International Emergency Medical Teams Training Workshop Special Report.

The World Health Organization's (WHO; Geneva, Switzerland) Emergency Medical Team (EMT) Initiative created guidelines which define the basic procedures to be followed by personnel and teams, as well as the critical points to discuss before deploying a field hospital. However, to date, there is no formal standardized training program established for EMTs before deployment. Recognizing that the World Association of Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) Congress brings together a diverse group of key stakeholders, a pre-Congress workshop was organized to seek out collective expertise and to identify key EMT training competencies for the future development of training programs and protocols. The future of EMT training should include standardization of curriculum and the recognition or accreditation of selected training programs. The outputs of this pre-WADEM Congress workshop provide an initial contribution to the EMT Training Working Group, as this group works on mapping training, competencies, and curriculum. Common EMT training themes that were identified as fundamental during the pre-Congress workshop include: the ability to adapt one's professional skills to low-resource settings; context-specific training, including the ability to serve the needs of the affected population in natural disasters; training together as a multi-disciplinary EMT prior to deployment; and the value of simulation in training. AlbinaA, ArcherL, BoivinM, CranmerH, JohnsonK, KrishnarajG, ManeshiA, OddyL, Redwood-CampbellL, RussellR. International Emergency Medical Teams training workshop special report. Prehosp Disaster Med. 2018;33(3):335-338.

Effects of the menstrual cycle on muscle recruitment and oxidative fuel selection during cold exposure.

Differences in core temperature and body heat content, generally observed between the luteal and follicular phase of the menstrual cycle, have been reported to modulate the thermogenic activity of cold-exposed women. However, it is unclear how this change in whole body shivering activity will influence fuel selection. The goal of this study was to quantify the effects of the menstrual cycle on muscle recruitment and oxidative fuel selection during low-intensity shivering. Electromyographic activity of eight large muscles was monitored while carbohydrate, lipid, and protein utilization was simultaneously quantified in the follicular and luteal phases of the menstrual cycle in nonacclimatized women shivering at a low intensity. The onset (∼25 min), intensity (∼15% of maximal voluntary contraction), and pattern (∼6 shivering bursts/min) of the shivering response did not differ between menstrual cycle phases, regardless of differences in core temperature and hormone levels. This resulted in lipids remaining the predominant substrate, contributing 75% of total heat production, independent of menstrual phase. We conclude that hormone fluctuations inherent in the menstrual cycle do not affect mechanisms of substrate utilization in the cold. Whether the large contribution of lipids to total heat production in fuel selection confers a survival advantage remains to be established.

Metabolic requirements of shivering humans.

This review examines the heat production component of thermoregulation in adult humans. It describes the energy requirements of shivering muscles as they attempt to provide sufficient heat to counterbalance increases in heat loss in cold environments. Emphasis is placed on types of metabolic substrates used under various shivering conditions as well as on the effects energy deficit and food consumption. During shivering, muscle recruitment intensity and pattern of fiber recruitment are highly variable between muscles and individuals. In addition, a number of studies have indicated that shivering can be sustained with different fuels for several hours under variable conditions of cold stress and CHO availability. However, little is still known on the effects of prolonged fasting and energy deficit in the cold on energy metabolism. Even though it is clear that food consumption increases the odds for survival, the metabolic fate of ingested substrates remains highly uncertain. Combining fundamental principles surrounding metabolic fuel selection with applied knowledge of human performance in the cold may allow important breakthroughs in this field of research.