News in Brief

Initiative underway to improve CPR nationwide

Only 46 percent of the more than 350,000 people who experience out-of-hospital cardiac arrest get immediate help before a professional arrives, according to the American Heart Association. To improve these numbers, the National Academies of Medicine conducted the Strategies to Improve Cardiac Arrest Survival: A Time to Act study of the system of response to cardiac arrest in the United States to identify opportunities for increasing patient survival.

One such area of opportunity cited in the report is public safety answering points (PSAPs) and emergency medical services (EMS). The National Highway Traffic Safety Administration’s Office of EMS and National 911 Program, supported by the Health and Human Services EMS for Children Program, consequently, has 911 and EMS stakeholders working to compile and share best practices for responding to cardiac arrest calls.

A team of 20 volunteers representing physicians and emergency medical directors, EMS agency leaders, PSAP leadership, and 911 operations and training managers and providers are working to develop a guide to best practices, training, and implementation guidelines for telephone CPR and High-Performance CPR (HP-CPR) for EMS personnel. The committee will establish a definition for HP-CPR and promote public awareness of the availability of these guidelines when they become available. This committee will convene throughout 2018; resources for PSAPs are expected to be available in the fall. Questions regarding the Dispatcher Assisted CPR project can be directed to nhtsa.national911@dot.gov.

“This effort is essential to our nation’s ability to increase survival rates for sudden cardiac arrest, a leading cause of death in the United States,” says Dr. Ben Bobrow, professor of emergency medicine at the University of Arizona and principal investigator for the project. “This novel initiative translates the latest science into action and unifies 911 and EMS to improve CPR practices to save more lives across the United States.”

Jon Krohmer, M.D., director of NHTSA’s Office of EMS, says representatives from EMS and 911 agencies and associations, as well as telecommunicators and EMS providers, will be asked to review the draft resources and provide input to the volunteer committee.

Additional information is at 911.gov.

9/11 Memorial redesigned to include names of the ill

The 9/11 Memorial & Museum at the World Trade Center recently revealed a proposed new design for the 9/11 Memorial that will honor also those afflicted by 9/11-related life-threatening illnesses. It is estimated that more than 400,000 men and women were exposed to contaminants on 9/11 and during the months-long rescue and recovery operations at Ground Zero. “The 9/11 memorial is evolving to honor those sickened.” Jon Stewart and Alice Greenwald, NEW YORK DAILY NEWS, May 30, 2018. http://www.firefighternation.com/articles/2018/05/design-to-honor-9-11-rescue-recovery-workers-unveiled.html.

Emergency physicians: No such thing as “dry drowning”

In recent months, there has been much press coverage of deaths or near-deaths of children attributed to “dry drowning.” However, according to some medical professionals, there is no such thing as dry drowning. It is a nonmedical and an incorrect term.

Emergency physicians Andrew Schmidt, DO, MPH; Justin Sempsrott, MD; and Seth Collings Hawkins, MD, reported in an article published in a medical journal1 that the highly publicized case of a Texas boy who reportedly died of dry drowning a week after having a wave crash over him while he was playing in shallow water was not true. They reported that an autopsy showed that the boy died of recurrent myocarditis, or an inflammation of the heart muscle. The doctors note that stories with the correct information, unfortunately, were not as prevalent as the original story citing dry drowning, which had caused much concern among parents and the public. Few news stories provided corrected information about the real cause of death, and subsequent social media posts spread more alarm by continuing to offer signs and symptoms of dry drowning.

They explained that dry drowning does not exist and that drowning deaths do not occur from unexpected deterioration days or weeks later with no preceding symptoms.

1. Andrew Schmidt, Justin Sempsrott, Seth Collings Hawkins. Special Report. Emergency Medicine News, 2018; 40 (6): 1 DOI: 10.1097/01.EEM.0000535015.19364.32. Wolters Kluwer Health. “Emergency physicians debunk ‘dry drowning’ myths, highlight drowning risk in older swimmers.” ScienceDaily. ScienceDaily, 6 June 2018. <www.sciencedaily.com/releases/2018/06/180606163050.htm>.

NIH outlines FY2018 research plan for HEAL Initiative

The National Institutes of Health (NIH) has released its research plan for the “Helping to End Addiction Long-term (HEAL) Initiative,” https://www.nih.gov/heal-initiative. The trans-NIH effort was launched in April 2018 “to advance national priorities in addressing the opioid crisis through science.” It focuses on improving treatments for opioid misuse and addiction and enhancing strategies for pain management. The multifaceted program includes preclinical, clinical, drug repurposing, and community-based approaches. https://www.nih.gov/news-events/news-releases/nih-launches-heal-initiative-doubles-funding-accelerate-scientific-solutions-stem-national-opioid-epidemic.

Congress had appropriated $500 million for fiscal year 2018 to augment NIH’s research relative to addiction and pain. Among the components of the FY2018 HEAL research plan are the following:

• Developing of extended-release and longer-acting opioid-use-disorder (OUD) medications and new therapies to counteract opioid-induced respiratory depression.
• Reformulating current medication-assisted treatments (MAT) to promote adherence to recovery programs by Americans on OUD medications.
• Supporting discovery and development of targets for nonaddictive pain management and therapies to treat those targets.
• Collecting data to determine what factors lead acute pain to transition to chronic pain and how to block that transition.
• Partnering with public and private groups to test effective treatments for pain and addiction using HEAL’s clinical trial networks.
• Expanding NIH’s advancing clinical trials in Neonatal Opioid Withdrawal syndrome (ACT NOW) to assess its prevalence and determine best practices for clinical care of infants with this condition.
• Advancing new models of care for OUD and test-integrated, evidence-based interventions within health care and criminal justice settings through the multisite HEALing Communities initiative.

