When firefighters work in hot conditions, altered immune and inflammatory responses may increase the risk of a cardiac event. The present study aimed to establish the time course of such responses. Forty-two urban firefighters completed a repeat work protocol in a heat chamber (100 ± 5°C). Changes to leukocytes, platelets, TNFα, IL-6, IL-10, LPS and CRP were evaluated immediately post-work and also after 1 and 24 h of rest. Increases in core temperatures were associated with significant increases in leukocytes, platelets and TNFα directly following work. Further, platelets continued to increase at 1 h (+31.2 ± 31.3 × 10(9) l, p < 0.01) and remained elevated at 24 h (+15.9 ± 19.6 × 10(9) l, p < 0.01). Sustained increases in leukocytes and platelets may increase the risk of cardiac events in firefighters when performing repeat work tasks in the heat. This is particularly relevant during multi-day deployments following natural disasters. Practitioner Summary: Firefighters regularly re-enter fire affected buildings or are redeployed to further operational tasks. Should work in the heat lead to sustained immune and inflammatory changes following extended rest periods, incident controllers should plan appropriate work/rest cycles to minimise these changes and any subsequent risks of cardiac events.

Although harmful consumption of alcohol and other drugs (both illicit and pharmaceutical) significantly contribute to global burden of disease, not all harms are captured within existing morbidity data sources. Indeed, harms occurring in the community may be missed or underreported. This paper describes the National Ambulance Surveillance System, a unique Australian system for monitoring and mapping acute harms related to alcohol and other drug consumption. Data are sourced from paramedic electronic patient care records provided by ambulance services from across Australia. Coding occurs in a purpose-built system, by a team of specialised research assistants. Alcohol, and specific illicit and pharmaceutical drugs, rather than broad drug classes, are manually coded and the dataset is reviewed and cleaned prior to analysis. The National Ambulance Surveillance System is an ongoing, dynamic surveillance system of alcohol and other drug-related harms across Australia. The data includes more than 140 output variables per attendance, including individual substances, demographics, temporal, geospatial, and clinical data (e.g., Glasgow Coma Scale score, naloxone provision and response, outcome of attendance). The National Ambulance Surveillance System is an internationally unique population-level surveillance system of acute harms arising from alcohol and other drug consumption. Dissemination of National Ambulance Surveillance System data has been used to inform and evaluate policy approaches and potential points of intervention, as well as guide workforce development

Methods: A handheld GE V-Scan™ with Dual Probe ultra-sound was available for use by physicians in the main medical tent. All treating physicians consented to participate and self-reported their training and proficiency using POCUS. After each use of POCUS, physicians completed a survey recording the indication, scans performed, and impact on diagnosis, management, and disposition of patients. Results: In total, POCUS was used on 28 patients out of the 686 patients seen in the main medical tent. The three most common indications for ultrasound were abdominal pain, gynecological complaints, and dyspnea. POCUS narrowed the differential diagnosis in 64% (18/28) and altered the working diagnosis in 21% (6/28) of patients. It confirmed the management plan in 57% (16/28) and altered it in 39% (11/28) of patients. Use of POCUS reduced the burden on the local healthcare infrastructure in 46% (13/28) of patients and prevented ambulance transport to a higher level of care in 32% (9/28) of patients. Conclusion: Physicians reported that POCUS aided in the diagnosis, management, and disposition of select patients at a remote multi-day mass gathering. POCUS helped to reduce the local healthcare burden caused by hosting a large-scale mass gathering by preventing or altering the urgency of transport to hospital for higher level care or diagnostic imaging. Study/Objective: To present information on an organization of health services and risk preparedness during the 2016 Rio de Janeiro Olympic Games. Background: Mass gatherings of international importance occur frequently in Brazil, especially in Rio de Janeiro. In 2014 and 2016 the country received two global sports events-the 2014 Fifa World Cup, and the 2016 Olympic Games in several Brazilian state capitals and in Rio. These events joined a great contingent of people and demanded the health sector to prepare for reception of incoming participants and visitors. Methods: The 'Prepara Brasil' Project investigated health services preparedness in Rio de Janeiro. A literature-based data collection instrument to assess available health infrastructure, health services and safety risks concerning the 2016 Olympic Games was made available online for spectators in all Olympic events. Filling out the survey form in real time and directly from the sports venues, was voluntary and participation was maximized through snowballing. After the Games data was accrued and analyzed. Results: A total of 61 spectators, 70% of which were university graduates completed the form. Participants attended 26 events in 42 different sports, during 17 of the 19 days of competition. Roughly 45% of respondents clearly identified locations of health services in Olympic venues. Inside the arenas, 17% of respondents could point out health services and health services personnel at a maximum distancing 50 meters or less (.3 mi) from their seats. Half of participants identified emergency exits and escape routes, and 80% considered safety measures in sports venues as strict. According to participants, crowding was obser...

IntroductionPatients seen by ambulance paramedics but not transported to hospital have not previously been studied in Australia. The purpose of this pilot study is to determine the feasibility of telephone interviews to describe and analyse patient factors, and determine short term patient outcomes associated with paramedic no-transport decisions.MethodTwenty (20) patients participated in semi-structured telephone interviews 13-30 days following an episode of care from an Australian urban ambulance service. Data analysis was conducted in two phases; firstly, a quantitative description of the patient characteristics and their outcomes; and secondly, a qualitative analysis using a thematic framework to determine if there were any common themes emerging from the interviews.ResultsOnly three (3) patients refused to participate in the interviews and none were unable to be located. The reasons patients expressed for not accepting transport were varied, though a common factor related to patient expectations of the service provided by paramedics. Patients had poor recall of advice provided by paramedics. All except one patient were successfully diverted from the emergency health system. Overall, patients expressed high satisfaction with their experience.ConclusionThe reasons patients choose for not being transported require further study but appear to be driven by their expectations of the service provided by Paramedics. Telephone interviews are a viable method for collecting data on non-transported ambulance patients.

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