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Talk:Emergency medical services

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Rural EMS
Having had a look at this content, it doesn't really fit into the Emergency medical services main page. That's not to say that there isn't all sorts of good information...my feeling was that it would do better as its' own page, with plenty of room for expansion. Rather than just deleting somebody's hard work, I've cut and pasted it here, so that when someone is ready to take a shot at doing a separate page, it's available:

Rural EMS
The face of rural/frontier EMS has changed dramatically since the 1966 National Academy of Sciences, National Research Council (NAS-NRC) white paper “Accidental Death and Disability: the Neglected Disease of Modern Society” marked the conception of modern EMS. Ambulance service of that era was more about a fast ride than medical care. It was provided as a low-investment by-product service of funeral homes and others whose primary business already had the requisite type of vehicle. The NAS-NRC white paper revealed the ill-equipped, ill-trained nature of these services, as well as the potential to do more harm than good. Subsequent reforms led to the birth of modern EMS with the Emergency Medical Services Systems Act of 1973. As standards for training, equipment and care changed, so did the providers of rural/frontier EMS. Dedicated ambulance vehicles staffed by trained EMT's operated by independent volunteer organizations, volunteer fire departments, local hospitals, and others replaced hearses.

In the past three decades, the EMS field, with its capabilities and role as a unique discipline at the crossroads of medicine, public health and public safety, has matured dramatically. At a rural car crash, the gold standard medical response has gone from hearse to helicopter. The pressure to provide advanced life support (ALS), created at first by enthusiastic EMTs within EMS agencies themselves, has become compounded by media-generated public expectation. The drive to provide ALS has had an effect similar to that experienced by funeral home ambulance operators pressed to provide safe, basic care in the early 1970s. More workplace issues arose. The 1950s brought much needed emphasis on the physical and mental health of EMS providers. EMS agencies dependent on volunteers for staffing and fund-raising for revenue, have found advancement difficult. Indeed, it is often a challenge to continue to assure the timely response of a basic life support ambulance in these settings. In the current era of preparing public safety for effective response to manage terrorist and other events, the reality of rural/frontier EMS is that the infrastructure upon which to build such a response is itself in jeopardy. The 1996 NHTSA “EMS Agenda for the Future,”41 the visionary guide upon which this document is based, states that “EMS of the future will be community-based health management which is fully integrated with the overall health care system.” A theme running through the Rural/Frontier EMS Agenda for the Future is that such EMS integration is not only a reasonable approach to making community health care more seamless and to meeting community health care needs that might not otherwise be met, but that providing a variety of EMS-based community health services may be crucial to the survival and advancement of many rural/frontier EMS agencies.

Another related theme is that EMS should not only weave itself into the local health care system but into the fabric of the community itself. Communities can objectively assess and publicly discuss the level and type of EMS care available, consider other options and accompanying costs, and then select a model to subsidize. Where this happens through a well-orchestrated and timely process of informed self-determination, community EMS can be preserved and advanced levels of care can be attained.

The National Rural Health Association National Rural and Frontier Emergency Medical Services Agenda for the Future document suggests other means of maintaining an effective EMS presence as well such as alternative methods of delivering advanced life support back-up, and the formation of regional cooperatives for medical oversight, quality improvement, data collection and processing. Emrgmgmtca (talk) 15:13, 15 September 2008 (UTC)

References and External Links
I have reviewed and either validated or invalidated all of the references and external links in the article. Unfortunately, being relatively new to Wikipedia, I am unsure how to edit a reference list, as has been used here. If someone could help out with this, the following was the result for the References section:

Ref 1. Delete...no longer valid. Ref 4. Delete...no longer valid. Hijacks to another website. Ref 10. Delete...no longer valid. Ref 11. Delete...no longer valid. Ref 13. Delete...no longer valid. Ref 14. Delete...no longer valid. Ref 20. Delete...no longer valid. Ref 24. Delete...link to ISBN number, not reference source. Ref 27. ???...Reference is valid and would be acceptable academically, but link doesn't work. Ref 32. Delete...no longer valid. Ref 35. Delete...no longer valid. Ref 52. Delete...no longer valid.

The External Links (See Also) have all been validated. Thanks for your help with this. Emrgmgmtca (talk) 14:16, 12 September 2008 (UTC)

Ref. 30 invalid as well. JGard4159 (talk) 03:28, 2 August 2020 (UTC)

EMS Specialties in this article
I would strongly suggest that all of the content of this article be as generic as possible, without the loads of regional variations that are currently being presented as if they were universal. As a result, I am proposing that all of the content on the various subspecialties (none of which are universal) be given their own separate articles, and linked to the main, generic article. These would include all content related to Wilderness 'medics' (and I'm using that term interchangeably for paramedics, EMTs and other types of technicians in other jurisdictions), Fire-medics, Flight medics, tactical medics, critical care medics, paramedic practitioners, and the lot. The content is interesting and should be available, but it is by no means universal, and it creates erroneous impressions, particularly for Wiki users who are not actually involved in the field. This would also elminate about eight of the items currently on the 'to do' list for this article, and move it a lot closer to completion. I would welcome your comments on this proposal, and also some help in implementing it, if you agree. Emrgmgmtca (talk) 12:49, 12 September 2008 (UTC)

I
I moved EMS from Emergency medical service to Emergency Medical Service because in the US, at least, it is called the Emergency Medical Service, with all three words starting with consonants capitalized. --Tomtom 15:12, 19 Apr 2005 (UTC)
 * This is incorrect: Emergency Medical ServiceS is the standard terminology worldwide.--Napthene 19:09, 22 July 2005 (UTC)

I added Registered Nurse (RN) to the levels of care listing. -geomedic

Requested move
Emergency Medical Services is the standard terminology, in worldwide use.--Napthene 19:09, 22 July 2005 (UTC)

It was suggested that this article should be renamed Emergency Medical Services. The vote is shown below:
 * Oppose. The naming conventions specify that article titles should be singular unless the plural is always used.  Google shows that the plural is more common (by a factor of 5), but the singular version still gets 230,000 hits .  Therefore I would argue for sticking with convention since both plural and singular are widely used.  Dragons flight 20:42, July 22, 2005 (UTC)
 * Oppose. I agree singular usage is prevalent enough to keep it singular. Niteowlneils 07:29, 23 July 2005 (UTC)
 * Support. The singular version doesn't feel correct. – AxSkov ( T ) 13:22, 23 July 2005 (UTC)
 * Support The plural is clearly used more. EdwinHJ | Talk 00:52, 26 July 2005 (UTC)
 * Support As a paramedic, I can say with authority that Emergency Medical Services, plural, is the correct form of the phrase, and is always used in that form by EMS professionals. —Preceding unsigned comment added by Seaturtle001 (talk • contribs) 10:33, 15 August 2008 (UTC)

This article has been renamed after the result of a move request. violet/riga (t) 21:33, 29 July 2005 (UTC)

Discussion
That said, I would support a move to emergency medical service--most of the hits in caps appear to be titles of articles/webpages or proper nouns (EG "Some County Emergency Medical Service"), while in-text usage is more likely all lowercase.[http://www.mishawakacity.com/ems.asp "Mishawaka’s emergency medical service needs continue to grow."] Niteowlneils 07:29, 23 July 2005 (UTC)

 * I really don't see why this article should use the Specifficaly US terminology. It talks about other countries at well. If there is something special about the EMS of the USA, start another, specific article, just like for SAMU, for instance. Rama 13:25, 23 July 2005 (UTC)

Personally I would agree with the lowercase version, but I've moved it to Emergency Medical Services based on the voting results. Please consider discussing this further. violet/riga (t) 21:33, 29 July 2005 (UTC)

It should be Emergency Medical Service - all capitals - because you are spelling out an acronym. Also, emergency medical care is something EMS does, but it is also something that other facilities and agencies provide. They are not the same thing. —Preceding unsigned comment added by 69.119.73.206 (talk) 01:56, 27 November 2007 (UTC)
 * Yes this page should be all capitals it spelling a acronym and based on the other articles ATLS, ACLS, and PALS to name a few this page should be Emergency Medical Services Medicellis (talk) 16:39, 22 July 2008 (UTC)
 * I believe this discussion was originally to rename "emergency medical service" to "emergency medical services". As far as capitalization, it should be lowercase.  Basically all acronyms are written in caps, but that does not mean the individual words should be in all caps.  I raised this issue recently at Talk:Emergency medical technician.  According to the WP:MOS, article titles should be in sentence case.  When writing out mid sentence, you would use lowercase, not uppercase.  This article is for "emergency medical services" - not "EMS" spelled out.  PALS and ATLS should be capitalized, since they are copyrighted programs.  However, ACLS and CPR should not be capitalized, since they are generic terms (like EMS/EMT).  --Scott Alter 21:27, 22 July 2008 (UTC)

Play and run
It seems to me that play and run is no different from scoop and run. Although it is not explicitely mentioned, if a patient needs to be stabilized before moving, they usually are unless it is known they can be stabilized en route, or an ER/medic can be reached within a short period of time. This is particularly true of codes. Of course, perhaps there is a slight distinction between these two care strategies, but I don't think it is portrayed very strongly.Shaggorama 07:46, 5 January 2006 (UTC)

The terminology I am familiar with is "load and go" or "stay and play". Load and go is official terminology in PHTLS (Pre-Hospital Trauma Life Support) and BTLS (Basic Trauma Life Support) which dictates certain critera that a patient would meet resulting in an immediate transport of the patient without further on-scene stabilization. Stay and play is lingo showing the opposite of load and go showing the patient requires further stabilization on-scene. One other linguistic variation of this include "swoop and scoop".

The Wikipedia article Golden hour (medicine) details the differences quite well. Firerescuelieut 17:09, 18 May 2006 (UTC)

EMS Specialties
I think that we should include certain select subspecialties in this article. ie EMT-T (tactical medics), Fire-Medics, etc. At least the tactical medics for sure, since they are a unique and interesting branch of the EMS services.

