Academic literature on the topic 'Paramedic triage'
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Journal articles on the topic "Paramedic triage"
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Kovacs, M., and S. Campbell. "LO31: Triage drift: Variation in application of the Canadian Triage Acuity Scale between triage nurses compared to triage paramedics in response to overcrowding pressures in an emergency department." CJEM 22, S1 (May 2020): S18. http://dx.doi.org/10.1017/cem.2020.87.
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Introduction: CTAS is a validated five-level triage score utilized in EDs across Canada and internationally. Moderate interrater reliability between prehospital paramedic and triage nurse application of CTAS during clinical practice has been found. This study is the first assessment of the variation in distribution of CTAS scores with increasing departmental pressure as measured by the NEDOCs scale comparing triage allocations made by triage nurses with those made by triage paramedics. Methods: We conducted a retrospective, observational cohort study of EDIS data of all patients triaged in the Halifax Infirmary Emergency Department from January 1, 2017-May 30, 2017 and January 1, 2018 - May 30, 2018. CTAS score assignment by nursing and paramedic triage staff were compared with increasing levels of ED overcrowding, as determined by the department NEDOCS score. Results: Nurses were more likely to assign higher acuity scores in all situations of department crowding; there was a 3% increased probability that a nurse, as compared to a paramedic, would triage as emergent when the ED was not overcrowded (Pearson chi-square(1) = 4.21, p < 0.05, Cramer's v = 0.028, n = 5314), and a 10% increased probability that a nurse, as compared to a paramedic, would triage a patient as emergent when EDs were overcrowded (Pearson chi-square(1) = 623.83, p < 0.001, Cramer's v = 0.11, n = 56 018). Conclusion: Increasing levels of ED overcrowding influence triage nurse CTAS score assignment towards higher acuity to a greater degree than scores assigned by triage paramedics.
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Cicero, Mark X., Barbara Walsh, Yauheni Solad, Travis Whitfill, Geno Paesano, Kristin Kim, Carl R. Baum, and David C. Cone. "Do You See What I See? Insights from Using Google Glass for Disaster Telemedicine Triage." Prehospital and Disaster Medicine 30, no. 1 (January 9, 2015): 4–8. http://dx.doi.org/10.1017/s1049023x1400140x.
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AbstractIntroductionDisasters are high-stakes, low-frequency events. Telemedicine may offer a useful adjunct for paramedics performing disaster triage. The objective of this study was to determine the feasibility of telemedicine in disaster triage, and to determine whether telemedicine has an effect on the accuracy of triage or the time needed to perform triage.MethodsThis is a feasibility study in which an intervention team of two paramedics used the mobile device Google Glass (Google Inc; Mountain View, California USA) to communicate with an off-site physician disaster expert. The paramedic team triaged simulated disaster victims at the triennial drill of a commercial airport. The simulated victims had preassigned expected triage levels. The physician had an audio-video interface with the paramedic team and was able to observe the victims remotely. A control team of two paramedics performed disaster triage in the usual fashion. Both teams used the SMART Triage System (TSG Associates LLP; Halifax, England), which assigns patients into Red, Yellow, Green, and Black triage categories. The paramedics were video recorded, and their time required to triage was logged. It was determined whether the intervention team and the control team varied regarding accuracy of triage. Finally, the amount of time the intervention team needed to triage patients when telemedicine was used was compared to when that team did not use telemedicine.ResultsThe two teams triaged the same 20 patients. There was no significant difference between the two groups in overall triage accuracy (85.7% for the intervention group vs 75.9% for the control group; P = .39). Two patients were triaged with telemedicine. For the intervention group, there was a significant difference in time to triage patients with telemedicine versus those without telemedicine (35.5 seconds; 95% CI, 72.5-143.5 vs 18.5 seconds; 95% CI, 13.4-23.6; P = .041).ConclusionThere was no increase in triage accuracy when paramedics evaluating disaster victims used telemedicine, and telemedicine required more time than conventional triage. There are a number of obstacles to available technology that, if overcome, might improve the utility of telemedicine in disaster response.CiceroMX, WalshB, SoladY, WhitfillT, PaesanoG, KimK, BaumCR, ConeDC. Do you see what I see? Insights from using Google Glass for disaster telemedicine triage. Prehosp Disaster Med. 2015;30(1):1-5.
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Fraess-Phillips, Alex J. "Can Paramedics Safely Refuse Transport of Non-Urgent Patients?" Prehospital and Disaster Medicine 31, no. 6 (September 19, 2016): 667–74. http://dx.doi.org/10.1017/s1049023x16000935.
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AbstractObjectiveThe goal of this search was to review the current literature regarding paramedic triage of primary care patients and the safety of paramedic-initiated non-transport of non-urgent patients.MethodsA narrative literature review was conducted using the Medline (Medline Industries, Inc.; Mundelein, Illinois USA) database and a manual search of Google Scholar (Google; Mountain View, California USA).ResultsOnly 11 studies were found investigating paramedic triage and safety of non-transport of non-urgent patients. It was found that triage agreement between paramedic and emergency department staff generally is poor and that paramedics are limited in their abilities to predict the ultimate admission location of their patients. However, these triage decisions and admission predictions are much more accurate when the patient’s condition is the result of trauma and when the patient requires critical care services. Furthermore, the literature provides very limited support for the safety of paramedic triage in the refusal of non-urgent patient transport, especially without physician oversight. Though many non-transported patients are satisfied with the quality of non-urgent treatment that they receive from paramedics, the rates of under-triage and subsequent hospitalization reported in the literature are too high to suggest that this practice can be adopted widely.ConclusionThere is insufficient evidence to suggest that non-urgent patients can safely be refused transport based on paramedic triage alone. Further attempts to implement paramedic-initiated non-transport of non-urgent patients should be approached with careful triage protocol development, paramedic training, and pilot studies. Future primary research and systematic reviews also are required to build on the currently limited literature.Fraess-PhillipsAJ. Can paramedics safely refuse transport of non-urgent patients?Prehosp Disaster Med. 2016;31(6):667–674.
