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13, 20 October 2012, Pages 4

THE AMBULANCE TIMES ~Touching everyone associated with Emergency Medical Services~

PAGE 2

Name’s Aedes Aegypti! See you on page 2

Indian Emergency System in Tatters

Motion Induced Blindness In a motor accident, wherein a speeding car hits a slower moving vehicle coming from the side, the speeding car drivers often swear that they just didn’t see the vehicle coming from the left or right. Well, they aren’t lying. They really don’t see the vehicle coming from the side, in spite... Pg 3

Know your doctor: What is ECP ? Until 2005 emergency contraceptive pills could be sold only on prescription, but since then government has made it over the counter, which means that it can be bought without a prescription. With the aggressive marketing through television commercials it might appear that ECP is THE method of contraception! Nothing could be farther from truth!..... Pg 2

Google launches turn-by-turn guide for India maps Bangalore: Google launched real-time traffic information and turn-by-turn voice-guided driving directions for Google Maps in India on Wednesday. With livetraffic information, Google will provide a colour-coded overlay of traffic information on Google Maps in six cities across the country:..Pg 4

TRADEW A T C H

Ambulance Prices In Delhi

3,66,291 EECO 8,23,413 TEMPO euro III 9,50,585 TEMPO euro IV

Trauma care barely exists across much of India, where 160,000 people die in road accidents every year. Some of those people would surely survive if the system were better. A 2006 report in the Indian Journal of Surgery found that more than 80 percent of Indians don’t get care within that “golden hour.” This delay hasn’t really improved in the last six years, said Dr. Mahesh Joshi, head of emergency medicine at Apollo, India’s largest network of private hospitals. “Even in big cities like Mumbai, it is virtually impossible for a heart or trauma patient to reach any doctor within the first hour,” he said. Some private emergency response networks are quicker, but they bring in less than 7 percent of the 4,000-odd patients that reach Apollo’s emergency rooms across the country every day, Joshi said. People don’t even know how to call for help. The emergency number could be 108 or 102 or 100, varying by state. A survey at Delhi’s top trauma center showed that 90 percent didn’t know they could reach an ambulance at 102.

67.90/ltr PETROL 46.95/ltr DIESEL

MEDICAL CONFERENCES IN OCTOBER IN DELHI

Asia Pacific Conference on Critical Care, 2012. APCC2012 Starts 1st DEC, 2012.

HYATT REGENCY, NEW DELHI

LAUGHTER SOS

If the patient is sitting up and talking to you, then the patient is not in V-Fib, no matter what the monitor says.

There were no emergency medical technicians in India less than a decade ago, and

only about 10,000 have been trained since 2005 in the nation of 1.2 billion, said Subodh

Prolonged CPR Hol d s B e ne f it s

Fu e l P r i c e s I n D e l h i

3rd International Conference on Stem Cells and Cancer 27-30 OCT’2012 RML HOSPITAL, DELHI

Local police do help accident victims reach hospitals, but their response times vary. In most cities, patrol cars don’t have room for a stretcher, and victims can be injured during transport. The police in Delhi are the quickest, said Tewari, and they bring in most of the cases that make it to the city’s top trauma center. Police say they are a stopgap solution to a problem that needs specialists. “A mechanism needs to be developed involving paramedics,” said Satyaveer Katara, one of the top officers in charge of the capital’s police control room. The only such mechanism in Delhi is the Centralized Accident and Trauma Service, which until recently ran just 34 ambulances for a population of nearly 17 million. In August, they added 70 more, but that’s still far from enough.

