Variations in the California Emergency Medical Services Response to Opioid Use Disorder

Introduction: Opioids contributed to over 300,000 deaths in the United States in the past 10 years. Most research on drug use occurs in clinics or hospitals; few studies have evaluated the impact of opioid use on emergency medical services (EMS) or the EMS response to opioid use disorder (OUD). This study describes the perceived burden of disease, data collection, and interventions in California local EMS agencies (LEMSA). Methods: We surveyed medical directors of all 33 California LEMSAs with 25 multiple-choice and free-answer questions. Results were collected in RedCap and downloaded into Excel (Microsoft Corporation, Redmond WA). This study was exempt from review by the Alameda Health System - Highland Hospital Institutional Review Board. Results: Of the 33 California LEMSAs, 100% responded, all indicating that OUD significantly affects their patients. Most (91%) had specific protocols directing care of those patients and repeat naloxone dosing. After naloxone administration, none permitted release to law enforcement custody, 6% permitted patient refusal of care, and 45% directed base hospital contact for refusal of care. Few protocols directed screening or treatment of OUD or withdrawal symptoms. Regular data collection occurred in 76% of LEMSAs, with only 48% linking EMS data with hospital or coroner outcomes. In only 30% did the medical director oversee regular quality improvement meetings. Of respondents, 64% were aware of public health agency-based outreach programs and 42% were aware of emergency department BRIDGE programs (Medication Assisted Treatment and immediate referral). Only 9% oversaw naloxone kit distribution (all under the medical director), and 6% had EMS-based outreach programs. In almost all (94%), law enforcement officers carried naloxone and administered it anywhere from a few times a year to greater than 200 in one LEMSA. Conclusion: This study represents an important description of EMS medical directors' approaches to the impact of OUD as well as trends in protocols and interventions to treat and prevent overdoses. Through this study, we can better understand the variable response to patients with OUD across California

Differing Air Traffic Controller Responses to Similar Trajectory Prediction Errors: An Interrupted Time-Series Analysis of Controller Behavior

A Human-In-The-Loop simulation was conducted in January of 2013 in the Airspace Operations Laboratory at NASAs Ames Research Center. The simulation airspace included two en route sectors feeding the northwest corner of Atlantas Terminal Radar Approach Control. The focus of this paper is on how uncertainties in the studys trajectory predictions impacted the controllers ability to perform their duties. Of particular interest is how the controllers interacted with the delay information displayed in the meter list and data block while managing the arrival flows. Due to wind forecasts with 20-knot over-predictions and 20-knot under-predictions, delay value computations included errors of similar magnitude, albeit in opposite directions. However, when performing their duties in the presence of these errors, did the controllers issue clearances of similar magnitude, albeit in opposite directions

UAS Traffic Management (UTM) Simulation Capabilities and Laboratory Environment

NASA has engaged in collaborative research with the FAA to explore the concepts and requirements necessary to enable the safe and scalable application of small unmanned aircraft systems (UAS) in low-altitude airspace. In this effort, the UAS Traffic Management (UTM) project has developed a multi-faceted simulation component that supports near-term live flight testing in addition to further term concept exploration. This paper provides an overview of the simulation capabilities currently available as part of the UTM project and the laboratory environment in which they are applied

An Integrated Tool Suite for En Route Radar Controllers in NextGen

This paper describes recent human-in-the-loop research in the Airspace Operations Laboratory at the NASA Ames Research Center focusing on en route air traffic management with advanced trajectory planning tools and increased levels of human-automation cooperation. The decision support tools were exercised in a simulation of seven contiguous high-altitude sectors. Preliminary data suggests the controllers were able to manage higher amounts of traffic as compared to today, while maintaining acceptable levels of workload

Case Study: Influences of Uncertainties and Traffic Scenario Difficulties in a Human-in-the-Loop Simulation

This paper presents a case study of how factors such as wind prediction errors and metering delays can influence controller performance and workload in Human-In-The-Loop simulations. Retired air traffic controllers worked two arrival sectors adjacent to the terminal area. The main tasks were to provide safe air traffic operations and deliver the aircraft to the metering fix within +/- 25 seconds of the scheduled arrival time with the help of provided decision support tools. Analyses explore the potential impact of metering delays and system uncertainties on controller workload and performance. The results suggest that trajectory prediction uncertainties impact safety performance, while metering fix accuracy and workload appear subject to the scenario difficulty

Naming is Power: Citation Practices in SoTL

Citing is a political act. It is a practice that can work both sides of the same coin: it can give voice, and it can silence. Through this research, we call for those contributing to the scholarship of teaching and learning (SoTL) to attend to this duality explicitly and intentionally. In this multidisciplinary field, SoTL knowledge-producers bring the citation norms of their home disciplines, a habit that calls for interrogation and negotiation of the citation practices used in this shared space. The aim of our study was to gather data about how citation is practiced within the SoTL community: who we cite, how we cite, and what values, priorities, and politics are conveyed in these practices. We were also interested in whether any self-selected categories of identity (e.g., gender, career stage) related to self-described citation practices and priorities. Findings suggest several statistically significant relationships did emerge, which we identify as important avenues for further research and writing. We conclude with 10 principles of citation practices in SoTL.

