Ambulances: Hotbeds of MRSA?

     Researchers investigating the presence of methicillin-resistant Staphylococcus aureus (MRSA) in ambulances found that nearly half of those examined in one urban fleet in the western U.S. tested positive for contamination.

     A team from Georgetown University collected swabs from five areas of 21 ambulances at two stations. They found that a total of 13 samples, coming from 10 vehicles, showed MRSA contamination. That's only 12% of the swabs taken, but 48% of the ambulances tested.

     Sample areas included the steering wheel, patient stretcher, EMT work area and Yankauer suction tip. More than half of the positive swabs came from the work areas. The authors cited high patient turnover rates and limited time for equipment sanitation as possible contributing factors.

     Commenting in Journal Watch (https://www.jwatch.org), emergency physician Kristi Koenig, MD, noted that "MRSA has become ubiquitous, but finding it in ambulances is a condemnation of our current sanitation practices and warns of an excessively casual attitude toward this highly destructive organism."

     The study appeared in the April-June issue of Prehospital Emergency Care.
-EMS-L

DISPUTE SETTLED, FORD Back in the Ambulance Game
     A legal dispute that led Ford Motor Co. to briefly stop its production of ambulances has been resolved, the company confirmed in June, meaning shipments from the auto giant will soon resume.

     Ford stopped producing new ambulances and shipping E Series cutaway van chassis in March following a long-running dispute with Navistar's International Truck and Engine Corp., which provides diesel engines for the company. That dispute dated to 2002, when Ford sued Navistar over problems with its engines and subsequently withheld payments to help cover warranty repair costs.

     As the dispute continued into this year, Navistar briefly stopped shipping 6.4-liter engines for Ford's F-Series Super Duty pickups. Those quickly resumed, but Ford then said it ran out of the older 6.0-liter engines used for more than 90% of the nation's ambulances, and production stopped.

     Virtually all new ambulances use Ford's E Series cutaway chassis and powertrain, a National Truck Equipment Association spokesman told MSNBC in March, and around 92% of those use International's PowerStroke 6.0-liter diesel engine.

     That engine will now be available once more to Ford customers, although the company isn't sure when.

STANDARD CREDENTIALS FOR FIRST RESPONDERS?
     Efforts by the U.S. Navy to develop a credentialing system for civilian first responders could lead to standard portable credentials for up to four million EMS, fire, police and other medical professionals.

     The project is being conducted through the Space and Naval Warfare Systems Center (SPAWAR) in Charleston, SC, reported Government Security News' Homeland Security Insider. SPAWAR personnel have compiled information on credentialing systems in current use, focusing on those that are "portable for incident access control boundaries that have limited to no supporting infrastructure."

     A new credentialing system would be compatible with existing federal credentials per Homeland Security Presidential Directive #12 and comply with Federal Information Processing Standard 201.
-Homeland Security Insider

Ford Statement
     "We have reached an agreement with Navistar on 6.0-liter diesel for E-Series. We are pleased that we will be able to once again deliver this important product to our customers in 2008. The diesel option will again be available on E350 regular-length wagons, E350 vans, [and] E350 and E450 cutaways- Production timing is still in the planning stages."

ResQPOD: A Big Step Forward in SCA Care?
     New medical devices are often promoted with hyperbole, and it's wise to regard big claims with big skepticism. But sometimes, the hype is genuinely warranted, and that appears to be the case with the ResQPOD. Consider some results:

     In the hospital, cardiac arrests generally have a survival rate of about 17%-19%. When doctors at St. Dominic-Jackson Memorial in Jackson, MS, began using the ResQPOD, theirs rose to 57%.

     In the field, only around a fifth of cardiac arrest patients survive to hospital admission. When Cypress Creek (TX) EMS began using the ResQPOD, its resuscitation rates increased by almost 50%, and the percentage of patients making it to the hospital jumped from 26% to 38%.

     It hasn't been around that long, but American emergency medicine's first impedance threshold device (ITD) may actually help revolutionize CPR and the care of cardiac emergencies.

     "I think the sites deploying it so far are seeing the kind of clinical benefit we anticipated-that is, nearly a 50% increase in return of spontaneous circulation rates or admission to the hospital," says Keith Lurie, MD, inventor of the ResQPOD and chief medical officer of the company that makes it, Advanced Circulatory Systems of Eden Prairie, MN. "We believe we're in a unique position to help patients. But really, it's just one piece in a machine that has to work well."

     The ResQPOD is used on patients receiving assisted ventilation to enhance circulation and increase blood flow to the heart and brain. First cleared for use in 2004, it works through inspiratory impedance-that is, it restricts air from entering the lungs during the chest-recoil phase of CPR, resulting in increasing negative pressure and a vacuum in the chest that, in turn, leads to greater venous return. What's more, when the chest wall recoils, it lowers intracranial pressure, allowing blood to flow more easily to the brain during the next compression.

     As a measure of its success, the ITD got a Class IIa recommendation-the second-highest possible-from the American Heart Association when the AHA revised its CPR/ECC guidelines in 2005. That's a stronger recommendation than any other device or drug used for increasing circulation during CPR.

     The ResQPOD is also part of a new project, Take Heart America, aimed at combining the most effective strategies against sudden cardiac arrest into integrated community efforts that produce better survival rates. Currently underway in three locations-Austin, TX; Columbus, OH; and St. Cloud, MN-the project involves broad CPR training for the general public, increased deployment of AEDs, use of the ResQPOD during CPR, and therapeutic cooling of SCA victims.

     That range of interventions underscores an important point: The ResQPOD is not a magic bullet. It is, rather, a tool communities can use, in concert with other essential tools, to raise their resuscitation and survival rates.

     "We have to know it's not a panacea," says Lurie, also an associate professor of medicine at the University of Minnesota. "It's a way to strengthen one link in the chain of survival, and there are other places for opportunity where we need to do a better job.

     "We're going to see the best gains in systems that have really taught CPR per the new guidelines. My belief is that in absolute magnitude gain, we'll see somewhere between a 3%-10% increase in hospital discharge rates with the ITD, depending on the overall efficiency of the system. But you're not going to get as big a gain if you don't have good control over the quality of CPR."
-John Erich, Associate Editor

AHA PROMOTES FASTER CARE
     The American Heart Association has announced the launch of Mission: Lifeline, an initiative to reduce heart attack deaths through quick activation of the systems and processes needed to treat them.

     Beginning with a call to 9-1-1, "this critical chain of events must move quickly and appropriately so that we can open the blocked artery-and restore blood flow to the heart muscle," AHA president Raymond Gibbons, MD, said of the effort. "This initiative will seek to improve quality and speed in many steps of this sequence of care for heart attack patients."

     Mission: Lifeline developed from a meeting of experts and stakeholders last year that considered ways to improve STEMI (ST-elevation myocardial infarction) care. Findings were published online in the AHA journal Circulation.

     Most heart attacks aren't STEMIs, but because they're quickly recognizable and treatable, STEMIs hold the most opportunity for improvements in response and treatment. Achieving those, proponents believe, will ultimately lead to better care for all heart attack patients.
-American Heart Association