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Occupational Injuries and Illnesses among Paramedicine Clinicians: Analyses of US Department of Labor Data (2010 – 2020)
- Brian J. Maguire, Ala’a Al Amiry, Barbara J. O’Neill
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue 5 / October 2023
- Published online by Cambridge University Press:
- 10 August 2023, pp. 581-588
- Print publication:
- October 2023
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Objective:
Paramedicine clinicians (PCs) in the United States (US) respond to 40 million calls for assistance every year. Their fatality rates are high and their rates of nonfatal injuries are higher than other emergency services personnel, and much higher than the average rate for all US workers. The objectives of this paper are to: describe current occupational injuries among PCs; determine changes in risks over time; and calculate differences in risks compared to other occupational groups.
Methods:This retrospective open cohort study of nonfatal injuries among PCs used 2010 through 2020 data from the US Department of Labor (DOL), Bureau of Labor Statistics; some data were unavailable for some years. The rates and relative risks (RRs) of injuries were calculated and compared against those of registered nurses (RNs), fire fighters (FFs), and all US workers.
Results:The annual average number of injuries was: 4,234 over-exertion and bodily reaction (eg, motion-related injuries); 3,935 sprains, strains, and tears; 2,000 back injuries; 580 transportation-related injuries; and over 400 violence-related injuries. In this cohort, women had an injury rate that was 50% higher than for men. In 2020, the overall rate of injuries among PCs was more than four-times higher, and the rate of back injuries more than seven-times higher than the national average for all US workers. The rate of violence-related injury was approximately six-times higher for PCs compared to all US workers, seven-times higher than the rate for FFs, and 60% higher than for RNs. The clinicians had a rate of transportation injuries that was 3.6-times higher than the national average for all workers and 2.3-times higher than for FFs. Their overall rate of cases varied between 290 per 10,000 workers in 2018 and 546 per 10,000 workers in 2022.
Conclusions:Paramedicine clinicians are a critical component of the health, disaster, emergency services, and public health infrastructures, but they have risks that are different than other professionals.
This analysis provides greater insight into the injuries and risks for these clinicians. The findings reveal the critical need for support for Emergency Medical Services (EMS)-specific research to develop evidence-based risk-reduction interventions. These risk-reduction efforts will require an enhanced data system that accurately and reliably tracks and identifies injuries and illnesses among PCs.
A Cohort Study of Occupational Fatalities among Paramedicine Clinicians: 2003 through 2020
- Brian J. Maguire, Barbara J. O’Neill, Ala’a Al Amiry
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 07 March 2023, pp. 153-159
- Print publication:
- April 2023
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Introduction/Study Objectives:
Emergency medical technicians (EMTs) and paramedics respond to 40 million calls for assistance every year in the United States; these paramedicine clinicians are a critical component of the nation’s health care, disaster response, public safety, and public health systems. The study objective is to identify the risks of occupational fatalities among paramedicine clinicians working in the United States.
Methods:To determine fatality rates and relative risks, this cohort study focused on 2003 through 2020 data of individuals classified as EMTs and paramedics by the United States Department of Labor (DOL). Data provided by the DOL and accessed through its website were used for the analyses. The DOL classifies EMTs and paramedics who have the job title of fire fighter as fire fighters and so they were not included in this analysis. It is unknown how many paramedicine clinicians employed by hospitals, police departments, or other agencies are classified as health workers, police officers, or other and were not included in this analysis.
Results:An average of 206,000 paramedicine clinicians per year were employed in the United States during the study period; approximately one-third were women. Thirty percent (30%) were employed by local governments. Of the 204 total fatalities, 153 (75%) were transportation-related incidents. Over one-half of the 204 cases were classified as “multiple traumatic injuries and disorders.” The fatality rate for men was three-times higher than for women (95% confidence interval [CI], 1.4 to 6.3). The fatality rate for paramedicine clinicians was eight-times higher than the rate for other health care practitioners (95% CI, 5.8 to 10.1) and 60% higher than the rate for all United States workers (95% CI, 1.24 to 2.04).
