Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 30 Dec 1999 16:55:16 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 30 Dec 1999 16:54:44 -0500 (EST) Received: via switchmail; Thu, 30 Dec 1999 16:54:44 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 30 Dec 1999 16:53:46 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 30 Dec 1999 16:52:41 -0500 (EST) Received: from quint.somtel.com (Quint.somtel.com [206.139.114.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 30 Dec 1999 16:52:38 -0500 (EST) Received: from oemcomputer (dialup-na-8.somtel.com [216.227.178.28]) by quint.somtel.com (8.8.5/8.8.5) with SMTP id QAA28722; Thu, 30 Dec 1999 16:52:35 -0500 Message-ID: <000a01bf5310$e443e460$1cb2e3d8@oemcomputer> From: "James Bender" To: , , "gillian Salton" , "Jeff Capobianco" , "John James Griffin" , "Kirsten Bender" , "Larry Gellman" , , "Matt Russell" , "Matt Sholl" , "Michael Campbell" , "Paul Morton" , "Ted Curcio" , "Timothy E. Burdick" Subject: W-EMED Our web site is updated Date: Thu, 30 Dec 1999 16:57:36 -0500 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_0007_01BF52E6.F8E0C8E0" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2615.200 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2615.200 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 570950016 0 1 P38C10.CNM This is a multi-part message in MIME format. ------=_NextPart_000_0007_01BF52E6.F8E0C8E0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Hello everyone, This is James in Maine, with the dissapointing snow fall. I have = finished updating the MATI website if anyone is interested. More = updates will come weekly now that I am done with the majority of my = college classes. www.mati-online.org James ------=_NextPart_000_0007_01BF52E6.F8E0C8E0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Hello everyone,
 
This is James in Maine, with the = dissapointing snow=20 fall.  I have finished updating the MATI website if anyone is=20 interested.  More updates will come weekly now that I am done with = the=20 majority of my college classes.
 
www.mati-online.org
 
James
------=_NextPart_000_0007_01BF52E6.F8E0C8E0-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 30 Dec 1999 21:22:22 -0500 (EST) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 30 Dec 1999 21:21:48 -0500 (EST) Received: via switchmail; Thu, 30 Dec 1999 21:21:48 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 30 Dec 1999 21:21:39 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 30 Dec 1999 21:21:05 -0500 (EST) Received: from hotmail.com (f313.hotmail.com [207.82.251.226]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 30 Dec 1999 21:21:02 -0500 (EST) Received: (qmail 58555 invoked by uid 0); 31 Dec 1999 02:20:31 -0000 Message-ID: <19991231022031.58554.qmail@hotmail.com> Received: from 206.172.255.49 by www.hotmail.com with HTTP; Thu, 30 Dec 1999 18:20:31 PST X-Originating-IP: [206.172.255.49] From: "Mike Webster" To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Wilderness EMT refresher/recert Date: Thu, 30 Dec 1999 19:20:31 MST Mime-Version: 1.0 Content-Type: text/plain; format=flowed Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P5B930.CNM ----Original Message Follows---- From: Bernie Roche Reply-To: wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Wilderness EMT refresher/recert Date: Wed, 29 Dec 1999 02:30:42 -0600 At 07:21 PM 12/28/99 -0800, you wrote: >I am looking for a W-EMT refresher/recert course. I live in Toronto, >Ontario in Canada and would like something in Ontario or one of the >states boardering/near to Ontario. Can anyone help me ??? > >You can email me directly at shannon@artraining.on.ca Hi: I don't know of any courses closer than those in Pennsylvania. I wouold suggest you might like to consider car-pooling with us to the next one. If this would help, e-mail me back. I'm also in Toronto, by the way Best Wishes, Bernie Roche, RN, BScN, W-EMT, OSJ WEMSI Web Site Administrator Hi: For anyone else that is interested Wilderness Medical Associates does a WEMT upgrade in Ontario. I believe a date is set for March of 2000 near the Toronto area. For details, location, etc. phone 1-877-945-3633 or 1-905-304-4442. Ask for Len James. Sincerely, Mike Webster WEMT (Barrie, Ontario, Canada) ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 29 Dec 1999 11:45:06 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Dec 1999 11:12:33 -0500 (EST) Received: via switchmail; Wed, 29 Dec 1999 11:12:33 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Dec 1999 11:11:33 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Dec 1999 11:10:46 -0500 (EST) Received: from mailhub.Dartmouth.EDU (mailhub.dartmouth.edu [129.170.16.6]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Dec 1999 11:10:42 -0500 (EST) Received: from donner.Dartmouth.EDU (donner.dartmouth.edu [129.170.208.3]) by mailhub.Dartmouth.EDU (8.9.3+DND/8.9.3) with ESMTP id LAA11372 for ; Wed, 29 Dec 1999 11:09:11 -0500 (EST) Message-id: <30790955@donner.Dartmouth.EDU> Date: 29 Dec 1999 11:10:41 EST From: Timothy.E.Burdick@Dartmouth.EDU (Timothy E. Burdick) Subject: Re: W-EMED Wilderness EMT refresher/recert To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset=iso-8859-1 Content-Disposition: inline Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by list.srv.cis.pitt.edu id LAA05636 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P0F4C0.CNM --- You wrote: I am looking for a W-EMT refresher/recert course. --- end of quote --- Nothing specific for you, but if you can find 10+ people interested, MATI might be able to do a contract W-EMT course for you in Toronto. Details avaliable at www.mati-online.org or email me back with questions. (If the sit is down for updating, try again in a few days.) Good luck, tim ---------- Tim Burdick, MATI Instuctor Moutain Aid Training International, INC www.mati-online.org timmer@dartmouth.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 29 Dec 1999 02:29:36 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Dec 1999 02:29:04 -0500 (EST) Received: via switchmail; Wed, 29 Dec 1999 02:29:04 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Dec 1999 02:27:58 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Dec 1999 02:27:26 -0500 (EST) Received: from titan.tcn.net (root@titan.tcn.net [199.166.4.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Dec 1999 02:27:23 -0500 (EST) Received: from Two (comp11.tcn.net [209.135.79.11]) by titan.tcn.net (8.8.5/8.6.9) with SMTP id CAA01816 for ; Wed, 29 Dec 1999 02:21:33 -0500 (EST) Message-Id: <199912290721.CAA01816@titan.tcn.net> X-Sender: broche@titan.tcn.net X-Mailer: QUALCOMM Windows Eudora Pro Version 4.0 Date: Wed, 29 Dec 1999 02:30:42 -0600 To: wilderness-emergency-medicine@list.pitt.edu From: Bernie Roche Subject: Re: W-EMED Wilderness EMT refresher/recert In-Reply-To: <84bun4$cj5n@eGroups.com> Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P0E6F0.CNM At 07:21 PM 12/28/99 -0800, you wrote: >I am looking for a W-EMT refresher/recert course. I live in Toronto, >Ontario in Canada and would like something in Ontario or one of the >states boardering/near to Ontario. Can anyone help me ??? > >You can email me directly at shannon@artraining.on.ca Hi: I don't know of any courses closer than those in Pennsylvania. I wouold suggest you might like to consider car-pooling with us to the next one. If this would help, e-mail me back. I'm also in Toronto, by the way. Best Wishes, Bernie Roche, RN, BScN, W-EMT, OSJ WEMSI Web Site Administrator http://www.wemsi.org/ broche@tcn.net Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 28 Dec 1999 22:22:55 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 28 Dec 1999 22:22:23 -0500 (EST) Received: via switchmail; Tue, 28 Dec 1999 22:22:23 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 28 Dec 1999 22:22:05 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 28 Dec 1999 22:21:23 -0500 (EST) Received: from mu.egroups.com (mu.egroups.com [207.138.41.151]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 28 Dec 1999 22:21:18 -0500 (EST) X-eGroups-Return: shannon@artraining.on.ca Received: from [10.1.2.119] by mu.egroups.com with NNFMP; 29 Dec 1999 03:21:17 -0000 Date: Tue, 28 Dec 1999 19:21:08 -0800 From: "Shannon Koppenhoefer" To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Wilderness EMT refresher/recert Message-ID: <84bun4$cj5n@eGroups.com> User-Agent: eGroups-EW/0.82 X-Mailer: eGroups Message Poster Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 33554560 0 1 P31060.CNM I am looking for a W-EMT refresher/recert course. I live in Toronto, Ontario in Canada and would like something in Ontario or one of the states boardering/near to Ontario. Can anyone help me ??? You can