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In the Paris Fire Brigade, in the context of cardiac arrest, the nurses have the greatest reported experience of intraosseous infusion. The adverse events reported are rare, given that the procedure is performed on patients in absolute emergency. All these elements are in favour of discussing a redefinition of the practice of intraosseous infusion by nurses in the specific context of immediate life-saving emergencies.

ObjectivesIncreased demands are placed on emergency services and their role and ability to act in incidents in challenging environments, for example, road tunnels. Collaboration between officers from emergency services (fire brigade, police and ambulance services) is important for an effective rescue effort. In Gothenburg, Sweden, a position as a senior ambulance officer (SAO) within the emergency medical services (EMS) has been introduced to support the regular force during major incidents. The aim of this paper was to explore the perceptions and experiences of the SAO’s new management role in challenging incidents, such as those occurring in road tunnels.DesignA qualitative interview study.SettingThe study was carried out from February to June 2019 in Gothenburg, Sweden, which is a municipality with several road tunnels and a population of approximately 580 000 people. SAOs collaborate with the corresponding function within the police and fire brigade, both having senior officers at major incident sites.ParticipantsTwelve SAOs.MethodsThe study used semistructured interviews. The collected data were analysed using qualitative content analysis.ResultsAccording to SAOs’ experience, prehospital medical management included not only leadership, but also planning, training and indepth knowledge of, for example, tunnel environments. Furthermore, SAOs adopted an encouraging and teaching role for their colleagues. SAOs’ responsibilities also included proactive planning together with the fire brigade and police, which was regarded as enhancing interorganisational collaboration. An overall theme emerged which the SAOs described as ‘A new holistic approach to EMS leadership and management’.ConclusionsThe participants considered that the new SAO role not only seems to improve the prehospital medical management, but also makes the EMS command structure during challenging incidents symmetrical with the fire brigade and police command structure. The implementation of national guidelines is desirable and is requested by the SAOs.

Background: In 2016 midnight of summer a bomb blast occurred at ammunition depot Pulgaon. Blast wasso severe that villagers in the radius of 10km witnessed the blast wave. It had killed 19 people which includedArmy officers, soldier & fire brigade men. As per police inquest & alleged history given by eyewitness,anauthority of Central Ammunition Depot at Pulgaon noticed fire at ammunition store of the depot. For thisreason emergency task force team of the depot got activated and few army personnel including fire brigadepersonnel rushed to the spot to control the fire. But unfortunately large amount of ammunition blastedsuddenly as the fire spread inside the ammunition storage. Because of this 19 parsons were died on thespot & many were injured. To tackle the disaster civil authority were informed. When it was noted thattotal 19 personnel were died in the mishap, the District civil authority approached to Mahatma GandhiInstitute of Medical Sciences, Sevagram to send forensic medicine expert team to do spot Post Mortem (PM)examination. The main challenge before the forensic team was to establish the identity of the unidentifiedbody apart from doing PM examination, so that the body can be handed over the kin as early as possible toend the uncertainty of their loved ones.Aims & Objective: Forensic casework was carried out with aim to study the pattern of injuries in the bombblast cases, and to assess forensic management done in mass disaster.Material and Method: Study was carried out on 15 dead bodies involved in the bomb blast injury. Itincludes observation based on post mortem examination and assessment of forensic management done byour team.Result: Bomb blast injury includes complex of injuries like burn injury(100%), decapitation (33%), injuryof internal abdominal organs (40%) & chest organs (80%), fracture of bones (46%), Amputation of limbs(33%), and external mechanical injuries like contusion, abrasions and lacerations (100%). Due to destructiveinjuries identity of the victim gets obscured (40%).Conclusion: Medicolegal postmortem, sample preservation and humanitarian action of establishing theidentity of victims are the forensic management in bomb blast injury.

