95 Anaesthesiology and Resuscitation Anaesthesiologie und Wiederbelebung Anesthesiologie et Reanimation Editors: R. Frey, Mainz.· F. Kern, St. Gallen O. Mayrhofer, Wien Managing Editor: H. Bergmann, Linz Mobile Intensive Care Units Advanced Emergency Care Delivery Systems Edited by R. Frey. E. Nagel and P. Safar Assistant Editor: Petra Rheindorf and Patricia Sands With 67 Figures Springer -Verlag Berlin Heidelberg New York ISBN-13: 978-3-540-07561-5 e-ISBN-13: 978-3-642-66284-3 DOl: 10.1007/978-3-642-66284-3 Library of Congress Cataloging in Publication Data. International Symposium Mobile Intensive Care Units and Advanced Emergeucy Care Units, Mainz 1973. Mobile inten sive care units, advanced emergency care delivery systems. IAnaesthesiology and resuscitation; 95) English or German. Bibliography: p. Includes index. 1. Emergency medical services-Congresses. 2. Intensive care units, Mobile-Congresses. I. Frey, Rudolf, 1917 - II. Nagel, Eugene L. III. Safar, Peter. IV. Title. V. Series. [DNLM: 1. Intensive care units-Congresses. 2. Mobile health units-Congresses. 3. Emergency health services Congresses. 4. Disasters-Congresses. WI An104E v. 95 / WX218 1615m 1973J RA645.5.157 1973 362.1'04'25 75-45258. The use of general descriptive names, trade marks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as under stood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying, machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to the publisher, the amount of the fee to be determined by agreement with the publisher. © by Springer Verlag Berlin Heidelherg 1976. Printing and binding: Meister-Druck Kassel. PREFACE Emergency care is improving throughout the world and thousands of lives are being saved each year. However, there are still too many patients who die before help reaches them in the form of advanced rescue and definitive emergency care techniques. In an effort to improve emergency care throughout the world, the International Committee of Emergency and Disaster Medicine meets bi annually. This meeting takes place in Mainz, Germany in September in order to discuss issues, exchange information, and establish re commendations designed to improve emergency care. The group is in~ dependent of political, national, racial, religious, or commercial influences and, in this sense, similar to the Club of Rome which attempts advances in sociology, biology and natural sciences. There fore, the organization could be called the "Club of Mainz" for the field of emergency and disaster medicine. The following book contains the proceedings of the International Symposiom on "Mobile Intensive Care Units and Advanced Emergency Care Units" at Mainz from September 24-27, 1973, and the discussions evoked by the first activities of the "Club of Mainz" and the inter nationally acknowledged "Recommendations". At this time we also announce the next meeting and International Symposium on Disaster Medicine, open to the public, organized by the "Club of Mainz" (October 1 - 2, 1977). Mainz, October 1976 RUDOLF FREY CONTENTS I. PZanning and Organization of the Emergency MediaaZ Serviaes System I. 1. The Concept of an Emergency Health Care Planning Team (K. LEE) ••.