When a hospital patient goes into cardiac arrest, one of the most difficult questions facing the medical team is how long to continue cardiopulmonary resuscitation. Now a new study involving hundreds of hospitals suggests that many doctors may be giving up too soon. The study found that patients have a better chance of surviving in hospitals that persist with CPR for just nine minutes longer, on average, than hospitals where efforts are halted earlier. There are no clear, evidencebased guidelines for how long to continue CPR efforts. The findings challenge conventional medical thinking, which holds that prolonged resuscitation

for hospitalized patients is usually futile because when patients do survive, they often suffer permanent neurological damage. To the contrary, the researchers found that patients who survived prolonged CPR and left the hospital fared as well as those who were quickly resuscitated. The study, published online in The Lancet, is one of the largest of its kind and one of the first to link the duration of CPR efforts with survival rates. It should prompt hospitals to review their practices and consider changes if their resuscitation efforts fall short, several experts said. Between one and five of every 1,000 hospitalized patients suffer a cardiac arrest. Generally they are older and sicker than nonhospitalized patients who suffer cardiac arrest, and their outcomes are generally poor, with fewer than 20 percent surviving to be discharged from the hospital. “One of the challenges we face during an in-hospital cardiac ar-

Satyawadi, chief executive of the Emergency Management and Research Institute. By contrast, the United States has 240,000 for a population that is a fourth of India’s. EMRI is one of the largest contributors to India’s emergency workforce, but the government doesn’t recognize their courses or those of other such institutions. There is a Paramedical Council of India, but they train technicians in areas like dialysis and echocardiograms — not emergency care. Even emergency rooms suffer from a lack of specialized trauma training. Emergency medicine was recognized as a subject only in 2009, and the programs accredited by the Medical Council of India admit only 22 doctors every year. The first batch won’t even graduate until 2014. Most emergency rooms are overburdened, with three or four doctors and a couple of interns managing several dozen cases at a time, said Dr. Arshad Anjum, a professor at Aligarh’s university medical college. At a packed emergency room in Delhi recently, patients with broken limbs, bleeding wounds, even burns kept piling up until they were forced to share beds, and when those ran out, stretchers. Waiting for care can have tragic consequences, as it nearly did for Bharat Singh’s brother. “If the delay had been any longer, we wouldn’t have been able to reattach the torn muscle,” said Dr. S.K. Das, the orthopedic surgeon who performed the operation. “In fact, he almost lost his leg.”

Source: Associated press Nasr ul hadi


IS N O D N 1 O W L E NS T ER M O I H STM CI T

THE AMBULANCE TIMES

WE Y OF

I have had the rarest opportunity of being a medical escort to more than 100 British national injured / those fallen sick in India return back home safely to all parts of UK . A special mention is to be made of the fact that of these patients about 25 percent were Indians with the British passport who spoke English with an accent however, the tight upper lip was missing. Doing this all this while I have closely seen and experienced healthcare and its delivery across the United Kingdom. I HAVE CROSSED LENGTHS AND BREATH OF UK BY GROUND AND AIR AMBULANCE(S), ON CAR, BY FOOT AND HAVE FINALLY UNDERSTOOD WHY INDIANS LOVE TO LOVE LONDON . Firstly there’s is no place on earth where an Indian can find Indian food so tastefully and authentically A SCOTTISH FRIEND I MET AT AN INDIAN cooked and served by Indians and RESTAURANT ENJOYING VEGETARIAN FOOD ! liked more by the locals. A special mention is to be made of ‘CHICKEN TIKKA MASALA’ which is more popular amongst the British. It is only in London that you will find an Indian ignoring an Indian because there are so many of them on the road and each and every time on seeing each other, one quietly whispers in their mind.” So you’ve made it too ‘ , grins, chuckles and moves forward. Needless to say that every parent wants its child to study in Oxford and every college in UK wants an Indian student because of their hard working nature , good schooling, impeccable English speaking talent and of course they are more than willing nature to pay with pride their fees on time and remain lifetime crazy about higher education. I am sure, nowhere else in the world, we would be greeted by a turban clad man on the passport control who politely ignores to acknowledge that he or she is of Indian descent and treats the other Indian as a mere guest tilting the loyalty towards the Queen. Hurriedly, crossing the passport control to the loo you find an Indian cleaning up the area who you resist to avoid but still smile politely and move on. Just outside the Airport you find a taxi with an Indian driver who drives you to Radisson Edwardian / Hilton / Sheraton and everywhere by Default the front desk and the concierge you will be welcome by an Indian. You just were driven in the hotel bus to the tube by an Indian ,the moment you step into the station, you find the security manned by an Indian. You reach Central London, Paddington and find more Indian restaurants than in Connaught Place Delhi (named after, the prince arthur, 1st duke of connaught (1850–1942), third son of queen victoria and uncle of king george vi). You enter Harrods and Selfridges and find Indian helping you with the French perfume saying this is what Kareena , Bipasha Priyanka and Anil Kapoor ji bought in their last visit and you buy the same without sniffing the paperstrip. In the late sixties when Indian government was trying to stop the exodus of Indians to UK by making films such as “Purab aur paschim” ( east and west – a film that showed the importance of indian values ) , till date there is a never ending queue of Indians at UK Visa offices in India planning to visit/settle for good in UK. The British stayed in India for 100 years and went back, but I am sure none of the Indians Living there in LONDON would ever come back. It is now their Home.

