An innovative approach to orotracheal intubations: the Alexandrou Angle of Intubation position.

Visualization of the vocal cords is paramount during orotracheal intubations. We employed a novel patient position in this derivation study. The Alexandrou Angle of Intubation (AAI) position is defined as a 20°-30° incline where the supine patient's head is elevated in relation to the body and legs. Our study participants were blinded to the goals of the research as well as our novel technique. Using intubation manikins, our participants ranked their preference for visualizing the vocal cords between the Flat, Trendelenburg, and AAI positions. A majority (58.8%) of our study participants preferred the AAI for visualizing the vocal cords over the other two positions. Future studies will reveal whether AAI will play a significant role in emergent airway management.

Federal and state public health authority and mandatory vaccination: is Jacobson v Massachusetts still valid?

Novel H1N1 influenza virus infected more than 43,000 people, killed 353 and spread to more than 122 countries within a few months. The World Health Organization declared a stage 6 worldwide pandemic. Healthcare workers and hospitals prepared for the worst. Federal and State regulations provided the legal framework to allow for the preparation and planning for a pandemic. One State had mandated both seasonal and Novel H1N1 vaccination of all healthcare workers in an effort to reduce transmission of influenza in healthcare facilities. The US Supreme Court decided in 1905 that the police power of the State permitted a State Department of Health the leeway to mandate vaccination in the face of a contagious disease. Law suits were filed, and a temporary injunction barring mandatory vaccination was entered by the court. While awaiting a court hearing, the mandatory vaccination regulation was rescinded because of the shortage of both seasonal and H1N1 vaccine. Based on the current state of the pandemic and the shortage of vaccination, it is possible that the US Supreme Court would uphold mandatory vaccination in a pandemic.

International Disaster Response Law: an introduction.

OBJECTIVE: To review the current state of International Disaster Response Law (IDRL) and identify barriers to development and future directions. DESIGN: This study is an introduction to the current status of IDRL. CONCLUSIONS: The data suggest that globally we will have increasing incidents and costs in responding to disasters, but the development of IDRL has not kept pace. The further development and refining of IDRL is imperative on a global scale. Additional barriers to the continued development of IDRL will have to be overcome. Global international stakeholders will need to develop mechanisms to promote the advancement of IDRL while minimizing the barriers to effective preparedness and response to global international disasters.

Dead bodies, disasters, and the myths about them: is public health law misinformed?

While the mission of public health is to fulfill society's interest in ensuring a healthy society as "public health is what we, as a society, do collectively to assure the conditions for people to be healthy," the mission of public health law is to assist in the creation of those conditions. However, at times of disaster, threats or risks caused by dead bodies often cause dramatic media coverage and public panic, which incite the passage of emergency public health laws. The unfortunate result of such emergency public health laws mandating immediate dead body disposal, often through mass burial, is that proper identification of the deceased is severely hampered, and families are frequently precluded from experiencing the grieving process and are unable to bring closure to such a traumatic event. Are such emergency public health laws misinformed? Are the threats of dead bodies of disasters a threat to the public's health? Are the perceived public health threats of dead bodies merely a myth-or is their cause for justified concern? Such a rush to burial not only may add to the psychological distress of survivors but it also forbids them the opportunity of seeing their loved ones being treated with dignity and respect. Additional consequence of "emergency" mass burial legislation without proper identification include legal problems associated with inheritance, life insurance, remarriage of spouses, parenting of surviving children, and even the threat of diplomatic tensions between nation states resulting from burial of foreign tourists. Disaster medicine specialists are often called upon to comment to the media, advise governmental agencies, and console families, as to the disposition of dead bodies and to the existence of any public health threats caused by the accumulation of human cadavers. Because disaster medicine specialists play a vital role in preserving the public's health, and because public fears of spread of infectious disease often escalate paralleling the accumulation of dead bodies, disaster medicine specialists must be properly informed of the epidemiologic risks and public health issues that dead bodies of disasters may pose. The purpose of this article is to provide a foundation for disaster medicine specialists in properly advising governments, the public, media, and families regarding the risks and fears concerning the health hazards of human cadavers resulting from disasters.

Public health law and disaster medicine: understanding the legal environment.

Disaster medicine specialists, policy makers, and the public often feel frustrated when they encounter the complex legal framework that surrounds public health emergencies and disasters. Such a framework is particularly difficult to understand when one considers that the federal government has no express powers over public health or disaster management. In fact, under the US Constitution, the states, rather than the federal government, possess public health governance. Although public health sovereignty formally resides within the states, and notwithstanding the federal government's lack of express constitutional powers over public health crises and disaster management, the federal government has gradually taken on a greater leadership role in managing public health emergencies. In order to clarify the state and federal responsibilities surrounding public health emergencies and disasters, this article explores necessary and pertinent legal topics. These topics include public health duties, public health disasters, state sovereignty, governmental coercion, de facto constitutional empowerment, separation of powers, limited powers, federalism, state police powers, general and federal declarations of emergencies, the Model State Emergency Health Powers Act (MSEHPA), and public health and national security.