A unique approach to providing orientation and supervised field experience for newly graduated paramedics and for the continuing education and recognition of experienced, skilled, operational paramedics is described. A group of 30 paramedic field instructors (PFI) was selected following application, development of criteria for selection, and interviews. This program had a positive effect in both realms during its first year of operation in the emergency medical services system in which it was implemented.

Introduction: Standard closed-chest CPR (SCPR) produces only 6–30% of normal blood flow. It is unlikely that this can sustain the viability of the brain for more than a few minutes in most CPR attempts, although in occasional cases of human resuscitation external CPR for up to two hours has been followed by recovery of consciousness. Thus various methods have been employed to improve this low perfusion state. It has been shown that abdominal compression by hand or MAST-suit can augment carotid artery blood flow during CPR but causes complications. Openchest CPR (OCCPR) has also been proven to be hemodynamically superior to SCPR. Since neurologic recovery has been studied after prolonged periods of total circulatory arrest but not after prolonged periods of CPR, we compared the prolonged use of SCPR and OCCPR in terms of ability to sustain signs of cerebral function during CPR and permit cerebral recovery after CPR.

The time has come when it may be asserted quite categorically that a new medical science, the theoretical foundation of reanimation, has emerged on the medical scene. At the International Congress of Traumatology held in Budapest in 1961, I proposed to call this new science reanimatology. My suggestion was based on the medical tradition of using the Latin roots of words. I am pleased that not only this term but also its notion are being increasingly used by experts in the field.

Although road accidents account for about 17% of hospital emergencies, they are the third commonest cause of death. Polytrauma is the main cause of death below the age of 40 years. Legislative action and safety measures (i.e. speed restriction, safety belts, safety helmets) and improvement in the hospital emergency care system in Germany resulted in a continuous reduction in road accident victims from about 19,000 in 1979 to about 12,000 in 1983. Additionally, the fall in personal injury resulted in savings of about 7,900 DM (US $3,000) in cases of minor injury, 79,000 DM (30,000 US$) in cases of severe injury and about 685,000 DM (280,000 US$) in cases where lives were saved.

Conventional emergency medical services (EMS) guidelines recommend that essentially every victim of any significant trauma be treated in the field as having an unstable spine injury. For example, any victim of any motor vehicle crash generally is assumed to have an unstable spine injury and is transported to the hospital in full-spine immobilization. This approach generally is reasonable and appropriate for the conventional EMS context of rapid transport, because patient symptoms and physical examination often are unreliable for the time period immediately following the event.

The specialized context of delayed or prolonged transport, however, requires a closer look at assessment criteria and treatment procedures for spine injury. Full-spine immobilization, if it is not required, can be unnecessarily difficult, impractical, impossible, and even dangerous during prolonged evacuation, especially in severe environments or when using improvized equipment. Prolonged transport also provides an opportunity to repeat patient surveys and to observe changes in the patient's condition over time.

Hazardous materials (HAZMAT) carry many inherent dangers. Such materials are distributed widely in industrial and military sites. Toxic trauma (TT) denotes the complex of systemic and organ injury caused by toxic agents. Often, TT is associated with other injuries that also require the application of life-support techniques. Rapid onset of acute respiratory failure and consequent cardiovascular failure are of primary concern. Management of TT casualties is dependent upon the characteristics of the toxic agents involved and on the demographics surrounding the HAZMAT incident.

Agents that can produce TT possess two pairs of salient characteristics: (1) causality (toxicity and latency), and (2) EMS system (persistency and transmissibility). Two characteristics of presentations are important: (1) incident presentation, and (2) casualty presentation. In addition, many of these agents complicate the processes associated with anaesthesia and must be dealt with. Failure of recognition of these factors may result in the development of respiratory distress syndromes and multiorgan system failure, or even death.

The authors, who served as anesthesiologists for 15 months at an International Committee of the Red Cross (ICRC) surgical field hospital in a Cambodian refugee camp, report their anesthesiologic experience with 2,906 patients. In spite of preferential use of regional anesthetic techniques, general anesthesia was required in 68% of the cases. Local infiltration anesthesia was applied in 21% of the cases, conduction anesthesia in 3%, and spinal anesthesia in 8%.

The Civil War in Georgia

On 9 April 1991, the Republic of Georgia proclaimed its independence from the Soviet Union. Sviat Gamsakhurdia, an anti-communist leader of the Georgian Nationalist movement, was elected President by an overwhelming majority. Soon after the election, however, Gamsakhurdia's popularity began to plummet. He was accused of suppressing any opposition, and he and his supporters accused the opposition of being in league with Moscow and seeking to sabotage Georgian independence. Demonstrators in Tbilisi, the capital city, demanded the resignation of the new government, and the government relied increasingly upon armed forces to maintain power.

When facing a situation involving mass casualties, we must consider the choices we have as individuals and as communities. The range of opportunity and privilege across the world is vast. Set against the background of natural and manmade disasters, how do we provide the right care at the right time for those in need? How can we share our collaborative knowledge?.

The recognition of the dignity of those in need is the first step.

Relationship building in the time of non-disaster leads to mutual understanding, facilitating care. Medicine brings science and experience into the art of clinical problem-solving. Disaster situations require rapid solutions based on prior planning, communicated with the understanding that optimal outcomes depend upon relationships based on respect, sharing knowledge of the local environmental resources, coupled with clinical care.