NEWS IN BRIEF

Study: Survival to hospital discharge doubles after cardiac arrest with improved CPR and device

At the American Heart Association’s (AHA) Scientific Sessions in November in Orlando, Florida, Tom P. Aufderheide, MD, professor of emergency medicine and director of the Resuscitation Research Center in the Department of Emergency Medicine at the Medical College of Wisconsin in Milwaukee, reported on a study he conducted. It showed that following the AHA revised 2005 cardiopulmonary resuscitation (CPR) techniques, the rates of hospital discharges doubled when the new guidelines were consistently and effectively applied.

According to a release from Advanced Circulatory Systems, Inc., the study tracked 893 patients in seven cities who experienced cardiac arrest outside of the hospital all the way through hospital discharge. When treated with the new CPR techniques and the use of the ResQPOD, an Impedance Threshold Device (ITD), the hospital discharge rates went from 7.9 percent to 15.7 percent, or double the survival rate of the control group of 1,424 patients. The average age of both study populations was 64 years; 65 percent of the study subjects were male.

Study participants included the Medical College of Wisconsin in Milwaukee; the Madison (WI) Fire Department; Allina Medical Transportation in Anoka County, MN; Wake County EMS in Raleigh, NC; Pinellas County EMS in Largo, FL; the Omaha (NE) Fire Department; and Cypress Creek (TX) EMS.

Information on the AHA 2005 CPR Guidelines is at www.americanheart.org.

Note: The generally cleared indication for the ResQPOD is a temporary increase in blood circulation during emergency care, hospital, clinic, and home use. Studies are ongoing in the United States to evaluate the long-term benefit of the ResQPOD for indications related to patients suffering from cardiac arrest, hypotension during dialysis, and severe blood loss. The references in this communication are not intended to imply specific outcome-based claims not yet cleared by the U.S. Food and Drug Administration. Clinical study references are available on request.

2008 Safety Stand Down to be held June 22-28

The 2008 Safety Stand Down will be held June 22-28. It will be known as the “Fire/EMS Safety, Health and Survival Week.” The week will be devoted to reviewing safety policies, evaluating the progress of existing initiatives, and discussing health and fitness. The focus of the event, initiated in 2005 and supported by the major fire service organizations, is reducing firefighter line-of-duty deaths. All departments are encouraged to participate and to invite other local fire and EMS responders to take part as well.

Additional information is available from the International Association of Fire Fighters’ Department of Occupational Health, Safety and Medicine at (202) 824-9304 or its Department of Fire/EMS Operations at (202) 824-1594.

WTC health program for national workers on hold

The Department of Health and Human Services is canceling the initiative that would have created a “processing center” for medical screening of Ground Zero workers from across the country, according to a New York Daily News report. The Bush administration said that the program would cost “far more money than Congress has provided” (as much as $165 million compared with the $52 million Congress provided). The government was seeking bids from private contractors to handle the work. The project would have organized and improved various 9/11 health programs and provided pharmacy benefits.

According to the Centers for Disease Control and Prevention (CDC), federal officials will work to develop “the best possible product.” The programs in place are expected to take care of sick workers until 2009, according to the CDC.

“Government ends WTC health program,” AP, http://www.nydailynews.com/news/2007/12/15_government_ends_wtc_health_prog…, December 17, 2007

FDA cautions about hazards of improper use of disinfectants on electronic medical equipment

Using excess cleaning and disinfecting liquids on some electronic medical equipment can be hazardous, according to the U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health Public Health Notification of October 31, 2007. The Centers for Disease Control and Prevention (CDC), Environmental Protection Agency (EPA), and Occupational Safety and Health Administration (OSHA) collaborated in preparing the notice.

The notice’s Background section explains that current infection-control strategies focus on cleaning and disinfecting frequently touched surfaces that contribute to cross-transmission of infections. These contaminated surfaces include surfaces and equipment with blood or other potentially infectious material, surfaces touched by gloved hands after the glove has had contact with patients, surfaces touched by patients and those contacted by or in the vicinity of aerosols and spatter, and surfaces about which healthcare professionals are uncertain of their state of cleanliness.

Over the past two years, federal agencies have been called to address problems associated with “inappropriate use of liquids on electronic medical equipment.” The problems included equipment fires and other damage, equipment malfunctions, and healthcare worker burns. Infusion pumps, ventilators, patient-controlled analgesia pumps, sequential compression device pumps, telemetry physiological signal receivers and transmitters, infusion fluid warmers, and infant antiabduction sensors have been involved. However, any equipment with unsealed electronic circuitry or components, such as computer workstations, handheld devices, and other monitoring equipment, can be affected, possibly posing life-threatening events to patients.

In most cases, the root cause of the problems likely was the corrosion of electronic circuitry by disinfecting or cleaning solutions that penetrated the equipment housings. Routinely spraying the housing with disinfectants or wrapping the housings with disinfectant-soaked towels is not recommended. Equipment manufacturers recommend wiping the housing with a soft cloth dampened wth a mild detergent and water.

The FDA recommends that personnel review their facility policies on equipment management and management’s assignment of the responsibility for key tasks.

