Time Savings and Safety of EMS Administration of Antibiotics for Open Fractures.

INTRODUCTION: Early administration of antibiotics for open fractures reduces serious bone and soft tissue infections. The effectiveness of antibiotics in reducing these infections is time-dependent, with various surgical associations recommending administration within one hour of injury, or within one hour of patient arrival to the emergency department (ED). The extent to which prehospital antibiotic administration in these situations might reduce the time to treatment has not been previously reported. The purpose of this study was to describe current prehospital use of antibiotics for traumatic injury, to assess the safety of prehospital antibiotic administration, and to estimate the potential time-savings associated with antibiotic administration by EMS clinicians. METHODS: This was a retrospective analysis of the 2019 through 2022 ESO Data Collaborative research data set. Included subjects were patients that had a linked ICD-10 code indicating an open extremity fracture and who received prehospital antibiotics. Time to antibiotic administration was calculated as the elapsed time from EMS dispatch until antibiotic administration. The minimum potential time saved by EMS antibiotic administration was calculated as the elapsed time from administration until ED arrival. To assess safety, epinephrine and diphenhydramine administration were used as proxies for the adverse events of anaphylaxis and minor allergic reactions. RESULTS: There were 523 patients meeting the inclusion criteria. The median (and interquartile range [IQR]) elapsed time from EMS dispatch until antibiotic administration was 31 (IQR: 24-41) minutes. The median potential time savings associated with prehospital antibiotic administration was 15 (IQR: 8-22) minutes. Notably, 144 (27.5%) of the patients who received prehospital antibiotics had total prehospital times exceeding one hour. None of the patients who received antibiotics also received epinephrine for presumed anaphylaxis. CONCLUSIONS: EMS clinicians were able to safely administer antibiotics to patients with open fractures a median of 15 minutes before arrival at the hospital, and 99 percent of the patients receiving antibiotics had them administered within one hour of EMS dispatch. EMS administration of antibiotics may be a safe way to increase compliance with recommendations for early antibiotic administration for open fractures.

The development and implementation of a method using blue mussels (Mytilus spp.) as biosentinels of Cryptosporidium spp. and Toxoplasma gondii contamination in marine aquatic environments.

Surveillance monitoring for microbial water quality typically involves collecting single discrete grab samples for analyzing only one contaminant. While informative, current approaches suffer from poor recoveries and only provide a limited snapshot of the microbial contaminants only at the time of collection. To overcome these limitations, bivalves have been proposed as effective biosentinels of water quality particularly for their ability to efficiently concentrate and retain microbial contaminants for long periods of time. In this study, we examined the use of indigenous blue mussels (Mytilus spp.) as biosentinels to monitor for the presence of Toxoplasma gondii and Cryptosporidium water. An efficient method to extract oocyst DNA from various mussel tissues followed by PCR-based detection of these pathogens was developed, which resulted in the detection down to 10 oocysts. This method was then used to conduct a small survey in Point Lobos and Morro Bay, California to determine prevalence T. gondii and Cryptosporidium. Results revealed that mussels from Morro Bay were contaminated with T. gondii (33 %), while mussels from Point Lobos were contaminated with T. gondii (54 %) and Cryptosporidium (26.9 %) oocysts. Phylogenetic analysis using the SSU rRNA gene identified two novel Cryptosporidium parvum-like genotypes. Overall, this study demonstrated the application of using native California Mytilus spp. as biosentinels for pathogen contamination along the central California shorelines. More importantly, T. gondii and Cryptosporidium were found at higher prevalence rates in Morro Bay and in Point Lobos, an area not previously reported to be contaminated with these pathogens.

Impact of Stormwater Discharges on Water Quality in Coastal Marine Protected Areas.

Marine protected areas worldwide limit harvest to protect sensitive fisheries, but rarely do they address water quality goals that may have equally demonstrable impacts. California has over 500 coastal shoreline miles of marine protected areas designated as Areas of Special Biological Significance (ASBS), but receives untreated wet weather runoff discharges from over 1600 storm drain outfalls. The goal of this study was to assess the extent and magnitude of water quality impacts in ASBS following storm events. A stratified probabilistic design was used for sampling receiving water shorelines near (discharge) and far (non-discharge) from storm drain outfalls. In general, reasonably good water quality exists in California's ASBS following storm events. Many of the target analytes measured did not exceed water quality standards. The post-storm concentrations of most constituents in discharge and non-discharge strata of ASBS were similar. The three potentially problematic parameters identified were total PAH, chromium, and copper.

