The foundation of modern-day emergency medical service (EMS) systems began in 1966, based on hospital medical care. Demand for evidence to support prehospital practices that have been in existence for the past half-century has continued to grow; yet, researchers have not adequately explored the relationship between the medical certification level of emergency first responders and the amount of time an ambulance spends on the scene. The purpose of this quantitative study was to examine and compare ambulance scene times for emergency responses when basic life support (BLS) certified first responders or advanced life support (ALS) first responders are first on the scene, and whether the level of first responder training reduces the time spent on the scene by a paramedic ambulance. A final research question dealt with whether there is a relationship between how long the first responder is on the scene and the amount of time an ambulance spends at the scene of an emergency. The publicly available archival data used for the study were from a community that had BLS and ALS first responders. Data analysis involved t-tests of the hypotheses for the first 2 research questions and a linear regression analysis of the hypotheses for the third research question. The findings showed that there is a clear difference in ambulance scene times based on the certification level of the first responders. Advanced life support first responders significantly reduced the scene time of ambulances when they arrived at the scene prior to the ambulance. Positive social change could result from this study if understanding the impact that ALS first responders have on ambulance scene times leads EMS planning managers to deploy resources more strategically, thus improving the efficiency of the public safety system and saving lives.

The development of a plant growth chamber capable of sustaining plant growth over multiple generations is a necessary step towards the attainment of a Controlled Ecological Life Support System (CELSS). The studies herein examine the effects of aeration abilities and rates on plants grown in three model nutrient delivery systems during germination and over the life-cycle of the plant. These studies are the first time a porous tube nutrient delivery system was compared to another active nutrient mist delivery system. During germination an indicator of hypoxic stress, alcohol dehydrogenase (ADH) activity, was measured and was more affected by aeration rate than mode of nutrient delivery. Over the life-cycle of the plant, however, plants grown in the porous tube system had the least ADH activity and the highest levels of shoot (leaf + stem), root and leaf biomass. None of the plants in any system, however, produced viable seed. This study highlights the need to optimize aeration capabilities in the root zone of enclosed chambers.

Purpose. To systematically develop and field test an intervention to engage families and healthcare teams in the decision-making process about life support for critically ill patients in the Intensive Care Unit (ICU). Setting. Adult medical-surgical ICU at a Canadian academic teaching hospital. Methods. The International Patient Decision Aid Standards (IPDAS) criteria and the Interprofessional Shared Decision Making (SDM) model guided the study of families facing decisions about life support for their relative in ICU that involved:1) systematic review; 2) qualitative descriptive study; 3) mixed methods field test of a novel patient decision aid (DA). Systematic review findings. Of 3162 citations, four trials evaluated interventions to improve communication between health professionals and patients/families. One intervention met eight of nine criteria for SDM but did not evaluate its effect on the benefit to communication. Qualitative study findings. Six family members and nine health professionals identified two options (life support or comfort care) and values associated with these options. Values included maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, giving the family enough time to adapt emotionally to the patient’s health situation, and the judicious use of healthcare resources. Families were unlikely to become engaged without healthcare professionals making the decision explicit and minimizing other barriers across the decision-making process. Field test findings. Family members and health professionals for eight patients indicated that the DA was feasible to use, acceptable to users, had the potential to do what was intended, and did not seem to present adverse consequences to users. An enhanced delivery strategy is needed for future evaluation of its effect on facilitating patient/family involvement in decisions. Conclusions. Limited involvement of families in the process of decision-making about life support in the ICU reinforced the need for effective interventions to facilitate SDM. These studies validated the operationalization of the IPDAS criteria, as part of a systematic process for developing and field testing DAs. However, IPDAS criteria stop short of elements necessary to consider when implementing the DA in the processes of care.

The objective of the proposed research is to study the integration of humans and automation for the operation of regenerative life support systems (RLSS). RLSS combine physico-chemical and biological processes with the purpose of increasing the autonomy of space habitats and the life quality of their living organisms by properly reusing byproducts and regenerating consumable resources. However, these processes require energy and time to transform chemical compounds and organic wastes into nutrients, consumables, and edible products. Consequently, the maintenance of RLSS imposes a considerable workload on human operators. In addition, the uncertainties introduced by unintended chemical reactions promoted by material loop closure may create unexpected situations that, if unattended, could translate into performance deterioration, human errors, and failures. The availability of novel chemical and biological sensors together with computational resources enable the development of monitoring and automation systems to alleviate human workload, help avoid human error, and increase the overall reliability of these systems. This research aggregates sensor data and human-expert situation assessments to create a representation of their situation knowledge base (\gloss{skb}). The representation is used in a switched control approach to the automation of RLSS, for decision support, and human-automation coordination. The aggregation method consists of an optimization process based on particle swarms. The purpose of this work is to contribute to the methodological development of situation-oriented and user-centered design approaches to human-automation systems. Experiments and simulations are supported on the process of respiration in an aquatic habitat acting as a RLSS.

