Category Archives: USA

Indiana | Indy EMS receives Fed grant funding for AED placement

IndyCARES, a division of Indianapolis Emergency Medical Services (IEMS) received notification last week that a grant submitted to the US Department of Health and Human Services; Health Resources and Services Administration, for AED placement and compression only CPR training in Indianapolis has been awarded.

The program will be administered by the Health and Hospital Corporation of Marion County with leadership and direction provided by Dr. Dan O’Donnell MD, and the Indiana University School of Medicine.

The grant provides $145,013.00 in funding for the first year of the AED placement and use program. Additional recommended funding by the grant includes $146,997.00 for year two and $149,040.00 for year three. Funding for years two and three are contingent on availability of funding and satisfactory progress of the proposed project. These figures represent 100 percent funding for the program with no local or state matching monies required.

The Indianapolis Targeted Cardiac Arrest Survival Program’s goal is to improve cardiac arrest survival in high risk areas around Indianapolis. This program aims to tailor CPR and AED education to the unique needs of local communities. Goals of the program are to expand the current community education provided by IndyCARES including recognizing the signs and symptoms of cardiac arrest, teaching chest compression only CPR, and appropriate application and use of an AED by the layperson.

Without rapid bystander intervention using CPR and an AED, the chances for Return of Spontaneous Circulation (ROSC) diminish greatly. Dr. Charles Miramonti MD, chief of IEMS indicated that “studies have shown a positive impact when cardiac arrest is recognized early and when intervention is rapid in the form of immediate CPR and defibrillation.” Miramonti also emphasized that working with Indianapolis Department of Public Safety to help identify areas where education and placement will be made is the next step moving forward. The search will focus on at risk populations where out-of-hospital cardiac arrest events are the highest and outcomes are the poorest.

Once high impact areas are identified, program leadership will engage local community leaders and partners on establishing a high impact CPR and AED education program unique to the specific community. Upon completion of this program, AED’s will be placed by IEMS. Additionally, the location will be recorded in the Computer Aided Dispatch (CAD) System. This will enable 9-1-1 dispatchers to let callers know where an AED is located in the event of a cardiac arrest. According to Dr. Dan O’Donnell MD, deputy medical director with IEMS, “Identification and engagement of key stakeholders in the identified high risk areas will be crucial to the success of the program.” An initial report is expected in early 2015 that will identify the locations that will best serve the population of Indianapolis.

The team at IndyCARES defines program success as training 500 citizens per year in citizen CPR and the placement of 20 AED’s annually for a period of three years. IEMS Public Information Officer, Carl Rochelle III, reports that over 4,000 citizens of Indianapolis have been trained in chest compression only CPR since IndyCARES inception in June 2011. These combined efforts can save lives as well as lead to improved patient outcome when followed by rapid AED use and treatment by first response emergency medical services. This program is a joint effort undertaken by the Health and Hospital Corporation of Marion County, the Indiana University School of Medicine Department of Emergency Medicine, Indianapolis Department of Public Safety and IEMS.

Indiana | Indy public safety agencies meet sombre Narcan milestone with resolve

Over the weekend, paramedics from Indianapolis Emergency Medical Services (IEMS) administered naloxone for the 630th time in 2014.  The significance of this number is that it surpasses the total number of persons receiving naloxone during the entire year of 2013.

Through a joint pilot program, Indianapolis Metropolitan Police Department and IEMS began to train and supply police officers with the medication that can stop a heroin overdose in minutes.

According to Dr. Dan O’Donnell MD, deputy medical director with IEMS, “the administration of naloxone is critical to life saving efforts, immediately halting the effects of heroin.”  While naloxone is critical to stopping an overdose it does not prevent addiction.

Recently, Troy Riggs, director of Indianapolis Department of Public Safety cited Mayor Greg Ballard’s Early Education and Public Safety Initiative as a key step in moving forward.  Riggs also reinforced that one of the primary missions of the agencies under Indianapolis DPS is preservation of life, “we value human life and will not give up on our citizens.” Part of the plan moving forward, Riggs added “are community outreach programs to help with rehabilitation.”

“Indianapolis continues to set the pace in the nation for recognition and intervention related to heroin.” according to Dr. Charles Miramonti, chief of IEMS, “Getting the information, training and medication in the hands of first responders is a crucial first step.”

