Emergency.Blog

Survival after cardiac arrest increases three-fold...

Tuesday, 11-Mar-2008

Survival after cardiac arrest increases three-fold with new resuscitation protocol

Medical Procedure News

A new paramedic resuscitation method called Cardiocerebral Resuscitation has reportedly resulted in a three-fold increase in the survival rates of out-of-hospital cardiac arrest. The results are published in the March 12 issue of one the world's foremost medical journals, the Journal of the American Medical Association (JAMA).

Data were gathered from Arizona emergency medical service agencies for almost three years, before and after firefighters and paramedics were trained in this new resuscitation protocol for out-of-hospital cardiac arrest (referred to as Minimally Interrupted Cardiac Resuscitation in the JAMA article). Developed at The University of Arizona Sarver Heart Center in Tucson, Ariz., Cardiocerebral Resuscitation focuses on uninterrupted chest compressions and delays placement of a breathing tube.

One subset analyzed the outcomes of 886 cardiac arrests that occurred outside a hospital setting in two metropolitan areas in Arizona. Survival to hospital discharge increased from 1.8 percent before providers were trained in Cardiocerebral Resuscitation to 5.4 percent after training. Survival increase was even better (4.7 to 17.6 percent) in the subgroup of patients with the most favorable circumstances, in which bystanders witnessed the arrest and called 911 immediately and the heart was fibrillating (quivering), making it more receptive to shocks from a defibrillator.

"We encourage all emergency medical providers to evaluate their survival rates and, if they are not satisfactory, to institute Cardiocerebral Resuscitation and see if it improves survival," says Gordon A. Ewy, MD, who co-authored the JAMA article. Dr. Ewy heads the Sarver Heart Center at The University of Arizona College of Medicine in Tucson, whose Resuscitation Research Group developed Cardiocerebral Resuscitation.

The study is part of the resuscitation evaluation project, Save Hearts in Arizona Registry and Education (SHARE), a collaboration between The University of Arizona Sarver Heart Center and the Arizona Department of Health Services' Bureau of EMS and Trauma System, which is lead by Bentley J. Bobrow, MD, an emergency medicine physician at Mayo Clinic in Scottsdale, Ariz.

"Our state has shown that emergency medical systems can make inexpensive, simple changes to their protocol that will dramatically improve meaningful survival," Dr. Bobrow said. "This was truly a collaboration among public health, emergency medical providers and higher education."

For the study, EMS personnel were trained to administer an initial series of 200 uninterrupted chest compressions over a period of approximately two minutes, then perform standard rhythm analysis and administer a single electrical shock, if indicated. Another 200 compressions are immediately performed, and the cycle is repeated three times. EMS workers also administered epinephrine intravenously as soon as possible and with each cycle of chest compressions.

-- Source: http://www.news-medical.net/?id=36138

- Reference: http://www.arizona.edu

Wind Chill Advisory - Midwest

COUNTIES OF...
WINNEBAGO-BOONE-MCHENRY-LAKE ILLINOIS-OGLE-LEE-
DE KALB-KANE-DUPAGE-COOK-LA SALLE-KENDALL-GRUNDY-
WILL-KANKAKEE-LIVINGSTON-IROQUOIS-FORD-LAKE INDIANA-
PORTER-NEWTON-JASPER-BENTON-

INCLUDING THE CITIES OF...

ROCKFORD...WOODSTOCK...WAUKEGAN...OREGON...DIXON...DEKALB...
AURORA...CHICAGO...OTTAWA...OSWEGO...MORRIS...JOLIET...KANKAKEE...
PONTIAC...WATSEKA...PAXTON...GARY...VALPARAISO...MOROCCO...
RENSSELAER...FOWLER

15:56 PM CST SAT JAN 19 2008 /456 PM EST SAT JAN 19 2008/

WIND CHILL ADVISORY REMAINS IN EFFECT UNTIL 12 PM CST /1 PM EST/ SUNDAY...

