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	<title>EMT City</title>
	<description>All Topics</description>
	<link>http://www.emtcity.com/index.php</link>
	<pubDate>Thu, 11 Mar 2010 21:43:17 +0000</pubDate>
	<ttl>15</ttl>
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		<title>EMT City</title>
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		<link>http://www.emtcity.com/index.php</link>
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	<item>
		<title>helmet in ems</title>
		<link>http://www.emtcity.com/index.php/topic/17894-helmet-in-ems/</link>
		<description><![CDATA[Hello,<br />
<br />
I am looking into the idea of having crews wear a helmet in the the ambulance. Does any US agency use a helmet in a ambulance. I do know the are used in England, Germany, New Zeland and Hong Kong.]]></description>
		<pubDate>Thu, 11 Mar 2010 21:43:17 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17894-helmet-in-ems/</guid>
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		<title><![CDATA[[NEWS FEED] Police Officers, Medics May Be Most Distracted Drivers - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17893-news-feed-police-officers-medics-may-be-most-distracted-drivers-jemscom/</link>
		<description><![CDATA[NEW YORK - Theirs are the most wired vehicles on the road, with dashboard computers, sophisticated radios, navigation systems and cellphones. While such gadgets are widely seen as distractions to be avoided...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/2010/03/police_officers_medics_may_be_most_distracted_drivers.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Thu, 11 Mar 2010 19:04:40 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17893-news-feed-police-officers-medics-may-be-most-distracted-drivers-jemscom/</guid>
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	<item>
		<title>Driving + Gadgets</title>
		<link>http://www.emtcity.com/index.php/topic/17892-driving-gadgets/</link>
		<description><![CDATA[There's an <a href='http://www.nytimes.com/2010/03/11/technology/11distracted.html?hp=&pagewanted=print' class='bbc_url' title='External link' rel='nofollow'>interesting story</a> in today's New York Times about emergency vehicles and distracted driving.  From the EMS perspective it talks about MDTs and GPS units and their use while driving.  What I find interesting is what some of the people they talk about are doing while driving.  I wonder if they do the same thing (e.g. play with their GPS while driving) in their POV.<br />
<br />
If nothing else, it's a good reminder to not be stupid behind the wheel.  Drive safely and get where you're going in one piece.<br />
<br />
-be safe<br />
<br />
<br />
<br />
<br />
<br />
<br />
<p class='citation'>Quote</p><div class="blockquote"><div class='quote'>The New York Times<br />
March 10, 2010<br />
Gadgets in Emergency Vehicles Seen as Driving Peril<br />
By MATT RICHTEL<br />
They are the most wired vehicles on the road, with dashboard computers, sophisticated radios, navigation systems and cellphones.<br />
<br />
While such gadgets are widely seen as distractions to be avoided behind the wheel, there are hundreds of thousands of drivers — police officers and paramedics — who are required to use them, sometimes at high speeds, while weaving through traffic, sirens blaring.<br />
<br />
The drivers say the technology is a huge boon for their jobs, saving valuable seconds and providing instant access to essential information. But it also presents a clear risk — even the potential to take a life while they are trying to save one.<br />
<br />
Philip Macaluso, a New York paramedic, recalled a moment recently when he was rushing to the hospital while keying information into his dashboard computer. At the last second, he looked up from the control panel and slammed on his brakes to avoid a woman who stepped into the street.<br />
<br />
“There is a potential for disaster here,” Mr. Macaluso said. Data does not exist about crashes caused by police officers or medics distracted by their devices. But there are tragic anecdotes.<br />
<br />
In April 2008, an emergency medical technician in West Nyack, N.Y., looked at his GPS screen, swerved and hit a parked flatbed truck. The crash sheared off the side of the ambulance and left his partner, who was in the passenger seat, paralyzed.<br />
<br />
In June 2007, a sheriff’s deputy in St. Clair County, Ill., was driving 35 miles per hour when a dispatcher radioed with an assignment. He entered the address into the mapping system and then looked up, too late to avoid hitting a sedan stopped in traffic. Its driver was seriously injured.<br />
<br />
Ambulances and police cars are becoming increasingly wired. Some 75 percent of police cruisers have on-board computers, a figure that has doubled over the last decade, says David Krebs, an industry analyst with the VDC Research Group. He estimates about 30 percent of ambulances have such technology.<br />
<br />
The use of such technology by so-called first responders comes as regulators, legislators and safety advocates seek to limit the use of gadgets by most drivers. Police officers, medics and others who study the field say they are searching to find the right balance between technology’s risks and benefits.<br />
<br />
The computers allow police, for example, to check license plate data, find information about a suspect and exchange messages with dispatchers. Ambulances receive directions to accident scenes and can use the computers to send information about the patient before they arrive at hospitals.<br />
<br />
“The technology is enormously beneficial,” said Jeffrey Lindsey, a retired fire chief in Florida who now is an executive at the Health and Safety Institute, which provides continuing education for emergency services workers.<br />
<br />
But he said first responders generally did not have enough training to deal with diversions that could be “almost exponential” compared with those faced by most drivers.<br />
<br />
The New York Fire Department, which coordinates the city’s largest ambulance system, said drivers were not supposed to use on-board computers in traffic. That is the role of the driver’s partner, and if the partner is in the back tending to a patient, the driver is supposed to use devices before speeding off.<br />
<br />
“There’s no need for our drivers to get distracted, because the system has evolved to keep safety paramount,” said Jerry Gombo, assistant chief for emergency service operations at the Fire Department. Drivers do get into accidents, he said, but he couldn’t remember a single one caused by distraction from using a computer.<br />
<br />
He also estimates the technology saves 20 to 30 seconds per call. “There’s no doubt we’re having quicker response time,” Mr. Gombo added.<br />
<br />
But in interviews, medics and E.M.T.’s in New York and elsewhere say that although they are aware of the rules, they do use their on-board computers while driving because they can’t wait for certain information.<br />
