Paramedics first line of treatment for stroke?
A study conducted by Jeffrey Saver, M.D., director of the University of California, Los Angeles UCLA Comprehensive Stroke Center, and his colleagues sought to determine if having paramedics administer stroke therapies as soon as stroke is suspected would shorten the time between stroke onset and treatment. According to Walter Koroshetz, M.D., acting director of the National Institute of Neurological Disorders and Stroke (NINDS), (http://www.ninds.nih.gov), the nation’s leading funder of research on the brain and nervous system: “This study shows that it is possible to get treatments to stroke patients even before they arrive at a hospital. Because a blocked blood vessel causes brain damage over minutes to hours, this prehospital approach to treatment is sure to be adopted and refined in future clinical research studies. Ultra-early brain salvage in stroke patients will someday surely reduce the tremendous burden of disability and death due to stroke.”
In most stroke trials, patients first undergo tests at a hospital before receiving initial treatment, which may be hours after the stroke occurred.
In the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) Phase 3 multicenter, randomized, placebo-controlled clinical trial, 1,700 patients suspected of having had a stroke were given magnesium sulfate or a placebo by paramedics within two hours of stroke onset. The paramedics used a version of the Los Angeles Prehospital Stroke Screen developed by the investigators to rapidly and accurately identify potential stroke patients. The paramedics then contacted a neurologist by cell phone to ascertain whether a patient should be included in the study. Patients approved for the study (or their representatives) then gave the study doctor their permission to be part of the trial.
The patients received a study drug faster than in other stroke trials; 74.3 percent of the patients received a study intervention within 60 minutes of stroke onset. “The most important finding of this study was that medication could be delivered within the ‘golden hour’ of first onset of stroke symptoms, when there is the greatest amount of brain to save,” explains Saver. “That means the prehospital paramedic delivery of the drug system developed in FAST-MAG could become a platform for testing additional drugs and devices in the future.”
Although the drug magnesium sulfate, tested in this study, did not perform any better than the placebo in improving patient disabilities 90 days after the stroke, Saver notes: “There are many promising drugs and devices in the pipeline that can be tried with this novel protocol.” He adds: “The study has opened up a new window in which the interventions are most likely to be effective.” He said several trials underway are using elements of the FAST-MAG platform to test promising agents for neuroprotection.
“We believe this study represents a paradigm shift in the treatment of stroke and potentially numerous other neurological conditions,” agrees co-principal investigator Dr. Sidney Starkman, co-director of the UCLA Stroke Center and professor of emergency medicine and neurology at the David Geffen School of Medicine at UCLA. “We’ve never done something this large that demonstrates that paramedics not only are eager to provide the best possible patient care, but also are capable of being invaluable partners in an intense, time-dependent clinical trial.”
The study is available at http://bit.ly/1DzwrXO (Saver et al., “Prehospital Magnesium Sulfate as Neuroprotection for Acute Stroke,” New England Journal of Medicine, February 5, 2015.)
NFPA 101®: increase compartment size in hospitals?
National Fire Protection Association (NFPA) members and authorities having jurisdiction are invited to participate in the discussion concerning the pros and cons of a proposed change for the 2018 revision of the 2015 edition of NFPA 101® Life Safety Code®. (http://bit.ly/1vY2j9K) The issue is whether the allowable smoke compartment in hospitals should be increased from 22,500 square feet to 40,000 square feet. July 6, 2015, is the closing date for the receipt of public input.
According to Ron Cote, P.E., principal life safety engineer at the NFPA, NFPA members rejected the proposal at the technical reports session of the NFPA Conference & Expo in June and proponents for the change, including members of the Life Safety Technical Committee on Health Care Occupancies (SAF-HEA), health care facility engineers who are members of the American Society for Healthcare Engineering, and other health care industry practitioners and regulators, plan to revisit the issue as part of the revision cycle for the 2018 edition.
Cote explains that the premise for the increase in smoke compartment size for new construction remains viable. New hospitals in the United States are designed to the Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Health Care Facilities, which allot a greater amount of floor space to individual patients. The FGI Guidelines help ensure that a new smoke compartment of 40,000 square feet has an occupant load similar to that traditionally associated with a 22,500-square-foot smoke compartment so that additional patients will not be placed at risk of fire within the smoke compartment.
Further, Cote says, “Smoke compartment size will be prevented from becoming excessive because a current code requirement limits the travel distance to reach a door to another smoke compartment to 200 feet. To meet the travel limitation, any smoke compartment that approaches 40,000 square feet will need access to more than one adjacent smoke compartment. A smoke compartment of typical proportions situated at an end of a rectangular-shaped building, so that it accesses only one adjacent smoke compartment along its narrow dimension, might approach 30,000 square feet before exceeding the 200-foot travel limitation-in other words, the 40,000-square-foot compartment size might not be realized because of the travel limitation.”
