In dubio pro CPR? The Controversial Status of 'Do Not Resuscitate' Imprints on the Human Body - a Swiss Innovation.

'Do not resuscitate' (DNR) imprints on the human body have recently appeared in medical practice. These non-standard DNR orders (e.g., tattoos, stamps, patches) convey the patient's refusal of resuscitation efforts should he be incapable of doing so. The article focuses on such innovative tools to express one's end-of-life wishes. Switzerland provides a unique example, as 'No Cardio-Pulmonary Resuscitation' stamps and patches have been commercialised. The article discusses the challenging legal questions as to the validity of non-standard DNR orders imprinted on the human body. It analyses the obligation of healthcare providers to honour such orders, either as an advance directive or an expression of an individual's presumed wishes, and withhold treatment. Finally, the article addresses the balancing of interests between the presumed wishes of an unconscious patient and his best interests of being resuscitated and potentially staying alive, a dilemma facing healthcare providers in a medical emergency.

A Cross-Sectional Study on China's Public Health Emergency Personnel's Field Coping-Capacity: Need, Influencing Factors, and Improvement Options.

OBJECTIVE: This study aimed to identify the important capacities that were most urgently needed during emergency response and factors associated with the Centers for Disease Control and Prevention (CDC) professionals' field coping-capacity for public health emergency. METHODS: Professional workers (N = 1854) from 40 CDC institutions were chosen using the stratified cluster random sampling method in all 13 municipalities of Heilongjiang Province, China. Descriptive analysis and multivariate logistic regression were used. RESULTS: Of 10 key capacities, the 3 that were most urgently needed during emergency response fieldwork as identified by respondents were crisis communication capacity, personal protection capacity, and laboratory detection capacity. Overall, 38.1% of respondents self-rated as "poor" on their coping-capacity. The logistic regression found that proficiency in emergency preparedness planning, more practical experiences in emergency response, effectiveness in training and drills, a higher education level, and a higher professional position were significantly associated with the individual's field coping-capacity. CONCLUSION: This study identified CDC professionals' most urgent capacity need and the obstructive factors and highlighted the importance of enhancing the capacity in crisis communication, personal protection, and laboratory detection. Intervention should be targeted at sufficient fund, formalized, and effective emergency training and drills, more operational technical guidance, and all-around supervision and evaluation.

Featured counter trafficking program: The law enforcement first responder protocol.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficking children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Law Enforcement First Responder Protocol, which trained law enforcement to recognize youth engaged in sex work as survivors of commercial sexual exploitation, rather than as "prostitutes", and to connect these survivors immediately with social services, advocates, timely medical care and ongoing follow-up.

"Felony assault should stick:" Assaulted EMS responders' frustration and dissatisfaction with the legal system.

INTRODUCTION: The prevalence of violence to first responders is reported in ranges of approximately 40% to 90%. Pennsylvania has a felonious assault statute to address such violence, but the prosecutorial process has been noted to cause first-responder dissatisfaction. METHODS: An exploratory qualitative study using individual interviews with snowball sampling was conducted with the Philadelphia District Attorney's office to understand the prosecutorial process when a first responder is assaulted and injured in a line of duty. The Philadelphia Fire Department provided a list of first responders who sustained a work-related injury from a patient or bystander assault so that particular cases could be discussed during the interviews. RESULTS: Emergent themes fell into two categories: factors that lead to a charge (prosecutorial merit, intent, and victim investment), and the judge's discretion in sentencing ("part of the job" mentality, concern for the defendant, and the justice system's offender focus). Immediately actionable tertiary prevention recommendations for fire departments, labor unions, and district attorney's offices were developed. CONCLUSION: Violence against fire-based emergency medical service (EMS) responders is a persistent and preventable workplace hazard. While felonious assault statutes express society's value that it is unacceptable to harm a first responder, this study found that such statutes failed to provide satisfaction to victims and that support when going through the court process is lacking. Assaulted EMS responders, their employers, and labor unions would benefit from the recommendations provided herein to help them extract a stronger sense of procedural justice from the legal process.

Decálogo del ejercicio de la profesión del técnico en emergencias sanitarias / Ten commandments for emergency medical technicians

No disponible

World Trade Center Health Program; amendments to list of WTC-related health conditions; cancer; revision. Interim final rule.

On September 12, 2012, the Administrator of the WTC Health Program (Administrator) published a final rule in the Federal Register adding certain types of cancer to the List of World Trade Center (WTC)-Related Health Conditions (List) in the WTC Health Program regulations; an additional final rule was published on September 19, 2013 adding prostate cancer to the List. Through the process of implementing the addition of cancers to the List and integrating cancer coverage into the WTC Health Program, the Administrator has identified the need to amend the rule to remove the ICD codes and specific cancer sub-sites, clarify the definition of ``childhood cancers,'' revise the definition of ``rare cancers,'' and notify stakeholders that the Administrator is revising WTC Health Program policy related to coverage of cancers of the brain and the pancreas. No types of cancer covered by the WTC Health Program will be removed by this action; four types of cancer--malignant neoplasms of the brain, the cervix uteri, the pancreas, and the testis--are newly eligible for certification as WTC-related health conditions as a result of this action.

