Out-of-hospital cardiac arrest is one of the leading causes of death in Mexico, but many survival and prognostic factors are unknown. The aim of this study was to assess out-of-hospital cardiac arrest in a Mexican city.

This was a prospective, cohort study that evaluated the records of the major ambulance services in the city of Queretaro, Mexico. Means, standard deviation, and percentages for the categorical variables were obtained. Logistic regression was performed to determine the effects between interventions, times, and return of spontaneous circulation (ROSC).

For an 11-month period, 148 out-of-hospital cardiac arrest cases were recorded. The mean age of the victims was 54 ±22.6 years and 90 (65.3%) were males. Forty-nine cases were related to cardiac disease, 46 to other disease, 27 to trauma, 18 to terminal illnesses, and three to drowning. Twelve (8.6%) patients had a pulse upon hospital arrival, but none survived to discharge. No victims were defibrillated prior to ambulance arrival. The collapse-assessment interval was 22.5 ±19:1 minutes, the mean value for the ambulance response times was 13:6 ±10:4 minutes. Basic emergency medical technicians applied chest compressions to 40 victims (27.2%), controlled the airway in 32 (21.8%), and defibrillated seven (4.8%). Chest compressions and airway control showed an OR of 8 and 12 respectively for ROSC.

The poor survival rate in this study emphasizes the need to improve efforts in provider training and public education. Authorities must promote actions to enhance prehospital emergency services capabilities, shorten response times, and provide community education to increase the chances of survival for out-of-hospital cardiac arrest victims in Mexico.

In several Iranian provinces, there are large numbers of landmines that threaten the lives of many civilians. Ilam is one of the most polluted areas with 1,086 injuries from landmines between 1989 to 1999, with an overall mortality rate of 36.4%. A remarkable number of deaths occurred before the injured were conveyed to the hospital. In this survey, the effects of on trauma outcome of the use of prehospital trauma life support provided by t rained paramedics and ru ral health workers as first responders were examined.

In an interventional, prospective study, 4,834 persons (general physicians, nurses, rural health workers, and emergency technicians, high- and low-educated people, layperson villagers, and nomads) were trained in one level of advanced (for general physicians and nurses) and four levels of basic life support courses during two years (2000–2001). Following the training, the data from 288 landmine victims who were referred to the main hospital in Ilam (trauma center) were registered prospectively (2001–2005). The effects of prehospital trauma life support training were assessed by using the Injury Severity Scale (ISS) score and prehospital physiologic severity (PSS) score.

There were 288 injuries from landmines in the Mehran region between 2002 and 2005. The mean ISS score was 20.3 with a median of 13. Forty percent were severely injured with an ISS score >15. Of the injured who received prehospital care at the Mehran Emergency Center, the mean value of the PSS scores was 6.40, which improved to 7.43 in the hospital (p = 0.01; 95% CI for difference -0.72 to -0.45), in comparison with 5.97 in the injured who were conveyed to Ilam Hospital directly (mean of ISS was approximately equal in both groups).The total mort ality rate was 27% between 2001 and 2005.

Prehospital educations and training help improve PSS scores and reduce the death toll of landmine accidents in the remote areas.

A survey was distributed to determine physicians' confidence levels in recognizing potential Category-A bioterrorism disease threats (e.g., smallpox, anthrax), preferred means of obtaining continuing medical education (CME) credits, and their knowledge of the Connecticut Department of Public Health's (DPH) disease reporting requirements.

Surveys were mailed to all physicians in the three-hospital Yale New Haven Health (YNHH) System (2,174) from January to March 2004; there were 820 respondents for a 37.7% response rate.

A total of 71% of physicians indicated that they were “not confident” that they could recognize five of the infectious agents named;they had higher confidence rates for smallpox (48.8%). Infectious diseases and emergency medicine physicians had the highest rates of confidence. Seventy-eight percent of physicians indicated conferences and lectures as their preferred CME learning modality. Nearly 72% of physicians reported a low familiarity with the DPH reporting requirements.