email me directly at shannon@artraining.on.ca Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-cs: R From: Keith Conover, M.D., FACEP X-RS-ID: X-RS-Flags: 0,0,1,1,0,0,0 X-RS-Sigset: 2 To: abuse@hotmail.com, abuse@houseit.com, postmaster@houseit.com Subject: (Fwd) W-EMED FREE SEX, Free forever, forever free! From: 203.1 Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Sun, 19 Dec 1999 19:39:44 -0500 Spam sent via your domain to an academic medicine list. Please do your best to track down this user and terminate all mail privileges. ------- Forwarded message follows ------- From: mbhdkp5@hotmail.com Date sent: Sun, 19 Dec 1999 19:06:12 -0500 (EST) To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED FREE SEX, Free forever, forever free! From: 203.151.51.96 Send reply to: wilderness-emergency-medicine@list.pitt.edu Ok, I'll keep this short! At the following site... http://www.geocities.com/ilovethisfreeplacex/enter.html you can download a program called Sextracker that finds you free sex on the internet, download is forever free, and free forever, no credit cards, no memberships, no hassles!. However, if you feel like spending some money, you can buy a legitimate password that would give you access to over 70,000 high quality adult sites 24/7 for a whole year (or a whole lifetime), your choice! 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To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu ------- End of forwarded message ------- -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 19 Dec 1999 15:29:20 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 19 Dec 1999 15:28:48 -0500 (EST) Received: via switchmail; Sun, 19 Dec 1999 15:28:48 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 19 Dec 1999 15:27:34 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 19 Dec 1999 15:26:13 -0500 (EST) Received: from boofura.swcp.com (boofura.swcp.com [198.59.115.28]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 19 Dec 1999 15:26:09 -0500 (EST) Received: from localhost (tanman@localhost) by boofura.swcp.com (8.8.5/8.8.0) with SMTP id NAA14160 for ; Sun, 19 Dec 1999 13:26:03 -0700 (MST) X-Authentication-Warning: boofura.swcp.com: tanman owned process doing -bs Date: Sun, 19 Dec 1999 13:26:03 -0700 (MST) From: TANMAN To: Wilderness Subject: W-EMED Wilderness Knots Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P142B0.CNM I have found these knots to be of use as an outdoorsman. STOPPER KNOTS Stopper Knots Overhand Knot Slipped Overhand Knot Double Overhand Knot Figure Eight Knot Stopper Knot Manrope Knot Monkey Fist Knot Sink Stopper Stevedore Knot Crown Knot Wall Knot Diamond Knot Double Diamond Knot BINDING KNOTS Binding Knots True Lover's Knot Sailor's Cross Square Knot Slipped Square Knot Granny Knot Thief Knot Surgeon's Knot Turquoise Turtle Knot Packer's Knot Clove Hitch Knot Constrictor Knot Timber Hitch Knot Boa Knot Turk's Head (Three-lead Four-bight) Turk's Head (Four-lead Five-bight) BENDS Bends Hunter's Bend Sheet Bend Double Sheet Bend Fisherman's knot Water Knot Double Fisherman's Knot Carrick Bend Blood Knot Ashley's Bend Lanyard Knot HITCHES Hitches Rolling Hitch Round Turn and Two Half Hitches Buntline Hitch Fisherman's Bend Cow Hitch Cow Hitch with Toggle Sheepshank Sheepshank Man O' War Marlingspike Hitch Highwayman's Hitch Waggorner's Hitch Snelling a Hook Clinch Knot Palomar Knot Improved Clinch Knot Square Lash Clove Hitch Diagnal Lashing Sheer Lashing Prusik Knot Bachmann Knot Klemheist Knot Italian Hitch LOOPS Loops Alpine Butterfly Bowline Bowline with Stopper Bowline with Two Turns Figure-Eight Loop Threaded Figure-Eight Loop Double Overhand Loop Double Overhand Sliding Loop Bowline on the Bight Portuguese Bowline Spanish Bowline Angler's Loop Jury Mast Knot Fisherman's Loop Double Fisherman's Loop Blood Dropper Knot Bimini Twist BRANDS and SENNITS Brands and Sennits Three-Strand Braid Four-Strand Sennit Five-Strand Sennit Six-Strand Sennit Ocean-Braid Mat Four-Strand Round Sennit Chain Sennit Round Crown Sennit Square Crown Sennit SPLICES and WHIPPINGS Splices and Whippings Back Splice Tapering a Splice Eye Splice Short Splice Long Splice Grommet Common Whipping French Whipping Moku Whipping Sailmaker's Whipping Palm and Needle Whipping West Country Whipping Seizing Stitch and Seize Thomas A. Naegele, DO Internet 9405 Lagrima de Oro NE 505-275-7267 Albuquerque, NM 87111 Board Certified Family Practice/Board Certified Quality Assurance MEDICAL WHITE PAPERS MAGAZINE FOR COMMUNITY PHYSICIANS http://www.swcp.com/~tanman/ FOR HUB Information Call MIKE at 303-220-1073 __________________________________________________________________ Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Fri, 10 Dec 1999 21:31:57 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 10 Dec 1999 21:31:06 -0500 (EST) Received: via switchmail; Fri, 10 Dec 1999 21:31:05 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 10 Dec 1999 21:29:10 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 10 Dec 1999 19:31:26 -0500 (EST) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 10 Dec 1999 19:31:06 -0500 (EST) Received: from micron (ehdup-u-38.rmt.net.pitt.edu [136.142.23.148]) by post-ofc06.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 10 Dec 1999 19:30:40 -0500 (EST) Message-Id: <199912110030.TAA28907@post-ofc06.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: pirie@istar.ca (Steven D. Pirie), wilderness-emergency-medicine@list.pitt.edu Date: Fri, 10 Dec 1999 18:57:54 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED New WEMSI Personal Wilderness Medical Kit document In-reply-to: X-mailer: Pegasus Mail for Win32 (v3.12b) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P30120.CNM On 10 Dec 99, at 2:47, Steven D. Pirie wrote: > The high strength steroid cream, mentioned is fluocinolone acetonide > cream 0.2%... I did not realize it came in this strength, as far as I > can tell it comes in the following... > > Potency (1-7) Strength > (1 High 7 Low) > > IV - fluocinolone acetonide 0.025% > VI - fluocinolone acetonide 0.01% > > How strong should we go? To be truthful, I don't think it really matters. According to my notes, Synalar HP comes in 0.2%, but it would probably be better to leave off the percentage because, for limited use, it just doesn't matter. > Does Zithromax have coverage for Giardia lamblia? If not should flagyl > be in the kit (as bismuth subsalicylate [another G. lamblia treatment] > was removed from the kit). I am not sure if "beaver fever" is a > problem down south, but it is up here. As far as I know, azithromycin doesn't cover Giardia -- on the other hand, think about the incubation period of Giardia -- most people develop it _after_ getting back from a trip. And, since this kit is for WEMTs with rescue teams, the chance a team will be out for a week and need to treat Giardia seems slim to none. And, if your patient has Giardia and say is dehydrated, would starting an antibiotic _now_ as opposed to a day from now make a big impact? > With respect to Zithromax (based on my limited understanding of the > drug) that it has comparable antimicrobial effect on Gram positive > bacteria (with cipro being the slightly more effective drug) but lacks > effectiveness (MIC-90 <30% sensitive) on Gram negative bacteria for > the most part (with the exception of M. catarrhalis, H. influenzae, > Legionella spp. and H. ducreyi. Cipro is far more effective on Gram > negative bacteria). Lastly Zithro is more effective with respect to > anaerobes. Maybe we should keep Cipro in the kit? Then again, I really > don't know a lot about the drug clinically and I am going on the > microbio angle (and my Sanford guide is 1996). Well, we wanted to standardize on a single antibiotic if possible. And how many gram negative infections is one likely to get in the wilderness on a SAR task? And how many patients are likely to need treatment for a gram negative infection? Azithromycin will cover most gram negatives that cause UTIs, and this is the most likely gram negative problem in the backcountry. > Maybe an oral airway (adult) should be in the minimum kit, incase > buddy falls, is uncon. and you have to go for help. Likewise if your > stabilizing the C-spine in an uncon pt. and waiting for the rest of > the team to arrive it is nice to place an OPA. It is also better then > nothing if digital intubation fails, and your left doing mouth to > mask. It is cheep and does not weigh much. If intubation fails, just stick the ET tube in the nose into the nasopharynx and use as a nasal airway -- should do the same thing as an oral airway without adding bulk and weight. > Instead of hydrocodone have you contemplated hydromorphone? > Hydromorphone is a better PO med for pain