Based in large part on the efforts in Indianapolis and the Indiana University School of Medicine, the state legislature recently passed a bill allowing emergency medical technicians (EMT’s) the ability to administer naloxone in the field. Soon, EMT’s with the Indianapolis Fire Department (IFD) will have access to naloxone on all of their response apparatus, increasing the chances of saving a life from heroin overdose.

Illinois | New state law requires high schools to train athletic directors and coaches on concussion reduction

Governor Pat Quinn signed legislation to help reduce and prevent concussions among high school athletes. The law requires training on concussion awareness and reduction for high school athletic directors and coaches. 

“Sports play a big role in the lives of many young people across our state,” Governor Quinn said. “While we want to ensure all children have the opportunity to play sports, we must also protect the health of our young athletes from potentially life-changing damage. This new law will help ensure that coaches will be better prepared to address and prevent concussions among their student athletes.”

House Bill 5431, sponsored by State Representative Carol Sente (D-Lincolnshire) and State Senator Dan Kotowski (D-Park Ridge), requires the Illinois High School Association to develop and implement an online training program on concussion awareness and reduction for all coaching personnel and athletic directors. The legislation was written in response to recent increases in concussions among adolescents, especially student athletes.

“I sponsored House Bill 5431 because I absolutely believe this can make a difference in our schools and help protect more young athletes this coming school season,” Rep. Sente said. “It’s important that our coaches and athletic directors in every sport are certified and they hold discussions with their players so young adults know the effects and potential harm of repetitive concussions and hits to the head.”

“We appreciate the confidence Governor Quinn and Representative Sente placed in the IHSA to work with respected medical professionals to develop and administer a top-tier program,” IHSA executive Director Marty Hickman said. “Risk minimization for student-athletes, especially as it relates to concussions, will continue to be a top priority for the IHSA.”

The online training will focus on concussion recognition and prevention, what to do when a player may have a concussion and education on the long-term effects of repetitive head trauma. Completion of the training and certification will be mandatory for all high school coaching staff. Student athletes will also receive concussion awareness education. The law goes into effect immediately.

“Today, we know more about the negative impact concussions have on student athletes than ever before,” Senator Kotowski said. “We have to ensure that coaches are informed about the consequences of traumatic head injuries and take steps to reduce their frequency and keep our kids safe.”

According to the Centers for Disease Control, a concussion can result from a blow to the head or body which causes the head to move violently. It can affect the athlete mentally or physically, causing light and noise sensitivity, concentration problems or confusion, balance problems and other symptoms. It is a type of traumatic brain injury (TBI). For more information on recognizing a concussion, please visit

Governor Quinn is committed to protecting and improving the health of young people in Illinois schools. Earlier this month the Governor signed legislation strengthening the Young Adult Heroin Use Task Force originally created by the Governor and the General Assembly in 2013 to address the growing problem of heroin use in Illinois High Schools.

This year the Governor signed legislation allowing trained school personnel to administer potentially life-saving epinephrine injections to help against serious allergic reactions. In June he signed a law that requires CPR and automated external defibrillator (AED) training for students in all Illinois high schools.

In 2013, Governor Quinn convened a School Safety Summit that included more than 50 top experts from across the state to develop short- and long-term actions to further safeguard Illinois schools and signed Rocky’s Law, which required schools to insure student athletes.

Illinois | First human WNv case confirmed for 2014

The Illinois Department of Public Health (IDPH) has confirmed the first human West Nile virus case reported in Illinois for 2014. The Chicago Department of Public Health reported a woman in her 70’s became ill in July.

“This first human case is a good reminder that we all need to take precautions,” said Illinois Department of Public Health Director Dr. LaMar Hasbrouck. “The mosquitoes that typically carry West Nile virus, commonly called the house mosquito, are not as noticeable as the swarms of floodwater mosquitoes we see with the heavy rains. Even if it does not look like there are a lot of mosquitoes outdoors, house mosquitoes are stealthy biters so make sure to use insect repellent when you’re outside.”

A bird collected in Henry County on May 29, 2014 and a mosquito sample collected in Madison County on May 30, 2014 were the first West Nile virus positive results this year. To date, West Nile virus has been reported in birds, mosquitoes and/or human case in 32 counties. At this time last, year, West Nile virus was reported in 49 counties.

