J Emerg Med
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The US government considers cyanide to be among the most likely agents of chemical terrorism. Cyanide differs from many other biological or chemical agents for which little or no defense is available because its individual and public health effects are largely remediable through appropriate preparedness and response. ⋯ Both of these attributes facilitate the rapid intervention necessary for saving lives. To realize the potential benefits of hydroxocobalamin, progress also needs to be realized in other aspects of readiness, including but not limited to developing plans for ensuring local and regional availability of antidote, educating emergency responders and health care professionals in the recognition and management of cyanide poisoning, and raising public awareness of the potential for a chemical weapons attack and of how to respond.
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This review aims to describe and evaluate current practices and controversies surrounding provision of pain relief in the prehospital setting. The review addresses analgesia indications and contraindications, frequency with which analgesics are used, and factors associated with improved prehospital analgesia care in Emergency Medical Services systems with both physician and non-physician staffing. As part of its evaluation of the state of the art in prehospital pharmacologic treatment of pain, the review will summarize available evidence relevant to the major drugs. Although some situations have been insufficiently studied to allow for definitive data-driven analgesia recommendations, the review will, where possible, include evidence-based recommendations concerning prehospital pain medication.