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The National Advisory Committee for Aeronautics (NACA) score is used by many emergency medical services to assess the severity of prehospital patients. Little is known about its discriminative performance regarding short-term mortality. We retrospectively included adult missions between 2008 and 2014 in a Swiss ground and air-based emergency medical services. We excluded uninjured or dead-on-scene patients. Primary outcome was assessment of the discriminative performance of the NACA score to classify the 48-h vital status of patients. Overall discrimination was quantified using the area under receiver operating characteristic curve (AUC). We also explored the influence of epidemiological characteristics (age and sex), mechanism (trauma or nontrauma) and clinical parameters (respiratory rate, oxygen saturation, heart rate, systolic blood pressure, capillary refill time, and Glasgow Coma Scale) on its discriminative performance. We then assessed the incremental value of these variables in the classification accuracy of a rule based on these variables in addition to the NACA score. We included 11 567 patients out of 11 639 (72 exclusions for missing data). Overall AUC was 0.86. The score was more discriminant for trauma (AUC = 0.95 vs. 0.83), and for younger patients (AUC = 0.91 for 16-59 vs. 0.78 for 84-104 years). Adding age, sex, mechanism, and clinical parameters resulted in a classification rule with higher discriminative performance than NACA score alone (AUC of 0.92 vs. 0.86; P < 0.001). The NACA score is an efficient way to discriminate victims regarding short-term mortality. Its performance can be enhanced by also integrating epidemiological and clinical parameters into an extended classification rule.

The ~1.97 million egg sets (~5 million eggs) housed in museums have not been used in proportion to their availability. We highlight the wide variety of scientific disciplines that have used egg collections and the geographic locations and sizes of these collections, to increase awareness of the importance of egg collections, improve their visibility to the scientific community, and suggest that they offer a wealth of data covering large spatial scales and long time series for broad investigations into avian biology. We provide a brief history of egg collections and an updated list of museums/institutions with egg collections worldwide. We also review the limitations, challenges, and management of egg collections, and summarize recent literature based on historical and recent museum egg materials.

From 2007 to 2010, 4558 migrating and breeding birds of 71 species were caught and examined for ticks in Switzerland. A total of 1205 specimens were collected; all were Ixodes ricinus ticks except one Ixodes frontalis female, which was found on a common chaffinch (Fringilla coelebs) for the first time in Switzerland. Each tick was analysed individually for the presence of Borrelia spp., Rickettsia spp., Anaplasma phagocytophilum and tick-borne encephalitis virus (TBEV). Altogether, 11.4% of birds (22 species) were infested by ticks and 39.8% of them (15 species) were carrying infected ticks. Bird species belonging to the genus Turdus were the most frequently infested with ticks and they were also carrying the most frequently infected ticks. Each tick-borne pathogen for which we tested was identified within the sample of bird-feeding ticks: Borrelia spp. (19.5%) and Rickettsia helvetica (10.5%) were predominantly detected whereas A. phagocytophilum (2%), Rickettsia monacensis (0.4%) and TBEV (0.2%) were only sporadically detected. Among Borrelia infections, B. garinii and B. valaisiana were largely predominant followed by B. afzelii, B. bavariensis, B. miyamotoi and B. burgdorferi ss. Interestingly, Candidatus Neoehrlichia mikurensis was identified in a few ticks (3.3%), mainly from chaffinches. Our study emphasizes the role of birds in the natural cycle of tick-borne pathogens that are of human medical and veterinary relevance in Europe. According to infection detected in larvae feeding on birds we implicate the common blackbird (Turdus merula) and the tree pipit (Anthus trivialis) as reservoir hosts for Borrelia spp., Rickettsia spp. and A. phagocytophilum.

In case of a major incident or disaster, the advance medical rescue command needs to manage several essential tasks simultaneously. These include the rapid deployment of ambulance, police, fire and evacuation services, and their coordinated activity, as well as triage and emergency medical care on site. The structure of such a medical rescue command is crucial for the successful outcome of medical evacuation at major incidents. However, little data has been published on the nature and structure of the command itself. This study presents a flexible approach to command structure, with two command heads: one emergency physician and one experienced paramedic. This approach is especially suitable for Switzerland, whose federal system allows for different structures in each canton. This article examines the development of these structures and their efficiency, adaptability and limitations with respect to major incident response in the French-speaking part of the country.

