Response time performance is related to increased survival for a relatively small group of patients with critical emergencies. Effectively utilizing current resources is a challenge for all emergency medical services (EMS) systems for reasons of cost-effectiveness and safety.

The objective of this study was to identify opportunities for improving ambulance response-time performance in an urban EMS system using fixed deployment.

This was a qualitative and quantitative case study which consisted of structured interviews with policy makers, managers, and workers in a fire department EMS division, as well as analysis of dispatch data and observation of dispatch operations.

The current computer-aided dispatch (CAD) system does not identify the closest ambulance to the emergency, and therefore, dispatchers must guess which unit is closer when units are not within their stations or “first due” areas. There is no means to track how often dispatchers guess correctly or how often the closest ambulance actually is dispatched to the emergency.

Temporal and geographic patterns were identified. Opportunities also were identified to improve response time performance through the use of dynamic deployment and peak-load staffing.

The results suggest that there were opportunities for improving ambulance response times by implementing strategies such as peak-load staffing and dynamic deployment. However, the most important improvement would be the implementation of a policy to send the closest ambulance to the emergency. More research is needed to identify how prevalent the failure to send the closest ambulance is within EMS systems that use fixeddeployment response strategies and computer-aided dispatch systems that are incapable of tracking unit locations outside of their stations.

Research on skill acquisition and retention in the prehospital setting has focused primarily on resuscitation and defibrillation. Investigation into other first aid skills is required in order to validate practices and support training regimes. No studies have investigated competency using an extrication cervical collar for cervical spine immobilization.

This study was conducted to confirm that a group of first responders could acquire and maintain competency in the application of an extrication cervical collar over a 12-month period.

Participants attended a standardized training session that addressed the theory of application of an extrication cervical collar followed by hands-on practice. The training was presented by the same instructor and covered the nine key elements necessary in order to be deemed competent in extraction cervical collar application. Following the practical session, the competency of the participants was assessed. Participants were requested not to practice the skill during the 12-month period. Following the 12-month period, their skills were re-assessed by the same assessor.

Of the 64 subjects who participated in the study, 100% were competent after the initial first assessment. Forty-one participants (64%) were available for the second assessment (12 months later); of these, 25 (61%) maintained competence.

Although the sample size was small, this research demonstrates that first responders are able to acquire competence in applying an extrication cervical collar. However, skill retention in the absence of usage or re-training is poor. Larger studies should be conducted to validate these results. In addition, there is a need for research on the clinical practice and outcomes associated with spinal immobilization in the prehospital setting.

Terrorist attacks have occurred in Tel-Aviv that have caused mass-casualties.The objective of this study was to draw lessons from the medical response to an event that occurred on 19 January 2006, near the central bus station, Tel-Aviv, Israel. The lessons pertain to the management of primary triage, evacuation priorities, and rapid primary distribution between adjacent hospitals and the operational mode of the participating hospitals during the event.

Data were collected in formal debriefings both during and after the event. Data were analyzed to learn about medical response components, interactions, and main outcomes. The event is described according to Disastrous Incidents Systematic AnalysiS Through—Components, Interactions and Results (DISAST-CIR) methodology.

A total of 38 wounded were evacuated from the scene, including one severely injured, two moderately injured, and 35 mildly injured. The severe casualty was the first to be evacuated 14 minutes after the explosion. All of the casualties were evacuated from the scene within 29 minutes. Patients were distributed between three adjacent hospitals including one non-Level-1 Trauma Center that received mild casualties. Twenty were evacuated to the nearby, Level-1 Sourasky Medical Center, including the only severely injured patient. Nine mildly injured patients were evacuated to the Sheba Medical Center and nine to Wolfson Hospital, a non-Level-1 Trauma Center hospital. All the receiving hospitals were operated according to the mass-casualty incident doctrine.

When a mass-casualty incident occurs in the vicinity of more than one hospital, primary triage, evacuation priority decision-making, and rapid distribution of casualties between all of the adjacent hospitals enables efficient and effective containment of the event.

Primary healthcare centers (PHCCs) frequently are contacted for emergency reasons and are expected to provide basic and advanced life support during emergency situations.

The aim of this study was to assess the availability of emergency equipment and the knowledge of the staff working in PHCCs.