EDITOR: SATISH BHARDWAJ | EMAIL: editor.theambulancetimes@gmail.com

2

The Morning After emergency contraceptive pill

A

s a Doctor on the move I have travelled to all parts of the world. But nowhere in the World do I get such a strong feeling of Déjà vu (already seen). London is the most preferred tourist destination of every Indian. Every practicing Indian Doctor at some point of time wanted to study in UK and everyone in the making has dreams of doing so in the future. All film makers want to shoot in London, even for fresh face or a seasoned film star this is the most preferred place to capture some frames with London in the background. Every lawyer feels given a chance he would love to practice in London. Every Indian automobile engineer wants to work in UK at least for some time. As far as food is concerned the best hotels, best street food and the best of Indian food is laid out on the streets of London. One wonders why there is so much London in every Indian, and why there are so many Indians in London? Why when we think of west, we think of London, UK and the mind does not easily cross the Atlantic. Is it to do with us being ruled by the British for more than 100 years? Despite being five and a half hrs away from the Greenwich on the World clock every Indian city is just 10 Hrs away from London Heathrow.

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Until 2005 emergency contraceptive pills could be sold only on prescription, but since then government has made it over the counter, which means that it can be bought without a prescription. More than 200,000 ECPs are sold in India every month. With the aggressive marketing through television commercials it might appear that ECP is THE method of contraception! Nothing could be farther from truth! The number of young girls presenting in OPDs with complaints of irregular bleeding patterns is increasing everyday, and one of the most common reasons ,if you take history carefully, is intake of ECP [ better known to lay public as I pill!], and that too not once or twice but 10 to12 times in last 6 months .I am sure the manufactures of the pill themselves would not have anticipated this kind of response.

mediately after the act also .One can take it upto 72 hours of having sex. How often can one take ECP? Only in emergency! which I think should not arise more than once or twice in a year. Repeatedly I would like to stress that sticking to regular method of contraception is recommended not only to save yourself from unwanted pregnancy but also to avoid side effects related to rampant use of ECP.

Is it 100% effective?

When should one use ECP?

If you are not using any other contraceptive method and you have had intercourse, the condom broke down or came off during the act. If you have missed at least 2 or 3 of your regular birth control pills, or if you have been forced to have sex

What is ECP?

It is a pill used by a woman to prevent pregnancy if she happens to have unprotected intercourse .This is not at all recommended as a method of regular contraception. This is also sometimes referred to as morning after pill but this is a misnomer as it can be taken im-

Of course NO! It is 75% effective….. meaning thereby that if 1000 women have unprotected intercourse in the middle two weeks of three menstrual cycle 80 will become pregnant. Use of ECPs will reduce this to 20 women, therefore one should always rule out pregnancy if one does not have periods 3 weeks after taking the pill. What are its side effects?

