Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 30 Dec 2002 12:35:04 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQN630ADQK0004GM@mb1i0.ns.pitt.edu>; Mon, 30 Dec 2002 12:35:03 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 30 Dec 2002 12:22:58 -0500 (EST) Received: from pop017.verizon.net (pop017pub.verizon.net [206.46.170.210]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 30 Dec 2002 12:22:51 -0500 (EST) Received: from Micron ([141.158.127.142]) by pop017.verizon.net (InterMail vM.5.01.05.09 201-253-122-126-109-20020611) with ESMTP id <20021230173047.DWPB10203.pop017.verizon.net@Micron>; Mon, 30 Dec 2002 11:30:47 -0600 Date: Mon, 30 Dec 2002 12:30:44 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED PRESTIGE with a new translation In-reply-to: <023701c2b018$54171de0$c7b62fc8@supercable.net.ve> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: traumamsd , wilderness-emergency-medicine@list.pitt.edu Cc: =?ISO-8859-1?Q?Jos=E9_Angel_Jarne_Navalon?= Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3E103C74.4375.D7874F@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02a) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at pop017.verizon.net from [141.158.127.142] at Mon, 30 Dec 2002 11:30:46 -0600 On 30 Dec 2002 at 11:13, traumamsd wrote: > I have made some improvements and changes in the original message. I > feel do, I have maintain the original meaning. The post is about a giant > oil spill in the northern coast of Spain. This is a bit off-topic, don't want to have a long discussion about it on this list. But I must say it affects me personally -- our mountain rescue teams here occasionally have friendly competitions among members. One is to see who has the best and biggest Swiss Army Knife/Leatherman tool, another is to see who brought the best tinned fish for lunch. The tinned seafood from that area, canned by Carlos Albo and distributed in the U.S. over the Internet at http://www.laespanolameats.com/storefront/fish.asp clearly takes the cake, er, tuna. Great stuff, so get it while you can, because with the disaster on the Spanish coast, you might not see it again for decades. (P.S. I have no association with Carlos Albo or La Espanola except that I like to eat their tinned seafood!) End of very-off-topic discussion. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i0.ns.pitt.edu [136.142.186.36]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 30 Dec 2002 10:32:46 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQN1SEMWPI0004Q4@mb2i0.ns.pitt.edu>; Mon, 30 Dec 2002 10:32:45 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 30 Dec 2002 10:17:11 -0500 (EST) Received: from supercable.net.ve ([216.72.155.5]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 30 Dec 2002 10:17:07 -0500 (EST) Received: (apparently) from sceptre ([200.47.182.199]) by supercable.net.ve with Microsoft SMTPSVC(5.5.1877.647.64); Mon, 30 Dec 2002 11:43:09 -0400 Date: Mon, 30 Dec 2002 11:13:32 -0400 From: traumamsd Subject: Re: W-EMED PRESTIGE with a new translation Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu, PSYCH-CI@MAELSTROM.STJOHNS.EDU Cc: =?Windows-1252?Q?Jos=E9_Angel_Jarne_Navalon?= Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <023701c2b018$54171de0$c7b62fc8@supercable.net.ve> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V6.00.2600.0000 X-Mailer: Microsoft Outlook Express 6.00.2720.3000 Content-type: text/plain; charset=Windows-1252 Content-transfer-encoding: 8BIT X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: I have made some improvements and changes in the original message. I feel do, I have maintain the original meaning. The post is about a giant oil spill in the northern coast of Spain. This particular coast is rich in seafood and fish. Thus the spill is not only a natural catastrophe is also a human tragedy because has taken out from the people (for at least 7 years) their main working recourse: The see. The area (Galicia) was a exporter of seafood to all Europe. Finally the spill was as big in area, as Tenerife island. Lastly the Galician area is a fiord coast north of Portugal and the land from where my father was born. Regards Manuel Sotelo MD If any one wants to see a power point photo presentation of the disaster mail me private ************************************************************************ I forward you this message that to my it has arrived me, and that it reflects the reality of Galicia that the politicians have determine to hide From "La Coruña" University we want to transmit you the following thing: Volunteers' calls are receiving from all over the world to come to collaborate and the Xunta of Galicia (local government), but there are telling the would be volunteers not to come. The Xunta of Galicia still has not provided tools for collection and storage of the residuals. The volunteers are using cubes to take out of the beach the oil spill, with a lot of effort and they are depositing in the ports bags of the oil spill without anyone coming to pick up the bags. People are cleaning without masks or gloves. Private associations have analyzed the fuel spill and it has been found to be CANCERIGENIC at inhalation, due to the organic gases and to the high content in sulfur. I can assure, that after two days in the beach, the sound that you make when breathing is as that of a patient with asbestosis. Also the mucous from the nose come out black. Hundreds of pelicans are dying in the beaches because people at the animal center can't help them, due to lack of staff and resources. I have been helping to pick up birds in Barrañan (a contaminated beach area), taking them with MY cubes and in MY car because nobody was taken charge of the pelicans. People of civil (defense) protection are not helping at the beaches. There is not neither a single government technician evaluating the situation. The local government won't CLEAN THE CONTAMINATED BEACH ROCKS because according to the Xunta of Galicia, "it will be taken care of by the sea." The oil spill have asphalted the coast (maybe as large of Californian coast) as if was a highway and the oil has already solidified. Greenpeace has been in Ferrol (a Main city of the area) cleaning WITH ITS OWN MEANS and the police has tossed them of the beach so that there are not seen by the media. The Government is avoiding the request the declaration of catastrophic area because according to the Executive there is not need. The company to which the Prestige ship belongs has freighted another ship with the same quantity of load to carry out the order that was lost. This ship will make next week the same journey that the Prestige and it will stop in La Coruña seaport, if nobody stops it. This ship was retained more than one week in another European port (I don't remember the name) and it was imposed a sanction($) to the owner of the ship for the serious structural deficiencies that the ship has. The ship doesn't have a double wall deposits and it already has 26 YEARS navigating around loaded with oil. With some luck, the fiord of the Coruña is the only one that has survived at this time the disaster. Portugal has via satellite control the evolution of the spill and it insists in that the sunken ship is still liberating oil. The Xunta of Galicia says that it is lie without having contributing any test to prove it, while the Portuguese government is publishing satellite pictures. The fishing ships that come near of the spill area are taking out their nets: ALL, the nets comes out full with petroleum (oil). The local government has been accused by shell-fisherman that they are not getting any help.Furthermore the shell-fisherman union clams that ask the local government for climbing gear, security lines and protection harness, to get to the rocky coast and the help was denied. Right now the climate is very bad the winter storms have already begun, and nobody will take charge of the volunteers if an accident occurs. Yesterday we made a 12 meters long banner with the motto "IS A CATASTROPHIC AREA! " and we hang it in Riazor( a beach), taking advantage of that the foreign press is here. When arriving home I found that on TV the banner was avoid by the media My mother has told me that she saw the volunteer team in television, but they didn't FOCUS THE BANNER. The day December 1, Sunday, a manifestation was summoned in Santiago of Compostela (Big city) to request the declaration of catastrophic area. THE MEDIA DID NOT REPORTED IT. It is necessary to achieve a strong popular movement, as soon as the catastrophe stops to be news and the foreign press leaves. (in London, the headlines of newspapers insist in that is THE MOST IMPORTANT ECOLOGICAL CATASTROPHE IN THE HISTORY OF EUROPE. People ALREADY IS EMIGRATING out of the region. And meanwhile, the president of the Xunta of Galicia is and the Spanish President Aznar are still reluctant to visit the "Costa da Muerte" (death coast). Here nobody gives up hope; to them the politicians are filling the mouth speaking of effectiveness and of democracy and what they have done is the most antidemocrat thing that one can do: THEY HAVE ABANDONED THE PEOPLE OF THIS TOWNS TO THEIR FATE. I am so mad, so disappointed and with such a sensation of impotence that I find difficult to write. I assure you that one thing is to see the catastrophe in television and other to be there, to play it, to smell it, and to see the beaches from the sand, to see the birds totally full with oil without being able to move and to see the fishermen, weather-beaten people and with a very hard life, CRYING when they see the sea. The platform "Nunca Mais" is requesting money to buy the material that the Xunta of Galicia doesn't give up. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i0.ns.pitt.edu [136.142.186.36]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 29 Dec 2002 12:50:39 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQLSBZXMMU0001IJ@mb2i0.ns.pitt.edu>; Sun, 29 Dec 2002 12:50:38 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 29 Dec 2002 12:31:42 -0500 (EST) Received: from jalon.able.es (jalon.able.es [212.97.163.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 29 Dec 2002 12:31:38 -0500 (EST) Received: from pepe ([212.97.161.197]) by jalon.able.es (Netscape Messaging Server 4.15) with SMTP id H7W6D401.Y19; Sun, 29 Dec 2002 18:39:08 +0100 Date: Sun, 29 Dec 2002 18:38:43 +0100 From: =?Windows-1252?Q?Jos=E9_Angel_Jarne_Navalon?