TEMPERATURES WILL DROP TO 10 TO 15 BELOW ZERO ACROSS FAR NORTHERN ILLINOIS OVERNIGHT...AND TO 5 TO 10 BELOW ZERO ACROSS THE REMAINDER OF NORTHERN ILLINOIS AND NORTHWEST INDIANA. WEST WINDS BETWEEN 10 AND 15 MPH WILL AGAIN PRODUCE DANGEROUSLY COLD WIND CHILL READINGS OF 20 TO 30 BELOW ZERO OVERNIGHT INTO SUNDAY MORNING.

WIND CHILLS OF 20 BELOW ZERO WILL CAUSE FROSTBITE IN LESS THAN 30 MINUTES. PROLONGED EXPOSURE TO THESE DANGEROUSLY COLD CONDITIONS CAN LEAD TO HYPOTHERMIA AND SERIOUS HEALTH RISK.

A WIND CHILL ADVISORY MEANS THAT VERY COLD AIR AND STRONG WINDS WILL COMBINE TO GENERATE LOW WIND CHILLS. THIS WILL RESULT IN FROST BITE AND LEAD TO HYPOTHERMIA IF PRECAUTIONS ARE NOT TAKEN.

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URGENT - WINTER WEATHER MESSAGE
NATIONAL WEATHER SERVICE DULUTH MN
1607 PM CST SAT JAN 19 2008

KOOCHICHING-NORTHERN ST. LOUIS-NORTHERN COOK/NORTHERN LAKE- NORTHERN ITASCA-CENTRAL ST. LOUIS-NORTHERN CASS-SOUTHERN ITASCA- SOUTHERN CASS-CROW WING-NORTHERN AITKIN-SOUTHERN AITKIN- CARLTON/SOUTHERN ST. LOUIS-PINE-DOUGLAS-BAYFIELD-BURNETT-WASHBURN- SAWYER-

16:07 PM CST SAT JAN 19 2008

...WIND CHILL ADVISORY REMAINS IN EFFECT UNTIL 12 PM CST SUNDAY...

BITTERLY COLD ARCTIC AIR COMBINED WITH WEST-NORTHWEST WINDS OF 5 TO 15 MPH...WILL CONTINUE TO PRODUCE WIND CHILL VALUES OF 25 TO 40 BELOW ZERO ACROSS THE NORTHLAND TONIGHT THROUGH SUNDAY MORNING. WIND CHILL VALUES THIS LOW CAN BE LIFE THREATENING...CAUSING FROSTBITE TO OCCUR IN 5 TO 10 MINUTES AND POSSIBLY LEADING TO HYPOTHERMIA.

IF YOU MUST TRAVEL ACROSS THE AREA THIS WEEKEND...BE SURE TO LET SOMEONE KNOW OF YOUR TRAVEL PLANS...AND CARRY A CELL PHONE AND WINTER SURVIVAL KIT IN CASE YOU BECOME STRANDED. WHEN WORKING OUTDOORS...DRESS IN LAYERS AND BE SURE TO TAKE FREQUENT BREAKS IN A WARM SHELTER. REMEMBER THAT PETS ARE SUSCEPTIBLE TO COLD WIND CHILLS AS WELL.

-- Source: National Weather Service

References on Hypothermia and Cold Weather Injuries

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"COLD Weather injuries"

Can be found at: http://www.emergency.com/coldwthr.htm

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Extreme Cold: A Prevention Guide to Promote Your Personal Health and Safety

Can be found at: http://www.bt.cdc.gov/disasters/winter/guide.asp

Notice: Dangerous Ecstasy laced with methamphetamine

EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF NATIONAL DRUG CONTROL POLICY
WASHINGTON, D.C. 20503

PRESS RELEASE
CONTACT: ONDCP PUBLIC AFFAIRS
THURSDAY, JANUARY 3, 2008
(202) 395-6618

CANADIAN-MADE, METH-LACED ECSTASY BEING DUMPED INTO U.S. ILLEGAL DRUG MARKETS
IS A ONCE-WANING FAD MAKING A COMEBACK IN A DANGEROUS NEW FORM?

