Going to work in 2030. A commuter gets into a car and turns the key. There is a faint noise of auto parts pumps and compressors. The dashboard comes to life. The motor does not actually turn over, though, until the driver presses on the accelerator. Then the vehicle moves out into heavy traffic.

Looking much like their forerunners from the twentieth-century, cars are moving so quietly that the swish of tires is louder than the purr of their electric motors. No fumes spew from exhaust pipes, just wisps of pure water vapour. No smog spoils the view of the mountains. Environmentally friendly transportation has arrived.

This journey began back in 1975 in Arizona cactus country when Geoffrey Ballard, a 43-year-old Canadian geophysicist, poked his way through a small, unkempt cement-block motel just a short walk from the Mexican border. He was looking for a cheap laboratory in which to pursue his dream of finding an alternative to the petrol-driven internal-combustion engine.

He bought the motel for $1400 and burned the filthy mattresses, but the building still stank, so he persuaded the local fire department to come for a training exercise. Watching their hoses blast the place clean, Ballard thought about the world’s overconsumption of fossil fuels. Reducing it would be tough, but he’d always been tenacious.

In the energy crisis of 1973 he was called to Washington to direct research into energy conservation. His wife, Shelagh, and their three school-age sons stayed in Arizona. For six months he supervised studies of virtually anything that did not depend on oil, coal or petrol. But disillusionment soon set in. Only ideas that promised results within a few years would be funded. On a visit home in early 1974, he told Shelagh that he wanted to return to Arizona and resume his quest for a better energy technology.

Ballard thought battery-powered electric cars were the best energy alternative. A big problem was the weight of lead in storage batteries. Could lithium, the lightest metal, be substituted? He had a friend, Ralph Schwartz, a quirky engineer who had been working with lithium and sulphur dioxide.

Needing an electrochemist, they went to see Keith Prater at the University of Texas at El Paso. Prater said he lacked experience with batteries. “I don’t want someone who knows about batteries,” said Ballard. “They know what won’t work. I want someone willing to try things that others might not.”

Within six months Prater was able to isolate a key ingredient, lithium dithionite. They mixed it in a  beaker with solvents, added copper strips and charged it with electricity. Then they hooked up a torch bulb – and it glowed! Prater was ecstatic. However, a practical battery would take money to develop.

Just at that time an acquaintance was refitting a submarine in Vancouver for oil exploration. Needing a package of instruments designed, he tracked down Ballard, hired him as a consultant and soon agreed to finance a lithium battery.

That’s when Ballard and Schwartz bought the rundown motel in Arizona and started to run experiments. On the weekends, Keith Prater flew in from El Paso, landing his two-seat Piper in an adjacent field. Living on pizza and beer, they worked until exhausted, taking naps on patio furniture, then getting back to the chemistry.

After two years, Schwartz bowed out. Ballard was still committed to alternative energy, but he and Shelagh were feeling the pull of Canada. Prater had met and married a Vancouver woman. So they moved operations to the submarine warehouse in Vancouver.

The project’s backer eventually pulled the financial plug. But his cousin, Horace Koessler, had money. He owned a seaplane and wanted a companion on an Arctic tour. “You will have a month to persuade me to invest in the battery project,” he said. Desperate for financing, Ballard took a flying course.

Their trip was a near disaster. Engine trouble and deteriorating weather forced them down on an isolated pond, and for three days they sat out torrential rains. Radio calls brought no help. Finally, Ballard hung a tarp over the engine, located the problem, straightened a carburetor linkage and got them home. Koessler put up $200,000.

Next, a smoke-detector firm injected money. By now a big, jovial engineer named Paul Howard had joined Ballard. Late on a Friday in 1979 he took a phone call. The smoke-detector firm had filed for bankruptcy, meaning Ballard’s company was now in receivership.

That weekend, Prater, Howard and Ballard agreed to form a new company. Ballard was the eldest by 11 years, with a track record and excellent business contacts, but he offered them equal partnerships. “There’s lots of responsibility to go around,” he said. They rented a small office and called themselves Ballard Research.

