Effect of dietary treatments on performance, oocysts shedding and lesion scores in broiler chickens experimentally challenged with Eimeria infection.

Although anticoccidials effectively control coccidiosis, a needed reduction in the reliance on antimicrobials in animal production leads to the exploration of alternative compounds. The present study aimed to test five different dietary treatments to counteract the negative impact of coccidiosis on broiler chickens' health and performance. 1-day-old male Ross 308 broilers (n = 960) were randomly assigned to one of eight treatments, with six cages per treatment (20 birds/cage). To the diet of the broiler chickens of treatments (Trt) 1-5, a synbiotic was added from d0-10. From d10-28, birds of Trt1 and Trt2 were fed synbiotics, whereas birds of Trt3 were fed diets with glutamine, and birds of Trt4 and Trt5 were fed diets with a combination of ß-glucans and betaine. From d28-35 onwards, birds of Trt1 were fed a diet with a synbiotic, whereas birds of Trt2-4 received diets with glutamine, and birds of Trt5 were fed a non-supplemented diet. Birds of the positive control group (PC; Trt6) were fed a standard diet supplemented with an anticoccidial (Decoquinate). The challenged negative control (NCchall; Trt7) and non-challenged negative control (NC) Trt8 were fed a standard diet without anticoccidial or other dietary treatment. At 7 days (d) of age, all birds were inoculated with 1 023, 115, and 512 sporulated oocysts of E. acervulina, E. maxima, and E. tenella, respectively, except for Trt8. Body weight gain (BWG), feed intake, and feed conversion ratio were assessed for each feeding phase (d0-10, d10-28 and d28-35) and overall experimental period (d0-35). Oocyst shedding, Eimeria lesion scores, cecal length, and relative weight were assessed at d13, d22, d28 and d35. Additionally, oocyst shedding was determined at d9 and d17. Litter quality was evaluated at d27 and d34, and footpad lesions at d34. During the starter (d0-10) and finisher (d28-35) periods, performance did not differ between the treatments. During the grower period (d10-28), Trt6 (PC) and Trt8 (NC) chickens had the highest BWG of all treatments (P < 0.001). Dietary treatment had no effect on litter quality and severity of footpad lesions. In the PC group (Trt6), low oocyst excretion and lesion scores were found. When comparing Trt1-5 with NCchall (Trt7), none of the treatments significantly reduced oocyst output or lesion scores. In conclusion, in this experiment, none of the dietary treatments performed similar or better compared to the PC group (Trt6) regarding performance or reducing Eimeria oocyst shedding or lesion scores.

Threonine requirement of broiler chickens during subclinical intestinal Clostridium infection.

The aim of this study was to determine the threonine requirement of broilers during a subclinical Clostridium infection. Three experiments were performed: experiments 1 and 2 to investigate the dose-response of threonine supplementation during infection and experiment 3 to validate the threonine requirement during infection. In each experiment, 1-d-old Ross 308 male broilers were used. An infection model was used with inoculation of Eimeria maxima and Clostridium perfringens at d 9 and 14 of age, respectively. Control birds were inoculated with saline and liver broth at d 9 and 14 of age, respectively. From d 9 of age, infected birds were fed diets differing in the standardized digestible threonine-to-lysine ratio (realized ratios experiment 1: 0.55, 0.58, 0.63, 0.69, and 0.72; realized ratios experiment 2: 0.64, 0.65, 0.67, 0.69, and 0.72; and realized ratios experiment 3: 0.63 and 0.67). Uninfected birds were fed diets with a realized Thr:Lys ratio of 0.63 in experiments 1 and 2 and of 0.63 or 0.67 in experiment 3. The incidence of lesions, lesion severity, and mortality rate of infected birds was not affected by the Thr:Lys ratio. Experiments 1 and 2 showed that the decrease in BW gain and feed intake was less severe in infected birds fed a diet with a Thr:Lys ratio of 0.69 and 0.67, respectively (not significant). Validation of the Thr:Lys ratio in experiment 3 showed that the BW gain and feed intake were higher for infected birds with a Thr:Lys ratio of 0.67 compared with infected birds with a Thr:Lys ratio of 0.63. This resulted in an increased BW gain and feed intake of 129 and 148 g, respectively, with a higher Thr:Lys ratio over a production period of 37 d. This indicates that a higher Thr:Lys ratio in infected birds improved production performance during infection with C. perfringens, although intestinal damage (incidence and lesion severity) was not affected.

