What is your definition for recommendation/Suggestion?Have you ever tried to answer this question to yourself or asked your parents or grandparents?Are you getting the same answer as what you think as a recommendation? ……But to me, Recommendation/Suggestion has completely transformed its meaning in the new digital era. It is nothing put personalized salesperson sitting right next to you like your shadow to jump and take your decisions even before you attempt to think.If you don’t believe me now, stop here – go to your google guru and key in “recommendation types”…!!!Unfortunately, all you will get is about product recommendation engine/ recommenders/ How to convert through efficient reco engine and youtube recommendations/ e-shopping recommendations / what is passive recommendations/ how to make your existing customers recommend your brand. Suggestions about ‘friends you may know’, pages you might like, movies of your choice (categorized), the information you might like and so on…Data rules the world. Aren’t we tired of saying every login collects in numerous personal data and companies/servers which collect the data know more than what we know about ourselves? Is that really stopping any one of us from browsing nor signing up before reading terms and conditions?We all know the consequences, but it’s a tangled web and there is no easy exit.Forget about digital medium which runs on latest fancy recommendation technologies.Even “word of mouth” practised since age-old days are also undeniably adulterated now leading to selling their own thoughts/ideas/views.Have you ever thought about this?I often get this belittle look when I recommend my friends, “Hey, don’t you show your sales skills here??” huh……So every person from the ‘non-sales’ community’s suggestion is candid and fair???As a kid, I was often warned to be beware of salespeople. In the late 80’s I remember salespeople as someone who walks door to door to sell/recommend petty things likes Soap/Paste/Detergent etc…or out in school selling Magic pens, memory pills & fancy paper cutting scissors.The warning here implies that salespeople are unfair and influence you to buy whatever they have in hand. It does not mean they are downright dishonest but are too pushy and are often self-serving with their persuasion.BUT “I find this bias against salespeople profoundly unfair.”Not because all sales people are telling the truth and are trustworthy.But the above-biased statement leaves the rest of all non-sales people to be judged too lightly, denoting that they only speak the truth.But in reality, every person or everything around us tries to influence & thrusts us by recommending & selling something or the other. Does it come as a surprise to anyone here?Selling does not have to be always physical products. More dangerous is influencing someone to view the world in the way they like it. Persuading someone to buy their own ideas/ beliefs/ thoughts does not yield any material gain. So this leads to the false conclusion that what they are trying to say is an unbiased truth.By any chance, if this “non-salesperson” makes you all think about people in Power – A politician, an activist, a preacher, a lawyer, any leadership roles, counsellor, spiritual guru, priests, rabbis or any profession in public relation – I am diverting your thoughts in a wrong path.The fact that “influencing other people’s mind” is so prevalent in all the above-mentioned type of public relation professions in the form of power or knowledge is irrefutable.But today, my non-sales people definition focusses on common people who are sitting right next to us all the time and try to snatch us and make little clones of them by constantly feeding their ideas and suggestions.NOW, CAN I SAY “Ideological Sales People are everywhere?”We’re all persuaders and influencers in our roles. As parents, we do try to convince our kid about the benefits of going to school or put an effort to make our partner watch our favourite movie or simply persuade our friend to become part of our cult.A person shifting his mindset from “non-sales” to “sales mode” begins by getting curious and trying to make others accept/ comply with whatever is preconceived in his mind. Or I should say that it is the sales mode which is dominant most of the time and works in many mysterious ways.But if it is clear there is no monetary gain (I had to reiterate the monetary part, as all human behaviour and social science terminologies are more used in Marketing & Sales than in real psychology), this can lead to a false conclusion that if someone has no incentive to disassemble, they’ll give an unbiased account of the truth.Why do people project and exaggerate what they like/believe and want everyone to agree with that?It is a natural human tendency to put forth a point and make sure it is compiled and agreed by all the other people in the group. But some people might go to any extent to exaggerate and add flavours to the information, find reasoning, give detailed descriptions and bring in substantial stories etc.to make other people comply.It definitely does give a sense of self-pride and accomplishment to make others agree with their beliefs and ideas.There are numerous ways to do that – Generally, influencers try to select the strategy based on the listener’s personality.There goes a social science term for this “Compliance Gaining” – While persuasion seeks to change people’s belief and attitudes, compliance gaining tries to appeal the emotional side to inspire actions. If you start searching about Compliance gaining you will find way too many techniques to convince a person and all of us will fall into more than one category listed. But I am not speaking about the learnt or trained way to convince and sell something. But by nature the inclination to make people agree with your thoughts is increasing a lot than ever before, it’s like getting a ‘like for your picture in the Facebook page’. Social Media enthusiast go to any extent to get a ‘like’ by enhancing the picture with numerous filters and photoshop techniquesLikewise, people want everyone around them to accept their suggestions and recommendations, by enhancing the information with the various strategy applied depending on the person who is listening to it. It gives self-importance and assurance when their ideas are reinforced by others.You can think about this — Do you agree that every person right next to you could be an influencer in more than one way?And beware Just because the person does not carry a suitcase full of products does not mean that he is not recommending suggesting his own ideas and influencing your thoughts.Well, now you may ask if you start analyzing the people next to you so much then it is difficult to live in a society.TRUE.Tamil Saint Poet, Thiruvalluvar has written a couplet apparently 2000 years ago referencing this issue.எப்பொருள் யார்யார்வாய்க் கேட்பினும் அப்பொருள்மெய்ப்பொருள் காண்ப தறிவு.Meaning: To discern the truth in everything, by whomsoever spoken, is wisdom.He is suggesting to evaluate the “suggestion” rather than the person who recommends.But my humbled instinct about this fact is with or without our permission, we are being influenced by the closest people around us. The more good influences we surround ourselves with, the happier we can be.“CHOOSE YOUR TRIBE & EVALUATE THEIR SUGGESTIONS CAREFULLY”