(Washington, DC) -- The White House Office of National Drug Control Policy (ONDCP) is warning public health and safety leaders across the country about a dangerous new drug threat coming from Canada. Ecstasy laced with methamphetamine (meth) has been entering the United States illegal drug markets, particularly in northern border states. Intelligence reports indicate that once smuggled into the U.S., the meth-laced Ecstasy is then being distributed throughout the country.

The dangerous poly-drug combination of methamphetamine and Ecstasy (MDMA) can have severe health consequences, especially as both drugs have toxic effects on the brain. They both can interfere with the body's ability to regulate temperature, leading to sharp increases in body temperature (hyperthermia), which can result in liver, kidney, and cardiovascular system failure and death. The potential for a life-threatening or fatal overdose is also increased when meth-laced Ecstasy is combined with alcohol. Recent laboratory research suggests that Ecstasy and meth combinations may produce greater adverse neurochemical and behavioral effects than either drug alone.

John Walters, the Nation's "Drug Czar," said, "This 'Extreme Ecstasy' is a disturbing development in what has been one of the most significant international achievements against the illicit drug trade. Historic progress against Ecstasy availability and use is in jeopardy of being rolled back by Canadian criminal organizations. Desperate to develop their client base, they are dangerously altering a product for which demand by youth and young adults had plummeted, and are exploiting vulnerabilities along our shared border. This is alarming for the youth of both Canada and the United States."

Ecstasy use in the United States rose in the late 1990s with the rise of the 'Rave' culture, however due to the well-coordinated national and international response -- Ecstasy use in the U.S. diminished in the early 2000s. In fact, the U.S. witnessed a 54 percent reduction since 2001 in the number of United States teens using Ecstasy in the past month, however recent data show progress against the drug has ebbed. The number of people in the U.S. who reported that they tried Ecstasy for the first time during the past year increased 40 percent between 2005 and 2006 -- from 615,000 to 860,000. One-third of these new users in 2006 were under age 18 when they started using Ecstasy.

And while still lower than its peak in 2002, past-month Ecstasy use has been increasing over the last two years among young adults aged 18-25. An estimated 326,000 young adults reported past-month Ecstasy use in 2006, compared to 231,000 in 2004. These increases coincide with increased trafficking of Ecstasy from Canada. Additionally, the latest Monitoring the Future Study, which tracks teen attitudes and behavior with respect to drug use, found decreases in the perception of risk of taking Ecstasy occasionally among 8th and 10th graders (-7% and -4%, respectively). After years of increased perception of risk for Ecstasy use, today's young people are not getting the message that Ecstasy use is dangerous and potentially deadly.

Prior to 2003, Europe (primarily The Netherlands and Belgium) was the predominant source of Ecstasy consumed in the United States. Increased cooperation among U.S. and European governments, combined with improved law enforcement operations and mass media reports, effectively dismantled the European -- U.S. Ecstasy trade. However, U.S. and Canadian intelligence reports indicate that Canada-based drug trafficking organizations are attempting to fill the supply void, and have drastically increased their Ecstasy production and trafficking.

The Royal Canadian Mounted Police (RCMP) estimates that the current combined production capacity of Canadian Ecstasy laboratories exceeds 2 million tablets per week. Federal, State, and local law enforcement agencies along the U.S. -- Canada border report large increases in the flow of Ecstasy from Canada into the United States. In 2003, 568,220 dosage units of Ecstasy were seized federally in the ten Northern border states; in 2006, 5,485,619 dosage units were seized.

Alarmingly, more than 55 percent of the Ecstasy samples seized in the United States last year contained methamphetamine. Cutting their product with less-expensive methamphetamine boosts profits for Canadian Ecstasy producers, likely increases the addictive potential of their product, and effectively gives a dangerous "face lift" to a designer drug that had fallen out of fashion with young American drug users.

