Crew Type Research Articles

Layover start timing predicts layover sleep quantity and timing on Long-Range and Ultra-Long-Range trips

Abstract Study Objectives Airline pilot sleep during layover is an important factor for alertness on subsequent flights. Assessing pilots’ sleep on layover is an important first step in helping them obtain the most recuperative sleep possible on layover. Here we investigate the quantity and timing of sleep during layovers and determine predictors for layover sleep. Methods Sleep was assessed in 256 pilots flying a total of 473 long-range (LR; flight time 12-16h) or ultra-long-range (ULR; flight time > 16h) trips. Sleep was assessed using actigraphy. We employed linear mixed-effects models with layover sleep characteristics as the outcomes. The predictor variables included operational factors and sleep history. Results Overall, pilots averaged 7.2 hours of sleep per 24 hours of layover, which was significantly less than their daily sleep before or after the trip. Layover start time (relative to home base time) was the most salient predictor of sleep timing and quantity during both shorter (∼24-h) and the first 24h of longer (∼48-h) layovers. During the last 24h of longer layovers, crew type predicted sleep quantity. Conclusions Although average sleep quantity during layovers was within the margins of recommended sleep duration, it was still less than pre- and post-trip sleep duration, suggesting modest sleep loss on layovers. Layover start timing was the strongest predictor of layover sleep quantity and timing and, thus, may be a modifiable factor to protect circadian-aligned sleep opportunities during layover.

Professional and public views about early return of patients from Comprehensive Stroke Centers to local Acute Stroke Centers in England following displacement by emergency care pathways

BackgroundMechanical thrombectomy is a highly effective emergency treatment for selected cases of ischemic stroke but can only be provided at hospitals with appropriate facilities and interventionists. Many patients require transfers for treatment, including some who are subsequently considered ineligible. To maintain capacity at thrombectomy centers, displaced patients should soon be returned to their local hospital following assessment and treatment, but return processes vary. We sought the views of stroke and ambulance services, clinicians, and public representatives about the timing, planning and implementation of acceptable processes to inform recommendations about the early return of patients (< 24 h) displaced as a result of thrombectomy pathways.MethodsThree workstreams were undertaken between 01/05/2023 and 31/10/2023: 1. An online survey of hospital stroke services supplemented by a convenience poll of stroke clinicians. 2. An online survey of ambulance services. 3. Focus groups with stroke patients and carers using a topic guide describing typical early return scenarios. The surveys used multiple choice answers supplemented by free text boxes for additional comments. Data were reported descriptively without statistical comparison. Focus group data were analyzed thematically using emergent coding.ResultsResponses were obtained from 32 stroke services, 44 stroke clinicians, and 11 ambulance services. Stroke service and clinician respondents generally supported early return for most clinical scenarios but advised caution regarding transfers < 4 h after thrombectomy and < 24 h for hemorrhagic stroke due to the higher risk of complications. Ambulance respondents highlighted travel time, immediate service pressures and crew type as influences upon providing early returns, but supported 24/7 provision. Twenty-nine patients and four carers participated in three focus groups. There was general acceptance of early return processes but these participants emphasized the need for clear communication and individualized decisions based upon clinical status, age, journey length, patient preferences and individual contextual factors.ConclusionsAll contributors were generally supportive of early patient returns to maintain thrombectomy center capacity, but the results suggest important organizational, clinical, and patient-focused considerations for successful implementation.

Maintenance scheduling at high-speed train depots: An optimization approach

Under the preventive maintenance policy, high-speed trains need to conduct periodical inspection/overhaul at dedicated depots, where maintenance facilities and maintenance crews are available. Due to the complicated structure of trains, the maintenance work is rich in a variety of types, characterized by mechanical components repaired, maintenance levels and etc. In practice, these types of maintenance work are integrated into maintenance packets, and different packets may require the specific types of crews. In this paper, a mixed integer linear programming model is proposed for the depot maintenance packet assignment and crew scheduling problem. The objective of the problem is to minimize the overall crew worktime, while the main constraints include the compatibility between maintenance packets and crew types, maintenance packet duration time and execution order, maintenance time window, and crew worktime limit. Besides, two families of valid inequalities are proposed to improve the baseline model. Computational experiments on a set of randomly generated instances show the effectiveness and efficiency of the improved model compared to the baseline one. Finally, a real-world case study from Shanghai South Depot is carried out to further validate the proposed approach. Improvements on both solution time and quality are achieved in contrast with the manual schedule.

