ENVS 1800 Lecture 18: ENVS 1800 Lecture 18 Notes

Process Mapping: Hospital Response Chain (A Question for the course of Introduction to Information System)

When someone calls 9‐1‐1, there are a series of actions and responses that get triggered, collectively known as the pre‐hospital response chain. This chain is described below.

The Call for Help

When an individual experiences a medical, they typically call 9‐1‐1 for help. It is important that the patient stays on the phone to provide the necessary information about the emergency situation. The patient relays important information to both 9‐1‐1 and the health communication centre.

9‐1‐1 Emergency Service

The 9‐1‐1 dispatcher's responsibility is to take the 9‐1‐1 call for help and determine if the situation requires police, firefighters or ambulance services. In some emergency situations, more than one service can be dispatched2. The 9‐1‐1 dispatcher also needs to identify the patient’s location so that the appropriate type of ambulance can be dispatched (land, air or water)3. To make these assessments, there are a series of questions that are asked. The patient plays an important role in answering these questions. The 9‐1‐1 dispatcher collects all of the information needed to make these assessments and enters it into the 9‐1‐1 system. Once all the pertinent information has been collected, the information and call are then immediately transferred to the health communication centre. Otherwise, the dispatcher continues to work with the patient on understanding the situation.

Health Communication Centre

The health communication centre’s (HCC) responsibility is to review the information sent by the 9‐1‐1 dispatcher and speak to the patient to assess the nature of the situation and, most importantly, prioritize the response of the ambulance services. Additional information from the patient is typically required to do so. Prioritization is key in situations where there are multiple emergency situations. If the HCC dispatcher determines that the situation is urgent, the medical and emergency information, as captured in the HCC system, is transferred to the ambulance service, and the required number of ambulances dispatched to the scene. In situations that are not considered urgent, alternative methods of transportation are then arranged.

Ambulance Service

An ambulance service has a series of responsibilities when they are dispatched. The ambulance service is alerted to the emergency via their on‐board system. Using the location information provided, the ambulance service is then responsible for ensuring the appropriate route is taken using the navigational component of their on‐board system. Depending on the weather conditions, location, and time of day, the best route may change. Once the ambulance service arrives at the scene, they are responsible for assessing the situation and determining whether the patient needs to be stabilized at the scene first. Depending on location, assessment, and priority, the ambulance service first determines which hospital is best suited for the patient. If the patient requires stabilization, the ambulance service will work with that hospital to stabilize the patient. Specifically, they speak with the doctors at the hospital using their hands‐free mobile phones to relay the status of the patient and to receive stabilization instructions. The patient is not transported until they are in a stable condition. Once the patient is stabilized, the ambulance service continues to work with the doctors to determine whether the patient’s situation is still critical and requires hospital care. If that is no longer the case, the ambulance service will return to their dispatch station and complete a vehicle and supply report and a scene report.

On route to the hospital, the ambulance service will relay all critical information to the destination hospital using their on‐board system as well as calling them to provide an updated patient status and estimated time of arrival. This enables the hospital to complete all the necessary preparations. When the ambulance service arrives at the hospital with the patient, the patient’s status is verbally transferred to the receiving physician at that hospital. At this point, the physician and team of health professionals assess and care for the patient.

After the patient transfer is complete, there are a series of reports that need to be written and submitted by the ambulance services: 1, Patient Care and Transfer Report; 2, Scene Report (if needed) 3, Patient Invoice 4, Vehicle and Supply Report

The patient care and transfer report is used by the hospital to fill in the patient chart and can be used to determine on‐going treatment. The ambulance service completes this report before leaving the hospital using their on‐board system and electronically submits it to the hospital. When this report is created, a scene report is not needed. A scene report is only created when the patient is not transferred to a local hospital, but assessment and care are provided at the scene. The scene report is for internal tracking purposes.

A patient invoice will be sent to the patient through the mail by the ambulance service: the typical cost for an ambulance service is $45 but if the receiving physician deemed the trip to be unnecessary, the bill will increase to $240. This information is provided by the physician in his verbal report to the ambulance service before they leave the hospital.

