Mechanical Ventilation in Mass Casualty Scenarios: Augmenting Staff: Project XTREME

Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators. Tactics to address these situations include efforts to lower demand by transferring patients to other institutions as well as efforts to augment staffing levels. Staff can be augmented by mobilization of deployable teams of volunteers from outside the region and through exploitation of local resources. The latter includes strategies to recruit local respiratory therapists who are currently in either non-clinical or non-hospital-based positions and policies that optimize existing respiratory therapy resources within an institution by canceling elective surgeries, altering shift structure, and postponing vacactions. An alternative approach would employ non-respiratory-therapy staff to assist in the management of patients with respiratory failure. Project XTREME (Cross-Training Respiratory Extenders for Medical Emergencies) is a cross-training program developed to facilitate training of non-respiratory-therapy health professionals to assist in the management of patients who require mechanical ventilation. It includes an interactive digital video disc as well as a competency validation laboratory and is designed to be performed at the time of an emergency. Pilot testing of the program suggests it is effective. (AU)

Mechanical ventilation in mass casualty scenarios. Augmenting staff: project XTREME.

Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators. Tactics to address these situations include efforts to lower demand by transferring patients to other institutions as well as efforts to augment staffing levels. Staff can be augmented by mobilization of deployable teams of volunteers from outside the region and through exploitation of local resources. The latter includes strategies to recruit local respiratory therapists who are currently in either non-clinical or non-hospital-based positions and policies that optimize existing respiratory therapy resources within an institution by canceling elective surgeries, altering shift structure, and postponing vacations. An alternative approach would employ non-respiratory-therapy staff to assist in the management of patients with respiratory failure. Project XTREME (Cross-Training Respiratory Extenders for Medical Emergencies) is a cross-training program developed to facilitate training of non-respiratory-therapy health professionals to assist in the management of patients who require mechanical ventilation. It includes an interactive digital video disc as well as a competency validation laboratory and is designed to be performed at the time of an emergency. Pilot testing of the program suggests it is effective.

Juvenile growth and palatability in co-occurring, congeneric British herbs.

Differential sensitivity (DS) storage dynamics describe a temporal niche axis that determines coexistence of competing taxa through a trade-off between environmental insensitivity and competitive ability at the recruitment stage. In DS storage dynamics, when the relevant environmental factor is low, the more sensitive, better competitor preferentially recruits; when the environmental factor is high, the environmentally sensitive species suffers high mortality and the environmentally insensitive taxon preferentially recruits. A herbivore defense/growth rate trade-off at the seedling/juvenile stage could support this dynamic. We therefore compared juvenile palatability, a measure of anti-herbivore defense, and early growth rate for five congeneric pairs of native British herbs. All five comparisons showed a positive association between average individual growth rate and average palatability to a native slug species. We observed no evidence of associations between early growth rate and adult palatability or between early growth rate and life history strategy (annual vs. perennial). Seed mass was not associated with either early growth rate or with life history strategy whether or not relatedness was taken into account. We offer two explanations as to why we found statistically significant support for a growth rate- defense trade-off when within-species studies so often produce only equivocal results.