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The International Liaison Committee on Resuscitation has called for a randomised trial of delivery to a cardiac arrest centre. We aimed to assess whether expedited delivery to a cardiac arrest centre compared with current standard of care following resuscitated cardiac arrest reduces deaths.

Supplemental Digital Content is available in the text.Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents’ assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system−treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome.

Kevin Barret, course leader for the BSc(Hons) Pramedic Practice course at the University of Brighton, chairs a discussion on automated chest compression devices, considering their efficacy, ease of use and when they should be employed.

The traditional role of the ambulance service as an emergency medical provider has evolved in recent times, with an emerging role being the promotion of public health. The current study explores this concept by evaluating one event in the ‘know your blood pressure’ (KYBP) campaign, conducted across Greater London by the London Ambulance Service NHS Trust (LAS) in April 2010. The event allowed members of the public to have blood pressure (BP) measurements and to receive advice on the health risks of high BP including stroke. Attendees with BP ≥ 140/90 were referred to their general practitioners (GPs).A subsequent telephone survey was conducted to assess campaign effectiveness. The event was attended by 2 274 people, 23% of whom had a high BP measurement. Overall 625 individuals participated in the telephone survey, over half of whom were referred for further medical attention. More than half of these individuals (56%) contacted their GP's surgery as advised. A number of individuals were either prescribed antihypertensive medication for the first time or were subsequently put on a higher dose or an alternative antihypertensive agent. An increase in knowledge of the risks of high BP was also reported. The positive findings demonstrate that ambulance services can have a role in promoting public health.

To describe a resuscitation protocol for out-of-hospital cardiac arrest designed for healthcare professionals that demands more from rescuers than does conventional cardiopulmonary resuscitation. It was introduced with the aim of improving survival that has remained disappointingly poor worldwide.

The standards required for optimal effect of chest compressions and the degree to which most practice falls short of ideal have not been widely appreciated. This review highlights some of the important data now available and offers a haemodynamic explanation that broadens current concepts.

The purpose of this review is to evaluate the 2005 guidelines on cardiopulmonary resuscitation.

Basic life support and rapid defibrillation for ventricular fibrillation or pulseless ventricular tachycardia are the only two interventions that have been shown unequivocally to improve survival after cardiac arrest. Several drugs are advocated to treat cardiac arrest, but despite very encouraging animal data, no drug has been reliably proven to increase survival to hospital discharge after cardiac arrest. This review focuses on recent experimental and clinical data concerning the use of vasopressin, amiodarone, magnesium, and fibrinolytics during advanced life support (ALS). Animal data indicate that, in comparison with epinephrine (adrenaline), vasopressin produces better vital organ blood flow during cardiopulmonary resuscitation (CPR). These apparent advantages have yet to be converted into improved survival in large-scale trials of cardiac arrest in humans. Data from two prospective, randomized trials suggest that amiodarone may improve short-term survival after out-of-hospital ventricular fibrillation cardiac arrest. On the basis of anecdotal data, magnesium is recommended therapy for torsades de pointesand for shock-resistant ventricular fibrillation associated with hypomagnesemia. In the past, CPR has been a contraindication to giving fibrinolytics, but several studies have demonstrated the relative safety of fibrinolysis during and after CPR. Fibrinolytics are likely to be beneficial when cardiac arrest is associated with plaque rupture and fresh coronary thrombus or massive pulmonary embolism. Fibrinolysis may also improve cerebral microcirculatory perfusion once a spontaneous circulation has been restored. A planned, prospective, randomized trial may help to define the role of fibrinolysis during out-of-hospital CPR.

OBJECTIVES

The administration of thrombolytic drugs outside hospital by emergency physicians is becoming more common. However, few in Europe live in areas where such a service is provided. The data suggest that the advantages can be appreciable in some circumstances but that the strategy may not be universally applicable. Curr Opin Anaesthesiol 12179-182.

We reviewed the effectiveness of a strategy involving paramedic ambulances and community education to reduce the delay to thrombolytic therapy in patients admitted with acute myocardial infarction, by analysing delay times recorded during routine treatment. Rapid identification and treatment of patients with acute myocardial infarction who were eligible for thrombolysis was carried out in the Accident and Emergency and Cardiac Care Units. Two hundred seventy-four patients were admitted with acute myocardial infarction over an 18-month period and treated with anistreplase (168) or streptokinase (106). The following median times were recorded: symptom onset to administration of thrombolytic therapy, 142 min (range 43-980 min); symptom onset to ambulance arrival, 60 min; ambulance with patient to arrival in hospital, 35 min; time to treatment in hospital (‘door to needle time’), 25 min; in-hospital delays were notably shorter for patients given anistreplase as opposed to streptokinase. Shortened delays for the delivery of thrombolytic therapy can be achieved by a strategy involving public education, the availability of resuscitation ambulances, and close liaison with the Accident and Emergency Department.

Objectives. This study was designed to compare the response of unstable angina and non-Q wave myocardial infarction during treatment with antithrombotic therapy.

The use of reporter genes to characterise sequence elements that act to regulate gene expression in transgenic plants has been vital to the development of foreign gene expression strategies for use in cereal transformation. ThegusA locus ofEscherichia coli, which encodes the enzymeß-glucuronidase (GUS), is by far the most popular reporter gene used in plant transformation. In this paper we extend the utility of the GUS reporter gene system in cereal transformation by describing and evaluating a number of novel constructs suitable for use in direct gene transfer experiments. These plasmids are all available from the Molecular Genetic Resource Service of the Center for the Application of Molecular Biology to International Agriculture.