Human Centered Decision Support Tools for Arrival Merging and Spacing

A simulation of terminal area merging and spacing with air traffic controllers and commercial flight crews was conducted. The goal of the study was to assess the feasibility and benefits of ground and flight-deck based tools to support arrival merging and spacing operations. During the simulation, flight crews arrived over the northwest and southwest arrival meter fixes and were cleared for the flight management system arrivals to runways 18 and 13 right. The controller could then clear the aircraft to merge behind and space with an aircraft on a converging stream or to space behind an aircraft on the same stream of traffic. The controller remained responsible for aircraft separation. Empirical research was performed to assess air and ground tools and the effects of mixed equipage. During the all tools conditions, 75% of the arrivals were equipped for merging and spacing. All aircraft were ADS-B equipped and flew charted FMS routes which were coordinated based on wake turbulence separation at the arrival runway. The aircraft spacing data indicate that spacing and merging were improved with either air or ground based merging and spacing tools, but performance was best with airborne tools. Both controllers and pilots exhibited low to moderate workload and both reported benefits from the concept

How Important is Conflict Detection to the Conflict Resolution Task?

To determine the capabilities and limitations of human operators and automation in separation assurance roles, the second of three Human-in-the-Loop (HITL) part-task studies investigates air traffic controllers ability to detect and resolve conflicts under varying task sets, traffic densities, and run lengths. Operations remained within a single sector, staffed by a single controller, and explored, among other things, the controllers conflict resolution performance in conditions with or without their involvement in the conflict detection task. Whereas comparisons of conflict resolution performance between these two conditions are available in a prior publication, this paper explores whether or not other subjective measures display a relationship to that data. Analyses of controller workload and situation awareness measures attempt to quantify their contribution to controllers ability to resolve traffic conflicts

Impact of Automation Support on the Conflict Resolution Task in a Human-in-the-Loop Air Traffic Control Simulation

To determine the capabilities and limitations of human operators and automation in separation assurance roles, the second of three Human-in-the-Loop (HITL) part-task studies investigated air traffic controllers ability to detect and resolve conflicts under varying task sets, traffic densities, and run lengths. Operations remained within a single sector, staffed by a single controller, and explored, among other things, the controllers responsibility for conflict resolution with or without their involvement in the conflict detection task. Furthermore, these conditions were examined across two different traffic densities; 1x (current-day traffic) and a 20 increase above current-day traffic levels (1.2x). Analyses herein offer an examination of the conflict resolution strategies employed by controllers. In particular, data in the form of elapsed time between conflict detection and conflict resolution are used to assess if, and how, the controllers involvement in the conflict detection task affected the way in which they resolved traffic conflicts

Equivalent titanium dioxide nanoparticle deposition by intratracheal instillation and whole body inhalation: the effect of dose rate on acute respiratory tract inflammation

BACKGROUND: The increased production of nanomaterials has caused a corresponding increase in concern about human exposures in consumer and occupational settings. Studies in rodents have evaluated dose–response relationships following respiratory tract (RT) delivery of nanoparticles (NPs) in order to identify potential hazards. However, these studies often use bolus methods that deliver NPs at high dose rates that do not reflect real world exposures and do not measure the actual deposited dose of NPs. We hypothesize that the delivered dose rate is a key determinant of the inflammatory response in the RT when the deposited dose is constant. METHODS: F-344 rats were exposed to the same deposited doses of titanium dioxide (TiO(2)) NPs by single or repeated high dose rate intratracheal instillation or low dose rate whole body aerosol inhalation. Controls were exposed to saline or filtered air. Bronchoalveolar lavage fluid (BALF) neutrophils, biochemical parameters and inflammatory mediator release were quantified 4, 8, and 24 hr and 7 days after exposure. RESULTS: Although the initial lung burdens of TiO(2) were the same between the two methods, instillation resulted in greater short term retention than inhalation. There was a statistically significant increase in BALF neutrophils at 4, 8 and 24 hr after the single high dose TiO(2) instillation compared to saline controls and to TiO(2) inhalation, whereas TiO(2) inhalation resulted in a modest, yet significant, increase in BALF neutrophils 24 hr after exposure. The acute inflammatory response following instillation was driven primarily by monocyte chemoattractant protein-1 and macrophage inflammatory protein-2, mainly within the lung. Increases in heme oxygenase-1 in the lung were also higher following instillation than inhalation. TiO(2) inhalation resulted in few time dependent changes in the inflammatory mediator release. The single low dose and repeated exposure scenarios had similar BALF cellular and mediator response trends, although the responses for single exposures were more robust. CONCLUSIONS: High dose rate NP delivery elicits significantly greater inflammation compared to low dose rate delivery. Although high dose rate methods can be used for quantitative ranking of NP hazards, these data caution against their use for quantitative risk assessment