Aim The detection of cardiac arrests by dispatchers allows telephone-assisted cardiopulmonary resuscitation (t-CPR) and improves Out-of-Hospital Cardiac Arrest (OHCA) survival. To enhance the OHCA detection rate, in 2012, the Paris Fire Brigade dispatch center created an original technique called "Hand On Belly" (HoB). The new algorithm that resulted has become a central point in a broader program for dispatch-assisted cardiac arrests. Methods This is a repeated cross-sectional study with retrospective data of four 15-day call samples recorded from 2012 to 2018. We included all calls from OHCAs cared for by Basic Life Support (BLS) teams and excluded calls where the dispatcher was not in contact directly with a witness. The primary endpoint was the successful detection of an OHCA by the dispatcher; the secondary endpoints were successful t-CPR and measurements of the different time intervals related to the call. Logistic regressions were performed to assess parameters associated with detecting OHCAs and initiating t-CPR. Results From 2012 to 2018, among the detectable OCHAs, the proportion correctly identified increased from 54% to 93%; the rate of t-CPRs from 51% to 84%. OHCA detection and t-CPR initiation were both associated with HoB breathing assessments (adjustedOR: 89, 95%CI: 31–299, and adjustedOR: 11.2, 95%CI: 1.4–149, respectively). Over the study period, the times to answering calls and the time to sending BLS teams were shorter than those recommended by international guidelines; however, the times to OHCA recognition and starting t-CPR delivery were longer. Conclusions The HoB effectively facilitated OHCA detection in our system, which has achieved very high performance levels.

The Rana Plaza collapse, which took place in Bangladesh in 2013, killed and injured at least 1135 and 2500 people respectively. Although the structural fault with the building had been identified before the collapse, the owner of the building and five garment factories housed in Rana Plaza had forced workers to continue production for 31 Western multinational corporations (MNCs). It was the deadliest structural failure in modern history, and resulted in a horrific rescue operation. First, the fire brigade did not have the necessary training and equipment to rescue the victims, and so the general public also participated in the rescue operation. Second, when victims were rescued, it was found that many of them had lost their limbs or suffered severe internal injuries, including internal organ failure, due to several days without water. After the completion of the rescue, the victims received neither appropriate compensation nor rehabilitation to overcome their psychological trauma and physical disabilities.

Background: Marseille is the second largest city in France. The Marseille Fire Brigade (BMPM) is the largest unity of the French Navy. This organization is in charge of rescue operations and medical intervention in the Marseille area. The aim of the study was to describe the epidemiology of interventions that required a physician to be present that were performed by the BMPM between the years of 2005 to 2017. Materials and methods: The statistical office database of the BMPM and the medical interventions forms (FIM) acquired from the BMPM medical ambulances (SMUR) archives were analysed from the years 2005 to 2017. Results: The BMPM performed a total of 2,375 interventions in the maritime environment between 2005 and 2017. A physician was necessary for intervention a total of 186 times. The extraction and analysis reports of 107 medical intervention forms found the BMPM archives revealed a significant number of interventions (67%) in the southern bay of Marseille and Frioul, specifically from the If and Planier islands. The majority of interventions (77%) took place within the 300m band. The most common cause of medical intervention was due to an accidental fall into the water, followed by boating (sailing and motor), and swimming. Drowning was the most common cause of mortality, consisting of 34% of all interventions. Diving accidents represented 14% of interventions. Trauma affected 22% of the study population and 83% of trauma patients were transported to the hospital under the supervision of a physician. Conclusions: Potential areas for improvement in the management of drowning victims are the use of Szpilman’s classification, sonography, and non-invasive ventilation. A recertification course for medical education training of BMPM doctors on the management of diving accidents could help to optimize the information recorded on FIM. Accident prevention training should be continued and reinforced when it comes to maritime activities.

INTRODUCTION: As a part of the emergency medical services, the Swedish fire brigade can increase the survival rate in out-of-hospital cardiac arrests. AIM: To compare the quality of cardiopulmonary resuscitation (CPR) performed by firefighters at a routine CPR practice versus when involved in a simulated life-saving event. METHODS: In this study, 80 firefighters divided into two groups performed CPR according to guidelines: one group indoors during a routine training session; the other group outdoors during a smoke diving exercise wearing personal protective clothing and self-contained breathing apparatus. Descriptive and inferential statistics were used to analyze the data. RESULTS: The results showed a tendency for the outdoor group to perform CPR with better ventilation and compression quality, as compared to the indoor group. The ventilation of the manikin was not hampered by the firefighters wearing personal protective clothes and self-contained breathing apparatus, as the Swedish firefighters remove their facial mask and ventilate the patient with their mouth using a pocket mask. CONCLUSIONS: Overall, the results in both groups showed a high quality of CPR which can be related to the fire brigade training and education traditions. CPR training is regularly performed, which in turn helps to maintain CPR skills.