Mussel Watch update: long-term trends in selected contaminants from coastal California, 1977-2010.

This study examined trends in contaminants measured during three decades of "Mussel Watch" monitoring on the California coast. Chlorinated organic contaminants and butyltins declined the most rapidly, with tissue concentrations in 2010 that were up to 75% lower than during the 1980s. Silver and lead declined at about half of the stations statewide, but generally exhibited slower rates of decline relative to the organic compounds. In contrast, copper increased at many stations, and PAHs showed little evidence for declines. Mussels from San Francisco Bay and the Southern California Bight were historically the most contaminated and have had the steepest declines. Overall, these data show that the "Mussel Watch" approach to monitoring contaminants in California has provided some of the best evidence of the effectiveness of actions to improve water quality over the past 30 years. These datasets also highlight challenges that remain in managing PAHs and copper.

The Mussel Watch California pilot study on contaminants of emerging concern (CECs): synthesis and next steps.

A multiagency pilot study on mussels (Mytilus spp.) collected at 68 stations in California revealed that 98% of targeted contaminants of emerging concern (CECs) were infrequently detectable at concentrations ≤ 1 ng/g. Selected chemicals found in commercial and consumer products were more frequently detected at mean concentrations up to 470 ng/g dry wt. The number of CECs detected and their concentrations were greatest for stations categorized as urban or influenced by storm water discharge. Exposure to a broader suite of CECs was also characterized by passive sampling devices (PSDs), with estimated water concentrations of hydrophobic compounds correlated with Mytilus concentrations. The results underscore the need for focused CEC monitoring in coastal ecosystems and suggest that PSDs are complementary to bivalves in assessing water quality. Moreover, the partnership established among participating agencies led to increased spatial coverage, an expanded list of analytes and a more efficient use of available resources.

Refocusing Mussel Watch on contaminants of emerging concern (CECs): the California pilot study (2009-10).

To expand the utility of the Mussel Watch Program, local, regional and state agencies in California partnered with NOAA to design a pilot study that targeted contaminants of emerging concern (CECs). Native mussels (Mytilus spp.) from 68 stations, stratified by land use and discharge scenario, were collected in 2009-10 and analyzed for 167 individual pharmaceuticals, industrial and commercial chemicals and current use pesticides. Passive sampling devices (PSDs) and caged Mytilus were co-deployed to expand the list of CECs, and to assess the ability of PSDs to mimic bioaccumulation by Mytilus. A performance-based quality assurance/quality control (QA/QC) approach was developed to ensure a high degree of data quality, consistency and comparability. Data management and analysis were streamlined and standardized using automated software tools. This pioneering study will help shape future monitoring efforts in California's coastal ecosystems, while serving as a model for monitoring CECs within the region and across the nation.

Assessing water quality in Marine Protected Areas from Southern California, USA.

Despite the regulatory mandate to maintain "natural water quality", there are ≥ 271 storm drain discharges that potentially threaten the 14 designated marine water quality protected areas in Southern California called Areas of Special Biological Significance (ASBS). After sampling 35 site-events, the geomean concentrations of total suspended solids, nutrients, total and dissolved trace metals, and polycyclic aromatic hydrocarbons in the ocean following storm events were similar between reference drainages and ASBS discharge sites. Concentrations of chlorinated hydrocarbons were nondetectable and no post-storm sample exhibited significant toxicity to the endemic purple sea urchin (Strongylocentrotus purpuratus) near ASBS discharge sites. A reference-based threshold was developed and, despite the similarities in average concentrations, there were some individual ASBS discharge sites that were greater than reference background. Cumulatively across all ASBS, the constituents that were most frequently greater than the reference-based threshold were nutrients and general constituents, followed by dissolved and total trace metals.