Aims: The management of cardiac arrest is based on international guidelines which, in particular, define a specific adrenaline administration scheme. However, among physicians practicing pre-hospital emergency medicine, significant inter-individual variations in the use of adrenaline have been observed. The aim of this study was to identify the factors underlying this failure to conform to guidelines. Procedure: We have conducted a prospective, qualitative, multi-center study and held individual semi-structured interviews with emergency physicians. Following transcription, a thematic analysis of the interviews was performed. Results: Thirteen interviews were conducted. Failure to observe adrenaline administration guidelines was observed in 7 interviewed practitioners. The interviewees tended to explain these deviations by their desire to enhance the chances of successful resuscitation (leading them to increase the dose of the adrenaline boluses) or, at the end of resuscitation, to empty the syringe of adrenaline, administering a final bolus considered to be the patient's "last chance". Patient weight, co-morbidities and age could also lead to dosage adjustments, as could some factors inherent to practitioners such as their level of knowledge of the latest recommendations or their personal habits. Conclusion: There is significant variability in the use of adrenaline by emergency physicians in the pre-hospital management of cardiac arrest. These gaps in practice require the implementation of measures intended to promote observance of scientific guidelines.

Objectif : La prise en charge de l’arrêt cardiaque repose sur des recommandations internationales définissant notamment un schéma précis d’administration d’adrénaline. Chez les médecins exerçant la médecine d’urgence préhospitalière, il existe pourtant d’importantes variabilités interindividuelles concernant l’usage de l’adrénaline. L’objectif de cette étude était d’identifier les facteurs à l’origine du nonrespect des recommandations. Matériel et méthodes : Nous avons mené une étude qualitative prospective et multicentrique fondée sur des entretiens individuels semi-structurés auprès de médecins urgentistes. Après retranscription, ils ont fait l’objet d’une analyse thématique par le premier auteur. Résultats : Treize entretiens ont été menés. Ils ont permis de conclure qu’un non-respect des recommandations concernant l’administration de l’adrénaline était retrouvé chez sept médecins. Les interviewés expliquaient essentiellement ces écarts par une volonté de majorer les chances de succès de la réanimation (ce qui les conduisait à augmenter la posologie), ou bien en fin de réanimation, à vider la seringue d’adrénaline afin d’administrer un bolus final considéré comme la « dernière chance » pour le patient. Le poids du patient, les comorbidités et l’âge pouvaient également conduire à ajuster la posologie, tout comme le souhait de mettre en oeuvre une « réanimation d’attente », le niveau de connaissance des dernières recommandations par les praticiens ou leurs habitudes personnelles. Conclusion : Il existe, chez les médecins urgentistes, une importante variabilité dans l’usage de l’adrénaline lors de la prise en charge préhospitalière de l’arrêt cardiaque. Ces écarts de pratique imposent la mise en oeuvre de mesures destinées à favoriser le respect des recommandations scientifiques.

Les ambulances de réanimation des Smur, encore appelées UMH (Unité mobile hospitalière), assurent le transport de patients potentiellement très sensibles aux infections. Or, la pratique extrahospitalière de l’urgence expose les cellules sanitaires à des sources de contamination multiples. Notre étude a pour objectif d’évaluer l’efficacité des procédures d’entretien de la cellule sanitaire à travers l’étude de la flore microbienne.

BACKGROUND:Patient's triage is a key element of mass-casualty incidents (MCIs) response, although performance of healthcare professionals in triage proved to be poor. It was assessed if specific teaching methods based on pattern recognition skill development can help healthcare students to improve their performance in triage.METHODS:128 medical and nursing students have been assessed while performing triage during disaster medicine exercises. Half of them (group 1) had previously been involved in a standard curriculum. The remaining half (group 2) benefited from specific teaching methods based on pattern recognition skill development.RESULTS:Performance of group 2 was significantly higher compared with group 1 (p<0.01). Group 2 had a lower overtriage rate.CONCLUSIONS:Disaster medicine courses based on pattern recognition skill development improve triage performance of healthcare students during simulated MCI. This study may have a high impact on healthcare students and professionals' education in the perspective of MCIs preparedness and response.