Prehospital emergency care in Singapore has taken shape over almost a century. What began as a hospital-based ambulance service intended to ferry medical cases was later complemented by an ambulance service under the Singapore Fire Brigade to transport trauma cases. The two ambulance services would later combine and come under the Singapore Civil Defence Force. The development of prehospital care systems in island city-state Singapore faces unique challenges as a result of its land area and population density. This article defines aspects of prehospital trauma care in Singapore. It outlines key historical milestones and current initiatives in service, training, and research. It makes propositions for the future direction of trauma care in Singapore. The progress Singapore has made given her circumstances may serve as lessons for the future development of prehospital trauma systems in similar environments. Key words: Singapore; trauma; prehospital emergency care; emergency medical services.

Deafness frequently observed in explosion victims, currently following terrorist attack, is a barrier to communication between victims and first responders. This may result in a delay in the initial triage and evacuation. In such situations, Paris Fire Brigade (Paris, France) proposes the use of assistance cards to help conscious, but deafened patients at the site of an attack where there may be numerous victims.Yavari-SartakhtiO, BricheF, JostD, MichaudN, BignandM, TourtierJP. A new triage support tool in case of explosion. Prehosp Disaster Med. 2018;33(2):213–214.

OBJECTIVES The aim of this study was to describe the characteristics of out-of-hospital cardiac arrest (OHCA) in different workplaces, their management, and the survival rate. METHODS A post hoc analysis included all the OHCA cases that occurred at the workplace and were listed in the Fire Brigade of Paris database registry (2010 to 2014). Utstein-style variables, survival, and types of workplace were analyzed. RESULTS The study included 298 OHCA cases, mostly young (44% between 18 and 50 years), male (86%), and nontraumatic (86%). Differences in the survival chain were found to be related to the types of work location: bystander cardiopulmonary resuscitation was performed in 0% to 55% of cases, and workplace-automated external defibrillators were used in 0% to 20% of cases. Long-term survival without major incapacity was 0% to 23%. CONCLUSIONS The characteristics of OHCA differ as a function of the type of workplace.

This study focuses on metaphors used in South African HIV/AIDS education to explain the struggle of the immune system when it becomes infected with HIV. Three versions of an educational text on HIV/AIDS were presented to a total of 543 learners from secondary schools in the Western Cape. Each learner was given either a text version including a deliberate metaphor that had been selected with the purpose of changing the reader’s perspective on the immune system (the immune system being presented metaphorically either as an army or as a fire brigade), or a text version without such a deliberate metaphor. The effects of these three text versions on understanding as perceived by the learners themselves, on attractiveness and on persuasiveness were investigated. Distinctions were made between respondents who apparently had recognised a metaphor in the text version with which they were presented and those who had not. No effects of text version on perceived understanding, attractiveness and persuasiveness were found. There were clear effects, however, of metaphor recognition. Readers who appeared to have recognised a metaphor found the text version they had read more understandable, attractive and persuasive than other readers. No interaction effects of text version and metaphor recognition were found. Southern African Linguistics and Applied Language Studies 2010, 28(2): 133–139

Made available in DSpace on 2013-08-12T18:21:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-01-01 Made available in DSpace on 2013-09-30T18:46:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:55:18Z No. of bitstreams: 0 Made available in DSpace on 2014-05-20T13:55:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-01-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) The presence of bees (Apis mellifera L.) in urban areas has increased in recent years due to environmental disturbances caused by humans. Bee migration to cities may provoke serious accidents, since some people present allergic reactions to their venoms. In Rio Claro city, São Paulo state, Brazil, the number of calls to the fire brigade for removal of bee swarms, and the number admissions in local hospitals due to bee stings were investigated during 2002 and 2003, and a correlation between these data and the average temperature, rainfall and relative humidity was found. The study period was divided into three phases according to the number of times that the fire brigade was called to remove swarms (263 times): January to July 2002-51 calls (19.39%); August 2002 to July 2003 - 140 calls (53.23%); and August to December 2003 - 72 calls (27.38%). A significant correlation among the number of calls, the local temperature and rainfall was detected. The number of accidents was not associated with environmental variables. Based on the current results, public activities for prevention of bee attacks may be developed to avoid unwanted contact between humans and these insects, and/or provide the appropriate management of the colonies. São Paulo State Univ UNESP Univ Estadual Paulista, Rio Claro Biosci Inst, Social Insects Study Ctr, Rio Claro, SP, Brazil São Paulo State Univ UNESP Univ Estadual Paulista, Rio Claro Biosci Inst, Dept Biol, Rio Claro, SP, Brazil São Paulo State Univ UNESP Univ Estadual Paulista, Rio Claro Biosci Inst, Social Insects Study Ctr, Rio Claro, SP, Brazil São Paulo State Univ UNESP Univ Estadual Paulista, Rio Claro Biosci Inst, Dept Biol, Rio Claro, SP, Brazil

