Time-Critical Emergencies in Suburban Parks and Outdoor Recreation Spaces.

Objective Prior studies have described the patterns of emergency medical service (EMS) activations in national parks in the United States. However, little data exists regarding EMS activations in local and regional outdoor recreational locations. We performed a retrospective analysis of EMS activations originating from parks and recreational areas in suburban Howard County, Maryland, to characterize those activations determined to be time-critical emergencies.

A Pilot Rapid Triage Process for Prehospital ST-Segment Myocardial Infarction Patients Direct to the Catheterization Lab.

Background Rapid treatment of ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) significantly reduces morbidity and mortality rates. Recent studies emphasize the importance of reducing total ischemic time, making first-medical-contact-to-balloon (FMCTB) time a key performance indicator. To improve FMCTB times in patients brought to the Emergency Department (ED) by Emergency Medical Services (EMS), we implemented a "Direct to Lab" (DTL) workflow during the following conditions: weekday daytime hours, when the lab is fully staffed, and for hemodynamically stable STEMI patients presenting via EMS.

Implementation of a prehospital whole blood program: Lessons learned.

Early blood administration by Emergency Medical Services (EMS) to patients suffering from hemorrhagic shock improves outcomes. Prehospital blood programs represent an invaluable resuscitation capability that directly addresses hemorrhagic shock and mitigates subsequent multiple organ dysfunction syndrome. Prehospital blood programs must be thoughtfully planned, have multiple safeguards, ensure adequate training and credentialing processes, and be responsible stewards of blood resources.

Current Evidence for Infection Prevention and Control Interventions in Emergency Medical Services: A Scoping Review.

Objectives: The aim of this review was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians.

Report And Methods: PubMed, Embase, CINAHL, and SCOPUS were searched from January 1, 2006 through March 15, 2022 for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven (11) observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective.

A review of infectious disease epidemiology in emergency medical service clinicians.

Background: The emergency medical service (EMS) workforce is at high risk of occupationally-acquired infections. This review synthesized existing literature on the prevalence, incidence, and severity of infections in the EMS workforce.

Methods: We searched PubMed, Embase, CINAHL, and SCOPUS from January 1, 2006 to March 15, 2022 for studies in the US that involved EMS clinician or firefighter populations and reported 1 or more health outcomes related to occupationally-acquired infections.

Meditations on Psychoanalysis, Race, and the Divided Self.

The author, an African American, reflects on what it means to be a psychoanalyst and the effectiveness of psychoanalytic thinking in response to the racial dilemma in the United States. The current climate is a result of longstanding inequality of the races and reflects the social unrest prompted by the Black Lives Matter movement and the police killings of unarmed Black people. Three poems are also presented expressing some of the ideas discussed in the meditation.

911 EMS Activations by Pregnant Patients in Maryland (USA) during the COVID-19 Pandemic.

Introduction: In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, United States Emergency Medical Services (EMS) experienced a decrease in calls, and at the same time, an increase in out-of-hospital deaths. This finding led to a concern for the implications of potential delays in care for the obstetric population.

Hypothesis/problem: This study examines the impact of the pandemic on prehospital care amongst pregnant women.

Role of Emergency Medical Services in Disaster Response - National Association of EMS Physicians Position Statement.

This is the official position statement of the National Association of EMS Physicians on the role of emergency medical services (EMS) in disaster response.

A Longitudinal Analysis of a Law Enforcement Intranasal Naloxone Training Program.

Introduction: The opioid crisis continues to claim lives at historically unprecedented levels and shows few signs of abating. One means of mitigating the harm from opioid abuse and unintentional overdose is training and equipping police officers to administer intranasal (IN) naloxone as part of a broader public health response. While an increasing number of state and local agencies have implemented law enforcement officer (LEO) naloxone training programs, due to the novelty of these programs, the evidence of program efficacy is limited.

Liver homing of clinical grade Tregs after therapeutic infusion in patients with autoimmune hepatitis.

Unlabelled: Autoimmune hepatitis (AIH) is an immune-mediated disease with no curative treatment. Regulatory T cell (Treg) therapy is potentially curative in AIH given the critical role of Tregs in preventing autoimmunity. To work effectively, adoptively transferred Tregs must migrate to and survive within the inflamed liver.

Diagnosis Prevalence and Comorbidity in a Population of Mobile Integrated Community Health Care Patients.

Introduction: Frequent calls to 911 and requests for emergency services by individuals place a costly burden on emergency response systems and emergency departments (EDs) in the United States. Many of the calls by these individuals are non-emergent exacerbations of chronic conditions and could be treated more effectively and cost efficiently through another health care service. Mobile integrated community health (MICH) programs present a possible partial solution to the over-utilization of emergency services by addressing factors which contribute to a patient's likelihood of frequent Emergency Medical Services (EMS) use.

Effects of neonicotinoids on putative escape behavior of juvenile wood frogs (Lithobates sylvaticus) chronically exposed as tadpoles.

Neonicotinoids are water-soluble neurotoxic insecticides widely used in agriculture that are being detected in nontarget aquatic environments. Nontarget aquatic wildlife, such as amphibians, may be at risk of exposure. Studies using larval stages suggest neonicotinoids are a minor concern to amphibians; however, behavioral effects manifesting later in life are not often considered.