The survey was conducted in 21 PHCCs located in the rural city of Isparta, Turkey, in 2001. The availability of emergency equipment, emergency drugs, intravenous parenteral solutions, and diagnostic-therapeutic equipment was evaluated. Knowledge of basic life support of the staff (n = 195) was evaluated using a 10-item test.

Two (9.5%) PHCs had a complete emergency kit with an airways bag, mask, intravenous parenteral solutions, emergency drugs, and other diagnostic equipment. Emergency equipment was easily accessible in 19 PHCCs (90.5%), while in the remaining centers, the equipment and drugs were stored in locked cabinets.The staff that was evaluated consisted of 43 doctors (22%), 132 nurses and midwifes (67%), and 20 health officers (11%). Doctors scored the highest knowledge score (65.5%), followed by nurses and midwives (58.6% and 56.7%, respectively), and health officers (52.5%).

Primary healthcare centers were not prepared to provide advanced life support. Knowledge scores were low and the staff was in need of basic life support training. Further arrangements must be stressed to make PHCC's “emergency-friendly centers” in Isparta, Turkey.

The immediate impact of exposure to severe wounds, dead bodies, and immediate threat to life has been understudied. Most studies focus on the acute stress disorder and/or post-traumatic stress disorder phases in order to assess rescue personnel's symptomatology, and tend to neglect the immediate exposure to elements of the disaster.

Rescue personnel who had a history of previous exposure to dead bodies would exhibit higher levels of acute stress symptoms, dissociation, and depressive symptoms within the 24 hours following a traumatic event.

Twenty-three rescue personnel participated in the search and excavation of dead and mutilated bodies following the Bet-Yehoshua train crash in Israel.The rescue personnel group was divided based on previous exposure to dead bodies. Each participant completed a demographic questionnaire, which included a question on perceived threat to life, the impact of event scale revised, the dissociative experience scale, and the center of epidemiologic studies depression questionnaire. Student's t-tests, along with multivariate analysis of covariance (MANCOVA) were conducted in order to learn which factors are related to psychiatric symptomatology following the immediate exposure to such stressors.

Among rescue personnel, those with previous exposure to dead bodies did not differ in their levels of acute stress symptoms, dissociation, and depressive symptoms from those who were not previously exposed to dead bodies.

These results may suggest the possibility that the impact of exposure to dead bodies does not emerge in the acute stress reactions (ASR) phase (up to 24 hours after the event), but later when people have time to process the trauma. Another possibility is that the rescue coping mechanisms of detachment may serve as a buffer for the horrific sights encountered during the ASR period.

In March 2006, a few cases of bird flu were discovered in approximately 10 rural settlements in Israel. As a result, approximately one million birds were destroyed within a three kilometer radius of the settle-ments. The Israeli population was instructed to take preventive measures against the spread of the infection.

The objective of this study was to compare the frequency of use of different sources of information by the population in the affected area with the general population during the first phase of a bird flu outbreak in Israel.

A telephone survey among two randomly selected, representative samples of adults was conducted. One sample involved 500 adult Israeli resi-dents; the other sample involved 103 adult residents from the affected area during the first phase of the outbreak. The use of different sources of infor-mation by the population concerning the disease was assessed. The differences in these parameters between the affected area and the nationwide population were analyzed using a chi-square and t-test analysis. A p-value of <0.05 was considered statistically significant.

Television was a significantly more common source of information in Israel as a whole (p <0.05), whereas friends (p <0.05) and local authorities (p <0.05) were significantly more common sources of information in the affected area.

The frequency of use of the sources of information by the pop-ulation during the early phase of a bird flu outbreak is different in the affect-ed area compared with the general population in the same country. Authorities must pay attention to this phenomenon and use the correct sources of information in each area in order to achieve better exposure of the population to the recommended behaviors during an outbreak.

The number of paramedics in Israel is increasing. Despite this growth and important role, the emergency medical organizations lack information about the characteristics of their work.

The objective of this study was to examine the characteristics of the paramedics' work, the quality of their working lives, the factors that keep them in the profession, or conversely, draw them away from it.

Cross-sectional study conducted through telephone interviews of a random sample of 50% of the graduates of paramedic courses in Israel (excluding conscripted soldiers).

