Comments (0) This is an interesting article by Laurie Barclay, MD posted on medscape.com. Click here to read.
If you don’t have an account on medscape.com or emedicine.com, I would highly recommend signing up. These are great sites for medical news and research. eMedicine has a CME case study email newsletter that is aimed more at physicians, but is a good exercise in critical thinking.
Another aeromedical tragedy occurred near Brownsville, TN early Thursday morning resulting in the loss of pilot Doug Phillips and nurses Misty Brogdon and Cindy Parker. Read more from WREG here.
The flight was operated by Hospital Wing.
This company information was gathered from the company’s website:
“‘The Wing’ is a non-profit air medical transport which provides inter-hospital transfers as well as emergency scene calls within 150 mile radius of Memphis. This area includes West Tennessee, Arkansas, Mississippi, Missouri, Alabama, and Kentucky.
Hospital Wing owns 5 helicopters equipped to transport critically ill and injured patients. Three helicopters are staffed 24 hours a day, seven days a week and one helicopter is available for PediFlite.
‘The Wing’ transports an average of 150 patients per month with 60% of these being trauma related. Scene flights account for approximately 35% of these transports.”
Our sincere condolences go out to the family and friends of those brave crew members who lost their lives in the line of duty.
News Release from the World Health Organization Website:
18 MARCH 2010 | GENEVA | WASHINGTON DC — In some areas of the world, one in four people with tuberculosis (TB) becomes ill with a form of the disease that can no longer be treated with standard drugs regimens, a World Health Organization (WHO) report says.
For example, 28% of all people newly diagnosed with TB in one region of north western Russia had the multidrug-resistant form of the disease (MDR-TB) in 2008. This is the highest level ever reported to WHO. Previously, the highest recorded level was 22% in Baku City, Azerbaijan, in 2007.
In the new WHO’s Multidrug and Extensively Drug-Resistant Tuberculosis: 2010 Global Report on Surveillance and Response, it is estimated that 440 000 people had MDR-TB worldwide in 2008 and that a third of them died. In sheer numbers, Asia bears the brunt of the epidemic. Almost 50% of MDR-TB cases worldwide are estimated to occur in China and India. In Africa, estimates show 69 000 cases emerged, the vast majority of which went undiagnosed.
Encouraging signs
Tuberculosis programmes face tremendous challenges in reducing MDR-TB rates. But there are encouraging signs that even in the presence of severe epidemics, governments and partners can turn around MDR-TB by strengthening efforts to control the disease and implementing WHO recommendations.
Two regions in the Russian Federation, Orel and Tomsk, have achieved a remarkable decline in MDR-TB in about five years. These regions join two countries, Estonia and Latvia, which have reversed rising high rates of MDR-TB, ultimately achieving a decline. The United States of America and China, Hong Kong Special Administrative Region (SAR), have achieved sustained successes in controlling MDR-TB.
Slow progress
Progress remains slow in most other countries. Worldwide, of those patients receiving treatment, 60% were reported as cured. However, only an estimated 7% of all MDR-TB patients are diagnosed. This points to the urgent need for improvements in laboratory facilities, access to rapid diagnosis and treatment with more effective drugs and regimens shorter than the current two years.
WHO is engaged in a five year project to strengthen TB laboratories with rapid tests in nearly 30 countries. This will ensure more people benefit early from life-saving treatments. It is also working closely with the Global Fund to Fight AIDS, Tuberculosis and Malaria and the international community on increasing access to treatment.
Additional information
Multidrug-resistant TB (MDR-TB) is caused by bacteria that are resistant to at least isoniazid and rifampicin, the most effective anti-TB drugs. MDR-TB results from either primary infection with resistant bacteria or may develop in the course of a patient’s treatment.
Extensively drug-resistant TB (XDR-TB) is a form of TB caused by bacteria that are resistant to isoniazid and rifampicin (i.e. MDR-TB) as well as any fluoroquinolone and any of the second-line anti-TB injectable drugs (amikacin, kanamycin or capreomycin).
These forms of TB do not respond to the standard six-month treatment with first-line anti-TB drugs and can take up to two years or more to treat with drugs that are less potent, more toxic and much more expensive, from 50 to 200 times higher. While a course of standard TB drugs cost approximately US$ 20, MDR-TB drugs can cost up to US$ 5 000, and XDR-TB treatment is far more expensive.
In 2008, there were an estimated 9.4 million new TB cases, and 1.8 million TB deaths. 440 000 MDR-TB cases are estimated to have emerged in the same year with 150 000 MDR-TB deaths. No official estimates have been made on the number of XDR-TB cases, but there may be around 25 000 a year with most cases fatal. Since XDR-TB was first defined in 2006, a total of 58 countries have reported at least one case of XDR-TB.
