Impact of in-Station Medication Automated Dispensing Systems on Prehospital Pain Medication Administration.

INTRODUCTION: Medication automatic dispensing systems (ADS) have been implemented in many settings, including fire-based EMS stations. The aim of this study was to evaluate the impact of in-station ADSs on controlled substance administration rates and EMS response intervals. METHODS: This study was a retrospective review of data from a single fire-based EMS agency. Medication administration rates and EMS response intervals were compared before ADS implementation (P1; 6/1/15 to 5/31/16) and after ADS implementation (P3; 6/1/17-5/31/19). Cases with missing data and during a one-year implementation period were excluded. RESULTS: 4045 cases were identified in P1 and 8168 in P3. The odds of morphine or versed administration increased following ADS implementation: OR = 1.77 (95% CI: 1.53, 2.03) and OR = 1.53 (95%CI: 1.18, 2.00) respectively. There were statistically, but likely not operationally significant increases in median response interval and transport interval from P1 to P3 of 14 seconds, (p < 0.001) and 39 seconds (p < 0.001) respectively. Time at hospital for all calls decreased by more than 11 minutes for all transports, from a median of 34 minutes (IQR; 23.7, 45.5) to 22.7 minutes (IQR:18.5, 27.6) in P3, p < 0.001 and by 27.9 minutes for calls in which a controlled substance was given: P1 = 50.6 minutes (IQR: 34.6, 63.2), P3 = 22.7 minutes (IQR: 18.3, 27.4), p < 0.001. CONCLUSION: In this system, medication ADS implementation was associated with an increase in the rates of controlled substance administration and a decrease in the time units were at hospitals.

Reliability of multi-purpose offshore-facilities: Present status and future direction in Australia.

Sustainable use of the ocean for food and energy production is an emerging area of research in different countries around the world. This goal is pursued by the Australian aquaculture, offshore engineering and renewable energy industries, research organisations and the government through the "Blue Economy Cooperative Research Centre". To address the challenges of offshore food and energy production, leveraging the benefits of co-location, vertical integration, infrastructure and shared services, will be enabled through the development of novel Multi-Purpose Offshore-Platforms (MPOP). The structural integrity of the designed systems when being deployed in the harsh offshore environment is one of the main challenges in developing the MPOPs. Employing structural reliability analysis methods for assessing the structural safety of the novel aquaculture-MPOPs comes with different limitations. This review aims at shedding light on these limitations and discusses the current status and future directions for structural reliability analysis of a novel aquaculture-MPOP considering Australia's unique environment. To achieve this aim, challenges which exist at different stages of reliability assessment, from data collection and uncertainty quantification to load and structural modelling and reliability analysis implementation, are discussed. Furthermore, several solutions to these challenges are proposed based on the existing knowledge in other sectors, and particularly from the offshore oil and gas industry. Based on the identified gaps in the review process, potential areas for future research are introduced to enable a safer and more reliable operation of the MPOPs.

Stability of subsea pipelines during large storms.

On-bottom stability design of subsea pipelines transporting hydrocarbons is important to ensure safety and reliability but is challenging to achieve in the onerous metocean (meteorological and oceanographic) conditions typical of large storms (such as tropical cyclones, hurricanes or typhoons). This challenge is increased by the fact that industry design guidelines presently give no guidance on how to incorporate the potential benefits of seabed mobility, which can lead to lowering and self-burial of the pipeline on a sandy seabed. In this paper, we demonstrate recent advances in experimental modelling of pipeline scour and present results investigating how pipeline stability can change in a large storm. An emphasis is placed on the initial development of the storm, where scour is inevitable on an erodible bed as the storm velocities build up to peak conditions. During this initial development, we compare the rate at which peak near-bed velocities increase in a large storm (typically less than 10(-3) m s(-2)) to the rate at which a pipeline scours and subsequently lowers (which is dependent not only on the storm velocities, but also on the mechanism of lowering and the pipeline properties). We show that the relative magnitude of these rates influences pipeline embedment during a storm and the stability of the pipeline.

Using "no problem found" in infusion pump programing as a springboard for learnning about human factors engineering.

BACKGROUND: A hospital took a second look at a device error with a syringe pump in which a dose of fentanyl was delivered in half the anticipated time. When the nursing staff could not reproduce the error, the pump was sent to biomedical engineering where "no problem was found." The biomedical staff subsequently performed another analysis, which led to discovery of the possible cause of the problem. MOBILIZING FOR HFE: A human factors engineering (HFE) task force, in considering the fentanyl delivery issue, identified a need to educate nursing and engineering on such incidents and to consider the consequences of override features. The HFE task force then reviewed a tool kit for briefing clinical units on education of staff on clinical safety issues. HFE ANALYSIS: Efforts to maximize device customization or simplification can have negative HFE consequences. The decision to allow for function overrides or nontraditional equipment use must be weighed against the potential compromises in patient safety. SUMMARY: The problems that arise from the interface between humans and devices are not limited to intravenous pumps or even medical devices. Awareness of the potential for HFE design flaws can be critical in reducing harm in health care.