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Nakata, Keiji. "Triage Problem Among the Ambulance Crew (Paramedic) in Japan." Prehospital and Disaster Medicine 34, s1 (May 2019): s173. http://dx.doi.org/10.1017/s1049023x19003972.
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Introduction:At various accidents or disaster sites, rescue, first aid, and transport to hospitals has been provided by ambulance crews (paramedics). In the case of mass casualties, they also need to operate triage for injured people.Aim:To consider and reveal challenges in triage by ambulance crews (paramedics) on-site.Methods:Interviews of seven ambulance crews (paramedics) and their instructors were conducted and their answers were analyzed.Results:(1.) Triage black tags: declaring “deceased: not able to survive” might give a heavy mental burden and psychological responsibility. Legal protection and an interstitial rule will be necessary in the future. (2.) Missed triage: the ambulance crew cannot perform a triage that may develop a legal problem. It is always important to prevent ambulance crews from being charged. (3.) Triage education and training: there are few triage trainings at fire departments although the number of emergency medical responses is increasing compared to fire response. It will be necessary to increase time of the triage education and training in near future. (4.) Command system (characteristic rank system in the fire department): There is a problem with the rank system in fire departments since confusion occurs when a commander of the First Aid Station is not a licensed paramedic. The ambulance crew (paramedic) usually consists of the three different ranked people. Individual operations are difficult during operation. Education for the paramedic executive is necessary for the fire organization.Discussion:For the triage by ambulance crew (paramedic), legal protection by medical control operation is required, and it may lead to a reduction of heavy mental burden. Triage training is needed to improve the training of triage. The ambulance crew (paramedic) operates under the fire department command system. However, at the time of disaster, the ambulance crew (paramedic) should also work under the medical command system.
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Cuttance, Glen, Kathryn Dansie, and Tim Rayner. "Paramedic Application of a Triage Sieve: A Paper-Based Exercise." Prehospital and Disaster Medicine 32, no. 1 (December 14, 2016): 3–13. http://dx.doi.org/10.1017/s1049023x16001163.
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AbstractIntroductionTriage is the systematic prioritization of casualties when there is an imbalance between the needs of these casualties and resource availability. The triage sieve is a recognized process for prioritizing casualties for treatment during mass-casualty incidents (MCIs). While the application of a triage sieve generally is well-accepted, the measurement of its accuracy has been somewhat limited. Obtaining reliable measures for triage sieve accuracy rates is viewed as a necessity for future development in this area.ObjectiveThe goal of this study was to investigate how theoretical knowledge acquisition and the practical application of an aide-memoir impacted triage sieve accuracy rates.MethodTwo hundred and ninety-two paramedics were allocated randomly to one of four separate sub-groups, a non-intervention control group, and three intervention groups, which involved them receiving either an educational review session and/or an aide-memoir. Participants were asked to triage sieve 20 casualties using a previously trialed questionnaire.ResultsThe study showed the non-intervention control group had a correct accuracy rate of 47%, a similar proportion of casualties found to be under-triaged (37%), but a significantly lower number of casualties were over-triaged (16%). The provision of either an educational review or aide-memoir significantly increased the correct triage sieve accuracy rate to 77% and 90%, respectively. Participants who received both the educational review and aide-memoir had an overall accuracy rate of 89%. Over-triaged rates were found not to differ significantly across any of the study groups.ConclusionThis study supports the use of an aide-memoir for maximizing MCI triage accuracy rates. A “just-in-time” educational refresher provided comparable benefits, however its practical application to the MCI setting has significant operational limitations. In addition, this study provides some guidance on triage sieve accuracy rate measures that can be applied to define acceptable performance of a triage sieve during a MCI.CuttanceG, DansieK, RaynerT. Paramedic application of a triage sieve: a paper-based exercise. Prehosp Disaster Med. 2017;32(1):3–13.
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Smith, K. E., K. Lobay, and M. Bullard. "P122: The use of decision support tools in the implementation of the Prehospital Canadian Triage Acuity Score (Pre-CTAS)." CJEM 18, S1 (May 2016): S119. http://dx.doi.org/10.1017/cem.2016.297.
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Introduction: The Prehospital Canadian Triage and Acuity Scale (Pre-CTAS) is based upon, and is consistent with, the CTAS (Canadian Triage and Acuity Scale). Paramedic-assigned Pre-CTAS scores using memory compared to Triage Nurse CTAS scores have previously demonstrated moderate inter-rater reliability. This is the first study to measure the effect of two different point-of-care decision support tools on the inter-rater reliability of paramedic assigned Pre-CTAS and Triage nurse CTAS scores. Methods: Paramedics were randomized to Pre-CTAS booklet or CTAS smartphone app during the one-year study period. Pre-CTAS scores assigned on arrival at hospital (AH) were compared with Triage Nurse CTAS scores and analyzed using Cohen’s Kappa. Paramedics were then surveyed to assess the perceived utility and satisfaction with the decision support tools. Results: For 1663 patient transports, the weighted kappa score for Paramedic AH vs. Triage Nurse CTAS was fair at 0.38 (95% CI 0.35-0.41). For patients whose initial on-scene and AH Pre-CTAS scores did not change (n= 1405, 85%), Paramedic-Triage Nurse agreement was moderate at 0.43 (95% CI 0.39-0.46). The survey revealed that tools, when employed, helped assign scores; however accessing the additional resource was cumbersome or time consuming, and scores were occasionally assigned post clinical encounter. Conclusion: Point-of-care external decision support tools did not affect Pre-CTAS and ED CTAS agreement. These tools may add complexity or be perceived to add time to documentation within the delivery of clinical care if not implemented with adequate support. Future research needs to evaluate the impact of clinical decision support embedded within an electronic patient care record consistent with many ED information systems.