On 9th April 2008 at 2:14 p.m., on the highway between Lausanne and Vevey in western Switzerland, there was a 72-car pileup including five trucks that caused one death and injured 26 others. The relatively light toll was attributed to reduced vehicular speeds on account of foggy weather, together with the quick actions and effectiveness of the first responders and the excellent collaboration between the various rescue groups (medical rescue services, fire and police departments). For the first time, we used an innovative on-site medical command and control system, based on a binomial team. Two hours after the accident, the last of the injured had been evacuated and first aid on the site had ended. This article describes how the Emergency Medical Services from the State of Vaud, Switzerland, handled the situation and how the binomial team is structured

Research on interhospital transfers provides a basis for describing and quantifying patient flow and its evolution over time, offering an insight into hospital organization and management and hospital overcrowding. The purpose of this study was to conduct a qualitative and quantitative analysis of patient flow and to examine trends over an eight-year period.A retrospective descriptive study of interhospital transfers was conducted between 2003 and 2011 based on an analysis of demographic, medical and operational characteristics. Ambulance transfers and transfers requiring physician assistance were analyzed separately.The number of interhospital transfers increased significantly over the study period,from 4,026 in 2003 to 6,481 in 2011 (+60.9%). The number of ambulance transfers increased by almost 300% (616 in 2003 compared to 2,460 in 2011). Most of the transfers (98%) were to hospitals located less than 75 km from the university hospital (median: 24 km, 5-44). In 2011, 24% of all transfers were to psychiatric institutions. 26% of all transfer cases were direct transfers from the emergency department. An increasing number of transfers required physician assistance. 18% of these patients required ventilatory support, whole 9.8% required vasoactive drugs. 11.6% of these transfers were due to hospital overcrowding.The study shows that there has been a significant increase in interhospital transfers. This increase is related to hospital overcrowding and to the network-based systems governing patient care strategies.

Exertional heatstroke is defined by an increase of core body temperature above 40 degrees C and neurological symptoms in association with exercise. It is related to excessive heat production, which overwhelms the endogenous mechanisms of thermoregulation. It is observed during intense physical activity in a hot and humid environment, most commonly in untrained subjects poorly adapted to such conditions. Clinical manifestations of exertional heatstroke are related to the induction of a systemic inflammatory response and a disseminated intravascular coagulation triggered by heat stress, which may lead to multiorgan dysfunction and death. Early management through rapid cooling is mandatory to prevent the devastating consequences of exertional heatstroke.

Objectif : Les transferts interhospitaliers de patients illustrent indirectement le fonctionnement en reseaux des hopitaux, leur organisation en centres de competences, ainsi que leurs conditions d’engorgement. Notre objectif etait d’etudier les transferts au depart d’un centre hospitalier universitaire (CHU) de reference, de quantifier ces flux, d’analyser leurs caracteristiques, ainsi que leur evolution au cours des dernieres annees.Methodes : Etude retrospective descriptive des transferts effectues entre 2003 et 2011 au depart du CHU, avec analyse des caracteristiques demographiques, medicales et operationnelles. Les transferts en ambulance ou avec une medicalisation ont fait l’objet d’une analyse distincte.Resultats : Depuis 2003, le nombre de transferts a nettement augmente, passant de 4 026 transferts en 2003 a 6 481 transferts en 2011 (+ 60,9 %). Les transferts en ambulance ont progresse de pres de 300 % (2003 : 616 ; 2011 : 2 460). La majorite (98 %) des transferts etait a destination des hopitaux de proximite dans un rayon de 75 km (mediane 24 km, 5-44). Dans 26 % des cas, les transferts etaient organises au depart des urgences. Les transferts a destination d’un etablissement psychiatrique representaient 24 % des transferts par ambulance en 2011.Un nombre croissant de transferts necessitait une medicalisation. Les patients concernes beneficiaient d’un soutien ventilatoire dans 18 % des cas et d’amines vasoactives dans 9,8 %. Dans 11,6 % des cas, ces transferts etaient organises en raison d’un engorgement du CHU.Conclusion : Cette analyse confirme un accroissement des transferts interhospitaliers. Cette augmentation etait principalement liee a leur fonctionnement en reseau, mais egalement a l’engorgement des structures hospitalieres.

The use of electronic control devices has expanded worldwide during the last few years, the most widely used model being the Taser. However, the scientific knowledge about electronic control devices remains limited. We reviewed the medical literature to examine the potential implications of electronic devices in terms of morbidity and mortality, and to identify and evaluate all the existing experimental human studies. A single exposure of an electronic control device on healthy individuals can be assumed to be generally safe, according to 23 prospective human experimental studies and numerous volunteer exposures. In case series, however, electronic control devices could have deleterious effects when used in the field, in particular if persons receive multiple exposures, are intoxicated, show signs of "excited delirium," or present with medical comorbidities. As the use of electronic control devices continues to increase, the controversy about its safety, notably in potentially high-risk individuals, is still a matter of debate. The complications of electronic control device exposure are numerous but often recognizable, usually resulting from barbed dart injuries or from falls. Persons exposed to electronic control devices should therefore be fully examined, and traumatic lesions must be ruled out.

Every medical practitioner is confronted on a daily basis with emergencies. Among these, life-threatening emergencies can have disastrous consequences in term of morbidity and mortality; 22 cardiac arrests and 10 deaths were reported among the 1,650 Swiss practices during a 5 year period. The occurrence of life-threatening emergencies at the office necessitates, according to the type and place of the practice, the skills of the practitioner and the organization of his practice, the implementation of procedures, equipments (for example room equipped with a defibrillator, respiratory nebulizer, splints, emergency drugs) and specific continuous education programs that should be encouraged and made available to the whole medical corporation.