The factors that attract paramedics to the profession have much to do with the essence of the job—rescuing and saving—and a love of what it involves, as well as interest and variety. Pressures at work result from having to cope with a lack of administrative support, paperwork, long hours, imbalance between work and family life, and salary. They do not come from having to cope with responsibility, the pressure of working under uncertain conditions, and the sudden transition from calm situations to emergencies. Dissatisfaction at work is caused by burnout, work overload, and poor health. Physical and mental health that impedes their ability to work is related to a sense of burnout and the intention to change professions.

The findings about the relationships between health, job satisfaction, and burnout, coupled with the fact that within a decade, half of the currently employed paramedics will reach an age at which it is hard for them to perform their job, lead to the conclusion that there is a need to reconsider the optimum length of service in the profession. There also is a need to form organizational arrangements to change the work procedures of aging paramedics.

Currently, there is no widely available method to evaluate an emergency department disaster plan. Creation of a standardized patient data- base and the use of a virtual, live exercise may lead to a standardized and reproducible method that can be used to evaluate a disaster plan.

A virtual, live exercise was designed with the primary objective of evaluating a hospital's emergency department disaster plan. Education and training of participants was a secondary goal.

A database (disastermed.ca) of histories, physical examination findings, and laboratory results for 136 simulated patients was created using information derived from actual patient encounters.The patient database was used to perform a virtual, live exercise using a training version of the emergency department's information system software.

Several solutions to increase patient flow were demonstrated during the exercise. Conducting the exercise helped identify several faults in the hospital disaster plan, including outlining the important rate-limiting step. In addition, a significant degree of under-triage was demonstrated. Estimates of multiple markers of patient flow were identified and compared to Canadian guidelines. Most participants reported that the exercise was a valuable learning experience.

A virtual, live exercise using the disastermed.ca patient database was an inexpensive method to evaluate the emergency department disaster plan. This included discovery of new approaches to managing patients, delineating the rate-limiting steps, and evaluating triage accuracy. Use of the patient timestamps has potential as a standardized international benchmark of hospital disaster plan efficacy. Participant satisfaction was high.

Road traffic crashes (RTCs) are common in Qatar, and are now considered the third leading cause of mortality. In this study, the safety devices used by the Qatari public at the time of RTCs were assessed and the association between seatbelt use by vehicle occupants involved in RTCs and severe injury/death in the prehospital setting was determined.

This study was a retrospective case-control investigation. A Hamad Medical Corporation Emergency Medical Services (EMS) database of RTCs occurring from January 2006 to April 2007 was utilized for this study, providing a total of 5,267 patient records (83.5 % male, 16.5% female, median age = 28 years). Patient demographics, crash characteristics, prehospital assessments, and interventions were identified, and use of safety devices was determined. Univariate analysis including chi-square, Student's t-test, and analysis of variance (ANOVA) was performed as appropriate. “Case” patients are defined as those who had specific, critical prehospital assessments, or who received advanced cardio-respiratory life support measures in the field. Logistic regression modeling was used to predict the probability of a case being unbelted, controlling for confounders.

Seatbelt use in Qatar was low: 33.9% of males and 32.6% of females wore seatbelts at the time of the RTC. Victims involved in a vehicle rollover crash were less likely to be belted than were those involved in a non-rollover incident (26.2% belted vs. 37.8%; OR = 0.59; 95%CI = 0.50–0.68). Case patients—those with defined critical assessment findings or resuscitation in the field—and control patients were similar in age (30 years vs. 28 years median). Case patients were disproportionately male (89.1% vs. 83.2%; OR = 1.65; 95%CI = 1.01–2.83) and were more likely to be victims of a vehicle rollover crash (44.7% vs. 23.8%; OR = 2.57; 95%CI = 1.84–3.59). Seatbelt use was significantly lower among cases than controls: 19.7% of cases were reported to have worn seatbelts compared to 34.2% of controls (OR = 0.47; 95%CI = 0.31–0.69). This relationship also persisted (OR = 0.51; 95%CI = 0.33–0.76) after controlling for confounders.

Seatbelt use in Qatar is low. Seatbelts are protective: in the pre-hospital setting unbelted vehicle occupants involved in RTCs were nearly twice as likely to suffer severe injury or death compared to belted patients. Prehospital morbidity and mortality appears to be reduced significantly by the consistent use of seatbelts by the motoring population in Qatar.