Funding MDR-TB control
In 27 high burden countries (i.e. countries estimated to have had at least 4000 MDR-TB cases arising annually and/or at least 10% of newly registered TB cases with MDR-TB), 1.3 million M/XDR-TB cases will need to be treated between 2010 and 2015 at a cost of US$ 16 billion over six years, rising from US$ 1.3 billion in 2010 to US$ 4.4 billion in 2015. Planned budget for 2010 are far below these figures, amounting to less than US$ 0.5 billion for all 27 countries. Actual funding available for 2010 was US$ 280 million. Funding needed for MDR-TB control in 2015 will be 16 times higher than what is currently available in 2010.
Strengthening laboratories
There is an urgent need to expand and accelerate in countries access to new, rapid technologies that can diagnose MDR-TB in two days rather than traditional methods which can take up to four months. EXPAND TB is a five year project targeting 27 countries, launched in 2008 and implemented by WHO, the Foundation for Innovative New Diagnostics (FIND), the Stop TB Partnership’s Global Drug Facility (GDF) and the Global Laboratory Initiative (GLI) with financial support from UNITAID. So far it has carried out a wide range of activities in 12 countries, including upgrading of infrastructure and training of staff. Technology transfer has started in countries, paving the way for more patients to be diagnosed accurately and rapidly enrolled on treatment. These upgrades should lead to eventual routine surveillance of drug resistance in affected countries.
Countries and case studies
Six countries are featured throughout the report in special focus sections. Bangladesh (one of the very few developing countries in which continuous surveillance among previously treated TB cases is being carried out in selected areas); China (first nationwide drug resistance survey conducted); Ethiopia (one of the first countries to introduce rapid molecular laboratory tests); Nepal and Romania (successful treatments of MDR-TB through Green Light Committee Initiative programmes); South Africa (policy changes for improving the management and care of M/XDR-TB).
MDR-TB in Africa
In Africa, there is a low percentage of MDR-TB reported among new TB cases compared with that in regions such as Eastern Europe and Central Asia, due in part to the limited laboratory capacity to conduct drug resistance surveys. Latest estimates of WHO put the number of MDR-TB cases emerging in 2008 in Africa at 69 000. Previous reports found high levels of mortality among people living with HIV and infected with MDR-TB and XDR-TB. In KwaZulu Natal in South Africa, an outbreak of XDR-TB killed 52 out of 53 people within three weeks, most of whom were HIV positive.
Risk factors: HIV and MDR-TB
Studies show that TB patients co-infected with HIV in three Eastern European countries (Estonia, Latvia, and the Republic of Moldova) were at a higher risk of having MDR-TB compared to TB patients without HIV infection. Similar findings have been made in studies from Lithuania, Ukraine and Mozambique.
The report highlights several reasons why drug-resistant TB may be associated with HIV, particularly in some Eastern European countries. However, more research is needed to determine whether there is an overlap between the MDR-TB and HIV epidemics worldwide.
Reporting on MDR-TB globally
This report presents drug resistance data from 114 countries and updated information from 35 of them. Despite the growing understanding of the magnitude and trends in drug-resistant TB, major gaps remain in geographical areas covered. Since 1994, only 59% of all countries globally have been able to collect high quality representative data on drug resistance. There is an urgent need to obtain information, particularly from Africa and those high MDR-TB burden countries where data have never been reported: Bangladesh, Belarus, Kyrgyzstan, Pakistan and Nigeria. Moreover, countries need to expand the scope of their surveys to cover entire populations, repeat surveys are needed to better understand trends in drug resistance and countries need to move towards adopting systematic continuous surveillance.
For more information contact:
Glenn Thomas – Communication Officer
Stop TB, WHO
Mobile phone: +41 79 509 0677
E-mail: thomasg@who.int
CDC, Emergency Preparedness and Response:
Current patterns in worldwide terrorist activity have increased the potential for casualties related to explosions, yet few civilian emergency medical service providers in the United States have experience treating patients with these injuries. One direct consequence of high-explosive detonations upon the body is blast lung injury—or, BLI. It is characterized by respiratory difficulty and hypoxia. BLI can occur, although rarely, without obvious external chest injury. Persons in enclosed-space explosions or in close proximity to the explosion are at highest risk. BLI presents unique triage, diagnostic, and management challenges.
Click here to read an important article published in JEMS about misplacing ET tubes. Article courtesy of Bryan Bledsoe D.O., F.A.C.E.P., EMT-P. This literature is for educational purposes only.
March 11, 2010 – By Matt Richtel
They are the most wired vehicles on the road, with dashboard computers, sophisticated radios, navigation systems and cellphones.
While such gadgets are widely seen as distractions to be avoided behind the wheel, there are hundreds of thousands of drivers — police officers and paramedics — who are required to use them, sometimes at high speeds, while weaving through traffic, sirens blaring.
The drivers say the technology is a huge boon for their jobs, saving valuable seconds and providing instant access to essential information. But it also presents a clear risk — even the potential to take a life while they are trying to save one.
Philip Macaluso, a New York paramedic, recalled a moment recently when he was rushing to the hospital while keying information into his dashboard computer. At the last second, he looked up from the control panel and slammed on his brakes to avoid a woman who stepped into the street.
