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Elevated suicide mortality rates have been reported for farmers and for the elderly. Very little literature exists that looks at the health of older minority farmers. This mixed-method study describes older African-American farmers (N = 156) in the contexts of active coping, personal satisfaction from farm work, and attachment to their farmland to provide insight into the psychosocial dimensions of their mental health. Findings show that the farmers have positive perspectives on work and farm future, and strong attachment to the land. Differences were noted by gender. Nurses can use these findings to frame culturally appropriate strategies for aging farmers to maximize positive outcomes.

Background: The Public Access Defibrillation (PAD) Trial found an overall doubling in the number of out-of-hospital cardiac arrest (CA) survivors when a lay responder team was equipped with an automated external defibrillator (AED), compared with cardiopulmonary resuscitation (CPR) alone., Objectives: To describe the types of facilities that participated in the trial and to report the incidence of CA and survival in these different types of facilities., Methods: In this post-hoc analysis of PAD Trial data, the physical characteristics of the participating facilities and the numbers of presumed CAs, treatable CAs, and survivors are reported for each category of facilities., Results: There were 625 presumed CAs at 1,260 participating facilities. Just under half (n = 291) of the presumed CAs were classified as treatable CAs. Treatable CAs occurred at a rate of 2.9 per 1,000 person-years of exposure; rates were highest in fitness centers (5.1) and golf courses (4.8) and lowest in office complexes (0.7) and hotels (0.7). Survival from treatable CA was highest in recreational complexes (0.5), public transportation sites (0.4), and fitness centers (0.4) and lowest in office complexes (0.1) and residential facilities (0.0)., Conclusions: During the PAD Trial, the exposure-adjusted rate of treatable CA was highest in fitness centers and golf courses, but the incidence per facility was low to moderate. Survival from treatable cardiac arrest was highest in recreational complexes, public transportation facilities, and fitness centers.

Objective: To measure the time to analgesia for patients with painful, isolated extremity injuries brought to the emergency department (ED) by emergency medical services (EMS)., Methods: A retrospective chart review of all patients presenting with isolated, painful extremity injuries during an 18-month period to a Level 1 trauma center. Medical records were reviewed by diagnostic codes for extremity injuries., Inclusion Criteria: patients 18 years or older transported to the ED by EMS; isolated, painful extremity injuries; received parenteral analgesia in the ED or by EMS. Excluded: multiple trauma patients, interfacility transfers, hemodynamically unstable patients, head-injured patients, intoxicated patients, and patients with mental status changes. Data elements: age, sex, EMS arrival time, EMS medication time, hospital triage time, and ED medication time. All "times to analgesia" were calculated from the EMS arrival time on scene., Results: Extremity injuries were identified in 706 patients. Of these, 104 patients with painful, isolated, extremity injuries met all inclusion criteria. Thirteen (12.5%) of 104 received analgesia by EMS during prehospital care. Ninety-one patients (88%) first received parenteral analgesia in the ED. The mean time to analgesia for EMS treated patients was 23 minutes (95% CI 16.7-30.2). Mean time to analgesia for patients treated in the ED was 113 minutes (95% CI 99.2-128.1). Mean time to analgesia after triage in this group was 75 minutes (95% CI 60.8-89.7)., Conclusion: In this study, patients received analgesia sooner when administered by EMS during prehospital care. There was a significant time delay after triage for patients first medicated in the ED.

Objective: The manufacturer of the laryngeal mask airway (LMA) reports success rates of 30-93% by practitioners attempting tracheal intubation through the LMA-Classic. No prior studies describe success rates through the (disposable) LMA-Unique by paramedics. The objective of this study was to measure the success rate of paramedics attempting to intubate the trachea blindly through the LMA-Unique., Methods: During a paramedic refresher class and an emergency medical services teaching day conference, paramedics previously trained in the use of the LMA-Unique as a "rescue" airway device were instructed in the technique of tracheal intubation through the LMA-Unique. A Laerdal LMA-mannequin was immobilized with an extrication collar and held by an investigator in the head-neutral position. Paramedics were first asked to insert the LMA-Unique as previously trained, and to confirm adequate ventilation by seeing inflation of the mannequin's lungs. Then, subjects were asked to pass a well-lubricated 6-0 Mallinckrodt endotracheal tube through the LMA-Unique within a 60-second period. Tracheal placement of the endotracheal tube was then confirmed by visualization of the expanding mannequin lungs. Rates of success of LMA-Unique placement and endotracheal tube placement were measured., Results: Fifty of the 52 (96%; CI 91% to 100%) paramedics successfully inserted the LMA-Unique on the first attempt. Only 11 of the 52 (21%; CI 10% to 32%) paramedics were successful in blind placement of the endotracheal tube into the trachea through the LMA-Unique within a 60-second period. The failures (41 of the 52) were visually confirmed to be located in the esophagus., Conclusion: In this study, when attempting blind tracheal intubation through the LMA-Unique, paramedics were rarely successful in tracheal placement. Basic LMA-Unique insertion, however, had a very high success rate.

