[Compression characteristics of graduated compression stockings used for prevention of venous thromboembolism].

BACKGROUND: Graduated compression stockings (GCS) are widely used to prevent perioperative venous thromboembolism. However, actual compression pressures of GCS on patients' legs have rarely been reported. METHODS: Four different types of GCS were evaluated. Compression pressures of GCS were measured hydrostatically by using a small balloon filled with water at the ankle, the calf and the knee (proximal end) in 463 legs of surgical patients. We also compared the influence of body mass index (BMI) on compression pressures of each GCS. RESULTS: No GCS ideally exerted compression of each sites of the legs while maintaining adequate pressure gradient from the ankle to the knee. It revealed that adequate compression of the calf and pressure gradient between the ankle and the calf could hardly be achieved simultaneously. In some GCS, BMI did not influence compression pressure but in the others compression tended to increase in patients with increased BMI. CONCLUSIONS: As the compression characteristics of GCS are different among products, selection of GCS is important for its effective use. To select a proper GCS, measurement of actual compression pressure seems necessary.

[A Kumamoto model of clinical training in tracheal intubation for paramedics].

BACKGROUND: Since July 2004, the Japanese Ministry of Health, Labor and Welfare approved certified paramedics to perform emergency prehospital tracheal intubation. A specialized training system in tracheal intubation has been established in Kumamoto Prefecture. METHODS: The Kumamoto Prefectural Medical Control Organization, a tracheal intubation task force was established: consisting of the departments of Anesthesiology at Kumamoto University and 11 other major hospitals, along with Kumamoto Prefecture and the 14 prefectural fire-departments. This group published the Kumamoto training guidelines and a training system for paramedics. RESULTS: Kumamoto Prefecture appealed for support of paramedic activity on television and in newspapers as public education. The prefectural governor officially asked hospitals to train paramedics. Because 9 of the 14 fire-departments had no regional teaching hospital, trainees were matched with other hospitals by the task force. The task force published a pamphlet to inform surgical patients about tracheal intubation training and to recruit patients as practice volunteers. Anesthesiologists undertook significant roles in making arrangements to facilitate the project at their hospitals, in addition to teaching paramedics prior to surgical procedures. CONCLUSIONS: The Medical Control Organization, Kumamoto Prefecture, anesthesiologists and emergency response personnel worked together successfully to promote the training program for clinical tracheal intubation by paramedics.