control, then again, it will > not help a cough like the hydrocodone will... Multiple uses is good. And hydrocodone is much more commonly used clinically - which means that medical control physicians will be more familiar with it. Thanks very much for your comments! --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Fri, 10 Dec 1999 03:11:08 -0500 (EST) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 10 Dec 1999 03:10:35 -0500 (EST) Received: via switchmail; Fri, 10 Dec 1999 03:10:35 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 10 Dec 1999 03:10:32 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 10 Dec 1999 02:59:45 -0500 (EST) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 10 Dec 1999 02:47:20 -0500 (EST) Received: from ip237.ottawa4.dialup.canada.psi.net ([154.5.13.237]) by mail1.toronto.istar.net with smtp (Exim 2.02 #1) id 11wKkY-00071N-00 for wilderness-emergency-medicine@list.pitt.edu; Fri, 10 Dec 1999 02:45:59 -0500 X-Sender: pirie@istar.ca (Unverified) Message-Id: Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Date: Fri, 10 Dec 1999 02:47:36 -0500 To: wilderness-emergency-medicine@list.pitt.edu From: pirie@istar.ca (Steven D. Pirie) Subject: W-EMED New WEMSI Personal Wilderness Medical Kit document Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P56770.CNM Dr. Conover and others, >A new WEMSI Personal Wilderness Medical Kit document has been released for >>public review. I was looking over the kit and though of a few things... The high strength steroid cream, mentioned is fluocinolone acetonide cream 0.2%... I did not realize it came in this strength, as far as I can tell it comes in the following... Potency (1-7) Strength (1 High 7 Low) IV - fluocinolone acetonide 0.025% VI - fluocinolone acetonide 0.01% How strong should we go? Does Zithromax have coverage for Giardia lamblia? If not should flagyl be in the kit (as bismuth subsalicylate [another G. lamblia treatment] was removed from the kit). I am not sure if "beaver fever" is a problem down south, but it is up here. With respect to Zithromax (based on my limited understanding of the drug) that it has comparable antimicrobial effect on Gram positive bacteria (with cipro being the slightly more effective drug) but lacks effectiveness (MIC-90 <30% sensitive) on Gram negative bacteria for the most part (with the exception of M. catarrhalis, H. influenzae, Legionella spp. and H. ducreyi. Cipro is far more effective on Gram negative bacteria). Lastly Zithro is more effective with respect to anaerobes. Maybe we should keep Cipro in the kit? Then again, I really don't know a lot about the drug clinically and I am going on the microbio angle (and my Sanford guide is 1996). Maybe an oral airway (adult) should be in the minimum kit, incase buddy falls, is uncon. and you have to go for help. Likewise if your stabilizing the C-spine in an uncon pt. and waiting for the rest of the team to arrive it is nice to place an OPA. It is also better then nothing if digital intubation fails, and your left doing mouth to mask. It is cheep and does not weigh much. Instead of hydrocodone have you contemplated hydromorphone? Hydromorphone is a better PO med for pain control, then again, it will not help a cough like the hydrocodone will... That is it for me, excuse any bizarre oversights, as it is the wee hours of the morning. Overall the kit revision looks great and I look forward to seeing the completed document. Keep up the good work. Cheers, Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 7 Dec 1999 13:13:03 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 7 Dec 1999 13:12:30 -0500 (EST) Received: via switchmail; Tue, 7 Dec 1999 13:12:30 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 7 Dec 1999 13:10:32 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 7 Dec 1999 13:08:20 -0500 (EST) Received: from wdcrobims02.ed.gov (wdcrobims02.ed.gov [165.224.216.148]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 7 Dec 1999 13:08:14 -0500 (EST) Received: by wdcrobims02.ed.gov with Internet Mail Service (5.5.2448.0) id ; Tue, 7 Dec 1999 13:07:05 -0500 Message-ID: From: "McCabe, Peter" To: "'wilderness-emergency-medicine@list.pitt.edu'" Subject: RE: W-EMED Wilderness Bike Race/ Foot Race Experience? Date: Tue, 7 Dec 1999 11:36:50 -0500 MIME-Version: 1.0 X-Mailer: Internet Mail Service (5.5.2448.0) Content-Type: text/plain Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P439D0.CNM Over the years we have provided course marshall and emerg first aid services for many off road mountain bike races in state parks and other areas. For some time we also did the 24 Hours of Canaan mountain bike race which is considered one of the top 5 in the country. Most major injuries we have seen are shoulder injuries where the rider has gone over the handlebars. Some have been head injuries where the helmet has shattered. There is, of course, a lot of "road rash" type injuries with some deep cuts requiring multiple layers of suturing. Our experience indicates few broken bones. Our services have always been in the field with local EMS standing by to assist with packaging, carry out and full EMT services at the trail-roadhead. At the 24 Hours of Canaan, the organizers have a pretty complete medical team on site with capability to respond both into the field on ATVs with litters, and to also provide fixed site services at the race event base. In some instances, ambulance runs can take 45-60 minutes one way so having available ambulance response is important. Our first aid services are free. Always! The charge is for marshalling services where we station people along the course, often at difficult terrain or junctions. This marshalling provides early alerts from passing racers re: injuries back on the trail. And, of course, we have people where the probabilities of accidents is high. Hope this helps. /s/ Peter McCabe Maryland Search & Rescue Group Peter A. McCabe Compliance Reports Project Coordinator, OCR/ED Telephone: (202) 205-9567 FAX: (202) 205-3698 > -----Original Message----- > From: Tim Kovacs [SMTP:Tkovacs@goodnet.com] > Sent: Monday, December 06, 1999 8:32 PM > To: MRA List > Cc: SAR-L; WEMS News > Subject: W-EMED Wilderness Bike Race/ Foot Race Experience? > > Which of your units have experience in Mtn Bike and Foot Races in the > wilderness? > > 1. Types of injuries you see. > > 2. General Logistics of staffing such an event for EMS-Rescue standby > different from an outdoor bouldering contest. > > Thanks for your input. > > Please respond privately to > > Tim Kovacs, > Operations Leader/ Paramedic, > C.A.M.R.A./ MCSO MR > tkovacs@goodnet.com > www.mra.org Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X X-NAV-TimeoutProtection7: X X-NAV-TimeoutProtection8: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Mon, 6 Dec 1999 20:50:44 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 6 Dec 1999 20:19:34 -0500 (EST) Received: via switchmail; Mon, 6 Dec 1999 20:19:33 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 6 Dec 1999 20:18:05 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 6 Dec 1999 20:13:23 -0500 (EST) Received: from mx0-smtp.goodnet.com (sloth.goodnet.com [207.98.129.103]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 6 Dec 1999 20:13:19 -0500 (EST) Received: from Ptkovacs (d5-38.phoenix.goodnet.com [209.140.135.39]) by mx0-smtp.goodnet.com with SMTP id SAA13584; Mon, 6 Dec 1999 18:12:59 -0700 (MST) Message-ID: <02dc01bf4052$ea1f9ee0$c1618dd1@Ptkovacs> From: "Tim Kovacs" To: "MRA List" Cc: "SAR-L" , "WEMS News" Subject: W-EMED Wilderness Bike Race/ Foot Race Experience? Date: Mon, 6 Dec 1999 18:32:18 -0700 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_02D9_01BF4018.3A3F8F60" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2314.1300 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu This is a multi-part message in MIME format. ------=_NextPart_000_02D9_01BF4018.3A3F8F60 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Which of your units have experience in Mtn Bike and Foot Races in the = wilderness? 1. Types of injuries you see. 2. General Logistics of staffing such an event for EMS-Rescue standby = different from an outdoor bouldering contest.=20 Thanks for your input. Please respond privately to=20 Tim Kovacs,=20 Operations Leader/ Paramedic, C.A.M.R.A./ MCSO MR tkovacs@goodnet.com www.mra.org ------=_NextPart_000_02D9_01BF4018.3A3F8F60 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Which of your units have experience in = Mtn Bike and=20 Foot Races in the wilderness?
 
1.    Types of injuries = you=20 see.
 
2.    General Logistics = of staffing=20 such an event for EMS-Rescue standby different from an outdoor = bouldering=20 contest.
 
Thanks for your input.
