What is the occupational risk to emergency care providers from the human immunodeficiency virus?

Three-rescuer CPR: the method of choice for firefighter CPR?

STUDY OBJECTIVE

To compare the quality of CPR provided by firefighters performing three-rescuer CPR with that achieved by firefighters trained to provide standard two-rescuer CPR.

DESIGN

Eight months after training a large number of firefighters to perform three-rescuer CPR, we used a quasi-experimental design to compare the performance of a randomly selected subset of these companies to that achieved by a control group of engine companies that received refresher training in standard two-rescuer CPR. Both groups used bag-valve masks to provide rescue ventilations. Testing was conducted on a no-notice basis with a recording mannequin. Key actions were scored by an experienced observer using explicit pass-fail criteria. Mannequin-generated strip charts were used to calculate the rate and depth of chest compressions and the ventilatory rate, volume, and minute ventilation in a blinded manner.

SETTING

Fire stations of the Memphis Fire Department. The department is the sole provider of first-responder emergency care to the citizens of Memphis, Tennessee (population, 610,000).

RESULTS

Three-rescuer teams delivered a mean minute ventilation substantially greater than that produced by two-rescuer teams (7.7 +/- 5.3 L versus 4.9 +/- 4.2 L, P < .001). Intergroup differences in the mean depth of chest compressions were less marked, but they were still significant (17.2 +/- 8.3 mm of recorder-needle deflection versus 13.7 +/- 7.0 mm, P < .001).

CONCLUSION

Three rescuers can produce better CPR than two when a bag-valve-mask device is used. The technique is easily learned and readily retained.

An analysis of emergency physicians' cumulative career risk of HIV infection

STUDY OBJECTIVE

To determine point and range estimates of the cumulative career risk of occupationally acquired human immunodeficiency virus (HIV) infection by emergency physicians as well as to determine if the efficacy of universal precautions was seriously diminished by prolonged risk over time.

DESIGN

Monte Carlo estimation of a mathematical model of cumulative risk. Eight scenarios were estimated for high versus low prevalence of HIV, no precautions versus universal precautions, and prevalence increasing to a steady state versus peaking and then declining.

MEASUREMENTS AND MAIN RESULTS

For high-prevalence areas, not using universal precautions, and assuming HIV seroprevalence increases to a steady-state level, the median estimate of cumulative risk of HIV infection over a 30-year career was 1.4% (90% of tolerance range, 0.2% to 14.0%); for low-prevalence emergency departments, the median was 0.1% (0.001% to 3.6%). Universal precautions with a presumed effectiveness of approximately 40% resulted in an approximate 30% decrease in risk.

CONCLUSIONS

Although the per-exposure risk is small, the cumulative risk of HIV infection may be disproportionately large. The efficacy of universal precautions does not appear to be substantially diminished over time.

Can AIDS be prevented after injury with contaminated instruments?

Particulate matter comparable in size with that of human immunodeficiency virus was subcutaneously injected into experimental animals. Such matter remained at the inoculation site long enough to suggest the possibility that human immunodeficiency virus can be destroyed in loco before it invades the host's circulation. These findings may be useful in developing a method to prevent acquired immunodeficiency syndrome after accidental injury with human immunodeficiency virus-contaminated instruments.