For the next four years they scrambled to pay the bills, mainly selling single-use lithium batteries. The rechargeable version worked, but each recharge was weaker than the previous one, like the spring of a watch running down. Then an exciting alternative appeared.

In 1983, the Canadian military wanted a fuel cell with a proton-exchange membrane (PEM) for silent power. A fuel cell is like a battery, but better. It requires no overnight charging. It reverses the familiar secondary-school science experiment in which electricity is put through water to produce hydrogen and oxygen. In a PEM cell, a polymer plastic membrane coated with platinum separates two flat electrodes. Hydrogen flows in on one side, oxygen from the air on the other. They combine to form water and generate electricity without combustion and nasty emissions.

“A fuel cell is electrochemistry,” Prater told colleagues. “It’s right up our alley.” Ballard got the contract and hired a technical team. Engineer David Watkins set up the lab. Danny Epp, a sailor who had worked on the submarine, did most of the day-to-day building. Ken Dircks did the testing. They bought a sample of a costly DuPont membrane developed for the US space programme. But their budget was so tight that Epp scrounged materials from rubbish bins. When he needed to make grooves on the electrode plates to channel the gases, he begged a company that sold trophies to lend him an engraving machine. In three years they had the most powerful PEM cell, for its weight and size, in the world. Watkins set up a display at an international conference in Phoenix. Hardly anyone had heard of Ballard Research, but scientists noticed the impressive results. Soon they were visiting the lab.

In 1987 entrepreneur Michael Brown read an article on fuel cells in his dentist’s surgery. A few weeks later he got a tip about Ballard. Excited by the fuel cell’s promise, he persuaded the Business Development Bank of Canada to join his firm, Ventures West, in a syndicate that raised $880,000.

Progress continued. The Ballard team replaced the DuPont membrane with one from Dow Chemical and left it running. To their amazement, it generated four times the previous power. As they watched, a finger-thick electric cable got so hot that copper strands began to melt and fuse. They yelled and jumped around. With this second, drastic boost in power, the electric car suddenly seemed feasible.

By 1998 Ballard Research needed additional financing. Brown and his partners decided that before they would commit more money, the Ballard founders had to bring in new leadership with more business skills.

Brown introduced them to Firoz Rasul, a 36-year-old engineer who had been marketing vice president of MDI Mobile Data. Recognizing their limitations in the world of megabusiness, Ballard founders gave Rasul an equal share of stocks as well as making him president. Rasul and Brown wrote a new business plan and raised $5 million.

To refine and market the fuel cell would mean enormous growth and at least ten years with no net earnings. Employees increased from 37 in 1989 to over 450 today. The company, now called Ballard Power Systems, changed headquarters. To raise the needed hundreds of millions of dollars, they had to establish annual targets for greater power, improved reliability, reduced cost – and meet them. And they did.

One key advanced, led by polymer specialist Alfred Steck, was a cheaper membrane, the heart of the fuel cell. Mixing novel polymer plastics, Steck’s group spread them to form films, dried them in a “clean room” and put them into cells. The first membranes turned brittle and failed after 300 to 500 hours, not good enough for a commercial vehicle. The “third generation” membrane, however, just kept running. When it passed 1000 hours, they broke out a bottle of champagne. At 5000 hours, another bottle. Then 10,000 hours. More champagne. When Steck had a  shelf of empty bottles, Ballard Power Systems had its own durable, affordable membrane.

By mid-1990 Ballard wanted to put the cell into a small bus to show that it could actually make wheels turn. He had been playing tennis with British Columbia’s Energy Minister Jack Davis, who said, “Give me a ‘green’ photo opportunity for the premier and I will get you the funding.” The province provided $2.7 million of the $4.1-million cost.

They unveiled the project in June 1993 outside Vancouver’s Science World. Premier Mike Harcourt waited with Ballard and the media. Suddenly Paul Howard, who was in charge, got a walkie-talkie call from the bus. “The compressor just stopped.” A small bolt – not part of the cell, but crucial – had broken.

