VISITAS RECIENTES

AUTISMO TEA PDF

AUTISMO TEA PDF
TRASTORNO ESPECTRO AUTISMO y URGENCIAS PDF

We Support The Free Share of the Medical Information

Enlaces PDF por Temas

Nota Importante

Aunque pueda contener afirmaciones, datos o apuntes procedentes de instituciones o profesionales sanitarios, la información contenida en el blog EMS Solutions International está editada y elaborada por profesionales de la salud. Recomendamos al lector que cualquier duda relacionada con la salud sea consultada con un profesional del ámbito sanitario. by Dr. Ramon REYES, MD

Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.

Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.
Fuente Ministerio de Interior de España

sábado, 27 de abril de 2019

Medical tourism: Are the savings worth the risks? Christopher Elliott, Special to USA TODAY

Medical tourism: Are the savings worth the risks? Christopher Elliott, Special to USA TODAY 


More people than ever are flying after surgery, thanks to the increased popularity of medical tourism. MedAire shares some tips on flying after surgery with USA Today.
hashtagmedicaltourism hashtagflying hashtagairlines 

Published 12:00 p.m. ET April 26, 2019


Bill and Eleanor Seavey run a small inn near Hearst Castle in California, but when they go on vacation, they head south. In a few weeks, they're planning to visit Los Algodones, Mexico, just across the border from Yuma, Arizona, for some sun – and dental work.

"Many of their dentists are trained in the U.S.," says Bill Seavey. "We can get work done for about one-third of the U.S. prices. Our local dentist actually recommended we go there."

Los Algodones, also known as "Molar City," is a small town in northern Baja California that caters to American and Canadian tourists trying to escape the high cost of medical care. As an added benefit, Yuma also holds the record for being the sunniest place in America.

Combining a vacation with a medical procedure is becoming more popular. A new study by Wise Guy Reports, a market research company, predicts the worldwide medical tourism market will grow from $56 billion in 2018 to $136 billion in 2023, a growth rate of 19% a year.

Here's what you need to know about medical tourism: There's a time to follow the Seaveys south and a time to stay closer to home. That's because you don't want to cut corners on some procedures.

The risks are real
There are real risks to combining a vacation and a medical visit. Consider the recent investigation of a Miami plastic surgery clinic by USA TODAY and the Naples Daily News. It found a clinic run like a factory assembly line, where poorly trained doctors line up patients and operate on as many as eight a day. In the past six years, the clinic and a nearby facility overseen by the same doctor have lost eight patients.


More: This business helped transform Miami into a national plastic surgery destination. Eight women died.

That's why it's so important to carefully screen any doctor or facility you're considering. "I would urge anyone thinking about medical tourism for surgery to be very careful," says Joshua Zuckerman, a New York plastic surgeon. "I would suggest patients seek countries with high-quality medical systems, training and technology, but I have even taken care of patients with serious complications from surgery undertaken in European countries. Cosmetic surgery is still significant surgery and requires specialized training to be performed safely."

It's not enough to find a doctor with positive reviews on social media. Look for board certifications that show your medical practitioner is a real expert. Also, check the state's medical board website to find out if your physician is in good standing (here's California's site, for example).

You don't want to cut corners on some medical procedures.
You don't want to cut corners on some medical procedures. (Photo: Getty Images)

When to go
Some destinations are worth considering for medical tourism, according to the editors at International Living magazine, a publication for American expatriates. Take Costa Rica, for example, a country that abolished its army and dedicated part of the money to healthcare. Now nearly 15% of international tourism comes to visit Costa Rica for medical services performed by highly trained, bilingual doctors.

"Most of the top plastic surgeons are located in the medical centers in or near the capital of San Jose, where medical tourists save 45% to 65% on procedures compared to back home," says Kathleen Evans, International Living's Coastal Costa Rica correspondent.

You can even save money on procedures such as LASIK surgery. In Costa Rica, she says prices range from $1,600 to $2,000 – for both eyes. "The licensed eye surgeons who perform LASIK in Costa Rica receive the same level of ophthalmology schooling as in North America and are using the same state-of-of-the-art, high-tech equipment that you would find back home,” she adds.

The conventional wisdom seems to be that if your procedure is relatively simple and the doctor checks out, you might want to consider becoming a medical tourist.

