Sport and alcohol: An emergency department study in Switzerland.

The aim of the present study was to empirically determine whether: (a) sport injuries were associated with alcohol consumption before the injury (acute intake) and with usual consumption patterns (chronic high intake and heavy intake on single occasions); (b) the risk of sport injuries related to alcohol consumption differs from that of other injuries; and (c) there are differences between the sexes and between types of sport. Data from 8694 patients attending the emergency department of Lausanne University Hospital between 1 January 2003 and 30 June 2004 were analysed. Of those patients, 4861 came to the hospital because of an injury and 885 patients were identified as having a sport injury (18.2%). Logistic regression was used to estimate the odds ratios of injury relating to alcohol consumption. With increasingly acute intake, the risk of sport and other injuries increased (sports injury and alcohol use in the 6 h before injury compared with no use: odds ratio=4.29, 7.46, and 14.75 for low, medium, and high alcohol use among women, and 2.81, 3.39, and 1.64 for low, medium, and high alcohol use among men). Alcohol consumption was associated with an increasingly higher risk of sport injuries compared with other injuries among women (consumption 6 h before injury: odds ratio=1.12, 1.23, and 1.56 for low, medium, and high alcohol use), but not men (odds ratio=1.17, 0.83, and 0.23 for low, medium, and high alcohol use). Regarding usual consumption patterns, those men and women injured while exercising were more often at-risk drinkers (men: 44%; women: 25%) compared with those injured during other activities (men: 37%; women: 13%). The results indicate that both men and women, but particularly women, should not practise sports after alcohol ingestion. The study raises questions as to whether sport should be generally promoted as an alternative to alcohol consumption in prevention programmes. Whereas some sports seem to be protective (e.g. endurance and fitness sport) for risky alcohol use, the majority are not. It is important to note, however, that we do not dismiss the beneficial effects of practising for an individual's health. The other positive aspect of practising, namely interacting socially with others, may come at the price of an increased alcohol use, particularly in a wet culture like Switzerland where any social contact is often accompanied by alcohol consumption.

Introduction to Homeland Security and Emergency Management for Local Officials, 2012

The purpose of the Introduction to Homeland Security and Emergency Management for Local Officials is to provide you with information regarding this system. Inside, you will learn about local and state emergency management and homeland security; the phases of homeland security and emergency management; hazards that affect the state; comprehensive planning requirements; emergency declarations; available state and federal assistance; and other important topics that will help you become more versed in homeland security and emergency management in Iowa.

Iowa Emergency Response Plan, October, 2010

The State of Iowa has adopted a multi-hazard approach to managing the consequences of emergency/disaster response. Underlying this approach is the principle that a standard set of generic functional capabilities can be employed to effectively address a wide variety of hazardous conditions and categories of incidents, whether these have a known probability of occurring or are totally unforeseen. Therefore, to the greatest extent possible, the activities described and assigned in this plan are organized along functional lines first, rather than by agency, type of hazard, or type of incident. Contained in this section of the Plan, known as the ―Basic Plan,‖ are instructions, policies, and explanatory information related to many or all of the agencies/entities involved in emergency/ disaster response, as well as information about the legal and administrative foundations for the Plan, the state’s characteristics and significant hazards, lines of succession for the state’s chief executive, plan activation requirements, and the structure of the response organization.

Iowa Strategy for Homeland Security and Emergency Management 2009-2014, August 31, 2009

Address sustainability in all efforts. Sustainability should be at the core of all levels of homeland security and emergency management effort in Iowa. Capabilities need to be built for the long term, and without a sustainability plan in place, projects can quickly deplete uncertain levels of funding. Utilize an all-hazards methodology. Developing capabilities that are effective during a variety of disaster and emergency scenarios represents sound planning and resource management. Enhance capabilities through joint planning, training and exercise. Effective capabilities developed through coordinated planning efforts and an ongoing joint training and exercising program to ensure sustainment of prepared response. Utilize a collaborative approach to build capability. We will utilize whatever partnerships are necessary to build capability in the most effective manner possible. Regional partnerships have been, and will continue to be, in the forefront of the State of Iowa’s efforts to build and enhance capability. Enhance statewide capabilities. Whenever possible, we will identify and augment existing resources to provide statewide capability during a disaster or terrorist attack. Awareness, outreach and education. Open communication is critical to the success of any initiative. All projects implemented will have awareness, education and outreach components to ensure that all stakeholders are informed as to their responsibilities, capabilities and access. Information sharing and a common operating picture. The timely exchange of critical/actionable information is imperative to the success of every operation. The identification of a common operating picture allows decision makers to make informed decisions based on a unified understanding of the events around them.

2012 Emergency Response Guidebook: A Guidebook for First Responders During the Initial Phase of a Dangerous Goods/ Hazardous Materials Transportation Incident,

A Guidebook for First Responders During the Initial Phase of a Dangerous Goods/Hazardous Materials Transportation Incident.

Are You Prepared? A Guide to Emergency Preparedness, October 24, 2013

Being prepared means making an emergency plan, building an emergency kit and being aware of the hazards that can impact you. Whether you are at home or at work, emergencies like tornadoes, flooding or winter storms can occur quickly and without warning. We can’t prevent emergencies, but we can prepare for them.

