Life-saving interventions

Scott, R. (1994). The History of the International Energy Agency 1974-1994, Vol. 1 Origins and Structure, Vol. 2 Major Policies and Actions. Paris, France OECDAEA. Tengs, R. O., et al. (1995). Five-Hundred Life-Saving Interventions and Their Cost-Ellectiveness. Risk Analysis 15(3) 369—389. 

T. O. Tengs et al., Five Hundred Life-saving Interventions and Their Cost-effectiveness, Risk Anal. Prod. SafeFood 15 (1995) 569-89. 

On arrival of the patient, determine whether the patient requires any immediate life-saving interventions. If these are required, stabilize the patient before or during decontamination. 

Tengs TO, Adams ME, Pliskin JS, et al. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal 1995 15 369-390. 

For the foreseeable future, it would seem sensible to consider the provision of both the best possible pretreatment options, especially when these are less reliant upon therapeutic intervention, and the best possible therapy options which are less reliant upon pretreatment. Such pretreatment and therapy regimens should be consistent with each other, as well as with subsequent medical management which is required to optimize the benefit of these life-saving interventions. 

Tengs, T. O., M. E. Adams, J. S. Pliskin, D. G. Saftan, J. E. Siegel, M. Weinstein, and J. D. Graham. 1995. Five hundred life-saving interventions and their cost-effectiveness. Risk Analysis... 

Individual casualty decontamination must be carried out fully as soon as possible to enable initial resuscitation and in order to prevent further absorption of the chemical agent. Immediate decontamination may be life-saving in the case of chemical agents and should be concurrent with life-saving interventions (LSIs) see Box 5.7. 

Early decontainination may be the only treatment required following chemical agent e>q>osure. Only life-saving interventions (LSIs) should be imdertaken in die hot zone in order to reduce further exposure of the casualty to the chemical agent involved and minimise contamination of emergency personnel. These interventions are summarised in Box 5.7. Casualties should be extracted to specific treatment areas within the cold zone as rapidly as possible according to triage priorities. 

Members of the fire service have specific PPE suits for managing chemical incidents as well as for enabling the extraction of casualties and providing immediate life-saving interventions at the scene. Level A protection is required when active release is potentially still occurring, or when the release has ceased but there is no information about... 

This incident serves to highlight the importance of basic airway management and early life-saving interventions following exposure to a suspected chemic agent. In this case many of the casualties were apparently laid on their backs or slumped in positions that resulted in the loss of airway protection, asphyxia and death. 

Life-saving intervention for severe cyanide toxicity. 

These patients should take first priority for treatment. Decontamination should not delay initial treatment. Removal of clothing as part of the resuscitation will reduce exposure. Initial management should be restricted to life-saving interventions such as provision of a patent airway, ventilation, needle thoracocentesis and control of significant haemorrhage. 

One potential difficulty of cost-benefit analysis is that it requires researchers to express an intervention s costs and outcomes in the same units. Thus, monetary values must be associated with years of life lost and morbidity due to disease and with years of life gained and morbidity avoided due to intervention. Expressing costs in this way is obviously difficult in health care analyses. Outcomes (treatment benefits) may be difficult to measure in units of currency. Translating disease and treatment outcomes into monetary measures may be more difficult than translating them into clinical outcome measures, such as years of life saved or years of life saved adjusted for quality. 

Human capital. This evaluates an intervention s effect on a patient s lifetime earnings. For example, a life saved at age 55 by an intervention = 10 years of expected earnings gained. Similarly, a life lost through an intervention or inaction can be evaluated the same way. 

Several disease states can result from abnormal blood clots. For example, strokes were mentioned previously. However, the most common and deadliest thrombotic disease is myocardial infarction (MI). Atherosclerosis has long been associated with reduced cardiac function and elevated mortality due to rupture of atherosclerotic plaques. The rupture of an atherosclerotic plaque usually results not only in blockage due to the plaque itself but also in the immediate formation of an occlusive blood clot, which results in an MI. Immediately after the initiation of an MI, a zone of necrosis begins to develop around the area as ischemia proceeds. It is during this early phase of ischemia (several hours) that therapeutic intervention not only can be life-saving but also can minimize the amount of necrotic heart tissue formed. 

The clinical benefits of lipid-lowering therapy for primary and secondary intervention are now well established based on the results of the AECAPS/TexCAPS, 4S, and other studies showing a reduction in CHD morbidity and mortality. The balance of benefits and costs has been examined in a few studies. The cost per year of life saved has been estimated to range from less than 10,000 to over 1 million dollars depending on the presence or absence of CHD, age of the patient, baseline total or LDL cholesterol level and reduction in cholesterol. 

Cost-effectiveness ratio—The outcome of cost-effective analysis. The numerator of the ratio summarizes the costs and financial savings associated with the therapy, including the costs of the therapy itself, side effects, medical costs and savings from avoided illness and disability. The denominator of the cost-effectiveness ratio reflects the health effect of the intervention. The year of life saved is probably the most commonly used measure of the health effect. 

Why did the IGD not treat this tachycardia The tachycardia rate (120 b.p.m.) was below the IGD rate cutoff (subsequently determined to be 160 b.p.m. in the VT zone). This is not an uncommon reason why an IGD does not elicit treatment, and is not a malfunction of the device. This circumstance points out the importance of not delaying treatment (i.e. per advanced cardiac life-saving protocol) should an imstable patient not receive IGD device intervention. 

Displacement, in whichever form it takes, can entail upheaval on many levels—societal, familial, and institutional—with specific consequences for those in the early years of life. For example, formal education for some children may be curtailed either due to lack of provision in the new location or through denial of access. Conversely, displacement can sometimes open up the possibility of schooling that had been unavailable previously. Beyond assistance in the so-called four primary life-saving areas -water and sanitation, nutrition, healthcare, and shelter—education has become an increasingly prominent element of humanitarian intervention. As a result children housed in displacement camps or other settings supported by aid agencies may be able to enter a classroom—however radimentaiy—for the first time. 

This leads to what is called the prevention paradox—it is a common irony that many people must take precautions to help the few. ° Few of us have experienced severe load on our seat belts (no immediate personal gain), but because most of us wear belts all of the time, the minority who are involved in crashes are protected. In preventive medicine this is known as herd immunity. In the UK, Rose et al. estimated that for every 400 drivers belted, one life is saved. Forty years ago, 600 children had to be immunised against diphtheria for every life saved. If the risk reduction offered to an individual is small (as it is in both these examples), then the cost to the individual of that intervention must be correspondingly small. ... 

How many years of life that is lost due to premature death and morbidity. Normally DALY = YOLL + YLD Years that would be saved following an intervention A generic term that includes the two most popular measures, the QALY and the DALY [46]... 

When determining which method of economic analysis she should use, she eliminated cost-minimization analysis because the treatment alternatives (service versus no service) will not result in equivalent outcomes. A cost-effectiveness analysis would not be appropriate because she is only interested in one particular program. A cost-utility analysis is also not appropriate because quality of life, while included in the project, is not the focus of her project. A cost-benefit analysis could be appropriate. A cost-benefit analysis requires that both the interventions and outcomes be valued in monetary units. She can determine the direct medical and/or nonmedical costs for each patient from data captured by her HMO. The HMO is very interested in costs, both those to implement the service and those it may save as a result. Cynthia decides that the most understandable analysis to present to the HMO is a cost-benefit analysis. 

Red Critical Unstable, with acute problems for immediate intervention is likely to save life or limb. Transport immediately. 

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