And when to stay
Sometimes you'll want to stay in the country. That's what I discovered when I sought treatment for my vision problems recently. I had a complicated prescription and suffered from splitting headaches.

I consulted with some of the best eye surgeons in the western United States. Their diagnosis wasn't hopeful. Since I'd already had LASIK in both eyes back in 2008, they were reluctant to operate again. All of them recommended just living with my current vision – except one.

That doctor happened to be based in Southern California. So in January, I rented an apartment in Studio City and took an Uber to his clinic, where he performed a procedure called photorefractive keratectomy (PRK) to fix my vision. Needless to say, this is not how you save money as a medical tourist.

But you can't argue with the results. I'm looking at my computer screen without glasses.

And that's the thing about medical tourism. Sometimes, you'll want to go to Molar City to have your teeth cleaned. And sometimes, you'll want to fly to Los Angeles to get your eyes fixed. It's not about your money – it's about your health.

Tips on flying after surgery
MedAire, a company that provides medical support to airlines, says more people than ever are flying after surgery, thanks to the increased popularity of medical tourism. Some of them are long-haul flights. For example, many people are traveling to India for highly complex medical procedures such as open-heart surgeries and pacemaker or cardioverter defibrillator implants. Amman, Jordan, is becoming a center of referral for laparoscopic bariatric surgeries and procedures. Once your doctor clears you for travel, here are a few tips on flying after surgery.

• Don't forget your paperwork. Contact the airline before the flight and request a medical information form. The MEDIF is often available on the airline’s website. Airline policies on fitness to fly vary, so research yours. Have a note from your doctor clearing you for travel by air.

• Mind the trapped gas. Surgery leaves some residual air inside the body. Any trapped gas in the body will expand at in-flight altitude, which can cause mild to severe discomfort and can even be life-threatening.

• Remember, there's less oxygen. Medical conditions sensitive to hypoxia, such as some pulmonary and cardiovascular diseases, could deteriorate in flight because of reduced oxygen pressure. That's also true for anemias, which also can occur following a surgery or medical procedure.

Christopher Elliott is a consumer advocate. Contact him at chris@elliott.org or visit elliott.org.

jueves, 18 de abril de 2019

AMR/FEMA Federal EMS Deployment Handbook Revised 2016 pdf FREE

AMR/FEMA Federal EMS Deployment Handbook Revised 2016 pdf FREE 
DOWNLOAD 

Faster and higher level #combat care to upgrade the golden hour to platinum 15 minutes by breakingdefense.com


faster and higher level #combat care to upgrade the golden hour to platinum 15 minutes

The Army’s Plan To Save The Wounded In Future War
Even with faster medevac aircraft, uparmored ambulances, and more medical personnel at the front, will casualties get to life-saving care within the "golden hour"?

CAPITOL HILL: The high-tech chaos of future battlefields will make it much harder to save wounded soldiers, the Army Chief of Staff warned Congress this week. Evacuating them will require not only new high-speed medevac aircraft and tank-like armored ambulances, Gen. Mark Milley said, but also a radical reorganization of the Army’s medical corps to bring care as close as possible to the front line.

We’ve covered the equipment part of this equation — more on that below — but the personnel side is equally important and quite possibly more complicated. “People can tell you how incredibly confused I was at the hearing [on] medical services last week,” Rep. Pete Visclosky, the chairman of the House defense appropriations subcommittee, told Army leaders at a hearing on the Army budget this week.

It turns out it’s confusing because two things are happening at once, Gen. Milley and Army Secretary Mark Esper explained:

There’s a military-wide reorganization — mandated by Congress — that’s consolidating Army, Air Force, and Navy/Marine medical services into a single Defense Health Agency system to provide more cost- efficient healthcare for troops and their families back in the US.
But there’s also an Army-specific reorganization intended to free up doctors, nurses, and other medical specialists from hospital duties in the US so they can train and deploy with frontline combat units.
“The Army several months ago started looking at what we need for the fielded force in terms of medics and docs and surgeons, PAs, you name it,” Sec. Esper said. (This is probably part of a much wider study of how to reorganize the Army for future multi-domain operations). “There’s a lot of change happening there,” the secretary said. “We didn’t think we had the right numbers and the right specialties for the fielded force, the units that go to war.”