<br />
States that ban drivers from texting or using hand-held phones tend to exempt first responders. And in many places where even they are forbidden to use cellphones behind the wheel, the edict is often ignored.<br />
<br />
“My partner was checking baseball scores as he was driving a patient to the hospital. I looked through the passageway and said, ‘You’ve got to stop that right now,’ ” recalls Greg Friese, a paramedic in central Wisconsin, who was treating a patient in the back. Mr. Friese also develops online training programs for medics, E.M.T.’s, police officers and firefighters.<br />
<br />
“We’re dealing with the carnage, which ranges from the trivial to the tragic, of distracted driving,” he said. “We should know better.”<br />
<br />
For police officers, there are reasons to constantly be checking a dashboard computer. They might check a license plate of a car they are tailing by using a keyboard to call up a screen, typing in the plate number, then reading more about the owner.<br />
<br />
“There’s no way you could do this without eventually running into something,” said Officer Shawn Chase, a spokesman for the California Highway Patrol, as he demonstrated use of the Gateway computer in a cruiser. And yet, he said, he has tried it, and others have, too.<br />
<br />
“The first time you almost rear-end something, you say, ‘Whoa, I better not do this,’ ” he said. “You learn quick.”<br />
<br />
Researchers are working to reduce the risk. At the University of New Hampshire, backed by $34 million in federal financing, they have been developing hands-free technology for police cars.<br />
<br />
The systems let officers use voice commands to operate the radio, lights and sirens and even speak a license-plate number into the on-board computer, which can then announce through a speaker basic information about the car. To activate voice commands, the officer must push a button on the steering wheel.<br />
<br />
“I can literally drive down the road, speak without holding the microphone, and turn on the lights and sirens without ever looking at the equipment,” said Captain John G. LeLacheur of the New Hampshire State Police, who has driven one of the 1,000 police cruisers nationwide, mostly in New Hampshire and other Northeast states, equipped with the new technology.<br />
<br />
Mr. LeLacheur said it sometimes failed to pick up his voice. “If it’s not doing what I want, I bypass it and do things the old-fashioned way,” he said.<br />
<br />
Another system uses digital video systems that can automatically read license plates in front of and behind police cruisers, and then check for things like unregistered plates and stolen vehicles.<br />
<br />
The solutions aren’t cheap, particularly for struggling state and local governments. A license-plate reader system from Panasonic can cost $8,000 for each car, including a $3,000 to $5,000 laptop.<br />
<br />
“We can barely get patrol cars and motorcycles,” said Mr. Chase of the California Highway Patrol. Referring to the hands-free devices, he said, “We’ve love to get this technology, but there are trade-offs.”</div></div>]]></description>
		<pubDate>Thu, 11 Mar 2010 13:47:54 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17892-driving-gadgets/</guid>
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		<title><![CDATA[[NEWS FEED] Five Students Injured after Science Experiment Goes bad at Toronto School - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17887-news-feed-five-students-injured-after-science-experiment-goes-bad-at-toronto-school-jemscom/</link>
		<description><![CDATA[TORONTO - A science lab experiment gone wrong at a Toronto-area high school sent several students to hospital Wednesday afternoon, launching an investigation by the Ministry of Labour.
Peel region police...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/2010/03/five_students_injured_after_science_experiment_goes_bad_at_toronto_school.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Thu, 11 Mar 2010 11:53:31 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17887-news-feed-five-students-injured-after-science-experiment-goes-bad-at-toronto-school-jemscom/</guid>
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		<title><![CDATA[[NEWS FEED] Florida Woman Dead after Botched 911 Call - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17888-news-feed-florida-woman-dead-after-botched-911-call-jemscom/</link>
		<description><![CDATA[PUNTA GORDA - A 9-1-1 dispatcher is on administrative leave, accused of mishandling a call that ended in a woman's death. Police say the dispatcher waited 14 minutes to send an ambulance to a 91-year-old...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/2010/03/florida_woman_dead_after_botched_911_call.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Thu, 11 Mar 2010 11:53:31 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17888-news-feed-florida-woman-dead-after-botched-911-call-jemscom/</guid>
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		<title><![CDATA[[NEWS FEED] Jackson Health System Nears Insolvency - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17889-news-feed-jackson-health-system-nears-insolvency-jemscom/</link>
		<description><![CDATA[CHRISTINE ARMARIO
Associated Press
MIAMI â€” The city's major hospital network, which runs Miami's only round-the-clock trauma center and is a safety net for the poor and uninsured, is running out of money...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/2010/03/jackson_health_system_nears_insolvency.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Thu, 11 Mar 2010 11:53:31 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17889-news-feed-jackson-health-system-nears-insolvency-jemscom/</guid>
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		<title><![CDATA[[NEWS FEED] D.C. Council Upset over EMS Complaints - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17890-news-feed-dc-council-upset-over-ems-complaints-jemscom/</link>
		<description><![CDATA[D.C. City Council members are angered over a growing number of allegations of misconduct by D.C. Fire and EMS. A number of high-profile cases involving the department came to a head following the death...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/video_news/2010/03/dc_council_upset_over_ems_complaints.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Thu, 11 Mar 2010 11:53:31 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17890-news-feed-dc-council-upset-over-ems-complaints-jemscom/</guid>
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		<title><![CDATA[[NEWS FEED] Two Indiana Children Rescued from Icy Water - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17891-news-feed-two-indiana-children-rescued-from-icy-water-jemscom/</link>
		<description><![CDATA[Two girls are recovering in the hospital after falling into the icy waters Wednesday afternoon.