Bioavailability of organic and inorganic zinc sources in male broilers.

The objective of the current study was to determine the bioavailability of an organic zinc source (Availa-Zn) compared with zinc sulfate in a European-type broiler diet. A total of 480 one-day-old male Ross 308 broilers were housed in 48 digestibility cages (10 birds per cage), being randomly divided over 9 treatments. At d 3, the number of birds was standardized to 8. Birds were fed a basal wheat-maize-soya diet (containing 33.5 mg of Zn/kg) with different supplementation levels of zinc (reference zinc source: inorganic zinc sulfate: 0, 5, 10, 15, 20, and 40 mg of Zn/kg of feed; test zinc source: Availa-Zn: 0, 5, 10, 15 mg of Zn/kg of feed). Production performance and tibia zinc content were measured. There were no differences in production performance between the different zinc sources when fed to broilers until 21 d of age. Tibia zinc content was increased linearly with the dietary zinc content up to 20 mg/kg zinc sulfate. The relative biological value of organic zinc was 1.64 compared with zinc sulfate as a reference zinc source (1.00), as indicated by the slope ratio of the linear response curves for both zinc sources, using tibia zinc content as a response parameter. In a practical European broiler diet, the organic Availa-Zn had a higher bioavailability than inorganic zinc sulfate.

Nutritional interventions to support broiler chickens during Eimeria infection.

Different combinations of gut health-promoting dietary interventions were tested to support broilers during different stages of Eimeria infection. One-day-old male Ross 308 broilers (n = 720) were randomly assigned to one of 6 dietary treatments, with 6 pens per treatment and 20 birds per pen, for 35 d. At 7 d of age (d7), all birds were inoculated with 1000, 100, and 500 sporulated oocysts of E. acervulina, E. maxima, and E. tenella, respectively. A 4-phase feeding schedule was provided. The dietary treatments (TRT) 1 to 4 included the basal diet supplemented with multispecies probiotics from d0 to 9 and coated butyrate and threonine from d28 to 35 but received four different combinations of prebiotics and phytochemicals from d9 to 18 and d18 to 28. The basal diet for the positive control (PC, TRT5) included diclazuril as a anticoccidial. The negative control (NC, TRT6) contained no anticoccidial. Performance was assessed for each feeding phase, and oocyst output, Eimeria lesion scores, cecal weight, litter quality, and footpad lesions were assessed at d14, d22, d28, and d35. Body weight gain (BWG) and feed intake (FI) were not affected by dietary treatment. PC broilers had the best feed conversion ratio (FCR) of all treatments from d0 to 35 (P < 0.001). None of the dietary treatments resulted in better litter quality or reduced footpad lesions compared to the PC. Moreover, the PC was most effective in reducing oocyst output and lesion scores compared to all other treatments. However, broilers that received the multispecies probiotics (d0 to 9), saponins (d9 to 18), saponins, artemisin, and curcumin (d18 to 28), and coated butyrate and threonine (d28 to 35) had the best FCR (P < 0.001) and lowest oocyst output and lesion scores compared to other dietary treatments. This study suggests that although the tested compounds did not perform as well as the anticoccidial, when applied in the proper feeding period, they may support bird resilience during coccidiosis infection.

Heterogeneous vancomycin resistance in Staphylococcus aureus: a review of epidemiology, diagnosis, and clinical significance.