“Those are two different capabilities,” Gen. Milley added. “One is [to] stay home in the medical treatment facilities, the hospitals, take care of soldiers and families. The other is a combat medical capability, distributed within tactical units: They’re going to be on the forward edge of the battlefield.”

Bell photo
Bell V-280 Valor tiltrotor in level flight with rotors facing forward. The V-280 is widely considered the leading candidate for the Future Long-Range Assault Aircraft (FLRAA)

The Air Support Problem

The problem, Milley explained, is that ground forces have gotten used to air support essentially on call 24-7. That includes rapid medical evacuation that could pick up casualties from the battlefield and quickly bring them to centralized medical facilities with lots of staff and equipment.

BAE photo
A medical variant of the BAE Armored Multi-Purpose Vehicle. AMPVs will serve as both armored ambulances and mobile operating rooms.

Against adversaries better-armed than the Taliban, that might not work. Russia and China have long-range precision missiles that can devastate big bases, forcing support services — including medical care — to disperse, hide, and keep relocating to avoid destruction. There are abundant anti-aircraft missiles to shoot down medevac aircraft, anti-tank missiles and land mines to destroy ground ambulances.

“Currently, in the combat we’re involved in now, we have dominance over the air and we pretty much can guarantee ourselves ground evacuation and/or air evacuation within this so-called golden hour,” Milley said. “If you are wounded and we get you to doctor in 60 minutes, your probability of survival is in excess of 90 percent.”

“In future combat, that may or may not be true,” Milley said. “Hence Future Vertical Lift [aircraft]…. and we’re uparmoring ground ambulances: That’s the AMPV program.” These are both ways to get casualties out of the combat zone faster without getting shot down or blown up on the way:

The Future Vertical Lift program aims to replace current helicopters with revolutionary new aircraft that are much faster, longer-ranged, and better able to evade Russian or Chinese air defenses. Its FLRAA variant in particular will replace the UH-60 Black Hawk for air assault, transport, and casualty evacuation.
The tank-like Armored Multi-Purpose Vehicle is basically an upgraded M2 Bradley troop carrier without the gun turret, which will replace the Vietnam-vintage M113 in a variety of supporting roles. While the Army has cut funding somewhat, the AMPV program will still deliver five variants, two of them medical vehicles: an ambulance and a mobile surgery.
But transporting casualties from the fight to the doctors is only half of the medevac equation. The other half is getting the doctors closer to the fight.

“Equally important,” Milley told the subcommittee, “we want to get the forward surgical teams… as far forward as possible.”

Air Force photo
Health care benefits for troops, military retirees, and their families — or, as in this picture, their pets — are an ever-growing cost to the Defense Department. Congress has directed the Pentagon to streamline the system, and the Army wants to put more medical personnel in combat units.

Mobilizing The Medics

“Today,” Milley explained to me after the hearing, “the medics, the physicians’ assistants, and the doctors, they work on a day to day basis in the MTF [on-base Medical Treatment Facilities], you know, to keep up their skills and stuff.” The base hospitals then loan medical staff to combat units before they deploy, a practice known as the Professional Filler System (PROFIS). The new system will reverse that, Miley said: “On a day to day basis, they’ll be in the tactical units, and then to keep their skills they’re go up to the hospital” as needed.

“It’s called ‘reverse PROFIS,'” Esper added. “The docs and PAs [will be] assigned to the operational units, and they get their repetitions by practicing in [the] MTF.”

Army photo
Army Secretary Mark Esper (left) and Chief of Staff Gen. Mark Milley (right) testify to Congress.

This may seem a subtle difference — Army medical personnel will still split their time between base hospitals and combat units — but it’s significant. Instead of working for base hospitals and only filling in at combat units when needed, medical personnel will belong to those combat units full-time, responsible first and foremost to operational commanders and regularly available to train for war.

Medical personnel are just one of the key “enablers,” from river-crossing companies to supply trucks, that the Army thinks it’ll need more of, in more units, over a wider area of battlefield than in the past. In future multi-domain operations, Milley told the committee, “it’s highly likely that ground forces will be cut off [and] isolated,” unable to get support from centralized logistical or medical bases in the rear.

