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17 results

  • New LA-ICP-MS cryocell and calibration technique for sub-millimeter analysis of ice cores

  • Sharon B. Sneed, Paul A. Mayewski, W.G. Sayre, Michael J. Handley, Andrei V. Kurbatov, Kendrick C. Taylor, Pascal Bohleber, Dietmar Wagenbach, Tobias Erhardt, Nicole E. Spaulding
  • Journal:
    Journal of Glaciology / Volume 61 / Issue 226 / 2015
    Published online by Cambridge University Press:
    10 July 2017, pp. 233-242
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  • Ice cores provide a robust reconstruction of past climate. However, development of timescales by annual-layer counting, essential to detailed climate reconstruction and interpretation, on ice cores collected at low-accumulation sites or in regions of compressed ice, is problematic due to closely spaced layers. Ice-core analysis by laser ablation–inductively coupled plasma–mass spectrometry (LA-ICP-MS) provides sub-millimeter-scale sampling resolution (on the order of 100 μm in this study) and the low detection limits (ng L−1) necessary to measure the chemical constituents preserved in ice cores. We present a newly developed cryocell that can hold a 1 m long section of ice core, and an alternative strategy for calibration. Using ice-core samples from central Greenland, we demonstrate the repeatability of multiple ablation passes, highlight the improved sampling resolution, verify the calibration technique and identify annual layers in the chemical profile in a deep section of an ice core where annual layers have not previously been identified using chemistry. In addition, using sections of cores from the Swiss/Italian Alps we illustrate the relationship between Ca, Na and Fe and particle concentration and conductivity, and validate the LA-ICP-MS Ca profile through a direct comparison with continuous flow analysis results.

  • An Historical Examination of the Development of Emergency Medical Services Education in the US through Key Reports (1966-2014)

  • Ingrid A. Brooks, Michael R. Sayre, Caroline Spencer, Frank L. Archer
  • Journal:
    Prehospital and Disaster Medicine / Volume 31 / Issue 1 / February 2016
    Published online by Cambridge University Press:
    11 December 2015, pp. 90-97
    Print publication:
    February 2016
  • Introduction

    The Emergency Medical Services (EMS) approach to emergency prehospital care in the United States (US) has global influence. As the 50-year anniversary of modern US EMS approaches, there is value in examining US EMS education development over this period. This report describes US EMS education milestones and identifies themes that provide context to readers outside the US.

    Method

    As US EMS education is described mainly in publications of federal US EMS agencies and associations, a Google search and hand searching of documents identified publications in the public domain. MEDLINE and CINAHL Plus were searched for peer reviewed publications. Documents were reviewed using both a chronological and thematic approach.

    Results

    Seventy-eight documents and 685 articles were screened, the full texts of 175 were reviewed, and 41 were selected for full review. Four historical periods in US EMS education became apparent: EMS education development (1966-1980); EMS education consolidation and review (1981-1989); EMS education reflection and change (1990-1999); and EMS education for the future (2000-2014). Four major themes emerged: legislative authority, physician direction, quality, and development of the profession.

    Conclusion

    Documents produced through broad interprofessional consultations, with support from federal and US EMS authorities, reflect the catalysts for US EMS education development. The current model of US EMS education provides a structure to enhance educational quality into the future. Implementation evaluation of this model would be a valuable addition to the US EMS literature. The themes emerging from this review assist the understanding of the characteristics of US EMS education.

    BrooksIA, SayreMR, SpencerC, ArcherFL. An Historical Examination of the Development of Emergency Medical Services Education in the US through Key Reports (1966-2014). Prehosp Disaster Med. 2016;31(1):90–97.

Prehospital Care of Neurologic Emergencies
  • Edited by Todd Crocco, Michael Sayre
  • Published online:
    05 August 2014
    Print publication:
    24 July 2014
  • Prehospital Care of Neurologic Emergencies is a reliable and definitive resource for emergency medical services personnel at multiple levels: physicians, paramedics, nurses and others who encounter these critically ill patients. This focused and succinct book addresses the management of a wide range of neurologic emergencies, including traumatic brain injuries, spinal cord injuries, strokes, and seizures. In these emergencies time is critical, and the simply presented, straightforward format of the patient care and management recommendations help readers to treat patients rapidly and confidently. Each chapter follows a standard format that includes an overview of each neurologic emergency, important background, key challenges, and areas requiring future investigation. This book is unlikely to be placed on your bookshelf; instead, you will keep it nearby for times when you face life-threatening neurologic emergencies. When seconds count, this book has the answers.