The results highlighted the breadth of perceived weaknesses among clinicians from disease recognition to reporting incidents, which signifies the need for greater training in these areas. As clinicians themselves emphasized their lack of skills and knowledge in this area, there should be a rapid development and dissemination of problem-based learning CME courses in bioterrorism preparedness.

The objective of this study was to evaluate the rapid training of medical students and their ability to provide effective manual ventilation using the bag-valve-mask technique.

A rapid training session highlighting essential aspects of the correct bag-valve-mask technique was given to 31 medical students.This was followed by a simulated experience with a certified respiratory therapist, monitored according to a checklist of essential bag-valve-mask (BVM) competency requirements. Pretest and post-test surveys assessed the medical students' knowledge and ability to provide adequate BVM technique.

Thirty-one students participated. Presurvey results demonstrated a clear identification of the potential risk for a disaster (pandemic, natural, bioterrorist) with 55% of students responding that a definite risk did exist. Their usefulness in such an event also was ascertained with 55% of students replying they would assist with basic medical tasks, assist doctors, or assist with cardiopulmonary resuscitation. Post-survey results administered after a 30-minute didactic session on the basic features of resuscitation equipment and the essential components of BVM technique demonstrated that a majority of students knew the proper head positioning maneuvers in cases not involving trauma (93%) and in cases involving trauma (72%). All students completed and passed the competency checklist.

Medical students can be rapidly trained and be utilized as a potential resource to carry out the potentially lifesaving task of manual ventilation using the BVM technique in a disaster situation in which the availability of mechanical ventilators and respiratory therapists may be limited.

In a cold, wet, or windy environment, cold exposure can be considerable for an injured or ill person. The subsequent autonomous stress response initially will increase circulatory and respiratory demands, and as body core temperature declines, the patient's condition might deteriorate. Therefore, the application of adequate insulation to reduce cold exposure and prevent body core cooling is an important part of prehospital primary care, but recommendations for what should be used in the field mostly depend on tradition and experience, not on scientific evidence.

The objective of this study was to evaluate the thermal insulation properties in different wind conditions of 12 different blankets and rescue bags commonly used by prehospital rescue and ambulance services.

The thermal manikin and the selected insulation ensembles were setup inside a climatic chamber in accordance to the modified European Standard for assessing requirements of sleeping bags. Fans were adjusted to provide low (< 0.5 m/s), moderate (2–3 m/s) and high (8–9 m/s) wind condi-tions. During steady state thermal transfer, the total resultant insulation value, Itr (m2 °C/Wclo; where °C = degrees Celcius, and W = watts), was calculated from ambient air temperature (°C), manikin surface temperature (°C), and heat flux (W/m2).

In the low wind condition, thermal insulation of the evaluated ensembles correlated to thickness of the ensembles, ranging from 2.0 to 6.0 clo (1 clo = 0.155 m2 °C/W), except for the reflective metallic foil blankets that had higher values than expected. In moderate and high wind conditions, thermal insulation was best preserved for ensembles that were windproof and resistant to the compressive effect of the wind, with insulation reductions down to about 60–80% of the original insulation capacity, whereas wind permeable and/or lighter materials were reduced down to about 30–50% of original insulation capacity.

The evaluated insulation ensembles might all be used for prehospital protection against cold, either as single blankets or in multiple layer combinations, depending on ambient temperatures. However, with extended outdoor, on-scene durations, such as during prolonged extrications or in mul-tiple casualty situations, the results of this study emphasize the importance of using a windproof and compression resistant outer ensemble to maintain adequate insulation capacity.

The purpose of this study was to: (1) explore experiences and responses of staff in caring for sheltered, frail, Hurricane Katrina evacuees; and (2) identify how planning and training can be enhanced for staff who may care for frail older populations during and after disasters.

