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May 18th, 2012 posted by Paul Rega, MD, FACEP May 18, 2012 @ 11:00 pm

EMS airway management

The EMS roundtable: Expert insights on airway management

EMS1 columnists debate the topic of airway management and outline the current trends and what the future may hold


Airway management is obviously a pretty broad area. But let’s begin by discussing the current state of the market. To narrow it down a little, let’s focus specifically on how it relates to both medics and agencies in particular.

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May 18th, 2012 posted by Paul Rega, MD, FACEP @ 10:46 pm

Hepatitis Awareness Month


Hepatitis Awareness Month and National Hepatitis Testing Day — May 2012


May 18, 2012 / 61(19);333-333

This month marks the 17th anniversary of Hepatitis Awareness Month and the first National Hepatitis Testing Day in the United States. In 2011, the U.S. Department of Health and Human Services (HHS) developed a comprehensive viral hepatitis action plan that outlines strategies in six areas to improve viral hepatitis prevention, care, and treatment in the United States (1). Three of these areas (protecting patients and workers from health-care–associated viral hepatitis, reducing viral hepatitis caused by drug-use behaviors, and strengthening surveillance) are highlighted by reports in this issue of MMWR.

The first report illustrates one major city’s approach to tracking infection among patients exposed to hepatitis B virus (HBV) or hepatitis C virus (HCV) in health-care settings. The second report examines outbreaks of HBV infection associated with assisted blood glucose monitoring among residents of assisted living facilities in Virginia. Finally, a Notes from the Field describes an investigation of HCV transmission among young persons in Wisconsin, which provides further evidence of a troubling increase in the incidence of HCV infection associated with drug use among adolescents and young adults. The findings in all three reports underscore the importance of viral hepatitis surveillance in detecting outbreaks and changes in transmission patterns.

The HHS action plan also established May 19 as National Hepatitis Testing Day. Testing for viral hepatitis is the first step in linking HBV- and HCV-infected persons to recommended care and treatment. Additional information about National Hepatitis Testing Day activities is available at


  1. US Department of Health and Human Services. Combating the silent epidemic of viral hepatitis: action plan for the prevention, care, and treatment of viral hepatitis. Washington, DC: US Department of Health and Human Services; 2011.

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May 18th, 2012 posted by Paul Rega, MD, FACEP @ 10:44 pm

Drowning in the USA, 2005–2009


In the United States, an average of 3,880 persons died from unintentional drowning each year during 2005–2009, and an estimated 5,789 received emergency department care for nonfatal drowning. Children aged ≤4 years had the highest rates of both fatal and nonfatal drowning, and the death rate for males was approximately four times the rate for females. Among children aged ≤4 years, 50.1% of fatal incidents occurred in swimming pools.


Drowning — United States, 2005–2009

MMWR Weekly

May 18, 2012 / 61(19);344-347

Drowning is a leading cause of unintentional injury death worldwide, and the highest rates are among children (1). Overall, drowning death rates in the United States have declined in the last decade; however, drowning is the leading cause of injury death among children aged 1–4 years (2,3). In 2001, approximately 3,300 persons died from unintentional drowning in recreational water settings, and an estimated 5,600 were treated in emergency departments (EDs) (4). To update information on the incidence and characteristics of fatal and nonfatal unintentional drowning in the United States, CDC analyzed death certificate data from the National Vital Statistics System and injury data from the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) for 2005–2009. The results indicated that each year an average of 3,880 persons were victims of fatal drowning and an estimated 5,789 persons were treated in U.S. hospital EDs for nonfatal drowning. Death rates and nonfatal injury rates were highest among children aged ≤4 years; these children most commonly drowned in swimming pools. The drowning death rate among males (2.07 per 100,000 population) was approximately four times that for females (0.54). To prevent drowning, all parents and children should learn survival swimming skills. In addition, 1) environmental protections (e.g., isolation pool fences and lifeguards) should be in place; 2) alcohol use should be avoided while swimming, boating, water skiing, or supervising children; 3) lifejackets should be used by all boaters and weaker swimmers; and 4) all caregivers and supervisors should have training in cardiopulmonary resuscitation.

Death certificate data for 2005–2009 were obtained from the National Vital Statistics System.* Fatal unintentional drowning was defined as any death for which the underlying cause recorded on death certificates was one of the following International Classification of Diseases, 10th Revision codes: W65–W74, V90, or V92. By international standards, boating-related drowning (V90 and V92) is classified as transportation-related death.† Boating-related deaths are presented in this report as a subcategory to allow for international comparison, although most boating in the United States is not for transportation.