After a stunned moment of horror, Howard orchestrated a comic-opera charade. Six Ballard workers, hidden from view, pushed the bus until it rolled silently down a slight incline towards the podium. Harcourt made a speech, then said, “Now let’s go for a ride.” But the crowd milled around. Reporters asked Howard one question after another. He just kept talking. There were too many people to move the bus safely, so the ruse worked. Harcourt left for another appointment. “Come back this afternoon for a ride,” Howard told reporters. By then the problem was fixed.

Government and motor-company officials began to visit for test runs. Vancouver and Chicago have even put in orders for city buses. Meanwhile, California has passed laws requiring that ten per cent of all cars sold starting in 2003 be zero emission vehicles. Other American states have followed suit, creating a potential market for fuel-cell cars.

Germany’s Daimler-Benz, the first major car company to experiment with a Ballard cell in the late 1980’s, seized the initiative. In 1996 it rolled out a minivan powered by Ballard cells. In a series of multi-million-dollar deals, Daimler-Benz bought a 20-per-cent share of Ballard in 1997, while Ford acquired a 15-per-cent stake the next year. The three firms formed two new joint companies to manufacture and market fuel cells and drive trains for electric vehicles.

“The starting pistol in the race to produce the first fuel-cell car has been fired,” says Juergen Hubbert, head of Daimler’s car division. “A new era in transport is dawning.”

“It’s an astounding leap,” says David Scott, professor of mechanical engineering at Canada’s University of Victoria. “The fuel cell will have an impact on transportation comparable to that of the microchip on communications.”

Ballard can barely keep up with the invitations to speak at universities. He advises students: “Do not be patient. All things do not come to those who wait. Dare to be in a hurry to change things for the better.”

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The As Seen on TV name brand offers a variety of items that can be enjoyed by women from all walks of life. The products are usually advertised on television first through infomercials or 30-second commercial ad slots. As Seen on TV products for women have been around for years, and the name itself has become a novelty. The categories are almost endless for women, and include everything from kitchenware to household appliances and products. Women are finding these products to be helpful in the kitchen, gym, outdoors, and even in the home office.

Let's explore some of the useful products available for women through the As Seen on TV brand.

Kitchen Products for Women

The kitchen is a place most women either love or hate. As Seen on TV products can make cooking and organization in the kitchen easier. For baking, some products women should consider include Batter Pro, Better Baker Gourmet Bowl Maker, Betty Crocker Cake Decorating Kit, Bagel Cutter, Chef's Wizard, and the Ove Glove. For food preparation, products for women include the Ultimate Chopper, Onion Magic, Quick Chop, Power Mixer, and Miracle Blade 3 with the Miracle Blade Block. For kitchen organization and storage, women love these items: Seal It, Pump and Seal Tabs, and Smartware.

Women and Fitness Products

Women also find As Seen on TV exercise products useful for getting into shape. Fitness products such as Ab Chair Deluxe, Ab Chair Elite, Core Sculptor, Taebo Amped, Zone Pilates, and Toning Gel help women enjoy great fitness without ever leaving their home. These products help tone muscle while eliminating some of that unwanted fat. Women will find many As Seen on TV ab machines and should choose the one that's right for them.

For diets, The Weight Loss Cure is an As Seen on TV book helping women lose weight and feel healthier. As Seen on TV products also offer numerous DVDs on weight loss and fitness.

Health and Beauty Products for Women

More and more women are becoming conscientious of their health and wellness. The As Seen on TV name brand has introduced a number of products to promote good health. Some of the more popular items include Back Relief Belt, Blue Relief, Contour Mattress Pad, Contour Secret Pillow, Coral Calcium supplements, Cybersonic Toothbrush, Gel Soles for Women, Ionic Pro Air Purifier, One Step Pedicare, Miracle Rub, Phase 4 Orthotics, PilloRest Pillow, Posture Perfect, and Smoke Away.

Whether women need relief for back pain or neck pain, more calcium through supplements, better foot support, or to quit smoking, there are great products for all these needs and more. Women can also find cosmetics, As Seen on TV hair products and accessories, and skin care products to enhance beauty. Some of these products are Ageless Woman skin cream, Epil Stop Hair Removal Cream, Hairagami Bucci, Teeni Hairdini, and True Ceramic Pro Iron.