ABC News(SEATTLE) — A potent storm brought heavy snow to parts of the Pacific Northwest on Friday, including the lowland areas of the Seattle metropolitan area. This was the second round of snow the region has seen this week.Radar on Saturday morning is showing numerous bands of heavy snow in the Seattle metro area with snowfall rates greater than 1 inch per hour occurring in some areas. Some snow is also falling toward Portland, OregonSeattle has already received 6.4 inches of snow at Seattle-Tacoma International Airport. This was a new daily record and the second-most snowfall in a single day in the past 20 years. It was also the most snow Seattle has received in a single day since 2012.The storm will slide south during Saturday and bring some snow to Oregon and Northern California. The storm then will slide inland later Saturday and bring snow to the northern Rockies on Sunday and early Monday.In Seattle, most of the snow will end during the day on Saturday, while heavy mountain snow will begin to pick up in the Sierra Nevada Mountains late Saturday.Seattle could pick up a couple more inches of snow Saturday morning before the heaviest snow winds down. Meanwhile the heavy snow will move south and east. In the higher elevations of southern Washington and Oregon 3 to 6 inches of snow will fall, with locally up to 1 foot in the highest elevations.The storm will combine with another system lurking near California to enhance the snowfall in the Sierra Nevadas over the weekend. Locally, 5 feet of additional snowfall will fall in the mountains this weekend.Cold moves into eastern USAfter a week where the Northeast got several tastes of spring, it is back to February across the region.Wind chills on Saturday morning are in the single digits across the Northeast after temperatures were in the 40s and 50s on Friday. This same arctic blast is bringing wind chills 30 below zero to parts of Minnesota and North Dakota.A new storm will quickly develop in the central U.S. on Sunday and tap into some moisture from the Gulf of Mexico. The moisture interacting with the colder air will cause light snow to spread from Minneapolis to Pennsylvania during the day on Sunday. Meanwhile, heavy rain will move into the Tennessee and Mississippi valleys.Another storm will develop right behind that one and bring a round of snow from the Midwest to the Northeast by Monday and Tuesday. This next storm looks a little stronger and taps into a little bit more moisture.The result could be 2 to 4 inches of rain in the Mississippi River Valley, which could cause some flash flooding by Monday. Locally, 2 to 4 inches of snow will fall through Monday in parts of the Upper Midwest. And locally 1 to 3 inches of snow will fall in parts of the Northeast and Mid-Atlantic through Monday.However, it remains somewhat unclear what this storm does on Tuesday and Wednesday. There is some indication the storm will continue to strengthen and interact with another system in the Atlantic. The result could amplify the snowfall totals in both the Midwest and parts of New England by Tuesday and Wednesday.Copyright © 2019, ABC Radio. All rights reserved
Laboratory Technician Apply(This will open in a new window from which you will be automatically redirected to an external site after 5 seconds) Database management (printing out lab freezing record every twomonths, making sure the database isup-to-date)Plasmids (central stocks maintenance, dna and glycerolstocks)Generate lentivirus for lab use and maintaindatabaseMaking LB medium and LB agarplatesAssisting samplepreparations School of Medicine -East Baltimore Campus Twitter More searches like this Organize glassware and plastic ware forexperimentsAutoclaving waters for culture lab and molecular biologyworkAssuming successful, independent operation of molecular biologyand the lab administration, it is expected that the successfulapplicant will participate in ongoing research projects. This willinclude:Planning experiments and evaluating/interpreting resultsutilizing detailed knowledge of research laboratory procedures andpractices.Research will involve utilizing basic laboratory equipment suchas centrifuges, pH meters, analytical balances, spectrophotometer,PCR machine, electrophoresis units, light microscopes, and laminarflow hoods.Thesuccessful applicant will likely also conduct experiments utilizingmore sophisticated instrumentation, such as super-resolutionfluorescence microscopes and electronmicroscopes.Minimum Qualifications(mandatory):HighSchool Diploma/GED with some sciencecoursework.PreferredQualifications:Someexperience with managing ispreferred.Training Certificate from Technical Institute preferred.Certificate from technical institute or internship experiencepreferred.Classified Title:LaboratoryTechnicianWorking Title: LaboratoryTechnicianRole/Level/Range: ACRO40/E/02/CB Starting Salary Range:$13.00-$16.93 per hour;commensurate with experienceEmployee group: Full Time Schedule: Monday-Friday/8:30am-5:00pm Exempt Status: Non-ExemptLocation: 04-MD:School of Medicine Campus Department name: 10002774-SOM Cell Bio Cell BiologyPersonnel area: School of MedicineThe successful candidate(s) for this position will be subject toa pre-employment background check.If you are interested in applying for employment with The JohnsHopkins University and require special assistance or accommodationduring any part of the pre-employment process, please contact theHR Business Services Office [email protected] For TTYusers, call via Maryland Relay or dial 711.The following additional provisions may apply dependingon which campus you will work. Your recruiter will adviseaccordingly.During the Influenza (“the flu”) season, as a condition ofemployment, The Johns Hopkins Institutions require all employeeswho provide ongoing services to patients or work in patient care orclinical care areas to have an annual influenza vaccination orpossess an approved medical or religious exception. Failure to meetthis requirement may result in termination of employment.The pre-employment physical for positions in clinical areas,laboratories, working with research subjects, or involvingcommunity contact requires documentation of immune status againstRubella (German measles), Rubeola (Measles), Mumps, Varicella(chickenpox), Hepatitis B and documentation of having received theTdap (Tetanus, diphtheria, pertussis) vaccination. This may includedocumentation of having two (2) MMR vaccines; two (2) Varicellavaccines; or antibody status to these diseases from laboratorytesting. Blood tests for immunities to these diseases areordinarily included in the pre-employment physical exam except forthose employees who provide results of blood tests or immunizationdocumentation from their own health care providers. Anyvaccinations required for these diseases will be given at no costin our Occupational Health office.Equal Opportunity EmployerNote: Job Postings are updated daily and remain online untilfilled.EEO is the LawLearn more:https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf You need to sign in or create an account to save Maryland, United States Johns Hopkins University Maryland, United States Salary Not Specified Save Laboratory Technician LinkedIn Similar jobs The successful candidate(s) for this position will be subject to apre-employment background check.If you are interested in applying for employment with The JohnsHopkins University and require special assistance or accommodationduring any part of the pre-employment process, please contact theHR Business Services Office at [email protected] For TTYusers, call via Maryland Relay or dial 711.The following additional provisions