NIOSH Continues Research to Improve Safety for Ambulance Service Workers and EMS Responders

Transportation incidents are the leading cause of work-related deaths in the United States; between 2003 and 2009, an average of almost 1,300 U.S. workers died from roadway crashes each year. The risk is even greater for emergency medical services (EMS) personnel. In 2002 field investigators estimated that the fatality rate for EMS workers was more than 2 times the national average for all workers.²
As part of the National Occupational Research Agenda (NORA), researchers at the National Institute for Occupational Safety and Health (NIOSH) set out to reduce ambulance crash–related injuries and deaths among EMS workers. Research addressed the layout and structural integrity of ambulance compartments, design of hardware, and occupant restraints.
NIOSH research revealed a number of important factors involved in ambulance worker injuries and deaths. For example, field investigators observed that EMS workers often ride on the squad bench without wearing a restraint. This allows them to lean forward, stand up, or change positions as needed to reach the patient or equipment, but places them at higher risk of striking bulkheads, cabinets, shelves, or other occupants during a crash. NIOSH crash tests also revealed the possibility of head injury if a worker’s head strikes the cabinets immediately above or behind them, and noted that vehicle structural failures can be a contributing factor in adverse outcomes of EMS crashes.

Impact

In 2007 NIOSH partnered with the Ambulance Manufacturers Division of the National Truck Equipment Association (AMD-NTEA) and the General Services Administration (GSA) to revise the GSA ambulance purchase specification and the companion AMD-NTEA test standards. This included increasing the head clearance for EMS workers above the seating positions, eliminating a significant source of head injury. NIOSH also worked with AMD-NTEA to establish a new crash test methodology Technical Committee. The committee used NIOSH research to develop a cost-effective test procedure to evaluate how components (seats, cot, equipment mounts) in a patient compartment would withstand a 30 mph frontal impact. This test procedure was published by the Society of Automotive Engineers (SAE) in May of 2010 as a recommended practice, and is already being used within the industry to improve ambulance seating and restraints. The team has developed a companion document covering vehicle response in side impact events, which SAE is expected to publish in late Summer 2011. The long-term goal is to bring ambulance patient compartments up to the same level of safety found in passenger vehicles.

NIOSH researchers continue to work with AMD-NTEA, GSA, manufacturers, and federal agencies on other recommendations to improve occupational safety for EMS workers. Ongoing efforts include creating and validating individual standards for seating and worker restraints, litter and patient restraints, and equipment mounting. These research-to-practice measures and collaborative efforts will improve the safety of EMS crew members in their mission to save the lives of others.

Relevant Information

• About 218,000 emergency medical technicians and paramedics were employed in 2009, according to the Bureau of Labor Statistics.⁴
• Between 500,000–800,000 workers are estimated to volunteer as emergency medical technicians or paramedics in addition to the 218,000 employed personnel. These figures do not include the many additional firefighters who are also trained in emergency medical services.

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Los pediatras recomiendan no llevar a los niños a la guardería hasta los dos años 11 de junio de 2013 | 12:00 CET

Los pediatras recomiendan no llevar a los niños a la guardería hasta los dos años

Fuente bebes y mas

Este fin de semana pasado se celebró en Sevilla el 62 Congreso de la Asociación Española de Pediatría, donde pediatras de toda España se reunieron para explicar novedades y debatir diversos temas relacionados con la profesión y con la salud de los niños.

Uno de los temas que trataron es el de las enfermedades infecciosas que los niños “cogen” en las guarderías o escuelas infantiles y, velando por la salud de los más pequeños, expresaron que no es aconsejable llevar a los niños a la guardería antes de los dos años.

Por qué esta recomendación

Según explicaron, se calcula que un niño que va a una escuela infantil padecerá diez procesos febriles al año, casi uno al mes. Esto, lógicamente, es una media, pues todos conocemos a algún niño que va a la guardería y aguanta como un jabato y en el otro extremo alguno de esos niños que ha tenido que ser borrado porque pagaba por no ir.

Añadieron que hay descritos unos 200 virus responsables del catarro común, virus que se contagian a través de la saliva cuando los niños tosen sobre los objetos que utilizan, las superficies por las que pasan y los juguetes que tocan.

Es lógico, los niños, hasta algún momento entre los dos a seis años, tienen un sistema inmunitario tremendamente inmaduro. Esto hace que tengan una facilidad pasmosa para coger infecciones y, dado que sus compañeros de grupo tienen la misma facilidad, los virus crezcan como la espuma y los niños caigan como moscas.

¿Y si no tengo otra?