Conclusions:Approximately 11 paramedicine clinicians are documented as dying every year. The highest risk is from transportation-related events. However, the methods used by the DOL for tracking occupational fatalities means that many cases among paramedicine clinicians are not included. A better data system, and paramedicine clinician-specific research, are needed to inform the development and implementation of evidence-based interventions to prevent occupational fatalities. Research, and the resulting evidence-based interventions, are needed to meet what should be the ultimate goal of zero occupational fatalities for paramedicine clinicians in the United States and internationally.
International Survey of Violence Against EMS Personnel: Physical Violence Report
- Brian J. Maguire, Matthew Browne, Barbara J. O’Neill, Michael T. Dealy, Darryl Clare, Peter O’Meara
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 5 / October 2018
- Published online by Cambridge University Press:
- 31 October 2018, pp. 526-531
- Print publication:
- October 2018
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Introduction
Each year, Emergency Medical Services (EMS) personnel respond to over 30 million calls for assistance in the United States alone. These EMS personnel have a rate of occupational fatality comparable to firefighters and police, and a rate of non-fatal injuries that is higher than the rates for police and firefighters and much higher than the national average for all workers. In Australia, no occupational group has a higher injury or fatality rate than EMS personnel. Emergency Medical Services personnel in the US have a rate of occupational violence injuries that is about 22-times higher than the average for all workers. On average, more than one EMS provider in the US is killed every year in an act of violence.
Hypothesis/ObjectiveThe objective of this epidemiological study was to identify the risks and factors associated with work-related physical violence against EMS personnel internationally.
MethodsAn online survey, based on a tool developed by the World Health Organization (WHO; Geneva, Switzerland), collected responses from April through November 2016.
ResultsThere were 1,778 EMS personnel respondents from 13 countries; 69% were male and 54% were married. Around 55% described their primary EMS work location as “urban.” Approximately 68% described their employer as a “public provider.” The majority of respondents were from the US.
When asked “Have you ever been physically attacked while on-duty?” 761 (65%) of the 1,172 who answered the question answered “Yes.” In almost 10% (67) of those incidents, the perpetrator used a weapon. Approximately 90% of the perpetrators were patients and around five percent were patient family members. The influence of alcohol and drugs was prevalent. Overall, men experienced more assaults than women, and younger workers experienced more assaults than older workers.
Conclusions:In order to develop and implement measures to increase safety, EMS personnel must be involved with the research and implementation process. Furthermore, EMS agencies must work with university researchers to quantify agency-level risks and to develop, test, and implement interventions in such a way that they can be reliably evaluated and the results published in peer-reviewed journals.
,Maguire BJ ,Browne M ,O’Neill BJ ,Dealy MT ,Clare D .O’Meara P International Survey of Violence Against EMS Personnel: Physical Violence Report . Prehosp Disaster Med.2018 ;33 (5 ):526 –531 .
Injuries and Fatalities among Emergency Medical Technicians and Paramedics in the United States
- Brian J. Maguire, Sean Smith
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- Journal:
- Prehospital and Disaster Medicine / Volume 28 / Issue 4 / August 2013
- Published online by Cambridge University Press:
- 09 May 2013, pp. 376-382
- Print publication:
- August 2013
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Introduction
Emergency medical services personnel treat 22 million patients a year, yet little is known of their risk of injury and fatality.
ProblemWork-related injury and fatality rates among US paramedics and emergency medical technicians (EMTs) are higher than the national average for all occupations.
MethodsData collected by the Department of Labor (DOL) Bureau of Labor Statistics were reviewed to identify injuries and fatalities among EMTs and paramedics from 2003 through 2007. The characteristics of fatal injuries are described and the rates and relative risks of the non-fatal injuries were calculated and compared to the national average.
ResultsOf the 21,749 reported cases, 21,690 involved non-fatal injuries or illnesses that resulted in lost work days among EMTs and paramedics within the private sector. Of the injuries, 3,710 (17%) resulted in ≥31 days of lost work time. A total of 14,470 cases (67%) involved sprains or strains; back injury was reported in 9,290 of the cases (43%); and the patient was listed as the source of injury in 7,960 (37%) cases. The most common events were overexertion (12,146, 56%), falls (2,169, 10%), and transportation-related (1,940, 9%). A total of 530 assaults were reported during the study period. Forty-five percent of the cases occurred among females (females accounted for 27% of employment in this occupation during 2007). In 2007, EMTs and paramedics suffered 349.9 injuries with days away from work per 10,000 full-time workers, compared to an average of 122.2 for all private industry occupations (Relative risk = 2.9; 95% CI: 2.7–3.0). During the study period, 59 fatalities occurred among EMTs and paramedics in both the private industry and in the public sector. Of those fatalities, 51 (86%) were transportation-related and five (8%) were assaults; 33 (56%) were classified as “multiple traumatic injuries.”