 * the only thing about this is that while there are subspecialty certifications such as Wilderness EMT/P, Flight Paramedic-Certified, and EMT-Tactical, they are not recognized as a licensure level. They should have their own section in the article, seperate of levels of provider because of this. Someone may be a Flight Paramedic, but they are still required to act in accordance with their state's definition of a Paramedic - I.E. a PAramedic cannot just off of classroom perform a surgical airway in Tennessee, but can with special licensure and training every six months. Fire-Medic is NOT an additional certification, but rather a job description. The training for Firefighter only intersects with EMS in that NFPA requires that Firefighter 1s have AT LEAST Basic First Aid and CPR/AED Training, some states make them achieve First Responder. A Fire-Medic is a Paramedic or Firefighter that has been crosstrained in both EMS and Fire. Our job is to give a basic, World-Wide overview of EMS in this article. Maybe this would be better in the Emergency Medical Technician Article. 75.64.179.85 (talk) 04:44, 21 May 2008 (UTC)chancegemtiv

 * I agree, the whole point of this article is a generic, worldwide view. That's the reason why the EMS by country pages have been established, to provide local specifics independent of the generic article.  All of the groups that you have referred to are of potential interest, and each deserves its own specific page, if you have the ambition to create them. One word of caution though; be careful about what you refer to each as...try to keep it to a generic description of the role, rather than jargon.  In a great many places, particularly worldwide, while the roles you are referring to may exist in some form, they are often not referred to by the titles that you are using.  In EMS, we tend to love our jargon and acronyms, and far too often, we develop an assumption that just because we do things a certain way at a local level, or call things by a certain title, that the rest of the world is exactly the same, and guess what?  It JUST ISN'T TRUE!!!  I work in an EMS system in a major metropolitan area in Canada, and we certainly have highly skilled and trained tactical medics (indeed, we had the first in our country), but we have NEVER used the term EMT-T!  In fact, most of the paramedics assigned to our Tactical Unit would probably object to being referred to as EMTs, period.  Emrgmgmtca (talk) 10:30, 12 September 2008 (UTC)

EMS by country
In looking over this and other EMS related articles (consider ambulance, for example) I'm seeing a lot of information that is country-specific. I also note that some articles are becoming lengthy, in part due to the inclusion of country-specific information, but fail to adequately cover common aspects of their subjects. What do people think about culling the country-specific information from the EMS, EMT, ambulance &c articles and placing this info in country-specific emergency_medicine/ EMS/ title to-be-determined articles? --Badger151 17:01, 1 December 2006 (UTC)
 * No one else seems to have any opinion on this one way or another, so, seeing as a month and a half has gone by without comment, I have moved large blocks of US-focussed info to Emergency Medical Services in the United States. As time permits, I hope to move more info over, and produce a less US-centric article here. --Badger151 02:47, 26 January 2007 (UTC)
 * Just come across this. Even now it is far too US-centric. If all such material is moved there will be nothing left! Clearly a major re-write is needed. I don't know about others, but I find this sort of thing most annoying. Much of this article has been written as though there is no world at all outside of the USA. Might it just have been better to rename this entire article and use it as a source for a new, non-country-specific article? Arcturus 20:39, 7 February 2007 (UTC)
 * Yes, the US is the country that many love to hate. So much so that it's become fashionable to bash the US on so many talk pages. But it's getting to the point that it reminds me of the reductio ad hitlerum. This is the English Wikipedia, and more primary English speakers live in the US than all other countries combined, so of course there are many English speaking editors from the US. It would be helpful if you would either edit the parts you have a problem with, or offer some constructive criticism. The demonizing isn't helpful (on this or any other talk page). MoodyGroove 22:18, 7 February 2007 (UTC)MoodyGroove
 * Nobody is knocking America. It's the writing and editing that's the problem. The subject of this article is clearly relevant across the world but it's written as though it's only relevant to the US - that's bad writing and editing. I'm not knowledgeable enough about the subject to deal with the problem, but many of the editors of this article obviously are, and I would encourage them to do something about it. I think it's preferable not to have country-specific articles about topics such as this. Arcturus 22:46, 7 February 2007 (UTC)

I note this issue hasn't been raised for a while. I support more country-specific information. There is so much variation between countries in the ways EMS is delivered, it would be better for this page to be divided into sections describing the various models of EMS practised in different regions/countries or, alternatively, be quite simple as a generic document with country-specific details of EMS included in those country's wikipedia entries. FlyingDoctor (talk) 12:30, 12 July 2008 (UTC)
 * EMS by country pages are currently being worked on. They are being expanded from the existing stubs, and also provided with a standard format for ease of reference and comparison.  So far, I have completed Canada, France, Germany, Italy and Norway.  Have a look at the completed pages, and let me know what you think.  Future plans include U.K., U.S.A., Australia, South Africa, and Hong Kong to be done, and I will get to these as I have time.  Any help would be appreciated.  This will permit this existing page to become purely generic, with references and links to the information for specific locales.  For an example of what I am talking about, see the 'Paramedic' page.  By the way, my ultimate goal for that is to also have specific pages on paramedics, providing more detail for different countries.  In addition, I have created a page for CEN 1789, the European standard for ambulances, with links to the European EMS pages.  If someone were interested enough to put in the effort creating pages, and had sufficient knowledge, similar pages for the U.S. standard KKK-1822, and the Australian standard would be valuable additions.  The whole intent of this is to make this entire section a great deal less U.S.-centric than it currently is.  For the record, that is not about bashing the U.S. by any means; I am the first one to recognize that the majority of writers here are from the States, and that people typically write about what they know.  That leaves it to the rest of us, wherever we are, to supplement what our U.S. colleagues are writing with a more global perspective, ensuring that pages that should be generic are generic, and that information from other places and perspectives is also shared.  The result will be not just a GA rating for Emergency medical services, but a more comprehensive and professional approach to how we present ourselves, both among ourselves and to others.  Emrgmgmtca (talk) 12:16, 12 September 2008 (UTC)
 * I just came across this post after adding my own at the bottom ("Organization in different countries"). I'm from the US and I have to agree with the thoughts here about this page being uber-US-centric (if you permit me). There's an awful lot going on out there that should be mentioned. The problem is that the vast majority of what's being done on this page, despite noble efforts by those such as Emrgmgmtca, is High-income-country-centric - the only systems we're talking about are in developed countries, which is only 1/3 of the story. There's a whole lot going on in developing countries that's really fascinating, but I don't believe would fall into a formal EMS wikipage, though it is prehospital nonetheless. I have put together a database of International EMS Systems on my own non-profit's website, www.trekmedics.org/projects/diems/ but, as i described below, i'm having trouble finding a way to add this due to potential COI (all my country pages are written based off reputable *international* medical journals). Likewise, with the attention that Prehospital Care Systems are getting from WHO, it would be responsible to acknowledge these prehospital schemes (in the British sense) with their own space. I support Flying Doctor's notion to create a generic document - that's what i did. Unfortunately, I can offer nothing more than the model i put together, as i don't have the wikiwherewithal to do this myself (nor the time to figure it all out). I would also say that India is deserving of an entire page based on their noble, yet ultimately misguided and unsupported (or exclusionary) adventures into EMS. i.e., EMRI, 108, 1298, CATS etc. It would serve as a good reference for other developing countries ... in the same spirit as the PAHO book "EMS Systems Development: Lessons Learned from the USA for Developing Countries" TrekMedics 69.119.99.196 (talk) 02:24, 22 September 2010 (UTC)

The White Paper
I edited the History section to include a link to The White Paper, as the article talks about "studies" in the 1960's but doesn't actually reference any.Yelruh 21:41, 3 September 2007 (UTC)

Suggested Merge
It has been suggested that the article Emergency Medical Care be merged into this Emergency medical services article. I oppose the merge on the basis of emergency medical care extending far beyond the EMS realm, and the qualification is much higher than everyday EMS personnel. It is similar to merging medical doctors into EMS on the basis that they are among the employed staff of the EMS.

Kindly state your opinion. —Preceding unsigned comment added by Princeattractive (talk • contribs) 22:13, 11 September 2007 (UTC)

 * I believe these articles need to be merged, as Emergency medical care is simply an extension of emergency medical services, with some extra training brought on board. There is no clear delineation between where standard EMS stops, and EMC starts - most EMC skills listed can be performed by normal paramedics or technicians in some areas.  In the UK, all paramedics now have to take the university route to the qualification, but are still only paramedics when qualified, making the university argument largely irrelevant.

 * In short, the page describes the gradually extending skills present in the EMS field, and as such can be adequately described in a subsection of the main article. Owain.davies 06:27, 12 September 2007 (UTC)

I would disagree with the merge. I have never heard the term Emergency medical care before. Although similar, they seem different enough to have seprate articles —Preceding unsigned comment added by 71.87.24.2 (talk) 13:44, 28 October 2007 (UTC)

In the North Eastern US Emergency Medical Care would be a broader topic that includes in hospital care through at least admission to the hospital if not beyond. In this context of the term I would think that this merger is inappropriate.

In looking over the article for Emergency Medical Care it seems that they are roughly equivalent subjects and that the difference in terminology is one of country of origin. As a Wiki-novice I ask the other more experienced editor/reader “How do we merge these two without leaving one group of countries unable to find the article by searching their local term?”

If the target audience were known to be familiar with the professional terminology, I might suggest "Pre-hospital care and rescue" as a new topic for a merged article but that is a term that is little known outside of the professional community in the US.

