NFNA safety survey: a report of data collected in 1988 versus 1998.

In 1998, the Air & Surface Transport Nurses Association ASTNA (formerly known as the National Flight Nurses Association [NFNA]) sponsored a follow-up safety survey to one it had conducted in 1988. The survey was sent out to all association members and identified whether a respondent of the survey was employed by a program that had policies addressing the safety topics identified in the survey and were compliant with the topic. Covered topics included scheduling practices, rest, refusal to fly because of safety issues, safety briefings, safety training, chemical restraints, hot off-loading, personal protective gear, and safety equipment installed in aircraft. The 1998 NFNA safety survey replicated a safety survey sent in 1988. The results of the two surveys were compared using side-by-side analysis with graphic comparison of trends that have occurred during the 10-year period. With the exception of hot loading/unloading, every category of questions recognized an increased frequency of both written policies and compliance or practice. The most significant improvement in compliance was "personal protective gear;" the category engendering the most concern was "refusal to fly due to safety issues." In 1998, only 52% of respondents worked in programs that "defined the flight nurses' responsibility and acceptable reasons for refusal to participate."

Personal protective equipment in helicopter EMS.

For a variety of reasons, air medical crews continue to be exposed to situations that can bring about severe personal injury or death. Despite recommendations from the Federal Aviation Administration and the Association of Air Medical Services, the use of personal protective equipment among air medical crews is not uniform or universal. Helmets have been shown to decrease morbidity and mortality from head injury, the most common form of injury in a helicopter crash. Flame-retardant clothing may likewise improve the outcome of an in-flight or post-crash fire and should include gloves. Additional consideration should be given to the appropriate undergarments. Protective footwear can also decrease injuries to air medical crews.

Alterations in erythrocyte Na+,K+-cotransport in normal and hypertensive human pregnancy.

Many physiological variables known or thought to affect erythrocyte Na+,K+-cotransport are altered in pregnancy. The interrelationships of Na+,K+-cotransport and pregnancy were therefore examined. Values were elevated by more than 30% in both second and third trimesters with a return towards non-pregnant levels in the postpartum period. Although pregnancy was also associated with elevated plasma cholesterol, renin activity and aldosterone, there was no significant relationship within the pregnant group between Na+,K+-cotransport and any of these factors. No change could be demonstrated in Na+,K+-cotransport values after 7 days of either high (greater than 250 mmol/day) or low (less than 50 mmol/day) sodium intake and values for those who developed pregnancy-associated hypertension (PAH, pre-eclampsia) were not significantly different from those in continuously normotensive women in either the second or the third trimesters of pregnancy.

An evaluation and education program for driving while intoxicated offenders.

This report addresses the development of a mandatory, inpatient, evaluation and education program aimed at reducing Driving While Intoxicated (DWI) at a major Army installation. The program was designed to provide extensive evaluation to all soldiers within a week of the DWI. The majority of soldiers are young males, a population known for heavy drinking and a disproportionate amount of both motor-vehicle accidents and fatalities. Among the initial 490 soldiers admitted to the program, 88% were found to meet DSM-III criteria for alcohol abuse or alcohol dependence. Factors associated with a diagnosis of abuse or dependence were age; scores on the Vaillant alcohol questionnaire, the MacAndrews and F scales of the MMPI, the Mortimer-Filkins questionnaire; BAC at time of arrest; a prior history of alcohol-related problems; and certain blood hematology and chemistry values. Results indicate that DWI is a marker for serious alcohol problems.

Sleep and nutritional deprivation and performance of house officers.

A study was conducted by the authors to compare cognitive functioning in acutely and chronically sleep-deprived house officers. A multivariate analysis of variance revealed significant deficits in primary mental tasks involving basic rote memory, language, and numeric skills as well as in tasks requiring high-order cognitive functioning and traditional intellective abilities. These deficits existed only for the acutely sleep-deprived group. The finding of deficits in individuals who reported five hours or less of sleep in a 24-hour period suggests that the minimum standard of four hours that has been considered by some to be adequate for satisfactory performance may be insufficient for more complex cognitive functioning.

Prevalence of polydrug use among alcoholic soldiers.

A survey was conducted to determine the extent of polydrug abuse among a population of alcoholics hospitalized in a military treatment program. It was discovered that approximately 21% of patients had no drug exposure other than alcohol, and 48% revealed a history of drug use more extensive then experimentation. Results further indicate that polydrug use was greatest among this population during the Vietnam era (1963 to 1972) and again during the year preceding their referral for treatment. Finally, a significant difference in age was found when comparing nonusers to users, and when comparing experimental/nonusers to all other users. This age difference places the low and nonuse groups as achieving their eighteenth birthday significantly before the mid-sixties and users afterwards, supporting the notion of a "drug accepting" versus "drug rejecting" generational difference.

Hematological concomitants of alcoholism: development and validation of a clinical screening technique.

An investigation into the use of blood chemistry variables in the identification of young adult alcoholics revealed that a combinative process utilizing 11 blood chemistry variables was superior to the use of individual measures. The investigation further validated the use of a linear discriminant analysis technique in identifying the blood chemistry measures and a discriminant function was produced that classified alcoholics and controls with a high degree of accuracy. This level of precision in prediction was maintained in validation trials on independent samples. The blood chemistry variables were extracted from a combination of commonly ordered blood tests. Results of the investigation indicate that clinical usage of the screening procedure is readily available without sophisticated computer support or exotic blood analysis.

A study of serum and myocardial digitoxin concentrations in man during cardiac arrest.

In 22 digitalized (of a total of 39) patients studied at random by radioimmunoassay during cardiac arrest, the mean serum digoxin concentration was 2.6 (+/- 1.86, range 0.6-8.2) ng/ml, significantly higher (P less than 0.001) than the "eudigitalized" concentration (1.3 +/- 0.52, range 0.5-2.3 ng/ml) determined under carefully standardized conditions in a non-toxic population. Half of the arrest patients had serum digoxin levels in the toxic range (2.4 ng/ml or above), mainly due to significant renal failure (mean serum creatinine concentration 2.9 +/- 2.66 v. 1 +/- 0.26 mg/dl for non-toxic subjects, P less than 0.001), partly due to a higher mean daily digoxin dose (0.40 v 0.31 mg/day, P less than 0.05) and frequently associated with potent diuretic therapy (73 v 54%). A smaller fraction of digitalized patients survived, both short- (27%) and long-term (14%), than did non-digitalized subjects (35% and 26%, respectively). The mean myocardial digoxin concentration was 150 (+/- 63.3, range 52-252) ng/g with an average myocardial/serum ratio of 62.5 (range 38-91). There were significant positive correlations between the serum digoxin and left-ventricular myocardial digoxin concentration (r=0.8107, P less than 0.01) or serum creatinine concentration (r=0.4637, P less than 0.001).