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Iezzoni, Lisa I., Dhruva Kothari, Carlos A. Camargo, Amy J. Wint, W. Scott Cluett, Yorghos Tripodis, and Joseph Palmisano. "Making Triage Decisions for the Acute Community Care Program: Paramedics Caring for Urgent Health Problems in Patients’ Homes." American Journal of Medical Quality 34, no. 4 (September 19, 2018): 331–38. http://dx.doi.org/10.1177/1062860618800582.
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The Acute Community Care Program (ACCP) initiative sends specially trained paramedics to evaluate and treat patients with urgent care problems in their residences during evening hours. ACCP safety depends on making appropriate triage decisions from patients’ reports during phone calls about whether paramedics could care for patients’ urgent needs or whether they require emergency department (ED) services. Furthermore, after ACCP paramedics are on scene, patients may nonetheless need ED care if their urgent health problems are not adequately treated by the paramedic’s interventions. To train clinical staff participating in all aspects of ACCP, including these triage decisions, ACCP clinical leaders developed brief vignettes: 27 represented initial ACCP triage decisions and 10 the subsequent decision to send patients to EDs. This report describes findings from an online survey completed by 24 clinical staff involved with ACCP triage. Clinical vignettes could be useful for staff training and quality control in such paramedic initiatives.
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Burns, John. "Paramedic-led acute home visiting services in primary care." Journal of Paramedic Practice 13, no. 6 (June 2, 2021): 238–44. http://dx.doi.org/10.12968/jpar.2021.13.6.238.
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Home visiting is traditionally carried out by GPs but it is becoming increasingly difficult for GPs to do, and many doctors want it removed from their contract. This is opening up a space for the paramedic profession, with paramedics carrying out home visits and designing future primary care services. Paramedics working within primary care can possess the knowledge, leadership and complex skills needed for home visiting, and some are independent prescribers; they can lead acute home visiting services (AHVS). AHVS require effective triage and access to electronic patient records, are underpinned by robust clinical governance and engage in clinical audits. Future primary care paramedic services could include online, video and face-to-face consultations, care home ward rounds, remote triage and home visiting. However, paramedics' contribution to general practice has not been fully evaluated and it may take time for this to become a norm. Regardless, primary care paramedicine has an opportunity to be innovative, shaking off risk-averse protocols for more enlightened practices, and lead the profession.
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Lee, Christopher W. C., Shelley L. McLeod, Kristine Van Aarsen, Michelle Klingel, Jeffrey M. Franc, and Michael B. Peddle. "First Responder Accuracy Using SALT during Mass-casualty Incident Simulation." Prehospital and Disaster Medicine 31, no. 2 (February 9, 2016): 150–54. http://dx.doi.org/10.1017/s1049023x16000091.
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AbstractIntroductionDuring mass-casualty incidents (MCIs), patient volume often overwhelms available Emergency Medical Services (EMS) personnel. First responders are expected to triage, treat, and transport patients in a timely fashion. If other responders could triage accurately, prehospital EMS resources could be focused more directly on patients that require immediate medical attention and transport.HypothesisTriage accuracy, error patterns, and time to triage completion are similar between second-year primary care paramedic (PCP) and fire science (FS) students participating in a simulated MCI using the Sort, Assess, Life-saving interventions, Treatment/Transport (SALT) triage algorithm.MethodsAll students in the second-year PCP program and FS program at two separate community colleges were invited to participate in this study. Immediately following a 30-minute didactic session on SALT, participants were given a standardized briefing and asked to triage an eight-victim, mock MCI using SALT. The scenario consisted of a four-car motor vehicle collision with each victim portrayed by volunteer actors given appropriate moulage and symptom coaching for their pattern of injury. The total number and acuity of victims were unknown to participants prior to arrival to the mock scenario.ResultsThirty-eight PCP and 29 FS students completed the simulation. Overall triage accuracy was 79.9% for PCP and 72.0% for FS (∆ 7.9%; 95% CI, 1.2-14.7) students. No significant difference was found between the groups regarding types of triage errors. Over-triage, under-triage, and critical errors occurred in 10.2%, 7.6%, and 2.3% of PCP triage assignments, respectively. Fire science students had a similar pattern with 15.2% over-triaged, 8.7% under-triaged, and 4.3% critical errors. The median [IQR] time to triage completion for PCPs and FSs were 142.1 [52.6] seconds and 159.0 [40.5] seconds, respectively (P=.19; Mann-Whitney Test).ConclusionsPrimary care paramedics performed MCI triage more accurately than FS students after brief SALT training, but no difference was found regarding types of error or time to triage completion. The clinical importance of this difference in triage accuracy likely is minimal, suggesting that fire services personnel could be considered for MCI triage depending on the availability of prehospital medical resources and appropriate training.LeeCWC, McLeodSL, Van AarsenK, KlingelM, FrancJM, PeddleMB. First responder accuracy using SALT during mass-casualty incident simulation. Prehosp Disaster Med. 2016;31(2):150–154.
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Dippenaar, Enrico. "Triage system performance: consistency and accuracy in the emergency centre." Journal of Paramedic Practice 12, no. 3 (March 2, 2020): 94–99. http://dx.doi.org/10.12968/jpar.2020.12.3.94.