JC Jjc1775 (talk) 14:02, 11 December 2007 (UTC)

I would have to agree with the unregistered author above. I have never heard of emergency medical care being the combination of EMS and rescue. Emergency medical care was the care provided by EMS providers AND hospital providers, especially physicians (hence their specialty being Emergency Medicine. They provide emergency medical care.). Does anyone have a source (since there isn't one on the other page) that actually shows that EMC is how the article states it to be?JPINFV (talk) 02:06, 11 March 2008 (UTC)

Article has been deleted... -JPINFV (talk) 20:32, 2 April 2008 (UTC)

 * Since Googlefight seems to think "emergency medical care" is more notable than "emergency medical services", I think the phrase "emergency medical care" should at least be mentioned in this article. --68.0.124.33 (talk) 14:02, 8 July 2008 (UTC)

 * 1. wp:google
 * 2. emergency medical care is a broader term that can be used to describe any emergency medical treatment [i.e. care]. That doesn't mean that the terms "emergency medical care" and "emergency medical service/system" mean the same thing. JPINFV (talk) 17:37, 8 July 2008 (UTC)

 * Instead of telling me on this talk page what something "can be" or "doesn't mean", please improve the article by mentioning the phrase "emergency medical care", and describing the difference (if any) between that and "emergency medical services" -- what it is, and what it does mean. Thank you. --68.0.124.33 (talk) 02:49, 14 July 2008 (UTC)

 * Emergency Medical Care could be done by any trained person (I'm thinking Volunteers here, eg. Certified first responder) and that would place it outside the realm of EMS. Exit2DOS2000   •T•C•  06:32, 14 July 2008 (UTC)

 * I don't think you quite understand what I'm talking about. An emergency physician intubating a patient is providing emergency medical care. An EMT-Basic putting a patient on a back board is providing emergency medical care. A boy scout splinting an broken bone is providing emergency medical care. Emergency medical care is something that is done, not a name for a system of providers, equipment, and training that is used to provide emergency care (i.e. an emergency medical system). Wikipedia is an encyclopedia, not a dictionary.

 * Furthermore, how dare you sit there and order me to do something. Wikipedia is a collaborative effort. If you want to add something, go ahead and add it yourself. Provided it's well written (if not, it will be rewritten, but the substance will remain), referenced, and correct, it'll stay in the article. No one here is responsible for your whims or adding information from a deleted artical simply because you want us to add it. JPINFV (talk) 12:43, 14 July 2008 (UTC)

 * Yes, I don't understand what the difference is (if any) between "emergency medical care" and "emergency medical service".
 * I want someone to add a sentence added to the article describing that difference (or else pointing out that they are the same).
 * You seem to be telling me that I am that "someone" -- that I should guess at the difference and put that guess in the article myself.
 * That seems to be an odd way of writing an encyclopedia.
 * Forgive me for plunging forward and doing just that, even though I feel that I am misunderstanding you yet again.
 * --68.0.124.33 (talk) 15:01, 22 July 2008 (UTC)

Change: "Prehospital"
Since it was submitted before I could finish the entry note, I added the term "prehospital" in "highest medical care" to clarify that the paramedic level is the highest level of prehospital care. Obviously (I hope, at least), the highest level of medical care is the physician level (specialty of Emergency Medicine in this case). —Preceding unsigned comment added by 70.22.228.240 (talk) 03:43, 3 March 2008 (UTC)

 * In most places in America, the Paramedic or Critical Care Paramedic is the HIGHEST level of Prehospital EMERGENCY care. WHile physicians are the highest level of care, they are not employed usually in a field response methodology due to the legal risks of this, as well as their limited effectiveness. (Most surgical or radiological interventions cannot be done in an Ambulance, expecially under movement). There are exceptions to this rule, such as Boston Fire (The Medical Director responds to major or complex incidents), or neonatal critical care transport (Most transports of less than 1000 grams are escorted by a Neonatologist or a Neonatal Nurse Practicioner). So this was technically correct. Although SMUR and certain Euro countries use Ambulance based MDs, this is not a very common practice. 75.64.179.85 (talk) 04:48, 21 May 2008 (UTC) chancegemtiv

 * So your problem with noting that paramedics are the highest level of prehospital care is, what, again? The only logical alternative is the scrap any mention of paramedics being the highest anything outside of highest level of EMT (using NHTSA levels). JPINFV (talk) 06:01, 21 May 2008 (UTC)

 * This issue keeps arising. I would respectfully suggest that we all try to remember that Wikipedia and its articles are not solely about the United States, and refrain from making statements that we pretty much KNOW already will only apply in the U.S..  The original unsigned contribution makes a valid point if you read it carefully; in that the physician is the highest level of medical care.  The whole thing goes off the rails when it, and subsequent posts, say that paramedics (of any type) are the highest level of anything, because that is simply not universally true; that statement ONLY works in the U.S..  Additionally, the comment by chancegemtiv about ambulance-based MDs not being 'a very common practice' is quite simply wrong.  Throughout France the role of paramedic is completely unknown and almost ALL (some Fire Service responses have ALS performed by a specially trained nurse, but these are quite limited) major emergency responses include the SMUR, which is physician-led in the field, all the time.  In the German-speaking parts of Europe (Germany, Austria, Switzerland) the response of a specially trained physician (Notarzt), occurs on almost all major emergencies.  In fact, in German speaking countries the Rettungsassistent, which is their version of a paramedic, is only permitted to practice ALS skills in the physical presence of the physician, except in cases of extreme emergency.  Emergency response by mobile physicians is, in fact, quite common in the majority of Europe, and not uncommon in the U.K..  We need to avoid making general statements as if they are universal truths, when in fact, they are only local, or regional, realities.  Emrgmgmtca (talk) 12:36, 12 September 2008 (UTC)

"Prehospital care" category
I am currently working on cleaning up the categorization of articles in Category:Prehospital care. Additionally, I have proposed renaming Category:Prehospital care to Category:Emergency medical services (as a more accurate, well known name to parallel Category:Firefighting, Category:Law enforcement, and Category:Rescue). If you have an opinion on the renaming of this category, please make a comment at Categories for discussion/Log/2008 April 3. So far, there has been very little interest this category one way or the other. --Scott Alter 11:25, 4 April 2008 (UTC)

Merge Proposal

 * Support I believe that Organization of emergency medical assistance needs to be re-organized and SELECT parts of the page be transferred over. The page is written on a soapbox and has little if NO evidence (no cites or references) supporting most of the article and really has no EMS DOT theory behind it. Please discuss your opinions. Thanks! Medicellis (talk) 15:44, 29 June 2008 (UTC)

 * Support - I've always thought this page added nothing to the wiki - even the title doesn't make sense! OwainDavies (about)(talk) edited at 18:31, 8 July 2008 (UTC)

 * Support - I'm not sure what there is that is even worthy of salvaging; it really adds nothing to what we are trying to achieve. Emrgmgmtca (talk) 12:40, 12 September 2008 (UTC)

Merge of Organization of emergency medical assistance

 * Article merged: See old talk-page Talk:Organization of emergency medical assistance
 * Per Articles_for_deletion/Organization_of_emergency_medical_assistance select parts of the page were merged into this article. These sections are in need of reference espeically the "stay and play" and "load and go".  I merged some of the other countries info, but this might be better merged into the specific EMS pages by countries, as I verify the information and I will move/merge the information as appropriate. Medicellis (talk) 23:12, 21 July 2008 (UTC)

Good Article (GA) drive
We have selected this article as Wikipedia talk:WikiProject Medicine/Emergency medicine and EMS task force good article drive. We feel this article is of the utmost importance and would like to spear head a drive! We hope we can have a good collaborative effort, appreciate any help editors can give. Medicellis (talk) 20:15, 5 August 2008 (UTC)
 * Happy to help with this! I'll try and get soime time later in the week, or maybe next week. OwainDavies (about)(talk) edited at 17:58, 6 August 2008 (UTC)

First responder
Something to add to this article, either under "First responder", or separately, is the difference between road-based and wilderness first responders. The logistics are so different. Ordinary first responder training involves patient assessment, use of equipment, and preparation for transport. Wilderness first responder also has patient assessment, but then stresses improvization. The available equipment may be limited, and transport by stretcher and ambulance may be days out of reach. --Una Smith (talk) 14:53, 6 August 2008 (UTC)
 * Agreed, I will be adding a Wilderness EMT and 1st responder into the section, as there are a important part of EMS not mentioned. If you have experience and want to expand please do

Medicellis (talk) 02:05, 7 August 2008 (UTC)
 * Wilderness Emergency Medical Technician
 * Wilderness First Responder

Emergent vs urgent
The article currently confuses emergency ("emergent") and urgent medical care. One short hand is for the difference is this: emergent = call 911, urgent = call or visit doctor today. --Una Smith (talk) 14:58, 6 August 2008 (UTC)
 * I'm not convinced that patients know the difference! Certainly in some countries, ambulances and EMS are regularly used for urgent (not emergency) conditions.  Loads of news stories for cites on that too, OwainDavies (about)(talk) edited at 17:59, 6 August 2008 (UTC)
 * Confusion may be widespread but that does not justify its continuation here; disambiguation is part of the job of an encyclopedia.  Some large metropolitan areas support multiple "ambulance" services that perform only non-emergency, non-urgent, scheduled transport of patients, often between hospitals and homes. --Una Smith (talk) 19:00, 6 August 2008 (UTC)
 * Often these services are conducted by what is called "medi-van" or "medivan", these services are usually a 3rd party private agency usually not associated with emergency medical services. Some private ambulance agency do provide this medi-van service but in complete different vehicles and are scheduled tranports.  But I in most cases this type of service is not considered EMS, in anyway shape or form, they provide no care and on the contrary if the patient cannot adjust there own oxygen the medi-van cannot transport that person.  I would consider all medi-can transport non-urgent or non-emergent transports.  If a ambulance is called it is considered emergent (as in 911) or urgent (as when called by a walk-in medical center). Medicellis (talk) 21:02, 6 August 2008 (UTC)
 * With all that being appreciated, I don't see many references to it in the article, and the fact remains that in some countries, like the UK, the ambulance services also perform the vast majority of the urgent transfer work - deploying front line crews to do so, so we can't ignroe it entirely. OwainDavies (about)(talk) edited at 08:10, 7 August 2008 (UTC)

Article title
The article content should be moved to Emergency medical service (singular of the current title), which now is a redirect here. --Una Smith (talk) 15:02, 6 August 2008 (UTC)
 * Oppose - There is an original discussion on this at the start of the talk page. Personally I think that services reads better, because we are covering EMS worldwide (i.e. many systems), rather than just one system - doesn't make grammatical sense to be service in the singular. OwainDavies (about)(talk) edited at 18:01, 6 August 2008 (UTC)

Too much on the citations?
I appreciate that citations are important, and i have spent a lot of time on WP adding them, but i think that there may be too many citation tags on this article. Citations are only for statements which are liekly to be challenged, and may not be common knowledge to someone with a grasp of the subject. Specifically, cite requests, such as on the first paragraph, where one is requested for stating that EMS is invovled with treatment and transport of patients in an emergency. I can't imagine that isn't common knowledge to anyone with a passing knowledge of the subject, or even to 90% of the world's population? I didn't want to remove the tags without raising it first, so i would appreciate opinions.