Individual, in-person, semi-structured interviews were conducted with 38 staff members in four nursing homes in Mississippi, sheltering 109 evacuees in November 2005, nine weeks after Hurricane Katrina.Twenty-four were direct care staff, including certified nursing assistants, licensed nurses, dietary aides, and social workers; 14 were support staff, including maintenance and business managers. The number interviewed in each nursing home averaged 9.5 (range 6–15). Using a discussion guide and focusing on their experiences caring for nursing home evacuees, staff were asked to describe: (1) experiences; (2) problems; (3) what helped; and (4) what was learned. Data were processed using grounded theory and thematic analysis. Responses of direct care staff differed in emphasis from those of support staff in several areas; responses from these groups were analyzed separately and together. Three of the researchers identified recurring themes; two organized themes conceptually.

Staff emphasized providing emotional reassurance to evacuees as well as physical care. Many described caring for evacuees as “a blessing,” saying the experience helped them bond with residents, evacuees, and other staff. However, caring for evacuees was difficult because staff members were extremely anxious and in poor physical condition after an arduous evacuation. Challenges included communicating with evacuees' families, preventing dehydration, lack of personal hygiene supplies, staff exhaustion, and emotional needs of residents, evacuees, and staff. Teamwork, community help, and having a well-organized disaster plan, extra supplies, and dependable staff helped personnel cope with the situation.

Staff of nursing homes that sheltered Katrina evacuees demonstrated resilience in the disaster's aftermath. Many placed the well-being of residents as their first priority. Results underscore the importance of planning, teamwork, and adequate supplies and staffing. Training for long-term care staff should emphasize providing emotional support as well as physical care for residents and evacuees during and following disasters. Nurses, social workers, and other staff members responsible for promoting emotional well-being for nursing home residents should be prepared to respond to disasters.

More than half of the world's disasters occur in the Asia-Pacific region. A simulation-based exercise to teach healthcare workers prehospital triage, tagging, and treatment methods was used to link disaster management theory to practice with a student-centered, hands-on educational activity. Various strategies for teaching disaster health education have been advocated, and best-practice disaster education models continue to be sought.

A manikin-based, primary triage and treatment course was adapted for international healthcare providers in the Asia-Pacific region using symbolic representations of triage categories and physical findings. The pedagogical construct that was used was an interactive, formative assessment in which faculty members mediated learner information gathering and interpretation during four simulation scenarios. After establishing a multi-casualty disaster context, a wireless, audience response system anonymously collected learner responses to four clinical situations: (1) leg wound (hemorrhagic shock/immediate); (2) chest wound (tension pneumothorax/immediate); (3) head wound (traumatic brain injury/expectant); and (4) limb trauma (leg fracture/delayed).

There were 182 healthcare providers from eight Asia-Pacific countries (including the US) that participated in four simulation seminars. The simulation sessions were successfully tailored to groups of learners that varied in size and professional composition.Expectant and delayed triage categories posed the greatest challenge to learners. In one of two groups that were queried, learner self-confidence in applying principles of triage and treatment improved significantly. At the conclusion of the simulation sessions, learners strongly agreed that manikin-based simulation improved their understanding of triage, and should be used to teach principles of primary triage and treatment.

Simulation training represents an opportunity to engage learners regardless of language and cultural barriers. Simulation-based training can be effective in introducing healthcare professionals to principles of primary triage and treatment in an effective and culturally sensitive manner.The characteristics of the course with respect to planned formative assessment and culturally competent scholarship were reviewed.

The objective of this study was to report on a nine years of experience of providing medical support during house parties (raves) in the Netherlands, where they can be organized legally.

This was a prospective, observational study of self-referred patients from 1997 to 2005. During raves, first aid stations are staffed with specifically trained medical and paramedical personnel. Self-referred patients were diagnosed, treated, and recorded using standardized methods.