OSHA’s Bloodborne Pathogens Standard(29 CFR 1910.1030) requires the use of an appropriate chemical disinfectant (Appendix III) on contaminated equipment. An item or surface is considered contaminated if it has blood or OPIM on it (OSHA’s definition of OPIM is in Appendix III) or is reasonably anticipated to be contaminated with blood or OPIM during a procedure that involves blood or OPIM contact. All disinfectants that meet OSHA’s definition of “appropriate” include directions to keep the item or surface wet for a specified contact time. Equipment that cannot tolerate this exposure to liquids may need special handling if it becomes contaminated and may have to be removed from use. It may be necessary to disassemble, wash, and soak the housing in the liquid disinfectant to avoid wetting the circuitry. Additional information on the recommended decontaminating procedures and specific agency requirements is at their respective Web sites:

• FDA medical device Public Health Notifications—www.fda.gov/cdrh/safety.html.
• OSHA Bloodborne Pathogens standard—www.osha.gov/SLTC/bloodbornepathogens/index.html.
• CDC infection control guidelines—www.cdc.gov/ncidod/dhqp/gl_environinfection.html.
• EPA general regulatory information on hospital disinfectants—www.epa.gov/pesticides/factsheets/antimic.htm and www.epa.gov/oppad001/chemregindex.htm.

Responders unite for traffic safety and expediency

The National Traffic Incident Management Coalition (NTIMC) launched the National Unified Goal for Traffic Incident Management at a press conference in November in Gaithersburg, Maryland. The International Association of Fire Chiefs (IAFC) and 18 other responder groups have joined the initiative. The National Unified Goal calls for incident responders from all disciplines to plan, train, and exercise together to clear crash scenes more safely and more quickly. Among the groups participating are firefighters, EMTs, highway workers, law enforcement officers, tow truck operators, and 911 professionals.

The Coalition’s policy “commits its member organizations to an ongoing, united multidisciplinary effort to work together more effectively and clear traffic incidents more efficiently and safely,” according to NTIMC. In addition, responders will ask motorists to slow down and move over when they approach traffic incident scenes to reduce the number of responders injured and killed by passing vehicles while working on the roadside and to enable them to clear the incident more quickly.

Farmers Insurance studies find seat belts offer “most important protection”

When a driver uses a seat belt, the odds of a fatality drop by almost 70 percent compared with a driver that is not buckled in, according to a Farmers Insurance study of 2006 fatal crash data released by the United States Department of Transportation. “Once again, we find strong statistical evidence that seat belts remain the most important protection for the driver,” notes Kevin Mabe, a Farmers Insurance economist who completed the study. The results were similar to those of the 2005 study conducted by Mabe. “A driver’s three-second choice to ‘buckle up’ will more than double his or her chances to survive a severe accident,” says Mabe.

Nighttime and winter driving, rollovers, ejections, vehicle fires, and motorcycle accidents were other factors that increased danger on the roads and decreased the chances of survival.

A copy of the preliminary study is available from Mabe at [email protected], or call (323) 932-3662.

USFA releases reports on fire department runs

The Fire Department Overall Run Profile and the Fire Department Fire Run Profile, developed by the National Fire Data Center, part of the U.S. Fire Administration, explore fire department run activity based on 2004 National Fire Incident Reporting System (NFIRS) data.

The Fire Department Overall Run Profile looks at all types of fire department runs or calls including fire; the focus of the Fire Department Fire Run Profile is strictly fire. Among the information contained in the reports is the following:

• Fifty-five percent of department responses require EMS and rescue services.
• False alarms account for 12 percent of all fire department runs; good intent calls account for 10 percent.
• About eight percent of calls involve fire.
• Forty-two percent of fire runs are to incidents involving structures; 35 percent are to outside fires.

Copies of the reports can be downloaded at http://www.usfa.dhs.gov/statistics/reports/index.shtm/.

Senate aviation bill would mandate EMS safety changes

The Aviation Investment and Modernization Act of 2007 (S. 1300), introduced to authorize appropriations for the Federal Aviation Administration (FAA) for fiscal years 2008 through 2011, would improve safety and capacity and also modernize the air traffic control system. It would also mandate changes for helicopter emergency medical service operators.

In addition, Section 508 “Increasing Safety for Helicopter Emergency Medical Service Operators” would mandate the following:

• Compliance with 14 CFR Part 135 regulations: No later than 18 months after the date of enactment of this Act, all helicopter emergency medical service operators shall comply with the regulations in part 135 of Title 14, Code of Federal Regulations, whenever there is a medical crew onboard, regardless of whether patients are onboard the helicopter.
• Implementation of flight risk evaluation program: Within 60 days after the date of enactment of this Act, the FAA shall initiate, and complete within 18 months, a rulemaking

  —to create a standardized checklist of risk evaluation factors based on its Notice 8000.301, issued in August 2005, and

  —to require helicopter emergency medical service operators to use the checklist to determine if a mission should be accepted.