More info on WP:CITE and When to cite

Any thoughts? OwainDavies (about)(talk) edited at 12:14, 7 August 2008 (UTC)
 * Aye, I agree I went a little over board on adding the cite tags. I will remove some, please during the GA drive make changes you feel need to be done like this as it helps with move the article forward, thanks for being WP:NICE and posting on here first! Medicellis (talk) 13:57, 7 August 2008 (UTC)

 * I agree. I've seen entire Doctoral dissertations with as few as 20 citations, and this article has nearly 70!!!  Furthermore, I just got finished attempting to validate them all, and there are ten or so that no longer work!  I'm not sure whether that's misunderstanding the purpose of citations, or simple insecurity on the part of some of the writers...to be honest, when you see the way some run around waving 'qualifications' or certification levels, I frankly wonder whether it might be the latter in some cases.  "Well...you're just an EMT-B and I'm an EMT-I 6 and 7/8s (whatever THAT is!)."  In some cases it feels like a sort of classism among ourselves, but I think that more often it is simple insecurity. It almost seems in some cases as if they feel that they have to cite every single statement that they make, and sometimes the citations used are a little weak.  To illustrate, if I were marking this article as a student paper, I would be more than willing to accept that EMS systems go by a variety of names without proof being provided, but here we have one citation for each type of name, and those don't provide descriptions of the title choice, they simply link to an organization's website, which generally doesn't explain why it is called what it is.

Emrgmgmtca (talk) 17:11, 12 September 2008 (UTC)

See also section
I would like opinions on wither we should add back in EMS in different countries with short paragraphs, or keep the section the way it is? Medicellis (talk) 14:29, 7 August 2008 (UTC)
 * Having seen both, I've always favoured just having the wikilinks in that section (although they ought to be to 'Emergency medical services in ***' rather than 'paramedics in ***' - actually i might fix that in a minute), because it makes the page more understandable. This doesn't stop the use of examples throughout the main article, although they should clearly be examples, not given as worldwide fact. OwainDavies (about)(talk) edited at 07:25, 8 August 2008 (UTC)
 * I agree with Owain, and that's the process that I've started. Frankly, there's nothing wrong with a fairly decent overview of the similarities and differences between systems in different parts of the world.  It allows the main article to remain generic, focused, and uncluttered, but permits the reader to find appropriate information on specific locales and systems when they want it.  Owain, the same thing could, and probably should, be done for the Paramedic article eventually.  There are enough differences in training, certification and permitted procedures from one place to the next to justify it.  It's also a good way to include the 'sub-specialties' such as Wilderness, Flight, Tactical, etc., without the generic article becoming cluttered and beginning to run off on tangents all over the place.  I'm thinking of it in terms of a cascading effect; read the generic, then compare countries, if you want that much information move on to specific services and systems.  Or read the generic "Paramedic", then compare Canadian and British or South African, then look at sub specialties if you need to.  To me, it makes sense, but I'd welcome both your thoughts.  Emrgmgmtca (talk) 17:22, 12 September 2008 (UTC)

Star of life pic typo
Owain, great work so far on helping me with the GA drive! It seems myself and you are the only two interested in improving this article and Im glad I have someone to help!. In regards to the pic, I love it but there is a typo. The caption built into the picture - Healing is spelled wrong. It is a easy fix with the pic and since you developed it prob is easier for you to change it with your edit program. Again thanks for all your hard work and help!! Cheers - Medicellis (talk) 18:36, 10 August 2008 (UTC)

 * Done! Poor proof checking i'm afraid! OwainDavies (about)(talk) edited at 20:04, 10 August 2008 (UTC)

Vote on Rural/Frontier EMS WP:GAEMS
Please vote to keep/delete or rewrite the section, It has WP:N and WP:V but very little. I say we re-name the section and have a complete re-write to make it complaint for a GA.

re-name and re-write Medicellis (talk) 21:33, 10 August 2008 (UTC)

 * Definitely rename - frontier is very US/canada centric. Don't know all that much about the subject, but I can see why some of the considerations are different. OwainDavies (about)(talk) edited at 05:32, 11 August 2008 (UTC)

 * What's the matter Owain? Can't visualize "Frontier" medics in the Netherlands???  Have you lot in the European Union run out of frontier???  Just Kidding!!!  We don't use the term in Canada, either...that one is a pure Americanism.  From my point of view, if they want inclusion, fine...but make it a separate, linked page, as I am proposing for the rest of the subspecialties.  Emrgmgmtca (talk) 17:27, 12 September 2008 (UTC)

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Merge of Organization of emergency medical CARE
Confusing english use of Emergency Medical Systems  Terms  and biasses induced by Emergency Medical Technicians  or Paramedics US/English Terminology and lobying  do not inform about the reality: USA decentralized and no Public Health integrated EMS nor on UK  Public Health NHS Centralized but near "Demedicalized" System. The two systems are not even comparable and set in Anglo American EMS systems !!. Even American or English lectors can not be informed in English Wikipedia about their systems inconsistencies because very few read in other lenguages and even they do not know that  (I have experencied it)they are censured and foreigner participation deleted.

EMS in .... Wikipedia articles in English are writen with te same biasses of American or English point of vue of paramedics and tunnel vision  physicians.

Biases are not a Anglosaxon speciality !!!!! I am trying in French, Spanish and Portuguese on Samu/IEMS articles to evit the same cultural and sociologic  biases in these lenguages i Know better than Enhlish.

Integrated Emergency Medical Care Services (IEMS) taking caring the patient from the Emergency Call to the Operating Room or Intensiva care unit through a MICU or a Emergency GP or Ambulance coud be a precision for differenciation of "EMS" that could stay with First Aid and Rescue 188.115.4.170 (talk) 10:43, 8 August 2010 (UTC) 188.115.4.170 (talk) 10:54, 8 August 2010 (UTC)

 * i'm afraid its not clear what changes you wish to bring about to the article with this comment. It seems from your edits that you have a very strong point of view about physician led systems being superior, but we can't reflect this opinion on wikipedia - only report what systems exist, and these systems are mentioned.  I would disagree that the US and UK systems aren't comparable, as they run along similar lines, the main difference being where the service is commissed from (and paid for by) - that difference in payment amounts to effectively a very small difference. It would be great to have some more information on the France-German system, but not by introducing bias to the topic.  OwainDavies (about)(talk) edited at 07:40, 9 August 2010 (UTC)

I disagree with the your asertions about  UK EMS (National Public Health ambulance System) is at the opoosite of US one,and  German (Federal State decentralized EMS) is very diffrenent than french (Centralized EMS State).

Your arguments about who liderizes EMS in different countries is also a bias of your point of vue Physician led EMS do not existe even in france all depend on Public Health Authority! I never said that Physician Led Systems are superior but I suppose you Physician has in near all countries has the technical laedership of Medical care.

Paramedical Personals are not to be put in Competition with Physicians and the Paramedic agressive lobying in this sense has to be regulated in Wikipedia ! Conflits between Paramedics, Ambulance Technicians, Nurses and Doctors have not to be accepted in Wikipedia.

English lenguage has not to vehiculate also  any linguisteic US or UK colonialism. I stay thinking that "Paramedic"(Ambulance Paramedical Care Personals) "Emergency Medical Systems" (Prehospital Emergency Ambulance Service)  are current english linguistic "errors" that Public Health Authorities have to day to regulate because they have not done it in the begining using normal current english clear terminology. I think nevertheless that your are convinced taht both of us are going up.

PS Wikipedia writen by "EMS" in ... the same writers are also full af linguistic biases and mistraductions. I ams am doing the same critics in to French or Belgians in French Wikipedia! even if I have other problems with the errors that all countreis ahave done implementing EMS (in your Sense) "Aide Médicale Urgente". In Spanish Italian and Portuguese wikipedia is the same fight against errors of the past.... Friendly —Preceding unsigned comment added by 90.24.213.253 (talk) 17:40, 10 August 2010 (UTC)

 * OK, it's still quite difficult to understand your points, but i'll try to address them as I understand them one at a time:

 * The UK EMS system is not as uniform as you seem to believe - there are 13 ambulance trusts in England alone, all working under contract to a commissioning body. They then in turn often subcontract work to private companies and voluntary societies and this looks likely to become more common.
 * You have indicated on several occasions that you believe a physician based system to be superior and most of your edits include parts which denigrate the paramedic role
 * I don't believe that there is competition between Paramedics/EMTs and Physicians. In most places they regard each other as complementary specialists
 * The term paramedic isn't english colonialism nor an error - it is a registered health care profession in many countries round the world, protected by law, making it very clear what it means.
 * I hope that makes it clear - i am just trying to make sure the article is reporting what happens - not what you would like to happen. OwainDavies (about)(talk) edited at 18:01, 10 August 2010 (UTC)

On Physician Leadership :Yes I confirm that I think that a Medical Care Sytem has to be headed by a Professional, Responsible Service Head Physician af a medical care team , I mean Professional with the deffinition of Sociologist Friedson who analyzes the conflicts with their assistants , like in an other Medical Care Service. In this sense I think that a emergency care service with a Medical Doctor in charge on the site and at command posts is "better for treatment" than  where only a Paramedical Personal is alone even with "protocols". I do not mean that Doctors can work without the indispensable Paramedical Assistants care Team!!!. But Doctors are not to be confined in an Admistrative and Consultant role  in an Emergecy Medical Care Service abandoning their proper responsability to their Paramedical Assistants Care Givers they must be present if necessary in all the steps of care.