Spectral Clustering Approximation For Large Scale Crew Disruption Data Of An Airline Company For Intelligent Crew Recovery

In the airline industry, after fuel costs, the crew costs con- stitute airlines’ second-highest cost items. For this reason, an airline needs to manage the valuable crew resource effi- ciently. Deviations from plans are fact in airline business and fixing deviations from crew schedules that occurred during operations by minimizing the crew-related delays and associated costs is one of the most important opera- tional burdens of airlines. In this context, the analysis of crew disruption data is vital in order to find disruption characteristics. Clustering analysis is one of the key meth- ods for analyzing the disruption characteristics. In this context, although there have been satisfactory studies in the literature and applications in the industry for small and medium-sized airlines, there is no good solution or industry practice for airlines with extensive networks and fleets. This study aims to analyze and categorize large- scale crew disruption data of a European airline. The relationship between categories of crew disruption and variables such as flight and crew types etc., are determined, and the disruption characteristics are revealed. For this purpose, clusters hidden in the large data set are extracted by spectral clustering. Due to the large size of the input data, a new approximation approach for spectral clustering is introduced. With the help of this new approximation approach, spectral clustering techniques are applied within a limited computational power and time frame as most real world scenario require. Even if the data set is gathered from one airline, the characteristics that are derived from the data is representing most of the cases an airline may face today. and will serve as a basis for further estimation and analysis of crew disruption.

Provision of immobilization or ice by paramedics in Southwestern Ontario.

Pain is the most common reason for prehospital transport. As emergency wait times increase, timely pain management is essential. In children, there is abundant evidence that prehospital pharmacologic analgesia is suboptimal, but little is known about non-pharmacologic therapies. We sought to characterize documentation by paramedics of non-pharmacologic (immobilization and ice) and pharmacologic analgesia in children with musculoskeletal injuries. We reviewed all ambulance call reports for children 0-17years transported to Southwestern Ontario regional hospitals from January 1, 2017, to December 31, 2019, with a musculoskeletal injury (Ontario Ministry of Health and Long-Term Care problem codes 66 and 67). Primary and secondary outcomes were documented immobilization or ice and pharmacologic analgesia, respectively. In a multivariable analysis, we explored the relationship between immobilization or ice and the following a priori covariates: age, sex, visible deformity, crew type, pain severity, and analgesia. Of 40,692 ambulance call reports reviewed, 4445 met inclusion criteria. There were 2584/4441 (58.2%) males, with a median (IQR) age of 14 (10, 16) years. In ambulance call reports with documented pain scores, 2106/3048 (69.1%) ambulance call reports reported "moderate or severe" pain. Immobilization or ice were documented in 1605/4445 (36.1%) and 385/4445 (8.7%) of ambulance call reports. Pharmacologic analgesia was documented in 275/1983 (13.9%) and 125/991 (12.6%) of ambulance call reports for primary care paramedics and advanced care paramedics, respectively. An increased odds of documented immobilization or ice was associated with moderate or severe pain [OR: 2.4; 95% CI 1.84-3.17; p < 0.01] and visible deformity [OR: 2.5; 95% CI 1.97-3.12; p < 0.01]. Documented immobilization and ice and pharmacologic analgesia to children by paramedics is suboptimal. Our findings underscore an important need for enhanced education surrounding the benefits of non-pharmacologic options for children with musculoskeletal injuries.

Respiratory Tract and Eye Symptoms in Wildland Firefighters in Two Canadian Provinces: Impact of Discretionary Use of an N95 Mask during Successive Rotations.

We examined whether discretionary use of an N95 mask reduced symptom reporting in wildland firefighters. The study collected data from two Canadian provinces during the 2021 fire season, with each firefighter followed for up to 4 rotations. Participants completed questionnaires on symptoms at the start and end of each rotation, when they reported also on mask use (if any) and completed a task checklist. Eighty firefighters contributed data. Nineteen firefighters were successfully fit-tested for N95 masks to wear whenever they felt conditions justified. Start-of-rotation symptoms reflected total hours firefighting in 2021. Symptoms of eye, nose and throat irritation and cough were more bothersome at the end of rotation. Cough, throat and nose (but not eye) symptoms were reported as significantly less bothersome at the end of rotation by those allocated masks, having allowed for crew type and start-of-rotation symptoms. Among those allocated a mask, use was most frequent during initial attack and least during driving and patrol. Reasons for not wearing included high work difficulty and low comfort. It is concluded that symptoms in wildland firefighters increased with hours of exposure. While provision of an N95 mask reduced symptoms, work is needed to overcome barriers to respiratory protection

Linking Ambulance Records with Hospital and Death Index Data to Evaluate Patient Outcomes.