The return of the city-state: urban governance and the New York City H1N1 pandemic.

This article examines New York City's response to the 2009 H1N1 pandemic in the context of the post-9/11 US security regime. While the federal level 'all-hazards' approach made for greater depth of support, it also generated unrealistic assumptions at odds with an effective local response. The combination of structurally induced opportunity and actor specific strengths (size, expertise) made for effective local governance by the New York City Department of Health and Mental Hygiene. By underlining the importance of locality as a first line of defence and linking defence function to policy initiative in regard to health governance, this study illustrates the continuing relevance of Weber's insight into the institutional structure of the city.

First responder and physician liability during an emergency.

First responders, especially emergency medical technicians and paramedics, along with physicians, will be expected to render care during a mass casualty event. It is highly likely that these medical first responders and physicians will be rendering care in suboptimal conditions due to the mass casualty event. Furthermore, these individuals are expected to shift their focus from individually based care to community- or population-based care when assisting disaster response. As a result, patients may feel they have not received adequate care and may seek to hold the medical first responder or physician liable, even if they did everything they could given the emergency circumstances. Therefore, it is important to protect medical first responders and physicians rendering care during a mass casualty event so that their efforts are not unnecessarily impeded by concerns about civil liability. In this article, the author looks at the standard of care for medical first responders and physicians and describes the current framework of laws limiting liability for these persons during an emergency. The author concludes that the standard of care and current laws fail to offer adequate liability protection for medical first responders and physicians, especially those in the private sector, and recommends that states adopt clear laws offering liability protection for all medical first responders and physicians who render assistance during a mass casualty event.

Seguridad de los pacientes en una uci. Percepción enfermera / Cost-effectiveness of a tlc-nosf polyurethane foam dressing

La seguridad de los pacientes y la prevención de los errores que pueden alterarla emergen como una nueva dimensión de los cuidados de enfermería a lo largo de la última década. Nuestro trabajo, utilizando una metodología cualitativa, nos ha permitido identificar veinticinco situaciones y actividades enfermeras en las que existen riesgo de errores; en todas ellas, las enfermeras que han participado en el estudio creen que se puede mejorar la seguridad del paciente; así mismo, se considera que las que conllevan mayor riesgo de error son: la documentación escrita a mano, el manejo de fármacos, los cambios de turno, la falta de entrenamiento en determinadas situaciones, y la ausencia de reuniones de trabajo multidisciplinar. Nuestro estudio ha permitido obtener una percepción global de la seguridad de los pacientes desde la perspectiva enfermera en una Unidad de Cuidados Intensivos (UCI)(AU)

Chronic wounds represent a drain on the Spanish health system, nowdays is necessary an optimization of the resources used and that is for this that is necessary justify the use of the products over others through cost-effective studies for to show the economic benefit to professionals and the life quality of patient. This article compares the use of a new technology for format polyurethane foam, TLC-NOSF, with the most commonly used products for treating wounds. This comparison is made using a cost-effectiveness model (Markov Model). The results demonstrate that treatment with polyurethane foam dressing with TLC-NOSF are cost-effective versus treatments with polyurethane foams most commonly used in Spain(AU)

Documento de asistencia y transferencia extrahospitalaria Grado de cumplimentación, indicador de calidad asistencial en un servicio de emergencias / Level of completion of the prehospital care and transfer record as a quality indicator in an emergency medical service

Fundamentos: el Documento de Asistencia y Transferencia Extrahospitalaria (DATE) es el homónimo extrahospitalario de Historia Clínica. En el presente artículo se plantea evaluar y comparar el grado de cumplimentación de los parámetros básicos de los DATE elaborados por las Unidades de Soporte Vital Básico (USVB) y con Enfermería (USVE) de Bilbao SAMUR durante 2010. Metodología: estudio descriptivo, retrospectivo y comparativo con aleatorización estratificada sobre una muestra representativa de 660 DATE (precisión 3%), atendiendo a la cumplimentación de los apartados fundamentales. Resultados: se consideró legible el 98,33%. El grado de cumplimentación general fue de un 90,31% (IC 89,24 - 91,31%) del total de apartados fundamentales del DATE para la USVE y 84,81% (IC 83,56 - 86%) para la USVB. El 34,1% del total de DATE se encontró completa y correctamente rellenado. La USVE obtuvo índices significativamente mayores (p<0,000). Destacaron deficiencias de registro de ‘echa y hora’, ‘lugar de asistencia’ y ‘anamnesis clínica’. Se encontraron diferencias entre el registro de los datos administrativos y los clínicos (88,64% vs 86,72%, p=0,02). Discusión: se consideran óptimos los parámetros tendentes al 100% de la cumplimentación y los no superiores al 80% deben ser objeto de revisión. De esta manera los índices obtenidos podrían considerarse aceptables, pero se debería reforzar el registro de datos administrativos y anamnesis en USVB, y alergias en ambos recursos. La USVE ha obtenido mejores índices. Debe inculcarse la necesidad de registrar la información clínica relevante como evidencia de una asistencia de calidad(AU)