Data on nonfatal drowning were gathered from NEISS-AIP, which is operated by the U.S. Consumer Product Safety Commission. NEISS-AIP collects data annually on approximately 500,000 initial visits for all types of injuries treated in U.S. EDs.§ Data are drawn from a nationally representative subsample of 66 hospitals out of 100 NEISS hospitals selected as a stratified probability sample of hospitals in the United States and its territories; the hospitals have a minimum of six beds and a 24-hour ED.

Nonfatal cases included those classified as having a precipitating or immediate cause of “drowning/near-drowning,” a diagnosis of “submersion,” or the mention of “drown” or “submersion” in the comment field. To collect and classify nonfatal cases in a manner similar to deaths, case narratives were reviewed and intentional and motor vehicle crash–related drownings were excluded. Persons who were dead on arrival or who died in the ED also were excluded. Each case was assigned a sample weight on the basis of the inverse probability of selection; these weights were summed to provide national estimates. National estimates were based on 605 patients treated for nonfatal drowning at NEISS-AIP hospital EDs during 2005–2009. Confidence intervals were calculated using statistical software to account for the complex sample design. Because of the small sample size, percentages of nonfatal injuries for location by age group were based on unweighted data and thus are not nationally representative.

Drowning was examined by age group, sex, race/ethnicity, location, disposition (e.g., treated and released, hospitalized or transferred), day of week, and month of year when possible. Persons identified as Hispanic might be of any race. Persons identified as white, black, or other race all were non-Hispanic. Rates were calculated using U.S. Census bridged-race intercensal population estimates.¶ Significant differences (p<0.05) between rates were determined using a t-test for nonfatal drowning rates and a z-test for death rates.

During 2005–2009, overall, an average of 3,880 persons died from unintentional drowning (including boating incidents) annually in the United States (1.29 deaths per 100,000 population) (Table). Rates were highest among children aged ≤4 years (2.55), and the death rate for males (2.07) was nearly four times that for females (0.54). The death rate for blacks (1.40) was significantly higher than the overall death rate (1.29), and the death rate for Hispanics was significantly lower (1.19). Racial/ethnic disparity in drowning death rates was greatest among children aged 5–14 years (blacks, 1.34; Hispanics, 0.46; and whites, 0.48). Approximately half (51.1%) of fatal drownings occurred in natural bodies of water. From 2005 to 2009, death rates declined significantly from 1.34 per 100,000 to 1.25 (p=0.002).

During 2005–2009, an estimated 5,789 persons on average were treated annually in U.S. EDs for nonfatal drowning (Table). Children aged ≤4 years accounted for 52.8% of the ED visits, and children aged 5–14 years accounted for 17.5%. Males accounted for 60.2% of nonfatal drowning patients, and 50.2% of the ED patients required hospitalization or transfer for further care. In addition, of nonfatal drowning injuries among those aged ≥15 years, 21.8% were associated with alcohol use.

Nonfatal (45.5%) and fatal (37.1%) incidents occurred most commonly on weekends and during June–August, 57.5% and 46.7%, respectively. Among children aged ≤4 years, 50.1% of fatal incidents and 64.6% of nonfatal incidents occurred in swimming pools (Figure). Drownings in natural water settings increased with increasing age group. Incidents in bathtubs accounted for approximately 10% of both fatal and nonfatal drownings and were most common among children aged ≤4 years.

Reported by

Orapin C. Laosee, PhD, Association of Southeast Asian Nations Institute for Health Development, Mahidol Univ, Nakhonpathom, Thailand. Julie Gilchrist, MD, Rose A. Rudd, MSPH, Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC. Corresponding contributor: Julie Gilchrist,, 770-488-1178.

Editorial Note

In the United States, children aged 1–4 years continue to have the highest drowning death rates, and those rates are higher than the rates for all other causes of death in that age group except congenital anomalies (3). Other groups at greater risk for drowning include males, who account for approximately 80% of fatal drowning victims, and blacks, whose drowning death rate is 9% higher than that of the overall population (and, among those aged 5–14 years, 116% higher than the overall population) (4,5). Males might be at greater risk because they are more likely to overestimate their swimming ability, choose higher risk activities, or more commonly use alcohol (6). Blacks might be at greater risk because they often lack survival swimming skills (7,8).

