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Airway management is a controversial topic in modern Emergency Medical Services (EMS) systems. Among many concerns regarding endotracheal intubation (ETI), unrecognized esophageal intubation and observations of unfavorable neurologic outcomes in some studies raise the question of whether alternative airway techniques should be first-line in EMS airway management protocols. Supraglottic airway devices (SADs) are simpler to use, provide reliable oxygenation and ventilation, and may thus be an alternative first-line airway device for paramedics. In 2019, Alachua County Fire Rescue (ACFR; Alachua, Florida USA) introduced a novel protocol for advanced airway management emphasizing first-line use of a second-generation SAD (i-gel) for patients requiring medication-facilitated airway management (referred to as “rapid sequence airway” [RSA] protocol).
This was a one-year quality assurance review of care provided under the RSA protocol looking at compliance and first-pass success rate of first-line SAD use.
Records were obtained from the agency’s electronic medical record (EMR), searching for the use of the RSA protocol, advanced airway devices, or either ketamine or rocuronium. If available, hospital follow-up data regarding patient condition and emergency department (ED) airway exchange were obtained.
During the first year, 33 advanced airway attempts were made under the protocol by 23 paramedics. Overall, compliance with the airway device sequence as specified in the protocol was 72.7%. When ETI was non-compliantly used as first-line airway device, the first-pass success rate was 44.4% compared to 87.5% with adherence to first-line SAD use. All prehospital SADs were exchanged in the ED in a delayed fashion and almost exclusively per physician preference alone. In no case was the SAD exchanged for suspected dislodgement evidenced by lack of capnography.
First-line use of a SAD was associated with a high first-pass attempt success rate in a real-life cohort of prehospital advanced airway encounters. No SAD required emergent exchange upon hospital arrival.
The classical period of Roman law is conventionally taken to have ended in ad 235 with the death of the Emperor Severus Alexander. It is true that the line of independent classical jurists breaks off there. But this was not a collapse but a change of direction. The leading jurists increasingly became involved in the process of imperial law-making; and their works were the constitutions they composed in the name of their emperor. The constitutions of Diocletian in particular (ad 284–305) show that half a century after the end of the classical period the standards of classical jurisprudence had been maintained. But this was not a period in which new original juristic work appeared; instead, the trend was towards the production of anthologies or epitomes of leading classical works. It therefore seems appropriate to refer to the period from about ad 235 to 305 as the ‘epiclassical’ period of Roman law and to date the decisive break between the classical and the post-classical to about ad 300 (Wieacker 1971).
Roman law divided free citizens into two classes: those who were independent (sui iuris) and those who were dependent on someone else (alieni iuris). The Roman family was patriarchal: all power was vested in the paterfamilias, who was the senior living male. So, a child (at least as long as he or she was legitimate) was subject to the power of his or her paterfamilias, whether father, grandfather, or great-grandfather. Paternal power (patria potestas) was lifelong, so that in principle a man who had already become a grandfather might still be subject to his father’s power and become independent only late in life.
The areas discussed in this chapter are distinct in modern legal systems but in Roman law they overlap or shade into one another. The first is crime; the second delict (or ‘tort’ as it is called in some modern systems); and the third the maintenance of public order through regulation and policing.
Chapter 1 dealt with the main sources of Roman private law, in the sense of the formal sources that created it. This chapter is about the use of Roman legal sources by the modern student or scholar. It gives an account of those sources and problems that arise in using them. Nearly all the surviving material of Roman law is transmitted in one or other of the Emperor Justinian’s compilations. The chapter begins with an account of the sources that survive independently of Justinian; it then moves on to the Digest and (very briefly) other parts of the Justinianic compilations. It concludes with a general discussion of the difficulties of trying to write history based on legal sources.
This chapter deals with the main legal issues that arise in connexion with Roman commerce: contract in general; the main commercial contracts: sale, contracts of loan and for security; and contracts for services, such as carriage of goods and building contracts. It then moves on to deal with how Roman businesses may have been organized: what sort of labour they used; and how they attempted to limit their liability. It concludes with the law of insolvency.
The last three chapters were concerned with substantive law: the rules that governed everyday life and its transactions. But, in the end, the question whether a person enjoys a particular right comes down to whether he or she is able to enforce it in practice. This is where the issue of procedure, of litigation, is important. The first section of this chapter gives a sketch of the workings of the various Roman civil procedures in the classical period; to a large extent, this is confined to the bare facts. The second section then attempts to draw out the significance of the procedural rules for the vindication of rights in practice. It also deals briefly with access to the courts and legal representation.
To begin with what is not in this book may seem odd; but that will otherwise remain unknown until the end, which seems unsatisfactory. This is not a comprehensive account of Roman law or even of Roman law in its social setting. It is highly selective. Its focus is on the so-called classical period of Roman law, from about the end of the Roman republic in 31 bc until the death of the Emperor Severus Alexander in ad 235. There is not much here about post-classical law; and there is almost nothing about pre-classical law.
For a basic account of the main institutions of Roman law, B. Nicholas, An Introduction to Roman Law (1962) is clear, elegant, and valuable. Much more recent and on a similar scale is Borkowski’s Textbook on Roman Law (6th ed. by P. du Plessis, 2020) For detailed information, one of the larger textbooks will be necessary. The leading modern account is that of M. Kaser, Das römische Privatrecht (2nd ed., 2 vols, 1971–1975). In English, the leading textbook is by W. W. Buckland, A Textbook on Roman Law (1963), a shade dry but exceptionally reliable and accurate; an alternative is J. A. C. Thomas, Textbook on Roman Law (1976). H. F. Jolowicz and B. Nicholas, Historical Introduction to the Study of Roman Law (1972) approaches the subject historically, and for a historian is probably a good place to start. F. Schulz, Classical Roman Law (1951) is a work by a great scholar that is sometimes idiosyncratic, often provocative, but always interesting. The leading account of Roman law in its social context remains J. A. Crook, Law and Life of Rome (1967).