The NIH news release is at: https://www.nih.gov/news-events/news-releases/nih-leadership-outlines-interdisciplinary-fy2018-research-plan-heal-initiative. For additional information, contact NIH News Media Branch, 301-496-5787, <e-mail:nihnmb@mail.nih.gov.

Collins FS, Koroshetz WJ, Volkow ND. Helping to End Addiction Over the Long-term: The Research Plan for the NIH HEAL Initiative <https://jamanetwork.com/journals/jama/fullarticle/2684941>Journal of the American Medical Association DOI: 10.1001/jama.2018.8826.

2017 wildfire season most costly in decades

Researchers at the University of Colorado (CU) at Boulder cited “fuel, aridity, and ignition” as the triggers for one of the largest and costliest U.S. wildfire seasons in recent decades. The 2017 wildfire season cost the United States more than $18 billion in damages; 71,000 wildfires scorched 10 million acres of land, destroyed 12,000 homes, forced 200,000 people to evacuate, and claimed 66 lives. The paper, coauthored by researchers at CU Boulder’s Institute of Arctic and Alpine Research (INSTAAR), Columbia University, and the University of Idaho, was published in the journal Fire.

“Last year, we saw a pile-on of extreme events across large portions of the western U.S.: the wettest winter, the hottest summer, and the driest fall—all helping to promote wildfires,” said lead study author Jennifer Balch, director of CU Boulder’s Earth Lab in the Cooperative Institute for Research in Environmental Sciences (CIRES).

The paper noted the following: 2017’s wet winter acted as the first trigger. The growth of fine grasses across the western United States was accelerated by the increased precipitation early in the year. These grasses were fuel for fire. In addition, the dry, arid conditions of summer and fall “baked the dense fields of grasses into dehydrated kindling” awaiting ignition. Balch’s research found that people were responsible for igniting almost 90 percent of the wildfires last year. Her previous studies showed that “human activity triples the length of the average fire season.”

“We expect to see more fire seasons like we saw last year,” says Megan Cattau, an Earth Lab researcher and a co-author on the study. “Thus, it is becoming increasingly critical that we strengthen our wildfire prediction and warning systems, support suppression and recovery efforts, and develop sustained policies that help us coexist with fire.”

As for the future, the researchers say that “computer climate models project an increased risk of extreme wet winters in California and a decrease in summer precipitation across the entire West Coast.”

Source: https://www.colorado.edu/. Jennifer Balch, Tania Schoennagel, A. Williams, John Abatzoglou, Megan Cattau, Nathan Mietkiewicz, Lise St. Denis. “Switching on the Big Burn of 2017.” Fire, 2018; 1 (1): 17 DOI: 10.3390/fire1010017. University of Colorado at Boulder. “The key triggers of the costly 2017 wildfire season: Series of wildfire factors that culminated in the big burns of 2017.” ScienceDaily. ScienceDaily, 5 June 2018. <www.sciencedaily.com/releases/2018/06/180605103439.htm>.

Stressful jobs associated with risk of heart rhythm disorders

Having a stressful job is associated with a higher risk of the heart rhythm disorder atrial fibrillation, according to the European Journal of Preventive Cardiology, a European Society of Cardiology (ESC) journal.1 The article described the most stressful jobs as “psychologically demanding” and those in which employees have little control over their work situation. Among the jobs cited as examples were assembly line workers, bus drivers, secretaries, and nurses. The study found that being stressed at work was associated with a 48 percent higher risk of atrial fibrillation, after adjustment for age, sex, and education. Atrial fibrillation is the most common heart rhythm disorder. Symptoms include palpitations, weakness, fatigue, light-headedness, dizziness, and shortness of breath. Atrial fibrillation causes 20 to 30 percent of all strokes and increases the risk of dying prematurely.2

Dr. Eleonor Fransson, associate professor of epidemiology, School of Health and Welfare, Jönköping University, Sweden, and study author, noted: “In the general working population in Sweden, employees with stressful jobs were almost 50% more likely to develop atrial fibrillation.” The study included 13,200 participants who were employed and had no history of atrial fibrillation, heart attack, or heart failure. They completed postal surveys on sociodemographics, lifestyle, health, and work-related factors. During a median follow-up of 5.7 years, 145 cases of atrial fibrillation were identified from national registers.  

“Work stress has previously been linked with coronary heart disease,” explains Dr. Fransson. “Work stress should be considered a modifiable risk factor for preventing atrial fibrillation and coronary heart disease. People who feel stressed at work and have palpitations or other symptoms of atrial fibrillation should see their doctor and speak to their employer about improving the situation at work.”

ESC Press Office, e-mail: press@escardio.org.

References

1. Fransson EI, Nordin M, Magnusson Hanson LL, Westerlund H. “Job strain and atrial fibrillation – Results from the Swedish Longitudinal Occupational Survey of Health and meta-analysis of three studies.” European Journal of Preventive Cardiology. 2018. DOI: 10.1177/2047487318777387.

2. Kirchhof P, Benussi S, Kotecha D, et al. “2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.” European Heart Journal. 2016;37:2893–2962.