There are always new As Seen on TV products for women. These products are usually available online so anyone can easily order them even if they don't watch a lot of television. For years, this has been a trusted name brand among women who enjoy trying new products for the home.

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For active and adventurous kids, buying kids mini trampoline is a great idea to keep them occupied and in one place. But, do you back off from buying trampolines for your kids because you feel that your little tots could get hurt jumping up and down on them? Get a mini trampoline with safety sides on it, so you don't have to be worried about your child's safety. While buying kids mini trampolines, also check out whether it is built to stand your kid's weight, and if it would withstand harsh play.

NewCoolToysOnline.com sells Mini Trampoline with Safety Sides at reasonable prices. The mini trampoline for kids assures safety and protection throughout the play and offers extra comfort too. This mini Jump-O-Lene is a perfect game for kids between three to six years of age.

You can inflate this Mini Trampoline with Safety Sides up to 82" diameter with a regular beach toy inflating pump. To make playtime more fun, the bouncing mattress in this Mini Trampoline with Safety Sides is built with two separate heavy duty vinyl cushions that add extra bounce. This outdoor activity toy has six separate air chambers with double valves and drain holes along the retainer walls.

Two children can perform mini trampoline exercises at a time on this trampoline. Set up the trampoline in the backyard or in your lawn or you could place it in the playroom inside the house also. Since the mini trampoline is compact, you can easily store it at home after use. If you are planning to host parties, the kids mini trampoline can help attract kids, and they can have lots of fun as well. Not only mini trampolines for kids, this online store has a wide collection of outdoor activity toys, backyard water toys, swimming pool toys, and lot more at amazing prices.

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With all the latest success of inflatable beds it seems only reasonable that other common items of furniture found in any home would be exposed to the scrutiny of the clever folk who work in the world of blow up items. Well today there are inflatable sofas or blow up sofas as some folk choose to call them.

An Inflatable sofa is similar to an inflatable mattresses in that all you have to do prior to use is fill them full of air, my advice is to use an electric powered pump for this as they're not that pricey and will fill that blow up sofa in just a few minutes. They can also resemble some of the trendiest pieces of household furniture available, coming in all types of designs and styles, with print designs from many popular cartoon and Disney characters. They also give you the advantage of using them when there is a specific need to do so and putting them away whenever you don't need them any longer.

Blow up sofas are generally used by high school students who live in dormitories, and who have no need for regular furniture. They've also created a bit of a trend among young couples who are in the process of setting up their home and are making use of inflatable sofas as an easy way to save money before they purchase good quality furniture. Campers have also spotted the benefits of owning an inflatable sofa and have begun carrying them to their camps. The most well-known use for inflatable sofas is most likely for kids, the choice of patterns is certainly catering to the younger market and it does provide an extremely cost effective way of furnishing your children's bed room in a design that will most likely make them really happy.

The most significant benefit of an inflatable sofa is the fact that they are inexpensive. You can buy a blow up sofa of excellent quality at about a one fourth of the cost of an typical sofa found in your local shop.

What ever brand you decide to buy, you should make sure that you follow the directions religiously while you inflate it. It has a risk attached that you may end up totally damaging it if you do not inflate it the right way. Also, this sort of damage can automatically terminate the guarantee on the blow up sofa.

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Sofina Inflatable Air Bed Queen Mattress Camping    US $49.99

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This summer may be remembered as the season of contrasts. While we suffered through a marathon of heat, smog and relentless drought, homeowners in the West scrambled to protect their homes and belongings as swollen rivers created historic flooding - washing through farms and residential neighbourhoods alike.

Few Canadian homeowners are properly prepared for floods - whether it's weather-induced, or a break in the home's own water or drainage systems. There's never been a better time to think about flood-preparedness... before water starts to rise in your house.

1. Safety first!

When you have water inside a home, you have a high risk of electrical shock. Where rubber boots and keep children and pets away. Equip yourself with rubber gloves, masks (N95 respirators are recommended) and whatever protective gear you have to work in what will be a contaminated environment.

