The safe and timely provision of blood is of crucial importance in the prevention and mitigation of morbidity and mortality due to trauma. The use of blood in the treatment of war casualties, soldiers as well as civilians, was analyzed retrospectively and the impact of massive blood transfusion on blood banking services and reserves of blood during the war in Sarajevo was assessed.

A retrospective analysis of 3,215 war casualties (1,815 civilians plus 1,400 military) who arrived to the casualty reception center of the State Hospital of Sarajevo during the period 11 May through 31 October 1992 was performed. Blood usage was reviewed in three stages: within 24 hours (h) of admission, after seven days of hospitalization, and after 30 days of hospitalization. The types of injury, survival rate, and blood-usage rate in a sample of 37 war casualties who required massive blood transfusions (MBT) during the period 11 May through 31 December 1992 was examined.

The civilian casualty rate in this series of patients was 56.5%. A total of 1,217/3,215 (37.9%) casualties were hospitalized. In this study, 16% (504/3,215) of total number of persons wounded received blood transfusion. Of these patients, 504/1,217 (41.4%) were transfused. A total of 971.1 liters of blood were transfused through 31 October 1992; 68% within 24 h of admission, 91% within the first seven days, and 100% within the first 30 days. From a total of 37 MBT recipients, 36 (97%) were injured by firearms. Survival rate among MBT patients was 30%. The MBT recipients comprised 2% of total hospitalized patients and 6% of total number of patients transfused. The amount of blood needed during episodes of MBT was 15% of total blood used through 31 December 1992.

Based on these data, prospective requirements for blood usage should take into account casualty triage, as follows: for each casualty transported to the hospital, hospitalized, or transfused, 0.302, 0.796, and 1.912 liters of blood respectively, will be needed for the first 30 days of treatment. Recipients of massive blood transfusions are a significant drain on blood reserves in war. This experience can be utilized in the development of revised guidelines for blood usage for an entire population affected by war.

Accurate field evaluations are critical in determining paramedic students' competency to provide patient care. The [U.S.] National Paramedic Curriculum does not address the skills needed by evaluators, and requirements to be a preceptor/evaluator vary from state to state. Therefore, it is imperative that educational programs develop an evaluation process that reflects valid performance criteria and assure a high degree of rating consistency among the evaluators. This study sought to determine the effects of using a video case based teaching approach in preparing paramedic preceptors for the role of evaluator.

Paramedic preceptors receiving the case-based teaching approach to prepare them for the role of evaluator would demonstrate significantly higher scores on a video posttest than paramedic preceptors who were not prepared for the role of evaluator using the case-based approach.

Thirty-four paramedic preceptors from a Midwestern fire-based Emergency Medical Services system were enrolled in this study. Two scripted video student/patient encounters were used to measure evaluation scores in a pretest-posttest comparison of control versus experimental group. The experimental group was given structured rating guidelines and practice applying those guidelines to a case study. Pretest and posttest scores were weighted and analyzed using Analysis of Variance.

Analysis of the pretest–posttest differences revealed significantly higher scores for the experimental group in the categories containing complex behaviors: communication F(1,16) = 13.21, p <.01, assessment F (1,16) = 8.81, p <.01, and knowledge F (1,16) = 29.64, p <.001. There was no significant difference between groups in the categories containing simple, easily observed behaviors: reliability F (1,16) = .55, p >.05 and cooperativeness F (1,16) = 3.02, p >.05.

Using the case study method and written guidelines that provide concrete examples of complex behaviors appears to increase reliability of evaluations among preceptors.

To use the clinical activities of an ambulance service as a tool to assess the residual and unmet medical need of a city in the aftermath of a major earthquake and to apply that assessment to the development of a training curriculum for the prehospital personnel.

The researchers conducted structured interviews with health care workers at all levels of the emergency health care delivery system in Gyumrii, Armenia, and carried out a retrospective frequency analysis of 29,010 ambulance runs for an 11-month period from February through December 1992. Runs first were assigned into the broad categories of: 1) Adult Medical; 2) Pediatric Medical; or 3) Trauma, and then, according to diagnosis. The runs then were classified further as: 1) Primary Care; 2) Basic Life Support (BLS); or 3) Advanced Life Support (ALS).

Adult Medical calls represented 24,684 (85%), Pediatric Medical calls 459 (1.6%), and Trauma calls 3,867 (13%). Only 12% of all ambulance calls resulted in transport to a medical facility, although this percentage was higher in children. Thirty percent of Adult Medical patients were diagnosed by the emergency medical providers as having exclusively a psychiatric problem.

