First responder communication in CBRN environments: FIRCOM-CBRN study.

INTRODUCTION: Recent terror attacks and assassinations involving highly toxic chemical weapons have stressed the importance of sufficient respiratory protection of medical first responders and receivers. As full-face respirators cause perceptual-motor impairment, they not only impair vision but also significantly reduce speech intelligibility. The recent introduction of electronic voice projection units (VPUs), attached to a respirator, may improve communication while wearing personal respiratory protection. OBJECTIVE: To determine the influence of currently used respirators and VPUs on medical communication and speech intelligibility. METHODS: 37 trauma anaesthetists carried out an evaluation exercise of six different respirators and VPUs including one control. Participants had to listen to audio clips of a variety of sentences dealing with scenarios of emergency triage and medical history taking. RESULTS: In the questionnaire, operators stated that speech intelligibility of the Avon C50 respirator scored the highest (mean 3.9, ±SD 1.0) and that the Respirex Powered Respiratory Protective Suit (PRPS) NHS-suit scored lowest (1.6, 0.9). Regarding loudness the C50 plus the Avon VPU scored highest (4.1, 0.7), followed by the Draeger FPS-7000-com-plus (3.4, 1.0) and the Respirex PRPS NHS-suit scored lowest (2.3, 0.8). CONCLUSIONS: We found that the Avon C50 is the preferred model among the tested respirators. In our model, electronic voice projection modules improved loudness but not speech intelligibility. The Respirex PRPS NHS-suit was rated significantly less favourably in respect of medical communication and speech intelligibility.

Survey of UK Health Care First Responders' Knowledge of Personal Protective Equipment Requirements.

INTRODUCTION: An adequate level of personal protective equipment (PPE) is necessary when treating patients with highly infectious diseases or those contaminated with hazardous substances. METHODS: Following National Institute for Health Research's Research Centre (London, United Kingdom) approval, the authors of this study conducted a survey of specialist registrars' knowledge of the respiratory and skin protection requirements needed during a resuscitation scenario with Advanced Life Support. Participant responses were compared to UK national recommendations and to a previous survey in 2009. RESULTS: A total of 98 specialist registrars (in Anesthesiology, n=51; in Emergency Medicine (EM), n=21; and in Intensive Care Medicine (ICM) n=26) completed hand-delivered surveys. The best knowledge of PPE requirements (76%) was found for severe acute respiratory syndrome (SARS), with less knowledge about PPE requirements for anthrax, plague, Ebola virus disease (EVD), and smallpox (60%). The results show limited knowledge of PPE requirements (20%-30%) for various chemical warfare agents. Personal protective equipment knowledge regarding treatment of sarin-contaminated casualties was over-rated by 80%, and for patients with EVD, it was over-rated by up to 67% of participants. CONCLUSION: The results of the tested cohort indicate that current knowledge regarding PPE for chemical warfare agents remains very limited.

Patient knowledge of the paracetamol content of over-the-counter (OTC) analgesics, cough/cold remedies and prescription medications.

AIMS: To test, by completion of a simple questionnaire, patient knowledge of whether 15 commonly used over-the-counter and prescription analgesics and cough/cold remedies contained paracetamol and patient knowledge of the 4 g maximum daily dose of paracetamol. METHODS: Patients in the emergency department triage waiting area of a busy London teaching hospital were asked to complete a standardised one-page questionnaire. From a list of 15 commonly used over-the-counter and prescription products, patients were asked which contained paracetamol, responding 'yes', 'no' or 'not sure' for each. They were also asked to state the recommended maximum daily dose of paracetamol. RESULTS: 910 patients were enrolled in the study (mean age 39 years, 53% women). The mean±SD score was 6.5±2.5. The maximum score was 14 (n=2) and the minimum score was 0 (n=11). For the recommended maximum daily dose, 93.7% (n=853) of patients gave an answer. Of these, 53.8% answered correctly, 4.7% quoted a supratherapeutic dose and 41.5% a subtherapeutic dose. CONCLUSIONS: Patient knowledge of paracetamol-containing products and of the maximum daily dose is currently insufficient to ensure safe use of the drug. Interventions are required to address these knowledge gaps to prevent unintentional repeated supratherapeutic ingestion of paracetamol. These interventions could include targeted public education and/or appropriate and effective medication labelling.

Emergency department presentations with suspected acute coronary syndrome--frequency of self-reported cocaine use.

The objective of this study was to assess the prevalence of self-reported cocaine use in individuals presenting to the Emergency Department (ED) with suspected myocardial ischaemia/acute coronary syndrome (ACS). A retrospective review (1 January to 31 December 2008) of all suspected myocardial ischaemia/ACS presentations to our ED was undertaken. Basic demographic data and use/nonuse of cocaine were recorded from notes; where appropriate the route of use, concomitant use of other recreational drugs/ethanol, presenting features and treatment(s) were extracted. Self-reported cocaine use was recorded in 54 (1.9%) of the 2810 presentations. The mean+/-SD age of those who self-reported the use of cocaine (28.9+/-9.0) was significantly lower than those who did not (52.3+/-12.7) (P<0.0001). Twenty (37.0%) of those with cocaine use had one or more features of potential cocaine (sympathomimetic) toxicity at presentation to the ED. In conclusion, self-reported recent cocaine use was documented in a clinically significant minority of patients with suspected myocardial ischaemia/ACS.