ConclusionsData from the DOL show that EMTs and paramedics have a rate of injury that is about three times the national average for all occupations. The vast majority of fatalities are secondary to transportation related-incidents. Assaults are also identified as a significant cause of fatality. The findings also indicate that females in this occupational group may have a disproportionately larger number of injuries. Support is recommended for further research related to causal factors and for the development, evaluation and promulgation of evidence-based interventions to mitigate this problem.
. ,Maguire BJ .Smith S Injuries and Fatalities among Emergency Medical Technicians and Paramedics in the United States . Prehosp Disaster Med.2013 ;28 (4 ):1 -7
Methicillin-Resistant Staphylococcus Aureus Nasal Colonization Prevalence among Emergency Medical Services Personnel
- Alaa Al Amiry, Richard A. Bissell, Brian J. Maguire, Donald W. Alves
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- Journal:
- Prehospital and Disaster Medicine / Volume 28 / Issue 4 / August 2013
- Published online by Cambridge University Press:
- 24 April 2013, pp. 348-352
- Print publication:
- August 2013
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Introduction
The prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among Emergency Medical Services (EMS) personnel is not well studied. Methicillin-resistant Staphylococcus aureus colonization can be a health hazard for both EMS personnel and patients. The aim of this study was to quantify the prevalence of MRSA colonization among EMS personnel. This study will help the scientific community understand the extent of this condition so that further protocols and policies can be developed to support the health and wellbeing of EMS personnel.
Hypothesis/ ProblemThe hypothesis of this study was that the prevalence of MRSA colonization among EMS personnel is significantly higher than among the general population.
MethodsThis was a cross-sectional study. A total of 110 subjects were selected from two major US Mid-Atlantic fire departments. Methicillin-resistant Staphylococcus aureus colonization was detected by nasal swabbing. Nasal swabs were inoculated onto a special agar medium (C-MRSAgar) with polymerase chain reaction testing performed. One-sided binomial distribution at the StudySize 2.0 Web calculator was used. Using the Web calculator, p (H0 proportion) = 1.5%; a difference (H1-H0) ‘Δ’ = 4.53% can be detected at α = 5% and power = 80% with N = 110.
ResultsSamples were collected from 110 volunteers. Seven samples were positive for MRSA, resulting in a prevalence of 7/110 or 6.4% (95% CI, 1.8%-11%; P < .0003) compared with a 1.5% prevalence of MRSA colonization among the general population.
ConclusionThere is evidence that EMS personnel have a higher prevalence of MRSA colonization than the general population. This can be a risk to patients and can be recognized as an occupational hazard.
. ,Al Amiry A ,Bissell RA ,Maguire BJ .Alves DW Methicillin-Resistant Staphylococcus Aureus Nasal Colonization Prevalence among Emergency Medical Services Personnel . Prehosp Disaster Med.2013 ;28 (4 ):1 -5
Contributors
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- By Dmitri Bezinover, Ira Todd Cohen, Garret Choby, Kimberly E. Fenton, David Goldenberg, Goldstein Scott, Brian W. Grose, Michael K. Hurst, Zara Karparvar, Jodie E. Landis, Thomas K. Lee, Jonathan D McGinn, Raymond Maguire, Daryn H Moller, Slawomir Oleszak, Michael Ondik, Steven L. Orebaugh, Sophie R. Pestieau, Shaji Poovathoor, Eric Posner, Leonard Pott, Diego Preciado, Elliot Regenbogen, Elias B Rizk, Ghassan J. Samara, Peggy A Seidman, Elizabeth H Sinz, MS Dana Stauffer, BS Joanne Stene, John Stene, Jay B. Tuchman, Yvonne Tsui, James Vosswinkel, Alison Wilson, Margaret Wojnar, Robert Yellon
- Edited by Peggy A. Seidman, Stony Brook University, State University of New York, Elizabeth H. Sinz, Pennsylvania State University, David Goldenberg, Pennsylvania State University
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- Book:
- Tracheotomy Management
- Published online:
- 25 October 2011
- Print publication:
- 20 October 2011, pp viii-xi
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Transportation-Related Injuries and Fatalities among Emergency Medical Technicans and Paramedics
- Brian J. Maguire
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- Journal:
- Prehospital and Disaster Medicine / Volume 26 / Issue 5 / October 2011
- Published online by Cambridge University Press:
- 26 October 2011, pp. 346-352
- Print publication:
- October 2011
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Introduction: This is the first study using national data to evaluate transportation risks among emergency medical technicians (EMTs) and paramedics (to be referred to hereafter as “EMTs”) in the United States.