may apply depending on whichcampus you will work. Your recruiter will adviseaccordingly.During the Influenza (“the flu”) season, as a condition ofemployment, The Johns Hopkins Institutions require all employeeswho provide ongoing services to patients or work in patient care orclinical care areas to have an annual influenza vaccination orpossess an approved medical or religious exception. Failure to meetthis requirement may result in termination of employment.The pre-employment physical for positions in clinical areas,laboratories, working with research subjects, or involvingcommunity contact requires documentation of immune status againstRubella (German measles), Rubeola (Measles), Mumps, Varicella(chickenpox), Hepatitis B and documentation of having received theTdap (Tetanus, diphtheria, pertussis) vaccination. This may includedocumentation of having two (2) MMR vaccines; two (2) Varicellavaccines; or antibody status to these diseases from laboratorytesting. Blood tests for immunities to these diseases areordinarily included in the pre-employment physical exam except forthose employees who provide results of blood tests or immunizationdocumentation from their own health care providers. Anyvaccinations required for these diseases will be given at no costin our Occupational Health office.Equal Opportunity EmployerNote: Job Postings are updated daily and remain online untilfilled.EEO is the LawLearn more:https://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdfImportant legal informationhttp://hrnt.jhu.edu/legal.cfm Biotechnology & Bioengineering Not specified Full Time jobs in Baltimore Science, Technology & Mathematics Not specified Full Time jobs in Baltimore Maryland, United States Facebook Laboratory Technician You need to sign in or create an account to save Save Laboratory Technician Salary Not Specified Salary Not Specified Johns Hopkins University Academic Affairs Not specified Full Time jobs in Baltimore Save Laboratory Technician Administrative Not specified Full Time jobs in Baltimore GeneralSummary/Purpose:Thelab support functions are essential and will involve ordering labsupplies, maintaining inventory, assisting sample and instrumentpreparations for experiments, managing database, and maintaininganimal colonies. We are seeking a highly motivated, energetic,independent individual, with an interest in neurobiology to work ina fast-paced and dynamic basic science lab. A willingness to workwith mice and careful recordkeeping regarding experiments are bothrequired. Strong computer skills are required to maintainelectronic databases. Exceptional organizational ability, attentionto details and strong communication skills will be required tocarry out the tasks. The candidate must be willing to learn andmaster new and complextechnologies.Depending on successful performance of essential lab managementfunctions, a lab technician may be assigned to an independentproject and may contribute as co-author to manuscripts. Theresearch requires an understanding of the theory behind molecularand cell biology experiments and applying analytical skills toidentify and trouble-shoot complex experiments, but no priorexperience in research isnecessary.Specific Duties &Responsibilities:OrderingManagingshipping/receivingStocking supplies (generate a list of supplies w/locations,quantities left). Check once aweek.Animal colonies maintenance(genotyping) Faculty Positions Not specified Full Time jobs in Baltimore Share You need to sign in or create an account to save Laboratory Technician Johns Hopkins University
The decision is the latest setback for Trump in his long-standing fight with Vance’s office over the release of documents.Last August, New York prosecutors issued a subpoena for eight years of Trump’s tax returns and other records, indicating the possibility of a wider criminal investigation. Since then, the dispute has gone through several courts, with Trump’s arguments repeatedly knocked back.In July, the Supreme Court rejected Trump’s argument of immunity, but allowed him to challenge the subpoena on its scope. The lower court’s rejection of that effort reflects the possibility that the district attorney will look at Trump’s real estate transactions for possible wrongdoing.A New York Times investigation revealed last month that the president had paid just $750 in taxes in 2016 and again in 2017. But the newspaper did not publish Trump’s returns. [NYT] — Sylvia Varnham O’Regan This content is for subscribers only.Subscribe Now Manhattan District attorney Cyrus Vance Jr and President Donald Trump (Getty; iStock)The saga of whether the public will ever get to see Donald Trump’s tax returns just got a little bit more interesting.A federal appeals panel ruled Wednesday that the Manhattan district attorney, Cyrus Vance Jr., can obtain Trump’s personal and corporate tax returns under a subpoena, rejecting the president’s argument that the probe amounted to political harassment.“None of the president’s allegations, taken together or separately, are sufficient to raise a plausible inference that the subpoena was issued out of malice or an intent to harass,” wrote the panel, presiding in the U.S. Court of Appeals for the Second Circuit.Should Trump appeal the decision, as he is expected to do, the case will head to the Supreme Court, according to the New York Times.Read more5 real estate takeaways from 20 years of Trump’s taxesTrump Organization properties losing $1M a day to pandemic
ShareTweetShareShareEmail Related Items:French handball, Paris Saint Germain handball, saint raphael HBC Nantes shocked by Fenix Toulouse – Montpellier save point in Istres The end of French Cup and amateur leagues ShareTweetShareShareEmailCommentsParis Saint Germain stayed at Championship race with Montpellier Handball after tight win in away clash with Saint Raphael 26:25 (13:12). The Danish TOP scorer Mikkel Hansen scored nine goals (eight from 7-meter), the decisive one in the last second of the match, while Nedim Remili and Luc Abalo netted four each.Montpellier made another step towards trophy by beating Massy 32:23.Saint-Raphaël – Paris (12-13) 25-26Saint-Raphaël: Popescu (12 saves), Demaille. Krantz (0/1), Barachet (1/2), Hubert, Abily (5/7), Sarmiento (2/4), Lynggaard (2/2), Caucheteux (7/11 dt 5/5 pen.), Vigneron (1/2), Trottet, Krakowski, Dipanda (4/8), Karalek (3/5), Eponouh, Hmam.Paris: Omeyer (30′ 3 saves), Corrales (30′ 7 saves). Mollgaard, Stepantic (1/3), Sagosen (1/2), Kounkoud, Damjanovic, Rémili (4/6), Abalo (4/7), Karabatic L. (1/3), Hansen (9/10 dt 8/8 pen.), Nielsen, Karabatic N. (2/5), Nahi (2/3).RESULTS:Cesson Rennes-Metropole 27 – 33 NantesTremblay 34 – 31 ToulouseDunkerque 30 – 31 AixIvry 24 – 22 Chambery SavoieMontpellier 32 – 23 Massy EssonneNimes 30 – 23 SaranSTANDINGS:1. Montpellier 17 15 1 1 491:409 312. Paris SG 17 13 1 3 512:436 273. Nantes 17 12 1 4 531:464 254. Nimes 17 10 2 5 463:442 225. St. Raphael 17 10 2 5 468:448 226. Aix 17 10 1 6 485:457 217. Dunkerque 17 9 1 7 443:455 198. Toulouse 17 8 1 8 493:494 179. Chambery Savoie 17 6 2 9 464:482 1410. Ivry 17 4 2 11 425:488 1011. Tremblay 17 4 2 11 473:495 1012. Cesson Rennes-Metropole 17 2 4 11 431:466 813. Massy Essonne 17 2 2 13 386:462 614. Saran 17 3 0 14 488:555 6 Recommended for you France with no more than 5.000 fans until end of October Click to comment Leave a Reply Cancel replyYour email address will not be published.Comment Name Email Website Save my name, email, and website in this browser for the next time I comment.
