Heart Attack Alert Program (NHAAP) Coordinating Committee describes the history of 9-1-1, its key elements, its current implementation status, and existing State legislation and standards. Currently, approximately 78% of the United States population, mainly in urban areas, has access to a 9-1-1 system. Approximately 195 United States cities with a population of greater than 100,000 people have access to enhanced 9-1-1. It is the contention of the NHAAP that 9-1-1 services should be universally available to all Americans to ensure seamless access to EMS and, potentially, early detection, evaluation, and treatment for AMI. This article reports several key recommendations for achieving this goal. 相似文献
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《Prehospital emergency care》2002,6(4):391-395
Objective. To obtain medical follow-up and determine reasons why elderly patients access paramedics via 9-1-1 and then refuse transport. Methods. A telephone survey of patients aged 65 years and older who refused transport and signed out against medical advice (AMA) after accessing paramedics via 9-1-1 was performed to obtain information about the patients' experiences, reasons why they refused, medical follow-up, and patient outcomes. Results. One hundred of 121 (83%) patients who were contacted by telephone participated in the survey. Patients stated that financial concerns were a major determinant in refusing to be transported. Overall, 70% of the patients reported receiving follow-up medical care. Care was obtained at an emergency department (ED) via a second 9-1-1 call in 16% of cases, at an ED via private vehicle in 13%, at an urgent care clinic by a private vehicle in 35%, and with a family physician via private car in 38% of cases. Of the patients who obtained follow-up, there was a 32% hospital admission rate, with 39% of those admitted to an intensive care unit setting. Finally, 80% of the sample studied did not speak to a physician online, with 49% stating that they would have changed their minds if a physician had suggested transport. Conclusion. The majority of patients who were 65 years of age and older and refused transport received follow-up care, with a significant number requiring admission to the hospital at the time of their follow-up. PREHOSPITAL EMERGENCY CARE 2002;6:391-395 相似文献
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Higgins T 《Clinical biochemistry》2012,45(13-14):1038-1045
Since the incorporation in 1976 of HbA(1c) into a monitoring program of individuals with diabetes, this test has become the gold standard for assessment of glycemic control. Analytical methods have steadily improved in the past two decades, largely through the efforts of the National Glycohemoglobin Standardization program (NGSP). The new definition of HbA(1c) and the introduction of an analytically pure calibrator have increased the possibility for greater improvements in analytical performance. Controversies exist in the reporting of HbA(1c). The use of HbA(1c) has expanded beyond the use solely as a measure of glycemic control into a test for screening and diagnosing diabetes. With improvements in analytical performance, the effects of demographic factors such as age and ethnicity and clinical factors such as iron deficiency have been observed. In this review, the history, formation, analytical methods and parameters that affect HbA(1c) analysis are discussed. 相似文献
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Matthew B. Jaffy BA Hendrika Meischke PhD MPH Mickey S. Eisenberg MD PhD 《Academic emergency medicine》1998,5(12):1146-1149
Abstract. Objective: Early aspirin administration during an acute myocardial infarction (AMI) decreases morbidity and mortality. This investigation examined the extent to which patients with a complaint of chest pain, the symptom most identified with AMI by the general population, self-administer aspirin before the arrival of emergency medical services (EMS) personnel.
Methods: In this prospective, cross-sectional prevalence study, data were derived through the analysis of EMS incident reports for patients with a complaint of chest pain from June 1, 1997, to August 31,1997.
Results: The study included 694 subjects. One hundred two (15%) took aspirin for their chest pain before the arrival of EMS personnel. Of the 322 subjects who reported taking aspirin on a regular basis, 82 (26%) took additional aspirin for their acute chest pain. Only 20 (5%) of the 370 patients who were not using regular aspirin therapy self-administered aspirin acutely (p < 0.001). In addition, patients with lower intensity of chest pain (p = 0.03) were more likely to take aspirin for their chest pain.
Conclusion: Only a relatively small fraction of individuals calling 9-1-1 with acute chest pain take aspirin prior to the arrival of EMS personnel. These individuals are more likely to self-administer aspirin if they are already taking it on a regular basis. It is also possible that they are less likely to take aspirin if their chest pain is more severe. 相似文献
Methods: In this prospective, cross-sectional prevalence study, data were derived through the analysis of EMS incident reports for patients with a complaint of chest pain from June 1, 1997, to August 31,1997.
Results: The study included 694 subjects. One hundred two (15%) took aspirin for their chest pain before the arrival of EMS personnel. Of the 322 subjects who reported taking aspirin on a regular basis, 82 (26%) took additional aspirin for their acute chest pain. Only 20 (5%) of the 370 patients who were not using regular aspirin therapy self-administered aspirin acutely (p < 0.001). In addition, patients with lower intensity of chest pain (p = 0.03) were more likely to take aspirin for their chest pain.
Conclusion: Only a relatively small fraction of individuals calling 9-1-1 with acute chest pain take aspirin prior to the arrival of EMS personnel. These individuals are more likely to self-administer aspirin if they are already taking it on a regular basis. It is also possible that they are less likely to take aspirin if their chest pain is more severe. 相似文献
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A simple method for constructing E1- and E1/E4-deleted recombinant adenoviral vectors. 总被引:14,自引:0,他引:14
We previously developed a two-plasmid in vitro ligation method that did not require a recombination step to produce new recombinant E1- or E1/E3-deleted adenoviral vectors. In this study, we have modified the system to improve the simplicity of vector construction and, in addition, to allow for production of an E1/E4-deleted vector. 相似文献