Health and writing processing of emotional experience at work - J.W. Pennebaker’s studies showed positive results on health through the use of the writing technique in different subjects. In line with these studies and Health Psychology’s goals, in this research we applied Pennebaker’s Writing Technique to subjects in a fire brigade sample who are often exposed to emotional experiences during their work. The sample was divided in three groups. The first group wrote about their most traumatic working experience (Negative exp. Gr.). The second group wrote about the most rewarding working experience (Positive exp. Gr.). The third group didn’t receive any writing task (Control Gr.). The aims of the present study were to assess: 1) an improvement on health parameters in the two writing groups in respect to the control group; 2) an effectiveness of writing in the Positive experience gr. in the short period, in the Negative experience gr. in the long period; 3) a possible interaction between writing and alexithymia levels. Comparing the data of the three groups we found out significant differences confirming our hypothesis on our three dependent variables: sick leave days (F = 3.60; p < 0.04); SCL-90 scores (F = 5.56; p < 0.0005) and number of physical examinations reported in the Health Interview (F = 4.11; p < 0.03). Regarding our second hypothesis, results of this study suggest the need of adapting the writing task instructions to the context for a more effectiveness of the technique. Finally, interaction between writing and alexithymia was not found, possibly due to low alexithymia levels in the sample in general.

We wish to report the case of one of our own patients, in whom hookah smoking had resulted in a carboxyhemoglobin concentration of 18% (detected by pulse oximetry) and consecutive syncope. Interestingly, the rescue team’s carbon monoxide alarms went off as soon as they entered the apartment. The fire brigade, which was alerted subsequently, measured a maximum indoor carbon monoxide concentration of 85 ppm in the apartment. Further operations found occasional indoor carbon monoxide concentrations of up to 200 ppm after hookah consumption.

In Sweden, the operators at emergency dispatch centres are responsible for allocating resources (e.g. ambulances, fire brigade, police) in response to calls. We analysed situations that the emergency operators experienced as difficult and their reflections on how they managed them. Interviews were conducted with all 16 emergency operators at a centre that serves a population of 275,000 and receives about 700,000 emergency calls annually. A phenomenological–hermeneutic approach was used for the analysis. Situations that operators experienced as difficult were characterized by uncertainty, communication difficulties and insufficient resources. Skills, knowledge and experience were regarded as important in the management of these situations, as were personal qualities such as sensitivity, insight, empathy and intuition. The emergency operators stated that they needed more guidance, feedback and education in their work. This would lead to an increased sense of certainty, which would lead to decreased stress and a better outcome for those in need.

In August 2014, Gillian Bennett, an 83-year-old with dementia, deliberately ingested a lethal drug. She posted a ‘right-to-die manifesto’ on her blog1 ‘deadatnoon’ just prior to her suicide, explaining that she didn’t want to become an ‘empty husk’, ‘a vegetable’, a living ‘carcass’, who would needlessly in her view cost tens of thousands of dollars ‘eating up the country’s money but not having the faintest idea who I am’ (‘Goodbye’, 2014). In stark contrast, David Hilfiker,2 a 69-year-old retired physician, describes the time since his diagnosis with Alzheimer’s disease as ‘one of the happiest periods in my life’ (‘About’, 2014).

