Detailed Analysis of Prehospital Interventions in Medical Priority Dispatch System Determinants

Background: Medical Priority Dispatch System (MPDS) is a type of Emergency Medical Dispatch (EMD) system used to prioritize 9-1-1 calls and optimize resource allocation. Dispatchers use a series of scripted questions to assign determinants to calls based on chief complaint and acuity.Objective: We analyzed the prehospital interventions performed on patients with MPDS determinants for breathing problems, chest pain, unknown problem (man down), seizures, fainting (unconscious) and falls for transport status and interventions.Methods: We matched all prehospital patients in complaint-based categories for breathing problems, chest pain, unknown problem (man down), seizures, fainting (unconscious) and falls from January 1, 2004, to December 31, 2006, with their prehospital record. Calls were queried for the following prehospital interventions: Basic Life Support care only, intravenous line placement only, medication given, procedures or non-transport. We defined Advanced Life Support (ALS) interventions as the administration of a medication or a procedure.Results: Of the 77,394 MPDS calls during this period, 31,318 (40%) patients met inclusion criteria. Breathing problems made up 12.2%, chest pain 6%, unknown problem 1.4%, seizures 3%, falls 9% and unconscious/fainting 9% of the total number of MPDS calls. Patients with breathing problem had a low rate of procedures (0.7%) and cardiac arrest medications (1.6%) with 38% receiving some medication. Chest pain patients had a similar distribution; procedures (0.5%), cardiac arrest medication (1.5%) and any medication (64%). Unknown problem: procedures (1%), cardiac arrest medication (1.3%), any medication (18%). Patients with Seizures had a low rate of procedures (1.1%) and cardiac arrest medications (0.6%) with 20% receiving some medication. Fall patients had a lower rate of severe illness with more medication, mostly morphine: procedures (0.2%), cardiac arrest medication (0.2%), all medications (28%). Unconscious/fainting patients received the following interventions: procedures (0.3%), cardiac arrest medication (1.9%), all medications (32%). Few stepwise increases in the rate of procedures or medications were seen as determinants increased in acuity.Conclusion: Among these common MPDS complaint-based categories, the rates of advanced procedures and cardiac arrest medications were low. ALS medications were common in all categories and most determinants. Multiple determinants were rarely used and did not show higher rates of interventions with increasing acuity. Many MPDS determinants are of modest use to predict ALS intervention. [West J Emerg Med. 2011;12(1):19-29.

Oscillatory Flows Induced by Microorganisms Swimming in Two-dimensions

We present the first time-resolved measurements of the oscillatory velocity field induced by swimming unicellular microorganisms. Confinement of the green alga C. reinhardtii in stabilized thin liquid films allows simultaneous tracking of cells and tracer particles. The measured velocity field reveals complex time-dependent flow structures, and scales inversely with distance. The instantaneous mechanical power generated by the cells is measured from the velocity fields and peaks at 15 fW. The dissipation per cycle is more than four times what steady swimming would require.Comment: 4 pages, 4 figure

Measuring Oscillatory Velocity Fields Due to Swimming Algae

Single cells exhibit a diverse array of swimming strategies at low Reynolds number to search for nutrients, light, and other organisms. The fluid flows generated by their locomotion are important to understanding biomixing and interactions between cells in suspension..

Oscillatory Flows Induced by Microoganisms Swimming in Two Dimensions

We present the first time-resolved measurements of the oscillatory velocity field induced by swimming unicellular microorganisms. Confinement of the green alga C. reinhardtii in stabilized thin liquid films allows simultaneous tracking of cells and tracer particles. The measured velocity field reveals complex time-dependent flow structures, and scales inversely with distance. The instantaneous mechanical power generated by the cells is measured from the velocity fields and peaks at 15 fW. The dissipation per cycle is more than 4 times what steady swimming would require

Promises Made, Promises Kept: The Practical Implications of the Private Securities Litigation Reform Act of 1995

This Article suggests approaches that can be taken in addressing the pragmatic concerns of companies with regard to the Private Securities Litigation Reform Act of 1995. These concerns include what form companies\u27 disclosures should take in order to secure the protection of the safe harbor. They also include a need for concrete guidance on the day-to-day response to obligations that are newly required by this statute. Individual directors of companies have no blueprint as to how their boards should respond to this new legislation. This Article provides practical approaches for directors

Potential mammalian filovirus reservoirs

Centers for Disease Control and Prevention http://www.cdc.gov/ncidod/EID/vol10no12/04-0346.htmEbola and Marburg viruses are maintained in unknown reservoir species; spillover into human populations results in occasional human cases or epidemics. We attempted to narrow the list of possibilities regarding the identity of those reservoir species. We made a series of explicit assumptions about the reservoir: it is a mammal; it supports persistent, largely asymptomatic filovirus infections; its range subsumes that of its associated filovirus; it has coevolved with the virus; it is of small body size; and it is not a species that is commensal with humans. Under these assumptions, we developed priority lists of mammal clades that coincide distributionally with filovirus outbreak distributions and compared these lists with those mammal taxa that have been tested for filovirus infection in previous epidemiologic studies. Studying the remainder of these taxa may be a fruitful avenue for pursuing the identity of natural reservoirs of filoviruses

Geographic potential for outbreaks of Marburg hemorrhagic fever

Am. J. Trop. Med. Hyg., 75(1), 2006, pp. 9–15 Copyright © 2006 by The American Society of Tropical Medicine and Hygiene 9 http://www.ajtmh.org/cgi/content/abstract/75/1/9Marburg virus represents one of the least well-known of the hemorrhagic fever-causing viruses worldwide; in particular, its geographic potential in Africa remains quite mysterious. Ecologic niche modeling was used to explore the geographic and ecologic potential of Marburg virus in Africa. Model results permitted a reinterpretation of the geographic point of infection in the initiation of the 1975 cases in Zimbabwe, and also anticipated the potential for cases in Angola, where a large outbreak recently (2004–2005) occurred. The geographic potential for additional outbreaks is outlined, including in several countries in which the virus is not known. Overall, results demonstrate that ecologic niche modeling can be a powerful tool in understanding geographic distributions of species and other biologic phenomena such as zoonotic disease transmission from natural reservoir populations