 
Please respond privately to =
 
Tim Kovacs,
Operations Leader/=20 Paramedic,
C.A.M.R.A./ MCSO MR
tkovacs@goodnet.com
www.mra.org
------=_NextPart_000_02D9_01BF4018.3A3F8F60-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Fri, 3 Dec 1999 07:25:01 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 3 Dec 1999 07:24:27 -0500 (EST) Received: via switchmail; Fri, 3 Dec 1999 07:24:26 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 3 Dec 1999 07:23:28 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 3 Dec 1999 07:22:38 -0500 (EST) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 3 Dec 1999 07:22:30 -0500 (EST) Received: from micron (ehdup-t-74.rmt.net.pitt.edu [136.142.23.84]) by post-ofc06.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 3 Dec 1999 07:22:25 -0500 (EST) Message-Id: <199912031222.HAA13654@post-ofc06.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu, asrc@list.pitt.edu Date: Fri, 3 Dec 1999 07:22:22 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: W-EMED New WEMSI Personal Wilderness Medical Kit document CC: sar-l@listserv.islandnet.com, mra@altadena.net, NCRC@ontosystems.com (NCRC Discussion List) X-mailer: Pegasus Mail for Win32 (v3.12b) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu A new WEMSI Personal Wilderness Medical Kit document has been released for public review. Note: because of the delay in posting this, the public comment period has been extended until MARCH 1 2000 despite what it says in the document itself. The following documents are available for your review at http://www.pitt.edu/~kconover/ 1. WEMSI Personal Wilderness Medical Kit version 1.2 This document contains a recommended personal medical kit for Wilderness EMTs with search and rescue teams. It includes an explanatory preface, of use to anyone building any kind of wilderness medical kit. There are also many detailed notes about why certain items were chosen or left out, and where to obtain some items. Again this should be invaluable for anyone designing a wilderness medical kit. Comments are solicited, as this version will be updated March 1 2000. Comments may be emailed to the address in the file, but we prefer that commentors join the wilderness-emergency-medicine Internet discussion list and discuss their comments with others on the list. Information on subscribing to this list may be found here: http://www.wemsi.org/mailing.html Some discussion of previoius versions may be found in the wilderness-emergency-medicine list archives, found here: http://www.wemsi.org/arch01.html 2. Errata and proposed changes for the above document This listing will be updated on a regular basis with the typographical errors to be fixed, formatting changes, and any substantial changes or corrections. http://www.pitt.edu/~kconover/ftp/errata.htm 3. Discussion of Trilisate as a potential replacement for ibuprofen/naproxen This document provides a detailed proposal for changing one of the medications in the listing. http://www.pitt.edu/~kconover/ftp/trilisate.htm 4. WEMSI Personal Wilderness Medical Kit (short) version 1.2 This contains only the listing of items from the above document, no discussion or notes. May be of use as a checkoff and to place in the kit. Adobe Acrobat PDF format MS Word 2000 format 5. WEMSI Team Medical Kit list This document outlines a "pie in the sky" list of everything a completely-equipped wilderness EMS team might have available. Primarily a planning and reference document, and unlike the Personal Kit above, this is not a kit that his been tested in the field in this configuration. http://www.wemsi.org/teammedkit1.pdf Also, I recently got some emails saying "where can I buy one of your medical kits." The WEMSI Personal Wilderness Medical Kit is NOT available for sale, unfortunately. We don't think that anyone sees enough commercial profit in making an expensive kit like this available for sale. If we're wrong, and someone does decide to start makking WEMSI kits available, please let us know and we will be certain to announce that fact widely. [Unfortunately, due to personal reasons, our webmaster hasn't been able to update www.wemsi.org with this document for almost two months. That's why it's on my personal page. But it will be transferred to www.wemsi.org as soon as possible, and a link will stay on my personal web page.] Thank you. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 1 Dec 1999 22:43:56 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 1 Dec 1999 22:43:23 -0500 (EST) Received: via switchmail; Wed, 1 Dec 1999 22:43:23 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 1 Dec 1999 22:43:14 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 1 Dec 1999 22:42:11 -0500 (EST) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 1 Dec 1999 22:42:06 -0500 (EST) Received: from micron (ehdup-t-35.rmt.net.pitt.edu [136.142.23.45]) by post-ofc05.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 1 Dec 1999 22:41:42 -0500 (EST) Message-Id: <199912020341.WAA20026@post-ofc05.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: mra@altadena.net Date: Wed, 1 Dec 1999 22:41:34 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: W-EMED WEMT in Wales CC: wilderness-emergency-medicine@list.pitt.edu, NCRC@ontosystems.com (NCRC Discussion List), sar-l@listserv.islandnet.com X-mailer: Pegasus Mail for Win32 (v3.12b) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu AMRG (Allegheny, not Alaska, Mountain Rescue Group) members Jack Grandey and I volunteered for part of November in North Wales. We were with a number of UK mountain rescue people, running the first WEMSI Wilderness EMT and Wilderness Command Physician courses in the UK. I kept a diary, with pictures (aren't digital cameras wonderful?), and turned it into a set of Web pages. You won't see any big wall rescue scenes -- this was a medical course, not a rescue course (though there was a weeklong rescue course associated with the WEMT course last year in Ireland). However, it may be of some interest, even if just for the scenes of North Wales. The link is at the top of my personal Web page, URL below. Thank you. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Mon, 29 Nov 1999 13:35:27 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 29 Nov 1999 13:34:52 -0500 (EST) Received: via switchmail; Mon, 29 Nov 1999 13:34:51 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 29 Nov 1999 13:33:36 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 29 Nov 1999 13:31:25 -0500 (EST) Received: from imo-d08.mx.aol.com (imo-d08.mx.aol.com [205.188.157.40]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 29 Nov 1999 13:31:16 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo-d08.mx.aol.com (mail_out_v24.4.) id h.0.8f33a269 (4588) for ; Mon, 29 Nov 1999 13:30:36 -0500 (EST) Message-ID: <0.8f33a269.2574204c@aol.com> Date: Mon, 29 Nov 1999 13:30:36 EST Subject: Re: W-EMED Aspirin & heart attacks in the wilderness To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P5B420.CNM In a message dated 11/28/99 9:47:43 AM Pacific Standard Time, morgan@icon.co.za writes: > Tom, > Add up the price of an aspirin a day for perhaps 40 years, for each of > several hundred people per live saved. Add the cost of the extra > medication to treat peptic ulcers, asthma, internal bleeding caused by > all these aspirin doses. > The maths does not encourage this as a good preventative treatment. > It is better to eat correctly, exercise, NO SMOKING. Treat high blood > pressure and high cholesterol. Take aspirin if there is a risk factor > for heart disease. > Arthur Hi WMED, I don't have the epidemiology here in front of me, but in addition to the "aspirin regimen" preventing MIs and CVAs, there are journal articles that suggest that pursuing the "aspirin regimen" for twenty years significantly decreases one's risk of getting colon cancer. In any event, if I'm "out there" and someone starts to "walk, talk, and look" like they are having an MI, I'm certainly going to be very strongly tempted to have them chew four baby aspirin except in those _very_ rare circumstances where they (1) are simultaneously also right in the middle of a hypertensive crisis or (2) are certain that they have allergic reactions to aspirin of anaphylactic-level severity. Regards, Jay Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 28 Nov 1999 16:59:31 -0500 (EST) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 28 Nov 1999 16:58:57 -0500 (EST) Received: via switchmail; Sun, 28 Nov 1999 16:58:56 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 28 Nov 1999 16:58:03 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 28 Nov 1999 16:57:37 -0500 (EST) Received: from apollo.cloudnet.com (apollo.cloudnet.com [204.221.240.12]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 28 Nov 1999 16:57:33 -0500 (EST) Received: from customer (sat045.cloudnet.com [204.221.241.45]) by apollo.cloudnet.com (8.9.3/8.9.3) with SMTP id PAA20839 for ; Sun, 28 Nov 1999 15:57:05 -0600 Message-ID: <004f01bf39ed$4a70c4c0$2df1ddcc@customer> From: "Tom Danzl" To: References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> <383A5E6C.89FCA610@icon.co.za> <002801bf36a5$491cef40$1df1ddcc@customer> <383F5D8C.1BDFCF7D@icon.co.za> Subject: Re: W-EMED Aspirin & heart attacks in the wilderness Date: Sun, 28 Nov 1999 16:09:48 -0600 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P3D910.CNM Arthur I see your point about the complications. But if 40 mg every other day is effective, is there really still a concern about the side effects? At least in 99.9% of the population? As regards the cost of the aspirin, I'm looking at a bottle of generic aspirin of 500 tablets for $2.49. At 40 mg every other day (if they can be cut that small!!!), we're talking about two tablets a month, or 24 tablets a year (skip the days you take them for a cold, headache or sore back). That's a 40 year cost of about $10.00 (seems like not much.....better check that math). I'm really playing the devil's advocate here. I don't know what the answer is, but would like to believe that an eight of an aspirin every other day would have some real beneficial effects. Tom Thomas J. Danzl Central Minnesota Cytogenetic Services 320-259-8708 http://www.cloudnet.com/~cmcs ----- Original Message ----- From: Arthur Morgan To: Sent: Friday, November 26, 1999 10:26 PM Subject: Re: W-EMED Aspirin & heart attacks in the wilderness > Tom, > Add up the price of an aspirin a day for perhaps 40 years, for each of > several hundred people per live saved. Add the cost of the extra > medication to treat peptic ulcers, asthma, internal bleeding caused by > all these aspirin doses. > The maths does not encourage this as a good preventative treatment. > It is better to eat correctly, exercise, NO SMOKING. Treat high blood > pressure and high cholesterol. Take aspirin if there is a risk factor > for heart disease. > Arthur > > Tom Danzl wrote: > > > > ----- Original Message ----- > > From: Arthur Morgan > > Subject: Re: W-EMED Aspirin & heart attacks in the wilderness > > > > > Michelle, > > > Taking aspirin ( as little as 40 mg on alternate days ) will certainly > > > decrease the chance of a fatal heart attack. However the financial cost > > > will be very large. > > > > I don't undestand why the financial cost will be so large. > > > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 28 Nov 1999 12:20:09 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 28 Nov 1999 12:19:35 -0500 (EST) Received: via switchmail; Sun, 28 Nov 1999 12:19:35 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 28 Nov 1999 12:17:49 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 28 Nov 1999 12:15:19 -0500 (EST) Received: from cgi.icon.co.za (cgi.icon.co.za [196.35.95.