Adverse Safety Events in Emergency Medical Services Care of Children With Out-of-Hospital Cardiac Arrest.

Importance: Survival for children with out-of-hospital cardiac arrest (OHCA) remains poor despite improvements in adult OHCA survival. Objective: To characterize the frequency of and factors associated with adverse safety events (ASEs) in pediatric OHCA. Design, Setting, and Participants: This population-based retrospective cohort study examined patient care reports from 51 emergency medical services (EMS) agencies in California, Georgia, Oregon, Pennsylvania, Texas, and Wisconsin for children younger than 18 years with an OHCA in which resuscitation was attempted by EMS personnel between 2013 and 2019. Medical record review was conducted from January 2019 to April 2022 and data analysis from October 2022 to February 2023. Main Outcomes and Measure: Severe ASEs during the patient encounter (eg, failure to give an indicated medication, 10-fold medication overdose). Results: A total of 1019 encounters of EMS-treated pediatric OHCA were evaluated; 465 patients (46%) were younger than 12 months. At least 1 severe ASE occurred in 610 patients (60%), and 310 patients (30%) had 2 or more. Neonates had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (332 [30%]), vascular access (212 [19%]), and ventilation (160 [14%]). In multivariable logistic regression, the only factor associated with severe ASEs was young age. Neonates with birth-related and non-birth-related OHCA had greater odds of a severe ASE compared with adolescents (birth-related: odds ratio [OR], 7.0; 95% CI, 3.1-16.1; non-birth-related: OR, 3.4; 95% CI, 1.2-9.6). Conclusions and Relevance: In this large geographically diverse cohort of children with EMS-treated OHCA, 60% of all patients experienced at least 1 severe ASE. The odds of a severe ASE were higher for neonates than adolescents and even higher when the cardiac arrest was birth related. Given the national increase in out-of-hospital births and ongoing poor outcomes of OHCA in young children, these findings represent an urgent call to action to improve care delivery and training for this population.

Natural variability of atmospheric temperatures and geomagnetic intensity over a wide range of time scales.

The majority of numerical models in climatology and geomagnetism rely on deterministic finite-difference techniques and attempt to include as many empirical constraints on the many processes and boundary conditions applicable to their very complex systems. Despite their sophistication, many of these models are unable to reproduce basic aspects of climatic or geomagnetic dynamics. We show that a simple stochastic model, which treats the flux of heat energy in the atmosphere by convective instabilities with random advection and diffusive mixing, does a remarkable job at matching the observed power spectrum of historical and proxy records for atmospheric temperatures from time scales of one day to one million years (Myr). With this approach distinct changes in the power-spectral form can be associated with characteristic time scales of ocean mixing and radiative damping. Similarly, a simple model of the diffusion of magnetic intensity in Earth's core coupled with amplification and destruction of the local intensity can reproduce the observed 1/f noise behavior of Earth's geomagnetic intensity from time scales of 1 (Myr) to 100 yr. In addition, the statistics of the fluctuations in the polarity reversal rate from time scales of 1 Myr to 100 Myr are consistent with the hypothesis that reversals are the result of variations in 1/f noise geomagnetic intensity above a certain threshold, suggesting that reversals may be associated with internal fluctuations rather than changes in mantle thermal or magnetic boundary conditions.