Endotracheal Intubation Success Rate in an Urban, Supervised, Resident-Staffed Emergency Mobile System: An 11-Year Retrospective Cohort Study.

In the prehospital setting, endotracheal intubation (ETI) is sometimes required to secure a patient's airways. Emergency ETI in the field can be particularly challenging, and success rates differ widely depending on the provider's training, background, and experience. Our aim was to evaluate the ETI success rate in a resident-staffed and specialist-physician-supervised emergency prehospital system. This retrospective study was conducted on data extracted from the Geneva University Hospitals' institutional database. In this city, the prehospital emergency response system has three levels of expertise: the first is an advanced life-support ambulance staffed by two paramedics, the second is a mobile unit staffed by an advanced paramedic and a resident physician, and the third is a senior emergency physician acting as a supervisor, who can be dispatched either as backup for the resident physician or when a regular Mobile Emergency and Resuscitation unit (Service Mobile d'Urgence et de Réanimation, SMUR) is not available. For this study, records of all adult patients taken care of by a second- and/or third-level prehospital medical team between 2008 and 2018 were screened for intubation attempts. The primary outcome was the success rate of the ETI attempts. The secondary outcomes were the number of ETI attempts, the rate of ETI success at the first attempt, and the rate of ETIs performed by a supervisor. A total of 3275 patients were included in the study, 55.1% of whom were in cardiac arrest. The overall ETI success rate was 96.8%, with 74.4% success at the first attempt. Supervisors oversaw 1167 ETI procedures onsite (35.6%) and performed the ETI themselves in only 488 cases (14.9%). A resident-staffed and specialist-physician-supervised urban emergency prehospital system can reach ETI success rates similar to those reported for a specialist-staffed system

A model-based assessment of the effects of projected climate change on the water resources of Jordan

This paper is concerned with the quantification of the likely effect of anthropogenic climate change on the water resources of Jordan by the end of the twenty-first century. Specifically, a suite of hydrological models are used in conjunction with modelled outcomes from a regional climate model, HadRM3, and a weather generator to determine how future flows in the upper River Jordan and in the Wadi Faynan may change. The results indicate that groundwater will play an important role in the water security of the country as irrigation demands increase. Given future projections of reduced winter rainfall and increased near-surface air temperatures, the already low groundwater recharge will decrease further. Interestingly, the modelled discharge at the Wadi Faynan indicates that extreme flood flows will increase in magnitude, despite a decrease in the mean annual rainfall. Simulations projected no increase in flood magnitude in the upper River Jordan. Discussion focuses on the utility of the modelling framework, the problems of making quantitative forecasts and the implications of reduced water availability in Jordan

Médecine d’urgence [Emergency medicine : update 2019]

At a time when « Smarter medicine » and « Choosing Wisely » campains become increasingly important, emergency medicine is no exception. Many recent studies lead us to reconsider our practices and to change our work-up and treatement strategies, to ultimately use only the ones with a real clinical benefit for emergency departement patients

Measurement and simulation of the 16/17 April 2010 Eyjafjallajökull volcanic ash layer dispersion in the northern Alpine region

The spatial structure and the progression speed of the first ash layer from the Icelandic Eyjafjallajökull volcano which reached Germany on 16/17 April is investigated from remote sensing data and numerical simulations. The ceilometer network of the German Meteorological Service was able to follow the progression of the ash layer over the whole of Germany. This first ash layer turned out to be a rather shallow layer of only several hundreds of metres thickness which was oriented slantwise in the middle troposphere and which was brought downward by large-scale sinking motion over Southern Germany and the Alps. Special Raman lidar measurements, trajectory analyses and in-situ observations from mountain observatories helped to confirm the volcanic origin of the detected aerosol layer. Ultralight aircraft measurements permitted the detection of the arrival of a second major flush of volcanic material in Southern Germany. Numerical simulations with the Eulerian meso-scale model MCCM were able to reproduce the temporal and spatial structure of the ash layer. Comparisons of the model results with the ceilometer network data on 17 April and with the ultralight aircraft data on 19 April were satisfying. This is the first example of a model validation study from this ceilometer network data