Among the reasons the NFPA membership rejected the size change at the NFPA conference was that smoke compartments in existing hospitals not designed to the FGI Guidelines are limited to 22,500 square feet. NFPA 101 applies both to new construction and existing building arrangements. The NFPA says that any provision for increased smoke compartment size should allow for the same language to be used in Chapter 18 for new facilities and Chapter 19 for existing facilities, which “would seem to rule out any mandate for compliance with the FGI Guidelines, as they are applicable only to new construction.”
One option, according to the NFPA, would be to apply “a substitute criterion to new and existing facilities of a maximum patient load per smoke compartment.” In addition, the NFPA recommends that the SAF-HEA committee “work to codify criteria necessary to permit the increase in smoke compartment size to be offered to nursing homes.”
Campaign should include fire sprinklers, group says
Common Voices, a coalition of advocates for a Fire-Safe America, has applauded the Nationwide Insurance® Make Safe Happen campaign introduced during the Super Bowl and featured on the Web but questions why the fire sprinkler is not included.
Common Voices, many of whose members have been victims of fire or otherwise negatively impacted by fire, notes in a release: “Fire sprinklers go one step beyond smoke detectors in that they can actually extinguish a fire and provide occupants with a safe path of escape.” The group suggests that Nationwide “expand its messaging to include fire sprinklers, especially since most insurance companies, including Nationwide, offer discounts for the installation of home fire sprinklers.”
NFPA standards open for public input
The following are among the National Fire Protection Association (NFPA)standards that are now open for public input. The deadline for comments is July 6, 2015.
- NFPA 402-2013, Guide for Aircraft Rescue and Fire-Fighting Operations.
- NFPA 424-2013, Guide for Airport/Community Emergency Planning.
- NFPA 472-2013, Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents.
- NFPA 473-2013, Standard for Competencies for EMS Personnel Responding to Hazardous Materials/Weapons of Mass Destruction Incidents.
- NFPA 791-2014, Recommended Practice and Procedures for Unlabeled Electrical Equipment Evaluation.
- NFPA 1144-2013, Standard for Reducing Structure Ignition Hazards from Wildland Fire.
- NFPA 1192-2015, Standard on Recreational Vehicles.
- NFPA 1194-2014, Standard for Recreational Vehicle Parks and Campgrounds.
- NFPA 1500-2013, Standard on Fire Department Occupational Safety and Health Program.
- NFPA 1582-2013, Standard on Comprehensive Occupational Medical Program for Fire Departments.
- NFPA 1801-2013, Standard on Thermal Imagers for the Fire Service.
- NFPA 1951-2013, Standard on Protective Ensembles for Technical Rescue Incidents.
- NFPA 1961-2013, Standard on Fire Hose.
- NFPA 1971-2013, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting.
Additional information is at http://bit.ly/1Gc6gv6.
Line-of-Duty Deaths
January 21. Firefighter Leslie “Les” W. Fryman, 58, Rosendale (WI) Volunteer Fire Department: cause not yet reported; afflicted January 14, 2015.
January 29. Firefighter Clifford “Cliff” Sanders, 55, Caney (KS) Volunteer Fire Department: cerebrovascular accident suffered the day before.
January 31. Assistant Chief Mike “Coop” Cooper, 68, Centerville (IA) Fire Department: fatal unknown injury suffered at home on January 30.
February 3. Firefighter Charlie V. Wallace, 74, Montgomery (NY) Fire Department: injuries suffered when struck by an auto in front of the fire station on January 10 while the department was preparing to respond to a call.
February 5. Chief Kenneth Lehr, 59, Medora (IL) Community Fire Protection District: struck by fire apparatus backing up on the highway at a motor vehicle accident as he was trying to clear a landing spot for a helicopter.
February 6. Firefighter Garry Rose, 67, McMechen (WV) Volunteer Fire Department: apparent heart attack.
February 11. Lieutenant Randy Parker, 46, Macon-Bibb County (GA) Fire Department: injuries suffered in a structure collapse at a fire.
February 15. Sergeant Kenneth M. Stanton, 52, Sandy Springs Fire Department, Pendleton, SC: struck by an auto at the emergency scene.
February 18. Firefighter Randy Hiti, 57, Rice Lake Fire Department, Duluth, MN: medical episode, cause unknown.
February 21. Captain Dwight W. Bazile, 57, Houston (TX) Fire Department: heart attack suffered on February 19.
February 22. Firefighter Edward Roddy, 48, Somerset (PA) Fire Department: heart attack he suffered at the scene of a fire on November 5, 2014.
Source: USFA Firefighters Memorial Database
