The effect of medetomidine-ketamine anesthesia on hemodynamic parameters during hemorrhagic shock in minipigs.

Hemorrhagic shock (HS) represents an acute event with high mortality. The optimal combination of anesthetics that would prevent hemodynamic collapse and allow damage control surgery has not yet been determined. We tested the hypothesis that a combination of dissociative anesthetic ketamine with alpha2-agonist medetomidine (MK group, n=10) would provide superior hemodynamic control compared to propofol-remifentanil (PR group, n=10) during HS in minipigs. A modified Wiggers' model of HS with a target mean arterial pressure (MAP) of 40 mm Hg and 2 h duration was used. All minipigs survived. HS led to a ~50 % decrease in cardiac output in both groups (P<0.001 for baseline vs. HS 120 min) with no differences between groups. Total volume of removed blood was larger in the MK group (1321+/-133 ml vs. 1111+/-246 ml in the PR group, respectively; P<0.05). MAP was higher during the initial phases of HS in the MK group than in PR group (P<0.05 at HS 30-90 min). HR was lower in the MK group at the late phases of HS (P<0.05 at HS 60-120 min). In conclusion, medetomidine-ketamine provides a feasible and possibly a more favorable alternative to the propofol-remifentanil combination in our model of HS in minipigs.

Disaster warning and evacuation responses by private business employees.

When people are advised that their place of employment is threatened with disaster, how do they respond? Interviews with employees (n = 406) of 118 businesses affected by one of seven recent disasters provide the first answers to this question. Multivariate analyses document the key variables that best predict variation are: 1) emergent perceptions of risk; 2) time of evacuation from work; 3) time of evacuation from home; 4) multiple evacuations; and 5) tension between work and family commitments. When warned of impending disaster, most employees initially responded with denial. Gradually, however, emergent perceptions of risk intensified especially among those living in communities in which the least amount of disaster planning had occurred or who resided in a mobile home or apartment. Highest levels of work and family tensions during these evacuations were reported by racial minority employees who had children living at home. Policy implications for these and other findings are discussed so as to pin-point changes business managers should make that will enable them to provide the leadership and compassion expected by employees.

Variations in disaster evacuation behavior: public responses versus private sector executive decision-making processes.

Data obtained from 65 executives working for tourism firms in three sample communities permitted comparison with the public warning response literature regarding three topics: disaster evacuation planning, initial warning responses, and disaster evacuation behavior. Disaster evacuation planning was reported by nearly all of these business executives, although it was highly variable in content, completeness, and formality. Managerial responses to post-disaster warnings paralleled the type of complex social processes that have been documented within the public response literature, except that warning sources and confirmation behavior were significantly affected by contact with authorities. Five key areas of difference were discovered in disaster evacuation behavior pertaining to: influence of planning, firm versus family priorities, shelter selection, looting concerns, and media contacts.