Dispatcher-assisted cardiopulmonary resuscitation increases the likelihood of survival and thus is highly recommended. However, the detection rate of out-of-hospital cardiac arrest (OHCA) is very different from one system to another, and early recognition of cardiac arrest in the dispatch centre remains challenging. The aim of this study was to assess the provision of dispatcher-assisted cardiopulmonary resuscitation in the main French dispatch centre. Methods In the Paris Fire Brigade, each patient over 15 years of age who presented an OHCA from 15 to 31 May 2012 was prospectively included. Field data and tape recordings of emergency calls were studied by three experienced physicians, to assess the rate (and delay) of OHCA recognition and chest compression initiation, and identify the causes of unrecognized OHCA. Results Among 82 consecutive calls for detectable cardiac arrest, the dispatcher recognized 50/82 (61%). The median times from call to OHCA recognition and from call to chest compression initiation were, respectively, 2 min 23s (1min 51s to 3min 7s) and 3min 37s (2min 57s to 5min). The main causes of non-recognition of OHCA were the absence or incomplete assessment of breathing and the presence of agonal breathing. No cardiac arrest was missed when the dispatcher followed the local dispatch algorithm; this included the gesture of putting the hand on the abdomen and measuring the breathing frequency. Hospital admission with a beating heart was paradoxically 18% for detected cardiac arrest and 47% for undetected cardiac arrest ( p =0.007). This paradox could be explained by the relation between agonal breathing and, on the one hand, good prognosis of OHCA and, on the other hand, difficulties in recognizing OHCA. Conclusion The improvement of cardiac arrest recognition in the dispatch centre seemed mandatory, as the cardiac arrests of better immediate prognosis were not well detected. The measurement of OHCA recognition and CPR initiation by phone should be encouraged in dispatch centres as a key to initiating corrective measures.

In the general framework of our activity of nearly 2000 requests for assistance (in the period August 1986 to June 1990), direct aid to burn patients represented 0.5% of cases. Though not a frequent occurrence, this is a very significant commitment from the technical and organizational points of view.

service—Neonatal Emergency Transport Service of Liguria Region, Gaslini Children’s Hospital, Genoa University, Italy—received a request for neonatal transport from Pontremoli, Tuscan Region, back to our neonatal intensive care unit (NICU). Unfortunately, our NICU had no available beds, so we decided to fly from Pontremoli to the NICU at Santa Chiara Hospital in Pisa. Pontremoli is a little village close to mountains on the way to the largest Italian plain, Padana plain, and to the city of Parma. The patients were micropreemie twins of uncertain gestational age (approximately 23-24 weeks). The birth of two such little babies in this rural first-level hospital was certainly an unexpected and highly emotional event. At the moment of the initial phone call, the first baby was just born; the physicians at Pontremoli hoped to transfer the mother in the hope that the second baby could be born in a third-level hospital, but it was immediately clear that the second twin would be born shortly. We immediately requested the intervention of the helicopter operated by the Fire Brigade of Genoa (Nucleo Elicotteri, Vigili del Fuoco), based at the Genoa International Airport, a 6-minute flight from Gaslini Hospital. In 8 minutes the Agusta Bell AB 412 Drago 54 was on the Gaslini helipad, ready to carry the neonatal transport team and the neonatal transport incubator Atom TR 850. METAR was LIMJ 140900z 04014KT CAVOK 03/M02 Q1029, and we were told that the weather was good and the morning was cold and sunny. The weather was good and the morning was cold and sunny. The pilots decided to fly as fast as possible to Pontremoli. We arrived at the hospital in 25 minutes after a 45-nm flight, and it appeared evident that there was an important landing problem. We knew that Pontremoli hospital did not have a helipad, but a little grassy area (Figure 1) had been used as a landing zone during previous neonatal transports. Unfortunately, the area was now used for car parkThe Sanctity of Life: a Micropreemie Twin Transport

