Incorporating priorities for waiting customers in the hypercube queuing model with application to an emergency medical service system in Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Risk assessment in the first fifteen minutes: a prospective cohort study of a simple physiological scoring system in the emergency department

Introduction The survival of patients admitted to an emergency department is determined by the severity of acute illness and the quality of care provided. The high number and the wide spectrum of severity of illness of admitted patients make an immediate assessment of all patients unrealistic. The aim of this study is to evaluate a scoring system based on readily available physiological parameters immediately after admission to an emergency department (ED) for the purpose of identification of at-risk patients. Methods This prospective observational cohort study includes 4,388 consecutive adult patients admitted via the ED of a 960-bed tertiary referral hospital over a period of six months. Occurrence of each of seven potential vital sign abnormalities (threat to airway, abnormal respiratory rate, oxygen saturation, systolic blood pressure, heart rate, low Glasgow Coma Scale and seizures) was collected and added up to generate the vital sign score (VSS). VSSinitial was defined as the VSS in the first 15 minutes after admission, VSSmax as the maximum VSS throughout the stay in ED. Occurrence of single vital sign abnormalities in the first 15 minutes and VSSinitial and VSSmax were evaluated as potential predictors of hospital mortality. Results Logistic regression analysis identified all evaluated single vital sign abnormalities except seizures and abnormal respiratory rate to be independent predictors of hospital mortality. Increasing VSSinitial and VSSmax were significantly correlated to hospital mortality (odds ratio (OR) 2.80, 95% confidence interval (CI) 2.50 to 3.14, P < 0.0001 for VSSinitial; OR 2.36, 95% CI 2.15 to 2.60, P < 0.0001 for VSSmax). The predictive power of VSS was highest if collected in the first 15 minutes after ED admission (log rank Chi-square 468.1, P < 0.0001 for VSSinitial;,log rank Chi square 361.5, P < 0.0001 for VSSmax). Conclusions Vital sign abnormalities and VSS collected in the first minutes after ED admission can identify patients at risk of an unfavourable outcome.

New Freedom through Medical Devices Based on the Global System for Mobile Communications: A Prospective Survey of 620 Users of the Swiss Limmex Emergency Wristwatch-An Original Study from Switzerland

About 500,000 elderly people in Switzerland suffer a fall each year. Thus medical attention and help are essential for these people, who mostly live alone without a caregiver. Only 3% of people aged over 65 in Switzerland use an emergency system. Personal telehealth devices allow patients to receive enough information about the appropriate treatment, as well as followup with their doctors and reports of any emergency, in the absence of any caregiver. This increases their quality of life in a cost-effective fashion. "Limmex"-a new medical emergency watch-was launched in Switzerland in 2011 and has been a great commercial success. In this paper, we give a brief review of this watch technology, along with the results of a survey of 620 users conducted by the Department of Emergency Medicine in Bern.

A Multi-agent System for Emergency Decision Support

This paper describes the multi-agent organization of a computer system that was designed to assist operators in decision making in the presence of emergencies. The application was developed for the case of emergencies caused by river floods. It operates on real-time receiving data recorded by sensors (rainfall, water levels, flows, etc.) and applies multi-agent techniques to interpret the data, predict the future behavior and recommend control actions. The system includes an advanced knowledge based architecture with multiple symbolic representation with uncertainty models (bayesian networks). This system has been applied and validated at two particular sites in Spain (the Jucar basin and the South basin).

Potential issues related to emergency core cooling system strainers performance at boiling water reactors: application to Cofrentes NPP (Spain)

From the 60s to the 90s, a great number of events related to the Emergency Core Cooling Systems Strainers have been happened in all kind of reactors all over the world. Thus, the Nuclear Regulatory Commission of the USA emitted some Bulletins to address the concerns about the adequacy of Emergency Core Cooling Systems (ECCS) strainer performance at boiling water reactors (BWR). In Spain the regulatory body (Consejo de Seguridad Nuclear, CSN) adopted the USA regulation and Cofrentes NPP installed new strainers with a considerable bigger size than the old strainers. The nuclear industry conducted significant and extensive research, guidance development, testing, reviews, and hardware and procedure changes during the 90s to resolve the issues related to debris blockage of BWR strainers. In 2001 the NRC and CSN closed the Bulletins. Thereafter, the strainers issues were moved to the PWR reactors. In 2004 the NRC issued a Generic Letter (GL). It requested the resolution of several effects which were not noted in the past. The GL regarded to be resolved by the PWR reactors but the NRC in USA and the CSN in Spain have requested that the BWR reactors investigate differences between the methodologies used by the BWRs and PWRs. The developments and improvements done for Cofrentes NPP are detailed. Studies for this plant show that the head loss due to the considered debris is at most half of the limited head loss for the ECCS strainer and the NPSH (Net Positive Suction Head) required for the ECCS pumps is at least three times lower than the NPSH available.

P.A.V.E.S. : Post-Accident Vehicle Emergency System

Dissertação apresentada ao Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Desenvolvimento de Software e Sistemas Interactivos, realizada sob a orientação científica do Doutor Fernando Reinaldo Silva Garcia Ribeiro, Professor Adjunto da Unidade Técnico-Científica de Informática da Escola Superior de Tecnologia do Instituto Politécnico de Castelo Branco.

Private provision of food aid : the emergency food assistance system /

Mode of access: Internet.

National training course, emergency medical technician - paramedic. Instructor's lesson plans. Module V: respiratory system.

Mode of access: Internet.

National training course, emergency medical technician - paramedic. Instructor's lesson plans. Module VI: cardiovascular system.

Mode of access: Internet.

National training course, emergency medical technician - paramedic. Instructor's lesson plans. Module VII: central nervous system.

Mode of access: Internet.

Federal laws affecting national banks, including provisions of U. S. Revised statutes, Federal reserve act, Deposit insurance law, Emergency banking act, Bank conservation act, Banking act of 1933, Banking act of 1935 and other laws affecting the national banking system as of January 1, 1950.

"Compiled to supersede and bring up to date the previous edition, published in 1940."

Federal laws affecting national banks, including provisions of U. S. Revised statutes, Federal reserve act, Deposit insurance law, Emergency banking act, Bank conservation act, Banking act of 1933, Banking act of 1935 and other laws affecting, directly or indirectly, the national banking system, as of January 1, 1936.

On cover: National bank laws as of Jan. 1, 1936

Test of a smock system on CPR primary emergency measures and medical errors during simulated emergencies

Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on: 1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.