“There is a potential for disaster here,” Mr. Macaluso said. Data does not exist about crashes caused by police officers or medics distracted by their devices. But there are tragic anecdotes.
In April 2008, an emergency medical technician in West Nyack, N.Y., looked at his GPS screen, swerved and hit a parked flatbed truck. The crash sheared off the side of the ambulance and left his partner, who was in the passenger seat, paralyzed.
In June 2007, a sheriff’s deputy in St. Clair County, Ill., was driving 35 miles per hour when a dispatcher radioed with an assignment. He entered the address into the mapping system and then looked up, too late to avoid hitting a sedan stopped in traffic. Its driver was seriously injured.
Ambulances and police cars are becoming increasingly wired. Some 75 percent of police cruisers have on-board computers, a figure that has doubled over the last decade, says David Krebs, an industry analyst with the VDC Research Group. He estimates about 30 percent of ambulances have such technology.
The use of such technology by so-called first responders comes as regulators, legislators and safety advocates seek to limit the use of gadgets by most drivers. Police officers, medics and others who study the field say they are searching to find the right balance between technology’s risks and benefits.
The computers allow police, for example, to check license plate data, find information about a suspect and exchange messages with dispatchers. Ambulances receive directions to accident scenes and can use the computers to send information about the patient before they arrive at hospitals.
“The technology is enormously beneficial,” said Jeffrey Lindsey, a retired fire chief in Florida who now is an executive at the Health and Safety Institute, which provides continuing education for emergency services workers.
But he said first responders generally did not have enough training to deal with diversions that could be “almost exponential” compared with those faced by most drivers.
The New York Fire Department, which coordinates the city’s largest ambulance system, said drivers were not supposed to use on-board computers in traffic. That is the role of the driver’s partner, and if the partner is in the back tending to a patient, the driver is supposed to use devices before speeding off.
“There’s no need for our drivers to get distracted, because the system has evolved to keep safety paramount,” said Jerry Gombo, assistant chief for emergency service operations at the Fire Department. Drivers do get into accidents, he said, but he couldn’t remember a single one caused by distraction from using a computer.
He also estimates the technology saves 20 to 30 seconds per call. “There’s no doubt we’re having quicker response time,” Mr. Gombo added.
But in interviews, medics and E.M.T.’s in New York and elsewhere say that although they are aware of the rules, they do use their on-board computers while driving because they can’t wait for certain information.
States that ban drivers from texting or using hand-held phones tend to exempt first responders. And in many places where even they are forbidden to use cellphones behind the wheel, the edict is often ignored.
“My partner was checking baseball scores as he was driving a patient to the hospital. I looked through the passageway and said, ‘You’ve got to stop that right now,’ ” recalls Greg Friese, a paramedic in central Wisconsin, who was treating a patient in the back. Mr. Friese also develops online training programs for medics, E.M.T.’s, police officers and firefighters.
“We’re dealing with the carnage, which ranges from the trivial to the tragic, of distracted driving,” he said. “We should know better.”
For police officers, there are reasons to constantly be checking a dashboard computer. They might check a license plate of a car they are tailing by using a keyboard to call up a screen, typing in the plate number, then reading more about the owner.
“There’s no way you could do this without eventually running into something,” said Officer Shawn Chase, a spokesman for the California Highway Patrol, as he demonstrated use of the Gateway computer in a cruiser. And yet, he said, he has tried it, and others have, too.
“The first time you almost rear-end something, you say, ‘Whoa, I better not do this,’ ” he said. “You learn quick.”
Researchers are working to reduce the risk. At the University of New Hampshire, backed by $34 million in federal financing, they have been developing hands-free technology for police cars.
The systems let officers use voice commands to operate the radio, lights and sirens and even speak a license-plate number into the on-board computer, which can then announce through a speaker basic information about the car. To activate voice commands, the officer must push a button on the steering wheel.
“I can literally drive down the road, speak without holding the microphone, and turn on the lights and sirens without ever looking at the equipment,” said Captain John G. LeLacheur of the New Hampshire State Police, who has driven one of the 1,000 police cruisers nationwide, mostly in New Hampshire and other Northeast states, equipped with the new technology.
Mr. LeLacheur said it sometimes failed to pick up his voice. “If it’s not doing what I want, I bypass it and do things the old-fashioned way,” he said.
Another system uses digital video systems that can automatically read license plates in front of and behind police cruisers, and then check for things like unregistered plates and stolen vehicles.
The solutions aren’t cheap, particularly for struggling state and local governments. A license-plate reader system from Panasonic can cost $8,000 for each car, including a $3,000 to $5,000 laptop.
“We can barely get patrol cars and motorcycles,” said Mr. Chase of the California Highway Patrol. Referring to the hands-free devices, he said, “We’ve love to get this technology, but there are trade-offs.”
Reproduced with permission from www.firefighterclosecalls.com and www.emsclosecalls.com
CDC Emergency Preparedness & Response
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