Turkey backed the proposal, Çavuşoğlu said on Sunday, but the Greek Cypriot government on Tuesday said it “cannot be accepted” since it does not tackle the resolution of the island’s 45-year-long division. Cypriot President Nicos Anastasiades will reply in detail to Akıncı’s proposal, the government said.Cyprus has been split between an ethnic Greek south and an ethnic Turkish north since Ankara’s 1974 invasion.The Republic of Cyprus — an EU member that is internationally recognized, except by Turkey — has issued licenses to oil and gas giants, including Total, Eni and Exxon Mobil, and expects to start extracting gas by 2025.In response, the Turkish Republic of Northern Cyprus — recognized only by Turkey — granted licenses to Turkey’s national oil and gas company TPAO.In May, Turkey announced it would start drilling in what is widely recognized as Cyprus’ exclusive economic zone, prompting an international uproar and condemnation from Brussels. Ankara claimed that the areas where it plans to drill are either part of its own continental shelf or in zones where Turkish Cypriots should have equal rights over any discoveries.The Turkish secular opposition backs the government on this issue. Its leader Kemal Kılıçdaroğlu denounced the EU’s measures on Tuesday, saying: “We have rights in the eastern Mediterranean and we will defend these rights until the end.” The EU’s decision to penalize Ankara come as Turkey, a NATO member, also braces for potential sanctions from the U.S. over its purchase of a Russian missile defense system. Also On POLITICO EU draws up measures against Turkey over Cyprus drilling By Jacopo Barigazzi Ankara will increase its hydrocarbon exploration efforts in the eastern Mediterranean in response to the EU’s decision to sanction Turkey, the country’s foreign affairs minister said Tuesday.On Monday, EU foreign ministers unanimously approved an initial series of measures against Turkey over Ankara’s drilling activities off the coast of Cyprus, which Brussels has condemned as “illegal.”Foreign Minister Mevlüt Çavuşoğlu dismissed the move, saying that there was “no need to take it very seriously,” and added: “If you [EU] take such decisions against Turkey, we will increase activities [in the Eastern Mediterranean].” He added a fourth Turkish drill ship would be sailing to the region “as soon as possible,” according to state media agency Anadolu.The measures agreed Monday include a cut in pre-accession funding for Turkey in 2020 — in the order of €145.8 million — and freezing negotiations on an Open Skies agreement with Turkey as well as summits and high-level meetings.EU foreign ministers also asked the European Investment Bank to review its lending activities in Turkey and invited the Commission to work on possible sanctions targeting companies and individuals involved in the drilling activity.Çavuşoğlu’s defiant response came on the same day that the Cypriot government shot down a proposal by Turkish Cypriot leader Mustafa Akıncı, who suggested forming a “joint committee” to ensure both communities on the ethnically-split island can benefit from the gas found in its waters.The Turkish Cypriot proposal, obtained by POLITICO and shared with Commission President Jean-Claude Juncker as well as EU foreign policy chief Federica Mogherini on Saturday, envisioned setting up a joint committee under the auspices of the EU and the United Nations.It includes an offer by the Turkish Cypriot administration to halt any off-shore activity in disputed areas “as soon as the rights of the Turkish Cypriots over the off-shore resources of the Island are guaranteed.”
If Steve Angello, Sebastian Ingrosso, and Axwell are the Swedish House Mafia, Thomas Gold is some sort of German house music Godfather. “You come to me, asking for a rager…” The guy has a hardcore and devoted following of fans who have seen him grow from a rising star in the Ibiza house music scene to the global superstar he is today. He’s truly one of the biggest names in the scene today, and this sold out show at New York City’s Roseland Ballroom goes to prove it.The venue was absolutely packed from the moment the doors opened as fans shuffled in early to catch openers Feenixpawl and Nari and Milani. Each act kept the crowd pumping while they awaited Thomas Gold to take the stage. Before he did though, a complete marching band took to the stage – snare drums, bass drums, trumpets – and just sort of greeted the crowd. Then an awesome video package was screened, pumping up the crowd with a countdown before the music hit and Roseland Ballroom was turned into a giant rave.Roseland’s production values are top notch, complete with more confetti than you could dream of, streams of lasers above the crowd, and constant blasts of CO2 that keep the crowd in a frenzy. The sound system and sight lines make it one of, if not the best place to see dance music in New York City. And that’s before you take into consideration the level of talent booked, where you’re getting guys like Thomas Gold spinning all night.And he did seemingly go all night. From 1:30am to a little past four, Thomas Gold manned the decks, bringing that pure house music sound to the masses. Most of Gold’s contemporaries tap out at around the 1.5-2 hour mark, so seeing him push it farther is a testament to his skills and endurance. Beyond his own megahits and classic cuts, Gold manages to build a fantastic set by throwing in his own personal favorites and a mix of what’s hot right now. But in a world where every DJ is mixing in a little dubstep or trap music, Thomas Gold is pure progressive house magic.Oh, and that marching band that greeted the stage? They came back at the end, dropping an awesome beat between the horns and drums while Gold spun behind them, before ripping into an absolutely incredible remix of Adele’s ‘Set Fire To The Rain’. Seriously, if Gold’s original remix wasn’t amazing enough, add a bunch of live musicians on the stage. By the way – trend alert – this is something that more DJ’s should bring to the table. We’ve seen traditional drummers with guys like Pretty Lights and Chase and Status, but the variety of different drums, and most surprisingly the horns, work so well.Overall, such a memorable show. The whole production was top notch between the screens, on stage dancers and performers, blow up horns that fell from the sky – it was awesome. Just so much going on all over the place, it’s hard not to have an amazing time. Thomas Gold really went all out for this show, it’s clear that he thought this show was special – and it showed off in the overall product. New Yorkers will definitely be awaiting Thomas Gold’s next return to Manhattan.Check out a video of Thomas Gold with his Drumline on “Fanfare”:[Credit to Acoustic Space for the video]
Rain reared its head in the final stage of the NASCAR Xfinity Series Alsco 300 at Charlotte Motor Speedway. The red flag came out at Lap 172 for weather before a big downpour hit the 1.5-mile track and caused a delay of one hour, one minute and 12 seconds. Television coverage of the conclusion of the race shifted from FS1 to FS2. Weather had played a role earlier in the race, bringing out a previous caution on Lap 125.At the time of the red flag, Brad Keselowski was scored as the race leader, according to NASCAR Timing & Scoring, with Daniel Hemric in second. Kyle Busch won the first two stages of the race and led 93 laps. However, a rash of cautions put drivers on varying strategies and caught in traffic, and Busch clipped the grass and went spinning and sliding into Chase Briscoe on Lap 161. Keselowski would go on to hold off Cole Custer for the race win in a NASCAR Overtime finish.RELATED: Weather updates | Busch rides through grass, tangles with BriscoeA mechanical issue derailed Chase Elliott’s day shortly into the final stage. Elliott is filling in for the suspended Spencer Gallagher in five races for GMS Racing starting with Saturday’s race at Charlotte. Rain canceled Saturday’s opening Monster Energy NASCAR Cup Series practice as teams prepared for Sunday’s Memorial Day tradition, the Coca-Cola 600 (6 p.m. ET, FOX). The session was scheduled to begin at 9:05 a.m. ET and run for 50 minutes. The schedule for the day was adjusted to move Xfinity Series qualifying to 10:20 a.m. ET with the final Monster Energy Series practice starting shortly after 11 a.m. ET and running for about an hour.NASCAR has 12 Toyota Tundra track drying units, 13 jet dryers, three vacuums (two track vacuums, 1 Elgin sweeper) and two tractor brooms on hand for track-drying efforts.RELATED: Full schedule | Kyle Busch on pole for Coca-Cola 600According to the National Oceanic and Atmospheric Administration, today’s forecast for Concord, North Carolina, included scattered showers and thunderstorms, mostly cloudy, with a high near 83. Chance of precipitation is 50%.
