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An innovative approach to orotracheal intubations: the Alexandrou Angle of Intubation position

Alexandrou, Nikolaos A; Yeh, Benson; Barbara, Paul; Leber, Mark; Marshall, Lewis W
Visualization of the vocal cords is paramount during orotracheal intubations. We employed a novel patient position in this derivation study. The Alexandrou Angle of Intubation (AAI) position is defined as a 20°-30° incline where the supine patient's head is elevated in relation to the body and legs. Our study participants were blinded to the goals of the research as well as our novel technique. Using intubation manikins, our participants ranked their preference for visualizing the vocal cords between the Flat, Trendelenburg, and AAI positions. A majority (58.8%) of our study participants preferred the AAI for visualizing the vocal cords over the other two positions. Future studies will reveal whether AAI will play a significant role in emergent airway management.
PMID: 18829206
ISSN: 0736-4679
CID: 2897392

Federal and state public health authority and mandatory vaccination: is Jacobson v Massachusetts still valid?

Marshall, Lewis W; Marshall, Brenda L; Valladares, Glenn
Novel H1N1 influenza virus infected more than 43,000 people, killed 353 and spread to more than 122 countries within a few months. The World Health Organization declared a stage 6 worldwide pandemic. Healthcare workers and hospitals prepared for the worst. Federal and State regulations provided the legal framework to allow for the preparation and planning for a pandemic. One State had mandated both seasonal and Novel H1N1 vaccination of all healthcare workers in an effort to reduce transmission of influenza in healthcare facilities. The US Supreme Court decided in 1905 that the police power of the State permitted a State Department of Health the leeway to mandate vaccination in the face of a contagious disease. Law suits were filed, and a temporary injunction barring mandatory vaccination was entered by the court. While awaiting a court hearing, the mandatory vaccination regulation was rescinded because of the shortage of both seasonal and H1N1 vaccine. Based on the current state of the pandemic and the shortage of vaccination, it is possible that the US Supreme Court would uphold mandatory vaccination in a pandemic.
PMID: 20496643
ISSN: 1932-149x
CID: 2897382

Dead bodies, disasters, and the myths about them: is public health law misinformed?

Gionis, Thomas A; Wecht, Cyril H; Marshall, Lewis W; Hagigi, Fred A
While the mission of public health is to fulfill society's interest in ensuring a healthy society as "public health is what we, as a society, do collectively to assure the conditions for people to be healthy," the mission of public health law is to assist in the creation of those conditions. However, at times of disaster, threats or risks caused by dead bodies often cause dramatic media coverage and public panic, which incite the passage of emergency public health laws. The unfortunate result of such emergency public health laws mandating immediate dead body disposal, often through mass burial, is that proper identification of the deceased is severely hampered, and families are frequently precluded from experiencing the grieving process and are unable to bring closure to such a traumatic event. Are such emergency public health laws misinformed? Are the threats of dead bodies of disasters a threat to the public's health? Are the perceived public health threats of dead bodies merely a myth-or is their cause for justified concern? Such a rush to burial not only may add to the psychological distress of survivors but it also forbids them the opportunity of seeing their loved ones being treated with dignity and respect. Additional consequence of "emergency" mass burial legislation without proper identification include legal problems associated with inheritance, life insurance, remarriage of spouses, parenting of surviving children, and even the threat of diplomatic tensions between nation states resulting from burial of foreign tourists. Disaster medicine specialists are often called upon to comment to the media, advise governmental agencies, and console families, as to the disposition of dead bodies and to the existence of any public health threats caused by the accumulation of human cadavers. Because disaster medicine specialists play a vital role in preserving the public's health, and because public fears of spread of infectious disease often escalate paralleling the accumulation of dead bodies, disaster medicine specialists must be properly informed of the epidemiologic risks and public health issues that dead bodies of disasters may pose. The purpose of this article is to provide a foundation for disaster medicine specialists in properly advising governments, the public, media, and families regarding the risks and fears concerning the health hazards of human cadavers resulting from disasters.
PMID: 18488831
ISSN: 1932-149x
CID: 2897412

Pediatric nerve agent poisoning: medical and operational considerations for emergency medical services in a large American city

Foltin, George; Tunik, Michael; Curran, Jennifer; Marshall, Lewis; Bove, Joseph; van Amerongen, Robert; Cherson, Allen; Langsam, Yedidyah; Kaufman, Bradley; Asaeda, Glenn; Gonzalez, Dario; Cooper, Arthur
Most published recommendations for treatment of pediatric nerve agent poisoning are based on standard resuscitation doses for these agents. However, certain medical and operational concerns suggest that an alternative approach may be warranted for treatment of children by emergency medical personnel after mass chemical events. (1) There is evidence both that suprapharmacological doses may be warranted and that side effects from antidote overdosage can be tolerated. (2) There is concern that many emergency medical personnel will have difficulty determining both the age of the child and the severity of the symptoms. Therefore, the Regional Emergency Medical Advisory Committee of New York City and the Fire Department, City of New York, Bureau of Emergency Medical Services, in collaboration with the Center for Pediatric Emergency Medicine of the New York University School of Medicine and the Bellevue Hospital Center, have developed a pediatric nerve agent antidote dosing schedule that addresses these considerations. These doses are comparable to those being administered to adults with severe symptoms and within limits deemed tolerable after inadvertent nerve agent overdose in children. We conclude that the above approach is likely a safe and effective alternative to weight-based dosing of children, which will be nearly impossible to attain under field conditions
PMID: 16651913
ISSN: 1535-1815
CID: 68933