Ausbildung von Rettungspersonal: Worin und wozu?

Zusammenfassung: Für viele an und für sich akzeptierte Interventionen in der Notfallmedizin fehlt die wissenschaftliche Evidenz. Das erschwert zwangsläufig die Ausbildungsinhalte des eingesetzten Personals. Rettungssanitäter werden in der Schweiz in allen lebensrettenden Basismaßnahmen ausgebildet, können aber in delegierter Kompetenz auch gewisse ärztliche Interventionen ausführen. Für Notärzte gilt, dass nur erfahrene und gut ausgebildete Kliniker im Rahmen eines strukturierten Weiterbildungsprogramms, respektive nach dessen Abschluss zum Einsatz kommen sollen, was dann aufgrund ihrer Entscheidungskompetenz und Teamleitungsfunktion auch in ethischen Spannungsfeldern vorteilhaft is

On the predominant nonlinear response of the extratropical atmosphere to meridional shifts of the Gulf Stream

Author Posting. © American Meteorological Society, 2017. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Climate 30 (2017): 9679-9702, doi:10.1175/JCLI-D-16-0707.1.The North Atlantic atmospheric circulation response to the meridional shifts of the Gulf Stream (GS) path is examined using a large ensemble of high-resolution hemispheric-scale Weather Research and Forecasting Model simulations. The model is forced with a broad range of wintertime sea surface temperature (SST) anomalies derived from a lag regression on a GS index. The primary result of the model experiments, supported in part by an independent analysis of a reanalysis dataset, is that the large-scale quasi-steady North Atlantic circulation response is remarkably nonlinear about the sign and amplitude of the SST anomaly chosen over a wide range of GS shift scenarios. The nonlinear response prevails over the weak linear response and resembles the negative North Atlantic Oscillation (NAO), the leading intrinsic mode of variability in the model and the observations. Further analysis of the associated dynamics reveals that the nonlinear responses are accompanied by the shift of the North Atlantic eddy-driven jet, which is reinforced, with nearly equal importance, by the high-frequency transient eddy feedback and the low-frequency wave-breaking events. Additional sensitivity simulations confirm that the nonlinearity of the circulation response is a robust feature found over the broad parameter space encompassing not only the varied SST but also the absence/presence of tropical influence, the varying lateral boundary conditions, and the initialization scheme. The result highlights the fundamental importance of the intrinsically nonlinear transient eddy dynamics and the eddy–mean flow interactions in generating the nonlinear downstream response to the meridional shifts in the Gulf Stream.The authors are grateful for the support from NASA (NNX13AM59G) and the NSF (AGS-1355339, OCE-1419235).2018-05-0

Meridional Gulf Stream shifts can influence wintertime variability in the North Atlantic storm track and Greenland blocking.

Author Posting. © American Geophysical Union, 2019. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geophysical Research Letters 46(3), (2019):1702-1708. doi:10.1029/2018GL081087.After leaving the U.S. East Coast, the northward flowing Gulf Stream (GS) becomes a zonal jet and carries along its frontal characteristics of strong flow and sea surface temperature gradients into the North Atlantic at midlatitudes. The separation location where it leaves the coast is also an anchor point for the wintertime synoptic storm track across North America to continue to develop and head across the ocean. We examine the meridional variability of the separated GS path on interannual to decadal time scales as an agent for similar changes in the storm track and blocking variability at midtroposphere from 1979 to 2012. We find that periods of northerly (southerly) GS path are associated with increased (suppressed) excursions of the synoptic storm track to the northeast over the Labrador Sea and reduced (enhanced) Greenland blocking. In both instances, GS shifts lead those in the midtroposphere by a few months.Our research has been conducted with the support of NSF (AGS‐1355339, OCE‐1419235, and OCE‐1242989), NASA (NNX13AM59G), and NOAA CPO Climate Variability and Predictability Program (NA13OAR4310139) grants to the Woods Hole Oceanographic Institution. We also thank three reviewers for their insightful comments on an earlier draft of this manuscript. Quarterly estimates of our Gulf Stream Index are available as a data file in the supporting information.2019-07-2

Links between Indo-Pacific climate variability and drought in the Monsoon Asia Drought Atlas