= Subject: W-EMED PRESTIGE Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: PSYCH-CI@MAELSTROM.STJOHNS.EDU Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V6.00.2800.1106 X-Mailer: Microsoft Outlook IMO, Build 9.0.2416 (9.0.2910.0) Content-type: multipart/mixed; boundary="Boundary_(ID_tNl7KK2+1yO4pc05F4iDIg)" Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk X-MS-TNEF-Correlator: This is a multi-part message in MIME format. --Boundary_(ID_tNl7KK2+1yO4pc05F4iDIg) Content-type: text/plain; charset=Windows-1252 Content-transfer-encoding: 8BIT I forward you this message that to my it has arrived me, and that it reflects the reality of Galicia that the politicians determine to hide From the University of A Coruña we want to transmit you the following thing: Volunteers' calls are receiving from all over the world that they want to come to collaborate and from the Xunta of Galicia they are telling them that them not they come that they don't make lack. All the existent material means are particular. The Xunta of Galicia still not it has negotiated the collection of the residuals with any company and the cubes that are taken out of the beach, with a lot of effort, they are deposited in the ports and in corners of the sandbanks without nobody comes to for them. People are cleaning without masks neither gloves and there are already associations that have analyzed (for her bill, of course) the fuel and they notice that it can be CANCERIGENIC for inhalation, due to the gases that you/he/she removes and to the high content in sulfur. I can make sure that after two days in the beach the sound that you take place when breathing is as that of a silicoso. The snots come out black. Dozens of pelicans are dying in the beaches because people of the center of fauna recovery don't give to coarse. I have been helping to pick up birds in Barrañan, taking them in MY cubes and in MY car because nobody was taken charge of them. People of civil protection are not in the beaches. There is not neither a single technician evaluating the situation. They won't CLEAN THE ROCKS because according to the Xunta of Galicia, "it will already take it to him the sea." We have the asphalted coast as if was a highway and it has already solidified. Greenpeace has been in Ferrol cleaning WITH ITS OWN MEANS and the police has tossed them of the beach so that to them doesn't see it the media. It won't request the declaration of catastrophic area because according to the Executive there is not TIDE QUARTER NOTE. The company to which the Prestige belongs has freighted another ship with the same quantity of load to carry out the order that he/she has gotten lost, clear. This ship will make next week the same journey that the Prestige and it will saturate in A Coruña, if nobody impedes it. This ship was retained more than one week in an European port (I don't remember the name) and it was imposed a sanction to the armador for the serious deficiencies that it presented. It is of A SINGLE HELMET and it takes 26 YEARS navigating somewhere around loaded with raw. With some luck, the creek of the Coruña that is the only one that has survived this time, you can asphalt in a couple of weeks. Portugal has put buoys via satellite to control the evolution of the stains and it insists in that is liberating rawwer in the area of the sinking. The Xunta of Galicia says that it is lie without contributing any test, while the Portuguese are publishing pictures via satellite. The ships that come out to faenar in the authorized area are taking out the apparels: ALL, those of surface and those of haulage full with petroleum. It is accusing to the perceberos that they don't help, being them those that better they are managed in the rocks. It is not this way: the president of the percebeiros brotherhood has declared (in a radio station of Spanish radio) that they have offered to clean from the first day, but they ask that the Xunta of Galicia is taken charge of those more than possible accidents that they could happen during the tasks of cleaning. Such and like they are the rocks of having impregnated and oily they need strings of security and protection harness, AND they won't GIVE THEM. The sea is very bad because, what I will be, the Monsoon have already begun, and nobody will take charge of them if they break a leg or if they are killed in the cliffs. Yesterday we made a pancarta 12 meters long with the motto "CATASTROPHIC AREA, ALREADY! " and we hang it in Riazor, taking advantage of that the foreign press is here. When arriving home I was seeing a while the party in having differed by television THE PANORAMIC TAKINGS OF THE TIERS INTERSECTED WHEN ARRIVING TO THE AREA OF THE PANCARTA. My mother has told me that she saw the party for television, but they didn't FOCUS THE PANCARTA and I assure you that it was read from all the one stadium. The day December 1, Sunday, a manifestation is summoned in Santiago of Compostela to request the declaration of catastrophic area. IN THE TV IT IS NOT SPOKEN OF IT. It is necessary to achieve that there is a strong popular movement, as soon as he/she stops to be news and leave the foreign press (in London, the covers of the newspapers insist in that is THE ECOLOGICAL CATASTROPHE IMPORTANT MA IN THE HISTORY DE EUROPE) this will fall in the forgetfulness. People ALREADY THIS EMIGRATING. And meanwhile, the president of the Xunta of Galicia is of hunt. The President Aznar has not still deigned to visit the Costa da Muerte. And here nobody doesn't resign. To them they are filled the mouth speaking of the environment, of the protection of the nature, of Kioto, River, etc., and then what? AND what is worse, to them they are filled the mouth speaking of effectiveness and of democracy and what they have made is the antidemocrat thing that one can make: THEY HAVE ABANDONED TO THE TOWN. I don't know if you will have arrived until here. I am so mad, so disappointed and with such a sensation of impotence that to my until I find difficult to write. I assure you that a thing is to see the catastrophe in television and other to be there, to play it, to smell it, and to see the beaches from the sand, to see the birds totally full with raw without being able to move and to see the fishermen, weatherbeaten people and with a very hard life, CRYING when seeing the sea. The platform "Nunca Mais" is requesting money to buy the material that doesn't give the Xunta of Galicia. --Boundary_(ID_tNl7KK2+1yO4pc05F4iDIg) Content-type: application/ms-tnef; name=winmail.dat Content-disposition: attachment; filename=winmail.dat Content-transfer-encoding: base64 eJ8+IisRAQaQCAAEAAAAAAABAAEAAQeQBgAIAAAA5AQAAAAAAADoAAEIgAcAGAAAAElQTS5NaWNy b3NvZnQgTWFpbC5Ob3RlADEIAQ2ABAACAAAAAgACAAEGgAMADgAAANIHDAAdABIAJgAAAAAAOgEB A5AGAHgSAAAlAAAACwACAAEAAAALACMAAAAAAAMAJgAAAAAACwApAAAAAAADADYAAAAAAB4AcAAB AAAACQAAAFBSRVNUSUdFAAAAAAIBcQABAAAAFgAAAAHCr2ETneEcWjMbNBHXuhPJ2y9VfnsAAAIB HQwBAAAAFQAAAFNNVFA6SkFKQVJORUBBQkxFLkVTAAAAAAsAAQ4AAAAAQAAGDgBM9Qdhr8IBAgEK DgEAAAAYAAAAAAAAAEvBYwArHb8RuLCOLZkh7H7CgAAACwAfDgEAAAACAQkQAQAAADQOAAAwDgAA JRkAAExaRnWVtCztAwAKAHJjcGcxMjUGMgD4C2BuZzMwOJ4yAfcCpANjAgBjaArAYHNldDAgB20C gH0lCoF2CJB3awuAZDQdDGBjAFALAwu0MiBJkiACEHJ3CxEgeQhgKCB0aAQAIAeBc2GUZ2UVQWEF QHRvFZD4eSBpBUAQ8AQgCsAFEPZ2CYAVkSwXMBMgFhQW0fcJcA7wBZB0BCAVUBYACXCHB0AW0Baw 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imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Wed, 25 Dec 2002 20:44:31 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQGNP5GHE4001MZG@mb1i0.ns.pitt.edu>; Wed, 25 Dec 2002 20:44:30 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 25 Dec 2002 20:27:33 -0500 (EST) Received: from pop015.verizon.net (pop015pub.verizon.net [206.46.170.172]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 25 Dec 2002 20:27:26 -0500 (EST) Received: from KLAPTOP ([141.158.127.142]) by pop015.verizon.net (InterMail vM.5.01.05.20 201-253-122-126-120-20021101) with ESMTP id <20021226013437.YANZ21001.pop015.verizon.net@KLAPTOP>; Wed, 25 Dec 2002 19:34:37 -0600 Date: Wed, 25 Dec 2002 20:34:24 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED "clearing" the cervical spine Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Cc: msr44@columbia.edu, arotjan@ic.sunysb.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3E0A1650.6033.6039CCE@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at pop015.verizon.net from [141.158.127.142] at Wed, 25 Dec 2002 19:34:31 -0600 > All Wilderness Medical Professionals: > > I am going winter backpacking in the high peaks region of the > Adirondacks in mid-January with my brother who is a WFR and we were > wondering, if it is acceptable to clear a spine of someone familiar > with the protocols and understands the possible ramifications. We > thought that it might not be acceptable because we each know the > tedious effort it takes to evac using a backboard on a snowy mountain > in adverse conditions. However, not attempting to clear the spine may > be just as dangerous as the evac. We will be going with two other > experience backpackers with no formal medical training. > > We look to your suggestions and comments, > > Andrew Rotjan EMT-B, WFR > arotjan@ic.sunysb.edu > > Michael Rotjan, WFR > msr44@columbia.edu BTW, subscription information may be found in my signature at the end of this message. Another reminder -- if you attempt to post to the list from one of your email addresses that isn't listed as a member of the list, that message (as with the one above) will bounce. Majordomo won't allow aliases, alas, so you'll have to subscribe with all email addresses from which you might want to post, and delete the duplicate replies. On the other hand, Majordomo is free and, unlike Yahoo, doesn't add advertisements to every email message. As regards the above message -- "acceptable" is context sensitive. Acceptable to the person whose cervical spine is "cleared"? Acceptable to your SAR team EMS medical director? Acceptable to your non-SAR EMS medical director? Acceptable to the EMS director for the state that issued your EMS certificate? Acceptable to the judge and jury when you're in court defending your actions? "Clearing" the cervical spine has different meanings. IF one follows the NEXUS criteria, then one is basically saying that "I have examined the patient, and based on the best information available to medical science at the present, there is essentially no chance that the patient requires x-rays, much less requires immobilization." I suggest you read the NEXUS articles if you haven't already. Contact your librarian to help you get copies to read. If, however, you mean "clearing" as "not immobilizing the cervical spine in someone who doesn't meet NEXUS criteria" then you're on your own there. You'd have to balance the risks and benefits, which is what you were supposed to learn about in your WFR or WEMT class. If you make a stupid decision, you may be lunch (or a new car) for some fortunate lawyer. If you make a reasonable decision, then you're probably OK. Abstracts of the most important of the NEXUS papers are reproduced below. > [Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of > a set of clinical criteria to rule out injury to the cervical spine > in patients with blunt trauma. National Emergency X- Radiography > Utilization Study Group [see comments]. N Engl J Med 2000; > 343:94-9.] BACKGROUND: Because clinicians fear missing occult > cervical-spine injuries, they obtain cervical radiographs for > nearly all patients who present with blunt trauma. Previous > research suggests that a set of clinical criteria (decision > instrument) can identify patients who have an extremely low > probability of injury and who consequently have no need for > imaging studies. METHODS: We conducted a prospective, observational > study of such a decision instrument at 21 centers across the United > States. The decision instrument required patients to meet five > criteria in order to be classified as having a low probability of > injury: no midline cervical tenderness, no focal neurologic > deficit, normal alertness, no intoxication, and no painful, > distracting injury. We examined the performance of the decision > rule in 34,069 patients who underwent radiography of the cervical > spine after blunt trauma. RESULTS: The decision instrument > identified all but 8 of the 818 patients who had cervical-spine > injury (sensitivity, 99.0 percent [95 percent confidence interval, > 98.0 to 99.6 percent]). The negative predictive value was 99.8 > percent (95 percent confidence interval, 99.6 to 100 percent), the > specificity was 12.9 percent, and the positive predictive value was > 2.7 percent. Only two of the patients classified as unlikely to > have an injury according to the decision instrument met the preset > definition of a clinically significant injury (sensitivity, 99.6 > percent [95 percent confidence interval, 98.6 to 100 percent]; > negative predictive value, 99.9 percent [95 percent confidence > interval, 99.8 to 100 percent]; specificity, 12.9 percent; positive > predictive value, 1.9 percent), and only one of these two patients > received surgical treatment. According to the results of > assessment with the decision instrument, radiographic imaging could > have been avoided in the cases of 4309 (12.6 percent) of the 34,069 > evaluated patients. CONCLUSIONS: A simple decision instrument based > on clinical criteria can help physicians to identify reliably the > patients who need radiography of the cervical spine after blunt > trauma. Application of this instrument could reduce the use of > imaging in such patients. > Panacek EA. Mower WR. Holmes JF. Hoffman