Despite continued cases of sudden in-custody death in subjects who are restrained, little is understood about the incidence of sudden death, its underlying pathophysiology, or its actual relationship to subject positioning. This paper reports data from 4828 consecutive use of force events (August 2006-March 2013 in 7 Canadian police agencies in 4 cities including Eastern and Western Canada. Methods: Human subjects committee approval was obtained in each city with approval for enrolment of subjects without consent. Consecutive subjects aged >18 years who were involved in a police use of force event were included regardless of the cause or outcome. Officers prospectively documented the final resting position of the subject, whether there was knowledge or suspicion that the subject was intoxicated with alcohol and/or drugs, suffering from emotional distress or any combination of those, the number and nature of a standardized list of features of excited delirium present, and the use of all force modalities alone or in combination. Our outcome of interest was sudden, unexpected in-custody death. Confidence intervals for differences were considered significant if the 95% confidence interval for the difference did not include zero. Assuming an alpha error of 5%, a beta error of 20%, a sample size of 1945 subjects per group gives our study 80% power to detect a difference of 0.5% in sudden death between the prone and not prone position. Results: During the study there were over 3.25 million consecutive police-public interactions; use of force occurred in 4,828 subjects (0.1% of police public interactions; 95% CI = 0.1%, 0.1%). 90% of subjects had complete information on positioning; none of the subjects without documentation of positioning died. Subjects were usually male (87.5%); median age 32 years. Subjects were abnormal with 81.5% of subjects documented to have one or more of alcohol and/or drug intoxication, and/or psychiatric/emotional distress at the scene. Significantly more subjects remained in a non-prone vs. prone position; yet over 2000 subjects remained prone. Although 5.3% more subjects with any assessed comorbidity were in the "not-prone" position, over 1500 with any assessed comorbidity were prone. Significantly more individuals with >3 features of excited delirium were not-prone while significantly more subjects with drug intoxication alone were in prone. There was no difference in CEW deployment in any mode between the positions. One individual died suddenly and unexpectedly; the individual was in the not prone position and exhibited all 10 features of excited delirium. No subject died in the prone position. In a worst case scenario our confidence intervals indicate, with a high degree of precision, that 99.8% of subjects would be expected to survive being in either the prone or notprone position following police use of force. Conclusions: Prone positioning is common following police-public interactions. In this study no subject died among thousands who remained in the prone position after po...

It is important for emergency physicians to be aware of new psychoactive agents being used as recreational drugs. ''Bath salts,'' which include 3,4-methylenedioxypyrovalerone (MDPV), mephedrone, and methylone, are the newest recreational stimulants to appear in Canada. There are currently more than 12 synthetic cathinones marketed as bath salts and used with increasing frequency recreationally. Although these drugs are now illegal in Canada, they are widely available online. We present a case report and discuss bath salts intoxication and its anticipated sympathomimetic toxidrome, treatment strategies, and toxicologic analysis, Treatment should not rely on laboratory confirmation. Since the laboratory identification of such drugs varies by institution and toxicologic assay, physicians should not misconstrue a negative toxicology screen as evidence of no exposure to synthetic cathinones. Illicit bath salts represent an increasing public health concern that involves risk to the user, prehospital personnel, and health care providers. RÉ SUMÉIl est important que les urgentologues connaissent les nouvelles substances psychoactives utilisé es comme drogues à usage ré cré atif. Les «sels de bain», qui contiennent de la 3,4-mé thylè nedioxypyrovalé rone (MDPV), de la mé phé -drone et de la mé thylone, sont les tout derniers stimulants à usage ré cré atif qui ont fait leur entré e au Canada. Il existe actuellement plus d'une douzaine de cathinones synthé -tiques, qui sont vendus comme des sels de bain et qui sont de plus en plus utilisé s à des fins ré cré atives. Bien que ces drogues soient maintenant illicites au Canada, on peut se les procurer facilement en ligne. Il y aura dans l'article un exposé de cas, suivi d'une discussion sur l'intoxication aux «sels de bain», le toxidrome sympathomimé tique pré visible, les straté gies de traitement et les analyses toxicologiques. Le traitement ne devrait pas reposer sur la confirmation des ré sultats des examens de laboratoire. Comme l'identification de ces drogues par les laboratoires varie d'un é tablissement à l'autre et selon les é preuves de dosage toxicologique, les mé decins ne devraient pas interpré ter à tort un test de dé pistage toxicologique né gatif comme un signe d'absence d'exposition à des cathinones synthé tiques. Les sels de bain illicites posent un problè me de santé publique, qui prend de l'ampleur et qui pré sente des risques pour l'utilisateur luimê me, pour le personnel pré hospitalier et pour les fournisseurs de soins de santé .

Emergency medicine (EM) training programs incorporate simulation for teaching as well as formative and summative assessment. The development of a simulation curriculum for Canadian postgraduate EM programs is underway and would be facilitated by a standardized, user-friendly, nationally endorsed simulation template. We convened a nationally representative group of simulation educators to participate in a three-phase process to develop and refine a simulation case template for Canadian EM educators. Participants provided feedback by means of free text comments and focus groups which were analyzed to inform modification of the template. We anticipate that this template will facilitate the sharing of cases across sites and the development of standardized cases for simulation-based assessment.

Free open access medical education (FOAM) resources in emergency medicine (EM) have grown exponentially in recent years. Within this movement, there are relatively few resources dedicated to simulation in EM. EM Sim Cases is a FOAM resource that was started in 2015 with the goal of creating a central database of simulation cases and scholarly articles that could be shared worldwide and thus reduce needless duplication of effort. Since 2015, EM Sim Cases has grown to have an annual average of 8,148 views per month from a total of 161 countries. It has an editorial team of 18 members as well as a leadership team of three. There is a robust, peer-reviewed case bank ranging in topic from neonatal resuscitation to end-of-life care as well as a number of simulation-relevant educational posts.

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