Challenges to Prehospital Care in Honduras.

Through a longitudinal field experience and interviews with rural and urban clinic workers in Honduras, the following data were collated regarding the challenges to prehospital Emergency Medical Services (EMS) in this country. In Honduras, both private and public organizations provide prehospital emergency care for citizens and face both financial and resource constraints. These constraints manifest in operational concerns such as challenges of integration of EMS systems with each other, differences in medical direction oversight, and barriers to public access.

Sublethal effects on wood frogs chronically exposed to environmentally relevant concentrations of two neonicotinoid insecticides.

Neonicotinoids are prophylactically used globally on a variety of crops, and there is concern for the potential impacts of neonicotinoids on aquatic ecosystems. The intensive use of pesticides on crops has been identified as a contributor to population declines of amphibians, but currently little is known regarding the sublethal effects of chronic neonicotinoid exposure on amphibians. The objective of the present study was to characterize the sublethal effect(s) of exposure to 3 environmentally relevant concentrations (1 μg/L, 10 μg/L, and 100 μg/L) of 2 neonicotinoids on larval wood frogs (Lithobates sylvaticus) using outdoor mesocosms.

Effect of Reverse Triage on Creation of Surge Capacity in a Pediatric Hospital.

Importance: The capacity of pediatric hospitals to provide treatment to large numbers of patients during a large-scale disaster remains a concern. Hospitals are expected to function independently for as long as 96 hours. Reverse triage (early discharge), a strategy that creates surge bed capacity while conserving resources, has been modeled for adults but not pediatric patients.

An Analysis of the Relationship Between the Heat Index and Arrivals in the Emergency Department.

Background: Heatwaves are one of the most deadly weather-related events in the United States and account for more deaths annually than hurricanes, tornadoes, floods, and earthquakes combined. However, there are few statistically rigorous studies of the effect of heatwaves on emergency department (ED) arrivals. A better understanding of this relationship can help hospitals plan better and provide better care for patients during these types of events.

Variables associated with effects on morbidity in older adults following disasters.

Introduction: Older adults are vulnerable to disproportionately higher morbidity following disasters. Reasons for this vulnerability are multifaceted and vary by disaster type as well as patient comorbidities. Efforts to mitigate this increased morbidity require identification of at-risk older adults who can be targeted for intervention.

Assessing pediatric and young adult substance use through analysis of prehospital data.

Introduction: Substance use in young adults is a significant and growing problem. Emergency Medical Services (EMS) personnel often encounter this problem, yet the use of prehospital data to evaluate the prevalence and magnitude of substance abuse has been limited.

Hypothesis/problem: This study evaluated drug and alcohol use through the use of prehospital and EMS data in one suburban county in Maryland (USA).

A fire department community health intervention to prevent carbon monoxide poisoning following a hurricane.

Portable generators are commonly used during electrical service interruptions that occur following large storms such as hurricanes. Nearly all portable generators use carbon based fuels and produce deadly carbon monoxide gas. Despite universal warnings to operate these generators outside only, the improper placement of generators makes these devices the leading cause of engine related carbon monoxide deaths in the United States.

Spatial separation from family in the mobile young of a biparental fish: risks and dynamics of returning home.

In species with extended parental care, mobile dependent young are potentially more vulnerable to predators when they stray and become separated from their parents. We would expect that the likelihood of, and latency time for, a separated young to safely return to its 'family unit' (i.e.

Assessing attitudes toward spinal immobilization.

Background: Prospective studies have improved knowledge of prehospital spinal immobilization. The opinion of Emergency Medical Services (EMS) providers regarding spinal immobilization is unknown, as is their knowledge of recent research advances.

Study Objectives: To examine the attitudes, knowledge, and comfort of prehospital and Emergency Department (ED) EMS providers regarding spinal immobilization performed under a non-selective protocol.

A poor association between out-of-hospital cardiac arrest location and public automated external defibrillator placement.

Introduction: Much attention has been given to the strategic placement of automated external defibrillators (AEDs). The purpose of this study was to examine the correlation of strategically placed AEDs and the actual location of cardiac arrests.

Methods: A retrospective review of data maintained by the Maryland Institute for Emergency Medical Services Systems (MIEMSS), specifically, the Maryland Cardiac Arrest Database and the Maryland AED Registry, was conducted.

Assessment of pulmonary neutrophilic inflammation in emphysema by quantitative positron emission tomography.

Rationale: Neutrophilic inflammation is understood to be of pathogenetic importance in chronic obstructive pulmonary disease (COPD) and may be quantified using 18-fluorodeoxyglucose positron emission tomography-computed tomography ((18)FDG PET-CT) as a noninvasive, spatially informative biomarker.

Objectives: To assess the potential usefulness of (18)FDG PET-CT as a surrogate measure of pulmonary neutrophilic inflammation in patients with usual COPD and α(1)-antitrypsin deficiency (AATD).

Methods: (18)FDG PET-CT imaging was performed in 10 patients with usual COPD, 10 patients with AATD, and 10 healthy control subjects.