ObjectiveLinkage of electronic administrative datasets is becoming increasingly common, offering a powerful resource for research and analysis. However, routine linkage of prehospital data with emergency department (ED) presentation and hospital admission datasets is rare. We describe a methodology used to link ambulance data with hospital ED presentations, admissions, and death records, and examine potential biases between matched and unmatched patients.MethodsIterative deterministic linkage methodologies were employed to link clinical, operational, and secondary triage ambulance data to ED presentations, hospital admissions, and death records in Victoria, Australia. Descriptive analyses and standardised differences were used to examine potential biases between matched and unmatched patients.ResultsA total of 2,813,913 ambulance records were available for linkage. Of the patients that were transported to a public ED (n=1,753,268), 83.3% matched with an ED record. Only small differences were observed between matched and unmatched patients for sex, year, time of day and attending crew type. The data elements with the largest standardised differences were patient age (0.25) and paramedic diagnosis (0.25). Matched patients were older (mean ± standard deviation: 55.6±25.7 vs 49.0±26.0 years) and more likely to have a paramedic-suspected cardiac, respiratory, neurological, or gastrointestinal/genitourinary condition, suspected infection/sepsis, or pain.ConclusionThis linked dataset will facilitate a large body of research into prehospital care and patient outcomes. Although future analysis of matched patients should acknowledge the linkage error rate, our findings suggest that results are likely to be generalisable to the broader ambulance population.

28 Assessment of Pain and Provision of Non-Pharmacologic Analgesia to Children by Prehospital Providers in Southwestern Ontario: A Cross-Sectional Study

Abstract Primary Subject area Emergency Medicine - Paediatric Background There is abundant evidence that provision of pharmacologic analgesia by prehospital providers to children is suboptimal. Most paediatric calls are performed by primary care paramedics (PCPs) who are unable to administer pharmacologic analgesia to children but can administer non-pharmacologic therapies. Objectives Our objective was to describe the provision of non-pharmacologic analgesia to children by prehospital providers. Design/Methods We reviewed all ambulance call reports (ACRs) of children 0-17 years with acutely painful conditions (headache, abdominal pain, injury, head/ears/eyes/nose/throat pain, and back pain) who were transported to a paediatric tertiary referral centre serving a catchment of &amp;gt; 1 million from 2017-2019. Data collection was recorded by two blinded assessors using a study-specific Excel™ sheet. The primary outcome was the proportion of children offered non-pharmacologic analgesia. We performed a stepwise logistic regression on the primary outcome using covariates defined a priori: age, sex, visible deformity, type of crew, complaint, pain score, call time, and prior analgesia. Results All 11,084 ACRs from January 1, 2017 to December 31, 2019 were reviewed. The sample included 5887/11084 (53.1%) males, ranging from 1 month to 17 years, with a mean (SD) age of 10.5 (5.6) years. Calls involved mainly PCPs [8576/11084 (77.4%)]. Non-trauma-related musculoskeletal injuries were most common, comprising 2743/11,084 (24.7%) of calls. Pain scores were documented in 6947/11084 (62.7%) of calls. The verbal numeric rating scale (0-10) was used in 5022/6947 (72.3%) of calls, with a mean (SD) score of 5.2 (3.2). Non-pharmacologic analgesia was provided in 2926/11084 (26.4%) of calls, most commonly splint (1115/2926, 38.1%) and ice (931/2926, 31.8%). Pharmacologic analgesia was provided in 458/11084 (4.1%) of calls. In the multivariate model, mild (OR: 3.2; 95% CI 2.3-4.4; p &amp;lt; 0 .001) and moderate pain (OR: 1.7; 95% CI 1.3-2.2) (versus no pain) were significant predictors of non-pharmacologic analgesia, whereas visible deformity (OR: 0.5; 95% CI 0.3-0.6; p &amp;lt; 0 .001) was a significant negative predictor. Conclusion The provision of non-pharmacologic analgesia to children in Southwestern Ontario by prehospital providers is suboptimal, despite moderate to severe pain. There is a clear need for education surrounding approaches to non-pharmacologic analgesia in children among prehospital providers.

