Changes in reperfusion strategy over time for ST segment elevation myocardial infarction in the Greater Paris Area: results from the e-MUST Registry.

Background: ESC guidelines recommend a shorter (90 min) delay for the use of primary percutaneous intervention (pPCI) in patients presenting within the first 2h of pain onset. Using registry data on STEMI patients in the Greater Paris Area, we assessed changes between 2003 and 2008 in the rates of pPCI, pre-hospital fibrinolytic therapy (PHF) and time delays in patients presenting within 2h of STEMI pain onset.

Methods: The Greater Paris Area was divided in 3 regions: Paris, the small and large rings.

[The Sino-French emergency and disaster medicine training center].

French (AP-HP) and Chinese (Beijing Health Office) hospitals, with support from the French company Total, collaborated in order to improve Chinese doctors' knowledge of emergency and disaster medicine prior to the Beijing Olympic Games. A Sino-French emergency and disaster medicine training center was subsequently opened in Beijing in 2008, with the aim of providing high-level continuous medical training for Chinese specialists in emergency medicine. Teaching in the management of critical situations was based on the use of a latest-generation simulator (Sim 3G; Laerdal).

[Thromboembolic events and air travel].

Relation between air travel and thromboembolic events is clearly demonstrated. The risk increases for travel of more than 5,000 km. Women are suspected to have an increased risk.

[ST-segment elevation acute coronary syndromes: Prehospital management strategies].

Prehospital management of ST-segment elevation myocardial infarction is a complex issue. Many components are involved, beginning with information of the public on the symptoms of heart attack, up to the choice of the final pathway and destination of the patients, with many intermediate steps including the regulation of emergency calls, the implementation of optimal diagnostic strategies, the choice of reperfusion therapy and of adjuvant medications. In recent years, optimization of these different components has led to improved patients' outcomes in this still life-threatening condition.

[Is there a doctor on board?].

Medical problems during flight have become an important issue as the number of passengers and of miles flown continue to rise. Cabin pressurization causes hypoxia, hypobaria and decreased humidity, which are responsible for most medical incidents occurring during flight. Worldwide daily medical incidents are estimated at 350, i.

Gender as a risk factor for pulmonary embolism after air travel.

It was the objective of this study to confirm the hypothesis that women experience an increased risk of pulmonary embolism (PE) and/or thromboembolic events after long-distance air travel. We systematically reviewed the records of all patients with confirmed pulmonary embolism after arrival at Roissy-Charles-de-Gaulle (CDG) Airport (Paris, France) during a 13-year period. The incidence of PE was calculated as a function of distance travelled and gender using Bayesian conditional probabilities obtained in part from a control population of long-distance travellers arriving in French Polynesia (Tahiti).

[Evaluation of patients' knowledge regarding counsels provided in case of chest pain after an acute myocardial infarction].

Introduction: an early call to the department of urgent medical assistance--Center 15 (SAMU-centre 15) is associated to shortest delays of reperfusion in case of myocardial infarction. However, patients are not always aware of this.

Objective: to assess the assimilated counsels by patients after an acute myocardial infarction.

[Pre-hospital management of acute coronary syndromes with ST elevation in the Ile-de-France Region: the E-MUST registry].

The E-MUST registry gathers patient data from the emergency ambulance service of the IIe-de-France for acute coronary syndromes with ST elevation seen within 24 hours from onset of symptoms. The parameters include the type of emergency phone call, details relative to the different phase of management, decisions of therapeutic strategy concerning pre-hospital thrombolysis or primary angioplasty and the different factors influencing these decisions. From January 2001 to June 2002, the mean delay from the onset of symptoms and the call-out of the emergency ambulance was 67.

Prognostic factors in victims of falls from height.

Objective: Falls from height cause significant mortality in the urban environment, but reliable prognostic factors have not been identified. Even the intuitive relation between the distance fallen and mortality rate has been questioned. Our objective was to determine factors predictive of increased mortality rate in victims of falls from height.

[Determination of early markers of a sanitary event. The example of the heat wave of August 2003 at the Samu 93-centre 15 in France].

Objective: The aim of this study was to determine, a posteriori, the parameters detecting an event in a French medical emergency dispatching centre (SAMU).