...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/video_news/2010/03/two_indiana_children_rescued_from_icy_water.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Thu, 11 Mar 2010 11:53:31 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17891-news-feed-two-indiana-children-rescued-from-icy-water-jemscom/</guid>
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		<title>Congrats LoneStar....AGAIN</title>
		<link>http://www.emtcity.com/index.php/topic/17886-congrats-lonestaragain/</link>
		<description><![CDATA[We always new you were a smart ass but I guess this proves it......<br />
<br />
<br />
<br />
<br />
<img src='http://rlv.zcache.com/deans_list_genius_gifts_button-p145577403203489715t5sj_400.jpg' alt='Posted Image' class='bbc_img' />]]></description>
		<pubDate>Thu, 11 Mar 2010 02:31:35 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17886-congrats-lonestaragain/</guid>
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		<title>The Banking Crisis Explained</title>
		<link>http://www.emtcity.com/index.php/topic/17885-the-banking-crisis-explained/</link>
		<description><![CDATA[Young Paddy bought a donkey from a farmer for £100. The farmer agreed to deliver the donkey the next day.<br />
<br />
<br />
The next day he drove up and said, 'Sorry son, but I have some bad news. The donkey's died.'<br />
<br />
<br />
Paddy replied, 'Well then just give me my money back.'    The farmer said, 'Can't do that. I've already spent it.'<br />
<br />
<br />
Paddy said, 'OK, then, just bring me the dead donkey.'  The farmer asked, 'What are you going to do with him?'<br />
<br />
<br />
Paddy said, 'I'm going to raffle him off.'     The farmer said, 'You can't raffle a dead donkey!'<br />
<br />
<br />
Paddy said, 'Sure I can. Watch me.. I just won't tell anybody he's dead.'<br />
<br />
<br />
A month later, the farmer met up with Paddy and asked, 'What happened with that dead donkey?'<br />
<br />
<br />
Paddy said, 'I raffled him off. I sold 500  tickets at two pounds a piece and made a profit of £898'<br />
<br />
<br />
The farmer said, 'Didn't anyone complain?'    <br />
<br />
<br />
Paddy said, 'Just the guy who won. So I gave him his two pounds back.'<br />
<br />
<br />
Paddy now works for the Royal Bank of Scotland]]></description>
		<pubDate>Wed, 10 Mar 2010 21:45:41 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17885-the-banking-crisis-explained/</guid>
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		<title>Irish Virginity Test</title>
		<link>http://www.emtcity.com/index.php/topic/17884-irish-virginity-test/</link>
		<description><![CDATA[Paddy is planning to marry, he is, and asks his family doctor how he could tell if his bride-to-be is still a virgin.<br />
<br />
His doctor says, "Aye, Paddy, all Irish use three things for what we call a Do-It-Yourself.... Virginity Test Kit.... a small can of red paint, a small can of blue paint and a shovel."<br />
<br />
Paddy asks, "Aye, and what do I do with these things, doctor?"<br />
<br />
The doctor replies, "Before ye climb into bed on your wedding night, you paint one of your balls red and the other ball blue. If she says, "That's the strangest pair of balls I ever did see...", you hit her with the shovel.<br />
<br />
<br />
<br />
<br />
<br />
May I just say to those who will not read this as humour, or try to read more into it than they should, I never have & never will condone violence towards women.]]></description>
		<pubDate>Wed, 10 Mar 2010 21:39:58 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17884-irish-virginity-test/</guid>
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		<title><![CDATA[[NEWS FEED] Hospital Administrator Voices Criticism over D.C. EMS - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17883-news-feed-hospital-administrator-voices-criticism-over-dc-ems-jemscom/</link>
		<description><![CDATA[WASHINGTON, D.C.- As the investigation into the death of Stephanie Stephens continues, a top official at Childrenâ€™s National Medical Center has made his views about the case known. In a letter to the editor...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/2010/03/hospital_administrator_voices_criticism_over_dc_ems.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Wed, 10 Mar 2010 17:59:23 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17883-news-feed-hospital-administrator-voices-criticism-over-dc-ems-jemscom/</guid>
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		<title><![CDATA[[NEWS FEED] DC EMS Crews Called Into Question Again - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17880-news-feed-dc-ems-crews-called-into-question-again-jemscom/</link>
		<description><![CDATA[D.C. EMS is under fire again after a woman says paramedics refused to take her to the hospital. The patient ended up in intensive care for more than a week, and now she's sharing her story after the city...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/video_news/2010/03/dc_ems_crews_called_into_question_again.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Wed, 10 Mar 2010 14:27:54 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17880-news-feed-dc-ems-crews-called-into-question-again-jemscom/</guid>
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		<title><![CDATA[[NEWS FEED] Albuquerque Works to Clarify Ambulance Contract - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17881-news-feed-albuquerque-works-to-clarify-ambulance-contract-jemscom/</link>
