Consensus statement: a framework for safe and effective intubation by paramedics.

This consensus statement provides profession-specific guidance in relation to tracheal intubation by paramedics - a procedure that the College of Paramedics supports. Tracheal intubation by paramedics has been the subject of professional and legal debate as well as crown investigation. It is therefore timely that the College of Paramedics, through this consensus group, reviews the available evidence and expert opinion in order to prevent patient harm and promote patient safety, clinical effectiveness and professional standards.

Subsurface absorption of anthropogenic warming of the land surface: the case of the world's largest brickworks (Stewartby, Bedfordshire, UK).

Stewartby works, for a time the world's largest brickworks, began operation around the start of the twentieth century and closed in 2008. Subsurface temperature measurements are available in its vicinity, obtained as part of monitoring of an adjacent landfill in one of the former quarries for the Oxford Clay, which was the raw material for brick manufacture. A striking subsurface temperature anomaly, an increment of ~12°C, was first measured in 2004, and has subsequently decayed over time.

Synergistic wetland treatment of sewage and mine water: pollutant removal performance of the first full-scale system.

Wetland systems are now well-established unit processes in the treatment of diverse wastewater streams. However, the development of wetland technology for sewage treatment followed an entirely separate trajectory from that for polluted mine waters. In recent years, increased networking has led to recognition of possible synergies which might be obtained by hybridising approaches to achieve co-treatment of otherwise distinct sewage and mine-derived wastewaters.

Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST): results from the pilot randomised controlled trial.

Background: High blood pressure (BP) during acute stroke is associated with poorer stroke outcome. Trials of treatments to lower BP have not resulted in improved outcome, but this may be because treatment commenced too late. Emergency medical service staff (paramedics) are uniquely placed to administer early treatment; however, experience of prehospital randomised controlled trials (RCTs) is very limited.

Detection of mixing dynamics during pumping of a flooded coal mine.

In complex hydrogeological environments the effective management of groundwater quality problems by pump-and-treat operations can be most confidently achieved if the mixing dynamics induced within the aquifer by pumping are well understood. The utility of isotopic environmental tracers (C-, H-, O-, S-stable isotopic analyses and age indicators-(14) C, (3) H) for this purpose is illustrated by the analysis of a pumping test in an abstraction borehole drilled into flooded, abandoned coal mineworkings at Deerplay (Lancashire, UK). Interpretation of the isotope data was undertaken conjunctively with that of major ion hydrochemistry, and interpreted in the context of the particular hydraulic setting of flooded mineworkings to identify the sources and mixing of water qualities in the groundwater system.

Phosphorus removal from waste waters using basic oxygen steel slag.

Few studies have characterized reactive media for phosphorus (P) removal in passive treatment systems in terms of both batch and continuous flow experiments. This study uses basic oxygen steel slag (BOS) from a U.K.

Iron and manganese removal in wetland treatment systems: rates, processes and implications for management.

Mine water drainage is a significant environmental problem throughout the world and constructed wetlands are being increasingly used to treat such contaminating discharges. Iron and manganese removal within a wetland treatment system at Whittle Colliery, UK which receives alkaline waters, was monitored to determine rates and processes within the different components of the system. In addition hourly samples were taken for a period of 24 h to determine the effect of photosynthetic organisms on metal removal.

The effect of pH on plant litter decomposition and metal cycling in wetland mesocosms supplied with mine drainage.

The long term effectiveness of compost-based wetland systems treating net-acidic mine waters is reliant upon a continuing supply of decomposed organic matter which provides the basic foodstock for sulphate reducing bacteria. The annual turnover of wetland vegetation within these systems has been suggested to be the primary source for this material once the original substrate has been consumed. This study aimed to determine whether plant litter (of Common Reed, Phragmites australis) decomposition rates and release of metals and nutrients were affected by pH using controlled experiments under laboratory conditions.

Buffering of alkaline steel slag leachate across a natural wetland.

Buffering of high-pH (>12) steel slag leachate is documented across a small, natural calcareous wetland. The alkaline leachate is supersaturated with respect to calcite upstream of the wetland (Sl(calcite) values +2.3) and becomes less saturated with progress across the wetland, to Sl(calcite) values of +0.

Rapid manganese removal from mine waters using an aerated packed-bed bioreactor.

In the UK, the Environmental Quality Standard for manganese has recently been lowered to 30 microg/L (annual average), which is less than the UK Drinking Water Inspectorate's Maximum Permitted Concentration Value (50 microg/L). Current passive treatment systems for manganese removal operate as open-air gravel-bed filters, designed to maximize either influent light and/or dissolved oxygen. This requires large areas of land.

The contribution of science to risk-based decision-making: lessons from the development of full-scale treatment measures for acidic mine waters at Wheal Jane, UK.

The use of risk-based decision-making in environmental management is often assumed to rely primarily on the availability of robust scientific data and insights, while in practice socio-economic criteria are often of considerable importance. However, the relative contributions to decision-making made by scientific and socio-economic inputs are rarely assessed, and even less commonly reported. Such an assessment has been made for a major remediation project in southwest England, in which some 300 l/s of highly acidic, metalliferous mine waters are now being treated using oxidation and chemical neutralisation.

Growth of Phragmites australis (Cav.) Trin ex. Steudel in mine water treatment wetlands: effects of metal and nutrient uptake.

The abandoned mine of Shilbottle Colliery, Northumberland, UK is an example of acidic spoil heap discharge that contains elevated levels of many metals. Aerobic wetlands planted with the common reed, Phragmites australis, were constructed at the site to treat surface runoff from the spoil heap. The presence of a perched water table within the spoil heap resulted in the lower wetlands receiving acidic metal contaminated water from within the spoil heap while the upper wetland receives alkaline, uncontaminated surface runoff from the revegetated spoil.

Hydrochemical stratification in flooded underground mines: an overlooked pitfall.

The fact that flooded underground mines are commonly hydrochemically stratified is often not appreciated. Water samples taken from the water surface in partly flooded shafts are often wrongly assumed to represent the water quality existing throughout the entire water column. In some cases, treatment systems have been designed on the basis of these often misleading water surface samples.

Substrate characterisation for a subsurface reactive barrier to treat colliery spoil leachate.

Subsurface permeable reactive barriers (PRB) have been used to successfully treat acidic mine drainage in Canada and offer great potential for doing the same in the United Kingdom. A PRB for the treatment of colliery spoil leachate from a site near Newcastle upon Tyne, UK, has been designed. The selection of the reactive media to be used is of paramount importance, with particular reference to permeability and reactivity.

Critical role of macrophytes in achieving low iron concentrations in mine water treatment wetlands.

Aerobic wetlands are increasingly being included in mine water treatment systems which need to achieve low residual iron concentrations (<0.5 mg L(-1)) in final discharges. Traditionally the macrophyte components of such systems have been thought to be insignificant sinks for major contaminants such as iron.