• Comprehensive consistent flight dispatch procedures: Within 60 days after the date of enactment of this Act, the FAA shall initiate and complete within 18 months a rulemaking
  —to create standardized flight dispatch procedures for helicopter emergency medical service operators based on the regulations in part 121 of Title 13, CFR; and
  —require such operators to use those procedures for flights.

  Improving situational awareness: Any helicopter used for EMS operations that is ordered, purchased, or otherwise obtained after the date S. 1300 is enacted would also be required to have onboard an operational terrain awareness and warning system (TAWS) that meets the technical specifications of section 135.154 of the Federal Aviation Regulations (14 CFR 135.154).

  Improving data available to investigators at crash sites:

  —Study. Within one year after the date of enactment of this Act, the FAA shall complete a feasibility study relative to requiring flight data and cockpit voice recorders on new and existing helicopters used for emergency medical service operations. The study shall address, at a minimum, issues related to survivability, weight, and financial considerations of such a requirement.

  —Rulemaking. Within two years after the date of enactment, the FAA shall complete a rulemaking to require flight data and cockpit voice recorders onboard such helicopters.
  www.rotor.com/DEfault.aspx?tabid=510&newsud905=54920&, Nov. 19, 2007

Line-of-Duty Deaths

November 12. Chief Stanley Engdahl, 78, McPherson County Rural Fire Department #2, Marquette, KS: heart attack.

November 13. Chief Ronny A. Bennett, 39, Orcutt (CA) Fire Protection District: heart attack.

November 21. Senior Firefighter Michael J. Tiuscik, 48, Kansas City (KS) Fire Department: unknown.

November 27. Firefighter John Curry, 30, Volusia County Fire Service, Deland, FL: injuries received when a tree fell on him during a training exercise at the training center while practicing power and chain saw use.

November 30. Assistant Chief Jon Bingham, 48, Geary (OK) Fire Department: heart attack.

Source: USFA Firefighters Memorial Database

News Glimpses

FDA adds warning on Avandia packaging. The U.S. Food and Drug Administration has announced that GlaxoSmithKline (GSK), the manufacturer of Avandia (rosiglitazone), used to treat type 2 diabetes, will add new information to the boxed warning in the drug’s labeling relative to the potential increased risk for heart attacks. Information on rosiglitazone maleate (marketed as Avandia, Avandamet, and Avandaryl) is at www.fda.gov/cder/drug/infopage/rosiglitazone/default.htm; the FDA Safety Alert on Avandia is at www.fda.gov/bbs/topics/NEWS/2007/new01636.html/. ● New safety rules for school buses. U.S. Transportation Secretary Mary E. Peters announced in November a new federal proposal that would mandate higher seat backs and new seat belt standards for the 474,000 U.S. school buses in service. One year after the rule goes into effect, all new school buses would be equipped with 24-inch seat backs, as opposed to the current 20 inches. Also, all new small buses, which are more prone to rollover than full-size buses, are to be equipped with three-point belts within three years of the new rule’s taking effect. Presently, only lap belts are required. Regarding larger school buses, the proposed rule, for the first time, would provide federal standards for seat belts for school districts that decide to add them. The districts would be allowed to use federal highway safety funds to cover the additional cost of equipping buses with seat belts. ● Metal fatigue not to blame for I-35W bridge disaster in Minnesota. The National Transportation Safety Board (NTSB) report on the I-35W bridge collapse in Minnesota in August, which killed 13 people, did not attribute the collapse to Minnesota Department of Transportation’s (MnDOT) lack of inspections and maintenance. The NTSB is looking into the design of the bridge’s gusset plates and the weight of the equipment used in a construction project on the bridge at the time of collapse. The cause of the disaster may not be determined for another year.

● FEMA to be focus of investigations in 2008. The Homeland Security inspector general says that the number of Federal Emergency Management Agency (FEMA) investigations scheduled for 2008 outnumber those planned for any of the divisions to be scrutinized. Of the 173 planned management reports, 53 are to involve FEMA and 31 the department’s management division. Thirteen of the investigations will be concerned with ongoing Gulf Coast recovery projects necessitated by Hurricane Katrina in 2005. These areas will include efficiency in devising plans for housing disaster victims, the possible use of lie detector tests during background checks when screening potential new hires, assessing the effectiveness of the Transportation Security Administration in ensuring screener uniforms and badges are not stolen, and determining how the department handles employee misconduct. “Homeland Security watchdog to focus on FEMA in 2008,” Eileen Sullivan, AP, http://www.dailymail.com/News/200712040598 ● Medtronic suspends sale of defibrillators. Medtronic, Inc. Sprint Fidelis defibrillation leads may have contributed to five patient deaths, according to the company. It said it found a “small chance of fractures in particular locations” on Sprint Fidelis models 1930, 6931, 6948, and 6949. Medtronic is asking doctors to stop implanting the leads and to return all unused ones to the company. Patients with Sprint Fidelis leads are asked to contact their doctor’s office. Information is available from Medtronic Patient/services, (800) 551-5544, ext. 41835. “Medtronic suspends sale of heart device,” AP, www.msnbc.msn.com/id/21302928/print/1/displaymode/1098, October 16, 2007