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 28 Nov 1999 12:15:14 -0500 (EST) Received: from mail450.icon.co.za (smtp.icon.co.za [196.35.95.40]) by cgi.icon.co.za (Postfix) with ESMTP id 44279464F9 for ; Sun, 28 Nov 1999 19:20:53 +0200 (SAST) Received: from icon.co.za (c3-ndf-46.dial-up.net [196.34.159.46]) by mail450.icon.co.za (8.9.3/8.9.3) with ESMTP id TAA17767 for ; Sun, 28 Nov 1999 19:14:56 +0200 (GMT) Message-ID: <383F5D8C.1BDFCF7D@icon.co.za> Date: Sat, 27 Nov 1999 06:26:52 +0200 From: Arthur Morgan X-Mailer: Mozilla 4.7 [en] (Win95; I) X-Accept-Language: en-GB,en,en-US,af,pl MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Aspirin & heart attacks in the wilderness References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> <383A5E6C.89FCA610@icon.co.za> <002801bf36a5$491cef40$1df1ddcc@customer> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P5F440.CNM Tom, Add up the price of an aspirin a day for perhaps 40 years, for each of several hundred people per live saved. Add the cost of the extra medication to treat peptic ulcers, asthma, internal bleeding caused by all these aspirin doses. The maths does not encourage this as a good preventative treatment. It is better to eat correctly, exercise, NO SMOKING. Treat high blood pressure and high cholesterol. Take aspirin if there is a risk factor for heart disease. Arthur Tom Danzl wrote: > > ----- Original Message ----- > From: Arthur Morgan > Subject: Re: W-EMED Aspirin & heart attacks in the wilderness > > > Michelle, > > Taking aspirin ( as little as 40 mg on alternate days ) will certainly > > decrease the chance of a fatal heart attack. However the financial cost > > will be very large. > > I don't undestand why the financial cost will be so large. > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X X-NAV-TimeoutProtection7: X X-NAV-TimeoutProtection8: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 25 Nov 1999 08:32:49 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Thu, 25 Nov 1999 08:32:18 -0500 (EST) Received: via switchmail; Thu, 25 Nov 1999 08:32:17 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 25 Nov 1999 08:31:28 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 25 Nov 1999 08:29:32 -0500 (EST) Received: from titan.janrix.com (titan.janrix.com [207.22.155.3]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 25 Nov 1999 08:29:28 -0500 (EST) Received: from tacker ([207.22.155.84]) by titan.janrix.com (Build 93 8.9.3/NT-8.9.3) with SMTP id IAA03012 for ; Thu, 25 Nov 1999 08:29:12 -0500 Message-ID: <017901bf3748$cae2d6e0$549b16cf@tacker> From: "Tacker Vordemberge" To: "Wilderness E.M.T." Subject: W-EMED Happy Thanksgiving! Date: Thu, 25 Nov 1999 08:27:15 -0500 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_0176_01BF371E.E0E65040" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 570950016 0 1 P37550.CNM This is a multi-part message in MIME format. ------=_NextPart_000_0176_01BF371E.E0E65040 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Retter and I want to wish you a joyful and safe Thanksgiving. We = also would ask that you say a prayer for all those, who could not be = with there families, serving around the world for your freedom as well = as the freedom of others. Thank you=20 "THAT OTHERS MAY LIVE!!!!!!" Retter Vordemberge John 'Tacker' Vordemberge = E.M.T. S.A.R. K-9 (in training) SAR DOG 110 SPC. U.S. ARMY ------=_NextPart_000_0176_01BF371E.E0E65040 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
    Retter and I want to wish you a = joyful and=20 safe Thanksgiving. We also would ask that you say a prayer for all = those, who=20 could not be with there families, serving around the world for your = freedom as=20 well as the freedom of others.
          &nbs= p;            = ;            = =20 Thank you
        =    =20             =    =20         "THAT OTHERS MAY = LIVE!!!!!!"
 
Retter=20 Vordemberge          &n= bsp;           =20 John 'Tacker' Vordemberge E.M.T.
S.A.R. K-9 (in=20 training)          &nbs= p;         SAR=20 DOG 110
          &nbs= p;            = ;            =             &= nbsp;   =20 SPC. U.S. ARMY
 
------=_NextPart_000_0176_01BF371E.E0E65040-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 24 Nov 1999 12:45:45 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 24 Nov 1999 12:45:09 -0500 (EST) Received: via switchmail; Wed, 24 Nov 1999 12:45:09 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 24 Nov 1999 12:44:42 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 24 Nov 1999 12:44:19 -0500 (EST) Received: from apollo.cloudnet.com (apollo.cloudnet.com [204.221.240.12]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 24 Nov 1999 12:44:13 -0500 (EST) Received: from customer (sat029.cloudnet.com [204.221.241.29]) by apollo.cloudnet.com (8.9.3/8.9.3) with SMTP id LAA06906 for ; Wed, 24 Nov 1999 11:43:44 -0600 Message-ID: <002801bf36a5$491cef40$1df1ddcc@customer> From: "Tom Danzl" To: References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> <383A5E6C.89FCA610@icon.co.za> Subject: Re: W-EMED Aspirin & heart attacks in the wilderness Date: Wed, 24 Nov 1999 11:56:46 -0600 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P1EDA0.CNM ----- Original Message ----- From: Arthur Morgan To: ; Michelle Sent: Tuesday, November 23, 1999 3:29 AM Subject: Re: W-EMED Aspirin & heart attacks in the wilderness > Michelle, > Taking aspirin ( as little as 40 mg on alternate days ) will certainly > decrease the chance of a fatal heart attack. However the financial cost > will be very large. I don't undestand why the financial cost will be so large. > Other ways of decreasing risk of death may be > cheaper over the life time of the person. There needs to be more > research into the dangers of long term aspirin before it can be > recommended. > Contraindications of aspirin ..................... Tom Danzl Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 24 Nov 1999 12:31:54 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Wed, 24 Nov 1999 12:31:18 -0500 (EST) Received: via switchmail; Wed, 24 Nov 1999 12:31:17 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 24 Nov 1999 12:29:13 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 24 Nov 1999 12:28:49 -0500 (EST) Received: from wdcrobims01.ed.gov (wdcrobims01.ed.gov [165.224.216.147]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 24 Nov 1999 12:28:42 -0500 (EST) Received: by wdcrobims01.ed.gov with Internet Mail Service (5.5.2448.0) id ; Wed, 24 Nov 1999 12:26:51 -0500 Message-ID: From: "McCabe, Peter" To: "'wilderness-emergency-medicine@list.pitt.edu'" , Michelle Subject: RE: W-EMED Aspirin & heart attacks in the wilderness Date: Wed, 24 Nov 1999 12:30:22 -0500 MIME-Version: 1.0 X-Mailer: Internet Mail Service (5.5.2448.0) Content-Type: text/plain Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P43270.CNM Continued high end usage of aspirin will cause mild to moderate hearing impairment. On cessation of aspirin hearing acuity will usually return. Peter A. McCabe Compliance Reports Project Coordinator, OCR/ED Telephone: (202) 205-9567 FAX: (202) 205-3698 > -----Original Message----- > From: Arthur Morgan [SMTP:morgan@icon.co.za] > Sent: Tuesday, November 23, 1999 4:29 AM > To: wilderness-emergency-medicine@list.pitt.edu; Michelle > Subject: Re: W-EMED Aspirin & heart attacks in the wilderness > > Michelle, > Taking aspirin ( as little as 40 mg on alternate days ) will > certainly > decrease the chance of a fatal heart attack. However the financial cost > will be very large. Other ways of decreasing risk of death may be > cheaper over the life time of the person. There needs to be more > research into the dangers of long term aspirin before it can be > recommended. > Contraindications of aspirin type drugs include any history of > peptic > ulcers, stroke, allergy, asthma. > If a patient has a typical story of heart attack ( crushing chest > pain, > weakness, altered sensation [including pain] in the arm, neck or jaw, > palpitations ) a single adult aspirin taken early will save as many > lives as all other treatment put together. However you will have to > accept a small number of fatalities due to bleeding ulcers, strokes, and > other vascular catastrophes. It will prevent, to some extent, > enlargement of the volume of death of heart muscle by limiting the clot > formation within the arteries of the heart. > One dose is enough. The action will last for at least a day. > Arthur > BTW distrust everything that you see on TV. > > Michelle Schonzeit wrote: > > > > After just finishing my yearly CPR-FPR and Outdoor Emergency Care > > refreshers for Ski Patrol, I happened to see the commercial for Bayer > > aspirin that says 'if taken before a heart attack Bayer aspirin can save > > your life', or something to that affect. At that time, it occurred to me > no > > where in my first aid courses have I ever heard such advice given, but I > > assume if they can broadcast it on TV it must have some legitimacy some > > where. > > So, I thought maybe someone on the list would know if this actually > > works, & under what circumstances, and if so why doesn't anyone like the > Red > > Cross or American Heart ever mention it (besides the legal consideration > > that you are then providing medication), and if used in the backcountry, > how > > long would the affect (if any) last, (i.e.. is it enough time to > evacuate > > someone with out having to do CPR in route) or would you need to > > readminister it every so often. Any thoughts anyone? > > > > Michelle Schonzeit - schonzeit@slic.com > > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 24 Nov 1999 16:25:37 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 