Review of Emergency Medical Services Vulnerability to High Consequence Infectious Disease in the United States.

Purpose: Emergency medical services (EMS) responders are a group of medically skilled professionals who perform a wide range of essential medical services within a community including emergency response, patient transport, and mobile integrated healthcare. The proper functioning of the EMS system is paramount to the well-being of the medical system and public health. The intent of this paper is to review current EMS standards and practice to determine the danger a high consequence infectious disease (HCID) may pose to these healthcare workers and the community. Areas Addressed: Through the review of EMS practice several areas were identified as vulnerabilities to the EMS network. These vulnerabilities consisted of the lack of standardized licensing practice, inconsistent medical direction, and the inability to properly implement the use of personal protective equipment (PPE). The compounding of these vulnerabilities allows for HCIDs to pose a serious threat to EMS personnel with the possibility of devastating and crippling the EMS infrastructure within the US. Discussion: The vulnerabilities identified must be addressed both to protect EMS providers and to enhance the resilience of the US healthcare system. Ways to address the identified vulnerabilities should focus on improving the EMS curriculum and increasing minimum levels of education for first responders. Targeting minimum education and training standards could be the most effect method of reducing the dangers of HCIDs to EMS systems.

The Role of Veterinarians in Mass Casualty Disasters: A Continuing Need for Integration to Disaster Management.

The need to prepare veterinarians to serve as part of the disaster medical response for mass casualty incidents has been recognized since at least the 1960's. The potential value of incorporating veterinarians for mass casualty disaster response has been noted by organizations throughout the world. Clinical veterinarians are highly trained medical professionals with access to equipment, medications, and treatment capabilities that can be leveraged in times of crisis. The ongoing threat of disasters with the current widespread healthcare access barriers requires the disaster management community to address the ethical constraints, training deficiencies and legal limitations for veterinary medical response to mass casualty disasters. An ethical imperative exists for veterinarians with translatable clinical skills to provide care to humans in the event of a mass casualty disaster with insufficient alternative traditional medical resources. Though this imperative exists, there is no established training mechanism to prepare veterinarians for the provision of emergency medical care to humans. In addition, the lack of clear guidance regarding what legal protections exist for voluntary responders persists as a barrier to rapid and effective response of veterinarians to mass casualty disasters. Measures need to be undertaken at all levels of government to address and remove the barriers. Failure to do so reduces potentially available medical resources available to an already strained medical system during mass casualty events.

Conceptualization of a Health Care Coalition Framework in Georgia Based on the Existing Regional Coordinating Hospital Infrastructure.

The watershed events of September 11, 2001; the anthrax attacks; Hurricane Katrina; and H1N1 necessitated that the United States define alternative mechanisms for disaster response. Specifically, there was a need to shift from a capacity building approach to a capabilities based approach that would place more emphasis on the health care community rather than just first responders. Georgia responded to this initiative by creating a Regional Coordinating Hospital (RCH) infrastructure that was responsible for coordinating regional responses within their individual geographic footprint. However, it was quickly realized that hospitals could not accomplish community-wide preparedness as a single entity and that siloed planning must come to an end. To reconcile this issue, Georgia responded to the 2012 US Department of Health and Human Services concept of coalitions. Georgia utilized the existing RCH boundaries to define its coalition regions and began inviting all medical and nonmedical response partners to the planning table (nursing homes, community health centers, volunteer groups, law enforcement, etc). This new collaboration effectively enhanced emergency response practices in Georgia, but also identified additional preparedness-related gaps that will require attention as our coalitions continue to grow and mature.

Periodic lateralized epileptiform discharges in La Crosse encephalitis, a worrisome subgroup: clinical presentation, electroencephalogram (EEG) patterns, and long-term neurologic outcome.

La Crosse virus encephalitis is the most common mosquito-borne virus in children in the United States. La Crosse virus encephalitis has emerged as a significant health concern due to its potential for acute morbidity, including seizures, alterations in mental status, and, in rare cases, death, as well as the potential for chronic morbidity, including, epilepsy and cognitive and behavioral disorders. The aim of this study is to provide a clinical description of the largest series of children reported with periodic lateralizing epileptiform discharges (PLEDS) associated with La Cross virus encephalitis with reference to their clinical course, seizure type, electroencephalogram (EEG) patterns, and 2- and 10-year long-term neurologic outcome. In addition, to evaluate whether this subset of children may indeed have more severe disease than children with La Crosse virus encephalitis without PLEDS, comparisons are made between the 2 groups on specific variables. All patients presented with fever and disorientation; 6 of the 9 (66%) presented with seizures. PLEDS localized to the temporal lobe in 7 patients (77%). The children with PLEDS had longer intensive care unit stays (6.5 +/- 2.4 vs 3.2 +/- 1.9; P < .0001), a higher rate of intubation (88% vs 20%; P < .001), and a higher rate of cerebral herniation (1%; P < .05) than children with La Crosse virus encephalitis without PLEDS. Follow-up data on the subset with PLEDS also suggest a relatively high rate of epilepsy and behavioral difficulties with hyperactivity symptoms, memory deficits, and school difficulties. The implications for recognition, management, and follow-up of this worrisome subset of patients with La Crosse virus encephalitis are discussed.

Cardiovascular magnetic resonance imaging.

Recent advancements in magnetic resonance imaging hardware and software permit the assessment of cardiovascular structure and function at rest and during exercise or pharmacology-induced cardiac stress. With these developments, knowledge of cardiovascular imaging protocols in the magnetic resonance imaging environment is critical for nursing personnel. The purpose of this article is to review information pertinent to working in a magnetic resonance imaging environment and to describe the requirements of nursing personnel performing cardiovascular magnetic resonance imaging examinations.

Parameningeal rhabdomyosarcoma in a patient with Costello syndrome.

Costello syndrome, a rare entity with multiple congenital anomalies, has been associated with a high incidence of benign and malignant tumors, particularly rhabdomyosarcoma. Although the head and neck is the most common site for rhabdomyosarcomas in children, only one other case in the literature has been reported of a head and neck rhabdomyosarcoma in a Costello patient. The authors describe a 3-year-old with a parameningeal infratemporal fossa rhabdomyosarcoma. Management is discussed with particular attention to the difficulties encountered due to the congenital heart abnormalities associated with the syndrome.