OBJECTIVE: To provide an overview of heterogeneously glycopeptide intermediate Staphylococcus aureus, its epidemiology, methods of diagnosis, and clinical relevance. DATA SOURCES: Literature was retrieved in December 2009 through Academic Search Premier, Alt-Health Watch, MEDLINE, OVID, and PubMed, using the search terms heterogeneous glycopeptide-intermediate Staphylococcus aureus, hGISA, hVISA, vancomycin-intermediate Staphylococcus aureus, GISA, and VISA (from 2003 to December 2009). Additional references were obtained through review of publication citations. STUDY SELECTION AND DATA EXTRACTION: All articles retrieved through the literature search and reference review were evaluated for inclusion in this review. DATA SYNTHESIS: Heterogeneously glycopeptide-intermediate S. aureus (hGISA) has been shown to significantly complicate treatment for patients with bacteremia and often escapes detection in clinical laboratories. Population analysis profile area under the curve ratio (PAP-AUC) is considered to be the gold standard of hGISA detection; however, it is labor-intensive, expensive, and not feasible in a clinical setting. The Etest macromethod is a reasonable alternative to PAP, yielding high sensitivity and specificity, and has potential for routine use in clinical laboratories. Due to these difficulties in detection, an exact prevalence is difficult to obtain though, based on available data, it appears that approximately 5-15% of isolates display this phenotype. hGISA is associated with prolonged bacteremia, high bacterial load infections, prolonged antibiotic therapy, prolonged hospitalization, treatment failure, and potential for increased mortality. CONCLUSIONS: Overall, hGISA is associated with a poor clinical course in patients with bacteremia. Information is still lacking regarding the actual prevalence of hGISA as well as the extent of its clinical impact. A uniform method of diagnosis must be established in order to better account for all cases of hGISA. More studies must be conducted to assess clinical outcomes of hGISA.

Effect of early life thermal conditioning and immune challenge on thermotolerance and humoral immune competence in adult laying hens.

Effects of early life experience with climatic (heat) and hygienic [lipopolysaccharide (LPS)] stress on adaptability to the same stressors in later life were studied in laying hens. Chicks were exposed to 37 degrees C for 24 h at d 5 of age (n = 12) or were i.v.-administered once with 1 mg/kg of BW of LPS at 6 wk of age (n = 12), whereas a control group was reared under standard conditions receiving a placebo treatment of PBS (n = 36). At 24 wk of age, hens treated in early life were reexposed to the same stressor. Early life control hens were exposed to heat stress (n = 12), i.v.-administered with LPS (n = 12), or not exposed (n = 12). To evaluate improvement of adaptability, effects of climatic and hygienic stress on performance, humoral immune competence, and endocrine responsiveness were investigated in hens with early life experience to the stressors and hens only exposed to the stressors in later life. Early life heat exposure did not affect performance, immune, and endocrine parameters. Treatment x time interactions were found for level of antibody (Ab) binding to LPS and keyhole limpet hemocyanin (KLH) after LPS administration, indicating that hens with early life LPS experience differed in response level (Ab binding to LPS) and response pattern (Ab binding to LPS and KLH) compared with hens administered with LPS only at adult age. Our data suggest that early life heat stress exposure did not affect adaptability of laying hens to heat stress in later life. However, early life LPS exposure affected kinetics and magnitude of Ab levels binding to LPS and KLH, indicating that early life LPS exposure can enhance the status of immune reactivity or induce a higher sensitivity to LPS.

Transfusion strategies in postinjury coagulopathy.