This article reports the results of a retrospective study of 8 years of experience of the Paris Fire Brigade with the prehospital use of hydroxocobalamin.The head physician at the Paris Fire Brigade extracted and summarized data from standardized forms completed at the fire scene and, when available, hospital reports to assess survival status and clinical parameters associated with the use of hydroxocobalamin for each patient who received it for smoke inhalation-associated cyanide poisoning from 1995 to 2003.Of the 101 patients administered hydroxocobalamin, 30 survived, 42 died (17 at the fire scene and 25 at the intensive-care unit), and survival status was not known in the remaining 29 patients. Among the 72 patients for whom survival status was known, survival rate was 41.7% after the administration of hydroxocobalamin. Of the 38 patients found in cardiac arrest, 21 had a return of spontaneous circulation during prehospital care. Of the 12 patients who were initially hemodynamically unstable (systolic blood pressure 0 toor =90 mmHg), 9 recovered systolic blood pressure an average of 30.6 minutes after the start of hydroxocobalamin infusion. Among nonsedated patients in the sample as a whole (n = 52), mean (SD) Glasgow coma scale score improved from 7.9 (5.4) initially to 8.5 (5.7) after administration of hydroxocobalamin. Among nonsedated patients who were initially neurologically impaired (n = 18), Glasgow coma scale score improved in 9 patients, did not change in 8 patients, and worsened in 1 patient. Two adverse events--red or pink coloration of urine or skin (n = 5) and cutaneous rash (n = 1)--were assessed as being possibly related to hydroxocobalamin.Hydroxocobalamin has a risk:benefit ratio rendering it suitable for prehospital use in the management of acute cyanide poisoning caused by smoke inhalation.

On a warm Monday morning in May, 2000, a 34-year-old female secretary went to her office in the middle of a German town. She noticed a strong smell of garlic on the stairs, intensified in the office itself, which prompted her six colleagues to open all the windows. They worked all the morning with a background smell of garlic. At noon, the weather took a turn for the worse, so they had to close the windows. The smell became more noticeable, and the secretary felt nauseated, and developed a headache and a sore throat. Her colleagues also started complaining of headache and nausea. In the middle of the afternoon, her 1·5 m houseplant (Ficus benjamini) suddenly lost all its leaves. The secretary’s boss decided to call the fire brigade. The fire brigade arrived at 4 pm, smelt the garlic, and immediately suspected phosphine contamination. They evacuated the offices, next-door buildings, a nearby parking lot, and the street. The secretary and her six colleagues (4 female, 2 male, 27–47 years old) were admitted to the hospital. We gave them glucocorticoid inhalers and intravenous N-acetylcysteine to prevent pulmonary oedema and liver failure. We did electrocardiograms, chest radiographs, spirometry, and blood tests in all patients, and found no abnormalities. Histamine provocation tests were negative on admission and at follow-up 4 weeks later, thus ruling out bronchial hyperreactivity; common after inhalation accidents. The source of the phosphine was a tobacco store next to the office. The owner had a tobacconist’s shop in the town and had started to import cigars from the Dominican Republic some years previously. He repacked and sold the cigars in Germany. His stock suffered from an infestation of tobacco fly and he had attempted to eliminate it by freezing all the repacked cigars. On one of his journeys to the Dominican Republic, his cigar producer had told him that he could buy a chemical which would eliminate the tobacco fly. It would have to be used for 3 days in his store and would pose no hazard to the user. The tobacconist ordered a bag with his next batch of cigars. He received 1·4 kg of a German product containing 57% aluminium phosphide with directions for use in Spanish. As his cigar producer had advised him, he spread all the 300 pellets in the store on a Saturday afternoon, planning to remove them on Monday afternoon. He did not realise that the

Since the early 70s, special attention has been given by the French authorities to disaster management. Integration of prehospital critical care as a part of the rescue organization was then decided. Several mass casualties situations have been observed in France and in Paris. Disaster plans for prehospital care and hospital organization have been implemented, utilized, and modified according to the acquired lessons. Practice of disaster medicine was considered as mandatory for the physicians working in the French Emergency Medical Services, called SAMU, and was included in the basic training. The SAMU organization has been described in details elsewhere [1,2]. In essence, SAMU is a nation-wide, regionalized public organization in charge of prehospital care. The SAMU includes a regional dispatching center and several Mobile Intensive Care Units based in major hospitals of the area. Physicians, specialized in anesthesiology or in emergency medicine, are directly involved in the patients’ treatment on scene and patients’ dispatching. In disaster situation, the SAMU plays an important role [3] and is closely associated with the Fire Brigade and the Police.

For the physician ‘emergency’ means any disease or lesion that endangers life in the short-term or that may have severely invalidating sequelae. The definition of ‘emergency’ is made by an expert and requires an initial technical assessment, the rapid employment of resuscitatory procedures and, in nearly all cases, admission to hospital.

