to meet patient need; 2' Dromptly by a system staffed adequately ac-
apportioned fn"i''ar #rr ,,{'o"ra be answerei and services """i, J R"'po"" times.would equal or be ;ffiil;',;;;;.liu.J would be classiless than current system times, 4' That 9ll calls ambulances that and phvsicians EMs bv ;il ;;;;i;;;o ffio'itv i" oid.' to ensure rapid response.to life;;;ii;;;;sig'n.d of poisonthreateningernergencres;5' Non life-threateningcases ihat turn-around o' center; Poison the to iil;;iJi"-;ria'ged ,. the hospital would be limited to an aver;fi.';i;ilt"tt.?t responseto field ;;;-"i ,." minutes; z. itte iMs physiclan and b' enhanced;8' All clinical ;il";;";;i.;;o,'1a'.o",-"', i".i"ai"g times'o{ intervention' would be recorded il;';ilLi g times would be Uv'ln"'"":riit. ims p}tysi"ians; All dispatch bv'.otpui"t, ^"d *ould be evaluatedeach ;;";;;d;"rrv""a supervisor' l0 Patient destination tii-pt'vti.lt" ;i'i?;;;; facility as determinedby the onclosest'appropriate the ;;"1J6"
iiffifi;i;y;i;i;;.
that on tle as.sumption i'ti" pt," wasbased
oJ EMS as to the the Medical Director *oiriJ advise the Chief that should patient care be and a.ii*ted, ""t.'t.inl "i a"rri,v risk, the"city would seekan immediate iniuncttonto l.i..ii'"J", io work Ambulances during the strike i;#';;;;;''ik*t1;"k asslsteo p"rl"a *at. manned by. 24 non-union EMS supervisors' amhv 60 lav suDervrsorstrom other city departments' These during the rvice se eis of ho"tt ,r.tit /r+ tirr"t# "t.'""a"a *i,r' the normal l,l14 unit hours' In addition' ;;ik;, ;;;;;..J pei'o"'el provided a citv-wide p.ll*-rtJfiie i;:il":it;;i""a Commuiirrt ,..porrr" service to life-threatening emergencies' through marntained was departments emergency with nication rese-rved usuallvnetwork machinc ;i;pho.,.'f".s'l-ili il;-;t;;i had had on;;; P;;;t Center use. Thirtv EMS phvsicians who continued line medic command reiponsibilrtics'in thc' system all 9ll calls triagrngto addition in duties i^ft"rt'TtaO-i..ponse from a recogiiioio"of, for tire triage of all 9ll calls were,adopted into red (lifenized urban EMS system.All calls were classi{ied yellow (urgent)and green(non-urgent)blptltt:]i:i ;;;;-c), at the nosprtar answering-iheEMS 911 line Turn-aroundttme number of sufficient of a m"intenance the in lrou.J ,o'U..rucial of ten average an to reduced was ittis il:**i;;t"r""i... personneland the -ltta". with the cooperationof supervisory amdepartmenfsof the city A strategvof anticipatorv ;;;;;;;.y rereduce to order in implemented was Urrfrri". deployme.rt 'fhis strategically to move to units ALS requi,ed rp""."im6t. and currcnt a'"iig""t.a positions basedon past patternsof service in not having "rilio"a. Thi, .yrt.- ,t"t,,, -"n^gtment resulted calls awaiting available rinits for,a t"lPo11t--9!f:::; ;; q;;; revlewor tion of careby on-sceneEMS physiciansand contrnutng no apparittp tn.Jt #a .-.rg..t.y depaitment recordsrevealed strike ent comDromlr., ,.t ..t.-qt,lity oi care delivered' An EMS provideda and dBase-l1l+' using "t.j,i.d t"pldrv il;"I#'il and guidedtacsensitivereal-time-o.ri,o, of EMs-performance Analvsisof EMS data indicatedthe avcragecall ;i;;j';";r.;i;"s. re;v;,.- fot the 79 hours of the strike to be 505 i;;; fJ,'il period included strike The hours uv.t,1i4unit ti"ii.lJ rp.;;;;, utilization .157resoonsesstatrcoby 714 unit hours Unit hour efficiencv)were calculatedand re;;;";;';;;"*-tllv;ttstrike ro;7.-i".t."t"iievel of svstem performancefor the ;.;ft'; with no sacrifice in accomphshed was ffiiJi i;s';;'s-ofinit strikel This averaqeresponse.,*.,-1ez min presirikevs 6 6 min contingencvplanning-foran urban EMS "xiri"ol.;;;...i.}"t .o..,ia t.tut "t i ptotoivp" of this form of disaster ;;;k"t;d;; strategy. management
to all physiciansat the Na1io1-qlAssociation "M"dical vey was distributed Service Phvsicians (N4PY-s-P) meetins. in ;;'E;;;**;t .rh. s,rru"v was also mailed to all PMD's in Michi;r;;;;;it8;. surveved45 PMD's respondedof the responPMD's the ;;;:ll1 d e n t s T 5 % a r e c o m p e n s a t e d f o r t h e i r t i m e s p e n t a s P M had D,s,ToT'. and 15% had malpracti". .ou.r"g" ioi their PMD duties' Most i" i"gtt aition as a result of their position' il;"';;;i;;d