I confirm my feeling Paramedical exists in English (why not to use it like Indian English do), Medic, Paramedic , Nurse, Matron, and Physician  are old ambiguous medical terms that canot be traduced litteraly in other lenguages like Sage Femme or Toobib in French or Galeno or Matrona in Spanish and Portuguese , we have to improove  linguistic exhange between us! and En:Wikipedia has to write in International English not in local Jargon reporting a censoring local point of vue.

I feel that the current begin to pass between us and you are near to understand that We can make a bridge over the Channel or the Atlantic about what is an Emergency Ambulance Medical Service and a Paramedical Ambulance Professional... Nevertheless Friendly yours 90.24.186.153 (talk) 13:04, 11 August 2010 (UTC)

 * OK, so we get to the heart of the issue which, as I see it, is that you object to the principle of paramedics and EMTs leading care in the out of hospital environment. Unfortunately for you, the majority of countries worldwide operate on a paramedic and EMT led system, and only a few use a physician led service, and wikipedia exists to report on what exists, not what anyone would like to be the case.   'International english' is effectively created through a corpus of worldwide usage, and all the major variants (British, North American, Australasian, South African) use paramedic in the sense given here and in almost all places covered by that, paramedic is a protected legal title.  Therefore, international english would, by default, include this usage of paramedic.  We cannot introduce other confusing terms in to the articles on the basis that a minority of other languages do not have a direct translation.  Regards OwainDavies (about)(talk) edited at 17:48, 11 August 2010 (UTC)

OK, so we get to the heart of the issue! which, as you see it, Yes I object to the principle of paramedics and EMTs leading care in the out of hospital environment. Out Emergency medical care is done in all countries by General Practionners and  Primary care  personals not by paremedics ! And in my long experience I knew and participated  the  difficult gestation of new Emergency and ambulance and Medical Regulation paraprofessionals (I have 72 ans and I Worked all my Professional career as consultant in these systems I knew many Medical Emergency Systems and their defects do not care about that).

An other problem is the linguistic problem English is neither an exclusivity of North American or UK inhabitants and nor of Emergency Medical Systems/Services in your sense (EMS) which introducted EMS as  their  jargon restricted meaning that is intraduisible. You canot forget if a "minority of other languages" do not have a direct translation has a conceptual and semantic profound meaning. If you are an american Citizen and your are bilingual the Spanish litteral traduction is of EMS is SUM Servicio de Urgencias medicas what it means? An ambulance Service or an Integrated Medical Emergency System?. See what it means in your north american neighbours like the Cuba SIUM that is much more pertinent.

I suggest you to aid the rewriting of these EMS english biased wikipedia articles by each country professionals and not to censure them with your point of vue but to aid them to write an International English.

I suggest you also to merge for, calming the game ,this EMS general article with "Ambulance" article of en: Wikipedia  that is much more international and has a yet a good spanish equivalent in es: Wikipedia (the french one is not so good) .I am working for that in French and Spanish prevent local biases.

I would wish also to have any reaction of Your Emergency Medical Medecine "authorities" and "academics" about many assertions writen in these articles that to be despised simply by then. For my part I will continue to react to because I think that Wikipedia has not to be left abandoned  by Care Professionals, Public Health Authorities and Medical Academic People  and they are a little responsible of your present problems.

Nevertheless staying Friendly reactive --Miguel Martinez Almoyna (talk) 09:49, 12 August 2010 (UTC)--Miguel Martinez Almoyna (talk) 09:49, 12 August 2010 (UTC)

 * Well at least we agree that you are trying to push a certain agenda. Unfortunately, that isn't allowed on Wikipedia!  As i said before, far more countries use the Paramedic/EMT system for emergency out of hospital care than use the physician led system, so the article must reflect this.

 * As for the translation - this is a non issue. This is the English wikipedia - if you are looking for information in another language, you should look on the alternative language versions, where hopefully someone can explain the difference.  As i explained before, international english is based on corpus, and pretty much all the major branches of English use the EMS/Paramedic/EMT phraseology, thereby making it de facto international standard.

 * There is no justification for merging this article with ambulance - ambulance is a vehicle, EMS is a system. They certainly overlap, but they are not the same thing.

 * You still haven't pointed out what parts of the article you think would be considered unsuitable by your unnamed 'authorities'. I think it would be most constructive to have you try and list out the problems on the talk page so they can be worked through or argued against.

 * I'm sorry to keep harping on about it, but Wikipedia reflects what happens in the world, not what any one editor wants the world to do. OwainDavies (about)(talk) edited at 21:25, 12 August 2010 (UTC)

I'm sorry to keep harping on about it, Wikipedia has not to  reflect what happens in USA or England or in the World of Emergency Medical Services seen by an only local point of vue  of a only local paramedic point of vue. en: Wikipedia writes in English that is not only the UK or US english readers. It is like if you see to me that also Spanish is an American also US monopol in Wikipedia!

Articles writen by US spanish writing paramedics are in the same way contestable.

EMS Emergency Medical Services are not good English terms and  the same for SUM Servicios de Urgencias Medicas they are untraductible and confusion bearing in international English or Spanish.

I wish than any Wikipedia "Editor" or responsible will read this discussion! Can you transmit?

Friendly yours —Preceding unsigned comment added by 90.24.186.168 (talk) 11:10, 18 August 2010 (UTC)

 * Whether or not you like the term, Emergency Medical Services is the term most widely used across english speaking countries (not just US & UK) and as per WP:COMMON is therefore the correct term to use. I don't see why the SAMU model is really any different apart from the physician lead on ambulances and clinical governance structure.  A modern EMS system gives appropriate care, not just ambulance care.  For instance, in the UK, if you call the emergency number (999 in this case) for an ambulance, but you do not require an emergency ambulance response, you will be passed on to a clinician (nurse, paramedic, doctor etc.) who will talk you through alternatives and connect you with a more appropriate service (an on call doctor, for instance), and the reverse is true if you call your doctor or NHS Direct with life threatening symptoms, where an ambulance will be summoned for you.  This is still EMS, but an integrated system.

 * I still think that this article acurately describes the different systems (paramedic led vs physician led etc.) without favouring one or the other, and if you want change you need to bring some specific examples and justification to the talk page here. I know there are dozens of other editors who watch this page, and as you suggest, maybe one of them has a different view and I would welcome it if they did.

 * I hope this helps, but i really think you need to address specifics from the article where you believe there is a difference to be noted. Regards, OwainDavies (about)(talk) edited at 12:08, 18 August 2010 (UTC)

Organization in different countries
I'm new to editing wikipages, so i'm looking for a little guidance. I'd like to add an external link to "The DIEMS Project - the Database for International EMS Systems" www.trekmedics.org/projects/diems/

At first, i wanted to add it beneath the last country listed, but then i got the feeling that it might technically belong as an External Link.

However, after continuing to read about the guidelines, i am suspicious that there could be problems with this, possibly regarding accusations of COI: the website belongs to a non-profit organization, Trek Medics International, which I run. However, aside from the field work we do, I have also begun compiling information on as many international EMS systems as i can find into a database (26 countries and counting) which is all supported by referenced material from reputable medical journals (we will not post anything unless it can be cited).

However, because the source page is a part of my non-profit's website, I suspect there might be some potential to be accused of COI, even though I aspire to do nothing but make this database available to as many people as possible for educational purposes (there are no ads or any other fundraising efforts included in this database).

Please advise how (if) i may go about adding this valuable educational resource to the page. Thanks TrekMedics (talk) 17:46, 21 September 2010 (UTC)

 * If anywhere, it would go in external links. It makes a good start as a reporting site, but there are a lot of gaps, and citations are not generally in line, so we only have your word for the reliability (no offence intended!).  As a general rule, under WP:SPS, this sort of self-published material is not usually permitted.  I think a better contribution for WP would be to add some of this information in to the relevant articles here along with the inline citations that open it up for checking by other editors.  I hope that is helpful, and that you can contribute some of this knowledge to wikipedia.  OwainDavies (about)(talk) edited at 20:20, 21 September 2010 (UTC)

Rendez-vous
During some research I discovered that the "rendez-vous" term is used somewhat differently. However the majority seems to use it as meeting with e.g. paramedic or doctor on the way to the hospital. I am sure that there is a term for both meeting at the patient. But what is it called?

When this question has been clarified it could be nice to incorporate it in the article. --|EPO| da: 19:22, 6 October 2010 (UTC)

 * I'm not sure to what extent this varies worldwide, but in the UK, meeting on scene tends to be 'backup', regardless of whether the extra resource is higher or lower qualified - it jsut reflects that extra resource is, or might be, required. In terms of rendezvous, you would generally see that in two contexts - the first being the one you've outlined, where an additional resource meets you on route (in order to make both transport time and time to definitive care as short as possible) and in the case where resources are required to meet off site before proceeding to scene (major incidents, violent incidents where police have not yet got control etc) and ambulances proceed to the designated rendezvous (usually termed RV) point.  As for refs to meet WP:V, i'm not sure, so let me look at some texts.  OwainDavies (about)(talk) edited at 08:28, 8 October 2010 (UTC)

 * My research showed that "rendez-vous" is used both for meeting en route (wuhuu! more French!) and at the patient. But also as you mention a location to meet before entering an unsecure area. My (primary) interest is to find out if there is a term describing the situation with an auxiliary unit meeting at the patient - which I think there is.
 * Looking forward to your response. --|EPO| da: 12:18, 8 October 2010 (UTC)

Who calls often?
EMJ 10.1136/emermed-2012-202146 JFW | T@lk  14:52, 17 April 2014 (UTC)

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Psycho-social emergency services?
Psycho-social emergency services? None existing in GB, USA, Canada, Australia?

title: Talk:Emergency medical services


text:
Ficus elastica

Ficus elastica, the rubber fig, rubber bush, rubber tree, rubber plant, or Indian rubber bush, Indian rubber tree, is a species of flowering plant in the family Moraceae, native to eastern parts of South and Southeast Asia. It has become naturalized in Sri Lanka, the West Indies, and the US state of Florida. Despite its common names, it is not used in the commercial production of natural rubber.