JR. NEXUS Group. Test > performance of the individual NEXUS low-risk clinical screening > criteria for cervical spine injury. [Journal Article. Multicenter > Study. Validation Studies] Annals of Emergency Medicine. > 38(1):22-5, 2001 Jul. Abstract BACKGROUND: The National Emergency > X-Radiography Utilization Study (NEXUS) recently validated the > ability of a decision instrument to define a population with an > extremely low risk of cervical spine injury (CSI) after blunt > trauma. It is unclear whether each of the 5 individual criteria is > necessary for the decision instrument to maintain its high > ensitivity. METHODS: NEXUS was a prospective observational study at > 21 emergency departments, which enrolled ll patients with blunt > trauma for whom cervical spine radiographs were ordered. In this > substudy, we examined the NEXUS database to determine the > contribution of each of the 5 individual low-risk clinical criteria > to the overall ensitivity of the decision instrument. RESULTS: All > but 8 of 818 patients with CSI, and all but 2 of 578 patients with > ignificant CSI, were identified by using the decision instrument. A > substantial number of patients with CSI (236/818 [29%]) and > patients with significant CSI (175/578 [30%]) met only 1 of the 5 > non--low-risk criteria, and each of the 5 riteria was the only > indicator of non--low-risk status in at least 8 patients with CSI > and at least 5 patients with significant CSI. CONCLUSION: Because > each of the 5 low-risk criteria was the only marker of > non--low-risk status in at least a few patients with significant > CSI, modification of the overall NEXUS decision instrument by > eliminating any one of the criteria would markedly reduce > sensitivity and make the instrument unacceptable for clinical use. > Lowery DW. Wald MM. Browne BJ. Tigges S. Hoffman JR. Mower WR. > NEXUS Group. Epidemiology of cervical spine injury victims. > [Journal Article] Annals of Emergency Medicine. 38(1):12-6, 2001 > Jul. Abstract STUDY OBJECTIVE: We sought to characterize > demographics and injury patterns among patients undergoing > emergency department cervical spine radiography for blunt traumatic > injury. METHODS: All patients with blunt trauma undergoing cervical > spine radiography at 21 centers were enrolled in this prospective, > observational study. Patients' date of birth, age, sex, and > ethnicity were noted before cervical spine radiography. RESULTS: > Demographic factors associated with cervical spine injury, present > in 818 of 33,922 patients, included the following: age of 65 years > or older (relative risk [RR] 2.09; 95% confidence interval [CI] > 1.77 to 2.59); "other" ethnicity (RR 1.79, 95% CI 1.46 to 2.19); > male sex (RR 1.72, 95% CI 1.48 to 2.00); and white ethnicity (RR > 1.50, 95% CI 1.31 to 1.72). Hispanic ethnicity (RR 0.64, 95% CI > 0.51 to 0.79), female sex (RR 0.58, 95% CI 0.50 to 0.67), black > ethnicity (RR 0.55, 95% CI 0.45 to 0.66), and age of less than 18 > years (RR 0.39, 95% CI 0.27 to 0.55) were associated with reduced > risk of cervical spine injury. CONCLUSION: Among patients > undergoing ED cervical spine radiography, cervical spine injury is > more common among the elderly, male subjects, and patients of white > or "other" ethnicity. Because cervical spine injury occurs in > patients in all demographic categories, however, this information > cannot be used to select individual patients who should or should > not undergo imaging. > Goldberg W. Mueller C. Panacek E. Tigges S. Hoffman JR. Mower WR. > NEXUS Group. Distribution and patterns of blunt traumatic cervical > spine injury. [Journal Article] Annals of Emergency Medicine. > 38(1):17-21, 2001 Jul. Abstract STUDY OBJECTIVE: Previous studies > of cervical spine injury involve individual institutions or special > populations. here is currently little reliable information > regarding natural cervical spine injury patterns after blunt > trauma. This ubstudy of the National Emergency X-Radiography > Utilization Study project was designed to accurately assess the > revalence, spectrum, and distribution of cervical spine injury > after blunt trauma. METHODS: We prospectively enrolled ll patients > with blunt trauma undergoing cervical spine radiography at 21 > diverse institutions. Injury status was etermined by review of all > radiographic studies obtained on each patient. For each individual > injury, we recorded which specific films revealed the injury, the > level and location of injury on each vertebra, and the age and sex > of the atient. RESULTS: Of 34,069 enrolled patients with blunt > trauma, 818 (2.4%) individuals had a total of 1,496 distinct > ervical spine injuries to 1,285 different cervical spine > structures. The second cervical vertebra was the most common level > of injury (286 [24.0%] fractures, including 92 odontoid fractures), > and 470 (39.3%) fractures occurred in the 2 lowest cervical > vertebrae (C6 and C7). The vertebral body, injured in 235 patients, > was the most frequent site of fracture. Nearly one third of all > injuries (29.3%) were considered clinically insignificant. > CONCLUSION: Cervical spine injuries occur in a small minority of > patients with blunt trauma who undergo imaging. The atlantoaxial > region is the most common site of injury, and the sixth and seventh > vertebrae are involved in over one third of all injuries. Other > spine levels are much more commonly involved than has previously > been appreciated. A substantial minority of radiographically > defined cervical spine injuries are of little clinical importance. > Mower WR. Hoffman JR. Pollack CV Jr. Zucker MI. Browne BJ. Wolfson > AB. NEXUS Group. Use of plain radiography to screen for cervical > spine injuries. [Journal Article. Multicenter Study. Validation > Studies] Annals of Emergency Medicine. 38(1):1-7, 2001 Jul. > Abstract STUDY OBJECTIVE: Standard radiographic screening may fail > to reveal any evidence of injury in some patients with spinal > injury. The purposes of this investigation were to document the > efficacy of standard radiographic views and to categorize the > frequencies and types of injuries missed on plain radiographic > screening of the cervical spine. METHODS: All patients with blunt > trauma selected for radiographic cervical spine imaging at 21 > participating institutions underwent a standard 3-view series > (cross-table lateral, anteroposterior, and odontoid views), as well > as any other imaging deemed necessary by their physicians. Injuries > detected with screening radiography were then compared with final > injury status for each patient, as determined by review of all > radiographic studies. RESULTS: The study enrolled 34,069 patients > with blunt trauma, including 818 patients (2.40% of all patients; > 95% confidence interval [CI] 2.40% to 2.40%) having a total of > 1,496 distinct cervical spine injuries. Plain radiographs revealed > 932 injuries in 498 patients (1.46% of all patients; 95% CI 1.46% > to 1.46%) but missed 564 injuries in 320 patients (0.94% of all > patients; 95% CI 0.94% to 0.94%). The majority of missed injuries > (436 injuries in 237 patients [representing 0.80% of all patients]; > 95% CI 0.80% to 0.80%) occurred in cases in which plain radiographs > were interpreted as abnormal (but not diagnostic of injury) or > inadequate. However, 23 patients (0.07% of all patients; 95% CI > 0.05% to 0.09%) had 35 injuries (including 3 potentially unstable > injuries) that were not visualized on adequate plain film imaging. > These patients represent 2.81% (95% CI 1.89% to 3.63%) of all > injured patients with blunt trauma undergoing > radiographicevaluation. CONCLUSION: Standard 3-view imaging > provides reliable screening for most patients with blunt trauma. > However, on rare occasions, such imaging may fail to detect > significant unstable injuries. In addition, it is difficult to > obtain adequate plain radiographic imaging in a substantial > minority of patients. Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i0.ns.pitt.edu [136.142.186.36]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Wed, 25 Dec 2002 20:47:21 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQGNSNSHNS0012W9@mb2i0.ns.pitt.edu>; Wed, 25 Dec 2002 20:47:20 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 25 Dec 2002 20:27:33 -0500 (EST) Received: from pop015.verizon.net (pop015pub.verizon.net [206.46.170.172]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 25 Dec 2002 20:27:27 -0500 (EST) Received: from KLAPTOP ([141.158.127.142]) by pop015.verizon.net (InterMail vM.5.01.05.20 201-253-122-126-120-20021101) with ESMTP id <20021226013439.YAOC21001.pop015.verizon.net@KLAPTOP> for ; Wed, 25 Dec 2002 19:34:39 -0600 Date: Wed, 25 Dec 2002 20:34:24 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED Hemostatic dressings Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3E0A1650.31084.6039DFB@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at pop015.verizon.net from [141.158.127.142] at Wed, 25 Dec 2002 19:34:31 -0600 [forwarded from Fabrice Czarnecki, M.D., who tried to post from an address that is not part of the w-emed list. A reminder to all that, in order to protect you from lots of spam, only messages from the precise address under which members joined will be accepted by the list.] > Do you have any clinical experience with hemostatic dressings (dry > fibrin, QuickClot, TraumaDex,...)? These hemostatic agents seem > promising in the lab, but I could not find any reports from actual > patient care. > > Fabrice Czarnecki, M.D. I will also note that I use Surgicel and Gelfoam on a rare but regular basis for hemostasis, such as difficult nosebleeds -- but it is rare that one needs them. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 19 Dec 2002 14:04:21 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQ7VYYXDBY00135N@mb1i0.ns.pitt.edu>; Thu, 19 Dec 2002 14:04:22 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 19 Dec 2002 13:50:17 -0500 (EST) Received: from imo-m07.mx.aol.com (imo-m07.mx.aol.com [64.12.136.162]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 19 Dec 2002 13:50:14 -0500 (EST) Received: from JadedMedic@aol.com by imo-m07.mx.aol.com (mail_out_v34.13.) id h.ae.33e1b766 (26116) for ; Thu, 19 Dec 2002 13:55:53 -0500 (EST) Date: Thu, 19 Dec 2002 13:55:52 -0500 (EST) From: JadedMedic@aol.com Subject: W-EMED PLBs approved for general sale in the US Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: AOL 8.0 for Windows US sub 234 Content-type: multipart/alternative; boundary="part1_ae.33e1b766.2b337038_boundary" Precedence: bulk --part1_ae.33e1b766.2b337038_boundary Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit Hi Folks, OK, _this_ is interesting. I just came across a story on the "Equipped To Survive" website (www.equipped.org) regarding how the use of 406Mhz Personal Locator Beacons (PLBs) has now been approved for general civilian use in the US starting next year. These widgets transmit directly to an overhead satellite, thus providing at least basic "SOS" capability in areas where cell phones don't work. Interesting stuff, Maynard. Oh, by the way, I have no commercial relationship with the website. Regards to all, Jay Wiseman, FA/CPR Instructor-at-large Visit my FA/CPR class preview/review website: http://hometown.aol.com/safescene/ "If you're gonna play the game, boy, you'd better learn to play it right." -- Kenny Rogers, "The Gambler" --part1_ae.33e1b766.2b337038_boundary Content-Type: text/html; charset="US-ASCII" Content-Transfer-Encoding: 7bit
Hi Folks,

OK, _this_ is interesting.  I just came across a story on the "Equipped To Survive" website (www.equipped.org) regarding how the use of 406Mhz Personal Locator Beacons (PLBs) has now been approved for general civilian use in the US starting next year.  These widgets transmit directly to an overhead satellite, thus providing at least basic "SOS" capability in areas where cell phones don't work.  Interesting stuff, Maynard.  Oh, by the way, I have no commercial relationship with the website.