DAYTONA BEACH, Fla. – When it comes to past success and high expectations, you’d be hard-pressed to find a more heralded group of teammates than the Acura Team Penske lineup for the Jan. 26-27 Rolex 24 At Daytona.As it has done seamlessly in the past, the team has brought together a diverse and accomplished group of drivers to contend for the season-opening trophy in the IMSA WeatherTech SportsCar Championship’s annual twice-around-the-clock event.RELATED: How to watch the Rolex 24Penske’s high-achieving lineup this year features three Indianapolis 500 winners, a pair of IndyCar champions and some of the finest sports car competitors in the world.The No. 7 Team Penske Acura ARX-05 DPi will be driven by three-time Indy 500 winner Helio Castroneves and 2017 WeatherTech Championship Prototype champion Ricky Taylor on a full-time basis, with help next weekend from 2016 Indy 500 winner Alexander Rossi, whose lone Rolex 24 appearance to date came in 2014 as part of the DeltaWing driver lineup.The No. 6 Team Penske Acura will again be driven full time this season by two-time Indy 500 winner and former NASCAR and Formula 1 star Juan Pablo Montoya and 2016 WeatherTech Championship Prototype champion Dane Cameron. Joining them for the Rolex is Simon Pagenaud, who won the 2016 IndyCar title with Team Penske.MORE: Star-studded, accomplish drivers highlight Rolex 24 fieldAnd judging by their time both in front of the cameras and in the garage during the recent Roar Before the Rolex 24 test weekend, the group has already begun to gel in an effort to land the big trophy in the season-opening event.“There are so many things we developed in the offseason and now hopefully we’ll be able to deliver,” Castroneves said. “Alex [Rossi] has joined us and good news is he’s using the same seat as [last year’s Penske driver] Graham [Rahal] so he ‘fits right in.’ Hopefully we’ll get the results we deserve.”Certainly, this race is an important part of Penske’s illustrious racing contribution. He’s won the Rolex three times, including overall in 1969 with the late Mark Donohue and Chuck Parsons.RELATED: Hall enshrinement another box checked for Roger PenskeLast year, the two-car Acura Team Penske program returned to sports car competition full time and placed ninth and 10th overall at Daytona. In qualifying, Castroneves put the No. 7 car on the outside pole position, and both cars ran competitively before mid-race issues ended their hopes of winning.Castroneves and Taylor scored the only victory for the team in its sports car return at the Mid-Ohio SportsCar Course in May. They led a 1-2 sweep for the team, with Montoya and Cameron’s No. 6 entry crossing the finish line close behind.A victory at Daytona this year would go a long way to setting the tone for a championship-contending season. Taylor was third and Montoya was seventh in the qualifying session that concluded the Roar and set the order for garage and pit selections.“We learned a ton in our first season, so I think we’re really ready to hit the ground running and make a push for the championship,” said Cameron.For Rossi, who competes full time for the Andretti Autosport team in IndyCar, this race is essentially opportunity with expectation.“Our expectation is to win,” Rossi said smiling. “I think we have the platform to do that. If you look at the success the team had last year as a new team coming in, they had a learning curve to catch up to the other teams and I think they did an amazing job with that.“Already going into this year there’s a lot of talk about how much progress they’ve made, so I think that warrants good expectations. These teammates are some of the best on the grid, I think, and I feel fortunate to have them coach me up as quickly as possible.”
Good:”ž Firefighters and other emergency responders must remove their turnout gear or jackets and be sheltered from the environment. Optimally, both the turnout coat and pants of firefighters should be removed to aid in passive cooling. If this isn’t possible, the turnout pants should be pushed down below the knees while the firefighter is seated in the rehab sector. In many cases, the firefighter will continue to warm as metabolic heat is produced even if the turnout gear is reduced. If passive cooling is employed, expand the rehab time before returning to the incident to allow for core cooling. It’s important to remember that standard pulse oximeters cannot identify carboxyhemoglobin nor can they account for hydrogen cyanide in the cells. For patients poisoned with either of these gases, the SO will likely appear normal, even though the patient is displaying signs and symptoms of hypoxia. Although first responder rehab will most often be implemented on the fireground, it should also be considered essential in other types of incidents. For example, hazardous materials technicians will often employ splash- and vapor-resistant personal protective equipment that impairs thermoregulation, resulting in rising core temperatures. An organized rehab sector may also be required at an extended”žEMS incident if conditions require long periods of work outdoors without sufficient protection from the sun and weather. Although evaporation is impaired when a firefighter is wearing turnout gear, sweat is still produced when warm blood moves from the body core and travels to the skin surface. Production of sweat removes water from the plasma, thus reducing the effective blood volume. How should I monitor personnel in the rehab sector? In some sporting events, the rate of EHS is as high as 1 to 1,000. Once EHS has occurred, the severity is directly related to the time the core body temperature remains above the critical threshold. There’s a misconception in the medical community that treating EHS by immersion will result in further heating and heat stress from peripheral vessel constriction. However, cold water immersion (CWI) is the gold standard for treating EHS.(16) The conductive capacity of cold water placed directly against the skin far exceeds any impairment of skin blood flow from vasoconstriction. It’s likely that hydrogen cyanide poisoning has always been a problem on the fireground but has only recently been recognized. In March 2006, a series of routine structure fires in”žProvidence,”žR.I., sent 28 firefighters to the hospital with headaches, dizziness and incoherence. Eight were found to have elevated levels of cyanide in their blood. A new cyanide antidote kit has been approved by the FDA (Hydroxocobalamin, Cyanokit from Dey, L.P., Merck KGaA of”žDarmstadt,”žGermany) and should be available to hospitals that treat firefighters exposed to smoke. Hydrogen cyanide is formed from the incomplete combustion of many common materials, including paper, cotton, silk and plastic. Hydrogen cyanide binds to proteins in the cell mitochondria and disrupts the use of oxygen. Temporal thermometers have become more popular in health-care settings. These thermometers move across the skin of the forehead and behind the ear to measure the blood temperature in the temporal artery. However, although these devices appear accurate in pediatric patients, studies have found they’re not as reliable in adults. Finally, adhesive thermometers placed on the forehead have been shown to be accurate in exercising athletes. However, these items may not work correctly during cool weather conditions. Regardless of the thermometer you choose, it should be used only to augment the clinical picture. A large ambulance can also be used for rehab. However, don’t commit an ambulance that’s tasked with transporting patients. It’ll be difficult to evict four or five firefighters from the back of the rig if a medical emergency occurs. In cities with an established transit system, emergency agencies can often request a bus to be available on scene for rehab. The heat burden and loss of plasma volume from sweat forces the heart to work harder. This may cause heart rates to be persistently elevated, even after the firefighter leaves the scene and removes the protective clothing. For example, at one training fire, we measured a core body temperature of 103_ F (39.4_ C) in an asymptomatic instructor associated with a heart rate of 170 beats per minute. Exertional heat stroke (EHS) is the life-threatening endpoint of untreated hyperthermia resulting from exercise or work in hot environments. Victims of EHS are typically unconscious or have significantly altered levels of consciousness, but may have brief lucid intervals. Although sick and unable to thermoregulate in classic heatstroke cases, EHS victims will be extremely diaphoretic, having worked under conditions that make them appear Ë™wet.