Description
It is a large tree in the banyan group of figs, growing to 30 - 40 m – rarely up to 60 m – tall, with a stout trunk up to 2 m in diameter. The trunk develops aerial and buttressing roots to anchor it in the soil and help support heavy branches.

It has broad shiny oval leaves 10 - 35 cm long and 5 - 15 cm broad; leaf size is largest on young plants (occasionally to 45 cm long), much smaller on old trees (typically 10 cm long). The leaves develop inside a sheath at the apical meristem, which grows larger as the new leaf develops. When it is mature, it unfurls and the sheath drops off the plant. Inside the new leaf, another immature leaf is waiting to develop.

Pollination and fruiting
As with other members of the genus Ficus, the flowers require a particular species of fig wasp to pollinate it in a co-evolved relationship. Because of this relationship, the rubber plant does not produce highly colourful or fragrant flowers to attract other pollinators. The fruit is a small yellow-green oval fig 1 cm long, barely edible; these are fake fruits that contain fertile seeds only in areas where the pollinating insect is present.

Range
The natural range of F. elastica extends from Nepal in the north to Indonesia, Bhutan, Northeastern India, Myanmar, Yunnan in China, and Malaysia. It has been widely introduced in most tropical regions of the world, including Hawaii and the West Indies. In Europe, it can be found in mild locations throughout the Mediterranean Basin.

Cultivation and uses
In parts of India, people guide the roots of the tree over chasms to eventually form living bridges. To this day there are large bridges woven from aerial roots in Meghalaya, India. Although the trees used for these bridges are very large, aerial roots can be found on F. elastica [https://planthouseaesthetic.com/do-rubber-plants-have-aerial-roots-heres-what-you-need-to-know/#:~:text=This%20tendency%20also%20manifests%20itself%20in%20captivity%20with%20plants%20as%20small%20as%201ft%2C%20as%20shown%20in%20the%20picture%20above. as small as 1ft tall.]

Ornamental
Ficus elastica is grown around the world as an ornamental plant, outside in frost-free climates (though it also tolerates light frosts) from the tropical to the Mediterranean and inside in colder climates as a houseplant. Although it is grown in Hawaii, the species of fig wasp required to allow it to spread naturally is not present there.

Most cultivated plants are produced by vegetative propagation. This can be done by cuttings or by layering.

In cultivation, it prefers bright sunlight but not hot temperatures. It has a high tolerance for drought, but prefers humidity and thrives in wet, tropical conditions. Ornamental hybrids (such as Robusta) have been derived from Ficus elastica with broader, stiffer and more upright leaves than the wild form. Many such hybrids exist, often with variegated leaves.

Latex
All parts of the plant contain an abundant milky white latex, a chemical compound separate from its sap and carried and stored in different cells. This latex was formerly used to make rubber, but it should not be confused with the Pará rubber tree (Hevea brasiliensis), the sap of which is the main commercial source of latex for rubber making. The latex of Ficus elastica has been tested for use in the manufacture of rubber, but without economic and technical results.

Just as with Hevea brasiliensis, the latex of Ficus elastica is an irritant to the eyes and skin and is toxic if taken internally.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Ficus elastica


text:
User:Timo Kouwenhoven

Biography
Timo Kouwenhoven 1972 was born in Helmond, The Netherlands. After being trained as a computer technician and electrotechnical engineer, he received a BSc (ingenieur) in informatics in 1995, specialising in factory automation. In 1996 he graduated from Middlesex University with an MSc in Co-operative Systems (CSCW). He is an alumnus of Singularity University, California.

Supporting individual knowledge workers and linking these to colleagues is a central objective in his work, building on the deployment of modern information and communication technologies. He publishes frequently and is an invited speaker for conferences and seminars relating to information management.

As a consultant/lecturer/researcher he is involved in the field of information management, specialising in:
 * Information Architecture
 * personas
 * design and usability
 * semantic technology
 * information visualisation
 * Information Retrieval
 * search engine selection and deployment
 * metadata schemas
 * semantic web
 * Multimedia Retrieval
 * image retrieval
 * spoken document retrieval
 * digital asset management
 * metadata schemes

Dutch

 * Stop met mailen, twitter je collega, interview met T. Kouwenhoven door M.J. Klaver, NRC Handelsblad, 27-10-08.
 * Achtergrond artikel over Enterprise 2.0, interview met T. Kouwenhoven door E. Vlietick, Computable, nr. 4, 2007.
 * Het Semantische Gat en web 2.0, T. Kouwenhoven, Automatiseringgids, week 25, juni 2006.
 * Zoekmachines en web 2.0: Gaan we daar last van hebben of profijt? T. Kouwenhoven, CIBIT e-zine, mei 2006.
 * S@P Jaarboek theme Audiovisual Archives, chapter on Searching and Navigating through audiovisual-archives, 2006.
 * Bladeren in Beeld en Geluid, T. Kouwenhoven en J. Oomen, Informatie Professional, Cram Uitgeverij, april 2006.
 * Twee taxonomieën voor één ministerie, interview met o.a. Timo Kouwenhoven, Intellectueel Kapitaal-magazine, 2005.
 * Corporate Taxonomies: Informatieontsluiting met taxonomieën, Welk middel voor welk doel?, T. Kouwenhoven and K. Schwarz, CIBIT, 2005.
 * Corporate e-Learning, E. Huisman, Boon, 2001. Co-author of chapter on e-Learning, Knowledge management and Communities of Practice.
 * Reengineering for Learning, T. Kouwenhoven, I&I Magazine, uitgeverij Cramwinkel, 1997.
 * Iterative Workflow Automation, het evolutionair ontwikkelen van workflowsystemen, T. Kouwenhoven. Workflow Magazine, 1997.
 * Groupware: het group’aware maken van organisaties, CIBIT booklet, E. Kruizinga en T. Kouwenhoven, 1996.
 * Kennismanagement moet voorafgaan aan Workflowmanagement, G. van Heijst en T. Kouwenhoven, Workflow Magazine, 1996.

English

 * T. Ferreira, R. Barradas Pereira, J. Ramón, T. Kouwenhoven, C. López de Echazarreta, J. Ventura-Traveset, J. Ávila-Rodríguez, G. Hein, Navipedia — The GNSS Wiki, A Reference for Global Navigation Satellite Systems, InsideGNSS, November 2012.
 * T. Kouwenhoven, K. Schwarz. Field Manual: domain model enhanced search, CIBIT, October 2005.
 * K. Schwarz, T. Kouwenhoven, V. Dignum, J. van Ossenbruggen. Supporting the decision process for the choice of a domain modeling scheme. In proceedings of the first workshop “Formal Ontology Meets Industry”, Verona, Italy, June 2005.
 * M. Lauwers (ed) Proceedings, Media Management in the Digital Era: changing sceneries, changing roles, International conference of the International Federation of Television Archives (FIAT/IFTA). Chapter: Searching and Navigating = Finding, Netherlands Institute for Sound and Vision, 2004.
 * T. Kouwenhoven. Reengineering for Learning. ACM SIGGROUP Bulletin Volume 19, Issue 1 (April 1998), ACM New York, 1998.
 * E. Kruizinga, T. Kouwenhoven. Real and Virtual: Best of Breed environments for Communities of Practice. KM Review, London, 1998.

Italian

 * R. Morici (trans). E. Huisman, T. Kouwenhoven, E. Kruizinga. La Piazza di Ninive (knowledge management case studies / good practices for reforming the Italian educational system), Ministerio della Pubblica Instruzione, Roma, Italia, 1999.

title: User:Timo Kouwenhoven


text:
Roberta Angelilli

Roberta Angelilli (born 1 February 1965) is an Italian politician. She was a Member of the European Parliament from 1994 to 2014. She served as Vice President of the European Parliament from 1 July 2009 to 1 July 2014.

In 2014, Angelilli was candidate for MEP with the New Centre-Right – Union of the Centre, but she was not re-elected. She was again a candidate for MEP in 2019 on the Brothers of Italy list but was not elected.

Education

 * 1993: Graduate in political science at La Sapienza University of Rome

Career

 * 1993–1996: Secretary-General of the Youth Front
 * 1996–1997: President of Youth Action
 * since 1985: Director of the AN Young Entrepreneurs Office
 * since 1998: Responsible for Community policies for the Rome section of AN
 * 1985–1992: Director of the environmental association "Fare Verde"
 * Founder of the international voluntary work organisation "Movimento Comunità"
 * 1994–2014: Member of the European Parliament

title: Roberta Angelilli


text:
Solidum Systems

Solidum Systems was a fabless semiconductor company founded by Feliks Welfeld and Misha Nossik in Ottawa, Ontario Canada in 1997. The company developed a series of rule-based network classification semiconductor devices. Some of their devices could be found in systems which supported 10 Gbit/s interfaces.

Solidum was acquired in October 2002 by Integrated Device Technology. IDT closed the Ottawa offices supporting the product in March 2009.

Misha Nossik was also the second chairman of the Network Processing Forum. The NPF also released the Look-Aside Interface which is an important specification for Network Search Elements such as Solidum's devices.

Products
Solidum produced a set of Traffic Classification devices called the PAX.port 1100, PAX.port 1200, and PAX.port 2500

The classifier chips were used in Network Switches and Load Balancers.

title: Solidum Systems


text:
John Arnold (watchmaker)

John Arnold (1736 – 11 August 1799) was an English watchmaker and inventor.