PURPOSE OF REVIEW: Coagulopathy represents one of the major challenges in the management of the severely injured patient. The present review will attempt to define the current 'optimal' transfusion strategies for the coagulopathic trauma patient and to assess potential weaknesses in the pertinent literature. RECENT FINDINGS: Existing limitations in the management of postinjury coagulopathy include the lack of a uniform definition of the entity, the lack of understanding the mechanisms, and the lack of accurate and rapid diagnostic tests. Rapid thromboelastography represents an improved diagnostic modality that allows 'point-of-care' testing of postinjury coagulopathy and monitoring of transfusion strategies. Ongoing controversies in the field include the optimal target blood pressure and the ideal threshold for blood component transfusions in the hospital. Furthermore, the concentration of plasma transfusions remains an ongoing debate. SUMMARY: Coagulopathy has a significant impact on survival after major trauma. Most recent publications in the field are of retrospective design, and thus do not allow definitive recommendations for clinical practice. Well designed prospective trials and improved basic research studies are required to improve this important aspect of trauma care.

Early-life origins of disparities in chronic diseases among Indigenous youth: pathways to recovering health disparities from intergenerational trauma.

Indigenous women and children experience some of the most profound health disparities globally. These disparities are grounded in historical and contemporary trauma secondary to colonial atrocities perpetuated by settler society. The health disparities that exist for chronic diseases may have their origins in early-life exposures that Indigenous women and children face. Mechanistically, there is evidence that these adverse exposures epigenetically modify genes associated with cardiometabolic disease risk. Interventions designed to support a resilient pregnancy and first 1000 days of life should abrogate disparities in early-life socioeconomic status. Breastfeeding, prenatal care and early child education are key targets for governments and health care providers to start addressing current health disparities in cardiometabolic diseases among Indigenous youth. Programmes grounded in cultural safety and co-developed with communities have successfully reduced health disparities. More works of this kind are needed to reduce inequities in cardiometabolic diseases among Indigenous women and children worldwide.

Effect of single or combined climatic and hygienic stress in four layer lines: 2. Endocrine and oxidative stress responses.

Effects of long-term climatic stress (heat exposure), short-term hygienic stress [lipopolysaccharide (LPS)], or combined exposure to these stressors on endocrine and oxidative stress parameters of 4 layer lines (B1, WA, WB, and WF) were investigated. The lines were earlier characterized for natural humoral immune competence and survival rate. Eighty hens per line were randomly divided over 2 identical climate chambers and exposed to constant high temperature (32 degrees C) or a control temperature (21 degrees C) for 23 d. Half of the hens housed in each chamber were i.v. injected with LPS at d 1 after the start of the heat stress period. The effect of heat, LPS, or combined exposure on plasma levels of corticosterone, 3,5,3'-triiodothyronine (T(3)), glucose, uric acid (UA), and TBA reacting substances (TBARS) were investigated. Except for UA, there were no interactions between heat stress and LPS administration. Heat stress enhanced levels of corticosterone, glucose, and TBARS, whereas levels of T(3) and UA were decreased. The T(3) levels, however, were enhanced by LPS administration, whereas levels of UA were decreased. Administration of LPS had no effect on levels of corticosterone and TBARS. Because both stressors caused a reduction in feed intake, it is assumed that changes in most of the plasma levels of the endocrine and oxidative stress parameters are related with the reduction in feed intake. Neither natural humoral immune competence nor survival rate, for which the lines have been characterized, was indicative for the endocrine and oxidative stress responses to different stressors. The present data suggest that hens were able to cope with single or combined heat stress and LPS administration and that heat stress and LPS administration acted like 2 independent stressors. Furthermore, the 4 layer lines differed in response patterns and response levels; line WB was physiologically most sensitive to environmental changes.

Effect of single or combined climatic and hygienic stress in four layer lines: 1. Performance.

