Obesity is associated with increased risk of cardiovascular disease (CVD) mortality. CVD is the leading cause of duty-related death among firefighters, and the prevalence of obesity is a growing concern in the Fire Service. Methods. Traditional CVD risk factors, novel measures of cardiovascular health and a measurement of CVD were described and compared between nonobese and obese career firefighters who volunteered to participate in this cross-sectional study. Results. In the group of 116 men (mean age 43 ± 8 yrs), the prevalence of obesity was 51.7%. There were no differences among traditional CVD risk factors or the coronary artery calcium (CAC) score (criterion measure) between obese and nonobese men. However, significant differences in novel markers, including CRP, subendocardial viability ratio, and the ejection duration index, were detected. Conclusions. No differences in the prevalence of traditional CVD risk factors between obese and nonobese men were found. Additionally, CAC was similar between groups. However, there were differences in several novel risk factors, which warrant further investigation. Improved CVD risk identification among firefighters has important implications for both individual health and public safety.
BackgroundOpioid overdoses are at epidemic levels in the United States. Emergency Medical Service (EMS) providers may administer naloxone to restore patient breathing and prevent respiratory arrest. There was a need for contemporary data to examine the number of naloxone administrations in an EMS encounter.MethodsUsing data from the National Emergency Medical Services Information System, we examined data from 2012–5 to determine trends in patients receiving multiple naloxone administrations (MNAs). Logis tic regression including demographic, clinical, and operational information was used to examine factors associated with MNA.ResultsAmong all events where naloxone was administered only 16.7% of the 911 calls specifically identified the medical emergency as a drug ingestion or poisoning event. The percentage of patients receiving MNA increased from 14.5% in 2012 to 18.2% in 2015, which represents a 26% increase in MNA in 4 years. Patients aged 20–29 had the highest percentage of MNA (21.1%). Patients in the Northeast and the Midwest had the highest relative MNA (Chi Squared = 539.5, p < 0.01 and Chi Squared = 351.2, p < 0.01, respectively). The logistic regression model showed that the adjusted odds ratios (aOR) for MNA were greatest among people who live in the Northeast (aOR = 1.18, 95% CI = 1.13–1.22) and for men (aOR = 1.13, 95% CI = 1.10–1.16), but lower for suburban and rural areas (aOR = 0.76, 95% CI = 0.72–0.80 and aOR = 0.85, 95% CI = 0.80–0.89) and lowest for wilderness areas (aOR = 0.76, 95% CI = 0.68–0.84). Higher adjusted odds of MNA occurred when an advanced life support (ALS 2) level of service was provided compared to basic life support (BLS) ambulances (aOR = 2.15, 95% CI = 1.45–3.16) and when the dispatch complaint indicated there was a drug poisoning event (aOR = 1.12, 95% CI = 1.09–1.16). Reported layperson naloxone administration prior to EMS arrival was rare (1%).ConclusionThis study shows that frequency of MNA is growing over time and is regionally dependent. MNA may be a barometer of the potency of the opioid involved in the overdose. The increase in MNAprovides support for a dosage review. Better identification of opioid related events in the dispatch system could lead to a better match of services with patient needs.
Naloxone is less often administered by EMT-basics, who are more common in rural areas. In most states, the scope-of-practice model prohibits naloxone administration by basic EMTs. Reducing this barrier could help prevent drug overdose death.
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