Hidden within the pastoral setting of rural America are the struggles of farm families who must cope with a decreasing economy, increasing technology, and one of the highest injury rates of any industry. Wives of farmers often juggle household responsibilities, hold an off-farm job, and work on the farm. Too often, wives are first on the scene of a serious injury to their spouses. All attention is focused on the farmer but the wife must cope with caregiving, her usual work, and the added full responsibility of the farm. This grounded theory study examined the process of spousal coping after a permanently disabling injury occurred to their farmer husbands. Interviews conducted with 12 farm wives elicited four themes in the coping process. These findings may help identify critical points of mental stress and form interventions to assist spouses of injured farmers in their adjustment to changing roles and responsibilities.

Objective: To report the preliminary experience of the Central New York emergency medical services (EMS) region with etomidate for prehospital facilitated intubation., Methods: Prospective recording of all intubations (facilitated and nonfacilitated) was completed during the first six months of the etomidate protocol, from January 1 to June 30, 2000. These results were compared with retrospective comparison data obtained for an 18-month period from stored documented prehospital care reports (PCRs), a period when diazepam was used for facilitated intubation., Results: During the study period, 343 (84%) of 409 attempted intubations were successful. Of these, 24 facilitated intubations (using etomidate) were attempted (all on breathing, agitated patients), and 19 (79%, CI 63%-95%) were successful. Eighteen of these (95%) were intubated successfully on the first attempt. The median age of the patients requiring intubation was 70 years (range 14-90), and 60% were female. There were no reported incidences of vomiting, broken teeth, or bleeding. The region's prior 18-month experience using diazepam for facilitated intubation resulted in ten (23%, CI 1%-36%) successful intubations of 43 facilitated intubation attempts., Conclusions: Preliminary data suggest increased rates of success for facilitated intubation using etomidate, when compared with diazepam, with most intubations successful on the first attempt. Limitations of this study include a small sample size and self-reporting of airway data by paramedics.

Objective: To evaluate the ability of paramedics to learn and apply the skill of introducer-aided oral intubation in the setting of the simulated "difficult airway." The authors hypothesized that, following a brief introduction to the device, intubation success rates would not differ for traditional and introducer-aided intubations of an immobilized airway mannequin., Methods: During a paramedic recertification class, experienced paramedics were given a brief didactic introduction to the "bougie-like" Flex Guide endotracheal tube introducer (ETTI). The participants were then asked to intubate adult mannequins immobilized in the head-neutral position, with and without the ETTI. "Successful placement" was defined as completion of the procedure within 30 seconds and endotracheal tube position confirmed by the investigator with direct visualization., Results: For both traditional and ETTI intubations, 34 (97%) of the 35 paramedics successfully intubated within 30 seconds. The two unsuccessful intubation attempts were recognized by the paramedic as esophageal intubations, and correct tube placement was obtained within an additional 30 seconds., Conclusion: In this study, use of the ETTI was mastered by the participants after only a brief didactic introduction to the device, with their ability to intubate an immobilized mannequin using the ETTI being equal to their ability to perform traditional intubation. These results suggest that use of the ETTI is easily learned, and may support the device's role in the prehospital management of the difficult airway.

Objective: To determine whether paramedics and on-line physicians screen patients for use of sildenafil citrate (Viagra) prior to prehospital administration of nitrates., Methods: A prospective, observational study was performed over a one-month period in three EMS systems. Consecutive radio communications between on-line physicians and paramedics concerning male patients with cardiac complaints were monitored. Investigators observed the frequency with which on-line physicians screened for sildenafil use prior to ordering nitrates. After observation of the radio communications was completed, a written survey was distributed to all paramedics in the three EMS systems., Results: Seventy-six physician-paramedic interactions were monitored. Nitrates were ordered by on-line physicians in 56 cases. No paramedic reported sildenafil use/nonuse, and no on-line physician inquired about the patient's potential use of the drug. Only half of the surveyed paramedics reported that they routinely screen for sildenafil use, and approximately a fourth reported that its use would not alter their management of chest pain patients., Conclusion: In this study, on-line physicians in three EMS settings did not screen for sildenafil use prior to ordering nitrates. While some paramedics do screen for sildenafil use, practice patterns among paramedics in these three systems were inconsistent.

Conjunctivitis has many bacterial and viral causes. If the cause is bacterial, treatment with a broad-spectrum antibiotic resolves the problem in 1 to 3 days in almost all cases. If signs and symptoms persist, referral to an ophthalmologist is wise. Most cases of viral conjunctivitis are accompanied by follicular reactions in the inferior fornix, as observed with adult inclusion disease. If dendrites are seen, trifluridine (Viroptic) is preferred for treatment. Referral to an ophthalmologist is advisable because recurrence with scarring and permanent loss of vision is possible. Many topical antibiotics include a corticosteroid component that never should be used unless the conjunctivitis or keratitis is proven to be nonherpetic.