Medical Oversight,Educational Core Content,and Proposed Scopes of Practice of Wilderness EMS Providers: A Joint Project Developed by Wilderness EMS Educators,Medical Directors,and Regulators Using a Delphi Approach

Introduction: A disparity exists between the skills needed to manage patients in wilderness EMS environments and the scopes of practice that are traditionally approved by state EMS regulators. In response, the National Association of EMS Physicians Wilderness EMS Committee led a project to define the educational core content supporting scopes of practice of wilderness EMS providers and the conditions when wilderness EMS providers should be required to have medical oversight. Methods: Using a Delphi process, a group of experts in wilderness EMS, representing educators, medical directors, and regulators, developed model educational core content. This core content is a foundation for wilderness EMS provider scopes of practice and builds on both the National EMS Education Standards and the National EMS Scope of Practice Model. These experts also identified the conditions when oversight is needed for wilderness EMS providers. Results: By consensus, this group of experts identified the educational core content for four unique levels of wilderness EMS providers: Wilderness Emergency Medical Responder (WEMR), Wilderness Emergency Medical Technician (WEMT), Wilderness Advanced Emergency Medical Technician (WAEMT), and Wilderness Paramedic (WParamedic). These levels include specialized skills and techniques pertinent to the operational environment. The skills and techniques increase in complexity with more advanced certification levels, and address the unique circumstances of providing care to patients in the wilderness environment. Furthermore, this group identified that providers having a defined duty to act should be functioning with medical oversight. Conclusion: This group of experts defined the educational core content supporting the specific scopes of practice that each certification level of wilderness EMS provider should have when providing patient care in the wilderness setting. Wilderness EMS providers are, indeed, providing health care and should thus function within defined scopes of practice and with physician medical director oversight.     

Lemierre syndrome in a child with recent pharyngitis

A 14-year-old boy presented with fever and progressive respiratory distress, one week after an episode of pharyngitis. Although there was a concern about pulmonary embolism secondary to a lower extremity fracture, his presentation was most consistent with Lemierre syndrome. This syndrome is an uncommon but potentially lethal complication of otolaryngological infections. Early recognition and aggressive antibiotic therapy are critical elements in reducing mortality. Emergency physicians should be aware of this syndrome because its incidence appears to be increasing.     

Structured exercise does not stabilize cognitive function in individuals with mild cognitive impairment residing in a structured living facility

Exercise has been shown to have positive effects on the brain and cognition in healthy older adults, though no study has directly examined possible cognitive benefits of formal exercise programs in persons with mild cognitive impairment (MCI) living in structured facilities. Thirty-one participants completed neuropsychological testing and measures of cardiovascular fitness at baseline and after 6 months of a structured exercise program that included aerobic and resistance training. While exercise improved cardiovascular fitness in persons with MCI, there was no improvement in cognitive function. Rather, MCI patients in this sample declined in performance on several tests sensitive to Alzheimer's disease. Examined in the context of past work, it appears exercise may be beneficial prior to the onset of MCI, though less helpful after its onset.     

Highly photoluminescent and stable silicon nanocrystals functionalized via microwave-assisted hydrosilylation

Herein, we report a microwave-assisted hydrosilylation (MWH) reaction for the surface passivation of silicon nanocrystals (Si-NCs) with linear alkenes. The MWH reaction requires only 20 minutes and allows us to produce Si-NCs with high photoluminescence quantum yields (PLQYs), reaching 39% with an emission maximum of 860 nm. Furthermore, we investigated the effect of ligand length on the photoluminescence properties of Si-NCs. We tested six alkenes with an even number of carbon atoms (from hexene-1 to hexadecene-1). The highest PLQY combined with a long stability (test period of 6 months) was observed when capping with the shortest ligand, hexene-1. The use of microwave heating turns the hydrosilylation step into a facile and sustainable process. In order to provide insight into the emissive properties of Si-NCs surface oxidation and luminescence decay were investigated using Fourier-transform infrared spectroscopy and time-resolved photoluminescence measurements.

Herein, we report a microwave-assisted hydrosilylation (MWH) reaction for the surface passivation of silicon nanocrystals (Si-NCs) with linear alkenes.