Regards to all,

Jay Wiseman, FA/CPR Instructor-at-large
Visit my FA/CPR class preview/review website: http://hometown.aol.com/safescene/
"If you're gonna play the game, boy, you'd better learn to play it right."  -- Kenny Rogers, "The Gambler"
 --part1_ae.33e1b766.2b337038_boundary-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i0.ns.pitt.edu [136.142.186.36]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 19 Dec 2002 12:00:40 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQ7RNM26C0000GBP@mb2i0.ns.pitt.edu>; Thu, 19 Dec 2002 12:00:40 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 19 Dec 2002 11:31:33 -0500 (EST) Received: from emerald.lightlink.com (emerald.lightlink.com [205.232.34.14]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 19 Dec 2002 11:31:30 -0500 (EST) Received: from roadweb (syr-24-59-74-157.twcny.rr.com [24.59.74.157]) by emerald.lightlink.com (8.8.8/8.8.8) with SMTP id LAA18578 for ; Thu, 19 Dec 2002 11:38:12 -0500 Date: Thu, 19 Dec 2002 11:36:48 -0500 From: Nigel Dyson-Hudson Subject: W-EMED fyi, this Fri, noon, webcast [EM] Smallpox Preparedness: Considerations for Response Team Volunteers Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200212191638.LAA18578@emerald.lightlink.com> MIME-version: 1.0 X-MIME-Autoconverted: from quoted-printable to 8bit by list.srv.cis.pitt.edu id LAA05069 X-Mailer: PocoMail 2.63 (1077) - Licensed Version Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Precedence: bulk Emergency Management seems to be a high info content, low noise, mailing list. nigel 1.From the Army in Jan. Advanced Management of Nerve Agent and Sulfur Mustard Casualties Course No. 03.NAGENT.A Live Satellite Broadcast 8 January 2003 1:00 - 3:00 PM ET (Test Signal from 12:30-1:00 PM ET) Sponsored by The U.S. Army Medical Command and the Department of Veterans Affairs Employee Education System and the Emergency Management Strategic Healthcare Group ... rest trimmed. 2. This Fri smallpox webcast. Timely.... Public Health Training Network Satellite Broadcast and Webcast Broadcast Site: http://www.phppo.cdc.gov/PHTN/Smallpox1220.asp For additional information on Smallpox: http://www.cdc.gov/smallpox Friday, December 20, 2002 12:00 Noon – 1:00 PM ET ..... trimmed Happy Holidays, Steve Davis http://all-hands.net http://AllHandsConsulting.com ...... Questions to Emergency-Management-owner@yahoogroups.com - to unsubscribe from this group, send an email to: Emergency-Management-unsubscribe@yahoogroups.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 7 Jan 2003 09:31:51 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQY60MK1Z2000RCN@mb1i0.ns.pitt.edu>; Tue, 7 Jan 2003 09:31:50 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 07 Jan 2003 09:07:45 -0500 (EST) Received: from mx4.magma.ca (mx4.magma.ca [206.191.0.253]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 07 Jan 2003 09:07:42 -0500 (EST) Received: from mail5.magma.ca (mail5.magma.ca [206.191.0.225]) by mx4.magma.ca (Magma's Mail Server) with ESMTP id h07EHM9S017412; Tue, 07 Jan 2003 09:17:22 -0500 Received: from business.magma.ca (ottawa-dial-64-26-163-160.d-ip.magma.ca [64.26.163.160]) by mail5.magma.ca (Magma's Mail Server) with ESMTP id h07EHJCS020004; Tue, 07 Jan 2003 09:17:20 -0500 (EST) Date: Tue, 07 Jan 2003 09:03:29 -0500 From: Langley R Muir Subject: W-EMED Drugs past Expiration Date Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: langley@mail.magma.ca To: tschimel@wyoming.com Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <5.1.0.14.0.20030107084339.00bc9e50@mail.magma.ca> MIME-version: 1.0 X-Mailer: QUALCOMM Windows Eudora Version 5.1 Content-type: text/html; charset="us-ascii" Precedence: bulk Tod:  I was quite interested in  your remark that 

"On the advice of our physician advisor we have been keeping meds up to 3 years after the pharmacist's expiration dates, as long as they're not discolored, degraded or have precipitates."

I understand Keith's Conover's motivation in drawing the W-MED list's attention to research articles relating to this and I can see that it is very expensive for an organization like NOLS to keep replacing medications every couple of years, since a complete replacement for all instructors kits could easily run into a couple of hundred dollars for each of a few hundred kits.

However, I do have a question about the liability.  The pharmaceutical companies have limited their liability with respect to adverse reactions and lack of drug potency by putting a very short expiry date  on their products.  I am sure that the fact that this enormously increases their profits is an entirely secondary consideration.  In a litigatious society such as the US I am surprised that NOLS would accept this responsibility by having an explicit policy of using stale-dated drugs on their public fee-based courses, explicitly contrary to the manufacturer's  recommendations.

It is, of course, all a question of risk management.  I can see where the objective risk could well be very small, although the literature on the topic seems to be sparse.  For an individual who is taking drugs for a specific condition and who only purchases them as needed, there is no reason whatsoever to take the risk of using dated drugs.  However, for an organization which provides services to the public for remuneration, I can see where the cost-benefit analysis might incline them to take the practical risk.   I have not, however, seen much evidence, even in relatively non-litigatious Canada, that cost-benefit analyses would absolve one of much responsibility.  After all, we are in a society that routinely will not accept risks greater than about one in a billion or trillion (10E-9 or 10E-12 per annum) in engineering design.  Savings of a few thousands of dollars would seem to be small potatoes in light of the potential court awards.

Following these comments, I have four questions for you:
  • Have you had competent legal advice on this matter? 
  • Has your physician advisor and/or his/her insurance carrier?
  • Have you actually done the risk analysis and cost/benefit calculations? 
  • Can you share them with us?
