EURECA (European Underground Rare Event Calorimeter Array) is an astro-particle physics facility aiming to directly detect galactic dark matter. The Laboratoire Souterrain de Modane has been selected as host laboratory. The EURECA collaboration unites CRESST, EDELWEISS and the Spanish-French experiment ROSEBUD, thus concentrating and focussing effort on cryogenic detector research in Europe into a single facility. EURECA will use a target mass of up to one ton, enough to explore WIMP – nucleon scalar scattering cross sections in the region of 10-9 – 10-10 picobarn. A major advantage of EURECA is the planned use of more than just one target material (multi target experiment for WIMP identification).

We performed a retrospective review of the charts of 252 adult, non-traumatic, prehospital cardiac arrest patients treated over a one-year period in order to assess the effectiveness of intravenous (IV) and endotracheal (ET) administration of epinephrine (0.5–1.0 mg) (EPI) in assisting restoration of a spontaneous pulse. Patients initially receiving IV-EPI were more likely to develop a spontaneous pulse earlier than those receiving a similar dose ET (7.3% vs 0.9%; p<0.01. In those patients who received a second dose of EPI, six (2.9%) regained a spontaneous pulse; each had been treated previously with IV-EPI. None who required a third dose of EPI regained a spontaneous pulse. In total, only five (2%) patients survived to discharge. We conclude that, in our system, patients who receive the currently recommended dose of EPI to treat cardiac arrest have a poor prognosis, and that IV-EPI is associated with a higher incidence of return of a spontaneous pulse compared to those treated ET.

The Society of Teachers of Emergency Medicine's, EMS Educators Committee performed a mail survey of emergency medicine residency training directors regarding their curricula for EMS. The Committee was interested in determining the quality and quantity of EMS training in emergency medicine residencies. Out of 66 programs, 48 responded (73%). The programs reported that they provide medical control for a mean of 4837 calls per year (range 0–20,000) and interact with a mean of eight EMS agencies. Ten programs (21%) do not offer any formal EMS administrative experience, while 42 (87%) programs require residents to participate in paramedic training, and 31 (65%) require participation in EMT training. Both the type and the amount of “in-field” experience reported by programs varied considerably, with some programs offering it only as an elective. Similarly, there was great diversity in the type and amount of experience with helicopter ambulances. In conclusion, there is wide disparity among the offerings from all residency programs. Each training program must evaluate its own EMS curricula and expand it to fill existing gaps. Specific topics to be covered are suggested.

Transcutaneous cardiac pacing (TCP) is a promisingprehospital intervention, but there are little data available regarding protocols to improve patient tolerance to TCP. A 50:50 nitrous oxide:oxygen analgesic mixture aho is a commonly employed prehospital intervention. In this randomized, prospective study, we compared the discomfort experienced by 18 healthy subjects when paced in two triah at the capture threshold: one following breathing of a 50:50 nitrous oxide:oxygen mixture; and the second breathing only room air. Discomfort was rated on an analog scale from 1 (minimal discomfort) to 10 (severe pain). Of the 18 subjects, 15 (83%) reported that nitrous oxide improved the tolerance to pacing at capture threshold. The median pain scores at capture threshold in the nitrous oxide and room air group were 3.8 and 5.0 respectively (P<.05). Nine of the subjects tolerated TCP for the maximum allotted time of 30 seconds in each trial; six tolerated TCP for a longer time period in the nitrous oxide trial; three tolerated TCP longer in the room air trial. These data suggest that inhalation of a 50:50 nitrous oxide:oxygen mixture may improve tolerance to TCP in the conscious patient.

Verification of endotracheal tube (ETT) location in prehospital setting and the emergency department (ED) is a challenging task. Unrecognized esophageal intubations with potentially dangerous consequences may occur more frequently in these environments than in less hectic settings. To evaluate the capabilities of a portable, non-directable, fiberoptic bronchoscope (Visicath; Saratoga Medical, Saratoga, Calif., USA) to detect appropriate ETT placement, a prospective series of 22 intubated prehospital, air-medical, or ED patients underwent fiberoptic verification (FOV) of a newly placed ETT. Each patient was intubated under urgent circumstances. The time required for FOV, ETT location, the relative difficulty of intubation, and the changes in management as a result of FOV were recorded. A total of 24 FOVs were performed, twenty-one tracheal (88%), and two esophageal (8%) intubations were identified. Position could not be identified in one case (4%). FOV confirmed placement in 23 intubations (96%) in less than 25 seconds. Seven intubations (29%) were judged to be “difficult.” FOV resulted in five minor changes in management (22%) and was the sole confirmation method for five intubations. We conclude that fiberoptic verification is a promising method of ETT position in air-medical and ED intubations.

The accuracy of the glucose reagent strip, Chemstrip bG, for the determination of the presence of hypoglycemia, euglycemia, or hyperglycemia was assessed in the prehospital setting when used by paramedics treating patients with an altered level of consciousness. Venous blood specimens were obtained from each of sixty-two patients. Serum glucose levels of the sample were determined by paramedics in the field using the Chemstrip bG and within three hours after sample acquisition by standard laboratory techniques. The sensitivity and specificity of detecting true hypoglycemia (serum glucose<61 mg/dl) using the field reagent strips were 100% and 83.3% respectively. The corresponding 95% lower limits of confidence (LLC) were 81.3% and 83 .3%. The sensitivity and specificity of field detection of the absence of hypoglycemia (serum glucose ≥ 61 mg/dl) were 86.6 % (LLC=80.9%) and 100% (LLC=81.3%) respectively. The accuracy of the reagent strips is specific but not sensitive for the determination of the presence of hyperglycemia (serum glucose > 179 mg/dl). Thus, the Chemstrip bG is an accurate means for the rapid identification of the presence or absence of hypoglycemia in the field setting by paramedics.

Transcutaneous Pacing (TCP) is a rapidly applied “non-invasive” technique that can be used successfully in the hospital, emergency department or field setting (1–9). Although the technique has been studied for three decades (7), it is only in the last few years that commercial units have been widely available. Improvements in pad design (particularly the development of non-metallic electrodes) and pulse characteristics (a pulse width of greater than 20 msec.) have allowed the development of units which may provide high capture rates with a level of discomfort which is tolerable in the conscious patient. Transcutaneous pacing may obviate the need for emergency transvenous pacing; further, it is easily adaptable to the field setting although early application appears to be needed for success (1,2).

No study has compared the relative effectiveness of different TCP units, and there are no published data on some of the devices. The purpose of this investigation was to compare the functions of five different external pacemaker units on ten volunteers, in order to determine: 1) what percent of subjects could be captured within the limits of tolerability (the capture rate); 2) how much current was required by each unit to capture (the capture threshold); and 3) the degree of discomfort produced by each pacemaker at the capture threshold.