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Triage systems have evolved over recent times with the use of tiered acuity to achieve a balance between patient need and resource availability. Triage is a way to sort patients based on acuity, irrespective of the setting, and whether by telephone, in the prehospital environment or in hospital. The growth of the paramedic profession means that paramedics are now working in emergency centres and having to contend with the concept of triage in this setting. The nature of emergency centres and the variety of patient presentations makes it nearly impossible to have a perfect system that is both consistent and accurate. Paramedics, as decision makers, should understand the underlying concepts of what makes a triage system perform well so best practice can be adopted with specific goals in mind. There is a patient-centred focus to do the most for the most at any given time and to ensure that resources are aligned with the needs of patients. It is vital to monitor a triage system's performance so that improvements or adjustments can be made in response to patient population needs over time. This commentary focuses on the main principles of triage system performance measures and what factors should be taken into consideration during clinical practice. Highlighting the concepts of triage reliability, validity and decision-making should help paramedics to understand the importance of conscious decision-making practice.
Dissertations / Theses on the topic "Paramedic triage"
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Sprivulis, Peter Carl. "Evaluation of the prehospital utilisation of the Australasian Triage Scale." University of Western Australia. Emergency Medicine Discipline Group, 2004. http://theses.library.uwa.edu.au/adt-WU2004.0055.
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[Truncated abstract] Background : Triage systems have evolved from battlefield casualty prioritisation tools to integral components of civilian emergency care systems over the last 50 years. There is significant variation in prehospital triage practices in Australia and little research has been undertaken to validate the triage systems used. There is considerable evidence to support the use of the Australasian Triage Scale (ATS) for triage in the emergency department setting and the ATS is used ubiquitously for emergency department triage in Australasia ... Conclusions : The findings of this thesis support integrating prehospital ATS allocations with emergency department triage processes. It is concluded that Paramedics apply the ATS similarly to nurses ... Allocations to ATS 1, 2 and 3 and most ATS 4 allocations by paramedics are valid when compared to nurse ATS allocations. Australasian Triage Scale category 5 is used inappropriately by paramedics and should be used rarely, if at all, by paramedics. The reliability of paramedic and nurse ATS allocations is sufficient to warrant a trial of the omission of retriage of ambulance presentations at Perth metropolitan emergency departments. However, early nursing assessment of a small proportion of ATS 3 patients may be required to ensure timely assessment for some mistriaged bone fide ATS 2 patients. Paramedic ATS allocations appear sufficiently reliable and valid to warrant a trial of their use as part of a two-tier trauma team activation system ... The implementation of standardised training between paramedics and nurses based on current Australasian College for Emergency Medicine guidelines is recommended. The implementation of paramedic triage audit, including comparison of paramedic ATS allocations with nurse ATS allocations may improve reliability between paramedics and nurses, and particularly the reliability of ATS 4 and ATS 5 allocations. Prehospital ATS allocations may prove useful in prehospital casemix analysis, the evaluation of prehospital service delivery and for prehospital research. Research opportunities include actual trials of the integration of prehospital use of ATS with emergency department triage and trauma system activation, and the evaluation of the ATS as a prehospital casemix and performance evaluation tool. Research into alternative triage tools to the ATS for use in the prehospital environment and into the impact of standardised triage training is also suggested.
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Brückner, Matthias [Verfasser], Werner [Akademischer Betreuer] Brannath, and Martin [Akademischer Betreuer] Posch. "Non-parametric Sequential and Adaptive Designs for Survival Trials / Matthias Brückner. Gutachter: Werner Brannath ; Martin Posch. Betreuer: Werner Brannath." Bremen : Staats- und Universitätsbibliothek Bremen, 2014. http://d-nb.info/1072226316/34.
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Zheng, Wenjing. "Apprentissage ciblé et Big Data : contribution à la réconciliation de l'estimation adaptative et de l’inférence statistique." Thesis, Sorbonne Paris Cité, 2016. http://www.theses.fr/2016USPCB044/document.
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Cette thèse porte sur le développement de méthodes semi-paramétriques robustes pour l'inférence de paramètres complexes émergeant à l'interface de l'inférence causale et la biostatistique. Ses motivations sont les applications à la recherche épidémiologique et médicale à l'ère des Big Data. Nous abordons plus particulièrement deux défis statistiques pour réconcilier, dans chaque contexte, estimation adaptative et inférence statistique. Le premier défi concerne la maximisation de l'information tirée d'essais contrôlés randomisés (ECRs) grâce à la conception d'essais adaptatifs. Nous présentons un cadre théorique pour la construction et l'analyse d'ECRs groupes-séquentiels, réponses-adaptatifs et ajustés aux covariable (traduction de l'expression anglaise « group-sequential, response-adaptive, covariate-adjusted », d'où l'acronyme CARA) qui permettent le recours à des procédures adaptatives d'estimation à la fois pour la construction dynamique des schémas de randomisation et pour l'estimation du modèle de réponse conditionnelle. Ce cadre enrichit la littérature existante sur les ECRs CARA notamment parce que l'estimation des effets est garantie robuste même lorsque les modèles sur lesquels s'appuient les procédures adaptatives d'estimation sont mal spécificiés. Le second défi concerne la mise au point et l'étude asymptotique d'une procédure inférentielle semi-paramétrique avec estimation adaptative des paramètres de nuisance. A titre d'exemple, nous choisissons comme paramètre d'intérêt la différence des risques marginaux pour un traitement binaire. Nous proposons une version cross-validée du principe d'inférence par minimisation ciblée de pertes (« Cross-validated Targeted Mimum Loss Estimation » en anglais, d'où l'acronyme CV-TMLE) qui, comme son nom le suggère, marie la procédure TMLE classique et le principe de la validation croisée. L'estimateur CV-TMLE ainsi élaboré hérite de la propriété typique de double-robustesse et aussi des propriétés d'efficacité du TMLE classique. De façon remarquable, le CV-TMLE est linéairement asymptotique sous des conditions minimales, sans recourir aux conditions de type DonskerThis dissertation focuses on developing robust semiparametric methods for complex parameters that emerge at the interface of causal inference and biostatistics, with applications to epidemiological and medical research in the era of Big Data. Specifically, we address two statistical challenges that arise in bridging the disconnect between data-adaptive estimation and statistical inference. The first challenge arises in maximizing information learned from Randomized Control Trials (RCT) through the use of adaptive trial designs. We present a framework to construct and analyze group sequential covariate-adjusted response-adaptive (CARA) RCTs that admits the use of data-adaptive approaches in constructing the randomization schemes and in estimating the conditional response model. This framework adds to the existing literature on CARA RCTs by allowing flexible options in both their design and analysis and by providing robust effect estimates even under model mis-specifications. The second challenge arises from obtaining a Central Limit Theorem when data-adaptive estimation is used to estimate the nuisance parameters. We consider as target parameter of interest the marginal risk difference of the outcome under a binary treatment, and propose a Cross-validated Targeted Minimum Loss Estimator (TMLE), which augments the classical TMLE with a sample-splitting procedure. The proposed Cross-Validated TMLE (CV-TMLE) inherits the double robustness properties and efficiency properties of the classical TMLE , and achieves asymptotic linearity at minimal conditions by avoiding the Donsker class condition
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Mohebbi, Hamid Reza. "Parametric Interaction in Josephson Junction Circuits and Transmission Lines." Thesis, 2011. http://hdl.handle.net/10012/5973.