Age, race/ethnicity, sex, and socioeconomic factors have been associated with lack of swimming ability among urban children (7). Swimming skills have been promoted as a means to reduce drowning risk, although concerns have been raised that initiating swimming lessons in young children might increase their risk for drowning (9). Teaching basic survival skills (e.g., ability to right oneself after falling into water, proceed a short distance, and float or tread water) to children aged ≥4 years in Bangladesh significantly reduced drowning rates (10). Furthermore, formal swimming lessons have been shown to reduce the risk for fatal drowning among children aged 1–4 years in the United States and China and might also reduce risk among older age groups (9). Other effective interventions include bystander cardiopulmonary resuscitation, four-sided pool fencing that separates the pool from the house and yard, and use of lifejackets (1,9).

Death certificates and ED records lack critical pieces of information, such as details on the victim’s activities and swimming ability, the body of water, weather conditions, health conditions, use of life jackets, type and functionality of fences or barriers, supervision type and quality (e.g., impaired), presence of lifeguards, and whether cardiopulmonary resuscitation was performed by a bystander. These data are needed to better understand drowning incidents, design interventions, and track their effectiveness. Among children aged <18 years, these data could be obtained by full implementation and analysis of data from the National Child Death Review Case Reporting System.** This system, managed by the National Center for Child Death Review in Okemos, Michigan, could provide data compiled by state and local teams to more completely describe drowning circumstances. Currently, 40 states voluntarily submit data to the system, and a public use data set is available to researchers through application to the center.

The findings in this report are subject to at least three limitations. First, whereas fatalities occurring in EDs were excluded from the nonfatal data presented, NEISS-AIP does not provide information on outcomes after hospitalization; therefore, data for fatal and nonfatal drownings might not be mutually exclusive. Second, some unintentional drownings might have been classified as undetermined and some homicides or suicides as unintentional. Finally, the extent of exposure to recreational water settings might vary by age, sex, season, level of swimming skill, or other factors; however, these data were not available. As a result, rates are population-based and do not account for exposure.

Parents and caregivers of children, and participants in and supervisors of activities in or near water, should be aware of drowning hazards, use appropriate prevention strategies, and be prepared with life-saving skills in the event of emergencies. Additional information regarding drowning risk factors and prevention strategies is available at and at


  1. Peden M, Oyegbite K, Ozanne-Smith J, et al, eds. World report on child injury prevention. Geneva, Switzerland: World Health Organization; 2008. Available at Web Site Icon. Accessed May 10, 2012.
  2. CDC. Vital signs: unintentional injury deaths among persons aged 0–19 years—United States, 2000–2009. MMWR 2012;61:270–6.
  3. CDC. Web-Based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at
  4. CDC. Nonfatal and fatal drownings in recreational water settings—United States, 2001–2002. MMWR 2004;53:447–52.
  5. Nasrullah M, Muazzam S. Drowning mortality in the United States, 1999–2006. J Community Health 2011:36;69–75.
  6. Howland J, Hingson R, Mangione TW, Bell N, Bak S. Why are most drowning victims men? Sex differences in aquatic skills and behaviors. Am J Public Health 1996;86:93–6.
  7. Irwin CC, Irwin R L, Ryan T D, Drayer J. Urban minority youth swimming (in)ability in the United States and associated demographic characteristics: toward a drowning prevention plan. Inj Prev 2011;15:234–9.
  8. Gilchrist J, Sacks JJ, Branche CM. Self-reported swimming ability in US adults, 1994. Public Health Rep 2000;115:110–1.
  9. Weiss J. Technical report: prevention of drowning. Pediatrics 2010;126:e253–62.
  10. Rahman A, Rahman F, Hossain J, Talab A, Scarr J, Linnan M. Survival swimming—effectiveness of SwimSafe in preventing drowning in mid and late childhood. Presented at the World Conference on Drowning Prevention, Danang, Vietnam, May 11, 2011.

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May 18th, 2012 posted by Paul Rega, MD, FACEP @ 10:38 pm

FEMA Daily Briefing, 5/18/12



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May 18th, 2012 posted by Paul Rega, MD, FACEP @ 4:50 am

(Audio) Mount St. Helens Erupts, May 18, 1980


For more than nine hours a vigorous plume of ash erupted, eventually reaching 12 to 15 miles (20-25 kilometers) above sea level. The plume moved eastward at an average speed of 60 miles per hour (95 kilometers/hour), with ash reaching Idaho by noon. By early May 19, the devastating eruption was over.


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May 18th, 2012 posted by Paul Rega, MD, FACEP @ 4:30 am

Degenerative brain disease in both athletes & in combat veterans


May 16, 2012
Brain Ailments in Veterans Likened to Those in Athletes

“Scientists who have studied a degenerative brain disease in athletes have found the same condition in combat veterans exposed to roadside bombs in Iraq and Afghanistan, concluding that such explosions injure the brain in ways strikingly similar to tackles and punches.

