The accuracy of the glucose reagent strip, Chemstrip bG, for the determination of the presence of hypoglycemia, euglycemia, or hyperglycemia was assessed in the prehospital setting when used by paramedics treating patients with an altered level of consciousness. Venous blood specimens were obtained from each of sixty-two patients. Serum glucose levels of the sample were determined by paramedics in the field using the Chemstrip bG and within three hours after sample acquisition by standard laboratory techniques. The sensitivity and specificity of detecting true hypoglycemia (serum glucose<61 mg/dl) using the field reagent strips were 100% and 83.3% respectively. The corresponding 95% lower limits of confidence (LLC) were 81.3% and 83 .3%. The sensitivity and specificity of field detection of the absence of hypoglycemia (serum glucose ≥ 61 mg/dl) were 86.6 % (LLC=80.9%) and 100% (LLC=81.3%) respectively. The accuracy of the reagent strips is specific but not sensitive for the determination of the presence of hyperglycemia (serum glucose > 179 mg/dl). Thus, the Chemstrip bG is an accurate means for the rapid identification of the presence or absence of hypoglycemia in the field setting by paramedics.

The use of pulse oximetry as an adjunct to clinical evaluation of oxygenation during aeromedical transport by helicopter and fixed-wing aircraft was evaluated. As evidenced by an oxygen saturation of 90% or less, 29 of 150 patients (29%) were hypoxemic in the presence of the flight team. Airway interventions were carried out by the flight team in 17 of these 29 hypoxemic patients. In 11 of these 17 instances, desaturation noted by pulse oximeter was the first evidence that airway interventions were indicated. In the other 12 cases of hypoxemia, no new airway interventions were carried out despite oximeter evidence of desaturation. Three of these patients subsequently required aggressive airway interventions following their arrival at the receiving emergency department. Of the 32 patients transported by fixed-wing aircraft, 27% had evidence of unsuspected hypoxemia detected only by the pulse oximeter. The hypoxemia seemed related to increasing altitude in eight of this latter group. Pulse oximetry is a valuable and feasible technique for monitoring patients during aeromedical transport. Its use may allow detection of physiologic hypoxemia before such becomes apparent clinically.

A new method for evaluating the capabilities and performance of a general hospital in masscasualty exercises is described. This method is based on the use of simulation techniques which are realistic relative to the types and availability of the manpower required and to the time consumed by the assessments, interventions, and administrative duties and demands for each casualty encountered and the total workload thrust on the hospital by the cumulative requirements of all of the casualties. The simulation can be accomplished only after the time and equipment required for every possible diagnostic, therapeutic, and administrative procedure has been assessed for the specific hospital. Thereafter, it is possible to define the exact type and quantity of resources, in terms of time and manpower, consumed cumulatively by every simulated casualty assessed and treated during the exercise. The simulated victims are selected from a pool of young physicians who are briefed thoroughly by senior staff physicians prior to the exercise. Thus, the simulated subjects are provided lists of problems and the appropriate options for treatment. They also serve as controllers in the definition of time and manpower consumed for their specific injury set. Given this setting, it is possible to assess the functional performance of a hospital as a unit and for each of its components and also realistically estimate its capacity to manage disaster victims using a simulation of a disaster situation with mass casualties.

Emergency Medicine has become an accepted specialty in the medical community, and with the recognition has come the responsibility for those of us who teach and practice it to study our clinical practices. We must be satisfied that our clinical judgments are well- founded, not only in emergency departments, but also in our special role as providers of prehospital medical care. With the advent of trauma centers and Advanced Trauma Life Support (ATLS) training, the pivotal issues of the prehospital care of the trauma victim, and the timeliness of transporting these patients to appropriate receiving hospitals have resulted in a pair of recurring criticisms in the medical literature.

The administration of IV fluids to traumatized patients in the field at first seems like a motherhood issue: It can't do any harm and might do some good, so why not use it? This rationale has resulted in its inclusion in prehospital trauma care since the advent of paramedic systems in this country approximately 15 years ago; yet it remains unproven. There are no convincing data in the literature to support the efficacy for the administration of IV fluids in the prehospital setting.

Both civilian and military authorities continually are compelled to develop and revise disaster plans in order to demonstrate that they are prepared to manage any major incident occuring within their jurisdiction. Such plans may have some distinct value in that they often contain lists of key persons and agencies to contact in the event of a major incident, or because they prospectively document local policies of operation when actions taken during the incident are subsequently criticized by second-guessers. However, elaborate plans generally are forgotten or initially disregarded at the scene of an actual emergency situation.

In general, preparations for disasters which result in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgery, and prolonged life support (PLS: intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks. Preliminary results permit the following generalizations: 1) a significant number of victims died slowly as the result of injuries such as external hemorrhage, head injury with coma, shock, or crush syndrome; 2) early search and rescue was performed primarily by uninjured covictims using hand tools; 3) many lives potentially could have been saved by the use of LSFA and ATLS started during extrication of crushed victims. 4) medical teams from neighboring EMS systems started to arrive at the site at 2-3 hours and therefore, A TLS could have been provided in time to save lives and limbs; 5) some amputations had to be performed in the field to enable extrication; 6) the usefulness of other resuscitative surgery in the field needs to be clarified; 7) evacuations were rapid; 8) air evacuation proved essential; 9) hospital intensive care was well organized; and 10) international medical aid, which arrived after 48 hours, was too late to impact on resuscitation. Definitive analysis of data in the near future will lead to recommendations for local, regional, and National Disaster Medical Systems (NDMS).

The roles of the veterinary sciences in disasters and emergencies related to exposures of the environment to harmful chemicals are reviewed. Characteristics of chemical emergencies which require the use of the veterinary sciences are discussed. Veterinary services are important in the: 1) definition of the kind and severity of the pollution through biological monitoring; 2) use of animals as monitors of the environment; 3) use of changes in the health status of animals for identification of pathophysiologic changes to man and other animals (sentinels); 4) maintenance of the hygiene of elements of the food chain; 5) evacuation and management of animal populations; 6) disposal of carcasses; and 7) treatment and follow-up of involved animal populations. Veterinary services are important components of responses to incidents marked by chemical pollution and must be included in the development of contingency plans to meet the demands created by chemical pollution.

Medical communications associated with a collision between a passenger train and three locomotives which resulted in the death of 16 and injury to at least 177 persons quickly overwhelmed the relatively sophisticated EMS communications center (SYSCOM) serving the state of Maryland, U.S.A. Other than traditional talk-by and ambulance-hospital communications, the system was saturated by: 1) communications between seven prehospital sectors; 2) persons moved into the field from their usual in-hospital environment who were not familiar or experienced with the use of radio communications; 3) traffic generated through the operations of 11 helicopters; and 4) the usual confusion that accompanies such events. The use of cellular telephones during this incident, substantially enhanced all levels of communications. Many of the participants expressed preference for this form of communications compared to the use of radios.

Problems associated with the use of cellular telephone communications included an insufficient number of channels made available by the telephonecommunications provider causing competition with non-essential personnel for use, and relatively short battery life. These problems can be solved by the provider opening more channels and by the use of larger power sources such as automobile storage batteries. It is concluded that portable and vehicle-mounted cellular telephones can serve as useful communications tools in mass casualty and disaster situations.