Iowa School Safety Guide, April 6, 2012

This document was developed for the schools of Iowa to use as a template to enhance current school safety programs; the creation of this document was a partnered effort at the state level between the aforementioned agencies. The purpose of this document is to give school districts and individual schools a planning resource to use when creating their school safety plans. Ultimately, schools can decide how much of this document they would like to incorporate into their current plan. The original document was created by the Minnesota Department of Homeland Security, and its use was granted to Iowa Homeland Security in 2011. Iowa pulled together a panel of experts to make this document specific to Iowa’s schools, and laws. It’s important to note the partnership created by this document is intended to continue through information sharing in relation to critical assets, infrastructure protection, and school safety. Iowa Homeland Security is a representative in the Iowa Department of Public Safety, Division of Intelligence Fusion Center. This partnership allows for streamlined information sharing to the critical infrastructure owner/operators across the state. The current plan for information sharing is through the Iowa Homeland Security and Emergency Management, Threat information and Infrastructure Protection Program (TIIPP) to the Iowa Department of Education for processing and dissemination statewide. Depending on the type of information being released it could be specific to a school, district or the education sector statewide.

Gériatrie aux urgences: une sélection de publications récentes [Elderly patients in the emergency department: a selection of some recent publications].

Geriatric patients presenting to the ED are at high risk of mortality as well as of cognitive or functional decline. Thus, ED is an ideal spot for interventions that can improve their outcome. In this article, we summarize six recent studies, regarding the utilization of prognostic evaluation scores in geriatric patients presenting to the ED, adverse drug reactions, the significance of elevated troponin in patients who have remained on the ground after a fall, the rationale of performing head CT in patients without focal neurologic findings after a fall, the ideal treatment of a proximal femoral fracture and the excessive use of urinary catheters in the ED.

Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: a randomized controlled clinical trial.

AIMS: To evaluate the effectiveness of brief alcohol intervention (BAI) in reducing alcohol use among hazardous drinkers treated in the emergency department (ED) after an injury; in addition it tests whether assessment of alcohol use without BAI is sufficient to reduce hazardous drinking. DESIGN: Randomized controlled clinical trial with 12-month follow-up conducted between January 2003 and June 2005. SETTING: Urban academic emergency department (ED) of the Lausanne University Hospital, Lausanne, Switzerland. PARTICIPANTS: A total of 5136 consecutive patients attending ED after an injury completed a seven-item general and a three-item alcohol screen and 1472 (28.7%) were positive for hazardous drinking according to the National Institute on Alcohol Abuse and Addiction definition; of these 987 (67.1%) were randomized into a BAI group (n = 310) or a control group with screening and assessment (n = 342) or a control group with screening only (n = 335) and then a total of 770 patients (78.0%) completed the 12-month follow-up procedures. INTERVENTION: A single 10-15-minute session of standardized BAI conducted by a trained research assistant. MEASUREMENTS: Percentage of participants who have changed to low-risk drinking at follow-up. FINDINGS: Data obtained at 12 months indicated that similar proportions were low-risk drinkers in BAI versus control groups with and without assessment (35.6%, 34.0%, 37.0%, respectively, P = 0.71). Data also indicated similar reductions in drinking frequency, quantity, binge drinking frequency and Alcohol Use Disorders Identification Test (AUDIT) scores across groups. All groups reported similar numbers of days hospitalized and numbers of medical consults in the last 12 months. A model including age groups, gender, AUDIT and injury severity scores indicated that BAI had no influence on the main alcohol use outcome. CONCLUSIONS: This study provides the evidence that a 10-15-minute BAI does not decrease alcohol use and health resource utilization in hazardous drinkers treated in the ED, and demonstrates that commonly found decreases in hazardous alcohol use in control groups cannot be attributed to the baseline alcohol assessment.

Practice guidelines for evaluation of Fever in returning travelers and migrants.

BACKGROUND: Fever upon return from tropical or subtropical regions can be caused by diseases that are rapidly fatal if left untreated. The differential diagnosis is wide. Physicians often lack the necessary knowledge to appropriately take care of such patients. OBJECTIVE: To develop practice guidelines for the initial evaluation of patients presenting with fever upon return from a tropical or subtropical country in order to reduce delays and potential fatal outcomes and to improve knowledge of physicians. TARGET AUDIENCE: Medical personnel, usually physicians, who see the returning patients, primarily in an ambulatory setting or in an emergency department of a hospital and specialists in internal medicine, infectious diseases, and travel medicine. METHOD: A systematic review of the literature--mainly extracted from the National Library of Medicine database--was performed between May 2000 and April 2001, using the keywords fever and/or travel and/or migrant and/or guidelines. Eventually, 250 articles were reviewed. The relevant elements of evidence were used in combination with expert knowledge to construct an algorithm with arborescence flagging the level of specialization required to deal with each situation. The proposed diagnoses and treatment plans are restricted to tropical or subtropical diseases (nonautochthonous diseases). The decision chart is accompanied with a detailed document that provides for each level of the tree the degree of evidence and the grade of recommendation as well as the key points of debate. PARTICIPANTS AND CONSENSUS PROCESS: Besides the 4 authors (2 specialists in travel/tropical medicine, 1 clinical epidemiologist, and 1 resident physician), a panel of 11 European physicians with different levels of expertise on travel medicine reviewed the guidelines. Thereafter, each point of the proposed recommendations was discussed with 15 experts in travel/tropical medicine from various continents. A final version was produced and submitted for evaluation to all participants. CONCLUSION: Although the quality of evidence was limited by the paucity of clinical studies, these guidelines established with the support of a large and highly experienced panel should help physicians to deal with patients coming back from the Tropics with fever.