During a nine-year period with 219 raves occurred, involving approximately three million participants, 23,581 patients visited the first aid stations. The medical usage rate (MUR) varied from 59–170 patients per 10,000 rave participants. The mean age increased from 1997 to 2005 from 18.7 ±2.7 to 23.3 ±5.7 years. The mean stay at the first aid station was 18 ±46 minutes. Most health problems were mild. Fifteen cases of severe incidents were observed with one death.

Unique data from the Netherlands demonstrate a low number of serious, health-related, short-term problems during raves.

Despite a global increase in conservative treatment of blunt liver injuries, the number of surgically treated traumas in one major trauma center in Iran has increased. The aim of this study was to unveil the reasons behind this increase in operative management by studying 228 consecutive patients at this regional center.

The increased number of liver injuries operated upon is due to the lack of a solid, well-defined trauma system.

A retrospective review of all patients admitted for liver trauma at Bahonar Hospital, Kerman, Iran, from March 2001 until March 2006 was conducted. Patient data were collected, studied and statistically processed with regard to demographics, clinical and laboratory findings, surgical procedures, complications, and mortality.

All patients who were admitted between 30–360 minutes after injury were included. Twelve hemodynamically stable patients were treated conservatively in an ordinary surgical ward.The remaining 216 patients, 153 of whom had blunt injuries, were hemodynamically unstable. A total of 70 patients were in hemorrhagic shock at the time of arrival. Hemodynamically unstable patients with either the suspicion of associated injuries and/or who displayed clinical deterioration and could not be observed in an ordinary surgical ward were treated surgically. The majority of patients who were operated upon in this series had a grade-II liver injury. The total mortality rate in surgically treated patients was 18.1%. None of the patients treated conservatively died.

Despite the low grade of their liver injuries, the high number of surgically treated patients in this series was due to the absence of a valid trauma system. This result should encourage the authorities to review current trauma systems and trauma surgical guidelines.

The majority of research that has explored workplace violence has focused on establishing the prevalence of violence in different settings. In general, there is a paucity of research that explores factors that may predict or increase the risk of experiencing violence in the workplace.

The aim of this research was to determine predictors of violence for paramedics.

A questionnaire was developed that focused on paramedics' experi-ences with six forms of violence: verbal abuse, property damage/theft, intimi-dation, physical abuse, sexual harassment, and sexual assault.The questionnaire was distributed randomly to paramedics throughout rural Victoria and metropolitan South Australia, and completed and returned anonymously.

Predictors emerged for verbal abuse, intimidation, sexual harassment, and sexual abuse. Specifically, gender was the only predictor of intimidation, sexual harassment, and sexual assault. Paramedic qualifications, how they responded to a call-out, and hours per week in direct patient contact emerged as a predictor of verbal abuse.

Certain factors predict or predispose paramedics to workplace violence. The need for workplace violence education and training is impera-tive for the prevention of violence, as well as for its management.

This study was performed in the Finnish Defense Forces to assess the potential applicability and value of short video clips as educational material to teach advanced airway management and as the first means of introducing the use of a laryngeal tube (LT) or an intubating laryngeal mask (ILMA) to inexperienced, military, first-responder trainees with no prior hands-on experience.

The 60 non-commissioned medical officers participating in this study were randomly assigned into one of two groups: the LT- and the ILMA-group. After viewing the video clips, the trainees were required to perform 10 consecutive, successful insertions of the given instrument into a manikin. The number and duration of the attempts required prior to the 10 consecutive successful insertions were measured.

The goal of 10 consecutive successful insertions was attained by all 30 subjects in the LT-group, and by 27 of 29 subjects in the ILMA-group with a maximum of 30 attempts. Improvement in the ease and speed of insertion was evident between the first and last consecutive insertions in both groups.

“Satisfactory” to “good” skill levels are achieved with the applied video-clip demonstration method, even in inexperienced first-responder trainees lacking previous hands on experience.