In 2013, a total of 76 counties in Illinois reported West Nile virus. Last year there were 117 human cases, including 11 deaths.

West Nile virus is transmitted through the bite of a mosquito that has picked up the virus by feeding on an infected bird. Common West Nile virus symptoms include fever, nausea, headache and muscle aches. Symptoms may last from a few days to a few weeks. However, four out of five people infected with West Nile virus will not show any symptoms. In rare cases, severe illness including meningitis or encephalitis, or even death, can occur. People older than 50 are at higher risk for severe illness from West Nile virus.

The best way to prevent West Nile disease or any other mosquito-borne illness is to reduce the number of mosquitoes around your home and to take personal precautions to avoid mosquito bites. Precautions include practicing the three “R’s” – reduce, repel and report.

  • REDUCE exposure – avoid being outdoors when mosquitoes are most active, especially between dusk and dawn.
    • Make sure doors and windows have tight-fitting screens. Repair or replace screens that have tears or other openings. Try to keep doors and windows shut, especially at night.
    • ­ Eliminate all sources of standing water where mosquitoes can breed, including water in bird baths, ponds, flowerpots, wading pools, old tires and any other receptacles.
  • REPEL – when outdoors, wear shoes and socks, long pants and a long-sleeved shirt, and apply insect repellent that contains DEET, picaridin, oil of lemon eucalyptus or IR 3535, according to label instructions. Consult a physician before using repellents on infants.
  • REPORT – In communities where there are organized mosquito control programs, contact your municipal government to report dead birds and areas of stagnant water in roadside ditches, flooded yards and similar locations that may produce mosquitoes.

Additional information about West Nile virus can be found on the Illinois Department of Public Health’s website at Surveillance numbers are updated every Wednesday afternoon

Kansas | First human WNv case reported for 2014

The Kansas Department of Health and Environment (KDHE) has announced the first reported case of West Nile virus for 2014. The individual that tested positive is an adult from Republic County.

West Nile virus can be spread to people through bites from infected mosquitoes, but it is not contagious from person to person. Symptoms range from a slight headache and low-grade fever to swelling of the brain or brain tissue and in rare cases, death. People who have had West Nile virus before are considered immune.

KDHE recommends the following precautions to protect against West Nile virus:

  • When you are outdoors, use insect repellent containing an EPA-registered active ingredient on skin and clothing, including DEET, picaridin, oil of lemon eucalyptus, or IR3535. Follow the directions on the package.
  • Many mosquitoes are most active at dusk and dawn. Be sure to use insect repellent and wear long sleeves and pants at these times or consider staying indoors during these hours.
  • Make sure you have good screens on your windows and doors to keep mosquitoes out.
  • Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children’s wading pools empty and on their sides when they aren’t being used.

West Nile virus cases are most common in the late summer and early fall months. In 2013, there were 92 cases of West Nile virus in Kansas. In addition to tracking cases of human illnesses caused by West Nile virus, KDHE assesses the potential for West Nile virus by conducting limited mosquito surveillance, including laboratory testing. At this time, there has not been a positive mosquito sample in Kansas.

Birds are not tested for West Nile virus in Kansas and KDHE will not be collecting information about dead birds. If you find a dead bird, KDHE recommends that you wear gloves, place the bird in a plastic bag, and dispose of it in the garbage.

The Centers for Disease Control and Prevention provides this web page with additional information about West Nile virus and preventing mosquito bites: or visit the KDHE website:

West Nile virus case counts are updated each Tuesday on our website here:

Vermont | EEE detected in mosquito pools in Whiting

Eastern equine encephalitis (EEE) virus has been detected in two batches of bird-biting mosquitoes collected from the town of Whiting on August 19.

This is the first detection of EEE virus in southern Addison County this year, and the first detection of this virus in Vermont since it was found in mosquitoes from Grand Isle in the middle of June.

West Nile virus was detected for the first time this season in mosquito pools collected in St. Albans two weeks ago.

Both viruses are spread to humans and some animals through the bite of an infected mosquito. No human or animal cases have been reported to date in 2014.