24 Nov 1999 16:25:00 -0500 (EST) Received: via switchmail; Wed, 24 Nov 1999 16:25:00 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 24 Nov 1999 16:24:11 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 24 Nov 1999 16:23:11 -0500 (EST) Received: from macs.mxim.com (macs.mxim.com [204.17.143.130]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 24 Nov 1999 16:22:59 -0500 (EST) Received: from localhost (localhost [127.0.0.1]) by macs.mxim.com (8.7/8.6.9) with SMTP id NAA28748 for ; Wed, 24 Nov 1999 13:22:19 -0800 (PST) Message-Id: <199911242122.NAA28748@macs.mxim.com> X-Mailer: exmh version 2.0.1 12/23/97 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 2 In-reply-to: Your message of "Tue, 23 Nov 1999 14:23:01 PST." Mime-Version: 1.0 Content-Type: text/plain; charset=us-ascii Date: Wed, 24 Nov 1999 13:22:19 PST From: Hal Lillywhite Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P468F0.CNM >Hal (and group) - Actually, Oregon is one of the few states (AFAIK) >that allows non-medical personnel who have had specific training to >administer epi (and glucagon). [1997 law quote deleted] It sounds like my information is outdated and positive changes have been made. That is good. Many years ago in a re-cert class we actually practiced giving each other sub-c shots as we would if we were using epi. Then a few years later they told us that 1st responder training wasn't enough to administer this med (even though otherwise untrained parents of asthmatics were allowed to do it). I'm glad to see the change. Obviously I hope other jurisdictions will take a similarly enlightened approach. I don't have access to the web so can't easily look up the law you reference. However I hope they have also changed things to allow people at my level to administer O2 when necessary. I was once taught how to use it (quite simple really), then 2-3 years ago at re-cert the instructor said we were no longer allowed to administer O2 "because it is a drug." Apparently the reasoning was that someone might overdose a COPD patient. >At our last epi class, taught by an RN who is a member of one of >the units and authorized by our physician advisor, we had about >20-25 people, only about 5 of whom are EMT's. The Sheriff's office >even sprung for 8 epi kits to be kept in key locations and vehicles. Good for them. Will they also spring for replacement costs when these are used, or better yet, become outdated without being used? This indeed addresses my concern that there is always a first reaction and we should be prepared in case the yellow jackets or something else causes this on a search operation. Having seen first hand what happened to a teammate in that event (and also having lost an office mate who had a reaction working at home), I am concerned about this problem. I suspect most of us could carry epi for years and never have need for it. However if we do need it we will need it *immediately*. Even in town the ambulance may not arrive in time to deal with a severe reaction. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 24 Nov 1999 12:26:06 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Wed, 24 Nov 1999 12:25:30 -0500 (EST) Received: via switchmail; Wed, 24 Nov 1999 12:25:30 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 24 Nov 1999 12:23:29 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 24 Nov 1999 12:23:03 -0500 (EST) Received: from imo15.mx.aol.com (imo15.mx.aol.com [198.81.17.5]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 24 Nov 1999 12:22:47 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo15.mx.aol.com (mail_out_v24.4.) id h.0.51fac633 (4233) for ; Wed, 24 Nov 1999 12:22:11 -0500 (EST) Message-ID: <0.51fac633.256d78c3@aol.com> Date: Wed, 24 Nov 1999 12:22:11 EST Subject: W-EMED Re: Chewable Benadryl tablets To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P44EC0.CNM Hi WMED, I picked up some of the chewable benadryl tablets at my local drugstore. They contain 12.5 mg of diphenhydramine per tablet (and are grape flavored! ). So an adult would get at least four such tablets, maybe as many as eight. BTW, at about seven bucks for a 24-pack, they're _expensive_ little buggers. I could have bought a much bigger bottle of the regular "sleeping pills" for the same price. So I guess these really are "only for emergency" usage. Also, shelf life -- under the presumably ideal conditions of sitting still on a shelf in a dry place -- seems to be about two years, and they come with twelve tablets in individual (and not particularly easy to open) blisters on a sheet of plastic. Anyhow, all things considered, they look promising. Regards, Jay Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 20:52:14 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 17:25:43 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 17:25:38 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 17:23:36 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 17:23:19 -0500 (EST) Received: from smtp2.teleport.com (smtp2.teleport.com [192.108.254.20]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 17:23:14 -0500 (EST) Received: (qmail 26654 invoked from network); 23 Nov 1999 22:23:05 -0000 Received: from user2.teleport.com (qmailr@192.108.254.12) by smtp2.teleport.com with SMTP; 23 Nov 1999 22:23:05 -0000 Received: (qmail 14685 invoked by uid 7893); 23 Nov 1999 22:23:02 -0000 Date: Tue, 23 Nov 1999 14:23:01 -0800 (PST) From: Richard Ries To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 2 In-Reply-To: <199911231927.LAA22931@macs.mxim.com> Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P00870.CNM On Tue, 23 Nov 1999, Hal Lillywhite wrote: > Unfortunately current regulations in Oregon do not encourage us > folks trained at lower levels (I'm a first responder) to carry and > administer epi (or even oxygen if you can believe that). If I > carried and used epi I would technically be in violation. One more > way the system puts silly rules ahead of saving lives. Hal (and group) - Actually, Oregon is one of the few states (AFAIK) that allows non-medical personnel who have had specific training to administer epi (and glucagon). Check out Oregon Revised Statutes (ORS) 433.800 thru 433.830 at http://landru.leg.state.or.us/ors/433.html ORS 433.805 summarizes the Legislature's intent: 433.805 Policy. It is the purpose of ORS 433.800 to 433.830 to provide a means of authorizing certain individuals when a licensed health care professional is not immediately available to administer lifesaving treatment to persons who have severe allergic responses to insect stings and other specific allergens and to persons who are experiencing severe hypoglycemia when other treatment has failed or cannot be initiated. [1981 c.367 s.1; 1989 c.299 s.3; 1997 c.345 s.2] At our last epi class, taught by an RN who is a member of one of the units and authorized by our physician advisor, we had about 20-25 people, only about 5 of whom are EMT's. The Sheriff's office even sprung for 8 epi kits to be kept in key locations and vehicles. Rick Ries Marion Co. SAR Salem, OR Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 16:34:12 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 16:33:39 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 16:33:38 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 16:31:47 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 16:31:16 -0500 (EST) Received: from argohouston.com (mail.argolink.net [209.144.1.128]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 16:31:09 -0500 (EST) Received: from h1z2r9 [209.176.43.17] by argohouston.com (SMTPD32-5.05) id A773A201EC; Tue, 23 Nov 1999 15:30:27 -0600 From: "SouthWest PaddleSports" To: Subject: RE: W-EMED Stupid Anaphylaxis Trick # 2 Date: Tue, 23 Nov 1999 15:35:28 -0600 Message-ID: <005e01bf35fa$aaa1f4a0$172bb0d1@h1z2r9> MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 (Normal) X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 Importance: Normal In-reply-to: <0.14c4de10.256c288f@aol.com> Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P60740.CNM I'm concerned that First-aiders do not have the "authority" from AHA or ARC to promote this inhaler trick. Those with the medical background to understand & substantiate their case (in court, as it were) may or may not want to overstep their license or credentials to find & offer an inhaler from a bystander to a victim. I think this is a great idea, personally, but then I'm a risk-taker like many of us in this field. This is something that should be in wilderness medical books if it is not. Patti Carothers, RN SouthWest PaddleSports 26322 I-45 North The Woodlands, TX 77386-1022 281-292-5600 or 1-800-We Paddle http://www.paddlesports.com > -----Original Message----- > From: owner-wilderness-emergency-medicine@list.pitt.edu > [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of > JadedMedic@aol.com > Sent: Tuesday, November 23, 1999 11:28 AM > To: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED Stupid Anaphylaxis Trick # 2 > > > > Hi WMED folks, > > This is the "part two" that I posted to the First Aid list. > > Regards, > > Jay > > XXXXXXXXXXXXXXXXXXXXX > > > Hi (again) folks, > > We all know how serious an anaphylactic reaction can be. It's > right up there > with airway obstruction and cardiac arrest as a condition that > can kill the > patient within a very few minutes. > > More importantly from a first aid viewpoint, anaphylaxis is a > condition that > has a very real potential to kill the patient before the "formal" > EMS troops > can arrive. Thus, it is especially important that a patient > having a severe > anaphylatic reaction receive treatment that has a reasonable > chance of being > helpful as soon as possible. Therefore First Aiders have an > especially high > need to know how to deal with this particular condition. > > (By the way, when I attended a series of wilderness emergency > care lectures > last year, the ER doc who gave the presentation on anaphylaxis was of the > opinion that deaths from this condition were far more common than > they are > believed to be.) > > Most of the time (hopefully) a patient prone to anaphyxaxis will have a > self-injector of epinephrine (Epipen, Anakit) available, with possible > back-up from epinephrine inhalers, diphenhydramine syrup or > tablets, etc., > that First Aiders might have on hand. However, what if none of these are > available? (Obviously, the "EMS troops" should be summoned immediately.) > > One possible means of helping such a patient would be to call out "does > anybody have an asthma inhaler?" > > While OTC asthma inhalers contain epinephrine -- which affects the heart, > blood vessels, and lungs, prescription