Exposure to Particulate Matter and Estimation of Volatile Organic Compounds across Wildland Firefighter Job Tasks.

Wildland firefighters are exposed to smoke-containing particulate matter (PM) and volatile organic compounds (VOCs) while suppressing wildfires. From 2015 to 2017, the U.S. Forest Service conducted a field study collecting breathing zone measurements of PM4 (particulate matter with aerodynamic diameter ≤4 μm) on wildland firefighters from different crew types and while performing various fire suppression tasks on wildfires. Emission ratios of VOC (parts per billion; ppb): PM1 (particulate matter with aerodynamic diameter ≤1 μm; mg/m3) were calculated using data from a separate field study conducted in summer 2018, the Western Wildfire Experiment for Cloud Chemistry, Aerosol Absorption, and Nitrogen (WE-CAN) Campaign. These emission ratios were used to estimate wildland firefighter exposure to acrolein, benzene, and formaldehyde. Results of this field sampling campaign reported that exposure to PM4 and VOC varied across wildland firefighter crew type and job task. Type 1 crews had greater exposures to both PM4 and VOCs than type 2 or type 2 initial attack crews, and wildland firefighters performing direct suppression had statistically higher exposures than those performing staging and other tasks (mean differences = 0.82 and 0.75 mg/m3; 95% confidence intervals = 0.38-1.26 and 0.41-1.08 mg/m3, respectively). Of the 81 personal exposure samples collected, 19% of measured PM4 exposures exceeded the recommended National Wildland Fire Coordinating Group occupational exposure limit (0.7 mg/m3). Wildland fire management should continue to find strategies to reduce smoke exposures for wildland firefighters.

Carbon monoxide exposures in wildland firefighters in the United States and targets for exposure reduction.

Background:Every year thousands of wildland firefighters (WFFs) work to suppress wildfires to protect public safety, health, and property. Although much effort has been put toward mitigating air pollutant exposures for the public and WFFs, the current burden in this worker population is unclear as are the most effective exposure reduction strategies.Objective:Quantify fireline carbon monoxide (CO) exposures in WFFs and identify predictors of exposures.Methods:We collected one-minute breathing zone CO measurements on 246 WFFs assigned to fires between 2015 and 2017. We used generalized estimating equations to evaluate predictors of CO exposure.Results:Approximately 5 percent of WFFs had fireline CO exposure means exceeding the National Wildfire Coordinating Group’s (NWCG) occupational exposure limit of 16 ppm. Relative to operational breaks, direct suppression-related job tasks were associated with 56% (95% CI: 47%, 65%) higher geometric mean CO concentrations, adjusted for incident type, crew type, and fire location. WFF perception of smoke exposure was a strong predictor of measured CO exposure.Significance:Specific job tasks related to direct suppression and WFF perceptions of smoke exposure are potential opportunities for targeted interventions aimed at minimizing exposure to smoke.

Airline crew scheduling: Models and algorithms

The airline crew scheduling problem has become a crucial but challenging task for commercial airlines for decades. Airlines are operating with two types of air crew: cockpit crew and cabin crew. Due to the unique operating characteristics, the scheduling problems for these two crew types are very different. Besides, according to the planning stage, the airline crew scheduling problem can be classified as tactical planning problems (traditional scheduling and robust scheduling, weeks or months before the actual operations) and operational planning problems (recovery, after disruptions have occurred during the operational stage). Realizing the significance of the airline crew scheduling problems and a lack of review on the modelling and algorithmic advancements in terms of each crew type and planning stage, we develop this paper to review the related literature from four aspects: the scheduling for cabin crew, the scheduling for both cabin crew and cockpit crew, the robust scheduling for cockpit crew, and the recovery for cockpit crew. For each stream, we examine a number of prior representative studies to review the advancements in model development and solution algorithm construction to generate insights. Finally, we conclude the review by proposing a future research agenda for the airline crew scheduling problem.