  • 14. Health Related Quality of Life Among Survivors of Prehospital Cardiac Arrest

  • Vipin Jain, Jennifer A. Brancel, David A. Bullard, Michael R. Sayre, Todd F. Breaux, Michael F. Uphus
  • Journal:
    Prehospital and Disaster Medicine / Volume 11 / Issue S2 / September 1996
    Published online by Cambridge University Press:
    28 June 2012, p. S39
    Print publication:
    September 1996
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  • Purpose: The purpose of this study was to measure the quality of life of cardiac arrest long-term survivors.

    Design: Prospective outcome evaluation.

    Setting: The emergency medical system of a mid-sized city.

    Type of participants: Prehospital cardiac arrest victims who had a resuscitation attempt from 5/93 through 12/95 and were discharged alive. Patients <18 were excluded.

    Measurements: Patients were surveyed by mail. Non-responders were telephoned. The questions assessed Glasgow-Pittsburgh overall performance (GPOP) scores before and after the cardiac arrest. Additional items assessed physical, role, affective, and cognitive functioning, and global health status.

    Main Results: 760 cases were collected. 40 had unknown vital status at hospital discharge. The survival rate to hospital discharge for the 270 patients with cardiac etiology and initial rhythm of ventricular fibrillation was 15%, and it was 6% for the other 450 patients. Of 68 survivors, 23 died before a survey was sent; two had unknown addresses. 21 patients (49%) responded, and four refused to participate. The mean interval from cardiac arrest to survey response was 531 days. Ten reported good post-arrest GPOP scores, 5 had moderate disability, 4 severe disability, and 2 were comatose. Cognitive function was improved in 1, unchanged 6, slightly worse 7, markedly worse 4, and none in 3. Eleven patients reported feeling happy. Global healdi was excellent for 2, very good 8, good 5, fair 2, and poor 3.

  • Teaching Basic EMTs Endotracheal Intubation: Can Basic EMTs Discriminate between Endotracheal and Esophageal Intubation?

  • Michael R. Sayre, John Sakles, Alan Mistler, Janice Evans, Anthony Kramer, Arthur M. Pancioli
  • Journal:
    Prehospital and Disaster Medicine / Volume 9 / Issue 4 / December 1994
    Published online by Cambridge University Press:
    28 June 2012, pp. 234-237
    Print publication:
    December 1994
  • Hypothesis:

    Advanced airway intervention techniques are being considered for use by basic emergency medical technicians (EMTs). It was hypothesized that basic EMTs would be able to discriminate reliably between intratracheal and esophageal endotracheal tube, placement in a mannequin model.

    Design:

    An airway mannequin with a closed chest cavity was intubated randomly either esophageally or tracheally, and the cuff was inflated. A stethoscope, bag ventilator, and laryngoscope were available next to the mannequin. Placement was assessed by auscultation or direct visualization at the discretion of the EMT. A blinded investigator graded the student.

    Setting:

    A classroom in a large, urban medical center.

    Participants:

    Subjects were basic EMTs who volunteered to take part after the conclusion of a six-hour endotracheal intubation training course.

    Results:

    Thirty-three subjects were tested. Seventeen of 18 (94%) tracheal intubations and 11 of 15 (73%) esophageal intubations were identified correctly. Only 72% of the students listened to the epigastrium, 81% listened to the lungs, and 85% attempted ventilation. The 10 students who visualized the cords discovered all five esophageal intubations. The 23 students who did not visualize the cords missed four and found six esophageal intubations.

    Conclusion:

    Basic EMTs had difficulty assessing endotracheal tube placement in a mannequin model. The 27% miss rate for identifying esophageal intubations suggests that basic EMTs will require additional training for safe field use of any airway that requires assessment of tube placement.

  • Letters

  • Lucy Creevey, Harvey Glickman, John Harbeson, Raymond Hopkins, Edmond Keller, Michael Lofchie, Sayre Schatz, Ernest Wilson III
  • Journal:
    ASA News / Volume 21 / Issue 3 / September 1988
    Published online by Cambridge University Press:
    20 October 2021, pp. 24-26
    Print publication:
    September 1988
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