		<description><![CDATA[There's been some tension brewing between the Albuquerque Fire Department and the ambulance company contracted to handle emergency transports. The city's first responders are not supposed to be transporting...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/video_news/2010/03/albuquerque_works_to_clarify_ambulance_contract.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Wed, 10 Mar 2010 14:27:54 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17881-news-feed-albuquerque-works-to-clarify-ambulance-contract-jemscom/</guid>
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		<title><![CDATA[[NEWS FEED] Paramedics Hail 'Hero' Boy from Arizona Bus Crash - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17882-news-feed-paramedics-hail-hero-boy-from-arizona-bus-crash-jemscom/</link>
		<description><![CDATA[SACATON, Ariz. â€” A bilingual 4th grader hurt in an Arizona bus accident that killed six people and injured more than a dozen others translated from an ambulance stretcher for busy rescue workers as they...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/2010/03/paramedics_hail_hero_boy_from_arizona_bus_crash.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Wed, 10 Mar 2010 14:27:54 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17882-news-feed-paramedics-hail-hero-boy-from-arizona-bus-crash-jemscom/</guid>
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		<title>More Bad News for DC EMS</title>
		<link>http://www.emtcity.com/index.php/topic/17879-more-bad-news-for-dc-ems/</link>
		<description><![CDATA[<a href='http://www.nbcwashington.com/news/local-beat/Another_Investigation_Into_DC_Emergency_Response_Washington_DC.html' class='bbc_url' title='External link' rel='nofollow'>http://www.nbcwashington.com/news/local-beat/Another_Investigation_Into_DC_Emergency_Response_Washington_DC.html</a><br />
<br />
A woman tells a story similar to that of the recent story about the 3 year old dying as a result of DC EMS.]]></description>
		<pubDate>Wed, 10 Mar 2010 13:47:56 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17879-more-bad-news-for-dc-ems/</guid>
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		<title>NSAIDs may interfere with skeletal healing</title>
		<link>http://www.emtcity.com/index.php/topic/17878-nsaids-may-interfere-with-skeletal-healing/</link>
		<description><![CDATA[Taken from Medscape... who knew that NSAIDs could increase fracture risk and interfere with fracture healing (especially COX-2 inhibitors like Celebrex)... think about all the fractures we see and how people self-medicate, and the potential for complications in the hip fracture geriatric population... <br />
<br />
To see Figure 1, you'll have to click this link: <a href='http://www.medscape.com/viewarticle/587888' class='bbc_url' title='External link' rel='nofollow'>http://www.medscape.com/viewarticle/587888</a> and click through the article. For those who prefer the forum format, here it is below... <br />
<br />
Treating Skeletal Pain: Limitations of Conventional Anti-inflammatory Drugs, and Anti-neurotrophic Factor as a Possible Alternative<br />
Cory J. Xian; Xin-Fu Zhou<br />
Authors and Disclosures <br />
Posted: 02/10/2009; Nat Clin Pract Rheumatol. 2009;5(2):92-98. © 2009 Nature Publishing Group<br />
<strong class='bbc'><br />
Summary</strong><br />
Inflammatory and injury-induced skeletal pain are common conditions, and both conventional n&#111;nselective NSAIDs and the newer cyclo-oxygenase-2-specific inhibitors are widely used as post-traumatic and post-surgical analgesics. However, new research suggests that these drugs, particularly the cyclo-oxygenase-2 inhibitors, have a negative effect on the healing process in fractured bone and within orthopedic surgical sites, thus highlighting a need to develop new approaches for managing skeletal pain. Various experimental studies have revealed that locally upregulated neurotrophic factors, especially nerve growth factor, have a major role in mediating injury-induced or inflammatory pain. Nerve growth factor inhibitors, therefore, might be an effective alternative modality for post-traumatic and post-surgical analgesia, without impairing bone healing.<br />
<br />
<strong class='bbc'>Introduction</strong><br />
Chronic pain is a leading cause of morbidity worldwide, with a prevalence of 50% in Europe—a figure that is likely to rise in elderly patients with chronic disorders, such as rheumatoid arthritis or osteoarthritis.[1] N&#111;nselective NSAIDs, which inhibit cyclo-oxygenase (COX)-1 and COX-2, and the newer COX-2-specific inhibitors are commonly used in the management of post-traumatic or post-operative skeletal pain. However, studies have demonstrated a strong association between these agents and impaired bone healing, highlighting the need for new approaches to skeletal pain management. Data from the past few years indicate that neurotrophins—growth factors that are required for the survival, development and maintenance of neuronal cells—might be involved in the pathophysiology of injury-induced or inflammatory skeletal pain. This Review discusses the inhibitory effects of NSAIDs (particularly COX-2-specific agents) on bone healing, and the potential role of neurotrophic factors as mediators of skeletal pain and as targets for the treatment of skeletal pain.<br />
<br />
<strong class='bbc'><br />
NSAIDS as Post-traumatic or POST-operative Analgesia</strong><br />
Conventional, n&#111;nselective NSAIDs, which inhibit COX-mediated production of prostaglandins, are widely used to treat pain and reduce inflammation in patients with chronic inflammatory or autoimmune disorders.[2] The management of acute post-operative pain, however, remains suboptimal, despite the increasing use of clinical acute pain services; furthermore, there are disparities in opinion, both between clinicians and in the clinical practice guidelines, regarding the use of the newer modalities in this setting.[3,4,5] Conventional NSAIDS have become an important component of both post-traumatic and post-operative analgesia, and are used frequently in the treatment of acute athletic injury.[6,7,8,9] The proven efficacy of these agents in the management of post-operative pain, together with their opioid-sparing role in multimodal analgesia, have led to significantly reduced levels of opioid-related side effects.[10] <br />
