Airway Management During a Mass Casualty Event

Mass casualty respiratory failure will lead to many challenges, not the least of which is safe and secure management of the victims ariways. These patients will be sicker than those typically managed in the operating room and will requiere more emergency management fo their ariways. Mass casualty incidents involving biological or chemical agents will pose the addittional risk of exposure to pathogen. During the severe acute respiratory syndrome epidemic in Toronto, airway manipulation was clearly identified as the procedure most associated with risk to health care workers. Planning for scenarios such as these will require consideration of personal protection for health care workers to minimize these risks. Understanting the risk involved and the airway techniques required for each possible scenario will be key to planning and preparation. (AU)

Mechanical Ventilation in Mass Casualty Scenarios: Augmenting Staff: Project XTREME

Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators. Tactics to address these situations include efforts to lower demand by transferring patients to other institutions as well as efforts to augment staffing levels. Staff can be augmented by mobilization of deployable teams of volunteers from outside the region and through exploitation of local resources. The latter includes strategies to recruit local respiratory therapists who are currently in either non-clinical or non-hospital-based positions and policies that optimize existing respiratory therapy resources within an institution by canceling elective surgeries, altering shift structure, and postponing vacactions. An alternative approach would employ non-respiratory-therapy staff to assist in the management of patients with respiratory failure. Project XTREME (Cross-Training Respiratory Extenders for Medical Emergencies) is a cross-training program developed to facilitate training of non-respiratory-therapy health professionals to assist in the management of patients who require mechanical ventilation. It includes an interactive digital video disc as well as a competency validation laboratory and is designed to be performed at the time of an emergency. Pilot testing of the program suggests it is effective. (AU)

Estrategias de ventilación y refrescamiento para el hospital provincial materno - infantil de San Miguel de Tucumán

Este trabajo responde a la solicitud de asesoramiento por parte del estudio de arquitectura Sessa - Ripari, para el acondicionamiento bioclimático correspondiente al concurso de anteproyectos para el Hospital Provincial Materno - infantíl de San miguel de Tucumán. Este anteproyecto resultó ganador del mismo, permitiendo la profundización del trabajo solicitado. Se presentan estrategias en el aprovechamiento de las brisas dominantes, tratamiento en el entorno del tratamiento en la envolviente edilicia. Se concideran como límites topes para las situaciones climáticas típicas los diagrámas de confort higrotérmico ampliados para ventilación natural. Se presentan simulaciones dinámicas de comportamiento no acondicionados mecanicamente, a efectos de validar los rangos de temperatura y humedad previstos (AU)