Hypothesis: This epidemiological study compares the transportation risks for EMTs to the transportation risks for all workers in the US.
Methods: The rates, relative risks, and proportions associated with the 1,050 injury cases with lost work days, and 30 fatalities resulting from transportation incidents occurring to EMTs in the US between 2006 and 2008 are described.
Results: The risk of transportation-related injury for EMTs in the US is about five times higher than the national average. Females were the victims in 53% of the cases yet females only accounted for about 27% of employment in this occupation. Twenty percent of cases resulted in 31 or more lost work days. There were 30 transportation related fatalities.
Conclusions: The US national EMS system is built on the premise of having an unlimited supply of 20 year olds interested in, and dedicated to, the provision of EMS care. Not only do we not have an unlimited supply of 20 year olds, we may be rapidly losing our current workforce through clearly preventable risks such as transportation incidents.
Emergency medical services workers face a rate of occupational injury that is much higher than the national average and transportation-related events are a significant component of that risk. Resources must be devoted to further research, and to the development and evaluation of interventions designed to mitigate these transportation-related hazards.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Epidemic and Bioterrorism Preparation among Emergency Medical Services Systems
- Brian J. Maguire, Stephen Dean, Richard A. Bissell, Bruce J. Walz, Andrew K. Bumbak
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- Journal:
- Prehospital and Disaster Medicine / Volume 22 / Issue 3 / June 2007
- Published online by Cambridge University Press:
- 28 June 2012, pp. 237-242
- Print publication:
- June 2007
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Introduction:
The purpose of this research was to determine the preparedness of emergency medical services (EMS) agencies in one US state to cope with a massive epidemic event.
Methods:Data were collected primarily through telephone interviews with EMS officials throughout the State. To provide a comparison, nine out-ofstate emergency services agencies were invited to participate.
Results:Emergency medical services agencies from nine of the 23 counties (39%) provided responses to some or all of the questions in the telephone survey. Seven of the nine out-of-state agencies provided responses to the survey. Most of the EMS agencies do not have broad, formal plans for response to large-scale bio-terrorist or pandemic events.
Conclusions:The findings indicate that EMS agencies in this state fundamentally are unprepared for a large-scale bioterrorism or pandemic event.The few existing plans rely heavily on mutual aid from agencies that may be incapable of providing such aid. Therefore, EMS agencies must be prepared to manage a response to these incidents without assistance from any agencies outside of their local community. In order to accomplish this, they must begin planning and develop close working relationships with public health, healthcare, and elected officials within their local communities.
Variables Influencing Medical Usage Rates, Injury Patterns, and Levels of Care for Mass Gatherings
- Andrew M. Milsten, Kevin G. Seaman, Peter Liu, Rick A. Bissell, Brian J. Maguire
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- Journal:
- Prehospital and Disaster Medicine / Volume 18 / Issue 4 / December 2003
- Published online by Cambridge University Press:
- 28 June 2012, pp. 334-346
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- December 2003
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Objectives:
Mass gatherings create difficult environments for which to plan emergency medical responses. The purpose of this study was to identify those variables that are associated with increased medical usage rates (MURs) and certain injury patterns that can be used to facilitate the planning process.
Methods:Patient information collected at three types of mass gatherings (professional American football and baseball games and rock concerts) over a three-year period was reviewed retrospectively. Specific variables were abstracted: (1) event type; (2) gender; (3) age; (4) weather; and (5) attendance. All 216 events (total attendance9,708,567) studied were held in the same metropolitan region. All MURs are reported as patients per 10,000 (PPTT).