<br />
The therapeutic effects of n&#111;nselective NSAIDs are mediated by inhibition of injury-induced or inflammation-induced COX-2 exp<b></b>ressi&#111;n.[11] Clinical studies have shown that, as a result of inhibition of the physiological enzyme, COX-1, NSAIDs can be associated with an increased risk of fracture in patients with rheumatic disease.[12] In addition, their use has been called into question following concerns about the associated increased risks of gastrointestinal and cardiovascular adverse events, increased bleeding, impaired wound healing, and increased bone nonunion rates.[3,13,14] Furthermore, evidence from experimental research conducted over the past two decades suggests that NSAIDs have an inhibitory effect on fracture repair.[11] <br />
<br />
The newer NSAIDS, which specifically inhibit COX-2, are as effective as classical NSAIDs and are associated with a lower risk of gastrointestinal adverse events, as well as a lack of inhibitory effects on platelet function and, therefore, a reduced risk of blood loss.[1,3,9] Large-scale studies, however, have shown that these newer agents can increase the risk of adverse cardiovascular events.[1,15,16,17] <br />
<strong class='bbc'><br />
Effects of COX-2-specific Inhibitors on Bone Fracture Healing</strong><br />
Bone healing is a complex process that involves the coordinated actions of various cell types. The initial hematoma formation and inflammatory response result in the release of cytokines and growth factors that are important in regulating subsequent healing events, such as infiltration of progenitor cells. In the reparative and remodeling phases, bone formation and remodeling involve angiogenesis and the formation and functions of bone-forming cells (i.e. osteoblasts) and bone-resorptive cells (i.e. osteoclasts). It is now clear that all these events are regulated by prostaglandins, the products of COX enzymes.[11] When COX-2 is induced during the inflammatory response, increased prostaglandin exp<b></b>ressi&#111;n upregulates various inflammation mediators and regulates the formation and activities of osteoblasts and osteoclasts.[18]<br />
 <br />
Given the central role of prostaglandins in the bone healing process and the widespread use of NSAIDs in the management of post-injury and post-surgery orthopedic pain, the possible adverse effects of these agents in bone healing, particularly the COX-2-specific inhibitors, are concerning. Blockade of COX-2 function has been associated with variable outcomes in experimental models of bone, ligament and tendon repair.[19] One clinical study showed that short-term use of the COX-2 inhibitor celecoxib had no effect on rates of nonunion following spinal fusion surgery;[20] however, another clinical study indicated that longer-term COX-2 inhibition could increase the risk of fracture and delay healing.[11] <br />
<br />
Experimental studies suggest that COX-2 inhibitors can impair tissue repair and recovery of mechanical strength following acute skeletal injury, which could have important clinical implications for the rates of ongoing morbidity and future susceptibility to injury.[21] Accumulating evidence suggests that COX-2 activity in the early stages of bone healing is critical for efficient bone repair. Indeed, fracture healing was shown to be impaired in mice with mutated COX-2.[22] Furthermore, administration of celecoxib during the early stages of fracture repair in rats (but not before or 14 days after fracture) significantly reduced the mechanical strength of the fracture callus and often caused bone nonunion.[23] Similarly, early post-operative administration of COX-2 inhibitors in rodent bone fracture models resulted in increased fibrous tissue at fracture sites, limited blood flow across the fracture, delayed remodeling of calcified cartilage, and reduced bone formation in the fracture callus, or delayed allograft healing and incorporation.[24,25,26,27] <br />
<br />
Interestingly, it has been shown that COX-2-specific drugs inhibit fracture healing to a greater degree than classical NSAIDS.[27] Moreover, the magnitude of this effect seems to be related to treatment duration, as the inhibitory effect was reversible after discontinuation of short-term treatment.[27] Up to 10% of bone fractures can result in delayed union or nonunion;[28] however, the extent of the contribution of COX-2 inhibitors to this rate of delayed union or nonunion remains to be investigated.<br />
<strong class='bbc'><br />
Guidelines on the use of NSAIDS in Fractures and Orthopedic Surgery</strong><br />
As NSAIDS are known to inhibit bone healing,[29] and opiates cause cognitive dysfunction and respiratory depression, the available treatment options for pain related to bone fractures or surgery remain limited. Based on animal and clinical studies, practical management guidelines have been generated to assist orthopedic surgeons and sports physicians with regard to the use of NSAIDS for analgesia. Clinicians are advised to carefully evaluate individual patient risk factors and the pharmacokinetics of individual NSAIDS when assessing the risks and benefits of discontinuing NSAID therapy in the perioperative setting.[14] NSAIDS can be used appropriately in the management of acute ligament sprains, muscle strains, tendinitis, and eccentric muscle injury, with the length of treatment being kept as short as possible. However, these agents are not recommended, or should be used with caution or only for a short duration,[6,27] in the treatment of fractures and stress fractures, which are associated with higher risks of nonunion or delayed union due to osseous, vascular, or patient-related factors,[25] or in the treatment of chronic muscle injury.[8] <br />