Purpose. To systematically develop and field test an intervention to engage families and healthcare teams in the decision-making process about life support for critically ill patients in the Intensive Care Unit (ICU). Setting. Adult medical-surgical ICU at a Canadian academic teaching hospital. Methods. The International Patient Decision Aid Standards (IPDAS) criteria and the Interprofessional Shared Decision Making (SDM) model guided the study of families facing decisions about life support for their relative in ICU that involved:1) systematic review; 2) qualitative descriptive study; 3) mixed methods field test of a novel patient decision aid (DA). Systematic review findings. Of 3162 citations, four trials evaluated interventions to improve communication between health professionals and patients/families. One intervention met eight of nine criteria for SDM but did not evaluate its effect on the benefit to communication. Qualitative study findings. Six family members and nine health professionals identified two options (life support or comfort care) and values associated with these options. Values included maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, giving the family enough time to adapt emotionally to the patient’s health situation, and the judicious use of healthcare resources. Families were unlikely to become engaged without healthcare professionals making the decision explicit and minimizing other barriers across the decision-making process. Field test findings. Family members and health professionals for eight patients indicated that the DA was feasible to use, acceptable to users, had the potential to do what was intended, and did not seem to present adverse consequences to users. An enhanced delivery strategy is needed for future evaluation of its effect on facilitating patient/family involvement in decisions. Conclusions. Limited involvement of families in the process of decision-making about life support in the ICU reinforced the need for effective interventions to facilitate SDM. These studies validated the operationalization of the IPDAS criteria, as part of a systematic process for developing and field testing DAs. However, IPDAS criteria stop short of elements necessary to consider when implementing the DA in the processes of care.

Purpose. To systematically develop and field test an intervention to engage families and healthcare teams in the decision-making process about life support for critically ill patients in the Intensive Care Unit (ICU). Setting. Adult medical-surgical ICU at a Canadian academic teaching hospital. Methods. The International Patient Decision Aid Standards (IPDAS) criteria and the Interprofessional Shared Decision Making (SDM) model guided the study of families facing decisions about life support for their relative in ICU that involved:1) systematic review; 2) qualitative descriptive study; 3) mixed methods field test of a novel patient decision aid (DA). Systematic review findings. Of 3162 citations, four trials evaluated interventions to improve communication between health professionals and patients/families. One intervention met eight of nine criteria for SDM but did not evaluate its effect on the benefit to communication. Qualitative study findings. Six family members and nine health professionals identified two options (life support or comfort care) and values associated with these options. Values included maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, giving the family enough time to adapt emotionally to the patient’s health situation, and the judicious use of healthcare resources. Families were unlikely to become engaged without healthcare professionals making the decision explicit and minimizing other barriers across the decision-making process. Field test findings. Family members and health professionals for eight patients indicated that the DA was feasible to use, acceptable to users, had the potential to do what was intended, and did not seem to present adverse consequences to users. An enhanced delivery strategy is needed for future evaluation of its effect on facilitating patient/family involvement in decisions. Conclusions. Limited involvement of families in the process of decision-making about life support in the ICU reinforced the need for effective interventions to facilitate SDM. These studies validated the operationalization of the IPDAS criteria, as part of a systematic process for developing and field testing DAs. However, IPDAS criteria stop short of elements necessary to consider when implementing the DA in the processes of care.

