Substrate Supporting Disc Method for Confirmed Detection of Total Coliforms and E. coli in all Foods: Collaborative Study

The Coli Complete® substrate supporting disc (SSD) method for simultaneous confirmed total coliform count and Escherichia coli determination in all foods was compared with AOAC most probable number (MPN) methods, 966.23 and 966.24. Twenty-nine laboratories participated in this collaborative study in which 6 food types were analyzed. Four food types, raw ground beef, pork sausage, raw liquid milk, and nut meats, were naturally contaminated with coliform bacteria. Two foods, dry egg and fresh frozen vegetables, were seeded with coliforms. Three food types, ground beef, raw liquid milk, and pork sausage, were naturally contaminated with E. coli. Although pork sausage was naturally contaminated, the level was very low (<10/50 g); therefore, additional E. coli were inoculated into 1 lot of this food type. Three food types, nut meats, dry egg, and fresh frozen vegetables, were inoculated with E. coli. For naturally contaminated samples, duplicate determinations were made on 3 separate lots for each food type. For inoculated samples, low, medium, and high contamination levels plus uninoculated control samples were examined in duplicate. Data were analyzed separately for total coliform bacteria and for E. coli. Mean log MPN counts were determined by the SSD method and the appropriate AOAC MPN method. Results were then analyzed for repeatability, reproducibility, and mean log MPN statistical equivalence. Results were statistically equivalent for all total coliform levels in all food types except frozen vegetable and raw nut meat uninoculated control samples and 1 lot of pork sausage where the SSD method produced statistically significant greater numbers. For the E. coli determinations, results were statistically equivalent across all samples and all levels for each food type. The SSD method has been adopted first action by AOAC International for confirmed detection of total coliforms and E. coli in all foods.

Emergency department patients with assault injuries: previous injury and assault convictions

STUDY OBJECTIVE

To compare the incidence of previous assault injury and assault conviction of patients presenting to the ED with assault injuries and the incidence of assault injury and conviction in nonassaulted control patients.

METHODS

We conducted a retrospective, medical record-based case-control study of ED patients with assault injuries and matched controls presenting with medical and surgical problems unrelated to assault. The setting was the ED of a 900-bed teaching hospital and Level I trauma center in an urban area. Our subjects were 50 patients who presented as victims of blunt trauma, 50 patients who presented with penetrating trauma, and 100 control subjects matched by age, sex, and ZIP code who presented concurrently with nonassault complaints.

RESULTS

The overall rate of previous assault injury was 35% and did not differ between cases and controls. Fifty-three patients had a history of criminal conviction, and 23 had a history of conviction for assault. Fewer patients presenting with assault injuries than controls had a history of conviction for assault (odds ratio [OR], .3; P < .02). Patients with penetrating injuries had the lowest incidence of assault conviction (OR, .13; P < .02). The subgroup of case subjects with criminal records had a higher rate of previous injury than those without records (P < .003).

CONCLUSION

ED patients with assault injuries did not have a history of assault injuries exceeding that of controls and were less likely to have been convicted of assault. Violence-prevention programs should be directed toward a broader population of ED patients instead of narrowly focusing on victims of assault.

Paramedic field instructors: an approach to training the newest paramedics while maintaining the interest of the most successful senior paramedics

A unique approach to providing orientation and supervised field experience for newly graduated paramedics and for the continuing education and recognition of experienced, skilled, operational paramedics is described. A group of 30 paramedic field instructors (PFI) was selected following application, development of criteria for selection, and interviews. This program had a positive effect in both realms during its first year of operation in the emergency medical services system in which it was implemented.

The effect of base station contact on ambulance destination

Concern has been raised that a single medical control base station serving a metropolitan area may preferentially divert ambulance patients to the base station hospital. Such concern may discourage the development of regional medical control systems. During the first six months of 1988, a retrospective cross-sectional analysis was made of all advanced life support (ALS) ambulance transports and all contacts to the single base station, known as Medical Resource Hospital (MRH). Destinations of all ALS ambulance calls dispatched through the county's 911 dispatch center were analyzed to determine whether the destinations were affected by MRH contact. There were 12,396 transports to 17 area hospitals with 1,272 (10.3%) of these requiring MRH contact. We hypothesized that if MRH contact did not affect destination, the proportion of all non-MRH ALS ambulance patients received by each hospital from the 911-dispatched group would equal the proportion of patients received by each hospital after MRH contact. Five hospitals received a statistically significant (P less than .003) different percentage of MRH contact patients than their proportion of 911-dispatched patients would have predicted. The three that received more were community hospitals in outlying areas. The remaining two were a large referral hospital and a smaller community hospital located in the urban area. The MRH hospital did not have a significantly different percentage of 911-dispatched patients after MRH contact. Similarly, destinations of specific ALS ambulances (two serving in the MRH ambulance catchment area and four in distant catchment areas) were evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of on-line medical control centralization on ambulance destination

Controversy regarding the establishment of on-line medical control in a single hospital in a regional Emergency Medical Service System is based, in part, upon the suspicion that ambulances might be diverted to that hospital. Ambulance transports to the University Hospital of Portland, Oregon, were studied over a six year period coinciding with that facilities' assumption of on-line medical control functions. No increases in ambulance transports to that facility could be demonstrated. Other variables resulted in absolute decreases in the number of these transports.