Do passenger deaths occur during commercial air travel? If so, how often and from what causes? We reviewed information reported to the International Air Transport Association on in-flight deaths that occurred during commercial air travel for the eight years between 1977 and 1984. Of the 120 airlines in the International Air Transport Association, 42 carriers reported deaths during these eight years. A total of 577 in-flight deaths were recorded, for a reported average of 72 deaths per year. Deaths occurred at average rates of 0.31 per million passengers, 125 per billion passenger-kilometers, and 25.1 per million departures. The majority of those who died were men (66%, 382/577) and middle-aged (mean age, 53.8 years). Most of the individuals (77%, 399/515) reported no health problems prior to travel. Physicians aboard the aircrafts offered medical assistance for 43% (247/577) of the deaths. More than half of the deaths (56%, 326/577) seemed to be related to cardiac problems. Sudden unexpected cardiac death was the cause of death in 63% (253/399) of the apparently healthy people and seems to be the major cause of death during air travel. These observations support the initiation of programs to train cabin personnel in the skills of basic cardiopulmonary resuscitation and in the use of automatic external defibrillators.(JAMA 1988;259:1983-1988)

Perhaps only by repeated audiograms made before, during, immediately after and some time after various separate harmful influences are at work can one study completely the respective effects on the hearing. Such a method would seem to be more satisfactory than one which depends on audiograms made after harm has been done. The latter method offers no way of distinguishing between the effects of the many factors at work over a period of time; whereas, if each possible influence can be studied separately, one may hope eventually to appreciate the damage done by each. How, for example, does one distinguish between the fatigue or damage from exposure to noise and the toxic effects of quinine and other drugs? According to most writers, these factors produce much the same effect on the hearing as shown in a final audiogram, but how large a part does each of any number of other

As the National Health Service (NHS) celebrates its 70-year-anniversary this month, Douglas Chamberlain, founder of the first paramedic unit in Europe, looks back at the evolution of the paramedic since the NHS was founded in 1948.

IN JANUARY 1964 Pantazopoulos11 reported a case of primary malignant melanoma of the right false cord treated by removal through thyrotomy in November 1961. The patient was well 17 months later. The author reviewed the literature1-3,5-10,12,13 through 1961 and was able to find only ten cases of malignant melanoma of the larynx, seven of which were primary and three metastatic. Apparently, he did not include the metastatic case of Faaborg-Anderson4 reported in 1953. A case of malignant melanoma metastatic to the larynx is reported here. REPORT OF A CASE A 55-year-old white, retired, coal-mining foreman, was referred to me by Dr. S. S. Marchbanks in January 1960 complaining of hoarseness of several months' duration. He was first seen by him in February 1946 complaining of a skin lesion of the chest at the site of the removal of a brown to black mole with a hot cautery

The article reports on the impact of the decision of the Third Circuit Court of Appeals in the U.S. in the court case Historic Boardwalk Hall LLC, et al. v. Commissioner on the rehabilitation tax credit market in 2012. It says that the denial of a federal tax credit allocation to the investor by the court due to its questionable position as a true partner created an issue regarding the credibility of the tax credit. It notes that it is uncertain whether the said incident represents an anomaly.

OBJECTIVE: To determine at what age children can perform effective chest compressions for cardiopulmonary resuscitation. Design Observational study. Setting Four schools in Cardiff. Participants 157 children aged 9-14 years in three school year groups (ages 9-10, 11-12, and 13-14). Interventions Participants were taught basic life support skills in one lesson lasting 20 minutes. MAIN OUTCOME MEASURE: Effectiveness of chest compression during three minutes' continuous chest compression on a manikin. RESULTS: No year 5 pupil (age 9-10) was able to compress the manikin's chest to the depth recommended in guidelines (38-51 mm). 19% of pupils in year 7 (age 11-12) and 45% in year 9 (age 13-14) achieved adequate compression depth. Only the 13-14 year olds performed chest compression as well as adults in other reported studies. Compression depth showed a significant relation with children's age, weight, and height (P<0.001). Multivariate analyses showed that, if the age and weight of the children were both known, the height (which is closely related to both) was no longer significant (P=0.95). No association was found between pupils' age, sex, weight, or height and the average rate of chest compressions over the three minute period. Similarly, no relation was found between year group and ability to place the hands in the correct position. During the three minutes' compression, compression rate increased and depth decreased. CONCLUSIONS: The children's ability to achieve an adequate depth of chest compression depended on their age and weight. The ability to provide the correct rate and to employ the correct hand position was similar across all the age ranges tested. Young children who are not yet physically able to compress the chest can learn the principles of chest compression as well as older children.

The article discusses the enactment of the federal Pension Protection Act of 2006 and the major changes of pension signed into law on August 17, 2006 in the U.S. The law is designed to leverage the funding of the defined benefit pension plans in order to protect workers and to restrain the expensive bailouts of the unsuccessful plans by the Pension Benefit Guaranty Corp. Amendments were also made to contribution plans, like the traditional profit-sharing plans.

Several letters to the editor are presented in response to articles in the January/February 2003 issue including "Monuments to Our Better Nature," "Before and Afterlife," and "Not So Radical."

<$O_ST_ABS>Authors synopsis<$C_ST_ABS>Paired atrial pacing in anaesthetized open-chest dogs increased the force of atrial contraction. In preparations in which the vagi had been cut, and propranolol administered or upper thoracic sympathectomy performed, paired atrial pacing resulted in augmentation of ventricular performance with increased cardiac output and raised systemic arterial pressure.

Discusses how an acquisition provides opportunity to establish or strengthen market position or improve profitability through economies of scale. Steps to be taken in getting started with the acquisition process. INSET: In your corner..