Elders report using EMS because of immobility, perceived medical needs, or requests by others. Similarly, the presence of acute illness symptoms, older age, and poor social and physical function, rather than health beliefs, predict EMS use among elders. These factors must be considered when managing the demand for EMS services.

ABSTRACT.Objective. To determine rates of immunization coverage among children 3 to 72 months of age in a large public housing development, to develop a community-based outreach program to increase coverage, and to evaluate the effect of the program.Design. A door-to-door canvass of the development by specially trained emergency medical technicians to enroll families, to determine immunization status from written records, and to follow-up to encourage immunizations and well-child care. The program was evaluated, comparing rates of immunization by age with an expectation based on the immunization histories before enrollment.Setting. A Chicago public housing development, October 1993 through December 1996.Outcome Variables. Antigen-specific and seriesspecific coverage based on written records.Results. Of the caregivers, 92% were able to identify a primary care provider. At the time of enrollment, 37% of 1075 children were up-to-date, but that proportion varied by age with 27% of children 19 to 35 months of age being up-to-date. The program increased rates of immunization compared with the expectation from the preenrollment rates. At their final assessment, 50% of the children were up-to-date. For individual vaccines, there was a positive program effect. For example, before enrollment, 22% of children 15 months of age had received measles, mumps, and rubella vaccine. However, 39% of children who were enrolled in the program before they were 12 months of age had received their first immunizations by 15 months of age.Conclusions. Children in the housing development had very low rates of immunization before enrollment. An in-person intervention was effective in reaching families and determining immunization status. In the 3-year enrollment and observation period, rates of immunization increased. Pediatrics 1999;104(6). URL: http://www. pediatrics.org/cgi/content/full/104/6/e69; immunization rates, public housing, outreach intervention.ABBREVIATIONS. DTP, diphtheria, tetanus, and pertussis vaccine; PCV, polio-containing vaccine; MMR, measles, mumps, and rubella vaccine; 4:3:1, 4 doses of DTP, 3 doses of PCV, and 1 dose of MMR; RTH, Robert Taylor Housing Development; PIP, Pediatric Immunization Program; AAP, American Academy of Pediatrics; ACIP, Advisory Committee for Immunization Practices; FACT, First Aid Care Team; Hib, Haemophilus influenzae type b; DTP1, first DTP dose.T he National Immunization Survey has found that nationally over three quarters of children 19 to 35 months of age are up-to-date for 4 doses of diphtheria, tetanus, and pertussis (DTP) vaccine, 3 doses of polio-containing vaccine (PCV), and 1 dose of measles, mumps, and rubella vaccine (MMR) (4:3:1).1 However, aggregate rates such as these mask considerable heterogeneity. In particular, there are some communities with concentrations of underimmunized children, communities that are therefore at increased risk for outbreaks of vaccinepreventable illnesses. Such communities have been termed pockets of need. The National Immunization Survey focuses on o...

Aeromedical transport is challenging not only because of limitations of equipment, unfamiliar surroundings, and challenging environmental conditions, but also due to difficulty in developing methodologies for research and data collection. To our knowledge, neurological changes at the oxygen tensions of a pressurized cabin have not been systematically studied. Here we report a case of intracranial hemorrhage during aeromedical transport and review the body’s cardiovascular and respiratory adaptation to decreased ambient oxygen tension. Previous experience with high altitude cerebral edema serves as guidance for mitigating the effects of vasogenic edema in patients at risk of neurological events who travel by air. Review of this case and relevant altitude-related physiological changes may be grounds for more conservative recommendations on aeromedical transport after an acute neurological event.

The clinical provision of medical care by emergency medical services (EMS) providers in the out-of-hospital environment and the operation of EMS systems to provide that care are unique in the medical arena. There is a substantive difference in the experience of individuals who provide medical care in the out-of-hospital setting and the experience of those who provide similar care in the hospital or other clinical settings. Furthermore, physicians who provide medical direction for EMS personnel have a clinical and oversight relationship with EMS personnel. This relationship uniquely qualifies EMS medical directors to provide expert opinions related to care provided by nonphysician EMS personnel. Physicians without specific EMS oversight experience are not uniformly qualified to provide expert opinion regarding the provision of EMS. This resource document reviews the current issues in expert witness testimony in cases involving EMS as these issues relate to the unique qualifications of the expert witness, the standard of care, and the ethical expectations.

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