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This research investigates the realization of parametric amplification in superconducting circuits and structures where nonlinearity is provided by Josephson junction (JJ) elements. We aim to develop a systematic analysis over JJ-based devices toward design of novel traveling-wave Josephson parametric amplifiers (TW-JPA). Chapters of this thesis fall into three categories: lumped JPA, superconducting periodic structures and discrete Josephson transmission lines (DJTL).
The unbiased Josephson junction (JJ) is a nonlinear element suitable for parametric amplification through a four-photon process. Two circuit topologies are introduced to capture the unique property of the JJ in order to efficiently mix signal, pump and idler signals for the purpose of signal amplification. Closed-form expressions are derived for gain characteristics, bandwidth determination, noise properties and impedance for this kind of parametric power amplifier. The concept of negative resistance in the gain formulation is observed. A design process is also introduced to find the regimes of operation for gain achievement. Two regimes of operation, oscillation and amplification, are highlighted and distinguished in the result section. Optimization of the circuits to enhance the bandwidth is also carried out.
Moving toward TW-JPA, the second part is devoted to modelling the linear wave propagation in a periodic superconducting structure. We derive closed-form equations for dispersion and s-parameters of infinite and finite periodic structures, respectively. Band gap formation is highlighted and its potential applications in the design of passive filters and resonators are discussed. The superconducting structures are fabricated using YBCO and measured, illustrating a good correlation with the numerical results.
A novel superconducting Transmission Line (TL), which is periodically loaded by Josephson junctions (JJ) and assisted by open stubs, is proposed as a platform to realize a traveling-wave parametric device. Using the TL model, this structure is modeled by a system of nonlinear partial differential equations (PDE) with a driving source and mixed-boundary conditions at the input and output terminals, respectively. This model successfully emulates parametric and nonlinear microwave propagation when long-wave approximation is applicable. The influence of dispersion to sustain three non-degenerate phased-locked waves through the TL is highlighted.
A rigorous and robust Finite Difference Time Domain (FDTD) solver based on the explicit Lax-Wendroff and implicit Crank-Nicolson schemes has been developed to investigate the device responses under various excitations. Linearization of the wave equation, under small-amplitude assumption, dispersion and impedance analysis is performed to explore more aspects of the device for the purpose of efficient design of a traveling-wave parametric amplifier.
Knowing all microwave characteristics and identifying different regimes of operation, which include impedance properties, cut-off propagation, dispersive behaviour and shock-wave formation, we exploit perturbation theory accompanied by the method of multiple scale to derive the three nonlinear coupled amplitude equations to describe the parametric interaction. A graphical technique is suggested to find three waves on the dispersion diagram satisfying the phase-matching conditions. Both cases of perfect phase-matching and slight mismatching are addressed in this work. The incorporation of two numerical techniques, spectral method in space and multistep Adams-Bashforth in time domain, is employed to monitor the unilateral gain, superior stability and bandwidth of this structure. Two types of functionality, mixing and amplification, with their requirements are described. These properties make this structure desirable for applications ranging from superconducting optoelectronics to dispersive readout of superconducting qubits where high sensitivity and ultra-low noise operation is required.
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Τσαρούχας, Νικόλαος. "Electrophysiologιcal study of brain hypoxia." Thesis, 2009. http://nemertes.lis.upatras.gr/jspui/handle/10889/4120.