Ã“ This is a key feature to note in the rehab sector. Don’t confuse regular heat exhaustion with the more severe EHS because they’re not Ë™dry.Ã“ Observe all the monitoring parameters available, the temperature and the clinical picture in order to determine how severely affected the firefighter may be from the heat. For short-duration incidents, self-rehab may be all that’s required. However, for incidents extending beyond the second SCBA cylinder, a formal rehab sector must be established. It’s the incident commander’s (or safety officer’s) responsibility to ensure crews are rotated through the rehab sector. Exposure to smoke and particulate matter created from combustion at a fire are known environmental hazards that can stress the cardiovascular system. Although firefighters routinely wear self-contained breathing apparatus (SCBA) during fire suppression, overhaul operations are often conducted without respiratory protection. The byproducts of combustion, a complicated mixture of chemicals, are suspended in the air during overhaul, posing a hazard to the firefighters inside the structure. Two common chemicals associated with significant risks are carbon monoxide (CO) and hydrogen cyanide. Although constantly improving, the thermal protective clothing worn by firefighters impairs both evaporation and convection processes. Even if moving air were blown onto the firefighter, the thick layers of the garment hamper effective convection. Further, thick layers of turnout gear impede the evaporation of sweat, causing it to collect in the garment and gradually increase the weight of the gear during the incident. Impairing thermoregulation ultimately results in a rising core body temperature. Even if the heat stress doesn’t progress to exertional heat illness, a firefighter usually suffers some consequence from the additional heat burden. Where do I set up a rehab sector? The resulting”žhypohydration reduces the stroke volume of every cardiac contraction. To maintain the cardiac output, the heart must beat faster to ensure sufficient blood is delivered to working muscles and vital organs. Initially, all personnel who have been involved with strenuous activity, fire suppression or suppression support in a warm or hot environment will likely be tachycardic and have rapid respirations, due to the combined effects of exertion and mild hyperthermia. CO is present in high concentrations during the overhaul phase of fire suppression.(4) When inhaled, it binds tightly to hemoglobin, forming”žcarboxyhemoglobin and impairs oxygen delivery. Some level of carboxyhemoglobin is expected simply from living in an urban environment or from smoking cigarettes. However, when the level in the blood rises due to significant or prolonged exposure, the resulting hypoxia may induce myocardial infarction. Under these conditions, the modest amounts of salt in commercial sport drinks can off-set salt loss in sweat and minimize medical events associated with electrolyte imbalances (e.g., muscle cramps and hyponatremia). Better:”ž Sport drinks are often ignored by the emergency service organizations due to a misconception of rehydration. It’s a common belief that sport drinks cause gastric distress and lead to further dehydration by pulling water from the cells. On the contrary, a drink that includes glucose and sodium chloride should be considered for prolonged incidents or if there’s inadequate access to meals or during the initial days of hot weather.(8) The victim is ultimately located, unconscious but alive, and is extricated from the building. He’s placed in the only ambulance on scene and rushed to the hospital. After multiple entries and changes of SCBA cylinders, the crews bring the fire under control. During a prolonged incident, it’ll be necessary to provide some form of nutrition to working firefighters. In many cases, this nutritional support can be satisfied with small foods easily eaten cold and without utensils. It’s important to ensure nutritional support is balanced. Most sport nutritionists recommend snacks that are primarily complex carbohydrates to maintain blood glucose levels with some protein and a lesser amount of fat. Many of the individually wrapped sport snacks meet these requirements and have the advantage of a long shelf life. Be sure to check the labels and have crews try items before purchasing any for your rehab operation. Supplements won’t be useful if the taste prevents them from being eaten on the scene. Best:”ž The optimal rehab sector is established by a specialty vehicle designed for this task. A large ambulance or small bus can be fitted with rehab equipment and dispatched as needed. For departments with smaller run volumes, it may be possible to share this resource across multiple agencies. A designated rehab vehicle has the advantage of placing medical and rehab equipment in the same vehicle. Placing tents on the vehicle allows for rapid expansion of the rehab sector during larger incidents or on days with mild weather. One firefighter complains of being unusually tired. He looks pale and diaphoretic. When the crew picks up their gear to return to the scene, the firefighter loses consciousness and strikes his head on an SCBA cylinder when he falls to the ground. Other firefighters tend to the man while a second ambulance is called to the scene. Course Objectives Powered cooling vests use a cooling source similar to a portable air-conditioner to chill a fluid that’s then circulated through a vest worn by the firefighter while in the rehab sector. A variant on the theme are vests containing a material that feels cool after being immersed in water. These vests feel cool when first applied but can quickly become insulators once the initial cooling has been consumed. Heat Stress For truly prolonged incidents, it will be necessary to provide major nutritional support, usually in the form of a hot meal. In many cases, you will need to rely on outside agencies operating a mobile canteen to meet these needs. Preplan with these agencies to confirm the items being provided can be brought in sufficient quantity and meet the nutritional needs of the crews. What do baking, athletics and firefighting all have in common? All of these professions have had members die of heat-related illness. Exertional heat illness can be a deadly process by itself, but when additional stress is placed on the cardiovascular system, it can increase a person’s risk for myocardial infarction, stroke or sudden cardiac arrest. Although exertional heat illness can’t be entirely eliminated from firefighting, it should never be fatal when proper medical supervision and appropriate rehabilitation services are available. Understand the stresses experienced by emergency responders during fire suppression or other extended incidents.Describe the functions and operations of on-scene rehab.Understand the physiological response of the body to environmental stresses.Identify exertional heat illness and describe the treatments.Describe the available modalities for rehydration and core temperature cooling.”ž Immediate rehab is also called Ë™self-rehab.