Finally, a vehicle and supply report will be created, for internal purposes, to track vehicle mileage, gas along with wear and tear. If there are any concerns with the vehicle or if maintenance is required the vehicle is sent to the fleet garage along with a paper report documenting the concerns. The vehicle is returned to the ambulance service when the repairs or maintenance are completed.

An inventory of the supplies on board the ambulance is taken and a list of the items needed to be replenished is electronically sent to the medical supplies warehouse via EDI for restocking. It is essential that those items are shipped quickly so that the ambulance is prepared for the next emergency. The ambulance always has reserves on board, but keeping those reserves replenished ensures they will not run out of supplies in an emergency situation.

Requirement: Draw the Process Map for the Hospital Chain Scenario

(Note: 1, Assume that the individual can call for 9‐1‐1 on their own. 2 In assignment we only have to focus on the land ambulance service; sub‐processes for the other services do not need to be elaborated on.)

The human body is truly remarkable and is designed tofunction effectively. Organs are important structures composed ofdifferent tissues that facilitate specific functions within thebody. Organs function as part of an integrated group of structuresknown as organ systems. These organ systems form the organizationalunits that are responsible for crucial processes necessary forsustaining life.

Examples of organ systems include but are not limitedto the cardiovascular system, the digestive system, themusculoskeletal system, the nervous system, the excretory system,the endocrine system and the respiratory system. Even organ systemsdo not function alone. These systems work together, interactingwith other organs in a functional network that keeps the body inbalance. (Look up the term homeostasis in your text.) When homeostasis orthe normal functioning of organ systems is disrupted, disease maydevelop causing injury to the body, or even death. In thisassignment, you will explore organ systems, as well as associateddiseases or malfunctions.

Assignment details:

Take a look at the following casestudies that detail an outcome associated with a disease/organmalfunction. Select onestudy to investigate further for yourassignment.

Critically evaluate the information provided andcorrelate it with the organ systems that are affected in thescenario. Use the information that you have gathered to answer theassignment questions that follow the case study. For assistancewith your assignment, please use your text, the AIU Library, Webresources, and course materials.

Case Study 1:

Atherosclerosis isnarrowing of arteries caused by the accumulation of fatty depositson the arterial walls.

On June 22, 2002 the St. Louis Cardinals werepreparing for their upcoming baseball game against the Chicagocubs. Concern arose when their prized pitcher, 33-year old DarrylKile did not show up for practice. Soon after, he was found stillin his hotel room where he had suddenly died in his sleep (New YorkTimes, 2002). It was discovered that the cause of death was relatedto three of his coronary arteries being 80-90% blocked as a resultof atherosclerosis (New York Times, 2002), which ultimately causedhim to undergo a heart attack.

Answer the following assignmentquestions:

1. Why would atherosclerosis result in a heart attack?Provide a brief explanation based on how the heart functions.
2. How are arteries different from veins andcapillaries? Describe the functions of both arteries andveins.
3. Vertebrates and some invertebrates have a closedcirculatory system. Explain the advantage of having a closedcirculatory system over an open circulatory system?
4. Briefly explain how the lymphatic system isassociated with the circulatory system?
5. Describe one disease that affects the lymphaticvessels similarly to the way that atherosclerosis affects thearteries?

Case Study 2:

Cigarette smoking remainsthe leading preventable cause of death in the United States,causing an estimated 438,000 deaths - or about 1 out of every 5 -each year (National Cancer Institute, 2008).

Mr. Amos is now 57 years old and has been smoking forthe past 30 years of his life. A recent doctor's visit reveals thatMr. Amos has stage 3 lung cancer, characterized by his symptoms ofnagging chest pain, fatigue, coughing up blood, substantial weightloss, and increased carbon dioxide levels in his blood. The doctorinformed Mr. Amos that had he quit his smoking habit several yearsago, he would have reduced his risk for developing lung cancerlater in life. Mr. Amos immediately begins treatment for the lungcancer that has metastasized to his lymph nodes.