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The current research work aims at the development of Biomedical Neuroengineering tools (Biotechnologies) for the in-depth functional study, rapid diagnosis, continuous monitoring and well-timed management of acute and chronic brain disorders, of individuals that are subjected to or suffer from any kind of systemic hypoxaemia or more localized brain hypoxia; as well as the functional assessment and continuous control of adaptability during the training of “altinauts” and generally of individuals that practice activities and function within environments of increased visual-cognitive-motor response demands (a type of brain “stress test”). For this purpose, we subject the entire visuocognitive system, from the elementary sensory to the most complex cognitive level, to an experimental test of categorical discrimination of complex visuocognitive stimuli, following ultra-rapid visual stimulation that leads to a motor response upon categorization of targets (images of animals elicit productive responses) and to its suppression upon categorization of nontargets (images of nonanimals elicit inhibitory responses). The oscillatory electro-physiological responses that are concurrently recorded at the occipital-temporal-parietal brain areas are analyzed in the time-domain (<20Hz) and in the joint time-frequency domain broadband (1-60Hz) with the Continuous Wavelet Transform that optimizes the multiresolution analysis of the high frequency (≥20Hz) γ-band oscillatory activity. This visuocognitive categorization test takes place in normoxaemic as well as hypoxaemic conditions (monitored reduction in the blood oxygen saturation from ≥97% to around 80% under conditions of hypobaric hypoxia within a hypobaric chamber), in order to assess electrophysiological markers that can detect and capture in the most sensitive and dynamic way even so transient, short-living and rather mild changes in brain function. The statistical parametric analysis of the time-frequency maps and the generalized, statistically safer, method of analysis of variance have established as the most sensitive and reliable the following markers: the major deflections of the evoked potentials, the phase-coherence factor of the oscillations across single-trials and the elicited energy of the evoked/phase-locked and the induced/total oscillatory activity. These electrophysiological markers in conjunction with psychometric tests allow for the investigation of the stages/levels of the decline as well as of the compensatory reserves in the visual-perceptive and cognitive-mental brain functions in order to determine the functional sensitivity thresholds of different brain functions to hypoxia. They open up the way for the functional characterization, the diagnosis and monitoring of brain insults or other acute and chronic pathological brain conditions.Η παρούσα ερευνητική εργασία στοχεύει στην ανάπτυξη εργαλείων Βιοϊατρικής Νευρομηχανικής (Βιοτεχνολογίες) για την σε βάθος λειτουργική μελέτη, ταχεία διάγνωση, συνεχή παρακολούθηση και έγκαιρη αντιμετώπιση οξέων και χρόνιων εγκεφαλικών διαταραχών, ατόμων που υπόκεινται σε ή πάσχουν από οιαδήποτε μορφή συστηματικής υποξαιμίας ή πιο εντοπισμένης εγκεφαλικής υποξίας, καθώς και για την λειτουργική αξιολόγηση και το συνεχή έλεγχο της προσαρμοστικότητας κατά την εξάσκηση των «υψιβατών», και γενικότερα ατόμων που ασκούν δραστηριότητες και λειτουργούν μέσα σε περιβάλλοντα αυξημένων οπτικο-γνωστικο-κινητικών απαιτήσεων (ένα είδος «στρες τεστ» για τον εγκέφαλο). Για το σκοπό αυτό υποβάλλουμε ολόκληρο το οπτικογνωστικό σύστημα, από το στοιχειώδες αισθητηριακό έως το πιο πολύπλοκο νοητικό επίπεδο, σε μια πειραματική δοκιμασία κατηγορικής διάκρισης σύνθετων οπτικογνωστικών ερεθισμάτων, μετά από υπερταχεία οπτική διέγερση που οδηγεί στην έκλυση κινητικής απάντησης κατά την κατηγοριοποίηση στόχων (εικόνες «ζώων» εκλύουν παραγωγικές αποκρίσεις) και στην καταστολή της κατά την κατηγοριοποίηση μη-στόχων (εικόνες «μη-ζώων» εκλύουν ανασταλτικές αποκρίσεις). Οι ταλαντωτικές ηλεκτροφυσιολογικές αποκρίσεις που συγχρόνως καταγράφονται στις ινιακές-κροταφικές-βρεγματικές περιοχές του εγκεφάλου αναλύονται στο πεδίο του χρόνου (<20Hz) και στο συζευγμένο χρονοφασματικό πεδίο ευρυζωνικά (1-60Hz) με το συνεχή μετασχηματισμό του κυματίου που βελτιστοποιεί την πολυφασματική ανάλυση της υψίσυχνης (≥20Hz) γ-ταλαντωτικής δραστηριότητας. Αυτή η δοκιμασία οπτικογνωστικής κατηγοριοποίησης λαμβάνει χώρα τόσο σε νορμοξαιμικές όσο και υποξαιμικές συνθήκες (ελεγχόμενη μείωση στον κορεσμό του αίματος σε οξυγόνο από ≥97% γύρω στο 80% για 15 λεπτά κάτω από συνθήκες υποβαρικής υποξίας μέσα σε υποβαρικό θάλαμο), προκειμένου να ελέγξουμε ηλεκτροφυσιολογικούς δείκτες που μπορούν να ανιχνεύσουν και να συλλάβουν με τον πιο ευαίσθητο και δυναμικό τρόπο ακόμη και τόσο βραχύβιες και σχετικά ήπιες μεταβολές της εγκεφαλικής λειτουργίας. Η στατιστική παραμετρική ανάλυση των χρονοφασματικών χαρτών και η γενικευμένη, στατιστικά πιο ασφαλής, μέθοδος ανάλυσης των διακυμάνσεων ανέδειξαν ως πλέον ευαίσθητους και αξιόπιστους τους ακόλουθους δείκτες: τις κύριες αιχμές των προκλητών δυναμικών, τον παράγοντα φασικής συνάφειας των ταλαντώσεων μεταξύ των μοναδιαίων καταγραφών και την εκλυόμενη ενέργεια των προκλητών/φασικά-κλειδωμένων και επαγόμενων/ολικών ταλαντώσεων. Οι ηλεκτροφυσιολογικοί αυτοί δείκτες σε συνδυασμό με ψυχομετρικές δοκιμασίες επιτρέπουν τη διερεύνηση των σταδίων/επιπέδων κάμψης καθώς και των αποθεμάτων αντιρρόπησης των οπτικο-αντιληπτικών και γνωστικών-νοητικών λειτουργιών του εγκεφάλου για τον καθορισμό των λειτουργικών ουδών ευαισθησίας διάφορων εγκεφαλικών λειτουργιών στην υποξία. Ανοίγουν μάλιστα το δρόμο. για το λειτουργικό χαρακτηρισμό, τη διάγνωση και την παρακολούθηση εγκεφαλικών προσβολών ή άλλων οξέων και χρόνιων παθολογικών καταστάσεων του εγκεφάλου.
Books on the topic "Paramedic triage"
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Zeitlin, Vladimir. Resonant Wave Interactions and Resonant Excitation of Wave-guide Modes. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198804338.003.0012.