Electrolyte Balance And Hydration Status During Wildland Fire Suppression

INTRODUCTION: Our laboratory has previously demonstrated the total energy fluid demands of wildland firefighters (WLFF) during arduous fire suppression. However, it remains unclear how current hydration strategies, occupational activity, and fire line provisions may alter overall hydration and electrolyte balance. PURPOSE: To determine WLFF fluid retention and urine production as influenced by environmental conditions, self-selected hydration practices, and work output during fire suppressions shifts. METHODS: 59 WLFF (9 female, 50 male; 29±6 yr) from various crew types were deployed to fire incidents across the United States during the 2019 fire season and were observed throughout a single work shift. Before and after shifts, a measure of nude body weight was obtained. In a subset of subjects (n=25), pre and post-shift blood samples were also drawn to evaluate serum electrolytes. Fireline-certified researchers monitored fluid intake and urine output parameters (frequency, specific gravity [USG], volume) in real-time via observational data capture using graduated cylinder, refractometer, and mobile tablets. Dependent t-tests were performed for all comparative analyses and statistical significance was established at p<0.05. RESULTS: WLFF worked shifts of 13.9±1.1 hr, during which 4.7±1.6 L of water was consumed. WLFF eliminated 2.3±1.1 L via 5.7±2.7 voids (412±192 mL.void-1). There were no noted differences in USG from morning voids compared to those measured post meridiem (1.0106±0.0147 and 1.0106±0.0187 for AM and PM USG, respectively; p>0.05). No changes in nude body weight were observed across the work shift (80±13.4 and 79.8±13.2 kg for pre- and post-shift, respectively; p>0.05). Serum sodium and potassium did not change between pre- and post-shift blood draws (pre = 142±2 and 4.3±0.3, post = 141±2 and 4.2±0.3, respectively; p>0.05). CONCLUSION: These results demonstrate adequate fireline electrolyte provisions and currently employed WLFF hydration strategies. Moreover, the uniformity of pre- and post-shift measures (body weight, serum electrolytes) demonstrates that USG alone is not adequately indicative of hydration status during extended occupational stress.

Carbon monoxide exposures among U.S. wildland firefighters by work, fire, and environmental characteristics and conditions

Carbon monoxide (CO) exposure levels encountered by wildland firefighters (WLFs) throughout their work shift can change considerably within a few minutes due to the varied tasks that are performed and the changing environmental and fire conditions encountered throughout the day. In a U.S. Forest Service study during the 2009–2012 fire seasons, WLFs from 57 different fires across the U.S. were monitored for CO using CO data-logging detectors while an observer recorded worker tasks, fire characteristics, and environmental conditions at scheduled intervals. Exposures to CO for 735 WLF’s work shifts were analyzed to assess the effect of variations among work tasks, fire characteristics, and environmental conditions. Geometric mean full shift time-weighted averages were low at 2.4 parts per million (ppm) and average length of work shift was 11 hr and 15 min. The task with the highest mean CO exposure was sawyer/swamper at 6.8 ppm; workers performing that task had an estimated 9 times higher odds of a having a 1-min CO measurement exceeding 25 ppm than the referent pump task (OR = 8.89, 95% CI = 1.97, 40.24). After adjusting CO exposure limits for shift length, elevation, and work level, 2% and 4% of the WLF’s work shifts exceeded the National Institute for Occupational Safety and Health’s recommended exposure level and the American Conference of Governmental Industrial Hygienist’s threshold limit value, respectively. In regression modeling, variables that were significantly associated with elevated levels of CO exposure included: task, fuel model, wind orientation, crew type, relative humidity, type of attack, and wind speed. In the absence of instruments such as CO detectors that can determine and alert WLFs to elevated CO levels, recognition of the conditions that lead to elevated levels of CO exposure can assist WLFs to effectively use administrative controls, such as work rotations, to minimize exposures.

Repair and Resource Scheduling in Unbalanced Distribution Systems Using Neighborhood Search

This paper proposes an optimization strategy to assist utility operators to recover power distribution systems after large outages. Specifically, a mixed-integer linear programming (MILP) model is developed for co-optimizing crews, resources, and network operations. The MILP model coordinates damage isolation, network reconfiguration, distributed generator re-dispatch, and crew/resource logistics. In addition, a framework for integrating different types of photovoltaic (PV) systems in the restoration process is developed. We consider two different types of crews, namely, line crews for damage repair and tree crews for obstacle removal. We also model the repair resource logistic constraints. Furthermore, a new algorithm is developed for solving the distribution system repair and restoration problem (DSRRP). The algorithm starts by solving DSRRP using an assignment based method, then a neighborhood search method is designed to iteratively improve the solution. The proposed method is validated on modified IEEE 123and 8500-bus distribution test systems.