John Arnold was the first to design a watch that was both practical and accurate, and also brought the term "chronometer" into use in its modern sense, meaning a precision timekeeper. His technical advances enabled the quantity production of marine chronometers for use on board ships from around 1782. The basic design of these has remained, with a few modifications unchanged until the late twentieth century. His legacy includes, together with Abraham-Louis Breguet, being one of the inventors of the modern mechanical watch. One of his most important inventions, the overcoil balance spring, is still used in most mechanical wristwatches.

It was from around 1770 that Arnold developed the portable precision timekeeper, almost from the point where John Harrison ended his work in this field. But, compared to Harrison's complicated and expensive watch, Arnold's basic design was simple whilst consistently accurate and mechanically reliable. Importantly, the relatively simple and conventional design of his movement facilitated its production in quantity at a reasonable price whilst also enabling easier maintenance and adjustment.

Three elements were necessary for this achievement:
 * A detached escapement, which gave minimal interference with the vibrating balance and balance spring
 * A balance design that enabled compensation for the effect of temperature on the balance spring
 * A method for adjusting the balance spring, so that the balance oscillates in equal time periods, even through different degrees of balance arc

Early life and work
John Arnold was apprenticed to his father, also a clockmaker, in Bodmin in Cornwall. He probably also worked with his uncle, a gunsmith. Around 1755, when he was 19, he left England and worked as a watchmaker in the Hague, Holland, returning to England around 1757.

In 1762, whilst at St Albans, Hertfordshire, he encountered William McGuire for whom he repaired a repeating watch. Arnold made a sufficient impression so that McGuire gave him a loan, enabling him to set up in business as a watchmaker at Devereux Court, Strand, London. In 1764, Arnold obtained permission to present to King George III an exceptionally small half quarter repeating watch cylinder escapement watch mounted in a ring. A similar repeating watch by Arnold has survived; it is of interest that the basic movement is Swiss in origin but finished in London. The escapement of this watch was later fitted with one of the first jewelled cylinders made of ruby.

Arnold made another watch for the King around 1768, which was a gold and enamel pair cased watch with a movement that had every refinement, including minute repetition and centre seconds motion. In addition, Arnold fitted bi-metallic temperature compensation, and not only was every pivot hole jewelled but the escapement also had a stone cylinder made of ruby or sapphire. Arnold designated this watch "Number 1", as he did with all watches he made that he regarded as significant, these numbering twenty in all.

Other early productions by Arnold from 1768 to 1770 display both originality and ingenuity; this includes a centre seconds watch wound up by depressing the pendant once a day. The movement of this watch was also fully jewelled with a temperature compensation device and a ruby stone cylinder escapement.

These watches were made as demonstrations of Arnold's talent and, in terms of style and substance, were similar to other "conversation pieces" being made at the same time as those being produced for James Cox and made primarily for export to the East.

The technical challenge
Arnold's facility and ingenuity, coupled with his undoubted charm brought him to the attention of the Astronomer Royal Nevil Maskelyne, who at this time was seeking a watchmaker skilled enough to make a copy of John Harrison's successful marine timekeeper. A full and detailed description of this watch was published by the Board of Longitude in 1767, entitled "The Principles of Mr. Harrison's Timekeeper", the intention clearly being for it to act as a blueprint for future quantity production. In fact, it was a highly complex and technically very advanced piece of micro engineering, and capable of being reproduced by less than a handful of watchmakers. However, the challenge was taken up by Larcum Kendall, who spent two years making a near identical copy (now known as K1) that cost £450, a huge sum at the time. Although successful as a precision timekeeper, the Admiralty for obvious reasons wanted a timekeeper on every major ship, and Kendall's was too expensive and took too long to make. Kendall made a simplified version (K2) in 1771, leaving out the complicated remontoir system. But the result was still too costly and, moreover, not as accurate as the original.

In retrospect therefore, it was a significant occasion when in 1767, Nevil Maskelyne presented John Arnold with a copy of the "Principles of Mr. Harrison's Timekeeper" as soon as it was published, evidently with a view to encourage him to make a precision timekeeper of the same kind. Maskelyne subsequently encouraged Arnold by employing him on several occasions, mostly in connection with watch and clock jewelling. In 1769, Arnold modified Maskelyne's centre seconds watch by John Ellicott, changing the cylinder escapement from steel to one made of sapphire. He lent this watch to the Astronomer William Wales for use in assessing the practicability of Maskelyne's Lunar distance method for finding the ship's longitude during the voyage of the Transit of Venus expedition to the West Indies in 1769. Around this time, Arnold also seems to have started to think about making an accurate timekeeper to find the longitude.

Arnold's first "Watch Machines"
Arnold's approach to precision timekeeping was completely different from that of Harrison, whose technical ethos was rooted in seventeenth- and early eighteenth-century theory and practice. Arnold knew that as the balance and balance spring control the timekeeping in a portable watch, he only needed to find a way of giving the balance a consistent impulse with minimal interference from the wheel work, together with an effective temperature compensation. After making some experimental machines, he produced what could be regarded as a production model to the Board of Longitude in March 1771.

This machine was completely different from Harrison's watch. It was a mahogany box of approximately 6 x that housed a movement that, though relatively simple, was close to the same size as Harrison's, with a balance of a similar diameter. The radical difference, however, was a newly designed escapement that featured a horizontally placed pivoted detent that allowed the balance to vibrate freely, except when impulsed by the escape wheel. The spiral balance spring also had a temperature compensation device similar to those in Arnold's watches, and based on Harrison's bimetallic strip of brass and steel. Arnold proposed manufacture of these timekeepers at 60 guineas each.

Three of these timekeepers travelled with the explorers James Cook and Captain Furneaux during their second voyage to the southern Pacific Ocean in 1772–1775. Captain Cook also had Kendall's first timekeeper on board as well as one of Arnold's. Whereas Kendall's performed very well and kept excellent time during the voyage, only one of Arnold's was still running on their return to England in 1775. The performance of these clocks was recorded in the logbooks of astronomers William Wales and William Bayly who were assessing their suitability for measuring longitude.

During this period, Arnold also made at least one precision pocket watch, a miniature version of the larger marine timekeepers.

This surviving watch dates from around 1769–1770, and is signed Arnold No. 1 Invenit et Fecit (Latin for 'invented and made'). The movement, which indicates centre seconds, has a steel balance with a bimetallic temperature compensation strip that acts on the flat balance spring. Though now altered, the original escapement was Arnold's horizontal pivoted detent as fitted to the larger timekeepers, which was, it seems, not entirely successful and needed improvements.

Around 1772, Arnold modified this escapement so that it now was pivoted vertically and acted on by a spring. This was a much more successful arrangement, and it is known that in 1772 at least two pocket timekeepers with this escapement were supplied to Joseph Banks at a cost of £100 (Arnold No.5), and also Banks' fellow Etonian Captain Constantine John Phipps, 2nd Baron Mulgrave. In a long and detailed article on this matter published in Australiana November 2014 Vol 36 No. 4, John Hawkins details the association between these two men and the imagined possibility that this instrument is one and the same. The world's first pocket chronometer originally destined for Cook's second voyage, purchased by Banks and lent to Phipps is known to have been a small centre seconds watch of a similar kind to those made by Ellicott. In 1773, Captain Phipps made a voyage to the North Pole, taking with him not only his Arnold pocket timekeeper and an Arnold box timekeeper in gimbals, but also Kendall's "K2" timekeeper. From Phipps's account, it appears that the pocket watch performed very well indeed and was a convenient instrument for ascertaining the longitude.

It seems likely that before 1775, Arnold's earliest pocket chronometers, such as those supplied to Phipps and Banks, were plain watches with centre seconds motion, largely resembling Maskelyne's cylinder watch by Ellicott. Certainly, those few surviving examples are of this caliper such as No. 3.

By 1772, Arnold had finalized the design of his pocket timekeepers and started series production with a standardized movement caliper, this being around 50 mm in diameter, larger than a conventional watch of the period, and showing seconds with a pivoted detent escapement and spiral compensation curb. However, the latter appears to have proved ineffective, which seems to have substantially slowed the rate of production.

Even though he produced a number of pocket timekeepers, from around 1772–1778, Arnold was still experimenting with different types of compensation balance and methods of balance spring adjustment. The most difficult problem to surmount was the problem of making an effective and continuously adjustable temperature compensation device. For technical reasons, the temperature compensation for the balance spring had to somehow be incorporated into the balance itself and not act on the balance spring directly as had been done previously by Arnold and others.

Arnold's first patent of 1775
In 1775, Arnold took out a patent for a new form of compensation balance with a bimetallic spiral at the centre. This spiral actuated two weighted arms, making them move in and out from the centre, changing the radius of gyration, and thus the period of oscillation. In the same patent, he included a new helical balance spring. This shape reduced lateral thrust on the balance pivots as they rotated, and reduced random errors from the "point of attachment" effect, which any balance with a flat spring suffers from. As Arnold stated rather succinctly in a 1782 letter to the Board of Longitude, "...the power in all parts of the spring is uniform."

The fact that Arnold had recognized the technical advantages of a balance spring of this form clearly demonstrates a high degree of insight. The balance that was the subject of the patent appears to have been an unsuccessful design. Certainly, some marine chronometers used this balance, but none have survived. Pearson records a balance of this kind in his possession that was 2.4 inches in diameter.

From 1772 to 1775, Arnold also made about 35 pocket timekeepers. Not many, about ten of these, survive and none in their original form, as Arnold was constantly upgrading their specification. They appear to have originally had a pivoted detent escapement, with a steel balance and a helical balance spring. A spiral bimetallic curb acting on this spring was intended to provide the temperature compensation, but this system evidently did not work, as every watch was subsequently altered and improved by Arnold shortly afterwards. Surviving chronometers from this series include Numbers 3, 29 and 28.

Further experimentation and invention by Arnold led to a breakthrough in the late 1770s. He redesigned the compensation balance and developed two designs that showed promise. Known as the "T" and "S" balances, and marked as such in Arnold's 1782 patent (probably because of their appearance), both employed bimetallic strips of brass and steel with weights attached, which changed the radius of gyration with change in temperature. Although these probably needed a lot of adjustment, they appear to have worked well compared to his previous attempts at a compensation balance.