“These detections confirm that both mosquito-borne viruses are circulating in Vermont again this year,” said Erica Berl, infectious disease epidemiologist for the Vermont Department of Health. “EEE can be a very serious disease and, although the risk of getting infected is low, it’s not zero. No matter where you live – enjoy the outdoors but take precautions to fight the bite.”

Take Action to Fight the Bite:

• Limit your time outside from dusk to dawn when mosquitoes are most active and biting. When you do go outside take precautions to prevent mosquito bites.

• Wear long-sleeved shirts and long pants outside when mosquitoes are active.

• Use insect repellents that are labeled as being effective against mosquitoes. Effective ingredients are DEET, picaridin and oil of lemon eucalyptus. For more information about choosing a repellent, go to and search for ‘insect repellent’

• Cover baby carriages or outdoor play spaces with mosquito netting.

• Install or repair screens on windows and doors to keep mosquitoes out.

• Reduce mosquito breeding habitats by getting rid of standing water and draining areas where water can pool, such as rain gutters, wading pools and old tires.

The Agency of Agriculture, Food & Markets recommends that owners of West Nile virus and EEE-susceptible species, including horses, camelids (llamas and alpacas) talk with their veterinarians about vaccinating their animals. West Nile virus and EEE can cause severe neurologic disease (incoordination, seizures and inability to stand) in horses and camelids and can result in high mortality rates in those species. Emus are susceptible to EEE and can be vaccinated with the equine vaccine.

For extensive information about EEE and West Nile virus and mosquito pool and veterinary testing results visit:

South Carolina | Fourteen people exposed to rabies in Anderson County

A  total of 14 people in Anderson County have been referred to their health care providers for rabies consultation in association with a case involving a kitten that tested positive for the disease, the S.C. Department of Health and Environmental Control reported today.

“Rabies is a threat to humans, pets and wild animals,” said Sandra Craig of DHEC’s Bureau of Environmental Health Services (BEHS). “All pet owners should have their dogs, cats and ferrets vaccinated regularly as required by state law. It is extremely important to the health of your pet, your family and you that pet vaccinations are kept up-to-date.

“This is a continuing investigation,” Craig said, “and it involves the quarantining of numerous pets. Unvaccinated pets that are exposed to the rabies virus must be quarantined or euthanized. Rabies is fatal once the virus reaches the brain, yet the heartache of losing a pet to this disease can be avoided. DHEC-sponsored rabies clinics are offered across the state by local veterinarians each spring, and low-cost vaccines are available every day at local veterinary clinics.

“Talk to your veterinarian to determine when you should vaccinate a young puppy or kitten, as well as when to schedule a booster. While puppies and kittens are still very young and not fully immunized, they should be monitored whenever they are outside in order to reduce possible exposure to diseases.

“About 275 South Carolinians must undergo preventive treatment for rabies every year, with most exposures coming from bites or scratches by a rabid or suspected rabid animal,” she said. “Wild animals contract the disease most often, but domestic pets can contract rabies as well.

“If you think you have been exposed to the rabies virus through a bite, scratch or the saliva of a possibly infected animal, immediately wash the affected area with plenty of soap and water,” Craig said. “Then be sure to get medical attention and report the incident to DHEC.”

There were 124 confirmed cases of animal rabies during 2013 in South Carolina. There have been 87 confirmed cases in animals statewide this year. This animal is the first to test positive in 2014 from Anderson County, with positive lab confirmation on August 19. There were 12 animals that tested positive in that county in 2013.

For more information about rabies, see DHEC’s webpage at, or contact your local DHEC BEHS office at The Centers for Disease Control and Prevention’s rabies webpages can be found at: and

New Hampshire | First human case of EEE in an adult from Conway

The New Hampshire Department of Health and Human Services (DHHS) is announcing the first human case of Eastern Equine Encephalitis (EEE) this season in an adult from Conway.

The most recent previous human case of EEE in New Hampshire was confirmed in 2009.

Also four additional mosquito batches were found to be positive in New Hampshire today; two in Derry and two in Candia. Three of these batches were bird biting mosquitoes indicating an increase in EEE activity in the bird population. One of the batches was a mammal biting species which increases the risk of additional human or veterinary cases of EEE.