Answer the following assignmentquestions:

1. What main components in cigarettes affect therespiratory system? Explain their effects on specific organs, cellsand/or processes in the respiratory system.
2. There are alternate mechanisms of transportingcarbon dioxide (CO2) and oxygen (O2 ) in the blood. Explain howsmoking might lead to increased levels of carbon dioxide in theblood.
3. Can smoking affect other organ systems of the body?Give specific examples and briefly explain your answer.
4. How can you correlate cellular respiration with therespiratory system?
5. Does smokeless tobacco present a reduced risk forlung cancer and other smoking associated diseases? Provide evidencefor your answer.

Case Study 3:

Gigantism is abnormallylarge growth during childhood caused by excess growth hormonesecreted by the anterior pituitary gland.

Robert Wadlow, born on February 22, 1918, weighed anormal eight pounds, six ounces. However, by the time Robertreached the age of six months old, he weighed 30 pounds (Hamilton,1993). Within only a year, his weight rose to 62 pounds, more thandouble the normal weight of a baby at 18 months. Aside from hisweight, Robert continued to grow at an astounding rate, reachingsix feet, two inches and 195 pounds by the time he was eight yearsold. Robert's unique size was attributed to an over activepituitary gland, which produced much higher than normal levels ofgrowth hormone. At the time of his death in July 1940 at the age of22, Robert had reached a height of 8 feet 11.1 inches and weighed485 pounds (Hamilton, 1993).

Answer the following assignmentquestions:

1. How does growth hormone regulate various bodyfunctions in adults, and what could cause the excess secretion ofgrowth hormone?
2. Discuss the relationship between growth hormone andinsulin, and are there complications associated with theirinteraction?
3. Why is gigantism usually more difficult to treatthan dwarfism?
4. Give examples of two other hormones secreted by thepituitary, and briefly describe how they specifically affect otherorgan systems of the body?
5. Some athletes have resorted to the illegal use ofanabolic steroids to increase strength and muscle size. How areanabolic steroids different from growth hormone? Briefly explainyour answer.

References

I need help on this microbiology question:

Contrary to our favorite science fiction books and movies, the chances of us finding another planet with a civilization comparable to, or even more advanced than our own, seems highly unlikely. But, through your work as a microbiologist at NASA, you have been able to help change our views as to what forms of life we should be looking for on planets in our solar system and around neighboring stars. Instead of radio signals or errant transmissions, we have begun looking for planets that have environments similar to those capable of sustaining life as we know it here on Earth. To determine what we could find out there, you have begun studying different unique and atypical environments found here on Earth. Although the harsh conditions of hot springs or undersea sulfur vents seem incompatible with most forms of life, organisms known collectively as "extremophiles" have still managed to survive and adapt to these extreme conditions. You believe extremophiles may help you gain insight into the potential metabolic requirements, processes, and challenges of extraterrestrial life. Thus far in your search, you have identified some prokaryotic cells that have evolved to survive in the extreme conditions of sulfur vents on the sea floor. These vents are found at great depths, where the crushing pressure and lack of light and oxygen are prohibitive to many forms of life. Bacteria that are not considered extremophiles reside in most ecological niches on this planet. There are some common criteria for the environment that would sustain these bacteria. Availability of water, pH that lies between 5 and 9, temperatures that will remain steady and below boiling; these are some of the characteristics that bacteria will require in their environment if they are to succeed. But in the environment of the ocean floor vents, not only is the pH of the water very low, but also the water temperature is unusually high due to the geologic activity that fuels the vents. Organisms that are adapted to such harsh conditions have necessarily evolved enzymes able to function beyond average optima, as well as a chemosynthetic metabolism capable of using vent organic and inorganic compounds as energy sources.

Part A - Comparable Earth Environments to Be Found on Another Planet

You identify the prokaryotic cells you've found as a species of bacteria. These bacteria appear to be living off of nutrients and sulfur compounds released from the vents on the sea floor. Over time, the bacteria must have evolved extreme metabolic and enzymatic capabilities to allow them to tolerate and even benefit from the extreme depths, the lack of oxygen, the low pH of the surrounding waters, high temperatures due to volcanic releases, and the unique nutrient source of the vents.

Choose the characteristics and their impact on enzyme activity that are not correct from the following statements. (more than one may be chosen)