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Figures from the National Audit Office (2005) reveal that stroke accounts for 11 per cent of deaths in England and Wales each year, that up to 30 per cent of [...]

Evidences indicate that declining competition in the US House elections is explained by two major factors, a shift in the partisan composition of House districts and a decline in the ability of challengers to compete financially with incumbents. The result thus helps to explain why, despite the relatively small size of their majority, Republicans are able to maintain control of the House since their 1994 takeover.

Background: Early access to critical care interventions may improve outcomes for severely ill and injured patients. South Africa (SA) faces the unique challenges of prolonged pre-hospital times and limited access to physicians. In 2008, the Health Professions Council of SA introduced paramedic rapid sequence induction (RSI), the gold standard critical care intervention for emergency airway management; however, the risk to benefit ratio in this context is unclear., Objective: We conducted a pilot study to identify if paramedic RSI in the SA pre-hospital care setting is effective and safe., Methods: We undertook a retrospective observational study of paramedic RSI performed by an emergency medical service, between 12 December 2009 and 12 December 2011., Results: Eighty-six RSIs were performed during the study period. No failed intubations were reported. Heart rate was significantly reduced from a median baseline value of 112 to 90 bpm, and oxygen saturations improved from 92% to 99% at handover following RSI. Nineteen patients (22%), however, had an adverse event (AE). Female patients (odds ratio (OR) 18.3; 95% confidence interval (CI) 3.46 - 99.38; p=0.001) and patients subsequently transported by helicopter (OR 7.24; 95% CI 1.44 - 36.32; p=0.016) remained independently associated with AEs after adjusting for confounders., Conclusions: RSI performed by specially trained paramedics is effective in terms of self-reported success. However, the 1 in 5 AE rate highlights safety concerns. The importance of a robust clinical governance programme to identify problems, refine practice and improve the quality of care is underscored.