Dwight L. Wilbur,M.D., Named Editor-in-Chief

Alcoholism is a serious matter, especially when alcoholics stop drinking. Within six to eight hours, they may have withdrawal symptoms, which may progress to delirium tremens from 48 to 96 hours after the last drink. Chlordiazepoxide will help ease patients through the withdrawal phase, although it offers no real advantage over paraldehyde. If delirium tremens occurs, giving fluids and correcting depleted electrolytes are most important.     

H EALTH C ARE F ACILITY P REPARATION FOR W EAPONS OF M ASS D ESTRUCTION

Weapons of mass destruction (WMD) are a threat that all health care facilities must be prepared for. Every health care facility is a vital part of the community response system and must be ready to respond. A terrorist attack using WMD can occur in any location, urban or rural. Private vehicles or buses may transport the majority of patients, with only a small percentage arriving by emergency medical services. Most will go to the hospitals closest to the incident, even if this results in overcrowding. Others will go directly to their private physicians' offices or primary hospitals, even if these facilities are not part of the local disaster plan. Most of these victims will not be decontaminated before arrival. If a hospital allows any of these patients in, the staff may become ill from the toxic exposure and the facility may require closure for decontamination. Since the risk is universal, all health care facilities must plan for the care of victims of a WMD incident. They must plan for communications that allow local government to transmit alerts regarding the emergency. Health care facilities must also communicate their status and emergency needs to local officials during the emergency. They must be prepared to establish a single entry control point and attempt to secure all other entrances. They must be able to establish a patient decontamination team from on-duty staff with only a few minutes' notice at any time of the day or night.     

A S URVEY OF F IRST-RESPONDER F IREFIGHTERS ' A TTITUDES,O PINIONS,AND C ONCERNS ABOUT T HEIR A UTOMATED E XTERNAL D EFIBRILLATOR P ROGRAM

Objective. To identify barriers to first-responder automated external defibrillator (AED) use by determining firefighter attitudes, opinions, and concerns about their AED program. Methods. An anonymous survey was mailed to all firefighters in a municipal department that had had first-responder defibrillation for more than two years. A follow-up survey was mailed to all nonrespondents. The survey requested firefighter demographics, comfort and experience with AED, definition of DOA (dead on arrival), and opinion of the program. Results. Of 749 firefighters surveyed, 686 responded (92%). The respondents had an average of 12 ± 8 years of experience; 66% felt very comfortable using the AED and 3% felt very uncomfortable. The respondents had applied an AED to a patient a median of 2 times (range 0–30); 24% had never applied an AED. Eighty-three percent reported they had been on the scene of an out-of-hospital cardiac arrest when their AED was not used for at least one patient. Predominant reasons for not applying an AED included the ambulance arrived “soon enough” (72%), the ambulance arrived first (63%), the patient was DOA (61%), and the patient had a do-not-resuscitate (DNR) order (32%). Eighty-one percent of the respondents correctly listed at least one clinical finding that defines DOA. Ninety-nine percent felt they should continue the AED program. The respondents gave numerous suggestions for improving the program, including being able to visualize the rhythm, increasing their level of care, and improved AED training. Conclusions. Municipal first response firefighters view their AED program favorably despite infrequently applying an AED. The appropriateness of withholding defibrillation because a secondary response unit will arrive “soon enough” should be reviewed. The definition of DOA should be reviewed to ensure that viable patients are not denied defibrillation.