This brings the total of EEE mosquito batches identified this season to five. There have been no West Nile Virus positives yet this year.

In 2013, there were 27 positives for EEE, including 24 mosquito batches and 3 animals. EEE and WNV are transmitted by the bite of infected mosquitos. This human finding will change the arboviral risk map for Conway to high and the surrounding municipalities of Chatham, Bartlett, Hales Location, Albany, Madison, and Eaton to moderate. The risk level in Derry will remain at moderate. The risk level for Candia will increase to moderate.

“This positive is at about the same time as the previous EEE patient identified in 2009,” said NH Public Health Director Dr. José Montero. “There is no way to know where exactly this individual was infected, but we do know that both of these diseases are present in New Hampshire so it is important that everyone remember to take steps to prevent mosquito bites to themselves and their loved ones.”

Symptoms of EEE disease often appear 4 to 10 days after being bitten. If you or someone you know is experiencing flu-like symptoms, including fever and headache, contact your local medical provider. EEE is a more serious disease than WNV and carries a high mortality rate for those who contract the serious encephalitis form of the illness. Symptoms may include high fever, severe headache, stiff neck, and sore throat. There is no specific treatment for the disease, which can lead to seizures and coma.

You can protect yourself and your family from WNV and EEE with a few simple steps, such as using effective mosquito repellant, wearing long sleeves and pants at dawn and dusk when mosquitoes are most active, removing standing water from around your house so mosquitoes do not have a place to breed, and by checking doors and windows to ensure screens are in place and in good condition to prevent mosquitoes from entering your home.

For more information about EEE and West Nile Virus visit the DHHS website at and the Centers for Disease Control and Prevention website at

Tennessee | DOH issues Extreme Heat Warning

The Tennessee Department of Health is working to reduce deaths and life-threatening conditions caused by summer heat. With temperatures reaching into the 90s in much of the state, Tennessee residents and visitors are urged to exercise caution and take preventive steps to avoid heat exhaustion and heat stroke.

“While the elderly, children and those with existing health issues are most at risk, extreme heat can affect anyone,” said TDH Commissioner John J. Dreyzehner, MD, MPH. “We want to remind everyone about ways to prevent heat-related illnesses and how to address them if they do occur.”

TDH and the Tennessee Emergency Management Agency remind first responders including paramedics, police and fire crews, to take appropriate steps to protect themselves and to be extra observant for signs of heat-related illnesses. TDH also urges doctors and hospital staff members to be vigilant for signs of heat-related illnesses among patients, and for residents to look out for one another.

“It’s important for Tennesseans to take action to help protect others who may be especially vulnerable to heat-related health problems, such as checking on neighbors who may be alone or reluctant to ask for help,” said TEMA Interim Director and Assistant Commissioner/Homeland Security Advisor David Purkey. “This simple measure can help prevent an emergency and save someone’s life.”

“Check regularly and often during hot weather with friends, relatives and others who are elderly and/or take medications,” said TDH Chief Medical Officer David Reagan, MD, PhD. “Some medications can alter the body’s ability to regulate body temperature, and some can cause impaired thinking, causing people to not take appropriate actions to leave an area that’s too hot.”

Here are some ways to stay safe and healthy in extreme heat:

•       Drink plenty of fluids. Pay attention to your thirst and drink cool liquids before you become very thirsty. Water is good, and sugar-free sports drinks can help replace lost salt and minerals. Avoid drinks with caffeine, which can cause the body to lose water. Avoid alcohol, which can dehydrate the body and impair your ability to think clearly, preventing recognition of heat distress signals.

•       Do not leave people or pets in cars for any length of time. Cars can heat to life-threatening temperatures in just a few minutes.

•       Stay cool indoors. If your home has more than one level, the lowest level will usually be cooler. Turn off unnecessary heat-generating items such as televisions and lights, and use fans if you have them. Consider cooking with a microwave instead of heating up the kitchen with the stove or oven. Take cool showers or baths. If your home does not have air conditioning, take advantage of air conditioned facilities such as shopping venues, restaurants, senior centers, libraries, churches and synagogues and recreation centers.

•       Limit time outside when possible. If you must be outside, wear light colored clothing, a hat and sunscreen, and seek shade whenever possible. Try to run errands early or late in the day when temperatures are cooler. Drink water and sports drinks often; hydration will help prevent heat exhaustion and heat stroke.