•••••••••..••••..••...••••••••••.••••••••••••.•• 2 I. 2. On the Organization in th~ Piemonte and Torino Areas (E. CIOCATTO and R. PATTONO) •.•••••••••••.••••••••••••••.•• 5 I. 3. The American Approach to Improvement of Emergency Medical Services: Community CQuncils of EMS (G. ESPOSITO) .••..•.•.• 11 I. 4. Political Roadblocks to Organizing Emergency Medical Services (EMS) in Allegheny County, USA (P. A. SANDS) •.••.•••••••••. 12 I. 5. Allegheny County, Pennsylvania's Emergency Care Non-System (D. BENSON) ...•••••••••••••.•••.••••••••••••••••••••••••••• 13 I. 6. Centralization of all Personnel and Equipment in Rescue Services (G. MUHLBAUER) •••••••••••••.•••••••••••••••••••••• 15 I. 7. Intervention of Helicopters in Disaster Relief and Rescue Service in the Federal Republic (H. BURGHART) .•..•••.•••••• 16 II. Communiaations II. 1. Telemetry Command in an Integrated Emergency Care System (C. T. LAMBREW) •••••••••••••••••••••.•.•.••••••••••••••••• 18 II. 2. Interdisciplinary Nature of Mobile Intensive Care Units (A. A. GABOR) ••.•••••••••••.••••••••••••••••••.••••.•••..• 19 II. 3. Possibilities and Limits in the Use of Bio-Telemetric Appliances in Rescue-Services (M. SCHORR) ••••••••••••••••• 20 II. 4. A Communication Set up for Air, Sea and Ground EMS (B. FAGERLUND) ...••.•••••.•••••••••....•••.•••••..••.••••. 21 III. Treatment at the Saene and During Transportation, InaZuding Physiaian Command III. 1. The MAST-1 Garment in Hypovolemic Shock (E. L. NAGEL) •••• 38 III. 2. Behandlung am Notfallort und wah rend des Transportes im Hochgebirge (B. HAID) •••..••.•..•••••. ' ....••••..•••••.••. 39 III. 3. Cardiovascular and Other Effects of Transporting III Patients (G. WADDELL) •••..•••.•.••.••.•••••.••••••..•.••. 42 VIII III. 4. A Simple Method for Continuous ECG Registration by Compact Casette Tape Recorder During Helicopter Transport (J. O. HAGELSTEN und K. JESSEN) ..•..•••.••.........•.•.•• 50 III. 5. Features of a New Intensive Care. Ambulance (H. REINHOLD) .. 56 III. 6. The S-61 Helicopter as Mobile Intensive Care Unit (K. JESSEN and J. O. HAGELSTEN) ••..........•••..•........ 58 III. 7. Mobile Neonatal Intensive Care (H. BARRIE) ..•.•..••..••.• 62 III. 8. Care for and Transport of Newborn Babies in the Ambulance Practice (G. TAKACS) ••..•.•...••..•...••....••...•...•..• 65 III. 9. Secondary Transportation in Southern Finland (M. KJELLBERG and M. MURTOMAA) .•....••...••.••...•..•..•. 68 111.10. The Mobile Intensive Care Unit in Helsinki (M. MURTOMAA) .. 71 111.11. Experiences in a Mobile Intensive Care Unit in Lagos (J. O. SODIPO) ..••...........•.......••..••....•••....... 74 111.12. Der Service d'Aide Medicale d'Urgence (P. GAUTHIER-LAFAYE) 78 111.13. Experiences with an Ambulance-Service in Oslo Manned by a Doctor (I. LUND and A. SKULBERG) ...•......•.•••••...... 81 111.14. Mobile Intensive Care Units (0. ¢YEN) .•••••...•..•..•••.• 84 111.15. Transport of the Severely Injured During Long-Distance Flight (K. H. WEIS and L. VIERMETZ) ••••••..•.•••••.••..•• 85 111.16. Function of a Coordinated Helicopter-Emergency Service (W. DICK and J. KILIAN) ••..••.••••.•.•••.•.•.•••..••••... 