2. No time to lose.

If the water does come, you'll need to work fast to clean up. Mould sets in quickly, but if you get carpets and furnishings dried within 48 hours, you greatly reduce the risk of serious mould damage.

3. Contact your insurance agent immediately.

Then get out the camera or video recorder and get a photographic record of the damage. Try to get enough detail to demonstrate the extent of the damage. In the case of widespread flooding (usually weather-related), be sure to register your flood-damaged home with your municipality, who may have a plan in place for resources or financial assistance.

4. Start to bail.

You'll need to remove all standing water, as well as any accumulated mud and other debris. If you have a pump, pails, squeegees, and a wet-vac, you'll want them all for this job. Large and small snow shovels can also be helpful for clearing debris.

5. Dispose of any contaminated goods.

Anything that has been touched by sewage, or that has been wet for more than a few days. You can't just throw these at the curb, by the way. Contact your municipality to ask how contaminated items should be discarded. You'll want more plastic bags than you can imagine. Be prepared to rip out wet insulation and drywall, if necessary. In some cases, partial panels can be saved. Don't try to save upholstered furniture, mattresses or bedding that has been touched by sewage.

6. Collect and dry wet belongings.

If items are wet but not contaminated, start gathering them into jumbo plastic totes, and get them outside to air-dry. You can wash them later; the important thing is to get them dry... fast. If you have any valuable papers that have been damaged, toss them into a (working) freezer until you have time to deal with them.

7. Rinse away contamination from the inside of the house.

Start at the top, and work down, removing any dirt or debris clinging to walls or furnishings. Bail the water, then rinse again, repeating the process at least a few times. A wet-vac is worth its weight in gold at this stage.

8. Wash, Wash, Wash!

Wash walls, ceilings and floors with a mild detergent - preferably unscented, as you're dealing with a very large area. For the same reason, bleach is not recommended: fumes are harmful and chemical reactions with organic materials are unpredictable.

9. Get drying! A dehumidifier is good.

Also open doors and windows, and set up fans to circulate the air. You may need professional help to dry carpets quickly.

10. Don't move back into your home until it's safe.

The house should be dry, appliances checked and furnace or AC inspected by a professional. If in doubt, get advice.

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The bed is the centerpiece of any bedroom. Whenever you decide to buy a bed, you have to keep in mind that the bed will be the deciding factor in the overall look of the room. Nowadays, bedroom furniture ranges from simple and traditional to modern and contemporary. Moreover, beds are designed in many different fashions to suit the comfort requirements of the customers. This guide will give a good idea about the various beds available in the furniture stores.

An adjustable bed is the most preferred bed for most people. Since it is comfort that we all look for in a bed, adjustable beds provide that by allowing you to change the bed according to your needs. So if a flat bed keeps you from getting a good night’s sleep, you can change the setting of the bed so that the bed is pulled up or down to meet your requirements. For people sufferings from medical problems like back pains, hernias and varicose veins, these recliners are the perfect choice.

A good choice for campers, air beds are very light and easy to carry. They are easy to inflate with the help of the electronic pumps available in the market. These beds are very comfortable as they distribute the body weight evenly. Also, the air beds do not have dust mites, making them the ideal choice for those allergic to the dust mites.

Children beds are also very popular among the customers. Special beds that cater to the needs of kids are available in the market and are built keeping a child's safety in mind. These beds are also very easy to assemble and dismantle and come in many different colors and themes. Safety rails as well as toy oriented looks make the child beds perfect for the little ones.

Water beds are all the rage these days. In spite of being rather expensive, water beds are finding many takers because of the relaxation they provide to the body and the mind. These beds are unique in that they provide heat flow movement to soothe you and use mattresses made of durable polyester filaments and special foams. You will have to be careful while buying water beds as you do not want them to accidentally burst open. With a little research you can get great water beds that provide the perfect cushion and rest.

Sofa bed is yet another type of modern bedroom furniture. As the name suggests, it can provide dual services of a sofa and a bed. They save valuable space by folding out as a sofa in the day and as a bed at night. Sofa beds are in great demand among the younger shoppers.