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The idea of resonant nonlinear interactions of waves, and of resonant wave triads, is first explained using the example of Rossby waves, and then used to highlight a mechanism of excitation of wave-guide modes, by impinging free waves at the oceanic shelf, and at the equator. Physics and mathematics of the mechanism, which is related to the phenomena of parametric resonance and wave modulation, are explained in detail in both cases. The resulting modulation equations, of Ginzburg–Landau or nonlinear Schrodinger type, are obtained by multi-scale asymptotic expansions and elimination of resonances, after the explanation of this technique. The chapter thus makes a link between geophysical fluid dynamics and other branches of nonlinear physics. A variety of nonlinear phenomena including coherent structure formation is displayed. The resonant excitation of wave-guide modes provides an efficient mechanism of energy transfer to the wave guides from the large to the small.
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Sheehan, Michelle. Parameterizing Ergativity: An Inherent Case Approach. Edited by Jessica Coon, Diane Massam, and Lisa Demena Travis. Oxford University Press, 2017. http://dx.doi.org/10.1093/oxfordhb/9780198739371.013.3.
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This chapter posits a parameter hierarchy to capture micro-parametric variation in ergative (or rather non-accusative) alignment, building on the proposal that ergative is an inherent case, assigned by little vs. Initial parameters determine the distribution of this inherent case across instances of little v in a given language, sensitive to various thematic features, and subsequent dependent parameters determine further properties of ergative-assigning vs such as the presence of a movement trigger and the suppression of structural Case features. This gives rise to a number of distinct ergative types depending on the distribution of ergative case, the presence/absence of syntactic ergativity, and the source of absolutive case in transitive contexts. The resultant parameter hierarchy serves to restrict the space of variation, modeling a number of proposed implicational universals in this domain, and provides a potential solution to the subset problem in acquisition by encoding a notion of relative markedness.
Book chapters on the topic "Paramedic triage"
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Wu, Jianrong. "Survival Trial Design under the Parametric Model." In Statistical Methods for Survival Trial Design, 49–60. Boca Raton : Taylor & Francis, 2018.: Chapman and Hall/CRC, 2018. http://dx.doi.org/10.1201/9780429470172-4.
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Wu, Jianrong. "Phase II Trial Design under Parametric Model." In Single-Arm Phase II Survival Trial Design, 9–24. Boca Raton: Chapman and Hall/CRC, 2021. http://dx.doi.org/10.1201/9781003129059-2.
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de Armas, Jesica, Laura Calvet, Guillermo Franco, Madeleine Lopeman, and Angel A. Juan. "Minimizing Trigger Error in Parametric Earthquake Catastrophe Bonds via Statistical Approaches." In Lecture Notes in Business Information Processing, 167–75. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-40506-3_17.
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Bispo, Regina, Joana Bernardino, Tiago A. Marques, and Dinis Pestana. "Discrimination Between Parametric Survival Models for Removal Times of Bird Carcasses in Scavenger Removal Trials at Wind Turbines Sites." In Advances in Regression, Survival Analysis, Extreme Values, Markov Processes and Other Statistical Applications, 65–72. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-34904-1_6.
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"General Parametric SP Estimation." In Success Probability Estimation with Applications to Clinical Trials, 107–14. Hoboken, NJ, USA: John Wiley & Sons, Inc., 2013. http://dx.doi.org/10.1002/9781118548516.ch5.
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Belbis, Bertrand, Lionel Garnier, and Sebti Foufou. "Construction of 3D Triangles on Dupin Cyclides." In Intelligent Computer Vision and Image Processing, 113–27. IGI Global, 2013. http://dx.doi.org/10.4018/978-1-4666-3906-5.ch009.
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This paper considers the conversion of the parametric Bézier surfaces, classically used in CAD-CAM, into patched of a class of non-spherical degree 4 algebraic surfaces called Dupin cyclides, and the definition of 3D triangle with circular edges on Dupin cyclides. Dupin cyclides was discovered by the French mathematician Pierre-Charles Dupin at the beginning of the 19th century. A Dupin cyclide has one parametric equation, two implicit equations, and a set of circular lines of curvature. The authors use the properties of these surfaces to prove that three families of circles (meridian arcs, parallel arcs, and Villarceau circles) can be computed on every Dupin cyclide. A geometric algorithm to compute these circles so that they define the edges of a 3D triangle on the Dupin cyclide is presented. Examples of conversions and 3D triangles are also presented to illustrate the proposed algorithms.
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"Overview of Time-to-Event Parametric Methods." In Design and Analysis of Clinical Trials with Time-to-Event Endpoints, 89–110. Chapman and Hall/CRC, 2009. http://dx.doi.org/10.1201/9781420066401-8.
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Peace, Karl, and Kao-Tai Tsai. "Overview of Time-to-Event Parametric Methods." In Design and Analysis of Clinical Trials with Time-to-Event Endpoints. Chapman and Hall/CRC, 2009. http://dx.doi.org/10.1201/9781420066401.ch3.
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"Fanny Solomian Getto i gwiazdy." In Polin: Studies in Polish Jewry Volume 11, edited by Antony Polonsky, 375–78. Liverpool University Press, 1998. http://dx.doi.org/10.3828/liverpool/9781874774051.003.0040.
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This chapter begins by studying paramedic Fanny Sołomian's book The Ghetto and the Stars which was published in 1995. Her recollections belong among the most important books about the Shoah. She shows how women were treated as sexual property, individual and communal, which added another duty for the battalion ‘doctor’, namely, innumerable abortions. She also describes the courts martial and executions without trial. The chapter then looks at The Memoir of Maria Koper. The manuscript, found and edited by Henryk Grynberg, was written by a young Polish Jew who had hidden in the countryside near Rawa Mazowiecka for two years. The chapter also considers Nathan Gross's series of short essays, Poets and the Shoah, which provides a reminder of the poets and poems that testify to the Shoah.