Ã“ For self-rehab, firefighters consume liquids while changing their SCBA cylinder. This allows for initial rehydration before re-entering the incident. For self-rehab to be effective, the fluids must be readily available to all fire companies. One method to ensure firefighters have the opportunity to perform self-rehab is to place bottles of water or sports drink with spare SCBA cylinders. This guarantees they’re at hand when the firefighter returns to the apparatus for the second cylinder. Carbon monoxide is difficult to clinically identify in the prehospital setting. However, handheld devices (CO-oximeters and breath analyzers) capable of measuring CO bound to hemoglobin are now available and being deployed to monitor firefighters during rehabilitation. Best: The ultimate adjunct to a rehab protocol is measuring body weight. Normal body weight in a standard work uniform should be obtained monthly and entered into a rehab database, so emergency personnel can be weighed in the rehab sector wearing a work uniform to estimate how much fluid has been lost through sweating. Remember to correct for sweat soaked into the uniform. In our system, we estimate sweat-soaked clothing at 0.5 kg. If a firefighter is standing on the scale in sweat-soaked clothing and the scale displays a normal weight, we assume they’ve lost 0.5 kg of fluid and rehydrate them accordingly. This technique requires the purchase of accurate, reliable scales and continuous monitoring of normal body weight. Best:”ž IV rehydration with normal saline has produced mixed reviews in terms of athletic performance.(12,13) Although most studies have shown IV and oral rehydration to be the equivalent in rehydration techniques, the comparison hasn’t been applied to first responders working in PPE or thermal protective clothing. Introducing fluids directly into the plasma volume may be beneficial when the environment and protective equipment impair thermoregulation. Two clearly superior aspects of IV fluid administration are the ability to deliver larger volumes of fluid in a short period and the effect of mild cooling. When considering the heat index, any temperature over 90_ F should be treated as dangerous in terms of personnel working in thermal protective clothing. Under these conditions, it’s imperative that an effective rehab section be established at every major incident fire so crews can be regularly assessed for heat stress and receive appropriate preventative treatment. It’s widely believed that caffeine exerts a diuretic effect that will impair performance in the heat. Contrary to popular belief, there’s no evidence that caffeine consumption results in water-electrolyte imbalance or reduced exercise heat tolerance.(10) However, the stimulant effect will raise the heart rate, which isn’t helpful in the context of fireground rehab. Therefore, we recommend avoiding caffeine in the rehab sector. Oral and tympanic thermometers are most common. Tympanic thermometers are very sensitive to position in the aural canal. If the tip of the thermometer is not facing the middle ear, falsely low readings will be obtained. Oral thermometers are reliable in the lingual pocket but will read falsely low if used after fluids have been consumed or if the person is breathing rapidly. One study compared oral thermometers with tympanic in firefighters after exiting a training fire and found the readings poorly correlated.(9) Environmental conditions can also magnify heat stress during an incident. Thermal burden is increased with rising temperature and”žrelative humidity. Warm air can hold more moisture than cold air, intensifying the problem during warm weather. As the relative humidity rises, evaporation is inhibited and causes sweat to accumulate on the skin surface once thermal protective garments have been removed. Air temperature and relative humidity together create the heat index, the temperature Ë™experiencedÃ“ by the firefighter. In the desert, a temperature of 92_ F with a relative humidity of 10% feels like 87_. The same 92_ F day during a”žPittsburgh summer with 70% relative humidity feels like 155_ and can rapidly lead to exertional heat illness. Fire suppression is a physiologically stressful activity requiring the firefighter to work at near-maximal heart rates for extended periods. The firefighter is exposed to a combination of heat from the fire and environment, and the metabolic heat generated from the heavy exertion. When combined with heavy thermal protective clothing, thermoregulation is impaired and core body temperature begins to rise. Better:”ž Passive cooling is inefficient, especially in hypohydrated individuals. Place hyperthermic emergency personnel into air-conditioned vehicles to aid in cooling. Misting fans have also become popular devices in rehab units. Although moving air around a person in need of rehab will enhance convective heat loss, the application of water mist will be effective only if the relative humidity is low. Even under optimal conditions, the misting fan will reduce core body temperature less than 1.8_ F (1.0_ C) during a 30-minute exposure.(15) Better:”ž The easiest way to provide shelter is to use a vehicle equipped with heat and air conditioning. Many fire departments are now ordering apparatus with air-conditioned closed cabs. Some of these vehicles are sufficiently large enough to allow for four to six individuals to enter the vehicle to escape the environment. Additional hypohydration will result in a loss of cardiac output if the rising heart rate and falling stroke volume can’t maintain the body’s need. When combined with the additional heat load, this combination of stressors make the heart endure near-maximal heart rates for extended time intervals. Forearm immersion takes advantage of the many superficial arm veins by placing the forearms and hands into cold water, enhancing the convective transfer of heat from the blood to the water. Studies have shown this technique can result in 0.5Ã1.5_ C cooling in a 30-minute exposure. It’s a hot, humid day in August when Engine 219-1 arrives first on the scene at a commercial structure fire. The crew advances a 2.5″ hose into the warehouse to begin an interior attack. With the arrival of truck 219, a crew is sent to the roof to ventilate. When it’s learned that the warehouse foreman can’t be found, a second crew is sent into the structure to search for the missing man. How do I rehydrate in the rehab sector? Best:”ž Applying cooling modalities directly to the responder are the best regimens for cooling. Some level of evidence supports the effectiveness of powered cooling vests and forearm immersion, which take advantage of the great conductive capacity of water. These methods can be effective modalities for cooling mildly hyperthermic emergency personnel but require a significant investment to place these items on a rehab unit. Good:”ž At a minimum, all personnel in the rehab sector should be logged in (and out) and have vital signs monitored every ten minutes. Repeated vital signs demonstrate trends toward improvement or deterioration once the individual is cooled and rehydrated. Rehab operations can be divided into two phases: immediate and formal. Many fire departments operate on the Ë™two-cylinder rule,Ã“ in which two full SCBA cylinders can be consumed during fireground operations before the firefighter must enter the rehab sector. When following this rule, the firefighter is expected to perform immediate rehab during the first-cylinder change. In addition to monitoring vital signs, assessing the responder’s temperature adds to the clinical picture when assessing them in the rehab sector. There are many types of thermometers available. True core temperature is different than most commonly measured temperatures (i.e., oral, tympanic, etc). Although most high-quality thermometers read accurately on normothermic people at Ë™room temperature,Ã“ device limitations are revealed when monitoring hyperthermic individuals who are performing physical exertion in adverse environments. Good: At a minimum, the rehab area must provide shelter from the sun and heat or the cold depending on the time of year. Be sure to keep the sector away from running vehicles to prevent exposure to CO and diesel exhaust, and if possible, place the rehab sector out of sight of the incident. A rehab area can be created using a tent and folding chairs, allowing a firefighter to remove turnout gear and be seated. Add fans on hot days and portable heaters on cold days. If using gas-fired torpedo heaters, be sure to monitor the sector with a four-gas meter to avoid CO exposure. Rehab Operations How do I cool personnel in the rehab sector? Caffeinated beverages are perhaps the most misunderstood fluid in the context of rehydration and performance. Caffeine stimulates the sympathetic nervous system and is generally considered in sport to be an”žergogenic aid that improves continuous exercise time to exhaustion. Good:”ž The traditional fluid used for rehydration, bottled water, is cheap and easy to store for extended periods. For every kilogram of fluid lost, a kilogram must be replaced. That means the typical weight loss of one kilogram experienced by a working firefighter will require 34 oz. of water to ensure full rehydration. Many individuals may not voluntarily consume this quantity, so intake should be encouraged and documented for each individual on the rehab sector log. Cardiovascular Stress Ã Blood Cardiovascular Stress — & Tears (Smoke Exposure) Heat stress placed on responders is both intrinsic (metabolic heat produced by the individual) and extrinsic (heat from exposure to open flame or heated areas, and the environment). Under normal conditions, the body sheds additional heat by”žconduction, convection, evaporation, respiration and radiation. Of these, evaporation of sweat and convection to air or circulating water are most efficient. The role of the rehab sector is to provide: 1) medical evaluation and treatment; 2) rehydration and nutrition; 3) protection from the elements; 4) supervised rest and recovery; and 5) firefighter accountability.