Drought patterns across monsoon and temperate Asia over the period 1877–2005 are linked to Indo-Pacific climate variability associated with the El Niño-Southern Oscillation (ENSO) and the Indian Ocean Dipole (IOD). Using the Monsoon Asia Drought Atlas (MADA) composed of a high-resolution network of hydroclimatically sensitive tree-ring records with a focus on the June–August months, spatial drought patterns during El Niño and IOD events are assessed as to their agreement with an instrumental drought index and consistency in the drought response amongst ENSO/IOD events. Spatial characteristics in drought patterns are related to regional climate anomalies over the Indo-Pacific basin, using reanalysis products, including changes in the Asian monsoon systems, zonal Walker circulation, moisture fluxes, and precipitation. A weakening of the monsoon circulation over the Indian subcontinent and Southeast Asia during El Niño events, along with anomalous subsidence over monsoon Asia and reduced moisture flux, is reflected in anomalous drought conditions over India, Southeast Asia and Indonesia. When an IOD event co-occurs with an El Niño, severe drought conditions identified in the MADA for Southeast Asia, Indonesia, eastern China and central Asia are associated with a weakened South Asian monsoon, reduced moisture flux over China, and anomalous divergent flow and subsidence over Indonesia. Insights into the relative influences of Pacific and Indian Ocean variability for Asian monsoon climate on interannual to decadal and longer timescales, as recorded in the MADA, provide a useful tool for assessing long-term changes in the characteristics of Asian monsoon droughts in the context of Indo-Pacific climate variability

Emerging European winter precipitation pattern linked to atmospheric circulation changes over the North Atlantic region in recent decades

Author Posting. © American Geophysical Union, 2017. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geophysical Research Letters 44 (2017): 8557–8566, doi:10.1002/2017GL074188.Dominant European winter precipitation patterns over the past century, along with their associated extratropical North Atlantic circulation changes, are evaluated using cluster analysis. Contrary to the four regimes traditionally identified based on daily wintertime atmospheric circulation patterns, five distinct seasonal precipitation regimes are detected here. Recurrent precipitation patterns in each regime are linked to changes in atmospheric blocking, storm track, and sea surface temperatures across the North Atlantic region. Multidecadal variability in the frequency of the precipitation patterns reveals more (fewer) winters with wet conditions in northern (southern) Europe in recent decades and an emerging distinct pattern of enhanced wintertime precipitation over the northern British Isles. This pattern has become unusually common since the 1980s and is associated with changes in moisture transport and more frequent atmospheric river events. The observed precipitation changes post-1950 coincide with changes in storm track activity over the central/eastern North Atlantic toward the northern British Isles.U.S. National Science Foundation Grant Number: AGS-1355339; NASA Physical Oceanography Program Grant Number: NNX13AM59G; WHOI2018-02-2

Interdisziplinäres Schockraum-Management unfallchirurgischer Patienten aus der Sicht der Mitarbeitenden

Zusammenfassung: Einleitung: Wir untersuchten, ob die Mitarbeiterbefragung in der Qualitätskontrolle des Schockraum-Managements von Nutzen sein kann. Methode: Konsekutive anonyme schriftliche Befragung (15Fragen, Likert-Skala 1-5) der klinisch Mitarbeitenden aller Schockraumeinsätze mit Verdacht auf Mehrfachverletzung von Juli 2002 bis Dezember 2003 (Anova; p<0,05). Ergebnisse: Bei 171 unfallchirurgischen Einsätzen retournierten 884Beteiligte den Antwortbogen. Die Beobachtungen der Mitarbeitenden hingen signifikant von der jeweiligen Schockraumsituation ab. Am meisten kritisiert wurden das Zeitmanagement und die eigene Ausbildung (Likert-Skala <4). Leitende- und Oberärzte bewerteten ihren Ausbildungsstand besser als Assistenzärzte und hatten häufiger einen ATLS®-Kurs absolviert (p<0,001). Es fanden sich signifikante systematische Unterschiede in den Beurteilungen, z.B. je nach Fachdisziplin der Antwortenden. Schlussfolgerung: Unser Fragebogen erwies sich als gut diskriminierendes Instrument und kann somit die Erfassung klinischer Parameter im Qualitätsmanagement der Schockraumphase sinnvoll ergänzen. Vor einer breiteren Anwendung werden allerdings zusätzliche Validierungs- und Korrelationsuntersuchungen benötig