In the late aftermath of a devastating earthquake, the ambulance service in Gyumrii, Armenia has been delivering a substantial proportion of non-emergency, primary care services. They have adopted this unconventional role to compensate for the deficit in health care facilities and personnel created by the disaster. The training program that the investigators developed reflected the actual work activities of the prehospital personnel demonstrated in their assessment.

Since the terrorist attacks of 11 September 2001, the amount of terrorism preparedness training has increased substantially. However, gaps continue to exist in training for the mental health casualties that result from such events. Responders must be aware of the mental health effects of terror-ism and how to prepare for and buffer these effects. However, the degree to which responders possess or value this knowledge has not been studied.

Multi-disciplinary terrorism preparedness training for healthcare professionals was conducted in Kansas in 2003. In order to assess knowledge and attitudes related to mental health preparedness training, post-test surveys were provided to 314 respondents 10 months after completion of the training. Respondents returned 197 completed surveys for an analysis response rate of 63%.

In general, the results indicated that respondents have knowledge of and value the importance of mental health preparedness issues. The respon-dents who reported greater knowledge or value of mental health preparedness also indicated significantly higher ability levels in nationally recognized bioterrorism competencies (p <0.001).

These results support the need for mental health components to be incorporated into terrorism preparedness training. Further studies to determine the most effective mental health preparedness training content and instruction modalities are needed.

Local health departments are among the first agencies to respond to disasters or other mass emergencies. However, they often lack the ability to handle large-scale events. Plans including locally developed and deployed tools may enhance local response. Simplified cluster sampling methods can be useful in assessing community needs after a sudden-onset, short duration event.

Using an adaptation of the methodology used by the World Health Organization Expanded Programme on Immunization (EPI), a Microsoft Access-based application for two-stage cluster sampling of residential addresses in Louisville/Jefferson County Metro, Kentucky was developed. The sampling frame was derived from geographically referenced data on residential addresses and political districts available through the Louisville/Jefferson County Information Consortium (LOJIC). The program randomly selected 30 clusters, defined as election precincts, from within the area of interest, and then, randomly selected 10 residential addresses from each cluster.

The program, called the Rapid Assessment Tools Package (RATP), was tested in terms of accuracy and precision using data on a dichotomous characteristic of residential addresses available from the local tax assessor database. A series of 30 samples were produced and analyzed with respect to their precision and accuracy in estimating the prevalence of the study attribute. Point estimates with 95% confidence intervals were calculated by determining the proportion of the study attribute values in each of the samples and compared with the population proportion. To estimate the design effect, corresponding simple random samples of 300 addresses were taken after each of the 30 cluster samples.

The sample proportion fell within ±10 absolute percentage points of the true proportion in 80% of the samples. In 93.3% of the samples, the point estimate fell within ±12.5%, and 96.7% fell within ±15%. All of the point estimates fell within ±20% of the true proportion. Estimates of the design effect ranged from 0.926 to 1.436 (mean = 1.157, median = 1.170) for the 30 samples.

Although prospective evaluation of its performance in field trials or a real emergency is required to confirm its utility, this study suggests that the Rapid Assessment Tools Package, a locally designed and deployed tool, may provide populationbased estimates of community needs or the extent of event-related consequences that are precise enough to serve as the basis for the initial post-event decisions regarding relief efforts.

The interaction patterns that result from the role performance of nurses and paramedics as they care for patients conveyed to the Emergency Department could impact substantially on outcome. The nature of this interaction was studied.

Structured interviews were conducted with 35 persons: 21 paramedics, 12 full-time emergency department nurses, and two ED physicians.

Open conflicts in the ED are not a common occurrence. The reports given by paramedics and the assessments of patients by the nurse at transfer seem to represent “flash points” of conflict. The characteristics of some of the hostile behaviors which do occur are defined.

Conflict does exist and the application of suggested interventions may serve to lessen such conflict.

Considerable attention is being addressed to injury prevention. This study addresses the acceptance of a home injury-prevention survey as an injury-prevention tool in rural communities.

The purpose of this study was to evaluate public acceptance of a home injury-prevention survey as a tool to educate and enlighten the public about home injuries.

All patients with home injuries who came to Wetzel County Hospital Emergency Department were asked if they would participate in a home injury-prevention survey. The study was conducted from 01 May to 01 July 1995. Paramedics were used as interviewers because of the closeness they enjoy with the community.

During the study period, 2,104 patients came to the emergency department of Wetzel County Hospital. Of these, 386 sought care because of an injury sustained in their homes. From this group, 23 (5.9%) patients agreed to participate in a home injury-prevention study; 363 (94.1%) refused.

A home injury-prevention survey alone does not seem to be an effective tool to aid in the reduction of home injuries, because it is not embraced by the general public.