Federal law enforcement officers are working with the RCMP to put greater pressure on Canadian Ecstasy producers through increased intelligence sharing and coordinated enforcement operations, and RCMP officials are focusing their efforts on the importation of precursor chemicals used in drug production. In the meantime, Director Walters is urging State and local public health officials to reinvigorate their prevention efforts, to enhance educational outreach to youth, parents, school systems, emergency departments, medical examiners, poison control centers, and law enforcement agencies regarding the hazards of Ecstasy and methamphetamine, to shore up treatment systems to look for and address the unique and well known challenges of meth addiction.

"We cannot allow our young people to once again be victimized by the 'Rave' culture, 'designer' drugs, or the myth that drug use is safe," said Director Walters. "We cannot afford to be complacent with the progress made against Ecstasy since 2001. Just as we must teach new generations of children to read, we must continue to educate new generations of young people on the harms of drug use."

Additonal reference: http://www.whitehousedrugpolicy.gov/

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Additional reference:

01/20/92-22:00CST -- "ECSTASY" IS BEING IMPORTED FROM EUROPE,
By Clark Staten, EMT-P, I/C, can be found at: http://www.emergency.com/ecstasy.htm

UPDATED List of Evacuations, Closures Due to Southland Wildfires

19:30PDT - 23 Oct 2007

UPDATED List of Evacuations, Closures Due to Southland Wildfires

LOS ANGELES, Oct. 23, 2007 (KABC-TV) - Here is a current list of evacuations, shelters and closures:

* MALIBU/"CANYON INCIDENT"

* AGUA DULCE, CANYON COUNTRY/"BUCKWEED INCIDENT"

* CASTAIC/"RANCH INCIDENT"

* LAKE ARROWHEAD/"GRASS VALLEY FIRE"

* GREEN VALLEY CREEK/"SLIDE FIRE"

* ORANGE COUNTY, IRVINE/"SANTIAGO INCIDENT"

* SAN DIEGO COUNTY/"HARRIS FIRE" & SAN DIEGO COUNTY, WITCH CREEK/"WITCH FIRE"

-- A toll-free hotline has been established by the governor's office for businesses interested in making "large quantity" donations to people displaced by the Southern California wildfires. The number is (800) 750-2858. It will be staffed from 8 a.m. to 10 p.m. by officials from the governor's Office of Emergency Services.

Individuals interested in donating items or volunteering to support relief efforts should contact the Red Cross at (800) 733-2767.

Extensive information can be found at: http://abclocal.go.com/kabc/story?section=local&id=5719546

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23 Oct 2007

2 S.D. Fires Merge, 1,000 Homes and Businesses Lost

Fires Burn 242,000 Acres, 513,000 Homes Evacuated

WITCH CREEK, Oct. 23, 2007 - The Harris and Witch Fires merged in San Diego County, creating a blaze that stretches 12 square miles. At least 513,000 homes were ordered to evacuate in San Diego County. There are voluntary evacuations for another 12,000 people.

Two other smaller fires are also burning in the area. The Rice Fire has burned some 7,000 acres in the Fallbrook area. On Tuesday morning, officials announced more than 1,000 homes and businesses had been lost, but that number is expected to climb.

So far there is no containment on the fires.

Erratic winds on Tuesday made things very difficult for fire crews. Winds would gust up to 60 miles per hour and then die down. Those winds are also spreading embers which can start smaller fires. Fire officials say aerial assaults are the key element in the fight against this fire.

Among the hardest-hit areas is northern Rancho Bernardo, where as many as 300 homes went up in flames Monday, according to a group of firefighters taking a break at a strip mall on West Bernardo Drive Monday night.

Officials say ten times more people have been evacuated than the 2003 Cedar Fire which charred 280,278 acres and killed 15 people.

The Harris Fire killed a Tecate man and injured 21 others since it began in rural southeastern San Diego County on Sunday.

Shelters were set up at Qualcomm Stadium, Santana High School, Poway Community Park, Poway Girls & Boys Club, Campo Community Center, Mission Hills High School, Mira Mesa High School, Escondido High School, the Del Mar Fairgrounds, El Toro Air Force Base, Steele Canyon High School and San Marcos High School. Several of the school shelters are full.