<strong class='bbc'><br />
Neurotrophic Factors in Injury-induced or Inflammatory Pain</strong><br />
Neurotrophins are a family of proteins that are essential for the proliferation, differentiation and survival of primary sensory neurons[30] and, as shown in recent studies, participate in the development of pain states. Each neurotrophin binds with high affinity to a specific receptor tyrosine kinase (Trk), and all bind to the common receptor p75. In adult animals, approximately 40–50% of primary sensory neurons express the nerve growth factor (NGF) receptor TrkA, 20–30% express the brain-derived neurotrophic factor (BDNF) receptor TrkB, and 20–30% of neurons express the neurotrophin 3 (NT3) receptor TrkC. Neurotrophins are expressed in sensory target organs and tissues, such as skin, blood vessels and visceral tissues;[31] BDNF is also highly expressed by a subpopulation of sensory neurons.[32] Neurotrophins released from their targets act on and maintain normal functioning of sensory neurons. In pathological conditions, such as trauma and inflammation, neurotrophins are upregulated by injured tissues,[33] and sensory nerve terminals are activated by target-derived neurotrophins, which participate in tissue healing and the development of pain.<br />
<strong class='bbc'><br />
Neurotrophins in Wound and Tissue Repair and Fracture Healing</strong><br />
Apart from its known biological effects on neuronal cells, NGF might also be an important component of the wound healing and tissue repair process. Early studies reported a therapeutic role for NGF in tissue repair, particularly in otherwise untreatable ulcers in patients with diabetes and in patients with severe pressure ulcers.[34] In addition, NGF accelerated the rate of wound healing both in normal mice and in healing-impaired diabetic mice.[35] Interestingly, NGF administered after injury was associated with the promotion of wound healing and increased numbers of fibroblasts and blood capillaries in granulation tissues in mice.[36] <br />
<br />
While NGF can be detected in periosteal osteoprogenitor cells in intact bone, NGF protein has also been detected in osteoprogenitor cells, marrow stromal cells, osteoblasts, some chondrocytes, endothelial cells, the periosteal matrix of the fracture callus, and skeletal muscle, suggesting that NGF and all these entities participate in fracture repair and re-innervation.[37] In a mouse model of fractured ribs, immunoreactivity of NGF, BDNF and NT3, and the receptors TrkA and TrkC, was observed in osteoblasts and/or hypertrophic chondrocytes in the bone forming area at the fracture callus.[38] In addition, mRNA levels of these neurotrophins were elevated during the healing process. Localized, intense ingrowth of new sensory nerve fibers containing the neuropeptide CGRP (calcitonin gene-related peptide) was also observed at the fracture callus in rats.[39] As CGRP immunoreactivity coincides with the amount of new bone formation, this finding suggests an association between CGRP-positive innervation and fracture healing.<br />
<br />
These findings indicate that neurotrophins might be involved in bone or nerve healing as autocrine and/or paracrine factors during fracture repair. Although treatment with anti-NGF antibodies did not seem to interfere with the bone healing process, as assessed by mechanical testing and histomorphometric analysis,[40] the potential role of neurotrophins and their mechanisms of action in bone fracture healing require further investigation.<br />
<strong class='bbc'><br />
Neurotrophins in Injury-induced or Inflammatory Pain</strong><br />
Various studies have shown that neurotrophins, mainly NGF, are involved in the pathophysiology of injury-induced pain in nerve tissues, peripheral tissues and intervertebral discs. Neurotrophins have an established role in neural survival, collateral sprouting of sensory axons,[41,42] and regulation of nociceptive sensory neurons.[43] Increased exp<b></b>ressi&#111;n and secretion of NGF, NT3 and BDNF have been implicated in injury-induced neuropathic pain after axotomy of the sensory system or the motor nerve.[44] Interestingly, tibial fracture in rats induced upregulation of NGF in hindpaw skin and tibia bone, as well as sciatic nerve neuropeptide content.[45] <br />
<br />
NGF is secreted by target tissues (such as macrophages and Schwann cells following nerve injury, and by basal keratinocytes in the skin), and regulates the excitability of nociceptor fibers by altering the exp<b></b>ressi&#111;n of key sodium channels, receptors and neuropeptides involved in the transmission of pain stimuli.[46] Local or systemic administration of NGF in rodents has been shown to induce acute thermal hyperalgesia and delay mechanical hyperalgesia, suggesting that NGF itself is sufficient to elicit hyperalgesia.[47,48] In addition, injection of NGF into the neck muscles of mice evoked neuronal activation in areas of the brainstem and cervical spinal cord that are involved in the processing of deep noxious input,[49] indicating that NGF has a role in the pathophysiology of neck muscle nociception. In humans, intravenous or intramuscular injection of low-dose NGF (1 &#956;g/kg) resulted in widespread pain in deep tissues and hyperalgesia at the injection site.[50,51] Systemic or local blockade of NGF bioactivity, however, inhibited the effects of inflammation on the sensitivity of sensory neurons.[48] <br />