inhalers may contain more > selective > drugs that (mostly) affect only the lungs. One such drug is called > albuterol. It's marketed under the trade names of Proventil and > Ventolin. > Another such drug is metaproterenol. It's marketed under the > trade names of > Alupent and Metaprel. > > A patient experiencing a severe anaphylactic reaction often has three > problems: (1) vasodialation, (2) bronchospasm, and (3) generalized edema, > with edema of the laryngeal area being the most worrisome. > > It's my belief that the bronchospasm of anaphylaxis is the aspect > of it that > is most fequently life-threatening, and both albuterol and metaproterenol > relax bronchospasm. Thus, if the anaphylaxis patient is experiencing a > dangerous level of respiratory compromise right there in front of > you, and > you have an albuterol or metaproterenol inhaler in your hand, and > you don't > hear the sound of a siren approaching, it seems to me that it only makes > sense to give the patient one or two puffs. > > A few comments. > > 1. These drugs reportedly have a stronger effect on the muscles > involved in > bronchospasm than epinephrine has. Also, epinephrine may be more poorly > absorbed via inhalation than either drug is. Thus, while the therapeutic > dose of epinephrine in such a situation is 10 to 20 puffs, I would be > considerably more conservative with how many albuterol or metaproterenol > puffs I gave the patient. The "party line" is apparently to give no more > than two puffs, and then wait at least ten minutes before giving more. I > know of no reason to disagree with this. > > 2. Not all inhalers carried by asthmatics contain > bronchodialators. Some > contain anti-inflammatory drugs such as corticosteroids. These > drugs take > several _days_ to become effective. Read the label. > > 3. Another drug commonly carried in inhaler form by asthmatics > is cromolyn. > This drug is an antihistamine and inhibits mast cell release. However, I > gather that its onset is relatively slow so it probably wouldn't be of > significant value in the situation I'm describing. > > 4. All of these measures are intended _only_ for very severe, > "there's no > tomorrow" type of situations in which more mainstream treatments are not > immediately available. If the patient is having only a mild to moderate > allergic reaction, especially without respiratory distress, I > would hold off > on giving them any albuterol or metaproterenol. > > 5. These selective bronchodialators will hopefully relieve the > bronchospasm > associated with anaphylaxis, and thus will (again, hopefully) > mitigate the > most common, major, immediate threat to the victim's life, but it > should not > be expected that they will have any significanct effect on the > other major > problems of anaphylaxis -- vasodialation and laryngeal edema. > > 6. BTW, one of my books mentioned in passing that oxygen was itself a > bronchodialator. > > What think? > > Regards, > > Jay Wiseman > FA/CPR Instructor at large > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 18:12:48 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Tue, 23 Nov 1999 18:12:15 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 18:12:15 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 18:10:40 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 18:10:13 -0500 (EST) Received: from imo28.mx.aol.com (imo28.mx.aol.com [152.163.225.72]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 18:10:09 -0500 (EST) From: Omikid@aol.com Received: from Omikid@aol.com by imo28.mx.aol.com (mail_out_v24.4.) id h.0.56f321c6 (4239) for ; Tue, 23 Nov 1999 18:09:33 -0500 (EST) Message-ID: <0.56f321c6.256c78ad@aol.com> Date: Tue, 23 Nov 1999 18:09:33 EST Subject: Re: W-EMED Stupid Anaphylaxis Trick # 2 To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P68400.CNM In a message dated 11/23/1999 05:53:53 PM Eastern Standard Time, rcries@teleport.com writes: > Unfortunately current regulations in Oregon do not encourage us > > folks trained at lower levels (I'm a first responder) to carry and > > administer epi (or even oxygen if you can believe that). If I > > carried and used epi I would technically be in violation. One more > > way the system puts silly rules ahead of saving lives. > I myself carry, for personal use, 2 epi pens at all times. One time I came across a jogger in the state park where I often go running who was in obvious respiratory distress/swollen face/tongue, and immediately, with little hesitation used my epi-pen., and summoned for help via amateur radio. Weather I overstepped my boundaries (as a senior nursing student at the time, by the way) or not, the epi obviously helped the woman a great deal, and gave her some time, although by the time EMS arrived, she was pretty bad. I am not sure what happened to the lady, or how things turned out, but I have this gut feeling that that Epi saved her life. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 20:52:52 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 10:18:02 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 10:17:58 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 10:15:50 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 10:14:17 -0500 (EST) Received: from truxa1.tcd.ie (truxa1.tcd.ie [134.226.1.158]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 10:14:13 -0500 (EST) Received: from tcd.ie (pc155.mee.tcd.ie [134.226.86.155]) by truxa1.tcd.ie (8.9.3/8.9.3) with ESMTP id PAA14216 for ; Tue, 23 Nov 1999 15:14:10 GMT Message-ID: <383AAF0F.9A9BC345@tcd.ie> Date: Tue, 23 Nov 1999 15:13:19 +0000 From: Gerry Butler Organization: TELTEC-TCD, Ireland X-Mailer: Mozilla 4.7 [en] (WinNT; I) X-Accept-Language: en MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Aspirin & heart attacks in the wilderness References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P09440.CNM Here in Ireland and the UK, the standard 'First Aid Manual', which is a 16 hour course, says that in the event of chest pain which may be cardiac related then one standard aspirin tablet (300 mg) should be given to the patient to chew. There are no contra-indications mentioned in the manual. This protocol is approved by all of the voluntary aid organizations, e.g. Red Cross, St. John Ambulance, etc. While I do not know of any direct legal challenge, it is known that in other cases where an attempt was made to sue a first aid provider it was dismissed by the courts on the grounds that the procedure in the manual was followed. Gerry Michelle Schonzeit wrote: > > After just finishing my yearly CPR-FPR and Outdoor Emergency Care > refreshers for Ski Patrol, I happened to see the commercial for Bayer > aspirin that says 'if taken before a heart attack Bayer aspirin can save > your life', or something to that affect. At that time, it occurred to me no > where in my first aid courses have I ever heard such advice given, but I > assume if they can broadcast it on TV it must have some legitimacy some > where. > So, I thought maybe someone on the list would know if this actually > works, & under what circumstances, and if so why doesn't anyone like the Red > Cross or American Heart ever mention it (besides the legal consideration > that you are then providing medication), and if used in the backcountry, how > long would the affect (if any) last, (i.e.. is it enough time to evacuate > someone with out having to do CPR in route) or would you need to > readminister it every so often. Any thoughts anyone? > > Michelle Schonzeit - schonzeit@slic.com > http://www.angelfire.com/mt/schonzeit > Whiteface Mt. Ski Patrol > Search & Rescue of the Northern Adirondacks > & Owner of an '89 Subaru!!! (my first car & I think the nicest car on the > road!!!) > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu -- Dr. Gerard Butler CEng MIEE, (EI0CH, WEMT) TELTEC Radio Systems and Propagation Group, Trinity College, Dublin Ireland Dublin+Wicklow Mountain Rescue Team Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 10:12:54 -0500 (EST) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Tue, 23 Nov 1999 10:12:52 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 10:12:52 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 10:11:35 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 10:09:47 -0500 (EST) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 10:09:44 -0500 (EST) Received: from unixs2.cis.pitt.edu (jmbst85@unixs2.cis.pitt.edu [136.142.185.53]) by post-ofc05.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Tue, 23 Nov 1999 10:09:35 -0500 (EST) Date: Tue, 23 Nov 1999 10:09:33 -0500 (EST) From: Jonnathan M Busko X-Sender: jmbst85@unixs2.cis.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Aspirin & heart attacks in the wilderness In-Reply-To: <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P0A110.CNM I'm sure that those on the list with access to more immediate references than I have with me right now can provide the huge mass of literature available on the use of ASA for the prevention and partial mitigation of MI, but the essence is as follows... Asprin irreversibly binds to platelets, essentially making them less "sticky." Because this is an irreversible process, it's effective for the life of the platelet (5-7 days) and does not need to be immediately repeated. However, if you read the literature, all of us should probably be taking a baby asprin a day to decrease our risk of MI. On the other hand, whoever decided that dying of AMI was less preferable than dying from degenerative neurological disease, CHF, or neoplasm certainly had a few screws loose (side editorial). Understand that the implications of this recommendation is that you are taking ASA to prevent the MI, and says nothing about taking the ASA once the MI starts... However, there is certainly enough literature to assure that taking the ASA once an MI starts is also quite beneficial. I'm sure someone will post the reference, but a fairly recent reference compared ASA to Thrombolytics (clot-busting medications) to ASA + thrombolytics looking at, I believe, just mortality (correct me if I'm wrong). ASA or Thrombolytics each reduced mortality by about 25%; that is, if all you had was one or the other, and you were having an MI, it didn't matter which you took in terms of your mortality. However, the combination of the two reduced mortality by about 48%; that is, if you used them both, you did better. From a weight / cost effectiveness perspective, I'd rather carry ASA in my wilderness field kit than a thrombolytic (although Keith has his own views on this). None of this tells you very much about the effectiveness in preventing primary lethal arrythmias of the sort that would cause a patient to go