Nausea ,vomiting, headache, cramps, heavy bleeding. In fact in recent times we have observed that a large number of case of ectopic pregnancy [pregnancy in fallopian tube, which can be potentially life threatening] have a history of intake of ECP in that cycle! One might experience bleeding after a few days of taking the pill and sometimes the period might get delayed for a few days. If you take these pills repeatedly then the periods get disturbed for 3 to 4 months. Is ECP the same as abortion pill? No absolutely not! Abortion pill is used once the pregnancy is confirmed, whereas ECP is used to avoid pregnancy. Abortion pill should never be used without supervision of a doctor. Is medical checkup required before taking ECP? Not really! Unless there is history of high BP, diabetes, previous tubal pregnancy, or allergy to levonorgestrel. All said and done one should be using a dependable method of contraception because… ECP does not protect against sexually transmitted diseases whereas condom does. Repeated use of ECP clearly implies that your partner is irresponsible and hence beware ! Higher failure rate as compared to regular pills or condom. It can disturb your menstrual cycle. It can give you a false sense of security that all is well as you might bleed irregularly and think that you are not pregnant whereas, you could be continuing with pregnancy! Believe me I have seen girls coming at 3 months of pregnancy with history repeated intake of ECPs,and I have operated upon young girls who presented in emergency with ruptured ectopic pregnancy with history of intake of ECP! Ruptured ectopic pregnancy is one of the life threatening emergencies in gynecology.

DR NEENA BAHL, M.D.

Senior Consultant, Maxhealthcare Saket Advanced Laparoscopic Surgeon, Gynecologist and Obstetrician drneenabahl9@gmail.com

DENGUE WOES CONTINUE IN CAPITAL NEW DELHI: Dengue cases are rising rapidly in the national capital this season with 30 fresh cases being reported today which puts the total number of patients reported so far to 420. According to data available, 420 cases of dengue have been detected here since the outbreak of the disease early this month. South Delhi Municipal Corporation reported the maximum number of cases at 167, while 164 cases were detected from the North Delhi Municipal Corporation area. 75 cases have so far been reported from East Delhi Municipal Corporation. Other cases were reported from

NDMC and Delhi cantonment area.

QUICK DIAGNOSIS OF DENGUE •

• Out of the 420 cases, five cases have been reported from outside • Delhi. A nine-year-old girl died due to dengue last month.

Abstracted from Times of India, 15 Oct 2012

NS1 antigen test full name is Platelia Dengue NS1 Ag assay, is a test for dengue NS1 Ag assay is an effective tool for diagnosis of DV infection. Within the first four days of illness. Early detection of DHF by NS1 assay helps in early confirmation and management of this vulnerable group.


THE AMBULANCE TIMES

News

Pocket-sized ultrasound device for quick-look cardiac imaging Although pocket-sized, simplified ultrasound devices have emerged to enable subjective point-of-care assessment, few data on their cardiac application exist. We sought to examine the image quality and the accuracy of subjective diagnosis of video loops obtained from a pocket-sized ultrasound device for 2 significant cardiac abnormalities, left ventricular systolic dysfunction and left atrial enlargement, obtained from a single, quick-look view.

Parasternal left ventricular long-axis images acquired with a miniaturized commercially available device (Acuson P10) were reviewed using subjective criteria for left ventricular systolic dysfunction and left atrial enlargement and were compared with M-mode measurements of left atrial systolic diameter and Epoint septal separation from a fully featured echocardiograph in 78 inpatients referred for standard echocardiography. Interpretive confidence and image quality were evaluated with each interpretation. Results Of 78 inpatient studies, 19% of pocket ultrasound and 13% of standard studies were technically limited (P = NS). Of 61 technically adequate studies, subjec-