Hintergrund: Nach Schätzungen des GRC (German Resuscitation Council) erleiden jährlich allein in Deutschland 50.000 Menschen außerhalb eines Krankenhauses einen Herz-Kreislaufstillstand. In jeder Minute ohne Herzdruckmassage sinkt die Überlebenswahrscheinlichkeit um 10%. Bis zum Eintreffen professioneller Helfer müssen die Basismaßnahmen (Basic-Life-Support - BLS) der Reanimation durch nicht-medizinische Laien durchgeführt werden. Laien werden durch Basic-Life-Support-Kurse in den Basismaßnahmen geschult. Diese Basismaßnahmen sind als Qualitätsparameter messbar. Fragestellung: In der vorliegenden Arbeit wurde untersucht, ob ein standardisierter BLS-Kurs die Basismaßnahmen positiv beeinflussen kann und ob dieser Effekt auch noch nach 6 Monaten nachweisbar ist. Besonderer Wert wurde dabei auf den klinisch und prognostisch wichtigen Qualitätsparameter der No-Flow-Fraktion (NFF) gelegt. Methodik: Diese Prospektive Studie umfasste eine Kontrollgruppe aus Laien, die einmal in ihren Leben einen Erste-Hilfe-Kurs besucht hatten und nun ohne Schulung drei mal einem gleichen standardisierten Reanimationsszenario (5min Dauer) zugeführt wurden. Die Reanimationsleistungen wurden stets als Paarleistung im Rahmen der 2-Helfer-Methode erfasst. Dem gegenüber standen die Teilnehmer der Interventionsgruppe, welche ebenfalls Laien waren, jedoch im Rahmen ihrer Stellung als 'Betriebsersthelfer' alle 2 Jahre in Reanimation geschult wurden. Auch diese Teilnehmer wurden drei Mal dem Reanimationsszenario ausgesetzt: Einmal vor dem Auffrischungskurs, unmittelbar nach dem BLS-Kurs und erneut ohne vorherige Re-Schulung nach 6 Monaten. Die erfassten Reanimationsleistungen wurden statistisch aufgearbeitet und verschiedenen Analysen unterzogen. Ergebnis: Ein standardisierter BLS-Kurs kann die meisten Qualitätsparameter der Reanimation signifikant verbessern. Der Effekt ist auch noch nach 6 Monaten nachweisbar, lässt jedoch bereits wieder nach. Trotz regelmäßiger Schulung zeigten die Teilnehmer der Interventiontionsgruppe vor der Re-Schulung vergleichbar schlechte Reanimationsleistungen, wie die Teilnehmder der Kontrollgruppe. Das optimale Schulungsintervall bleibt somit weiter unklar. Der klinisch relevante Parameter NFF wird durch den BLS-Kurs drastisch verbessert, bleibt jedoch unzureichend hoch.

The objective of the present article is the approach of 2010 ECC & CPR Guidelines and their principal modifications. Guidelines are the result of scientific evidence and clinical research that support statements and new recommendations. Some important changes in 2010 present in the Chain of Survival which includes aspects of Postresuscitation Care1,2. CPR Guidelines were published and uploaded on-line (Resuscitation and Circulation publication) in October 18th, 20109,10. One of the most important training and learning strategies is the dissemination of concepts from ILCOR CPR and ECC Guidelines which had extended into ERC and AHA. This has allowed the medical personnel to treat patients victims of cardiac arrest or cardiac emergency efficiently. We are convinced that interactive methodology and clinical simulation are essential for training and learning. We cannot know cardiopulmonary resuscitation without discussion of science and performance of lively clinical scenery cases for each of the main topics in CPR and ECC / El presente artículo busca como objetivo primordial, una aproximación a las Guías 2010 y principales cambios; estamos convencidos que el entrenamiento y aprendizaje de ella se basa en los conceptos de metodología activa y simulación clínica, no podemos tener un conocimiento de la ciencia y protocolos de reanimación cardiopulmonar sin antes no haber experimentado la discusión de temas y desarrollo de casos escenarios vivenciales, para cada uno de los tópicos descritos a continuación. Una de las estrategias más importantes es la diseminación de los conceptos contenidos en las Guías ILCOR de Reanimación Cardiopulmonar que se han consensuado en la ERC y AHA. Ello ha permitido que el personal de salud trate a los pacientes victimas de paro cardiaco o emergencias cardiacas con mayor eficiencia. Las guías actuales fundamentan todos sus aspectos en investigación y recomendaciones, los cambios se iniciaron con una variación sustantiva de la cadena de supervivencia incorporando conceptos de integración de cuidados postparo1,2. Las Guías de Reanimación Cardiopulmonar fueron publicadas y puestas on-line (Resuscitation y American Heart Association) en Octubre 18, 20109,10.

Thesis. 1977. Ph.D.--Massachusetts Institute of Technology. Dept. of Chemical Engineering. / M̲i̲c̲ṟo̲f̲i̲c̲ẖe̲ c̲o̲p̲y̲ a̲v̲a̲i̲ḻa̲ḇḻe̲ i̲ṉ A̲ṟc̲ẖi̲v̲e̲s̲ a̲ṉḏ S̲c̲i̲e̲ṉc̲e̲.̲ / Bibliography : leaves 286-295. / by Albert Sacco, Jr. / Ph.D.

Thesis (Ph.D.)--Massachusetts Institute of Technology, Dept. of Chemical Engineering, 1980. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND SCIENCE. / Bibliography: leaves 190-192. / by James Edwin Garmirian. / Ph.D.