Rapid 20th century warming reverses 900-year cooling in the Gulf of Maine

The Gulf of Maine, located in the western North Atlantic, has undergone recent, rapid ocean warming but the lack of long-term, instrumental records hampers the ability to put these significant hydrographic changes into context. Here we present multiple 300-year long geochemical records (oxygen, nitrogen, and previously published radiocarbon isotopes) measured in absolutely-dated Arctica islandica shells from the western Gulf of Maine. These records, in combination with climate model simulations, suggest that the Gulf of Maine underwent a long-term cooling over most of the last 1000 years, driven primarily by volcanic forcing and North Atlantic ocean dynamics. This cooling trend was reversed by warming beginning in the late 1800s, likely due to increased atmospheric greenhouse gas concentrations and changes in western North Atlantic circulation. The climate model simulations suggest that the warming over the last century was more rapid than almost any other 100-year period in the last 1000 years in the region

Interdecadal Pacific Oscillation reconstructed from trans-Pacific tree rings: 1350–2004 CE

The interdecadal Pacific Oscillation (IPO) represents the decadal mode of the El Niño-Southern Oscillation phenomenon. As such the IPO is one of the dominant modes of decadal climate variability on both sides of the Pacific Ocean basin. For this paper we utilized a newly developed tree-ring data network comprised of five multi-centennial Vietnamese cypress ring-width chronologies that range from around 11°N–23°N latitude. We combined these data with an average of tree-ring derived drought indices from the North American Drought Atlas over the south central USA, from a box that spans from 27.5°N–35.0°N, 85.0°–110.0°W and contains 55 gridpoints and more than 100 tree ring site chronologies, these 2 locations exhibit rainfall variations that are strongly, negatively correlated with each other and are representative of the influence of the IPO on terrestrial rainfall. The final reconstruction model, weighted most heavily on the three most southerly of the five Vietnamese cypress records, spans from 1350 to 2004, and explains nearly 57% of the variance in the original IPO data for the 5-month season of October–February. The reconstruction model passes all standard statistical tests using a split calibrationverification scheme. We reveal 15 positive and 15 negative phase shifts of the IPO prior to the period of instrumentation, suggesting that the IPO has been active for at least the past seven centuries with varying degrees of intensity. We compare our reconstruction with two related millennial records: the MacDonald and Case (Geophys Res Lett 32(8):L08703, 2005) tree ring-derived reconstruction of the Pacific Decadal Oscillation, and an ice core-derived reconstruction of the IPO from the Law Dome Ice core in Antarctica by Vance et al. (Geophys Res Lett 33(6):L06712, 2015). While there is good general agreement with the latter record, there are three key periods of the past where the two records are out of phase, and we explore the reasons for this disparity. Direct comparison with the related Tripole Index (TPI) shows weaker correlation, likely owing to the stronger relationship between our tree ring data and the equatorial Pacific region relative to the north and south regions of the Pacific that combine to comprise the TPI calculation

Improving Australian rainfall prediction using sea surface salinity

This study uses sea surface salinity (SSS) as an additional precursor for improving the prediction of summer (December-February, DJF) rainfall over northeast Australia. From a singular value decomposition between SSS of prior seasons and DJF rainfall, we note that SSS of the Indo-Pacific warm pool region [SSSP (150oE-165oW and 10oS-10oN), and SSSI (50oE-95oE and 10oS-10oN)] co-vary with Australian rainfall, particularly over the Northeast. Composite analysis based on high (low) SSS events in SSSP and SSSI region is performed to understand the physical links between the SSS and the atmospheric moisture originating from the regions of anomalously high (low) SSS and precipitation over Australia. The composites show the signature of co-occurring La Niña and negative Indian Ocean dipole (co-occurring El Niño and positive Indian Ocean dipole) with anomalously wet (dry) conditions over Australia. During the high (low) SSS events of SSSP and SSSI regions, the convergence (divergence) of incoming moisture flux results in anomalously wet (dry) conditions over Australia with a positive (negative) soil moisture anomaly. Furthermore, we show from the random forest regression analysis that the El Niño Southern Oscillation is the most important precursor for the Australian rainfall, followed by the SSS of the western Pacific warm pool (SSSP). The random forest regression also predicts Australian rainfall, and this prediction is improved by including SSS from the prior season. This evidence suggests that sustained observations of SSS can improve the monitoring of the Australian regional hydrological cycle