86 111.17. Importance and Complications in Application of Cava Catheters under Transport Conditions (E. KESSLER and W. WERNITSCH) ••.••......••..••.•.•..•.••.•.•....•.••••..• 88 111.18. Possibilities of Pain Alleviation at the Site of an Accident or Disaster (G. SEHHATI, W. ERDMANN and H. P. STEGBAUER) ••••••..•.••..•..•.•••••.•••...••..•..••. 90 111.19. Ambulance Design and Equipment for Mobile Intensive Care (P. SAFAR, G. ESPOSITO and D. BENSON) ....•..•...••.. 91 IV. Continuing Life Support in the HospitaZ IV. 1. Critical Care Medicine: Organizing and Staffing ICUs (P. SAFAR and A. GRENVIK) ...••••..•.••.•...••.•.••••...... 96 IV. 2. Patient Care during Inter-Hospital Transfer (G. WADDELL) 97 V. Data Acquisition and EvaZuation of System V. 1. Evaluation Research (P. A. SANDS) •..•...•.•.••••••••.•.••.• 100 V. 2. Evaluation of an EMS System by Analysis of Compiled Data from Run Reports and the Emergency Department Log (W. T. HAECK) •• 106 IX V. 3. The Computer Interrogative Textbook Project: A Preliminary Report (G. A. WYKER, J. J. DINEEN, and J. G. WIEGENSTEIN) •. 114 v. 4. Ein Vorschlag zur Verbesserung neurochirurgischer Verlaufs- kontrollen (G. FAUPEL) .••.••••.•••••.•••••••••••.••••.••••• 119 VI. Training of Non-Physieians and Physieians VI. 1. Erkennung und Erste Hilfe durch Laien (Ausbildung der Bevolkerung) (A. R!2IRMARK) ••.•••••••••••••••••••••••••••••• 124 VI. 2. Operation of Cardiac Emergency Care Delivery System by Paramedical Personnel (L. B. ROSE) •••••••.•••••••••••••••• 128 VI. 3. The Training of Emergency Medical Technicians-Cardio- vascular (L. B. ROSE) •• '• •••••.•••••••' ••••••••••••••••••••• 131 VI. 4. Recognition and First Aid by Bystanders (H. ZIELIaSKI) •••• 135 VI. 5. Suggestions for the Organization of Mobile Intensive Care Units (P. LUST) •••••••••••••••••••••••••••••••••••••• 138 VI. 6. Present Situation in the Training of Rescue Personnel (F. SKORSKI) .•••.•.•••••••.•••••••••.••••••••••••••.•••••• 141 VI. 7. Evolution of Emergency Medical Technicians and Paramedics in the U.S.A. (P. SAFAR) ••••••••••.•••••••••••. 143 VI. 8. Inadequacy of Prehospital Emergency Care (D. BENSON and C. STEWART) .••••••••..••••••••••••••••.•••.••.•••.•.•• 146 VI. 9. First Aid and Emergency Care Training: Its Effect on Pre hospital Emergency Care (K. CRONIN, D. BENSON and K. ROGERS) ••••••••.•••••••••••••••••••••••••••••••.•.••••. 147 VI.l0. Advanced Life Support by Volunteer Fire Department Ambulance Personnel (D. BENSON and J. A. WEIGEL) .•...••••• 148 VI.ll. Teachability of Unemployed and Undereducated Individuals as Emergency Medical Technicians (EMT's) (M. BROWN) ••••••• 149 VII. The Emergeney Cardiae Care System VII. 1. The Influence of Prehospital Emergency Cardiac Care upon Community Mortality from Coronary Artery Disease (R. S. CRAMPTON, J. A. GASCHO, J. R. MILES Jr., R. STIL- LERMANN and R. F. ALDRICH) •••••••.••••••••••.•••••••••••• 152 VII. 2. Einsatzerfahrungen mit dem ZUricher "Kardiomobil" (G. KREIENBUHL, P. C. BAUMANN, P. FREY, F. HEINZELMANN, P. M5HR und W. STEINBRUNN) •••..•••••••••••••••••••••.•.•• 1 58 VII. 3. Blind Defibrillation (W. J. GRACE, R. J. KENNEDY and C . T. NOLTE) •••••.••••••••••••••••••.••••.