Results:The 5,899 patient encounters yielded a MUR of 6.1 PPTT. Patient encounters totaled 3,659 for baseball games (4.85 PPTT), 1,204 for football games (6.75 PPTT), and 1,036 for rock concerts (30 PPTT). The MUR for Location A concerts (no mosh pits) was 7.49 PPTT, whereas the MUR for the one Location B concert (with mosh pits) was110 PPTT. The MUR for Location A concerts was higher than for baseball, but not football games (p = 0.005). Gender distribution was equal among patrons seeking medical care. The mean values for patient ages were 29 years at baseball games, 33 years at football games, and 20 years at concerts. The MUR at events held when the apparent temperature was £80°F significantly lower statistically than that at events conducted at temperatures <80°F were (18°C) (4.90 vs. 8.10 PPTT (p = 0.005)). The occurrence of precipitation and increased attendance did not predict an increased MUR. Medical care was sought mostly for minor/basic-level care (84%) and less so for advanced-level care (16%). Medical cases occurred more often atsporting events (69%), and were more common than were cases with traumatic injuries (31%). Concerts with precipitation and rock concerts had a positive association withthe incidence of trauma and the incidence of injuries; whereas age and gender were not associated with medical or traumatic diagnoses.
Conclusions:Event type and apparent temperature were the variables that best predicted MUR as well as specific injury patterns and levels of care.
Vaccine Administration by Paramedics: A Model for Bioterrorism and Disaster Response Preparation
- Bruce J. Walz, Richard A. Bissell, Brian Maguire, James A. Judge II
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- Journal:
- Prehospital and Disaster Medicine / Volume 18 / Issue 4 / December 2003
- Published online by Cambridge University Press:
- 28 June 2012, pp. 321-326
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- December 2003
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The events of 11 September 2001 have had a profound effect on disaster planning efforts in the United States. This is true especially in the area of bioter-rorism. One of the major tenets of bioterrorism response is the vaccination of at-riskpopulations. This paper investigates the efficacy of training emergency medical services paramedics to administer vaccines in public health settings as preparation for and response to bioterrorism events and other disaster events.
The concept of vaccination administration by specially trained paramedics is not new. Various programs to provide immunizations for emergency services personnel and at-risk civilian populations have been reported.
Vaccination programs by paramedics should follow the guidelines of the National Vaccine Advisory Committee of the Centers for Disease Control and Prevention (CDC). Thispaper compares the seven standards of the CDC guidelines to routine paramedic practice and education. It is concluded that paramedics are adequately trained to administer vaccines. However, specific training and protocols are needed in the areas of administrative paperwork and patient education. A proposed outline for a paramedic-training program is presented.
Mass-Gathering Medical Care: A Review of the Literature
- Andrew M. Milsten, Brian J. Maguire, Rick A. Bissell, Kevin G. Seaman
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- Journal:
- Prehospital and Disaster Medicine / Volume 17 / Issue 3 / September 2002
- Published online by Cambridge University Press:
- 28 June 2012, pp. 151-162
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- September 2002
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Mass-gatherings events provide a difficult setting for which to plan an appropriate emergency medical response. Many of the variables that affect the level and types of medical needs, have not been fully researched. This review examines these variables.
Methods:An extensive review was conducted using the computerized databases Medline and Healthstar from 1977 through May 2002. Articles selected contained information pertaining to mass-gathering variables. These articles were read, abstracted, analyzed, and compiled.
Results:Multiple variables are present during a mass gathering, and they interact in complex and dynamic ways. The interaction of these variables contributes to the number of patients treated at an event (medical usage rate) as well as the observed injury patterns. Important variables include weather, event type, event duration, age, crowd mood and density, attendance, and alcohol and drug use.
Conclusions:Developing an understanding of the variables associated with mass gatherings should be the first step for event planners. After these variables are considered, a thorough needs analysis can be performed and resource allocation can be based on objective data.
An Eight-Year Review of Legal Cases Related to an Urban 9-1-1 Paramedic Service
- Brian J. Maguire, Frank V. Porco
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- Journal:
- Prehospital and Disaster Medicine / Volume 12 / Issue 2 / June 1997
- Published online by Cambridge University Press:
- 28 June 2012, pp. 83-86
- Print publication:
- June 1997
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Introduction:
An eight year retrospective analysis was conducted to determine the type and outcome of lawsuits related to the provision of 9-1-1 paramedic service in an urban environment.
