Worldwide, more than 1000 scuba (self-contained underwater breathing apparatus) diving injuries per year requiring hyperbaric recompression are documented. Approximately 80 to 90 fatalities per year are reported in North America. On average, there were 16 diving injuries requiring hyperbaric recompression therapy in scuba divers aged 19 years and younger in North America between 1988 and 2002. The youngest injured diver was 11 years old, and the youngest fatality was 14 years old during this time period. In the year 2000, certifying recreational scuba diving organizations lowered the minimum age to 8 from age 12 years for participation in the sport. We report a case of a highly trained adolescent scuba diver who, despite having advanced diving certifications, had 2 separate episodes of diving-related injuries requiring hyperbaric recompression therapy. A discussion of medical considerations in the care of the child and adolescent scuba diver is included.
Abnormal spirometry was observed in (5.3%) of subjects, particularly individuals experiencing higher Exposure Intensity, Duration, or Respiratory Symptoms. The small number of smokers and subjects failing to wear protective respiratory masks showed greater declines.
We were watching the fire blaze through the North Tower (Tower 1) of the World Trade Center when we saw the second jet strike the South Tower (Tower 2). The mood in the offices of the New York City Police Department (NYPD) Medical Division was one of disbelief. We realized we were facing probably the largest multicasualty incident in the city's history. Almost immediately, NYPD headquarters issued a level three (highest) mobilization order and the entire NYPD was deployed.The World Trade Center incident was technically an 'aircraft crash', which meant the Fire Department of New York (FDNY) were to assume command and control. The FDNY Emergency Medical Services (EMS) command assumed responsibility for patient triage, assessments, management, and transport. The command center was established in the lobby of the South Tower (Tower 2). Search and rescue became the primary focus of the response but this could only be achieved if the disaster was also contained and controlled. All this required the full deployment of personnel and resources from both the FDNY and the NYPD. Initial impressions and demandsSeveral issues had to be dealt with immediately and simultaneously: controlling and containing the fires, dealing with the possibility of collateral building collapses, mobilizing triage at numerous locations, stabilizing and mobilizing the anticipated vast numbers of casualties, and conducting search and rescue efforts. However, at first, chaos and confusion reigned. This was initially because communications were severely hampered by the loss of local telephone services and the onset of overwhelming cellular phone traffic. But this initial confusion was minor compared with the huge loss of personnel and resources as the FDNY command center was buried when the South Tower (Tower 2) collapsed.Command and control was further hampered by the physical characteristics of the area. The World Trade Center site (17 acres) was effectively divided into two areas (north and south) by an unstable partially collapsed pedestrian walkway. The rubble formed 'mountains' and 'valleys' that were dangerous and unstable to walk on. Some of the debris piled three to four storeys high with 50 foot (16 m) AbstractThe World Trade Center attack cast some physicians in roles outside their usual hospital practice. The incident required several physicians to function in the dangerous environment of the disaster. Priorities and triage strategies established by the police, emergency medical service and fire departments, while adhered to, required instantaneous modification and upgrading given the vast loss of civilian and rescue personnel lives. Many civilian medical staff presented themselves with good intentions but needed to be placed out of the collapse zone for fear of incurring additional casualties. In addition, problems with re-establishment of command and control, communications, personnel and equipment replacement all impacted on the rescue effort. This article recounts the roles played by the two coauthors during the World Trade Center a...
Background: Acute respiratory failure (ARF) has become one of the most prevalent serious pathologies encountered in the emergency medical service (EMS). In hospital settings, noninvasive ventilation (NIV) therapy prevents complications from more aggressive treatments for that condition. However, the scarce evidence on the benefits of NIV in prehospital EMS (i.e., during transport to the hospital) is inconclusive. Objectives: To determine whether the administration of NIV during prehospital EMS in cases of ARF reduces in-hospital mortality compared with starting NIV on arrival to in-patient EMS. Methods: This is a multicentre, observational, prospective cohort study. We recruited a total of 317 patients from the Madrid region (Spain) who were prescribed NIV for their ARF using a nonprobabilistic consecutive sampling method. Analyses of the main outcome (in-hospital mortality) and secondary outcomes (length of hospital stay, readmissions, percentage of intensive care unit admissions, and costeffectiveness) will include descriptive analyses of patients' characteristics, as well as bivariate and multivariate analyses and cost-effectiveness analysis. Discussion: This study will provide data on NIV management in prehospital and in-patient EMS in patients with ARF. Results will contribute to the existing evidence on the benefits of NIV in the context of prehospital EMS while underlining the importance of a standardized formal training for physicians and nurses working in prehospital and in-patient EMSs. Conclusion:The VentilaMadrid study will provide valuable data on the clinical factors of patients receiving NIV in prehospital EMS. Further, were our hypothesis to be confirmed, our results would strongly suggest that the administration of NIV in prehospital EMS by medical and nursing profesionals formally trained in the technique reduces mortality and improves prognoses.
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