reili;;;;i;'l"ii""r'"ppoi..,
with office ssu were,provided
The average !;r;;, 65%hada system-wid"d"t" retrievalsystem'PMD'sfrom hours/week 15 is duties their ;i;;!;; o"iioi-i"g i0,000ALS runsper vearweremorerre;'"*;;;il;;;;;;;';#. uv ' gout"''n'ntai so"rce\6e"rovs 22"/o' :l'fiti;;;il;.tt"i.a lt00%vs 74%' 7' :.ijii i; ;it;;;;ce'and"equipment pro'vided P <-'005} 33%' vs svstem data {81% ; ..001ffiJ;-.."irri""a hours duties their. {22'4 periorming week per andspentmoretime than 10'000 il;:i h;J;;;'; ..00;i PMD'srrom areaswith less a hospital by ALS runs/year*".. -o,. ii"quttttly compensated in theperdifference n-o < Thttt'*as 03). P 15%, vs ,o"i". iOl'i'. The medi< 83) P l5%, vs iit:onltSU i"g.f .""i"-.'l"t.ft"J1" to requlrea .rt aii..tion of a prehospitaicaresystem..appears
il;r'';;;f i:,h:::,itiT;jfi i:'"r:**:,x',;i'l;,il1X,* most communltresrecer
Stress in Urban EMS / Diminishing -RC 105 NALyle'RBBass deid-onnel PE Pepe Morecock Department
Medicine; bJo.r.i."nLor Medicine,BaylorCollegeoj of Houston PsychologyUnrversity of-EOucationar medical services It is generallyacceptedthat urban emergency
:','Jr::':i.i:l':'; filjfi*iliit?Ts"l;n",lli'*,'mJ;1"'1".'"".ffi undertook thererore we it' i'a"" ;o ;; ;,;;;; ;;;;; ;;';fi ilii;,';,;il;f
(PMR) relaxation tr,. "rl."tt oi piog'"ttiutmuscle a small
group tti.st r'"tt"otdiscussions{GSFD}in ;;il;;;;a iMs p"tto"nel our purpose was to formallv #;i;;;il;fi tt",.'iir'oit-term) and triit llong-term)'indica;;;5;;"-;.;h,ii" or GSFD would alter tors of strcss ".ra to tttlay-*hether PMR c i t h e r o f t h e s e s h o r t - t c r m o r l o n g - t e r m a n x i e t y i n d i c a t o r sarinthis oi medical care pioviders' TWelve-paramedics' ili;;"";;; Houston oJ i;;- p.''o"n'l rosters of the citv ;ii;:;'lu";;i;;i ot rlnls'oiuision, were tested Ior indicators ;ililp;;,;.* sessions' "nd after completion of {our two-hour-long ;;;;JbJf;;. (STAI)' a standardized ;h;S;te-Trait et"ittv i""t"torv ;-generalanxietv"The long-term and "g'o"ps' titott-tttt ;;;i";;;i"il
il;ffi:il:
1O4 Administration Su-p-portfor ProiectfiJarcai Oirectors: A Profil-e F swor/ williamBeaumont
*.'""J*ii!a-into t*o
r' P.Yhol Group
both PMR and PMR alone was useo, and Group II, in whom that' on initial STAI demonstratejl rt.'tttJts .,r.a. Cib-;;;; 74th percentileof nortesting, the 12 parameaitt i'"tta at the lor,.reitstressieveland the having mal adults (with first d;;;;;i; 'lc,A;-;;iici-';.itin witiLt there were no significant differences s c o r e s o b s e r v e d b e t w e e n G , o . , p ' I a n d - I l , - t h e r e wsession e r e s i gfor nificant "i1itt end of the fourth "t.tt i"aii'tit il;;I"i'' terms of state)anxtety both groups in terms of trait (but not in to particiIn the nine paramedicswho were available -,tti""gnout indicators. mean trart anxiety scores study' entire the "r,. +l-2 atire-test to 36 1 at post-test{P !nr"g.i ttg;tri"*,ry-rt": .05).Recognirtngtne iimitationi of this small pilot study',we levth"t"t"b"tt EMS personnel do have high stress "iii;;;i;J;J appears to the gtttttal population' and that it ;il^;i,h ;6;cf for decreasingtratt itrr, prtan "io.," -^y bJa useful modality be'further iechniques PMR. that t.";;;t;J anxiety levels. we Ptt"-t-d:t^:y: evaluatedin this specialiitJ gto"p of medical :gt impact on lon that EMS peisonnel stressand its ;i;;;;;;;;.nd in turn, remedialfacand, ciosely .rr-ir.r.d-rr{or. b. oerformance iors be sought.
Hospital,RoYalOak, Michigan Prehosoitaladvancedlifesupport{ALS)providedbynonphysi^Gities, Survey of EllS Svs-tems.in Maior Cooper 106 phystctal / cians is providedunder the-supervistonot a T::]::: M r<o.nigtbutgl R Lee. L Stein' MA E Sloan, Hart, R director to as the proiecirnedical EmergencyMedicine ffi:,;;1;;;;il-;;i";;;d Hospitals Affilia6d ot-tttinois U"it"ititv pMo, the a:, well as ihe PMD' as of the time required. ,tt. time.required. ipitdi'il;.r. Finrji il ".r.t. ,h. Y:]1'::L: Chicago ResidencY, a surrisk involved' thi medico-legal
i..ft"i."f supportgivenand
46