tive interpretation of pocket ultrasound images had a sensitivity, specificity, and accuracy of 79%, 52%, and 64% for left atrial diameter more than 4 cm; 47%, 98%, and 82% for E-point septal separation more than 1 cm of; 83%, 62%, and 74% for either abnormality; and 92%, 82%, and 87% for either abnormality when interpretive confidence was present (n = 23). The pocket ultrasound image quality scores were significantly lower than the standard echocardiograph (P < .001). The pocket-sized device provided adequate imaging for screening of 2 significant cardiac entities. Subjective interpretation of a single parasternal view may help identify patients with cardiac disease. The advent of hand-carried ultrasound devices has created a new paradigm for ultrasound use. In cardiovascular applications, as opposed to formal echocardiography, “point-of-care” or hand-carried cardiovascular ultrasonography can quickly diagnose life-threatening disease such as pericardial tamponade, guide procedures such as venous or arterial access, and screen for “silent” disease states such as early atherosclerosis left ventricular dysfunction [9], and abdominal aortic aneurysm As a burgeoning field that requires specific demands of ultrasound equipment such as portability, rapid boot time, and simplified user interfaces, hand-carried ultrasound has created new users in emergency medicine who are quick to apply diagnostic ultrasound at the bedside without the need for detailed quantitation. The specific imaging applications performed with pocketsized ultrasound are currently undefined and will be critical in the determination of clinical accuracy and utility of these devices. Abstracted from American Journal of Emergency Medicine Volume 30, Issue 1 , Pages 32-36, January 2012 ~ Bruce J. Kimura, MD

D O OTI N IN UCED BLINDNESS M In a motor accident, wherein a speeding car hits a slower moving vehicle coming from the side, the speeding car drivers often swear that they just didn’t see the vehicle coming from the left or right. Well, they aren’t lying. They really don’t see the vehicle coming from the side, in spite... of broad day-

scanning the horizon and scanning their instrument panel, and never to fix their gaze for more than a couple of seconds on any single object. They are taught to continually keep their heads on a swivel and their eyes always moving. Because, if you fix your gaze on one object long enough

light. This phenomenon on the car drivers’ part is known as “Motion Induced Blindness”. It is unbelievable but it is true, and it is definitely frightening. Armed forces pilots are taught about motion induced blindness during training, because it happens faster at high speeds; and to some extent it is applicable to car drivers also, especially the fast ones. So, if you drive a car, please read this carefully. Once airborne, pilots are taught to alternate their gaze between

while you yourself are in motion, your peripheral vision goes blind. That’s why it is called motion induced blindness. For fighter pilots, this is the only way to survive in air; not only during aerial combat, but from peacetime hazards like midair collisions as well. Till about three decades ago, this “heads on swivel & eyes moving” technique was the only way to spot other aircraft in the skies around. Now-a-days they have on-board radars, but the old technique still

holds good. Let me give you a small demonstration of motion induced blindness. This is the same demonstration that is used for trainee pilots in classrooms before they even go near an aircraft. Just click on the link below. You will see a revolving array of blue crosses on a black background. There is a flashing green dot in the center and three fixed yellow dots around it. If you fix your gaze on the green dot for more than a few seconds, the yellow dots will disappear at random…, either singly, or in pairs, or all three together. In reality, the yellow dots are always there. Just watch the yellow dots for some time to ensure that they don’t go anywhere! So, if you are driving at a high speed on a highway and if you fix your gaze on the road straight ahead, you will not see a car, a scooter, a buggy, a bicycle, a buffalo or even a human being approaching from the side. Now reverse the picture. If you are crossing a road on foot and you see a speeding car approaching…, there’s a 90% chance that the driver isn’t seeing you, because his/her peripheral vision may be blind! And you may be in that blind zone!

Source: http://www.msf-usa.org/ motion.html

PROLONGED CPR HOLDS BENEFITS (CONT. FROM PAGE 1) rest is determining how long to continue resuscitation if a patient remains unresponsive,” said Dr. Zachary D. Goldberger, the lead author of the new study, which was financed by the American Hospital Association, the Robert Wood Johnson Foundation and the National Institutes of Health. “This is one area in which there are no guidelines.”Dr. Goldberger and his colleagues gathered data from the world’s largest registry of in-hospital cardiac arrest, maintained by

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3 pg 3

LIFE SKILLS

For your Head Only Around the block or around the world, it makes sense to leave home with a helmet securely fastened on your head, since it’s one of the best items of protective gear you can use.