Factors affecting smoke and crystalline silica exposure among wildland firefighters

Smoke exposure data among U.S. wildland firefighters for carbon monoxide, respirable particulate and respirable crystalline silica are presented from a field surveillance program between 2009 and 2012. Models to predict fireline-average exposure to each inhalation hazard were developed and fit to the available data. The models identify factors to consider when defining similar exposure groups and designing future data collection. Task-based rather than shift-average data collection is important because the work activity representing the majority of fireline time, the position up- or downwind of the fire, and the proportion of time this combination represented were significant factors in the model for carbon monoxide, and all but wind position were significant for respirable particulate matter. The wind position versus the fire was not important for respirable quartz exposure. The crew type was an important factor in each model.

Metabolic Demand of Hiking in Wildland Firefighting

The objective of this study was to document characteristics of hiking during wildland firefighter (WLFF) training and wildfire suppression. For the first time, the overall physical demands during wildland firefighting were evaluated in the field using global positioning systems coupled with wireless physiological monitoring and load carriage prediction models. Male (n=116) and female (n=15) interagency hotshot crew and type II WLFFs on wildfires volunteered for this direct observation study. Participants' heart rate, internal temperature, speed, and elevation gain were monitored throughout training and during wildfire suppression. The Pandolf and Santee equations were used to predict metabolic rate to estimate oxygen consumption of uphill and downhill hiking. Equipment weight varied by crew type (type II: 24±9 kg and interagency hotshot crew: 28±6 kg; P<0.05). Grade of terrain was steepest during training hikes, and ingress hikes were statistically different from egress and training hikes (ingress: 4±9%, shift: 4±9%, egress: 1±8%, training hikes: 10±9%; P<0.01). Estimated oxygen consumption was highest during ingress hikes and was significantly different from all other hike types on fire assignments (ingress: 22±12, shift: 19±12, egress: 19±12 mL·kg-1·min-1; P=0.01). Oxygen consumption was higher during training hikes (34±14 mL·kg-1·min-1) than during job-related hikes (P<0.01). The greatest metabolic demand during wildfire assignments occurred during ingress hikes. On average, this was close to the estimated metabolic demand of the job qualification arduous pack test. However, greater metabolic demand occurred for periods during both shift (on the job) and training hikes. These data quantify the demands associated with actual wildland performance of WLFFs and can help define future work capacity testing and training procedures.

MP36: Safety and clinically important events in PCP-initiated STEMI bypass in Ottawa: a health record review

Introduction: In Ottawa, STEMI patients are transported directly to percutaneous coronary intervention (PCI) by advanced care paramedics (ACPs), primary care paramedics (PCPs), or transferred from PCP to ACP crew (ACP-intercept). PCPs have a limited skill set to address complications during transport.The objective of this study was to determine what clinically important events (CIEs) occurred in STEMI patients transported for primary PCI via a PCP crew, and what proportion of such events could only be treated by ACP protocols. Methods: We conducted a health record review of STEMI patients transported for primary PCI from Jan 1, 2011-Dec 21, 2015. Ottawa has a single PCI center and its EMS system employs both PCP and ACP paramedics. We identified consecutive STEMI bypass patients transported by PCP-only and ACP-intercept using the dispatch database. A data extraction form was piloted and used to extract patient demographics, transport times, and primary outcomes: CIEs and interventions performed during transport, and secondary outcomes: hospital diagnosis, and mortality. CIEs were reviewed by two investigators to determine if they would be treated differently by ACP protocols. We present descriptive statistics. Results: We identified 967 STEMI bypass cases among which 214 (118 PCP-only and 96 ACP-intercept) met all inclusion criteria. Characteristics were: mean age 61.4 years, 78% male, 31.8% anterior and 44.4% inferior infarcts, mean response time 6 min, total paramedic contact time 29 min, and in cases of ACP-intercept 7 min of PCP-only contact time.A CIE occurred in 127 (59%) of cases: SBP&amp;lt;90 mmHg 26.2%, HR&amp;lt;60 30.4%, HR&amp;gt;100 20.6%, malignant arrhythmias 7.5%, altered mental status 6.5%, airway intervention 2.3%, 2 patients (0.9%) arrested, both survived. Of the CIE identified, 54 (42.5%) could be addressed differently by ACP vs PCP protocols (25.2% of total cases). The majority related to fluid boluses for hypotension (44 cases; 35% of CIE). ACP intervention for CIEs within the ACP intercept group was 51.6%. There were 6 in-hospital deaths (2.8%) with no difference in transport crew type. Conclusion: CIEs are common in STEMI bypass patients however a smaller proportion of such CIE would be addressed differently by ACP protocols compared to PCP protocols. The vast majority of CIE appeared to be transient and of limited clinical significance.