(2)”žAlthough this article focuses on fireground rehab at hot weather incidents, it’s important to remember rehab is required for every environmental condition. If carbohydrate concentrations are too high, delays in gastric emptying can be observed when mixing a sport drink from a powder; be sure to follow the directions and add sufficient water to avoid overly concentrated solutions.(9) Cooling for Exertional Heatstroke Heat stress also affects blood clotting and clot resolution.(3) With heat stress comes co-activation of coagulation (which makes blood thicker) and”žfibrinolysis (which makes blood thinner). As the body temperature returns to normal, fibrinolysis down-regulates to its normal level while coagulation remains activated for a period of time. This results in the blood being Ë™thickerÃ“ than normal under heat-stressed conditions. Combined with an increased endogenous epinephrine surge and the cardiovascular stress from the strenuous work associated with fire suppression, the addition of Ë™activatedÃ“ coagulation to these traditional cardiac stressors can accelerate the progression to myocardial infarction, resulting in a crippling heart attack or sudden death. In the case of a high-rise fire, the optimal place for rehab may be a few floors from the fire floor, a safe distance from fire suppression but close enough to allow reasonable access to the incident. 1. Karter M Jr, Molis J. Ë™Firefighter injuries for 2004.Ã“. NFPA Journal 2005;99:50-57.”ž2.”žDickinson E, Wieder M.”žEmergency Incident Rehabilitation,”žUpper”žSaddle”žRiver: Pearson Prentice Hall; 2004.”ž3. Bouchama A, Bridey F, Hammami M. Ë™Activation of coagulation and fibrinolysis in heatstroke.Ã“. Journal of Thrombosis and Haemostasis 1996;76:909-1015.”ž It’s not unusual for a firefighter to lose 1Ã2 kg of fluid in a prolonged incident or an exceedingly hot environment. Ideally, fluid replacement should equal fluid losses, requiring the firefighter to consume as much as 2 L of fluid before returning to the incident. More than a liter of fluid in the stomach will likely cause gastric distress. This can be overcome by providing a rapid bolus of normal saline through a peripheral arm vein. Additionally, a rapid bolus of normal saline will result in core cooling of as much as 1.0_ F.(14) Why Rehabilitation? Breathing and heart rates that remain elevated after providing fluids and cooling signal a worsening condition, and should be evaluated by a physician. Additionally, abnormal blood pressures should have the cause identified and treated; however, a normal blood pressure doesn’t rule out cardiovascular strain. In many instances, the resources for CWI won’t be readily available. The need for immediate cooling is still imperative. An effective mode of cooling used by field military units involves wrapping the victim in sheets soaked in ice-cold water, readily accomplished by placing two sheets into a cooler of ice water. Remove the clothing from the victim, and wrap one sheet on the anterior and lateral skin surface of the supine patient. After applying for 60Ã90 seconds, return the sheets to the cooler and apply the second sheet. Monitor the core temperature during this procedure and discontinue when a core temperature of 102_ F (39_ C) is achieved. Finally, the particulates found in fire smoke have both acute and chronic cardiovascular effects. Short-term exposure can trigger myocardial infarction, especially among those with pre-existing heart disease.(5) Long-term exposure may speed or change the process of atherosclerosis, creating a medical condition that increases the risk of myocardial infarction and stroke.(6,7) There are many possible solutions for incident rehab. We’ve attempted to answer the most common questions with”žgood, better and”žbest strategies. Conclusion CWI isn’t without risk. If the EHS victim is overcooled, there’s a risk of shivering or hypothermic afterdrop. Hypothermic afterdrop occurs if the body is overcooled and requires re-warming. This can be avoided with proper precautions. Any prehospital provider tasked with treating EHS should have the required equipment to measure rectal temperature. A flexible thermistor should be placed 10 cm into the rectum and remain in place during CWI.(17) This will allow the patient to be removed from the immersion when the core temperature reaches 102_ F (39_ C). In cases where a rigid rectal thermometer is used, the cooling rate of 0.2_ can be used to calculate when 39_ will be reached. This allows the victim to be removed before too much cooling is applied. Once initial cooling has been accomplished, the EHS victim can be transported to the emergency department. Fireground rehab is an essential component of any incident that may save lives and improve the health of responders. Preplanning for rehab is essential to ensure you have the means and protocols to monitor firefighters and to provide effective rehydration and cooling. It may also be necessary to provide nutritional support during extended incidents. Caring for the health and safety of firefighters during an incident will not only ensure their ability to work at the current incident but allows the crew to return to service, ready to answer the next alarm. Providing Nutrition during Rehab Firefighters suffer more than 80,000 injuries and nearly 100 line-of-duty deaths each year. Although the risk of morbidity and mortality rises dramatically when performing fire suppression at a non-residential structure, most firefighter injuries occur during fire suppression at single- and two-family homes. More than half of firefighter deaths are due to cardiovascular events, and nearly a quarter of the injuries are attributed to overexertion and strain.(1) The incident commander orders the first-arriving crews to report for rehabilitation while the second alarm crews begin the overhaul.”žEMS has left the scene with the extricated patient, so the crews remove their turnout coats and begin to drink bottled water on their own. The NFPA 1584: Recommended Practice on Rehabilitation for Members Operating at Incident Scene Operations and Training Exercises(2003) is a consensus document outlining recommendations for incident rehabilitation. This document will be beneficial to any organization developing rehab procedures but can be customized to meet the capabilities and needs of your organization and the environment (hot/cold) in which you customarily operate. We maintained the spirit of”žNFPA 1584 in this article, but we’ve supplemented that guideline with recommendations from the sports medicine and exercise physiology literature. Cardiovascular Stress Ã Sweat References Better: Baseline vital signs have been recorded for all emergency personnel and made available to rehab staff both during rest and after a fixed period of aerobic exercise (e.g., standardized one-mile run/walk). This data should be kept with rehab supplies or vehicles, and updated annually. Knowing the individual’s vital signs after exercise without the addition of heat stress allows the rehab officer to make rational decisions about returning a firefighter to the incident.