Effects of long-term climatic stress (heat exposure), short-term hygienic stress [lipopolysaccharide (LPS)], or a combination of both challenges on performance of 4 layer lines were investigated. The lines were earlier characterized by natural humoral immune competence and survival rate. At 22 wk of age, 80 hens per line were randomly divided over 2 identical climate chambers and exposed to a constant high temperature (32 degrees C) or a control temperature (21 degrees C) for 23 d. Half of the hens housed in each chamber were i.v. injected with LPS at d 1 after the start of the heat stress period. The effect of heat, LPS, or a combined challenge on feed intake, BW, hen-day egg production, egg weight, and egg shell thickness were investigated. Feed intake, BW, hen-day egg production, egg weight, and egg shell thickness were significantly reduced by heat stress. Administration of LPS significantly reduced feed intake, BW (LPS x time interaction), hen-day egg production, and egg weight (LPS x time interaction). Hens were able to recover from LPS administration but did not completely adapt to heat stress. Hens still lost weight, had a lower feed intake and hen-day egg production after 23 d of continuous exposure to heat stress. These data suggest a different nature of short-term LPS exposure versus long-term heat exposure affecting performance parameters of laying hens, and different adaptation mechanisms of hens toward these stressors. Neither natural humoral immune competence nor survival rate, for which the lines had been earlier characterized, were indicative of the response to different stressors. However, significant line x heat interactions were found for feed intake and hen-day egg production, and a line x heat x time interaction for BW, whereas a line x LPS interaction was found for hen-day egg production and a line x LPS x time interaction for BW. The lines had similar response patterns, but differed in response levels, suggesting that some lines were better able to adapt to stressors than others.

Effect of single or combined climatic and hygienic stress on natural and specific humoral immune competence in four layer lines.

Effects of long-term climatic stress (heat exposure), short-term hygienic stress [lipopolysaccharide (LPS)], or a combination of both challenges on the immune competence of 4 layer lines was investigated. The lines were earlier characterized for natural humoral immune competence and survival rate. Eighty hens per line were randomly divided over 2 identical climate chambers and exposed to a constant high temperature (32 degrees C) or a control temperature (21 degrees C) for 23 d. Half of the hens housed in each chamber were i.v. injected with LPS at d 1 after the start of the heat stress period. Within each of the treatment groups, half of the hens were s.c. immunized with human serum albumin (HuSA) at d 2 after the start of the heat stress period to measure specific antibody (Ab) titers to HuSA. The effect of heat, LPS, or a combined challenge on specific Ab titers to HuSA, natural Ab titers to keyhole limpet hemocyanin or HuSA (in hens that were not immunized with HuSA), and activity of the classical and alternative complement pathways were investigated. Heat stress enhanced specific and natural immune responses. Administration of LPS enhanced natural immune responses but decreased specific immune responses. The lack of interaction between heat stress and LPS administration, except for natural Ab titers to HuSA, suggest that these were 2 independent stressors. The lines had a similar response pattern but differed in the response level. Neither natural humoral immune competence nor survival rate, for which the lines had been characterized, was indicative of the specific and natural immune response to different stressors. Lipopolysaccharide and heat stress initiated sequential responses over time, with an earlier effect of short-term LPS exposure (within the first and second week) and a later effect of long-term heat exposure (within the second and third week). These data suggest that LPS and heat stress affect the natural and specific immune competence of laying hens.

Natural humoral immune competence and survival in layers.

The relation between survival and levels of humoral components of innate (and specific) immune competence of laying hens was investigated in a population of 1,063 laying hens from 12 purebred layer lines. Natural immune competence of the chickens was studied by measuring levels of natural antibodies (NAb) binding to keyhole limpet hemocyanin (KLH) or lipopolysaccharide (LPS), respectively, and hemolytic (classical and alternative) complement activity at 20, 40, and 65 wk of age. In addition, levels of antibodies binding a Newcastle disease vaccine strain as a measure of specific immunity were investigated at 20 wk of age. A distinction could be made between lines showing high or low immune competence with respect to NAb, complement activity, and specific antibodies. Within lines, significant correlations were found for each of the innate parameters among the 3 ages. The innate and specific parameters were, however, not correlated with each other. Based on the limited data set, it was not possible to draw conclusions on line differences for innate or specific immune competence in relation to survival. However, regardless of line, low levels of NAb binding to KLH or high levels of NAb binding to LPS were detected in chickens that did not survive the laying period. The major difference between the responses of NAb binding to KLH or LPS was that the chickens probably did not encounter KLH, which suggests a reflection of the capacity to respond, whereas the chickens most probably did encounter LPS, which suggests a reflection of the active status of the innate humoral immune system. In conclusion, we propose that levels (KLH) and activation (LPS) of components of natural antibodies are indicative for the probability that chickens survive a laying period.