LO019: The prevalence and characteristics of non-transported EMS patients in Nova Scotia

Introduction: An undefined yet potentially significant risk for Emergency Medical Services (EMS) systems are patients who access 911 with an ambulance response who are not transported to hospital (non-transport). Our objective was to determine the prevalence and associated characteristics of non-transport and potentially clinically adverse non-transports in Nova Scotia. Methods: We conducted a secondary analysis of pooled cross-sectional, population-based administrative data in a provincial EMS system that provides care to 920,000 residents. Electronic patient care record (ePCR) data was retrospectively analyzed for one calendar year (2014). The dependent variables were non-transport status and potentially adverse non-transport status. Potentially adverse non-transports were defined as a repeat call within 48 hours for a related complaint with the outcome of transport or death. Independent variables include patient characteristics, (age, sex, vitals and paramedic clinical impression), operational (crew type and response code) and environmental (time, date, and location). For both objectives we determined the prevalence of the outcome of interest, and associated characteristics. Results: There were 74,471 EMS responses between January to December 2014, 18.9% (n=14, 094/74,471) resulted in a non-transport. The characteristics most associated with non-transport are: age, paramedic clinical impressions, number of co-morbidities, response mode, and incident location type. As age decreased, the likelihood of non-transport increased. Younger non-transported patients (0-15 years old) (OR 2.2, 99.9% CI 1.9-2.5) are more likely to have non-transport. Relative to other paramedic clinical impressions, glycemic issues (OR 4.8; 99.9% CI 3.9-5.7) and wellness checks (OR 6.5; 99.9% CI 5.7-7.3) are more likely to have a non-transport. Non-transports are more likely at a detention facility (OR 4.1; 99.9% CI 3.2-5.1) or a roadway (OR 2.4; 99.9% CI 2.1-2.8). 5.6% (n=798/14094) of non-transport patients were classified as a potentially adverse non-transport. Conclusion: This study demonstrated that a significant portion of patients (18.9%) had a non-transport outcome, but only a small percentage (5.6%) were considered potentially adverse. The results of this study provide timely information to policy makers and healthcare practitioners on the scope of this issue, and suggest potential directions for future study and clinical decision making.

고층건물 골조공사의 택트공정계획 최적화모델 개발에 관한 연구

Tact scheduling is accepted as an efficient method that can reduce idle times during construction. To achieve an optimized tact system, various conditions should be satisfied. Many existing studies addressed various aspects related to applying tact system on construction job-site, including 1) crew balancing by working site rotation in a condominium construction with multiple buildings, 2) the tact system involved in synchronizing a single type of crew on finishing work, and 3) the development of a scheduling model of structural framing construction by working space zoning in a high-rise building. However, no existing studies attempt to apply the tact scheduling method to the structural framing construction for the single building having multiple units. Therefore, this study develops the optimization model and presents its application, which can schedule the tact system for a high-rise building. It is concluded that the proposed method can efficiently optimize the tact scheduling in case of multi-crew to milti-process model.

Polyaniline/ethylene vinyl acetate composites as dielectric sensor

The compressive stress (pressure) sensitivity of dielectric properties has been studied on ethylene vinyl acetate (EVA)/polyaniline (Pani) composites prepared through In‐situ synthesis of polyaniline in the solution of insulating EVA matrix. It is observed that the dielectric constant and loss increase with the increase in applied pressure, that is some piezoelectric effect is observed for these composites. The dielectric properties are also found to increase with respect to time when subjected under constant pressure. It is seen that changes in dielectric constant and loss follow some exponential relationships with respect to applied pressure and time duration under constant stress, and the relaxation time for the composites can be calculated. The relaxation time decreases with the increase in concentration of Pani in a composite. However, a composite with lower Pani content exhibits relatively higher change in dielectric properties against applied pressure and time duration under compression compared to one with higher loading. Granular crew type morphology of Pani is observed through scanning electron microscopic (SEM) study. This study reveals that these EVA‐Pani composites can be used as dielectric sensor. POLYM. ENG. SCI., 54:1632–1639, 2014. © 2013 Society of Plastics Engineers