Prehospital Protocols for Post-Return of Spontaneous Circulation Are Highly Variable.

BACKGROUND: Up to 44% of out-of-hospital cardiac arrest (OHCA) patients will rearrest in the immediate post-return of spontaneous circulation (post-ROSC) period, and rearrest is associated with decreased survival. Cardiac arrest guidelines are often equivocal regarding what post-ROSC care should be provided in the prehospital setting and when hospital transport should be initiated. Prehospital protocols must balance the benefit of time-dependent hospital-based care with the risk of early rearrest. We sought to describe current prehospital protocols for post-ROSC care in the treatment of OHCA. METHODS: A single trained abstractor systematically reviewed a purposeful sample of prehospital protocols for adult non-traumatic cardiac arrest from the United States using an a priori standardized data abstraction form. Protocols were either stand-alone or integrated into intra-arrest care. Exclusion criteria were non-911 ground transport agencies and protocols not revised since the 2015 American Heart Association guideline update. All protocols were publicly available via the Internet. Data abstraction was conducted in May 2019. Measures of interest were counted and summarized. Proportions and 95% confidence intervals were calculated. RESULTS: We identified and reviewed 82 prehospital protocols from 46 states and the District of Columbia. Seven protocols were excluded due to the revision date, leaving 75 protocols included in the study. Six protocols (8%; CI 3.7-16%) provide no guidance on prehospital post-ROSC care. 12-lead electrocardiogram (ECG) acquisition (63/75 [84%; CI 73-91%]) and transport to percutaneous coronary intervention-capable hospitals (55/75 [73%; CI 62-83%]) are common, although not ubiquitous. Of those that do require a 12-lead ECG, 40% [CI 27-54%] required the presence of an ST-elevation myocardial infarction to inform their transport decision. Only 9 (12%; CI 6.4-22%) provide any guidance on when to initiate transport post-ROSC, with 4 (5%; CI 2-13%) requiring a post-ROSC stabilization period prior to transport. CONCLUSION: Prehospital treatment and transport protocols for post-ROSC care are highly variable across the United States.

An initial assessment of spent mushroom compost as a potential energy feedstock.

The Irish mushroom industry has expanded rapidly in the last decade, particularly in the border counties. Its success has generated concern, however, as the production of spent mushroom compost (SMC) has increased. Until recently, SMC as an agricultural waste has been disposed of without due consideration to the environment. As County Councils increasingly address river pollution, restrictions will prevent expansion of the mushroom industry without an SMC waste management solution. This paper looks at the availability and composition of SMC and considers its potential as an energy feedstock. Variability in SMC composition was investigated by sampling from various locations over several months. Analyses showed that, on a dry ash free basis, SMC has a calorific value equivalent to sewage sludge which has been successfully fired for many years. Compositional analysis confirmed the dry fuel as consistent in make-up and showed the moisture content to vary within 60-77%, on an as-received basis.

A re-appraisal of wood-fired combustion.

Targets for a considerable increase in electricity generation from renewables have been set in order to reduce greenhouse gas emissions and fossil fuel dependence. Extensive planting of willow, poplar and alder as energy crops has been planned for power generation plants which use wood as the fuel. The current trend is to use gasification or pyrolysis technology, but alternatively a case may be made for wood combustion, if wood becomes readily available. A range of wood-fired circulating fluidised bed combustion (CFBC) plants, using from 10 to 10,000 dry tonne equivalent (DTE)/day, was examined using the ECLIPSE process simulation package. Various factors, such as wood moisture content, harvest yield, afforestation level (AL) and discounted cash flow rate (DCF) were investigated to test their influence on the efficiency and the economics of the systems. Steam cycle conditions and wood moisture content were found to have the biggest effects on the system efficiencies; DCF and AL had the largest influences on the economics. Plants which could handle more than 500 dry tonnes/day could be economically viable; those using more than 1000 dry tonnes wood/day could be competitive with large-scale, conventional coal-fired plants, if sufficient wood were available.

The potential for adding plastic waste fuel at a coal gasification power plant.

Plastics wastes from a municipal solid waste plant have a high energy content which make it an interesting option for co-processing with coal. The potential for adding plastic waste to a coal fired Texaco IGCC (Integrated Gasification Combined Cycle) power station is examined. The resulting efficiency increases due to the improved gasification qualities of plastic over coal. For the overall economics to be the same as the coal only case, the maximum amount that the power station can afford to spend on preparing the plastic waste for use is similar to the assumed coal cost, plus the avoided landfill cost, minus the transport cost. The location of the power station plays a key role, since this has an effect on the transport costs as well as on the landfill charges. The sensitivity of the economics of co-processing plastic waste with coal for a variety of power station operational parameters is presented.