Basics: A Prehospital Care and Transfer Recording (PCTR) is an out-of-hospital medical recording. This paper was made to assess and compare the level of fulfillment of the basic parameters of the PCTR developed by the Life Support Units with nurses (Life Support Units with Nurse, LSUwN and without nurses (Basic Life Support Units, BLSU) from SAMUR Bilbao in 2010. Methodology: A descriptive, retrospective and comparative study was performed by analysing a randomized sample of 660 PCTR (precision 3%), aiming to check the fulfillment of the basic data. Results: 98.33% of total recordings were readable. In overall, fulfillment rate was 90.31% (CI 89.24 - 91.31%) of all basic parameters for LSUwN PCTR and 84.81% (CI 83.56 to 86%) for BLSU. 34.1% of PCTR were completely and correctly fulfilled. The LSUwN scored significantly better (p<0.000). There were recording failures in ‘date and time’, ‘address’ and ‘physical examination’. There were differences between the recording of clinical and administrative information (88.64% vs 86.72%, p = 0.02). Discussion: In order to consider a parameter has optimal, it has to reach 100% of fulfillment. If it doesn't, and its score reaches no more than 80%, it should be reviewed. In this case, the results would be considered acceptable, but the administrative items of BLSU records, and allergies in both units should be strengthened. LSUwN has obtained better scores. The need of recording clinical information must be instilled as evidence of quality care(AU)

World Trade Center Health Program requirements for the addition of new WTC-related health conditions. Final rule.

Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 amended the Public Health Service Act (PHS Act) to establish the World Trade Center (WTC) Health Program. Sections 3311, 3312, and 3321 of Title XXXIII of the PHS Act require that the WTC Program Administrator develop regulations to implement portions of the WTC Health Program established within the Department of Health and Human Services (HHS). The WTC Health Program, which is administered by the Director of the National Institute for Occupational Safety and Health (NIOSH), within the Centers for Disease Control and Prevention (CDC), provides medical monitoring and treatment to eligible firefighters and related personnel, law enforcement officers, and rescue, recovery and cleanup workers who responded to the September 11, 2001, terrorist attacks in New York City, Shanksville, PA, and at the Pentagon, and to eligible survivors of the New York City attacks. This final rule establishes the processes by which the WTC Program Administrator may add a new condition to the list of WTC-related health conditions through rulemaking, including a process for considering petitions by interested parties to add a new condition.

When disaster hits, where does the standard of care go?

On July 22, 2011, it was reported in the news that a $25 million-dollar settlement was reached in a class-action lawsuit alleging that Memorial Medical Center in Louisiana failed to adequately prepare for the devastating catastrophe known as Hurricane Katrina. This magnitude of a claim raises serious questions regarding the viability of lawsuits and the lack of immunity available to hospital facilities, physicians, nurses and other healthcare providers for the provision of emergency aid during national disasters. This article is intended to address one aspect of the legal issues facing healthcare providers and to analyze the standard of care by which facilities and individual providers may be judged, measured and assessed following national disasters.

Achieving public health legal preparedness: how dissonant views on public health law threaten emergency preparedness and response.

BACKGROUND: Effective management of modern public health emergencies requires the coordinated efforts of multiple agencies representing various disciplines. Organizational culture differences between public health (PH) and emergency management (EM) entities may hinder inter-agency collaboration. We examine how PH and EM differ in their approach to PH law and how such differences affect their collaboration towards PH preparedness. METHODS: We conducted 144 semi-structured interviews with local and state PH and EM officials between April 2008 and November 2009. Thematic qualitative analysis in ATLAS.ti was used to extract characteristics of each agency's approach to PH legal preparedness. RESULTS: Two conflicting approaches to the law emerge. The PH approach is characterized by perceived uncertainty regarding legal authority over preparedness planning tasks; expectation for guidance on interpretation of existing laws; and concern about individual and organizational liability. The EM approach reveals perception of broad legal authority; flexible interpretation of existing laws; and ethical concerns over infringement of individual freedoms and privacy. CONCLUSIONS: Distinct interpretations of preparedness law impede effective collaboration for PH preparedness. Clarification of legal authority mandates, designation within laws of scope of preparedness activities and guidance on interpretation of current federal and state laws are needed.

Plan Especial de Protección Civil ante el riesgo sísmico en la Región de Murcia (Sismimur) / No disponible

No disponible