Agricultural Emergency in Iowa, 1933

This book contains ten articles, originally published as circulars of the Iowa Agricultural Experiment Station dealing with the Iowa Agricultural farm crisis situation in 1932 and 1933.

Preserving the health of ambulance personnel : some preliminary results from a study of pre-hospital emergency interventions

Little is known about the health of ambulance personnel, especially in Switzerland. This lack of knowledge is particularly striking in the specific field of occupational health. This study aims to identify and better understand protective and risk factors affecting the health of ambulance personnel. Both mental and physical health are considered. The approach used comprised two steps. The first step began in July 2008 and consisted in a qualitative study of real work activities performed by ambulance crews involved in pre-hospital emergency interventions. Researchers shadowed ambulance personnel for the duration of their entire work shift, in average for one week. The paper-pen technique was used to note dialogues, interactions, postural aspects, etc. When the situation allowed it, interventions were filmed. Some selected video sequences were used as a support for selfconfrontation interviews. Observations were performed by three researchers and took place in eleven services, for a total of 416 hours of observations (including 72 interventions + waiting time). Analysis, conducted by a multidisciplinary team (an ergonomist, an occupational therapist and a health psychologist), focused on individual and collective strategies used by ambulance personnel to protect their health. The second step, which is currently ongoing, aims to assess global health of ambulance personnel. A questionnaire is used to gather information about musculoskeletal complaints (Nordic questionnaire), mental health (GHQ-12), stress (Effort-Reward imbalance questionnaire), strategies implemented to cope with stress (Brief COPE), and working conditions. Specific items on strategies were developed based on observational data. It will be sent to all ambulance personnel employed in the French-speaking part of Switzerland. Preliminary analyses show different types of strategies used by ambulance personnel to preserve their health. These strategies involve postural aspects (e.g. use doorframe as a support to ease delicate manipulations), work environment adaptations (e.g. move furniture to avoid awkward postures), coping strategies (e.g. humor), as well as organisational (e.g. formal and informal debriefing) and collective (e.g. cooperation) mechanisms. In-depth analysis is still ongoing. However, patient safety and comfort, work environment and available resources appear to influence the choice of strategies ambulance personnel use. As far as possible, the strategies identified will be transformed into educational materials for professional ambulance personnel.

Characteristics of highly frequent users of a Swiss academic emergency department: a retrospective consecutive case series.

OBJECTIVES: The aim of this study was to describe the demographic, social and medical characteristics, and healthcare use of highly frequent users of a university hospital emergency department (ED) in Switzerland. METHODS: A retrospective consecutive case series was performed. We included all highly frequent users, defined as patients attending the ED 12 times or more within a calendar year (1 January 2009 to 31 December 2009). We collected their characteristics and calculated a score of accumulation of risk factors of vulnerability. RESULTS: Highly frequent users comprised 0.1% of ED patients, and they accounted for 0.8% of all ED attendances (23 patients, 425 attendances). Of all highly frequent users, 87% had a primary care practitioner, 82.6% were unemployed, 73.9% were socially isolated, and 60.9% had a mental health or substance use primary diagnosis. One-third had attempted suicide during study period, all of them being women. They were often admitted (24.0% of attendances), and only 8.7% were uninsured. On average, they cumulated 3.3 different risk factors of vulnerability (SD 1.4). CONCLUSION: Highly frequent users of a Swiss academic ED are a highly vulnerable population. They are in poor health and accumulate several risk factors of being even in poorer health. The small number of patients and their high level of insurance coverage make it particularly feasible to design a specific intervention to approach their needs, in close collaboration with their primary care practitioner. Elaboration of the intervention should focus on social reinsertion and risk-reduction strategies with regard to substance use, hospital admissions and suicide.

Els Plans Individualitzats en les regulacions del Departament d’Educació de juny de 2008. Aplicació d’enfocaments multidimensionals en la seva elaboració

Recentment, el Departament d’Educació de la Generalitat de Catalunya ha publicat regulacions sobre els plans individuals per als alumnes considerats més vulnerables. Se n’han determinat els components i les condicions que s’han de donar per al seu inici. Aquest article considera la possibilitat de desenvolupar aquests plans individuals a partir d’enfocaments multidimensionals d’atenció a les necessitats singulars de l’alumnat de les escoles ordinàries, i presenta algunes propostes per abordar aquests procediments des de les perspectives relacionades amb els Plans Educatius Individualitzats en contextos diferents.