MOBILE MANNERS the American Heart Association, identifying 64,339 patients who went into cardiac arrest at 435 hospitals in the United States from 2000 to 2008. The patients who got the most added benefit from prolonged CPR were those whose conditions do not respond to defibrillation, or being shocked. The extra time spent on prolonged CPR may give doctors time to analyze the situation and try different interventions, they said. “You can keep circulating blood and oxygen using CPR for sometimes well over 30 minutes and still end up with patients who survive and, importantly, have good neurological survival,” said Dr. Jerry P. Nolan, a consultant in anesthesia and critical care medicine at Royal United Hospital NHS Trust in Bath, England, who wrote a commentary accompanying the article.

Source: The New York Times By RONI CARYN RABIN Published: September 4, 2012

Painful: The worst and the most irritating question to answer on Mobile phone. “Where are you “.

ZEN WAY

Never ask this question/start the conversation with a question . Just mention your concerns and ask for an answer.

ZEN ADVICE

Dear Friends this is a very painful question to be answered in the day to day life by anyone and everyone . We are all busy and have started to dislike encroachment into our privacy even if we are Doctors or other medical service providers. Generally the priviledge to get this “where are you?”the priviledge goes to the spouse/meaningful partner.


S E M I T E C N A L UB M A E H T

News

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4

Muamba–Heart Attack and After! LUCK

LIFE

Bolton’s Fabrice Muamba collapses during purs-Bolton match 17 March 12 21:33 GMT Bolton Wanderers midfielder Fabrice Muamba was left critically ill after collapsing during an FA Cup quarter-final tie against Tottenham. The 23-year-old was rushed to the intensive care unit of the heart attack centre at the London Chest Hospital. Medics spent six minutes trying to resuscitate him on the field after he fell to the ground with no other players around him. The

SCIENCE

Muamba quits five months after heart attack, but there will be a job at Bolton Bolton will offer Fabrice Muamba the chance to stay at the club in a new role after the midfielder was forced to quit playing, five months after suffering a near-fatal heart attack on the pitch. The decision was made after Muamba went to see leading cardiologist Pedro Brugada in Belgium last week. Although the routine clean-up operation went well, the 24-year-old was given the ‘devastating news’ that he would not be able to make a comeback.In a statement, he said: “While the news is devastating, I have much to be thankful for. I thank God that I am alive and I pay tribute once again to the members of the medical team who never gave up on me.”

Post-Cardiac Arrest CareManagement

RESPIRATORY • • • • • •

Avoid hyperoxia I Keep Oxygen Saturation 93-97% I Poor outcomes associated with PaO2 >300 mmHg I Avoid Hyperventilation I Keep Tidal Volumes and ventilation rates low I Hyperventilation increases intra-thoracic pressure and decreases venous return and cardiac output I • Hyperventilation results in decreased CO2 and cerebral Vasoconstriction

“The fact they got him breathing again makes you marvel at the work these paramedics, doctors and nurses do.”

CIRCULATORY

score was 1-1 when the match was abandoned after 41 minutes.”Bolton Wanderers can confirm that Fabrice Muamba has been admitted to The Heart Attack Centre at The London Chest Hospital where he is in a critically ill condition in intensive care,” said a joint statement from Bolton and the hospital released at 2130 GMT on Saturday. Medical staff gave the former England Under-21 international mouth-to-mouth resuscitation and tried to revive him with a defibrillator. Muamba, who needed 15 defibrillator shocks to restart his heart following the incident on March 17, made a miraculous recovery at the London Chest Hospital and was discharged a month later. All aircraft operating with one or more flight attendants must carry: A defibrillator An i.v. kit with connectors and i.v. normal saline Bag valve mask resuscitator and masks Emergency drugs: antihistamine (oral), aspirin, atropine, bronchodilator inhaler, lidocaine (lignocaine), non-narcotic analgesic. Basic instructions for equipment and drugs

LOVE

And Muamba’s partner Shauna tweeted her appreciation to all the well-wishers who have helped him throughout the recovery. She wrote: ‘Thanks for all the support. We’re looking forward to whatever the future holds.

