The Society of Teachers of Emergency Medicine's, EMS Educators Committee performed a mail survey of emergency medicine residency training directors regarding their curricula for EMS. The Committee was interested in determining the quality and quantity of EMS training in emergency medicine residencies. Out of 66 programs, 48 responded (73%). The programs reported that they provide medical control for a mean of 4837 calls per year (range 0–20,000) and interact with a mean of eight EMS agencies. Ten programs (21%) do not offer any formal EMS administrative experience, while 42 (87%) programs require residents to participate in paramedic training, and 31 (65%) require participation in EMT training. Both the type and the amount of “in-field” experience reported by programs varied considerably, with some programs offering it only as an elective. Similarly, there was great diversity in the type and amount of experience with helicopter ambulances. In conclusion, there is wide disparity among the offerings from all residency programs. Each training program must evaluate its own EMS curricula and expand it to fill existing gaps. Specific topics to be covered are suggested.

This study investigated the capacity of selected personal and work environment characteristics, in combination with occupational stress, to predict job satisfaction for 495 emergency medical technicians (EMTs) who provided emergency medical services in a rural area in the United States. Using data obtained during a three-year survey, multiple regression analysis identified work group cohesiveness and effective supervisory behavior as the best predictors of job satisfaction. The perceived level of occupational stress and years of experience as an EMT were inversely related to job satisfaction, but EMTs who responded to the survey as they were preparing to enroll in advanced training programs were more satisfied with their jobs than were other subgroups. These results suggest that job satisfaction can be enhanced by reinforcing cooperation and cohesiveness within EMS work groups, by establishing and maintaining effective communication networks between EMS administrators and EMTs, and by providing opportunities for professional growth and development for EMTs.

The ability to deliver large volumes of intravenous (IV) fluids may be critical to the successful prehospital resuscitation of hypovolemic patients. We compared the time required to deliver one liter of crystalloid solution, using an administration set-up consisting of a 16-guage (g), 1.25 inch, intravenous cannula, a pneumatic pressure bag, and either conventional intravenous tubing (3.2 mm internal diameter [ID]) or large bore (4.4 mm internal diameter [ID]) “shock” tubing. With the fluid bag positioned at 110cm (46 inches) above the level of the cannula, the mean elapsed time to deliver 1,000ml using the conventional tubing set-up was 6.0 minutes, while the same volume could be delivered in only 2.7 minutes with the shock tubing configuration. This time was reduced to 1.8 minutes when the intravenous cannula size was increased to 14g. By attaching a liter of fluid to each arm of the “Y” adapter of the shock tubing, virtually uninterrupted fluid flow may be maintained at this rate. We feel this intravenous configuration could enhance greatly the ability of paramedics to provide fluid resuscitation in the field setting. When such IVs are established en route to a receiving hospital, this technique may prove to be an important adjunct to improving patient outcome from hypovolemic shock.

Obtaining and maintaining patient consent for treatment should be one of first considerations in every encounter between the health care practitioner and the patient. The emergency health care provider must be able to make rapid and correct assessments of the patient's consent to treatment before such treatment is commenced. The following paper will discuss the primary issues in this area.

Disasters are defined as events caused either by natural or technological occurrences, that overwhelm the resources that are immediately available to manage or mitigate the impact of the event. Disasters, by their very nature, are newsmakers. With the improvement in telecommunications, the barriers of distance are reduced to the extent that the people of the world all are members of what Marshall MacLuhan called the “global village.” It now is a common practice to watch the effects of a disaster on the other side of the world, from the safety and comfort of the living room, live on television. The capacity to empathize with the victims, and to feel almost a part of the incident, results in tremendous public attention and an urging of governments, not directly affected by the event, to get involved and “do something!”

Sound disaster preparedness and a well-organized, local and material response will considerably reduce the necessity for calling on international assistance in the event of disaster. However, despite an excellent level of preparedness, some dramatic situations in the wake of a large-scale disaster always will make the mobilization of international resources absolutely essential.

The international network for disaster relief is quite complex. Many governments have set up emergency relief teams to cope with disasters in their own countries and are able to assign these teams to international relief operations. This type of governmental assistance is provided under agreement with the other governments involved. The United Nations (UN), through the Office of the UN Disaster Relief Coordinator (UNDRO), can play a role in coordinating emergency operations.

The increasing openness (glastnost) of the Soviet authorities has brought about a new era of accountability but sadly has coincided with a series of disasters, both natural and manmade. Chernobyl, the Armenian earthquake, and recently a gas explosion which involved two passenger trains have been reported widely and medical teams from the West were invited to assist with the care of the injured. We were part of a multidisciplinary team involved in the care of victims of the train disaster.

The United States Congress presently is considering comprehensive legislation regarding emergency medical services (EMS) and trauma systems planning. This legislation amends the Public Health Service Act and, if enacted, would represent the federal government's first significant statutory mandate to exercise a leadership role in EMS since the federal EMS program was abolished in the early 1980s. On 14 November 1989, the House passed House Resolution (H.R.) 1602, Trauma Care Systems Planning and Development Act of 1989, authored by Representative Jim Bates. The Senate is considering similar legislation (S. 15) by Senator Alan Cranston, titled the Emergency Medical Services and Trauma Care Improvement Act of 1989. The Senate Bill is awaiting final action by the full Senate. If the Senate approves S. 15, a joint House and Senate conference committee will meet to present its own conference report to each of those bodies for consideration and passage.

Therapy following an acute cerebrovascular insult traditionally has focused on preserving function of the uninjured cerebral tissue. However, in recent years, interest has developed on the possibility of restoration of function to the injured areas of the brain. Lessons learned in reperfusion following acute myocardial infarction have raised newer questions about the utility of reperfusion to other areas of the body subjected to acute ischemic events. In addition, studies with acute cerebral ischemia have suggested that calcium channel antagonists improve outcome, either by decreasing cerebral vasospasm, offering neuronal protection by inhibiting the formation of toxic metabolites in the injured neurons, or by some combination of these two mechanisms. Other experimental therapies, such as the use of hypervolemic hemodilution, attempt to restore cerebral blood flow following an acute vasospasmic or thromboembolic event. As these new therapies develop, we will see a major emphasis on restoring cerebral function following acute stroke.

The problem of protection and sheltering of hospitalized patients in wars and other national emergencies has been reviewed by many countries in recent years. Presently, there are wide differences in policies that range from full underground sheltering of hospitals as adopted by the Swiss, partially protected to almost fully protected facilities in hospitals as adopted by the Israelis, to no protection at all as in most other countries.