Age- and breed-dependent adapted immune responsiveness of poultry to intratracheal-administered, pathogen-associated molecular patterns.

Immune modulation of poultry by airborne pathogen-associated molecular patterns (PAMP) was studied. White and Brown layer chicks were exposed intratracheally during 5 consecutive days at 7 wk of age with Escherichia coli-derived lipopolysaccharide (LPS), Saccharomyces cerevisiae-derived 1,3 beta-glucan (BGL), a combination of both, or PBS as a control. Six weeks later, birds received similar or crossover PAMP treatments. Body weight (gain), feed conversion, (primary and secondary) specific antibody responses to model antigens, and natural antibody levels were measured. In general, BGL enhanced but LPS exposure decreased primary immune responses at 7 wk of age, whereas both PAMP-enhanced secondary immune responses but decreased primary immune responses at 13 wk of age. Body weight gain and feed conversion at both ages were negatively affected by LPS, especially in White birds, but not by BGL. Pathogen-associated molecular patterns exposure at 7 wk of age also affected Ab responses at 13 wk of age. Birds exposed to a combination of LPS + BGL at 7 wk of age had significantly lower secondary total and IgG Ab responses at 13 wk of age. Birds from both breeds showed enhanced BW gain after exposure to LPS at 13 wk of age, when initially challenged at 7 wk of age with LPS, BGL, or a combined challenge with both. Pathogen-associated molecular patterns exposure at 7 wk of age affected humoral immunity and BW gain at 13 wk of age in a positive (BGL) or negative (LPS) fashion. Repeated exposure to PAMP did not affect Ab responses, but crossover exposure to PAMP in general enhanced Ab responses. Body weight gain was positively affected by repeated exposure but not by crossover exposure, suggesting adaptation of the birds to early PAMP exposure. Our findings suggest that sensitivity of poultry for immune modulation by airborne PAMP differs between ages, is breed-dependent, and is not irreversible of nature. In addition, our data suggest different adaptation to hygienic conditions, both with respect to immune reactivity and BW gain.

Clifford algebra approach to the coincidence problem for planar lattices.

The problem of coincidences of planar lattices is analyzed using Clifford algebra. It is shown that an arbitrary coincidence isometry can be decomposed as a product of coincidence reflections and this allows planar coincidence lattices to be characterized algebraically. The cases of square, rectangular and rhombic lattices are worked out in detail. One of the aims of this work is to show the potential usefulness of Clifford algebra in crystallography. The power of Clifford algebra for expressing geometric ideas is exploited here and the procedure presented can be generalized to higher dimensions.

Septic Arthritis of the Hip in the Setting of Hemophagocytic Lymphohistiocytosis: A Case Report.

CASE: A twenty-two-month-old boy with septic hip arthritis had persistent elevated inflammatory markers and daily fevers despite multiple antibiotic regimens and repeated surgical debridements yielding negative cultures. After exhaustive work-up for other infectious, rheumatologic, and immunologic etiologies, he met diagnostic criteria for hemophagocytic lymphohistiocytosis (HLH) and developed cultures positive for fungal hip arthritis. Following treatment for HLH and fungal hip arthritis, he improved and was discharged. CONCLUSION: No previous report in the literature specifically associates HLH with septic hip arthritis, to our knowledge. Surgeons should suspect underlying immunologic deficiencies and atypical infectious causes of septic arthritis when usual treatment modalities have failed.

Volume calibration alone may be misleading.