Cheers.  Langley

Langley R. Muir,  PhD                           
4 Valewood Crescent                             tel:  1-613-824-9391
Ottawa, Ontario                         fax:  1-613-824-9391
Canada,  K1B 4E8                                e-mail:  langley@magma.ca Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i0.ns.pitt.edu [136.142.186.36]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Wed, 8 Jan 2003 00:19:22 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQZ100C0RQ0017HV@mb2i0.ns.pitt.edu>; Wed, 8 Jan 2003 00:19:22 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 08 Jan 2003 00:01:54 -0500 (EST) Received: from smtp02.mrf.mail.rcn.net (smtp02.mrf.mail.rcn.net [207.172.4.61]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 08 Jan 2003 00:01:51 -0500 (EST) Received: from 216-164-250-95.s603.tnt1.atn.pa.dialup.rcn.com ([216.164.250.95] helo=daisy.erols.com) by smtp02.mrf.mail.rcn.net with esmtp (Exim 3.35 #4) id 18W8V6-00066Q-00; Wed, 08 Jan 2003 00:11:37 -0500 Date: Wed, 08 Jan 2003 00:10:57 -0500 From: Tony Canike Subject: W-EMED EMS Con Ed for NCRC weeklong Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: canike@pop.erols.com To: erncrc@yahoogroups.com, wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <5.2.0.9.0.20030108000350.02127780@pop.erols.com> MIME-version: 1.0 X-Mailer: QUALCOMM Windows Eudora Version 5.2.0.9 Content-type: text/plain; charset="us-ascii"; format=flowed Precedence: bulk Anybody have any experience getting EMS ConEd credits approved for NCRC weeklong level 1? I'm specifically interested in getting Pennsylvania EMS ConEd credits for the upcoming June NM course. If pre-approval were granted by the PA Dept of Health, would it be useful to anyone? Are there any PA EMTs attending the June Level 1? If such approval was valid for all NCRC courses following the same curriculum for the next few years would that be useful to anyone? It takes a bit of work to put the documentation together and I am trying to determine if it would be worthwhile to try. Thanks, Tony. NSS 44230 WEMT-B, NREMT-B Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Wed, 18 Dec 2002 21:16:56 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQ6WSX79N20011V7@mb1i0.ns.pitt.edu>; Wed, 18 Dec 2002 21:16:56 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 18 Dec 2002 20:54:59 -0500 (EST) Received: from imo-m04.mx.aol.com (imo-m04.mx.aol.com [64.12.136.7]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 18 Dec 2002 20:54:55 -0500 (EST) Received: from GaidenMstr@aol.com by imo-m04.mx.aol.com (mail_out_v34.13.) id h.140.583362b (25711) for ; Wed, 18 Dec 2002 21:00:59 -0500 (EST) Date: Wed, 18 Dec 2002 21:00:59 -0500 (EST) From: GaidenMstr@aol.com Subject: Re: W-EMED forwarded for Charles who posted from a nonmember address . . . Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <140.583362b.2b32825b@aol.com> MIME-version: 1.0 X-Mailer: AOL 8.0 for Windows US sub 234 Content-type: multipart/alternative; boundary="part1_140.583362b.2b32825b_boundary" Precedence: bulk --part1_140.583362b.2b32825b_boundary Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit Folks, There is much to say about the fibrin bandage. Yes, US Special Operations is in the process of using these types of bandage but there is still a strict protocol that has to adhered to and I can only predict that this bandage will not be available to the general public to purchase off the shelf for another year or so because it is in an FDA testing/approval phase as we speak. I would also suggest that all of you do extensive research on these items before going out and testing them your patients. There are some current products out there in the form of a powder that cauterizes the wound to stop the bleeding, but what happens to the surrounding tissue and what are the long term affects? I would get prepared for the Kiotsin and fibrin bandage to come out in the next year or two for public use but don't quote me. Yes, it would be nice to get something out there in the near future to help these patients out. Just a note. Bob M. --part1_140.583362b.2b32825b_boundary Content-Type: text/html; charset="US-ASCII" Content-Transfer-Encoding: 7bit Folks,

       There is much to say about the fibrin bandage.  Yes, US Special Operations  is in the process of using these types of bandage but there is still a strict protocol that has to adhered to and I can only predict that this bandage will not be available to the general public to purchase off the shelf for another year or so because it is in an FDA testing/approval phase as we speak.  I would also suggest that all of you do extensive research on these items before going out and testing them your patients.  There are some current products out there in the form of a powder that cauterizes the wound to stop the bleeding, but what happens to the surrounding tissue and what are the long term affects?  I would get prepared for the Kiotsin and fibrin bandage to come out in the next year or two for public use but don't quote me.  Yes, it would be nice to get something out there in the near future to help these patients out.&n! bsp; Just a note.

Bob M. --part1_140.583362b.2b32825b_boundary-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i0.ns.pitt.edu [136.142.186.36]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Wed, 18 Dec 2002 18:13:02 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQ6QDWRQES000DC6@mb2i0.ns.pitt.edu>; Wed, 18 Dec 2002 18:13:02 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 18 Dec 2002 17:53:34 -0500 (EST) Received: from out001.verizon.net (out001pub.verizon.net [206.46.170.140]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 18 Dec 2002 17:53:32 -0500 (EST) Received: from Micron ([141.158.127.181]) by out001.verizon.net (InterMail vM.5.01.05.20 201-253-122-126-120-20021101) with ESMTP id <20021218225937.IQWI4606.out001.verizon.net@Micron>; Wed, 18 Dec 2002 16:59:37 -0600 Date: Wed, 18 Dec 2002 17:59:35 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED forwarded for Charles who posted from a nonmember address . . . Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: clmccomas@ctc.net Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3E00B787.30816.161E7CE@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02a) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at out001.verizon.net from [141.158.127.181] at Wed, 18 Dec 2002 16:59:36 -0600 ust an FYI. The U.S. Marine Corps have already purchased enough thrombin powder packets to issue one to each Marine. The U.S. Special Operations forces (SEALS, Rangers...) is getting ready to buy enough thrombin bandages to issue to individual operators. So hopefully we will see the prices of such bandages go down in the future if that is an issue for putting it in a WEMT kit. A great deal of research is going on for some sort of "fix a flat" solution for penitrating injuries of the abdomen and pelvis regions, but no luck so far. > > From: "Keith Conover, M.D., FACEP" > Date: 2002/12/18 Wed PM 04:19:48 EST > To: James Bender > CC: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED Re: bleeding to death in the backcountry: staples? > Rainey clips? > > Don't think this is any better than thrombin powder, Surgicel or > Gelfoam, and I don't recommend carrying those, either. > > On 17 Dec 2002 at 10:18, James Bender wrote: > > > Kieth what about using TruamaDEX powder to stop the bleeding? Would > > closing the would in this manner increase the chance of infection? > > --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Wed, 18 Dec 2002 16:35:28 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQ6MYYDSKM000WK3@mb1i0.ns.pitt.edu>; Wed, 18 Dec 2002 16:35:28 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 18 Dec 2002 16:13:49 -0500 (EST) Received: from out003.verizon.net (out003pub.verizon.net [206.46.170.103]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 18 Dec 2002 16:13:46 -0500 (EST) Received: from Micron ([141.158.127.181]) by out003.verizon.net (InterMail vM.5.01.05.20 201-253-122-126-120-20021101) with ESMTP id <20021218211950.SDW21770.out003.verizon.net@Micron>; Wed, 18 Dec 2002 15:19:50 -0600 Date: Wed, 18 Dec 2002 16:19:48 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED Re: bleeding to death in the backcountry: staples? Rainey clips? In-reply-to: Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: James Bender Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3E00A024.25865.1068A62@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02a) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at out003.verizon.net from [141.158.127.181] at Wed, 18 Dec 2002 15:19:49 -0600 Don't think this is any better than thrombin powder, Surgicel or Gelfoam, and I don't recommend carrying those, either. On 17 Dec 2002 at 10:18, James Bender wrote: > Kieth what about using TruamaDEX powder to stop the bleeding? Would > closing the would in this manner increase the chance of infection? > > their web site for more infor is www.traumadex.com > > James E.M. Bender, NREMT-P > EMS Disaster Coordinator > > OSF Saint Francis Medical Center > 530 NE Glen Oak Ave > Peoria, IL 61637 > > Phone: 309-655-7746 > Pager:309-497-9184 > Web: www.paems.org > ----- Original Message ----- > From: "Keith Conover, M.D., FACEP" > To: > Cc: > Sent: Saturday, December 14, 2002 5:22 PM > Subject: bleeding to death in the backcountry: staples? Rainey clips? > > > > [Note to WEMSI staff and WEMSI-Europe list members; if you didn't get > > a copy of this via the wilderness-emergency-medicine list as > > indictated by the [wmed] prefix and the list tagline, please see the > > instructions near the end to become a member of the list. We expect > > that everone on these two staff lists will be familiar with any and > > all discussions on the wmed list.] > > > > Thought that would be an attention-grabbing subject line. > > > > But seriously, people can slowly bleed to death from lacerations. I've > > seen a lot of interest recently in a variety of powders for bleeding > > control, ranging from what seems to be clay to thrombin powder. I > > personally like Surgicel or Gelfoam for bleeding control when really > > needed. > > > > However, direct pressure seems to be a better answer for most > > bleeding, and after due discussion, WEMSI has _not_ added any of those > > surgical hemostatic materials to the WEMSI Personal Wilderness Medical > > Kit list (posted at www.wemsi.org). > > > > However, there are some lacerations that will continue to ooze, and > > ooze enough that people can die from them. Scalp lacerations are the > > most obvious and common. > > > > But the real key to hemostasis for scalp wounds is closure. Now, it's > > not all that easy to close scalp lacerations when they're bleeding > > like stink, even in an ED with good surgical lighting and other people > > to help. Sometimes you have to tie off the bleeders, and even if you > > use a stapler rather than sutures, it's not always that easy to get > > the wound closed, even if you use a stapler on scalp wounds all the > > time. > > > > I think that asking a WEMT to try to suture a scalp wound is a waste > > of time. It will not work and it just annoys the pig (whoops, sorrry, > > that's about trying to teach a pig to whistle). If someone sutures > > all the time, fine, but otherwise, a stapler is clearly much easier to > > use. But a stapler's not all that easy to use, especially in adverse > > situations. > > > > I was looking for better solutions, and did some searching for bigger > > surgical staples, i.e., ones that would be a lot easier to use when > > your goal is stopping the bleeding, not a definitive closure. I tried > > looking for veterinary ones that might be bigger and easier to use. > > But no luck. I did find that 3M makes a small stapler that holds a