A revolution in precision timekeeping
Around 1777, Arnold redesigned his chronometer, making it larger in order to accommodate the new "T" balance that worked with his pivoted detent escapement and patented helical spring. The first chronometer of this pattern was signed "Invenit et Fecit" and given the fractional number 1 over 36, as it was the first of this new design.

It is generally known as Arnold 36 and was, in fact, the first watch that Arnold called a chronometer, a term that subsequently came into general use and still means any highly accurate watch. The Royal Observatory, Greenwich tested Arnold 36 for thirteen months, from 1 February 1779 to 6 July 1780. The testers placed it in several positions during the trial, and even wore it and carried it around. The watch exceeded all expectations, as it demonstrated great accuracy. The timekeeping error was 2 minutes 32.2 seconds, but the error in the last nine months amounted to just one minute. The greatest error in any 24 hours was only four seconds, or one nautical mile of longitude at the equator.

Subsequently, Arnold produced a pamphlet that detailed the trial and results, with attestations of veracity from all those concerned with the tests. Maskelyne's assistant, the Rev. John Hellins, was in charge of the pamphlet. The astonishing performance of this watch caused controversy, because many thought the result was either a fluke or a "fix" of some kind, particularly as Maskelyne was, effectively, one of Arnold's patrons.

From a technical point of view, however, the design was entirely sound and highly accurate over long periods. Arnold evidently learned the lessons that Harrison had learned before him—using a large, quickly oscillating balance (18,000 beats per hour) with small pivots. Arnold's detent escapement provided minimal interference with the controlling helical balance spring, since the temperature compensation was in the balance itself. Harrison had suggested this as a prerequisite, though he never developed the idea. Arnold's pivoted detent escapement did not need oil on acting surfaces, with the advantage that the rate of action did not deteriorate, and remained stable for long periods. At the time, only vegetable oil was available, which degraded quickly compared to modern lubricants.

This chronometer, 60mm in diameter, is housed in a gold case, and miraculously has survived in perfect and original condition. It can be seen in the collections of the National Maritime Museum, Greenwich, London, having been saved for the nation in 1993.

In Britain, prior to Harrison's marine watch, a small, or very small watch (such as Arnold's ring watch) was generally regarded as the ultimate test of watchmaking skill, especially with regard to complex and accurate watches. Both Harrison and Arnold however, demonstrated that an accurate watch had to be of large diameter, so by the end of the 18th century, a watch of large size was considered the primary characteristic of a well-made and superior watch.

Arnold's second patent of 1782
In 1782, Arnold took out another patent to protect the latest and most important inventions, which were potentially lucrative. Several other watchmakers, most notably Thomas Earnshaw, had started to copy Arnold's work. Around 1780, Earnshaw modified his detent escapement by mounting the detent on a spring to create the spring detent escapement.

During the same period, between 1779 and 1782, Arnold finalized the form of his chronometer watches. Through continuous experimentation, he worked out a way to make an effective but simple form of compensation balance. At the same time, he discovered a simple modification to his helical balance spring that let develop concentrically and, also, confer the property of isochronism on the oscillating balance. Not only this, but adjustments to the compensation balance and the balance spring could be carried out in a simple, calculated way. These were the main subjects of the patent, which he took out in 1782.

The balance consisted of a circular steel balance wheel with two bimetallic strips attached diametrically. Each bimetallic strip terminated with a screw thread mounted with a weight or balance nut. The further along the strip this nut was screwed, the greater the compensating effect. Another part of the patent concerned an addition to the form of the balance spring—a coil of smaller radius at each end of the helical spring, which offered increasing resistance to the rotating balance as it turned towards the end of each vibration. This was an important invention, as it largely eliminated the problem of the positional adjustment of balance controlled watches. This device, known as the Overcoil balance spring, is still used today in most precision mechanical watches.

Another part of the patent concerned the escapement—a modification of Arnold's pivoted detent escapement that essentially mounted the detent on a spring. The specification only shows the part of this escapement that is the method of impulse on the impulse roller.

A 1794 John Arnold pocket chronometer, No. 485/786, substantially rebuilt in 1840, was used by the Belville family from 1835 to 1940 to distribute accurate time to users in London. It had been made, with a gold case, for the Duke of Sussex, who rejected it because it "looked like a bedpan". When Ruth Belville, the "Greenwich time lady", died in 1943 the watch was left to the Worshipful Company of Clockmakers.

Patents and plagiarism
The fact that Arnold had gained great success by modifying the technology of the timekeeper by means of simple yet effective mechanical techniques also meant that other watchmakers could copy these methods and use them without permission. This is why Arnold took out his patents.

Two other makers also made precision watches with the detached escapement: Josiah Emery and John Brockbank. Both were friends of Arnold, and both employed the highly skilled workman and escapement maker Thomas Earnshaw. Josiah Emery used, with Arnold's permission, an earlier form of his compensation balance and helical balance spring, in conjunction with the detached lever escapement of Thomas Mudge. John Brockbank employed Earnshaw to make his pattern of chronometer, but with Brockbank's design of compensation balance.

In 1780, while making these chronometers for Brockbank, Earnshaw modified the pivoted detent by mounting the locking piece on a spring, thus dispensing with the pivots. Arnold managed to see this new idea and promptly took out the 1782 patent for his own design of spring detent, but it is not known whether this preceded Earnshaw's own idea.

Therefore, there has been a great deal of debate over who invented the spring detent escapement, Arnold or Earnshaw. This argument, first initiated by Earnshaw, has been continued by horological historians (such as Rupert Gould) to the present day. However, the argument is irrelevant. In recent years, research has established that Arnold's success was not due to the form of detent escapement, but to his original methods of adjusting the balance spring for positional errors by manipulating the overcoil terminal curve. For obvious reasons, Arnold tried to keep these methods secret; certainly it is recorded that he clearly expressed his concerns about possible plagiarism to Earnshaw, warning him in no uncertain terms not to use his Helical balance spring.

Nevertheless, a year later, in 1783, Earnshaw—through another watchmaker, Thomas Wright—took out a patent that included Earnshaw's pattern of integral compensation balance and spring detent escapement in the multiple specification. However, both of these were undeveloped and compared to Arnold's were of little use, the balance especially having to be redesigned.

Eventually, after much argument, the Board of Longitude granted Earnshaw and Arnold awards for their improvements to chronometers. Earnshaw received £2500 and John Arnold's son, John Roger Arnold, received £1672. The bimetallic compensation balance and the spring detent escapement in the forms designed by Earnshaw have been used essentially universally in marine chronometers since then. For this reason, Earnshaw is also generally regarded as one of the pioneers of chronometer development.

However, because Arnold's balance spring patents were in force (each for 14 years), Earnshaw could not use the helical balance spring until the 1775 patent lapsed in 1789, and, in the case of the 1782 patent, 1796. Until around 1796, Earnshaw made watches with flat balance springs only, but after 1800 practically every marine chronometer, including those by Earnshaw, had a helical spring with terminal overcoils.

Arnold was the first to produce marine and pocket chronometers in significant quantities at his factory at Well Hall, Eltham from around 1783. During the next 14 or 15 years, he produced hundreds before he had any kind of commercial competition. These indicate that authors such as Gould and Sobel are incorrect in their assertion that there was commercial rivalry between Arnold Sr. and Earnshaw.

Arnold and Breguet
The important Swiss French watchmaker Abraham-Louis Breguet became a great friend of Arnold. In 1792, the Duke of Orleans met Arnold in London and showed him one of Breguet's clocks. Arnold was so impressed that he immediately travelled to Paris and sought permission for Breguet to take on his son as his apprentice. Arnold appears to have given Breguet carte blanche to incorporate or develop any of Arnold's inventions and techniques into his own watches.

These included his balance designs, helical springs made of steel or gold, the spring detent escapement, the overcoil balance spring, and even the layout of an Arnold dial design that Breguet incorporated into his own. These were made from engine-turned gold or silver—a pattern that became the classic and distinctive Breguet dial. Arnold's pattern first appeared in 1783, on the enamel dials Arnold designed for his small chronometers, and the proportions and layout of their figuring is identical to that of the classic "Breguet" type of engine-turned metal dials which appeared around 1800, and which were quite unlike anything else made in France or Switzerland at the time.

Arnold and the 'tourbillon'
Arnold also appears to have been the first to think of the concept of the tourbillon; this must have derived from his known work on the recognition and elimination of positional errors. In the tourbillon device, the balance and escapement is continuously rotated and virtually eliminates errors arising from the balance wheel not being perfectly balanced whilst in vertical positions. Arnold appears to have experimented with this idea but died in 1799, before he could develop it further. It is known that Breguet made a successful and practical tourbillon mechanism around 1795 but, nevertheless, he acknowledged Arnold as the inventor by presenting his first tourbillon in 1808 to Arnold's son John Roger. As a tribute to his friend Arnold Sr., he incorporated his first tourbillon mechanism into one of Arnold's early pocket chronometers, Arnold No.11. An engraved commemorative inscription on this watch reads:

 * "The first Tourbillon timekeeper by Breguet incorporated into one of the first works of Arnold. Breguet's homage to the revered memory of Arnold, given to his son AD 1808."

This important and significant watch is now in the British Museum's collection of clocks and watches. By the time of Arnold's death in 1799, he was the most famous watchmaker in the world, recognized for his pre-eminence as the inventor of the precision chronometer.

John Roger Arnold
Arnold's son John Roger Arnold was born in 1769 and served an apprenticeship with both his father and the eminent Swiss-French watchmaker Abraham-Louis Breguet. He became Master of the Worshipful Company of Clockmakers in 1817. From 1787, he and his father founded the company Arnold & Son. After his father's death in 1799, John Roger continued the business, taking John Dent into partnership between 1830 and 1840. After his death in 1843, the company was bought by the horologist Charles Frodsham.

title: John Arnold (watchmaker)