into cardiac arrest and need CPR. However, since platelet acelyation keeps a clot from getting LARGER, and since presumably more blockage is bad, I can only assume that giving chronic ASA therapy and/or giving 81-325 mg of ASA on first suspicion of MI will reduce the incidence of lethal arrythmias in MI. But since heart attack does not = Cardiac arrest, I'm not sure if the MI literature can be extrapolated to cardiac arrest. Any other input would be greatly appreciated. In terms of providing ASA to patients, the principle of stump medicine may apply. That is, if you happen to have ASA with you, and it happens to be sitting on a stump beside a patient, and you happen to mention to the patient that taking the ASA will decrease his/her risk of death from MI, and you happen to look away, no one can control what the patient does with that ASA. As a side note, as a care provider, you can't give ASA (unless specifically authorized to do so under a medical command system), but you certainly can give anyone anything you've got if you're a private civilian (not that I'm advocating that anyone share their haldol, but ASA is usually pretty benign.) Anyone and everyone else, feel free to chime in (or provide references for my babbling). Jonnathan Jonnathan M. Busko, MPH, NREMT-P, CCEMT-P MS IV, University of Pittsburgh School Of Medicine. -_---__----___-----____------_____-------______--------_______---------_______- Primum Non Nocere -_______---------_______--------______-------_____------____-----___----__---_- On Tue, 23 Nov 1999, Michelle Schonzeit wrote: > After just finishing my yearly CPR-FPR and Outdoor Emergency Care > refreshers for Ski Patrol, I happened to see the commercial for Bayer > aspirin that says 'if taken before a heart attack Bayer aspirin can save > your life', or something to that affect. At that time, it occurred to me no > where in my first aid courses have I ever heard such advice given, but I > assume if they can broadcast it on TV it must have some legitimacy some > where. > So, I thought maybe someone on the list would know if this actually > works, & under what circumstances, and if so why doesn't anyone like the Red > Cross or American Heart ever mention it (besides the legal consideration > that you are then providing medication), and if used in the backcountry, how > long would the affect (if any) last, (i.e.. is it enough time to evacuate > someone with out having to do CPR in route) or would you need to > readminister it every so often. Any thoughts anyone? > > Michelle Schonzeit - schonzeit@slic.com > http://www.angelfire.com/mt/schonzeit > Whiteface Mt. Ski Patrol > Search & Rescue of the Northern Adirondacks > & Owner of an '89 Subaru!!! (my first car & I think the nicest car on the > road!!!) > > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 09:43:15 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 09:43:13 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 09:43:13 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 09:42:46 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 09:40:52 -0500 (EST) Received: from buzz.slic.com (buzz.slic.com [206.25.233.41]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 09:40:48 -0500 (EST) Received: (qmail 18548 invoked by uid 0); 23 Nov 1999 14:40:47 -0000 Received: from saratoga-async74.slic.com (HELO oemcomputer) (216.207.140.74) by buzz.slic.com with SMTP; 23 Nov 1999 14:40:47 -0000 Message-ID: <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> From: "Michelle Schonzeit" To: References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> Subject: W-EMED Aspirin & heart attacks in the wilderness Date: Tue, 23 Nov 1999 09:46:15 -0500 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P358B0.CNM After just finishing my yearly CPR-FPR and Outdoor Emergency Care refreshers for Ski Patrol, I happened to see the commercial for Bayer aspirin that says 'if taken before a heart attack Bayer aspirin can save your life', or something to that affect. At that time, it occurred to me no where in my first aid courses have I ever heard such advice given, but I assume if they can broadcast it on TV it must have some legitimacy some where. So, I thought maybe someone on the list would know if this actually works, & under what circumstances, and if so why doesn't anyone like the Red Cross or American Heart ever mention it (besides the legal consideration that you are then providing medication), and if used in the backcountry, how long would the affect (if any) last, (i.e.. is it enough time to evacuate someone with out having to do CPR in route) or would you need to readminister it every so often. Any thoughts anyone? Michelle Schonzeit - schonzeit@slic.com http://www.angelfire.com/mt/schonzeit Whiteface Mt. Ski Patrol Search & Rescue of the Northern Adirondacks & Owner of an '89 Subaru!!! (my first car & I think the nicest car on the road!!!) Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 12:29:17 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 12:29:15 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 12:29:15 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 12:28:58 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 12:28:21 -0500 (EST) Received: from imo-d04.mx.aol.com (imo-d04.mx.aol.com [205.188.157.36]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 12:28:17 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo-d04.mx.aol.com (mail_out_v24.4.) id h.0.14c4de10 (4558) for ; Tue, 23 Nov 1999 12:27:44 -0500 (EST) Message-ID: <0.14c4de10.256c288f@aol.com> Date: Tue, 23 Nov 1999 12:27:43 EST Subject: W-EMED Stupid Anaphylaxis Trick # 2 To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P1DBC0.CNM Hi WMED folks, This is the "part two" that I posted to the First Aid list. Regards, Jay XXXXXXXXXXXXXXXXXXXXX Hi (again) folks, We all know how serious an anaphylactic reaction can be. It's right up there with airway obstruction and cardiac arrest as a condition that can kill the patient within a very few minutes. More importantly from a first aid viewpoint, anaphylaxis is a condition that has a very real potential to kill the patient before the "formal" EMS troops can arrive. Thus, it is especially important that a patient having a severe anaphylatic reaction receive treatment that has a reasonable chance of being helpful as soon as possible. Therefore First Aiders have an especially high need to know how to deal with this particular condition. (By the way, when I attended a series of wilderness emergency care lectures last year, the ER doc who gave the presentation on anaphylaxis was of the opinion that deaths from this condition were far more common than they are believed to be.) Most of the time (hopefully) a patient prone to anaphyxaxis will have a self-injector of epinephrine (Epipen, Anakit) available, with possible back-up from epinephrine inhalers, diphenhydramine syrup or tablets, etc., that First Aiders might have on hand. However, what if none of these are available? (Obviously, the "EMS troops" should be summoned immediately.) One possible means of helping such a patient would be to call out "does anybody have an asthma inhaler?" While OTC asthma inhalers contain epinephrine -- which affects the heart, blood vessels, and lungs, prescription inhalers may contain more selective drugs that (mostly) affect only the lungs. One such drug is called albuterol. It's marketed under the trade names of Proventil and Ventolin. Another such drug is metaproterenol. It's marketed under the trade names of Alupent and Metaprel. A patient experiencing a severe anaphylactic reaction often has three problems: (1) vasodialation, (2) bronchospasm, and (3) generalized edema, with edema of the laryngeal area being the most worrisome. It's my belief that the bronchospasm of anaphylaxis is the aspect of it that is most fequently life-threatening, and both albuterol and metaproterenol relax bronchospasm. Thus, if the anaphylaxis patient is experiencing a dangerous level of respiratory compromise right there in front of you, and you have an albuterol or metaproterenol inhaler in your hand, and you don't hear the sound of a siren approaching, it seems to me that it only makes sense to give the patient one or two puffs. A few comments. 1. These drugs reportedly have a stronger effect on the muscles involved in bronchospasm than epinephrine has. Also, epinephrine may be more poorly absorbed via inhalation than either drug is. Thus, while the therapeutic dose of epinephrine in such a situation is 10 to 20 puffs, I would be considerably more conservative with how many albuterol or metaproterenol puffs I gave the patient. The "party line" is apparently to give no more than two puffs, and then wait at least ten minutes before giving more. I know of no reason to disagree with this. 2. Not all inhalers carried by asthmatics contain bronchodialators. Some contain anti-inflammatory drugs such as corticosteroids. These drugs take several _days_ to become effective. Read the label. 3. Another drug commonly carried in inhaler form by asthmatics is cromolyn. This drug is an antihistamine and inhibits mast cell release. However, I gather that its onset is relatively slow so it probably wouldn't be of significant value in the situation I'm describing. 4. All of these measures are intended _only_ for very severe, "there's no tomorrow" type of situations in which more mainstream treatments are not immediately available. If the patient is having only a mild to moderate allergic reaction, especially without respiratory distress, I would hold off on giving them any albuterol or metaproterenol. 5. These selective bronchodialators will hopefully relieve the bronchospasm associated with anaphylaxis, and thus will (again, hopefully) mitigate the most common, major, immediate threat to the victim's life, but it should not be expected that they will have any significanct effect on the other major problems of anaphylaxis -- vasodialation and laryngeal edema. 6. BTW, one of my books mentioned in passing that oxygen was itself a bronchodialator. What think? Regards, Jay Wiseman FA/CPR Instructor at large Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 14:29:53 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Tue, 23 Nov 1999 14:29:20 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 14:29:20 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 14:28:46 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 14:28:03 -0500 (EST) Received: from macs.mxim.com (macs.mxim.com [204.17.143.130]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 14:27:53 -0500 (EST) Received: from localhost (localhost [127.0.0.1]) by macs.mxim.com (8.7/8.6.9) with SMTP id LAA22931 for ; Tue