lot > > of staples; can be used either by itself or stuck into a sort of > > reusable handle; and this sans the reusable handle looks ideal for > > carrying in a personal medical kit (they have wide and narrow > > versions, we obviously wand the wide, but even the wide ones aren't > > that wide). But I still wish I could find a stapler that uses bigger > > staples, just for emergency closure; anyone seen anything like that? > > > > And, an alternative: for neurosurgery, there are little clips called > > Rainey clips that can be easily attached to the edges of a scalp wound > > to control bleeding; however, you need a special and somewhat heavy > > clip-applying tool to get them on. What do people think about those > > as opposed to staples? > > > > Thanks for your thoughts. > > Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) > > http://www.pitt.edu/~kconover > > - Information Systems Coordinator, Dept. of EM, Mercy Hospital > > - Clinical Assistant Professor, Dept. of Emergency Medicine, > > Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) > > - > > Medical Director, Wilderness EMS Institute > > (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe > > wilderness-emergency-medicine" to Majordomo@list.pitt.edu) > > - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. > > --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sat, 14 Dec 2002 20:55:46 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQ1AWAE51M000NGK@mb1i0.ns.pitt.edu>; Sat, 14 Dec 2002 20:55:45 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 14 Dec 2002 20:44:18 -0500 (EST) Received: from pop016.verizon.net (pop016pub.verizon.net [206.46.170.173]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 14 Dec 2002 20:44:08 -0500 (EST) Received: from Micron ([141.158.127.181]) by pop016.verizon.net (InterMail vM.5.01.05.20 201-253-122-126-120-20021101) with ESMTP id <20021215014937.FWBI4233.pop016.verizon.net@Micron>; Sat, 14 Dec 2002 19:49:37 -0600 Date: Sat, 14 Dec 2002 20:49:35 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED Re: bleeding to death in the backcountry: staples? Rainey clips? In-reply-to: <20021215004337.30451.qmail@web13305.mail.yahoo.com> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Jonnathan Busko Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3DFB995F.14736.2424E6B@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02a) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at pop016.verizon.net from [141.158.127.181] at Sat, 14 Dec 2002 19:49:37 -0600 References: <3DFB76DF.15304.1BB89B5@localhost> Jonnathan, your message bounced from the wmed list as a nonmember, but I'll reply and that'll get it there. On 14 Dec 2002 at 16:43, Jonnathan Busko wrote: > Keith, > > I'm not convinced it isn't worth taking the time > to each a wilderness EMT to do a running suture with > 2.0 silk, prolene, etc. It's big and ugly but will > catch all the involved layers, can be cranked pretty > tight, and is relatively easy to do, even in the worst > of conditions. he principle would also work with > fishing line and a hook with the barb clipped off for > those who really like multipurpose toys. Also, it's > easier to open a suture in the wilderness setting on > day 2 when the pus begins to drain out. Trouble is that silk (I'd recommend 0 silk with an attached needle, have to check what's available), if you're worried about infection, is worse than staples. And given what I've seen of interns in the ED, getting WEMTs to be able to do a good hand tie (unless they want to carry a needle holder and do an instrument tie) is problematic. And staples don't come untied. > Having said that, I like the idea of the 3m wide > stapler. I think the handle for the Rainey clips is > too bulky and too single purpose to be added to the > kit. I'm still using the mini-staplers you got a few > years back but would like to see a wider stapler as > well. > > Just my thoughts, > > Jonnathan 3M has similar ones but with about 25 staples instead of 5, indeed, they're quite small and light. Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sat, 14 Dec 2002 18:34:41 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KQ15YE3WA4000N9T@mb1i0.ns.pitt.edu>; Sat, 14 Dec 2002 18:34:41 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 14 Dec 2002 18:17:00 -0500 (EST) Received: from pop015.verizon.net (pop015pub.verizon.net [206.46.170.172]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 14 Dec 2002 18:16:57 -0500 (EST) Received: from Micron ([141.158.127.181]) by pop015.verizon.net (InterMail vM.5.01.05.20 201-253-122-126-120-20021101) with ESMTP id <20021214232225.TKIA24616.pop015.verizon.net@Micron>; Sat, 14 Dec 2002 17:22:25 -0600 Date: Sat, 14 Dec 2002 18:22:23 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED bleeding to death in the backcountry: staples? Rainey clips? Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Cc: wemsi-staff@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3DFB76DF.15304.1BB89B5@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02a) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at pop015.verizon.net from [141.158.127.181] at Sat, 14 Dec 2002 17:22:25 -0600 [Note to WEMSI staff and WEMSI-Europe list members; if you didn't get a copy of this via the wilderness-emergency-medicine list as indictated by the [wmed] prefix and the list tagline, please see the instructions near the end to become a member of the list. We expect that everone on these two staff lists will be familiar with any and all discussions on the wmed list.] Thought that would be an attention-grabbing subject line. But seriously, people can slowly bleed to death from lacerations. I've seen a lot of interest recently in a variety of powders for bleeding control, ranging from what seems to be clay to thrombin powder. I personally like Surgicel or Gelfoam for bleeding control when really needed. However, direct pressure seems to be a better answer for most bleeding, and after due discussion, WEMSI has _not_ added any of those surgical hemostatic materials to the WEMSI Personal Wilderness Medical Kit list (posted at www.wemsi.org). However, there are some lacerations that will continue to ooze, and ooze enough that people can die from them. Scalp lacerations are the most obvious and common. But the real key to hemostasis for scalp wounds is closure. Now, it's not all that easy to close scalp lacerations when they're bleeding like stink, even in an ED with good surgical lighting and other people to help. Sometimes you have to tie off the bleeders, and even if you use a stapler rather than sutures, it's not always that easy to get the wound closed, even if you use a stapler on scalp wounds all the time. I think that asking a WEMT to try to suture a scalp wound is a waste of time. It will not work and it just annoys the pig (whoops, sorrry, that's about trying to teach a pig to whistle). If someone sutures all the time, fine, but otherwise, a stapler is clearly much easier to use. But a stapler's not all that easy to use, especially in adverse situations. I was looking for better solutions, and did some searching for bigger surgical staples, i.e., ones that would be a lot easier to use when your goal is stopping the bleeding, not a definitive closure. I tried looking for veterinary ones that might be bigger and easier to use. But no luck. I did find that 3M makes a small stapler that holds a lot of staples; can be used either by itself or stuck into a sort of reusable handle; and this sans the reusable handle looks ideal for carrying in a personal medical kit (they have wide and narrow versions, we obviously wand the wide, but even the wide ones aren't that wide). But I still wish I could find a stapler that uses bigger staples, just for emergency closure; anyone seen anything like that? And, an alternative: for neurosurgery, there are little clips called Rainey clips that can be easily attached to the edges of a scalp wound to control bleeding; however, you need a special and somewhat heavy clip-applying tool to get them on. What do people think about those as opposed to staples? Thanks for your thoughts. Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i0.ns.pitt.edu [136.142.186.36]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 13 Dec 2002 18:37:46 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KPZRRVGN0O0032A1@mb2i0.ns.pitt.edu>; Fri, 13 Dec 2002 18:37:46 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 13 Dec 2002 17:51:56 -0500 (EST) Received: from out002.verizon.net (out002pub.verizon.net [206.46.170.141]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 13 Dec 2002 17:51:53 -0500 (EST) Received: from Micron ([141.158.127.181]) by out002.verizon.net (InterMail vM.5.01.05.20 201-253-122-126-120-20021101) with ESMTP id <20021213225712.IHTJ8264.out002.verizon.net@Micron>; Fri, 13 Dec 2002 16:57:12 -0600 Date: Fri, 13 Dec 2002 17:57:10 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED Improvising suppositories Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Cc: fczarnecki@hotmail.com Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3DFA1F76.2352.1B18562@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02a) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at out002.verizon.net from [141.158.127.181] at Fri, 13 Dec 2002 16:57:11 -0600 [Fabrice posted this from a hotmail address that is not currently a member of the list, I am forwarding with my comments. We teach WEMTs to use a bit of chocolate, e.g., an M&M, and crush it together with the pill, and then form into a suppository. --Keith Conover, M.D., FACEP, listowner] Forwarded message: > I am looking for information on how to improvise suppositories in = > expedition conditions. > > Fabrice Czarnecki, M.D. Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i0.ns.pitt.edu [136.142.186.36]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 22 Nov 2002 17:14:29 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KP6CRBQP7Q000FZJ@mb2i0.ns.pitt.edu>; Fri, 22 Nov 2002 17:14:28 EDT Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 22 Nov 2002 17:00:35 -0500 (EST) Received: from pop018.verizon.net (pop018pub.verizon.net [206.46.170.212]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 22 Nov 2002 17:00:28 -0500 (EST) Received: from KLAPTOP ([141.158.127.36]) by pop018.verizon.net (InterMail vM.5.01.05.09 201-253-122-126-109-20020611) with ESMTP id <20021122220226.CTHX1825.pop018.verizon.net@KLAPTOP>; Fri, 22 Nov 2002 16:02:26 -0600 Date: Fri, 22 Nov 2002 17:01:03 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED (Fwd) [ems-l] Dr. Mitchell's Response to the Lancet Article Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wemsi-staff@list.pitt.edu, wemsi-europe@yahoogroups.com Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3DDE62CF.23692.6427DFA@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at pop018.verizon.net from [141.158.127.36] at Fri, 22 Nov 2002 16:01:12 -0600 Given the recent discussion of whether CISD works or not, this message might be of interest. I will also add my own criticism, which is that CISD was designed for use with public safety personnel (fire, rescue, police, EMS) and only with the use of peer debriefers -- which was not the case in many of the studies in the metaanalysis. Take care. ------- Forwarded message follows ------- Date sent: Tue, 17 Sep 2002 17:26:23 -0500 From: "Dr. Bryan Bledsoe" Subject: [ems-l] Dr. Mitchell's Response to the Lancet Article To: EMS-L List Server Send reply to: EMS-L List Server You are currently subscribed to ems-l as: kconover@pitt.edu To change your subscription go to: http://listserv.unc.edu/cgi-bin/lyris.pl?enter=ems-l ----- Dr. Mitchell's response was posted on the ICISF web siteand forwarded to the EMS Research list: It Is Neither New Nor News Jeffrey T. Mitchell, Ph.D., CTS President International Critical Incident Stress Foundation And Clinical Associate Professor of Emergency Health Services, University of Maryland Baltimore County Would you be surprised if you read headlines today that said "Pepto Bismol is not a cure for cancer?" In all likelihood, you would not be surprised. The antacid has never claimed that it is a cure for cancer. Therefore, we should be equally unsurprised when The Lancet comes out with a study that says that single session debriefings are ineffective. We have known since the beginning of CISM services back in the mid 1970's that single session debriefings are ineffective. In fact, the first article ever written about the Critical Incident Stress Debriefing (CISD) in 1983, then known as the "Mitchell Model", clearly indicated that there are many interventions which needed to be linked and blended together into a comprehensive, systematic and multi-component program of crisis intervention. Therefore, the findings in The Lancet are not new, nor are they newsworthy. What may be more surprising is that The Lancet has allowed itself to publish a study with several serious misconceptions and fatal flaws. In other words,there is some questionable science in the article. Without going into a very lengthy, point-by-point, description of the problems with The Lancet article, suffice it to say the following: 1. The authors of The Lancet article confuse crisis intervention with psychotherapy. 