The provision of EMS service among 120,000 cardiac incidents in Mississippi over 10 years (1995 to 2004) was “highly equitable for African-Americans and whites,” Guy David, assistant professor of health care management, told Research Monitor. David and Professor Scott Harrington, both at The Wharton School at the University of Pennsylvania in Philadelphia, mined data from state (MEMSIS, Medicaid, health) and national (census, commerce, agriculture) departments, as well as the CDC, to assess potential race bias in EMS.
They report average response times of 9.06 minutes in the 21 mostly white counties, 8.75 minutes in the 25 mostly black counties, and 9.75 minutes in the 36 mixed-race counties. Fifty-seven, 62 and 53 percent of calls, respectively, had response times of eight minutes or less. The researchers also found little or no evidence of race-related certification differences in EMS personnel. However, when controlling for response time, blacks were more likely to die before EMS arrived—a finding that requires further research, the researchers note, as it may be due to race-related cardiac-incident severity differences, the scope of bystander assistance or delays in calling EMS after symptom onset. — Journal of Health Economics, doi 10.1016/jhealeco.2010.03.004, published online March 16, 2010.
We think we know clean, but when Jonathan Borak, M.D., and Adjunct Professor Greg Sirianni, both at Yale University in New Haven, Conn., reviewed definitions of “clean” according to 24 agencies—ANSI, ASTM, CDC, NFPA, NIOSH and OSHA, among others—they found a mess. Most agencies call for clean reusable clothing, respirators and eye/face protection but do not define what clean is. What’s more, they offer no or varying methods for cleaning such gear.
“It is not possible to know if employees are adequately protected,” Sirianni told Research Monitor, or if employer-generated cleaning programs are adequate, since no agency offers methods for determining if gear is actually clean or sanitized. He and Borak propose collaboration among pertinent agencies to adopt a single set of cleaning and clean standards. — Journal of Occupational and Environmental Medicine, 52(2):190–196, February 2010.
Antibiotic-resistant MRSA reared its highly infectious head in 25 of 51 southern Maine ambulances tested by Robert Brown, OMS-IV, and colleagues at the University of New England in Biddeford, Maine. Service type (fire or non-fire) and call volume did not account for finding at least one MRSA-contaminated spot in 49 percent of the rigs. — Prehospital Emergency Care 14(2):176–181, April–June 2010 issue. [Note: See the related report, “Is Your Stethoscope Clean?” in the April 2009 Research Monitor.]
EMS systems that utilize poison control centers may avoid transports for some patients and prevent unnecessary system-wide costs. Scott A. Bier, M.D., at Darnall Army Medical Center in Fort Hood, Texas, and Douglas J. Borys, Pharm.D., at Texas Poison Center Network in Temple, reviewed 386 Austin, Texas, cases in which EMS called poison control. Just 63 of the patients (16 percent) needed transport to a hospital; poison control recommended at-home observation for most and administration of medication in only 6 percent. The researchers estimate non-transports saved the city more than $205,000 between 2004 and 2006. — The American Journal of Emergency Medicine doi:10.1016/j.ajem.2009.05.015, published online March 9, 2010.
When comparing spine motion in cadavers, a scoop stretcher and the lift-and-slide maneuver limited motion better than log-rolling. Gianiuca Del Rossi, Ph.D., and colleagues at the University of South Florida in Tampa used a 3-D electromagnetic tracking device to measure angular and linear motion of the spine during each maneuver. They did so first on intact spines, then on spines with destabilized fifth and sixth cervical vertebrae. The scoop stretcher and the lift-and-slide methods comparably restricted spine motion. — The American Journal of Emergency Medicine doi:10.1016/j.ajem.2009.03.014, published online Feb. 25, 2010.
Emergency service managers seeking ways to convince elderly patients of the worth of home CO detectors, take note: In-home motor vehicle-caused CO deaths appear disproportionately high in men and women older than 80 years. Of 837 CO poisoning incidents in the U.S. from March 2007 through September 2009, 59 (8 percent) were due to a vehicle running in a garage. Among the 17 cases involving patients older than 80 years, 15 patients were found dead at the scene, reports Neil B. Hampson, M.D., at Virginia Mason Medical Center in Seattle. As you might expect, incidents were more common in states with higher numbers of elderly residents. — The American Journal of Emergency Medicine doi:10.1016/j.ajem.2009.09.010, published online March 12, 2010.
Your … ahem … bowel function may respond to rotating or night shifts with constipation, diarrhea, cramping, bloating or abdominal pain—in other words, symptoms of IBS. Willemijntje A. Hoogerwerf, M.D., and colleagues at the University of Michigan in Ann Arbor noted more reports of IBS in nurses working day/night rotations and straight nights. In total, 36 of 75 rotating-shift nurses and 44 of 110 night-shift nurses, or 48 and 40 percent, reported IBS compared with about 31 percent (66 of 214 nurses) on straight days. For comparison, IBS might be expected in about 20 percent of the general population. Poor sleep, difficulty falling asleep and daytime sleepiness were more common among nurses reporting IBS, regardless of their work shift. Even so, rotating shifts were highly associated with IBS. — The American Journal of Gastroenterology doi:10.1038/ajg.2010.48, published online Feb. 16, 2010.