•       Pace yourself if working or exercising outdoors. Try to work during early morning or evening hours to avoid being outside in the hottest part of the day. If you are not used to working or exercising in a hot environment, start slowly and gradually increase effort. If your heart is pounding or you gasp for breath, stop the activity and rest in a cool, shady area.

•       Use the buddy system. Partner with a friend and watch each other for signs of heat-related illness. Senior citizens are more susceptible, so if you know someone over age 65, check on him or her over the phone twice a day.

Heat exhaustion is caused by depletion of body fluids and electrolytes and usually occurs in extreme heat or when a person is unable to adapt to heat. Signs include weakness, nausea, cramps and sometimes loss of consciousness. Heat stroke is a more serious condition that occurs when the body’s core temperature rises to dangerous levels; the body’s cooling system and sweating stop and can damage the brain and other organs. Signs of heat stroke include short, rapid breathing; fast pulse; lack of sweating and confusion. These indicate immediate medical treatment is required, so call 911 if you or someone else has these symptoms and take steps right away to get the person to a cooler area until more help arrives.

For more information on staying safe and healthy during extremely hot weather, visit

Research | Highly drug resistant, virulent strain of Pseudomonas aeruginosa arises in Ohio

A team of clinician researchers has discovered a highly virulent, multidrug resistant form of the pathogen, Pseudomonas aeruginosa, in patient samples in Ohio.

Their investigation suggests that the particular genetic element involved, which is still rare in the United States, has been spreading heretofore unnoticed, and that surveillance is urgently needed. The research is published ahead of print in Antimicrobial Agents and Chemotherapy.

The P. aeruginosa contained a gene for a drug resistant enzyme called a metallo beta-lactamase. Beta-lactamases enable broad-spectrum resistance to beta-lactam antibiotics, including carbapenems, cephalosporins, and penicillins, because they can break the four atom beta-lactam ring, a critical component of these antibiotics’ structure.

The initial isolate of metallo-beta-lactamase-producing P. aeruginosa was identified in March, 2012, in a foot wound of a 69-year-old man with type 2 diabetes living in a long-term care facility. During 2012-2013, the investigators identified this highly antibiotic-resistant infection in six other patients. One of the seven patients subsequently died of the infection.

The cases are linked epidemiologically via admission to a community hospital and residence in long-term care facilities in Northeast Ohio. The one exception was a patient from Qatar who was transferred into a tertiary medical center in Ohio, says lead author Federico Perez, of the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA.

The investigators subsequently found that the metallo beta-lactamase was contained within an integron, a genetic element that can jump from one species of bacterium to another, can reside on plasmids or within the chromosomes, and is known for being able to contain multiple antibiotic resistance genes.

This particular metallo beta-lactamase, verona integron-encoded metallo beta-lactamse (VIM), is widespread globally, if not in the US. “VIM enzymes confer resistance to imipenem and all other beta-lactams,” says Perez. “They are not inhibited by metallo beta-lactamase inhibitors.”

“Alarmingly, the [extensively drug-resistant] phenotype expressed by some of these isolates precluded any reliable antibiotic treatment since they even displayed intermediate resistance to colistin, an ‘agent of last resort’,” the researchers write. “Patients who were affected had multiple comorbidities, endured prolonged colonization, required long-term care and, in one instance had a lethal outcome from a bloodstream infection.”

On top of everything else, genomic sequencing and assembly showed that the integron was part of a novel 35 kilobase region that included a transposon (another mobile genetic element) and the so-called Salmonella Genomic Island 2 (SGI2). That indicated that a recombination event had occurred between Salmonella and P. aeruginosa, contributing even more resistance genes to the latter.

“This is the first description of genetic exchange of a large mobile element—the Salmonella Genome Island—and resistance genes between P. aerugenosa and Salmonella, says Perez. “This movement of genetic material creates concern that metallo beta-lactamases will disseminate rapidly in these enteric pathogens that are also very invasive. We are also concerned about the possibility of enhanced virulence.”

The manuscript can be found online at The final version of the article is scheduled for the October 2014 issue of Antimicrobial Agents and Chemotherapy.