The researchers also discovered what they believe is the mechanism by which explosions damage brain tissue and trigger the wasting disease, called chronic traumatic encephalopathy, or C.T.E., by studying simulated explosions on mice. The animals developed evidence of the disease just two weeks after exposure to a single simulated blast……

“Our paper points out in a profound and definitive way that there is an organic, structural problem in the brain associated with blast exposure,” said Dr. Lee E. Goldstein of Boston University’s School of Medicine and a lead author of the paper, which was published online Wednesday by the peer-reviewed journal Science Translational Medicine…….”

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May 18th, 2012 posted by Paul Rega, MD, FACEP @ 4:27 am

Red Wine And Red Grapes And Alzheimer’s Disease


Georgetown University Medical Center.

“Could A Compound Found In Red Wine And Red Grapes Change The Course Of Alzheimer’s Disease?.”

Medical News Today. MediLexicon, Intl., 14 May. 2012. Web.
15 May. 2012. <

“…..Resveratrol is a compound found in red grapes, red grape juice, red wine, chocolate, tomatoes and peanuts. Pre-clinical and pilot clinical research studies suggest that resveratrol may prevent diabetes, act as a natural cancer fighter, ward off cardiovascular disease, and prevent memory loss, but there has been no large definitive study of its effects in humans. …..”With this clinical trial, we’ll find out if daily doses of pure resveratrol can delay or alter memory deterioration and daily functioning in people with mild to moderate dementia due to Alzheimer’s.” ……….”




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May 18th, 2012 posted by Paul Rega, MD, FACEP @ 4:25 am

Where does the word, “Syphilis”, come from?


Syphilis [′si-f(ə-)ləs]

From Syphilis sive morbus gallicus (“Syphilis or the French disease”) (1530) by Italian physician and poet Girolamo Fracastoro. The poem tells of Syphilus, a shepherd who insulted the sun god of Haiti. In retaliation, the god sends a plague to Haiti, and Syphilus is the first victim.

The first recorded syphilis epidemic was in 1495, during the First Italian War. After the French captured Naples, disbanded soldiers spread syphilis across Europe. For nearly 500 years, scholars have argued whether Columbus brought syphilis to Europe from the New World. Recent research supports Fracastoro’s New World origin for the disease.



  1. Franzen C. Syphilis in composers and musicians—Mozart, Beethoven, Paganini, Shubert, Schumann, Smetana. Eur J Clin Microbiol Infect Dis. 2008;27:1151–7. DOIExternal Web Site IconPubMedExternal Web Site Icon
  2. Harper KN, Zuckerman MK, Harper ML, Kingston JD, Armelagos GJ. The origin and antiquity of syphilis revisited: an appraisal of Old World pre-Columbian evidence for treponemal infection. Am J Phys Anthropol. 2011;146(Suppl 53):99–133. DOIExternal Web Site IconPubMedExternal Web Site Icon
  3. Quetel C. The history of syphilis. Baltimore: Johns Hopkins Press; 1990.

Suggested citation for this article: Etymologia: syphilis. Emerg Infect Dis [serial on the Internet]. 2012 Jun [date cited]. Web Site Icon

DOI: 10.3201/eid1806.ET1806

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May 18th, 2012 posted by Paul Rega, MD, FACEP @ 4:06 am

Types of drowning by age


Alternate Text: The figure above shows the distribution of fatal and estimated nonfatal drownings, by location and age group in the United States during 2005-2009, according to the National Vital Statistics System and National Electronic Injury Surveillance System – All Injury Program. Among children aged ≤4 years, 50.1% of fatal incidents and 64.6% of nonfatal incidents occurred in swimming pools.


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May 18th, 2012 posted by Paul Rega, MD, FACEP @ 3:57 am

5 Crimean-Congo hemorrhagic fever deaths in the Black Sea region of Turkey



ANKARA, Turkey, May 16 (UPI) — “Five people have died in the Black Sea region of Turkey…….from Crimean-Congo hemorrhagic fever………The disease, which affects mainly farm and slaughterhouse workers in the countryside and in the central Anatolia and Black Sea regions, is normally transmitted by bites from infected ticks or through direct contact with infected blood tissue in livestock.

Transmission between humans, through exposure to contaminated blood, is rare.

As a result of global warming, ticks carrying the virus are multiplying faster……..

The disease, for which there is no vaccine, causes hemorrhage, high fever, muscle pain and vomiting. In severe cases, the disease can cause a body rash, bleeding from the bowels and gums and renal failure.

The disease……has a mortality rate of about 30 percent…….”

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