Although endocrine-disrupting chemicals (EDCs, including pesticides) are thought to increase the risk of hypospadias, no compounds have been formally identified in this context. Human studies may now be possible via the assessment of meconium as a marker of chronic prenatal exposure. The objective of the present study was to determine whether or not prenatal exposure to pesticides (as detected in meconium) constitutes a risk factor for isolated hypospadias. In a case-control study performed between 2011 and 2014 in northern France, male newborns with isolated hypospadias (n = 25) were matched at birth with controls (n = 58). Newborns with obvious genetic or hormonal anomalies, undescended testis, micropenis, a congenital syndrome or a family history of hypospadias were not included. Neonatal and parental data were collected. Foetal exposure was assessed by determining the meconium concentrations of the pesticides or metabolites (organophosphates, carbamates, phenylurea, and phenoxyherbicides) most commonly used in the region. Risk factors were assessed in a multivariate analysis. The pesticides most commonly detected in meconium were organophosphates (in up to 98.6% of samples, depending on the substance) and phenylurea (>85.5%). A multivariate analysis revealed an association between isolated hypospadias and the presence in meconium of the phenylurea herbicide isoproturon and of the phenoxyherbicide 2-methyl-4-chlorophenoxyacetic acid (odds ratio [95% confidence interval]: 5.94 [1.03–34.11] and 4.75 [1.20–18.76]) respectively). We conclude that prenatal exposure to these two herbicides (as assessed by meconium analysis) was correlated with the occurrence of isolated hypospadias. The results of our case-control study (i) suggest that prenatal exposure to pesticides interferes with the development of the male genitalia, and (ii) emphasize the importance of preventing pregnant women from being exposed to EDCs in general and pesticides in particular.

s 16th World Congress on Disaster and Emergency Medicine s49 increase in insurance fines. The insurance experts affirm that the number of accidents resulting in material damages is inversely proportional to the driver's age. The inexperience of the young paramedic results in crashes, additionally endangering the patient that the vehicle is transporting. Another aspect that complicates the problem is proving that the damaged emergency vehicle is not juridically responsible. In spite of repeated orders given to the paramedics regarding their driving technique; the number of accidents has not decreased. Two years ago, drive data recorders (DDR) were installed in ambulance. The DDRs are linked by WiFi by the car key. Each paramedic is identified by his/her key. Each key is recovered once a week and a software program is used to detect problems. Data are compiled for the speed, the beacons, the sirens, and the geographical position of the ambulance, in real time. This information has been made available by the judicial processes. Since the implementation of the DDRs, the number of ambulance road crashes and complaints has decreased. Of the 4.7 ambulance crashes each year (prior to the implementation), the number of incidents has decreased to 0.6. After one-year period of adaptation, the paramedics accepted the principle, particularly because it protects them from the risks of false declarations of contravening. Hopefully, the number of accidents will decrease due to this system.

Results: Data were obtained from January 2006 to December 2007. Of 20 eligible months, 25,549 trauma patients presented to the emergency department. A total of 5,168 (20.2%) sustained head trauma, and 3,336 head CTs were performed with a 29.1% positive rate of substantial head injuries. The mean rate of missed head injuries among different physicians was 4.8% (range: 3.6-5.7%,p = 0.78). The monthly data were analyzed and a moderate correlation between monthly trauma volume and the decrease in positive rate of head CTs was identified (Pearson r = -0.511, p <0.05). By introducing different cut-point values of trauma volume, the threshold of trauma census in discriminating the significant decrease of positive head CTs was identified. Conclusions: The findings imply that the head CT scans might have been misused in the overcrowded setting, despite the fact that there is a standard guideline justifying its use. This phenomenon also warrants future studies focusing on the quality of care indicators regarding unnecessary examinations and the overall cost-effectiveness analysis.