All San Diego Unified School District schools will be closed for the remainder of the week due to the fires, and classes at UC San Diego have been canceled for the rest of the week as well... -- Source: KABC & CNS - http://abclocal.go.com/kabc/story?section=local&id=5719545

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Residents urged to avoid non-emergency cellphone calls

SAN DIEGO COUNTY, CA: San Diego County authorities today asked residents to avoid making non-emergency calls on their cellphones as voice traffic surged and prevented some connections. Emergency officials managing response to the fires said text messages were fine.

Many callers, in contrast, received messages that all circuits were busy. It wasn't immediately clear if cell towers were destroyed in the blazes, compounding the standard surge as people abandoned their houses and checked in with one another by cell.

"It's not unusual in an emergency situation," said spokesman Joseph Farren of CTIA-The Wireless Assn., an industry group.

"Think of an L.A. highway at 6 p.m. If you have a lot of calls going in to one site, it overwhelms the site. You want to avoid that kind of rush-hour gridlock and keep the lines open for true emergencies." Spokesmen for Verizon Wireless and other major carriers didn't immediately respond to interview requests.

Continues/Source: LA Times, Joseph Menn and Michelle Quinn, http://www.latimes.com/business/la-fi-cell24oct24,1,1018637.story?

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Editor's note: The editors and webmasters at Emergency.com/Emergency.Blog would like to thank S.D. County resident Col. Gary Wilson (Col. USMCR, Ret.) for all of his contributions and information. Col. Wilson and several other readers have provided us with a perspective that has allowed us to better understand and report the situation of citizens at risk in the SoCal fires... If you have information or pictures that you would like to share here...send to webmaster@mail.emergency.com

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Report from the UCSD Medical Center burn unit

6:23 p.m. October 22, 2007

Report from the UCSD Burn Unit

By Lee Grant, UNION-TRIBUNE STAFF WRITER

SAN DIEGO COUNTY, CA: At UCSD Medical Center's burn unit yesterday, the human toll from the fires inundating the county was heart-rending -- 14 patients hospitalized including four firefighters injured in the rural Potrero area, three in critical condition, one in fair. Four other patients were also in critical condition, four in fair, one in good, many with serious inhalation damage.

Dr. Raul Coimbra, director of the hospital's trauma, burn and surgical intensive care units, and Leslie Franz, director of UCSD's Health Sciences Communications & Public Affairs, were taking stock as they paused for a breather in the lobby of the modernistic structure at Arbor Drive and Front Street.

Like most hospitals in the county, UCSD cancelled elective procedures in anticipation of additional victims of the fires, and because many physicians and nurses, including Coimbra and the burn unit director, Dr. Bruce Potenza, and neurosurgeon Dr. larry Marshall, had to rush away to help their families evacuate their own homes.

"We're prepared for more, able to accept and care for them," said Franz. "We've learned from experience (the 2003 Cedar fire) to be prepared, to make sure we have available beds and staffing. There's lots of personnel in the burn and intensive care units."Protecting the identity of patients and barring visitors other than relatives, Coimbra talked earnestly how his team, including five burn trauma surgeons, responded to what he called "a mass casualty."

Dr. Bruce Potenza, the burn unit chief, was on duty for 24 hours, said Coimbra, but left Monday morning for north Poway where his family was ordered to evacuate.

Coimbra and the staff were particularly taken with the firefighters who were hurt fighting the Potrero blaze.

"We look at them as our partners," he said, speaking quietly. "We're touched and saddened and compelled to help them and try and save their lives.

"For all the patients, everybody's doing everything they can. There's lots going on -- changing bandages -- adjusting ventilators. We're aggressive in excising burn tissue early and stopping infection. We're on the cutting edge of treatment and much of it has been developed here."

Added Franz, "This is an intense, catastrophic event. We do this work every single day for people who need this kind of care not only in San Diego County but Imperial County and Baja California."

Coimbra said the burn patients all came "in the last 24 hours. We got so many in such a short period of time -- seven are really sick with burns and inhalation injuries, six have serious burns but no inhalation damage." Article source/continues at: http://www.signonsandiego.com/news/metro/20071022-1823-bn22moreburn.html