​FormerFormer general practitioner Penwortham, Preston (b 1921; q Middlesex Hospital, London, 1956), died from bronchopneumonia on 2 July 2005. Figure 1 After war service with the Royal West Africa Force in the Gold Coast, India, and Burma, and then qualifying, Tudor Griffiths Davies did his house jobs in Preston Royal Infirmary. He was general practitioner in Great Harwood before joining the family practice in Penwortham. He served on the hospital committee of Preston Royal Infirmary as a police surgeon and was medical officer to Lancashire Fire Brigade. He was a member of Marylebone Cricket Club (MCC) from 1955, and he enjoyed team membership of Middlesex Hospital rugby and cricket teams, with a season captaining the cricket. Retirement was marred by a broken hip, Dupuytren's contractures, and ultimate blindness from glaucoma diagnosed in 1971. He leaves a wife, Dilys; two children; and four grandchildren.

All except 17 (1.7%) of 990 fire fighters employed by the Western Australian Fire Brigade between 1 October 1939 and 31 December 1978 were successfully followed up to 31 December 1978. Mortality from all causes was less than expected (SMR 0.80 with 95% confidence interval 0.67 to 0.96). There was evidence of the healthy worker effect but none that mortality increased with increasing duration of employment. A small proportional excess of deaths from road traffic accidents ( SPMR 1.66) appeared to be unrelated to fire service. Deaths from other accidents, poisonings, and violence were significantly less than expected (SMR 0.35 with 95% confidence interval 0.10 to 0.90) and may indicate an effect of training and experience on accident proneness. There was no evidence of increased mortality from cardiovascular or respiratory disease, or from any other cause.

Khogali, M. (1969). Brit. J. industr. Med., 26, 308-313. A population study in cotton ginnery workers in the Sudan. An epidemiological study in cotton ginneries in the Sudan covered 323 permanently employed ginnery workers, a random sample of 35 seasonal farfara workers, and a control group of 24 members of a fire brigade. All the workers studied were men. The study showed a prevalence of byssinosis (defined as chest tightness starting on return from the annual holiday and continuing for at least three consecutive days) in 20% of the ginnery workers and in 48·6% of the farfara workers. Workers exposed to dust showed a mean fall in F.E.V. 1·0 of -0·10 litre during the shift, while workers not so exposed showed a mean rise of +0·23 litre; this difference was statistically significant. The F.E.V. 1·0 was adjusted for age and standing height. The adjusted means of F.E.V. 1·0 were significantly lower for workers exposed to dust compared with those in the control group. The workers with byssinosis showed a statistically significant fall in F.E.V. 1·0 when compared with all ginnery workers; and a highly significant fall when compared with cotton workers without chest symptoms. An attempt was made to grade the byssinotics according to the extent of fall in F.E.V. 1·0 during the shift. The concentration of fine dust ( 1·0 , the mean fall in F.E.V. 1·0 , and the fine dust concentration.

In this paper it is described the general architecture of the Computerized system conceived by TEMA in collaboration with the Italian Fire Brigade Branch for the emergencies management.

In the spring of 1977, several representatives of the sections surgery, anesthesiology, internal medicine, and radiology were consulted to work out a Medical Disaster Control Plan. This plan is intended to supplement the basic civil defense plans of the Mainz-Bingen District Authorities and the Mainz City Administration, Department for Civil Defense and Disaster Control.

In 1971, 704 people were accidentally drowned in the UK and a further 402 deaths involved an ‘open verdict’ at inquest (RoSPA).

Study Objective: In July 1998, a pilot trial which used fire fighters as medical first-responders for the first time in Australia, was implemented in Melbourne. We aimed to assess the impact of the introduction of a medical first-responder role to the fire service, on the fire fighters both professionally and personally. Methods: Focus groups were conducted at the fire stations located in the study area. Data from the focus groups was collated and examined for themes. The issues identified as important through the focus groups were then incorporated into a questionnaire. Results: The fire fighters located at the pilot stations involved in the first-responder programme appear to view their new role as first-responders as a positive addition to their emergency profession. Some areas of the programme were identified by this study as in need of improvement. Some aspects of the communication strategies utilised by the Fire Brigade were highly criticised. Some aspects of the support system offered by the Fire Brigade also appear to be regarded as unfavourable. Conclusion: Results from this study provide useful information on professional fire fighter first-responder programmes and their impact on participating personnel. These results can be used to improve training modules, communication strategies and support services.