Methods:For the evaluation period of May 1986 to March 1994, all litigation cases related to Ambulance Service or paramedics were collected and analyzed. This urban 9-1-1 Paramedic Service has an estimated call volume of >60,000 assignments resulting in >30,000 patient encounters during the evaluation period.
Results:Seven lawsuits were filed against the service. No lawsuits were related to tardy response, failure to transport, or patient care negligence of any kind. All of the litigation was related to motor vehicle collisions (MVC).
Conclusion:The data suggest that motor vehicle collisions are a significant medicallegal risk to the EMS community. In addition, it was found that the use and lack of use of seatbelts was an important component in many of the suits.
Effects of co-existent cerebrovascular disease on rate of progression in Alzheimer's disease
- Gregory RJ Swanwick, Michael Kirby, Robert F Coen, Conor P Maguire, Desmond O'Neill, Bernard J Walsh, Davis Coakley, Brian A Lawlor
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- Journal:
- Irish Journal of Psychological Medicine / Volume 13 / Issue 3 / September 1996
- Published online by Cambridge University Press:
- 13 June 2014, pp. 91-94
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- September 1996
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Objective: The aim of this study was to determine whether patients with possible Alzheimer's disease (AD) who do not meet criteria for vascular dementia but who nonetheless have clinical or radiographic evidence of cerebrovascular disease (CVD), differ in presentation or rate of progression from patients with probable AD.
Method: Baseline cognitive and functional scores were obtained from 154 patients who had either possible or probable AD. Repeat data after a 12 month interval were obtained on 73 of these patients. Baseline data and rates of progression were compared for probable AD patients and possible AD patients with evidence of co-existent CVD.
Results: The diagnostic groups did not differ at baseline with a mean mini-mental state examination (MMSE) score of 18.1. Comparison of the longitudinal data showed a mean annual drop of 4.1 points on the MMSE in both groups.
Conclusions: The patients with and without evidence of co-existent CVD did not differ either at baseline or prognostically suggesting that evidence of CVD does not affect the rate of progression in AD. However, further longitudinal studies using neuropathological criteria are warranted to determine whether such data can be interpreted in favour of including possible AD cases in clinical trials of probable AD.
Memory impairment in Alzheimer's disease: replication and extension of the delayed word recall (DWR) test
- Robert F Coen, Gregory RJ Swanwick, Conor Maguire, Michael Kirby, Brian A Lawlor, J Bernard Walsh, D Coakley
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- Journal:
- Irish Journal of Psychological Medicine / Volume 13 / Issue 2 / June 1996
- Published online by Cambridge University Press:
- 13 June 2014, pp. 55-58
- Print publication:
- June 1996
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Objective: The original DWR test, which measured delayed free recall, was reported to have high predictiveaccuracy in discriminating Alzheimer's disease (AD) patients from control subjects (overall accuracy of 95%).Comparison of differential performance in free recall and recognition of the same material may be of clinical interest. In the present study a delayed recognition component was added to the DWR test and the utility of both measures in discriminating AD patients from control subjects was evaluated.
Procedure: This extended version of the DWR test was administered to 66 patients meeting NINCDS/ADRDA criteria for probable AD and 42 control subjects.
Results: In a comparison between 42 of these patients (MMSE range 18–29), and 42 age matched healthy controls, both the delayed free recall and recognition measures were highly accurate in distinguishing patients from controls. The free recall measure achieved 98% sensitivity, specificity and overall accuracy, while the recognition measure yielded 98% sensitivity, 95% specificity, and 96% overall accuracy. The recognition performance of all 66 patients, ranging in severity from very mild to severe (MMSE range 11–29), was also evaluated to determine its relationship, if any, to measures of global cognitive impairment. While therecognition measure correlated poorly with MMSE and CAMCOG there was a modest but significant correlation with the CAMCOG memory subscale.
Conclusions: In this study of highly selected AD patients both the free recall and recognition measures were sensitive and specific indicators of AD compared to control subjects. Recognition performance appears to be more closely related to degree of amnesia than to degree of global cognitive impairment.