Claro, ahora llegan las preguntas de madres y padres que no tienen otro remedio que llevar a sus hijos a la guardería: ¿qué pueden hacer? Y la respuesta está clara, si no hay otra, pues el niño tiene que ir porque alguien le tiene que cuidar. Allí deberán tener especial cuidado con la higiene de los niños, de sus manos, de los juguetes, de las superficies, para prevenir en la medida de lo posible contagios.

Además, los padres deben ser responsables de la salud de sus hijos y, si están enfermos, no llevarlos para evitar que otros niños les contagien algo más y que sus hijos no contagien a los de los demás. Es triste esto que voy a decir, pero a veces las educadoras juegan un papel esencial cuando en la puerta utilizan su ojo clínico para ver que algún niño llega enfermo y pedir amablemente a su padre o madre que se lo lleve a casa.

Como dice Carlos González, la guardería, las escuelas infantiles, son una buena solución a un problema de conciliación laboral y familiar. Más allá de eso, si los padres se lo pueden combinar para estar con el niño, o si alguna abuela o abuelo están deseosos de hacerlo, el mejor sitio para estar es en casa, donde el número de virus es mucho menor y la probabilidad de contagio es mucho menor.

En lo que respecta a socialización, tampoco hay prisas. Ya habrá tiempo en el colegio de jugar con otros niños, de conocer más normas sociales de las que se utilizan en casa y de contagiarse también de unos cuantos virus. Y si se sigue el consejo de los pediatras, yendo a la guardería con dos años, el riesgo de padecer una infección será menor, pues tendrán más defensas.

Vía | ABC de Sevilla
Foto | Ministerio Interior de Ecuador en Flickr
En Bebés y más | Carlos González: “La escuela infantil no es necesaria para los niños”, ¿Saco a mi hijo de la guardería?, La guardería aumenta el riesgo de enfermedades agudas infecciosas

BBC News: Doctors call for global consensus on diagnosis of death. There needs to be international agreement on when and how death is diagnosed, two leading doctors suggest

Doctors call for global consensus on diagnosis of death

By Smitha Mundasad Health reporter, BBC News

There needs to be international agreement on when and how death is diagnosed, two leading doctors suggest.

At a European meeting of anaesthetists they said improvements in technology mean the line between life and death is less clear.

They called for precise guidelines and more research to prevent the rare occasions when people are pronounced dead but are later found to be alive.

The World Health Organisation has begun work to develop a global consensus.

In the majority of cases in hospitals, people are pronounced dead only after doctors have examined their heart, lungs and responsiveness, determining there are no longer any heart and breath sounds and no obvious reaction to the outside world.

'Permanent damage to brain'

But Dr Alex Manara, a consultant anaesthetist at Frenchay Hospital in Bristol, said more than 30 reports in medical literature, describing people who had been determined dead but later found to be alive, had driven scientists to question whether the diagnosis of death can be improved.

At a meeting of the European Society for Anaesthesiology he said that on some occasions doctors do not observe the body for long enough before someone is declared dead. 

"Italians and Brits are probably built in the same way - it makes sense to have the same criteria for death for both” Dr Jerry Nolan Consultant in intensive care, Bath Royal United Hospital, UK

Dr Manara called for internationally agreed guidelines to ensure doctors observe the body for five minutes, in order not to miss anyone whose heart and lungs spontaneously recover.

Many institutions in the US and Australia have adopted two minutes as the minimum observation period, while the UK and Canada recommend five minutes. Germany currently has no guidelines and Italy proposes that physicians wait 20 minutes before declaring death, particularly when organ donation is being considered.

Dr Jerry Nolan, consultant in intensive care at the Royal United Hospital in Bath, who is not involved in the conference, said: "In hospitals, where patients are monitored closely, and after the appropriate resuscitation has taken place, waiting five minutes to observe the body is a good idea.

"There is evidence to show that once you start going beyond five minutes without a circulation or oxygen to the brain you start seeing permanent damage to brain cells."

At the conference, Ricard Valero, professor of anaesthesia at the University of Barcelona, considered the rarer scenario of patients in intensive care units whose hearts and lungs are kept functioning by machines.

In such scenarios, doctors use the concept of brain death - often conducting neurological tests to monitor any brain activity in the patient.

'Variations don't seem logical'

But the criteria used to establish brain death have slight variations across the globe.

In Canada, for example, one doctor is needed to diagnose brain death; in the UK, two doctors are recommended; and in Spain three doctors are required. The number of neurological tests that have to be performed vary too, as does the time the body is observed before death is declared.

"These variations in practice just do not seem logical," Prof Valero said.

He proposed further research to support a global consensus on the most appropriate criteria to diagnose brain death.

Dr Nolan said: "In principle an international guideline on death is a very good idea. It is likely to help in terms of the movement of doctors between countries and, importantly, with public confidence.

"Italians and Brits are probably built in the same way. It makes sense to have the same criteria for death for both."