<br />
Nociceptive nerve ingrowth into the usually aneural inner parts of painful lumbar intervertebral discs is a known cause of discogenic back pain; accumulating evidence suggests that NGF-induced nerve growth could have a key role in the pathophysiology of inflammatory back pain. A localization study showed a causal link between substance-P-positive, CGRP-positive nociceptive nerve ingrowth into the painful disc and NGF produced by blood vessels growing into the disc from adjacent vertebral bodies.[52] <br />
<br />
In addition, inflammatory back pain in the lumbar facet joints has been associated with increased numbers of BDNF-positive neurons and the phenotypic switch to large neurons innervating these joints in rats.[53] BDNF-positive small dorsal root ganglion (DRG) neurons have an important neuromodulatory role in inflammatory conditions; therefore, the presence of BDNF immunoreactivity in DRG neurons innervating the intervertebral disc suggests that, under physiological conditions, these DRG sensory neurons can transmit inflammatory pain from the intervertebral disc.[54] Furthermore, constitutive NGF exp<b></b>ressi&#111;n in cultured human intervertebral disc cells was increased in the presence of the proinflammatory cytokines interleukin-1&#946; and tumor necrosis factor.[55] Similarly, cultured lumbar NGF-sensitive DRG neurons exhibited increased axonal growth potential in response to neuronal injury in the presence of tumor necrosis factor.[56] <br />
<br />
These studies suggest that, apart from being involved in the pathophysiology of neuropathic pain following nerve and peripheral tissue injury, neurotrophins have an important role in the development of injury-induced or inflammation-induced back pain.<br />
<br />
<strong class='bbc'>Possible Mechanisms of Action of NGF in Bone-Injury-Induced Pain</strong><br />
Although the potential pathophysiological mechanisms of NGF in bone-injury-induced pain remain unclear, the studies discussed above suggest that the ensuing inflammation triggers a cascade of proinflammatory cytokine upregulation, which in turn increases NGF synthesis in macrophages, chondrocytes, fibroblasts and osteoblasts at the site of injury (Figure 1). NGF released from these cells might then directly or indirectly act on sensory neurons, resulting in pain. NGF activates TrkA on sensory nerves, upregulating the exp<b></b>ressi&#111;n of pronociceptive molecules, such as capsaicin receptor (TRPV1), BDNF, and neuropeptides (substance P and CGRP), in sensory neurons, which mediate nociception via peripheral and central mechanisms. NGF also causes pain indirectly by activating TrkA on mast cells, which release a variety of nociceptive activators such as neuropeptides.[47] Furthermore, NGF can activate TrkA on sympathetic neurons, which triggers sprouting of sympathetic nerves and the release of catecholamines, which interact with sensory neurons and cause ectopic nerve firing. Nociceptive activators produced from central or peripheral routes might act upon nociceptive sensory neurons, causing the release of neurotransmitters in the dorsal horn, which in turn sensitize spinal cord neurons and transmit pain after a bone injury. Bone-injury-induced pain might, therefore, be mediated by increased nociception due to the actions of NGF on both the peripheral and central nervous pathways.<br />
  <br />
Figure 1.<br />
<br />
Potential functions and mechanisms of action of NGF in the development of post-injury pain. Inflammatory cells or bone healing cells at the fracture site upregulate NGF, which can act on sensory neurons directly or indirectly, resulting in pain. NGF activates its receptor (TrkA) on sensory nerves, which upregulates the exp<b></b>ressi&#111;n of pronociceptive molecules, such as BDNF and neuropeptides (e.g. SP and CGRP) in sensory neurons, which mediate nociception via peripheral and central mechanisms. In addition, NGF can cause pain indirectly by activating TrkA on mast cells (which release a variety of nociceptive activators) and on sympathetic neurons. Abbreviations: BDNF, brain-derived neurotrophic factor; CGRP, calcitonin gene-related peptide; DRG, dorsal root ganglion; NGF, nerve growth factor; SP, substance P; TrkA, receptor tyrosine kinase A.<br />
<br />
<strong class='bbc'>Anti-NGF Therapy for Injury-INDUCED or Surgery-induced Pain</strong><br />
Despite the development of new technologies to aid post-operative pain control,[4] safer and more effective modalities for pain management after skeletal trauma or surgery are still needed. As most of the CGRP-positive sensory nerve fibers innervating the bone express the NGF receptors TrkA and p75,[57,58] blocking the sensitization and activation of these fibers and nociceptors would represent an attractive approach to relieving musculoskeletal pain induced by trauma, injury or surgery. Increasing attention, therefore, has focused on evaluating the potential efficacy of anti-NGF therapy in pain management.<br />
<br />