Methods: Six parameters were retained: total number of medical requests received by the Samu 93-centre 15: the number of decisions to send a mobile intensive care unit (MICU), number of decisions to send a non-medical unit, number of decisions to send a general practitioner and number of deaths observed by the physicians of the MICU. For each parameter, a daily referential was established over the five previous years (1998 to 2002) and compared with the results of August 2003

Results: The number of decisions to send a non-medical unit and the number of decisions to send a general practitioner were unchanged.

Measurement of carbon monoxide in simulated expired breath.

Background: Environmental carbon dioxide (CO) detectors used as an early warning method have been adapted to measure CO concentration in expired breath. This technique has been validated in smokers with relatively low CO concentrations, but its applicability to poisoning has not been demonstrated.

Objective: To compare the reliability of toxicologically significant CO measurements performed using a portable CO detector with those obtained using infrared spectrometry, the standard method for blood CO concentration determination.

[Victims of fall from height. Study of 287 patients and determination of clinical prognostic factors].

Introduction: Fall from height is a common cause of severe blunt urban trauma but this mechanism of trauma is poorly documented.

Objective: To describe initial clinical parameters, injuries and outcome in patients victims of falls from height and to determinate clinical prognostic factors.

Study Design: Retrospective study from January 1998 to May 1999 and prospective study from June 1999 to September 2000.

[Impact of the law of the 4 March 2002 relative to patients' rights on request for medical information received in a medical dispatching center and mobile intensive care unit (Samu 93)].

Introduction: Law of the 4 March 2002 allowed patient's access to his medical record. This law could increase the number of requests in medical dispatching centers and prehospital intensive care units.

Objective: The aim of this study was to evaluate the impact of this law on the number of requests for medical information received in our unit.

[Thromboembolic events related to travel, with the train too].

Introduction: The risk of thromboembolic events related to travel is not exclusively due to air travel. We report the case of a patient who presented pulmonary embolism after prolonged train travel.

Observation: An 82 Year-old patient had a significant past history of ischemic heart disease.

Stroke associated with pulmonary embolism after air travel.

Prolonged air travel is associated with an increased incidence of thromboembolic events. The occurrence of stroke was studied in patients with pulmonary embolism after air travel in a review of all flights arriving at Charles de Gaulle Airport in Paris during an 8-year period. Thromboembolic stroke and patent foramen ovale were diagnosed in four patients with pulmonary embolus.

[Thoracic trauma].

Approximately 30% of trauma cases include significant chest trauma as a component. The vast majority of chest trauma is related to motor vehicle accidents. A key of management of patients with blunt thoracic trauma is a high index of suspicion for thoracic injury, in particular aortic injury.

[Organization of medical rescue during catastrophes with limited effects occurring in urban areas].

Objective: We conducted a survey regarding the organization of medical rescue during major events (catastrophes with limited effects) occurring in urban areas (Paris and immediate suburbs). The goal of this work was to study the availability of on site medical help and the real needs.Study design - Retrospective survey.

Severe pulmonary embolism associated with air travel.

Background: Air travel is believed to be a risk factor for pulmonary embolism, but the relation between pulmonary embolism and distance flown has not been documented. The aim of this study was to investigate whether the duration of air travel is related to the risk of pulmonary embolism.

Methods: From November 1993 to December 2000, we systematically reviewed all cases of pulmonary embolism requiring medical care on arrival at France's busiest international airport.

[Measurement of carbon monoxide in expired breath in prehospital management of carbon monoxide intoxication].

Introduction: Carbon monoxide detectors are currently used by the French prehospital medical teams. These detectors can also be used to measure expired breath carbon monoxide concentration. The interest of this measurement has never been studied.

[Availability of antidotes in French emergency medical aid units].

Objective: To study the availability of antidotes in French emergency medical aid units (SAMU).

Methods: The physicians or nurses responsible for antidotes in French emergency medical aid units (SAMU) were interviewed by phone. The study involved 102 SAMU in metropolitan France.

Study of the "sniffing position" by magnetic resonance imaging.

Background: The "sniffing position" is widely considered essential to the performance of orotracheal intubation and has become the cornerstone of training in anesthesiology. However, the anatomic superiority of this patient head position has not been established.

Methods: Eight healthy young adult volunteers underwent magnetic resonance imaging scanning in three anatomic positions: head in neutral position, in simple extension, and in the "sniffing position" (neck flexed and head extended by means of a pillow).