••••••••••••••• 1 64 VII. 4. The Efficacy of Pre-Hospital Therapy in Cardiac Disease (J. LEWIS) •••••••••••••••••.••••••••••••.•••••••••••••••• 166 VII. 5. Cardiopulmonary Resuscitation, Basic Life Support Self Training System for All Personnel (P. SAFAR, P. BERKEBILE and M. SCOTT) •.•...••.•..•••..•••••••••••••••.••••••••••.. 168 x VIII. Disaster Preparedness and Care VIII. 1. Emergency Care in Major Accidents (Railway, Air, Road, Industrial) (0. ¢YEN) •.•..•••••.•••••••••••••.•••••••.•• 172 VIII. 2. Intensive Care under Primitive Conditions (0. ¢YEN) ••••• 173 VIII. 3. The Catastrophe Plans for Lausanne and the Canton of Vaud (J. FREEMAN and G. JACCARD) ........................ 176 VIII. 4. International Preparedness Operation and Coordination in Cases of Disaster (M. BODI) •••••••••••••••••••••••••• 185 VIII. 5. Die arztliche Versorgung bei GroBkatastrophen (K. W. WEDEL) ••.•.••••••.•••••.••••••••••••••••••••••••• 187 VIII. 6. The Involvement of the Police Service in Great Britain with the Medical Services at Times of Disaster (B. FISHER) •••••••••.•••.•••••••••••••••••••.•••.•.••••• 190 VIII. 7. A Network of Base' Hospitals for Large Scale Catastrophes (W. ERDMANN and R. FREY) ••••••••••••••.•.••••••••••••••. 198 VIII. 8. Emergency Care Medicine under Primitive Conditions (E. DAERR) ••••••••••••.••••••••••••••••.•••••••.•••••••• 202 IX. Researah and Innovations IX. 1. Research in Emergency and Critical Care Medicine (ECCM) (P. SAFAR) .••••••••..•••••••••••••••.••••••••••••••••.•••• 204 IX. 2. Reducing of Vibration Stress Inside Emergency-Ambulance (J. HELLING, H. K. v. ANSEMBOURG, E. R6HL and H. WOLFF) ••• 207 IX. 3. Tragen, AusfUhrungen und Abmessungen. Anordnung der Lagerung in den Transportsystemen (H.-W. ORNTH) ••••••••••• 213 IX. 4. International Cooperation in the Field of Rescue-Technical Investigation (A. R¢RMARK) ••••••••••••••••••••••••••••••.• 227 IX. 5. Considerations on International Teamwork in the Field of Aid in Catastrophes and Emergency Medicine (P. W. KOLB) ..••..•••••••••••••.••••••••••••.••••.•.•••••• 229 IX. 6. Verbesserungen des Rettungswesens in Rheinland-Pfalz (P. HENNES) ••.••..•••••••..•••••••••••••••••••••••••••.••• 230 X. Reaommendations ............................................... 235 XI. EmpfehZungen ................................................. 253 LIST OF CONTRIBUTORS AND PARTICIPANTS OF SYMPOSIUM AFRICA, L., M. D., President, Phillipine Soc. f. Anesthes., Phillipine General Hospital, Manila, Phil. AHNEFELD, F. W'o Prof. Dr., Department fUr Anaesthesiologie der Uni versitat, D-79 Ulm/Donau, Steinhovelstr. 9 ALDRICH, R. F., M. D., University of Virginia, Medical Center, Charlottesville, Virginia 22901, USA ALLAN, D., M. D., Chief Anesthesiologist, Children's Hospital, Chicago, Illinois, USA ANSEMBOURG von, Graf, H. K., Dipl. Ing., Institut fur Kraftfahrwesen, Rhein.-Westfalische Technische Hochschule, D-51 Aachen BARRIE, H., M. D., Charing Cross Hospital, Department of Paediatrics, Fulham Palace Road, London W 6 8RF, England BAUMANN, P. C., Dr., Institut fUr Anaesthesiologie der Universitat, Kanton£pital, Ramistr. 