The use of spirometry is becoming more and more widespread in non-laboratory situations such as general practice or occupational medicine. In these non-laboratory situations, volume calibration with a 3000 ml syringe is often the only feasible method to ensure that the spirometer produces valid and reproducible data. Sophisticated equipment to calibrate forced manoeuvres with standard waveforms are not present. In this study, we assessed whether volumetric calibration is a guarantee for valid and comparable spirometric results. Two portable spirometers were tested. On 8 consecutive test days, both spirometers were calibrated with a 3000 ml syringe in accordance with the American Thoracic Society (ATS) guidelines. The comparability of the spirometric results (forced expiratory volume in 1 S, FEV1) was tested in two ways. Firstly, the spirometers were compared to each other using the results from 43 volunteers on the same 8 test days. The spirometers were presented in a randomized order and volunteers were asked to perform a series of reproducible manoeuvres in both spirometers. Paired observations were analysed, using Bland and Altman plots. Secondly, the spirometers were compared to a 'gold standard', a computer-driven syringe (CDS). Calibration with the 3000 ml syringe showed that both spirometers complied with the ATS criteria for volume calibration for diagnostic spirometry. However, paired FEV1 data obtained in subjects showed a systematic, volume-dependent difference between the two spirometers (mean difference: 289 ml, P < 0.001, systematic difference: 8.6%, P < 0.0001). This systematic difference was confirmed by the comparisons with the CDS. Volume calibration may be misleading. The results from volume calibration may meet the ATS criteria, but this is no guarantee that data from forced manoeuvres are accurate. If CDS equipment to simulate standard wave forms is not available, it is recommended that biological calibration is performed regularly and, if possible, that paired data from two (or more) different spirometers are compared.

Mobilization of trauma teams for aircraft disasters.

With more survivors of air crashes involving jumbo jets, an improved plan for life-saving emergency care at the crash site is discussed. The concept of airlifting predesignated Trauma Teams to the crash site from large medical centers within a radius of 100 miles is discussed. The "work-shop" for these teams is described in detail, providing an operating and intensive care facility at the scene of the disaster. It is shown how this kind of planning can be applied to natural disasters with multiple casualties as well as to airport disasters.

Passenger survival in wide-bodied jet aircraft accidents vs. other aircraft: a comparison.

An analysis of survival of passengers involved in accidents over the last decade shows approximately three time fewer fatalities, in proportion to the number of passengers involved, in wide-bodied jets than in piston aircraft. Various factors affecting the improved survival rates are discussed. Application of these points with particular reference to airport disaster planning is made. It is shown that there are larger numbers of survivors when life-saving emergency treatment utilizes the concept of "bringing the hospital to the disaster." Details of the Mobile Emergency Hospital developed at Kennedy International Airport are described.

A metropolitan airport disaster plan--coordination of a multihospital response to provide on-site resuscitation and stabilization before evacuation.

At the John F. Kennedy International Airport in New York City, disaster planning has been an integral part of the airport operations for the past 20 years. The medical component of this disaster planning has focused around the Medical Office at JFK. Through this office, on-site emergency medical teams have been established and trained from all ranks of airport personnel. Following the crash of a Boeing 727 aircraft in 1975, a new concept was added to disaster planning for JFK, which involves bringing the hospital, its facilities, and its personnel to the scene. A new piece of equipment, known as Emergency Mobile Hospital, was developed with the cooperation of the airlines, the operating authority of the airport, and other interested parties. Two such vehicles are now in constant readiness at the airport, and together provide two operating rooms, 12 monitored ICU beds, a 16-bed burn unit, and 72 other beds to be used for on-site stabilization of critically ill patients, before transfer to a definitive care facility. Under the auspices of a single area medical school (New York Medical College) and its affiliated departments of surgery, trauma teams are made available to be airlifted to the scene within 30 minutes of notification. Additional medical teams from other medical school hospitals serve as backup support. The principle of bringing the hospital to the emergency, and of assembling trauma teams for the initial phase, remains the same for Kennedy Airport as for that of any other metropolitan airport.