2. The Lancet study further confuses crisis intervention with counseling and psychotherapy. The terms in the article are used as if they were synonymous. 3. The authors mistakenly claim that single session debriefings are the standard of practice in the field. 4. The Lancet article blends into its meta-analysis counseling or therapy sessions, individual consultations, and group processes that are clearly not CISDs nor are they crisis intervention contacts. In the study, there are things that the authors call "CISD" but instead they are group processes that violate the standard procedures in the field. There are even "debriefings" that are described by the authors as not being CISDs. The article then proceeds to describe all of these different types of interventions as if they were CISDs. They put everything under one label, CISD. The most fatal flaw in the study is that the interventions assessed are not all the same thing. If you are measuring different things within a study that erroneously claims that they are all the same then you cannot draw any legitimate conclusions. 5. Each of the studies in the meta-analysis is an older study, which has already been reviewed and critiqued. There are no new studies in The Lancet meta-analysis. Each of the reviewed studies is seriously flawed. Putting them all in a new wrapping does not improve the quality of the studies. They were gravely flawed when they were first written and they remain so now. For those of us who provide CISM services, this comes as a relief since we do not do, nor do we promote, single session debriefings. We instead use and promote a comprehensive, systematic and multi-component approach to crisis intervention. So, The Lancet article is not about us and instead further validates ICISF's protocol of CISM.. It is telling people that which we already know. Single session debriefing is ineffective. We have been saying the same thing since the inception of CISM twenty-eight years ago. So,whoever is doing them should stop that practice. We agree with that one point. The media frenzy that has surrounded the release of The Lancet article is unwarranted and inappropriate. The headlines are claiming that early intervention, crisis counseling, and grief counseling all do not work. The Lancet article does not cover any of those things. It has nothing to do with September 11, early intervention, the work of the American Red Cross or the National Organization for Victim Assistance, grief counseling, crisis counseling, disaster response, and the efforts of ICISF CISM teams who responded. Its only conclusion is that single session debriefings are ineffective. No news there. On the other side of the coin, a National Institutes of Mental Health document, Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims / Survivors of Mass Violence. A Workshop to Reach Consensus on Best Practices has just been released. The press release for the NIMH study says, "Early Mental Health Intervention Reduces Mass Violence Trauma." This document supports early intervention and the use of a comprehensive, systematic and multi-component approach to crisis intervention. It affirms that there is a role for paraprofessionals in early intervention. It also supports the concept that only properly trained people should be providing early intervention services. Those are the things that ICISF promotes and we can certainly agree with the standards suggested by the NIMH report. The monograph is new and it is newsworthy. Let's pay more attention to it. References: National Institute of Mental Health (2002). Mental Health and Mass Violence; Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence. A Workshop to Reach Consensus on Best Practices. NIH Publication No. 02-5138, Washington, D.C.; US Government Printing Office Van Emmerik, A., Kamphuis, J., Hulsbosch, A., Emmelkamp, P. (2002). Single Session Debriefing After Psychological Trauma: A Meta- Analysis. The Lancet, Vol. 360, Pg. 766-771 . ------- End of forwarded message ------- --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 22 Nov 2002 17:14:57 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KP6CRWHQRA002S76@mb1i0.ns.pitt.edu>; Fri, 22 Nov 2002 17:14:56 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 22 Nov 2002 16:59:23 -0500 (EST) Received: from pop018.verizon.net (pop018pub.verizon.net [206.46.170.212]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 22 Nov 2002 16:59:14 -0500 (EST) Received: from KLAPTOP ([141.158.127.36]) by pop018.verizon.net (InterMail vM.5.01.05.09 201-253-122-126-109-20020611) with ESMTP id <20021122220114.CSZS1825.pop018.verizon.net@KLAPTOP>; Fri, 22 Nov 2002 16:01:14 -0600 Date: Fri, 22 Nov 2002 17:01:01 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED (Fwd) [ems-l] More Data Against CISM/CISD Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wemsi-staff@list.pitt.edu, wemsi-europe@yahoogroups.com, wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3DDE62CD.2746.6427807@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at pop018.verizon.net from [141.158.127.36] at Fri, 22 Nov 2002 16:01:12 -0600 See the accompanying message with a response from Mitchell. ------- Forwarded message follows ------- Date sent: Mon, 05 Aug 2002 12:39:40 -0500 From: "Dr. Bryan Bledsoe" Subject: [ems-l] More Data Against CISM/CISD To: EMS-L List Server Send reply to: EMS-L List Server You are currently subscribed to ems-l as: kconover@pitt.edu To change your subscription go to: http://listserv.unc.edu/cgi-bin/lyris.pl?enter=ems-l ----- NATO has joined the growing lists of organizations dropping CISM/CISD. The following iare two of their conclusions: "There is still no consensus on the role, if any, of very acute interventions. Classic CISD debriefing can no longer be recommended. The balance between getting people to talk to people, and getting people to talk to professionals, has not been established." and "It may be that the best time for interventions is not in the immediate aftermath of an attack, but in the following weeks, when people have stopped telling their own stories, but some, those perhaps most distressed, still require empathic audiences. Read the full document at: http://www.nato.int/science/e/020325-arw2.htm BEB Bryan E. Bledsoe, DO, FACEP Midlothian, Texas All outgoing email scanned by Norton Antivirus and guaranteed "virus free" or your money back. ------- End of forwarded message ------- --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 22 Nov 2002 17:18:43 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KP6CWKW692002ZTT@mb1i0.ns.pitt.edu>; Fri, 22 Nov 2002 17:18:42 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 22 Nov 2002 16:59:26 -0500 (EST) Received: from pop018.verizon.net (pop018pub.verizon.net [206.46.170.212]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 22 Nov 2002 16:59:21 -0500 (EST) Received: from KLAPTOP ([141.158.127.36]) by pop018.verizon.net (InterMail vM.5.01.05.09 201-253-122-126-109-20020611) with ESMTP id <20021122220118.CTAE1825.pop018.verizon.net@KLAPTOP>; Fri, 22 Nov 2002 16:01:18 -0600 Date: Thu, 21 Nov 2002 15:12:00 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED F.A.S.T.-1 adult IO device Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Bernie Roche , wilderness-emergency-medicine@list.pitt.edu, wemsi-europe@yahoogroups.com, wemsi-staff@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3DDCF7C0.24716.B84BF3@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02) Content-type: Multipart/Digest; boundary=Digest-7B594B7B Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at pop018.verizon.net from [141.158.127.36] at Fri, 22 Nov 2002 16:01:12 -0600 --Digest-7B594B7B Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID for ; Tue, 24 Sep 2002 11:05:27 -0400 (EDT) Received: from lambada.oit.unc.edu ([152.2.22.80]) by pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01KMVKOEHQRQ004H3H@mb1i0.ns.pitt.edu> for kconover@imap.pitt.edu (ORCPT rfc822;kconover@pitt.edu); Tue, 24 Sep 2002 11:05:26 EDT Content-return: allowed X-URL: Date: Tue, 24 Sep 2002 10:05:14 -0500 From: David.W.Gammell@HealthPartners.Com Subject: [ems-l] F.A.S.T. 1 Adult IO Sender: bounce-ems-l-665447@listserv.unc.edu To: EMS-L List Server Reply-to: EMS-L List Server Message-id: MIME-version: 1.0 X-Mailer: Internet Mail Service (5.5.2656.59) Content-type: text/plain; charset=iso-8859-1 X-Message-Id: <65475E548F4D434EA3A4F33059CAE41E01562B24@NEWMAN> List-Owner: List-Subscribe: List-Unsubscribe: X-List-Host: The UNC List Server You are currently subscribed to ems-l as: kconover@pitt.edu To change your subscription go to: http://listserv.unc.edu/cgi-bin/lyris.pl?enter=ems-l ----- Over the last 1 1/2 years we have completed a field trial using the F.A.S.T. 1 Adult IO. We had a 70% completion rate with our first 40 attempts. I believe we have had several successes in a row since the field trial was completed. The F.A.S.T. 1 is easy to use and does not require a lot of continuing education. I believe the device sells for about $100.00 each. For more information see www.pyng.com. David Gammell EMS Quality Advisor Regions Hospital EMS St. Paul, MN --Digest-7B594B7B Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID for ; Tue, 24 Sep 2002 11:21:09 -0400 (EDT) Received: from lambada.oit.unc.edu ([152.2.22.80]) by pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01KMVL7WHEMO004EBO@mb1i0.ns.pitt.edu> for kconover@imap.pitt.edu (ORCPT rfc822;kconover@pitt.edu); Tue, 24 Sep 2002 11:21:09 EDT Content-return: allowed X-URL: Date: Tue, 24 Sep 2002 10:20:53 -0500 From: David.W.Gammell@HealthPartners.Com Subject: [ems-l] F.A.S.T. 1 Adult IO Sender: bounce-ems-l-665447@listserv.unc.edu To: EMS-L List Server Reply-to: EMS-L List Server Message-id: MIME-version: 1.0 X-Mailer: Internet Mail Service (5.5.2656.59) Content-type: text/plain; charset=iso-8859-1 X-Message-Id: <65475E548F4D434EA3A4F33059CAE41E01562B26@NEWMAN> List-Owner: List-Subscribe: List-Unsubscribe: X-List-Host: The UNC List Server You are currently subscribed to ems-l as: kconover@pitt.edu To change your subscription go to: http://listserv.unc.edu/cgi-bin/lyris.pl?enter=ems-l ----- Dr. Wesley, We have not experienced a problem with the F.A.S.T. 1 being dislodged during CPR. It comes with a protective dome that helps protect the site. David Gammell EMS Quality Advisor Regions