In a mouse model of femur fracture, treatment with anti-NGF antibody on the first day after fracture resulted in a 50% reduction in pain-related beh&#097;vior and did not seem to interfere with bone healing, as assessed by mechanical testing and histomorphometric analysis.[40] A similar study showed that administration of anti-NGF antibody reduced fracture-induced pain-related beh&#097;viors by over 50%, a level of reduction also achieved with a dose of 10 mg/kg of morphine.[29] Moreover, bone healing was not impaired, as measured by callus formation, fracture site bridging or mechanical bone strength. This study also indicated that NGF is likely to be involved in the maintenance, but not the acute generation, of fracture pain. As CGRP-positive and TrkA-positive fibers constitute the majority of sensory fibers innervating the bone, the antihyperalgesic action of an anti-NGF antibody could be effective in attenuating pain resulting from bone fracture or bone surgery. However, although anti-NGF treatment reduced nociceptive sensitization and preserved some bone mass in a rat model of tibial fracture, it did not decrease hindpaw edema, warmth or cytokine production, suggesting that anti-NGF treatment reduced some, but not all, signs characteristic of the complex regional pain syndrome.[45] This finding might have been due to the complexities involved in the pathogenesis of injury-induced skeletal pain and NGF signaling.[45] <br />
<br />
Furthermore, anti-NGF therapy seems to be efficacious in reducing pain associated with spinal cord injury or bone cancer. Administration of anti-NGF antibodies attenuated mechanical hyperalgesia following spinal cord injury in rats, suggesting that anti-NGF therapy is a potential analgesic treatment for central pain.[59] In a mouse prostate model of bone metastasis, where significant bone formation and bone destruction occur simultaneously, NGF-blocking antibody produced a significant reduction in both the early and late stages of bone cancer pain-related beh&#097;viors.[57] Interestingly, this therapy did not influence tumor-induced bone remodeling, formation of osteoblasts and osteoclasts, tumor growth, or markers of sensory or sympathetic innervation in the skin or bone. In a similar mouse model of bone cancer, administration of an anti-NGF antibody was found to produce a profound reduction in both ongoing and movement-evoked pain-related beh&#097;viors.[58] <br />
<br />
<strong class='bbc'>Conclusions</strong><br />
Both conventional and COX-2-specific NSAIDS are important components in the management of pain after skeletal trauma or surgery. The limitations associated with these agents, including a possible role in the impairment of fracture healing, highlight the need to develop new modalities of pain management. Neurotrophic factors, particularly NGF, have been shown to mediate injury-induced or inflammatory pain of the skeleton, and studies have demonstrated that anti-NGF therapy could represent an attractive and effective alternative to NSAIDs, without compromising bone healing and remodeling. Further studies are required to understand how NGF and other neurotrophic factors, and their receptors, mediate pain evoked by injury, surgery, chronic inflammation, or cancer of the skeletal system. Questions remain regarding the cellular sources of the neurotrophic factors at or near the pain epicenter, and the molecular mechanisms of pain development. In addition, future studies are needed to evaluate or develop more-effective analgesic agents, based on the neuropathic roles of neurotrophic factors with minimal interference of their normal physiological neurotrophic functions and their functions in tissue and bone healing. More preclinical and clinical studies are needed to determine the role of these potential new modalities in clinical practice.]]></description>
		<pubDate>Wed, 10 Mar 2010 10:33:46 +0000</pubDate>
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		<title>paramedic school preperation</title>
		<link>http://www.emtcity.com/index.php/topic/17877-paramedic-school-preperation/</link>
		<description><![CDATA[hello all i've recently completed the EMT course and am now NREMT certified.  i look forward to preparing myself to get into paramedic school and know that i should be taking prep courses such as chemistry, anatomy, physiology, acls and such.  i'm curious whether or not there's a certain order you guys would recommend i take these courses to better understand each course?  any feedback would be appreciated, thanks!  <img src='http://www.emtcity.com/public/style_emoticons/default/smile.gif' class='bbc_emoticon' alt=':)' /><br /><br />i'm sure i left out some courses on the list above but if you recommend anything else please let me know <img src='http://www.emtcity.com/public/style_emoticons/default/smile.gif' class='bbc_emoticon' alt=':)' />]]></description>
		<pubDate>Wed, 10 Mar 2010 09:14:18 +0000</pubDate>
		<guid>http://www.emtcity.com/index.php/topic/17877-paramedic-school-preperation/</guid>
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		<title><![CDATA[[NEWS FEED] Records Contradict City Account of DC Toddler's Death - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17872-news-feed-records-contradict-city-account-of-dc-toddlers-death-jemscom/</link>
		<description><![CDATA[ROBY CHAVEZ
Reprinted with Permission
WASHINGTON, D.C. - The controversy surrounding the death of 2-year-old Stephanie Stephens continues. Her parents made two 911 calls to get her help, but ambulance...
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		<pubDate>Tue, 09 Mar 2010 17:16:09 +0000</pubDate>
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		<title><![CDATA[[NEWS FEED] MedSled Use Grows in Massachusetts - JEMS.com]]></title>
		<link>http://www.emtcity.com/index.php/topic/17873-news-feed-medsled-use-grows-in-massachusetts-jemscom/</link>
		<description><![CDATA[Area schools and hospitals learn advantages of MedSled device.
...
	<br /><br /><a href='http://www.jems.com:80/news_and_articles/news/video_news/2010/03/medsled_use_grows_in_massachusetts.html' class='bbc_url' title='External link' rel='nofollow'>View the full article</a>]]></description>
		<pubDate>Tue, 09 Mar 2010 17:16:09 +0000</pubDate>
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