Paramedics may delay transport of patients with potential cardiac ischemia. Deviations from protocol occur frequently and the care documented for prehospital patients with chest pain is variable. The expected care described by written protocols does not correlate with the treatment documented.

Abstract. Objective: To determine the accuracy of police reports (PRs), ambulance reports (ARs), and emergency department records (EDRs) in describing motor vehicle crash (MVC) characteristics when compared with an investigation performed by an experienced crash investigator trained in impact biomechanics. Methods: This was a cross-sectional, observational study. Ninety-one patients transported by ambulance to a university emergency department (ED) directly from the scene of an MVC from August 1997 to April 1998 were enrolled. Potential patients were identified from the ED log and consent was obtained to investigate the crash vehicle. Data describing MVC characteristics were abstracted from the PR, AR, and medical record. Variables of interest included restraint use (RU), air bag deployment (AD), and type of impact (TI). Agreements between the variables and the independent crash investigation were compared using kappa. Interrater reliability was determined using kappa by comparing a random sample of 20 abstracted reports for each data source with the originally abstracted data. Results: Agreement using kappa between the crash investigation and each data source was 0.588 (95% CI = 0.508 to 0.667) for the PR, 0.330 (95% CI = 0.252 to 0.407) for the AR, and 0.492 (95% CI = 0.413 to 0.572) for the EDR. Variable agreement was 0.239 (95% CI = 0.164 to 0.314) for RU, 0.350 (95% CI = 0.268 to 0.432) for AD, and 0.631 (95% = 0.563 to 0.698) for TI. Interrater reliability was excellent (kappa > 0.8) for all data sources. Conclusions: The strength of the agreement between the independent crash investigation and the data sources that were measured by kappa was fair to moderate, indicating inaccuracies. This presents ramifications for researchers and necessitates consideration of the validity and accuracy of crash characteristics contained in these data sources.

IIn a recent publication Carr and Sollner 1 have reported on the water uptake and the swelling of collodion membranes in water and solutions of strong inorganic electrolytes. They determined the weight and volume changes of collodion membranes when placed in water and when transferred from water to solutions of strong electrolytes. It was found that dried collodion membranes swell reversibly to an appreciable extent when placed in water, the swelling varying from 5 to 11 per cent depending on the brand of collodion. The water uptake as determined by the weight increase is larger than could be accounted for by the volume increase, swelling accounting for only 60 to 70 per cent of the water taken up by the membranes. When the "water-wetted dried" collodion membranes were transferred from water to solutions of various strong electrolytes, there was no detectable change in volume. Similarly, when "porous" membranes were transferred from water to solutions of strong electrolytes, there was no significant volume change.Without giving further details, Carr and Sollner I stated that the problem of water uptake and swelling of collodion membranes is more complex in aqueous solutions of many organic compounds. This is of interest in view of the fact that the permeability of collodion membranes to various organic substances in aqueous solutions was found by several investigators to be anomalously high.Michaelis and Fujita 2 reported that strychnine, quinine, and other alkaloid cations penetrate dried collodion membranes with approximately the same ease as do sodium ions, which undoubtedly are much smaller.Collander, s measuring the relative permeability of about thirty organic nonelectrolytes and weakly dissociated compounds, mostly acids, found that with a few exceptions the permeability decreased regularly with increasing molecular 1

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