100, CH-8006 Zurich, Schweiz BENSON, D., M. D., University of Pittsburgh School of Medicine, Department of Anesthesiology, Pittsburgh, Pennsylvania 15261, USA BERGMANN, H., Prof. Dr., Institut fur Anaesthesiologie, Allgem. off. Krankenhaus, Linz/Donau, osterreich BODI, M., Dr., Organisation Internationale de Protection Civile, 28, Ave. Pictet de Rochemont, P. O. Box 124, CH-1211 Geneve 6, Schweiz BOYD, D., M. D., Director, Emergency Medical Services, Depart ment of Health, Education and Welfare, U. S. Public Health Service, U. S. Government, Washington, DC BROSE, R., D. P. H., Assoc, Prof. of Community Med. Univ. Kansas, Kansas City, USA BROWN, M., Assoc, Director, Freedom House Ambulance Service, Pitts burgh 15261, USA BURGHART, H., Dr., Stadtisches Krankenhaus Harlaching, Aht. Chirurgie, D-8000 Munchen-Harlaching, Sanatoriumsplatz CIOCATTO, E., Prof. Dr., Istituto di Anesthesiologia e Rianimazione dell' Universita di Torino, Corso Polonia 1, Torino, Italien CRAMPTON, R. S., M. D., Box 158, Department of Medicine, University of Virginia, Medical Center, Charlottesville, Virginia 22901, USA DAERR, E., Dr., D-53 Bonn-Bad Godesberg, Weissdornweg 122 XII DICK, W., Prof. Dr., Department fur Anaesthesiologie der Universitat D-79 Ulm/Donau, Steinhovelstr. 9 DINEEN, J. J., M. D., ~erican College of Emergency Physicians, 241 East Saginaw Stre~~, East Lansing, Michigan 48823, USA ERDMANN, W., Prof. Dr., Division of Anesthesia Research, University of Alabama Medical Center, Birmingham, Alabama 35294, USA ESPOSITO, G., M. P. H., Emergency Medical Services, Comprehensive Health Planning, Chatham Center, Pittsburgh, Pennsylvania 15219, USA FAGERLUND, B., Dr., Lovisenberghospital, Oslo, Norway FAUPEL, G., Ass. Prof. Dr., Neurochirurgische Universitatsklinik, Langenbeckstr. 1, D-65 Mainz FISHER, B. E., Chief Inspector City of London Police, London 26, Old Jewry, E. C. 2, England FREEMAN, J., Prof. Dr., Service Universitaire d'Anesthesiologie, H8pital Cantonal, CH-1011 Lausanne, Schweiz FREY, P., Dr., Stadtspital Triemli, Abteilung fur Anaesthesie, CH-8055 Zurich, Schweiz FREY, R., M. D., Professor and Chairman, Department of Anaesthesiology/Reanimation, Johannes Gutenberg University, Mainz, Germany GABOR, A. A., Dr. med. habil., Hungarian National Emergency and Ambulance Service, General Direction, Marko u. 22, Budapest V, Ungarn GASCHO, J. A" M. D., University of Virginia, Medical Center, Charlot tesville, Virginia 22901, USA GAUTHIER-LAFAYE, P., Prof. Dr., Department d'Anesthesiologie, H8pital Civil, F-67 Strasbourg, Frankreich GRACE, W. J., Prof. M. D., St. Vincent's Hospital, Medical Center, 153 W. 11th Street, New York, N. Y. 10013, USA HAECK, W. T., M. D., Emergency Department, Jackson Memorial Hospital, Jacksonville, Florida 33136, USA HAlO, B., Prof. Dr., Institut fur Anaesthesiologie der Universitat, Innsbruck, 5sterreich HAGELSTEN, J. 0., M. D., Mosevangen 11, DK-2860 Soborg, Danemark HEINZELMANN, F., Dr., Institut fur'Anaesthesiologie der Universitat, Kantonspital, Ramistr. 100, CH-8006, Zurich, Schweiz HELLING, J., Prof. Dr.-Ing., Institut fur Kraftfahrwesen der Rhein. Westfalischen Hochschule, D-51 Aachen HENNES, P., Dr., Ministerium des Innern des Landes Rheinland-Pfalz, 0-65 Mainz HOLLOWAY, R. M., Prof. M. D., Emergency Medical Service, New York, N. Y. 10013, USA