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DuLong, Jessica. "“Gray ghosts”." In Saved at the Seawall, 97–113. Cornell University Press, 2021. http://dx.doi.org/10.7591/cornell/9781501759123.003.0007.
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This chapter focuses on events after the collapse of the North Tower. Minutes after the pulverized remnants of 1 World Trade Center settled out of the air along Manhattan's western shore, mariners started evacuating people. Many people caught up in the unfolding catastrophe also had the duty of protecting children. Parents, teachers, daycare workers, and sitters were all forced to navigate their way through the danger while simultaneously soothing their frightened charges. Although they could not stop the planes from crashing or buildings from falling, people from all quarters rose up and stepped forward to provide whatever assistance they could. All along New Jersey's North River waterfront, emergency medical technicians (EMTs) and paramedics, administrators and doctors, firefighters and police were working to establish and supply triage centers. Instrumental to their efforts were ordinary citizens helping every way they could. Personnel from nearby hospitals, medical centers, and emergency management offices worked with fire department and hazmat crews to establish makeshift facilities to decontaminate, assess, treat, and direct evacuees to different transit options. Their efforts were supported by the contributions made by employees of local businesses, among others.
Conference papers on the topic "Paramedic triage"
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Acharya, Subrata, and Omotayo Victor Imani. "A novel resource management approach for paramedic triage systems." In 2017 IEEE International Conference on Bioinformatics and Biomedicine (BIBM). IEEE, 2017. http://dx.doi.org/10.1109/bibm.2017.8217763.
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Nikodem, Jan, Maciej Nikodem, Paweł Gawłowski, and Ryszard Klempous. "Training system for first response medical emergency groups to guide triage procedures." In the 8th International Workshop on Innovative Simulation for Healthcare. CAL-TEK srl, 2019. http://dx.doi.org/10.46354/i3m.2019.iwish.005.
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"The work presents training system which provides a structured, simple and practical approach to triage training, for first response paramedic and emergency medical services personnel, as implementation of the triaging procedures in mass casualty accidents. The proposed training system allows to train the procedures at all three levels of hierarchical chain of strategic, tactical and executive command management. It provides reliable connectivity at the scene based on Bluetooth Low Energy standard or Internet connection with the use of mobile 4G LTE communication networks infrastructure. In training system we use simulators of vital human signs based on mobile devices, which generate so-called the victim's life cycle chart, consisting of the heartbeats and respiratory rates, systolic and diastolic blood pressure, and capillary refill time, used as the basis for triage categorization. Presented training system increases trainees competence level in executive as well as control and governance skills."
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Han, Dong Hoon, Sun K. Yoo, Ki Won Kang, Do Yoon Kim, Yong Kwi Lee, Dong Keun Kim, and Jeong Chae Kim. "Computerized triage system for paramedics in the pre-hospital emergency medical service phase." In 6th International Special Topic Conference on Information Technology Applications in Biomedicine, 2007. IEEE, 2007. http://dx.doi.org/10.1109/itab.2007.4407415.
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Diederichs, C., J. Tignon, G. Dasbach, C. Ciuti, Ph Roussignol, C. Delalande, A. Lemaitre, and J. Bloch. "Optical parametric oscillation in a vertical triple microcavity." In 2006 Conference on Lasers and Electro-Optics and 2006 Quantum Electronics and Laser Science Conference. IEEE, 2006. http://dx.doi.org/10.1109/cleo.2006.4627793.
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Kute, Shweta B., and Omkar N. Buwa. "Triple Droop Control Parametric Variation in Autonomous Microgrid." In 2018 International Conference on Computing, Power and Communication Technologies (GUCON). IEEE, 2018. http://dx.doi.org/10.1109/gucon.2018.8675047.
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Diederichs, C., J. Tignon, G. Dasbach, C. Ciuti, Ph Roussignol, C. Delalande, A. Lemaître, and J. Bloch. "Optical Parametric Oscillation In A Vertical Triple Microcavity." In PHYSICS OF SEMICONDUCTORS: 28th International Conference on the Physics of Semiconductors - ICPS 2006. AIP, 2007. http://dx.doi.org/10.1063/1.2730289.
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Fengxia, Zhang. "Reverse Triple I Methods Based on Parametric-Implication Operators." In 2010 International Conference on Digital Manufacturing and Automation (ICDMA). IEEE, 2010. http://dx.doi.org/10.1109/icdma.2010.125.
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Cassemiro, Katiúscia N., Alessandro S. Villar, Marcelo Martinelli, and Paulo Nussenzveig. "Triple Quantum Correlations from an Above-Threshold Optical Parametric Oscillator." In International Conference on Quantum Information. Washington, D.C.: OSA, 2008. http://dx.doi.org/10.1364/icqi.2008.jmb43.
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Adeel, Muhammad Safian, and Umar Rashid. "Optimization of Stochastic-Resonance based Schmitt Trigger through parametric analysis." In 2009 Third International Conference on Electrical Engineering (ICEE). IEEE, 2009. http://dx.doi.org/10.1109/icee.2009.5173183.
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Kazma, Coskun, Vecdi Emre Levent, and Nizamettin Aydin. "Parametric Trigger Signal Generation with Microcontroller and FPGA Based Architectures." In 2019 4th International Conference on Computer Science and Engineering (UBMK). IEEE, 2019. http://dx.doi.org/10.1109/ubmk.2019.8907075.
Full textReports on the topic "Paramedic triage"
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Sterbentz, J. W. Radionuclide mass inventory, activity, decay heat, and dose rate parametric data for TRIGA spent nuclear fuels. Office of Scientific and Technical Information (OSTI), March 1997. http://dx.doi.org/10.2172/481850.
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