Even with more medics at the front, however, more soldiers will be wounded in a future war with Russia or China than in Iraq or Afghanistan, and it will be much harder to get them to safety.

So, Rep. Mario Diaz-Balart asked in the hearing, can we count on evacuating soldiers in the golden hour in future conflicts?

“Probably not,” Milley said bluntly. “Evacuating soldiers in high intensity combat against a potential adversary like the Russians or Chinese or even North Korea — first of all the scale and scope of casualties will be significant, really significant, and the ability to evacuate those casualties within sixty minutes….”

The general looked grim. “We’ll try,” he said, “but I’m not guaranteeing.” 

miércoles, 17 de abril de 2019

WHO guideline recommendations on digital interventions for health system strengthening free PDF

WHO guideline recommendations on digital interventions for health system strengthening free PDF 

Publication details

Number of pages124
Publication date2019
LanguagesEnglish
ISBN978-92-4-155050-5

DOWNLOAD

The key aim of this guideline is to present recommendations based on a critical evaluation of the evidence on emerging digital health interventions that are contributing to health system improvements, based on an assessment of the benefits, harms, acceptability, feasibility, resource use and equity considerations. For the purposes of this version of the guideline, the recommendations examine the extent to which digital health interventions available via mobile devices are able to address health system challenges at different layers of coverage along the pathway to universal health coverage (UHC). By reviewing the evidence of different digital interventions, as well as assessing the risks against comparative options, this guideline aims to equip health policy-makers and other stakeholders with recommendations and implementation considerations for making informed investments into digital health interventions.
This guideline urges readers to recognize that digital health interventions are not a substitute for functioning health systems, and that there are significant limitations to what digital health is able to address.

FEMA Incident Action Planning Guide free PDF

FEMA Incident Action Planning Guide free PDF 
DOWNLOAD


Dr. Carol Cunningham

 Dr. Carol Cunningham was appointed State Medical Director for the Ohio Department of Public Safety, Division of EMS in July 2004 https://www.linkedin.com/in/carol-cunningham-m-d-090643b/
and is a board certified emergency physician at Cleveland Clinic Akron General Medical Center and an associate professor of emergency medicine at Northeast Ohio Medical University. She is the co-principal investigator for the National Association of State EMS Officials (NASEMSO) National Model EMS Clinical Guidelines project and serves on the Ohio Medical Coordination Plan Committee and Pediatric Disaster Coalition. She served as the EMS Medical Director representative on the National EMS Advisory Council (NEMSAC) for 5 years following her membership on the NEMSAC's Education and Workforce Committee.

Dr. Cunningham received her medical degree and completed an emergency medicine residency at the University of Cincinnati. She has seven years of experience as a flight physician, eleven years of experience as a tactical EMS medical director, and is a fellow in the American Academy of Emergency Medicine and the Academy of Emergency Medical Services.

Dr. Cunningham completed the National Preparedness Leadership Initiative and the Women and Power program at the Harvard Kennedy School of Executive Education and the Homeland Security Executive Leadership Program at the Naval Postgraduate School & the U.S. Department of Homeland Security Center for Homeland Defense and Security. She is the 2012 recipient of the American Academy of Emergency Medicine's James Keaney Leadership Award.

In addition to her continued duties as a senior oral board examiner, Dr. Cunningham completed a 3-year term on the American Board of Emergency Medicine (ABEM) EMS Examination Committee in 2014 after 4 years of service as an item writer on the historic ABEM EMS Examination Task Force. She is a member of the editorial board of the Journal of EMS (JEMS), a contributing editor for the EMS Insider, and has served on several committees and panels at the National Academy of Medicine (formerly the Institute of Medicine of the National Academies), the Department of Health and Human Services' Agency for Healthcare Research and Quality, and the EMS Program Steering Committee of the National Fire Academy Board of Visitors.

Dr. Cunningham was appointed to the Executive Steering Committee of the Department of Homeland Security (DHS) Science & Technology Directorate's First Responder Resource Group and the OnStar® Public Safety Advisory Council and serves on the EMS Support Team of the Department of Homeland Security/Federal Emergency Management Agency (DHS/FEMA) National Integration Center Strategic Resource Group, the Board of Directors of the Committee for Tactical Emergency Casualty Care, and the Board of Trustees of the Rock and Roll Hall of Fame and Museum.