Hospital EMS Subject: RE: Central lines From: "Keith Wesley" Date: Sat, 21 Sep 2002 11:11:09 -0500 X-Message-Number: 4 Regions Hospital as one of the trial centers and has very encouraging results. We are going to examine them in the state of Wisconsin for approval at the paramedic level. My concern is how stable are they during CPR? Keith Wesley, MD FACEP EMS Education Sacred Heart Hospital Eau Claire, WI --Digest-7B594B7B Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID for ; Wed, 25 Sep 2002 13:33:44 -0400 (EDT) Received: from lambada.oit.unc.edu ([152.2.22.80]) by pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01KMX45L10UA004M8C@mb1i0.ns.pitt.edu> for kconover@imap.pitt.edu (ORCPT rfc822;kconover@pitt.edu); Wed, 25 Sep 2002 13:33:43 EDT Content-return: allowed X-URL: Date: Wed, 25 Sep 2002 12:30:07 -0500 From: David.W.Gammell@HealthPartners.Com Subject: [ems-l] F.A.S.T. 1 IO Sender: bounce-ems-l-665447@listserv.unc.edu To: EMS-L List Server Reply-to: EMS-L List Server Message-id: MIME-version: 1.0 X-Mailer: Internet Mail Service (5.5.2656.59) Content-type: text/plain; charset=iso-8859-1 X-Message-Id: <65475E548F4D434EA3A4F33059CAE41E01562B32@NEWMAN> List-Owner: List-Subscribe: List-Unsubscribe: X-List-Host: The UNC List Server You are currently subscribed to ems-l as: kconover@pitt.edu To change your subscription go to: http://listserv.unc.edu/cgi-bin/lyris.pl?enter=ems-l ----- Dr. Bledsoe, Regions Hospital EMS provides medical direction to 10 ambulance services in St. Paul and the surrounding area. We also serve several services in Western Wisconsin. Of the 40 attempts, only a couple were made by St. Paul Fire. Because access can be obtained and fluids running in approximately 90 seconds, we encourage our providers to attempt the adult IO on patients who have a GCS < 6, no purposeful movement, and may be a difficult stick. We have all heard of medics wasting time attempting an IV 1, 2, or even more times. The F.A.S.T. 1 Adult IO has provided rapid access in difficult patients with very few problems. Have a great day, Dave Gammell Regions Hospital EMS Subject: Re: F.A.S.T. 1 Adult IO From: "Dr. Bryan Bledsoe" Date: Tue, 24 Sep 2002 10:13:50 -0500 X-Message-Number: 4 David: With all due respect, why would there be a need for 40 attempts at a sternal IV in St. Paul, MN (population of 277,454 in the last JEMS survey)? That number seems very high. Is the standard IV success rate low there with the St. Paul FD? How many runs were there in the 1 1/2 years? Just curious. Bryan E. Bledsoe, DO, FACEP Midlothian, Texas --Digest-7B594B7B-- Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i0.ns.pitt.edu [136.142.186.36]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 3 Nov 2002 16:47:21 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KOFSA4I7RK001VGG@mb2i0.ns.pitt.edu>; Sun, 3 Nov 2002 16:47:20 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 03 Nov 2002 16:20:21 -0500 (EST) Received: from pop016.verizon.net (pop016pub.verizon.net [206.46.170.173]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 03 Nov 2002 16:20:18 -0500 (EST) Received: from Micron ([141.158.127.36]) by pop016.verizon.net (InterMail vM.5.01.05.09 201-253-122-126-109-20020611) with ESMTP id <20021103213751.IOTR1630.pop016.verizon.net@Micron>; Sun, 03 Nov 2002 15:37:51 -0600 Date: Sun, 03 Nov 2002 16:37:48 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED Re: Drugs past expiration date In-reply-to: <3DC57F46.A45FD661@wyoming.com> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Tod Schimelpfenig , tschimel@wyoming.com Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3DC550DC.29380.52C6EA1@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02a) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at pop016.verizon.net from [141.158.127.36] at Sun, 3 Nov 2002 15:37:50 -0600 When they say "epinephrine content" this refers to the assay of the liquid for biologically active epinephrine, not that there is actual loss of liquid, I can assure you of that, this is standard language and doesn't refer to leaking. Hope that helps. On 3 Nov 2002 at 12:55, Tod Schimelpfenig wrote: > Dr Conover > > Thanks for the posting. This is an issue for outdoor programs, as well > as personal medical kits. At NOLS we could throw out large quantities > of medications every year if we followed expiration dates. On the > advice of our physician advisor we have been keeping meds up to 3 years > after the pharmacist's expiration dates, as long as they're not > discolored, degraded or have precipitates. I do have a question. > > The Medical Letter article says, in reference to the Epi-pens, that the > autoinjectors "contained less than 90% of the labeled epinephrine > content 10 months after the expiration date." This implies they leak, > not necessarily that the medication has lost it's potency. > > I can only access the abstract. They must mean potency, but again the > language is vague. Can we check the original reference to verify this > question? Simons et al. J Allergy Clin Immunol 2000; 105:1025. > > Tod > --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i0.ns.pitt.edu [136.142.186.35]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 3 Nov 2002 09:54:42 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KOFDUJR2OC000TKS@mb1i0.ns.pitt.edu>; Sun, 3 Nov 2002 09:54:42 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 03 Nov 2002 09:30:23 -0500 (EST) Received: from supercable.net.ve ([216.72.155.5]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 03 Nov 2002 09:30:17 -0500 (EST) Received: (apparently) from sceptre ([200.47.182.199]) by supercable.net.ve with Microsoft SMTPSVC(5.5.1877.647.64); Sun, 03 Nov 2002 11:05:38 -0400 Date: Sun, 03 Nov 2002 07:09:48 -0400 From: traumamsd Subject: Re: W-EMED "Drugs Past Their Expiration Date" Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000b01c28348$96f4ba20$c7b62fc8@supercable.net.ve> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V6.00.2600.0000 X-Mailer: Microsoft Outlook Express 6.00.2600.0000 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <3DC4306E.13441.C5AA28@localhost> I would like to add that the US Army has in deposit (for emergencies) drugs with over 10 years of their expiration date. The expiration date except for a few drugs (due to toxic metabolites or lost of its potency) is for sales and storing purposes. To have a drug in deposit over 3 years cost a lot to the manufacturing company and there is the question that pops up "why it wasn't sold in 3 years?". Other tip the same drug sold by the same company has different expiration dates (or none) depending the country is sold. On the other hand, the local laws and regulations must be read carefully to avoid problems. Regards Manuel Sotelo M.D. One question that often comes up is: "when do I need to replace all the meds in my wilderness medical kit?" and another is "can I use meds if they're outdated?" Well, this week's issue of The Medical Letter [Vol. 44 (Issue 1142), October 28, 2002] provides some answers. In an article entitled "Drugs Past Their Expiration Date" the editors of this highly-respected medical publication provide useful guidance that you'll almost never get from pharmacies or drug companies. I simplify for the purposes of a brief email, see the article through your library or through www.medicalletter.org for the whole story. High points: * Expiration date is usually 2-3 years from date of manufacture, which is chosen because the drug is known to be stable until that date, NOT that it'll be bad after that. * If a pharmacy repacks drugs, they generally give a one-year expiration date. * The only bad thing to come from taking outdated drugs of which we know was some kidney damage from outdated tetracycline -- and newer formulations of tetracycline are unlikely to cause this (nonetheless, there are many better choices for an antibiotic for wilderness medical kits). * Drugs generally retain their potency for years after their expiration date, although pills are more stable than liquids. Injectable liquids that are discolored, cloudy or have precipitate shouldn't be used, otherwise they're probably OK. Epi-Pen injectors tend to drop down to less than 90% of potency about a year after expiration date, even if they're not discolored, so people with Epi-Pens should make sure they replace them regularly -- however don't hesitate to use an outdated one if it's truly necessary, it just might not be as powerful as expected. * Many drugs stored under reasonable conditions retain 90% of their potency for at least 5 years after the expiration date on the label, and sometimes much longer. Hope this is of interest. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i0.ns.pitt.edu [136.142.186.36]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sat, 2 Nov 2002 20:19:44 -0500 (EST) Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KOELE4LKO4001WSO@mb2i0.ns.pitt.edu>; Sat, 2 Nov 2002 20:19:44 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 02 Nov 2002 19:49:50 -0500 (EST) Received: from pop017.verizon.net (pop017pub.verizon.net [206.46.170.210]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 02 Nov 2002 19:49:47 -0500 (EST) Received: from Micron ([141.158.127.36]) by pop017.verizon.net (InterMail vM.5.01.05.09 201-253-122-126-109-20020611) with ESMTP id <20021103010712.DWFJ1423.pop017.verizon.net@Micron> for ; Sat, 02 Nov 2002 19:07:12 -0600 Date: Sat, 02 Nov 2002 20:07:10 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED "Drugs Past Their Expiration Date" Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3DC4306E.13441.C5AA28@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.02a) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk X-Authentication-Info: Submitted using SMTP AUTH LOGIN at pop017.verizon.net from [141.158.127.36] at Sat, 2 Nov 2002 19:07:12 -0600 One question that often comes up is: "when do I need to replace all the meds in my wilderness medical kit?" and another is "can I use meds if they're outdated?" Well, this week's issue of The Medical Letter [Vol. 44 (Issue 1142), October 28, 2002] provides some answers. In an article entitled "Drugs Past Their Expiration Date" the editors of this highly-respected medical publication provide useful guidance that you'll almost never get from pharmacies or drug companies. I simplify for the purposes of a brief email, see the article through your library or through www.medicalletter.org for the whole story. High points: * Expiration date is usually 2-3 years from date of manufacture, which is chosen because the drug is known to be stable until that date, NOT that it'll be bad after that. * If a pharmacy repacks drugs, they generally give a one-year expiration date. * The only bad thing to come from taking outdated drugs of which we know was some kidney damage from outdated tetracycline -- and newer formulations of tetracycline are unlikely to cause this (nonetheless, there are many better choices for an antibiotic for wilderness medical kits). * Drugs generally retain their potency for years after their expiration date, although pills are more stable than liquids. Injectable liquids that are discolored, cloudy or have precipitate shouldn't be used, otherwise they're probably OK. Epi-Pen injectors tend to drop down to less than 90% of potency about a year after expiration date, even if they're not discolored, so people with Epi-Pens should make sure they replace them regularly -- however don't hesitate to use an outdated one if it's truly necessary, it just might not be as powerful as expected. * Many drugs stored under reasonable conditions retain 90% of their potency for at least 5 years after the expiration date on the label, and sometimes much longer. Hope this is of interest. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End --