“Is there a doctor on the plane?” Flying is often said to be the safest form of transport.. This applies only to flying by commercial aircraft, how- ever, as the accident rates for general aviation (private flying and nonscheduled air transport) are considerably higher, making travel by railway safest overall. Airlines try to avoid diversion of aircraft from their planned flight path, as diversions are expensive, with an estimated cost of US$100 000 to divert a fully laden Boe- ing

747 to an alternative airport if the aircraft is not able to take off again

flowing traffic, yellow for minor slowdowns, and red for significant congestion. The data for traffic is crowd-sourced from Android mobile users which transmits their current location at regular intervals. The data

is anonymized to protect the identity of the phone user and

contact for advertisment

-

References- . Mattu and Herbert (2012) EM: RAP 12(4): 5-6 2. Stub (2011) Circulation123(13): 1428-­351.

flight time hours limitations of the pilots. This does not take into account costs incurred by the other passengers in missing connecting flights researchers in germ any analy zed more than

10,000

emergencies on flights run by two euro -

pean carriers and found half of them were due to passengers fainting. the flight safety foundation studied in - flight medical

1996–1997 1132 medical incidents. of these incidents, 22.4% were caused by vasovagal syn cope, 19.5% by cardiac events and 11.8% by neurological events. It is likely that a doctor who travels on even just one long-haul flight each year will encounter an in-flight emergency sooner or care aboard selected us air carriers in and recorded

and complete its journey within the

Google launches turn-by-turn guide for India maps Bangalore: Google launched real-time traffic information and turn-by-turn voice-guided driving directions for Google Maps in India on Wednesday. With live-traffic information, Google will provide a colourcoded overlay of traffic information on Google Maps in six cities across the country: Bangalore, New Delhi, Bombay, Chennai, Hyderabad, and Pune. Users can see traffic information by enabling the “Traffic” layer on the Google Maps desktop website or on Google Maps for mobile on their smartphones. Roads for which enough traffic information is available will be labelled green for free

• Prevent Hypotension I • Keep Mean arterial pressure (MAP) 65-100 (preferably 70-80 or higher) I • Start low dose pressor and increase if Blood Pressure begins to fall I • Replace fluids to treat hypovolemia I • Treat underlying cause I • Early Angioplasty (PCI) for EKG signs of ST ElevationMyocardial Infarction (STEMI) I • Consider early PCI even if no signs of STEMI on EKG I • Coronary events are responsible for 40% of Cardiac Arrests

the feature is an opt-in service, said Darren Baker, product manager for Google Maps. Google will also explore gathering data from other sources to improve the service, said Baker. In some cities, like Bangalore, a dedicated Traffic Management Centre (TMC) monitors traffic on major roads and crucial junctions. Additional Commissioner of Police (Traffic) M.A. Saleem said that the TMC has nearly five enforcement cameras and 160 surveillance cameras across the city. “We are open to providing this data to anyone who needs it”, he said. Abstracted from: Livemint.com

later, and be expected to respond to a request for help. The most likely case will be one of vasovagal syncope, followed by a cardiac or respira- tory emergency. The doctor will receive assistance from cabin crew fully trained in CPR and in the use of an AED. Cardiac drugs or strong analgesia will usually be available on board. Support and reassurance may also be given by satellite phone speaking to a fellow emergency physician, who will have encountered all this before on a daily basis. In the event of critical illness, the responsibility for recommending to divert a plane in the rare case this proves necessary may also be shared and corroborated.

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vishal 9910433333, ems news-rishi 9310012126, editorial- editor.theambulancetimes@gmail.com

REGISTERED NEWSPAPER - RNI No. DELENG/2012/41958. PRINTED AND PUBLISHED BY: Satish Kumar Bhardwaj. PRINTED AT : Intergraphic reproductions pvt Ltd A 11 DDA Sheds ,Okhla Industrial area, Phase -1 New Delhi 110020


THE AMBULANCE TIMES