Many other types of beds like canopy beds, bunk beds, platform beds and iron beds can be seen in a furniture store. Each of these bed types provides its own features that cater to a specific section of the society. Due to stiff competition, manufacturers keep taking out unique beds. You, thus, have a great selection to choose from provided you know the pros and cons of each type. With the help of this guide, bedroom furniture purchase should be a breeze for you.

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History of paramedicine Early history Throughout the evolution of what we now call paramedicine, there has been an ongoing association with military conflict. One of the first indications of a formal process for managing injured people dates from the Imperial Legions of Rome, where aging Centurions, no longer able to fight, were tasked with organizing the removal of the wounded from the battlefield and providing some form of care.

Such individuals, although not physicians, were probably among the world's earliest surgeons, suturing wounds, completing amputations, and not through training, but by default. This trend would continue throughout the Crusades, with the Knights Hospitallers of the Order of St. John of Jerusalem, known throughout the British Commonwealth today as St. John Ambulance, filling a similar function. The first vehicle that was specifically designed as an ambulance was created during the Napoleonic War, and called the ambulance volante.

Created by Napoleon's Chief Surgeon, Baron Dominique Jean Larrey, this new horse-drawn contrivance was intended to transport the wounded rapidly to surgeons, waiting at the rear.

Such vehicles were seen by the military as a general resource, and care of the wounded was not given much priority; it was not uncommon for such vehicles to be tasked with carrying fresh ammunition to the battlefront, before they transported the wounded back.

The basic design of such vehicles remained unchanged for nearly 100 years. Early civilian ambulance services While communities had organized to deal with the care and transportation of the sick and dying as far back as the plague in London, England (1598, 1665), such arrangements were typically temporary. In time, however, such arrangements began to formalize and become permanent. During the American Civil War, Jonathan Letterman had devised a system of forward first aid stations at the regimental level, where principles of triage were first instituted. Letterman, with the rank of major, served as the medical director of the Army of the Potomac. He established mobile field hospitals to be located at division and corps headquarters. The United States Army had reeled from inefficient treatment of casualties, in part because of the adoption of new firearm technology such as breech-loading rifles and Mini ball systems. Letterman established mobile field hospitals to be located at division and corps headquarters. This was all connected by an efficient ambulance corps, established by Letterman in August 1862, under the control of medical staff instead of the Quartermaster Department.

Letterman also arranged an efficient system for the distribution of medical supplies. His system was adopted by other Union armies and was eventually officially established as the medical procedure for the entirety of the United States' armies by an Act of Congress in March 1864. Following the American Civil War, some veterans began to attempt to apply what had they had seen on the battlefield to their own communities, through the creation of volunteer life-saving squads and ambulance corps. This translation to civilian use did not occur in the same way everywhere; in Britain, early civilian ambulances were often operated by the local hospital or the police, while in some parts of Canada, it was common for the local undertaker (having the only transport in town in which one could lie down) to operate both the local furniture store (making coffins as a sideline) and the local ambulance service. In larger centers in various countries, such services might fall to the local Health Department, the Police, the Fire Department, or some combination of all of the above. Once again, the civilian model followed the lead of the military; although there were a handful of motorized ambulances just prior to the First World War (19141918), the concept of motorized ambulances was proven first on the battlefield, and spread rapidly to civilian systems immediately following the war. There is some debate as to when the first formal training of "ambulance attendants" began. The generally accepted belief is that this occurred in the United States, at Roanoke, Virginia, with the Roanoke Life Saving and First Aid Crew, under Julian Stanley Wise, in 1928. While this may have been true of the U.S., Canadian records indicate the members of the Toronto Police Ambulance Service received a mandatory five days of training, conducted by St. John, as early as 1889 , and well developed printed manuals, clearly beyond the scope of simple first aid, were present in England even earlier. In terms of advanced skills, it is known that, once again, the military led the way. During the Second World War (1939-1945) and the Korean Conflict, battlefield 'medics' were administering painkilling narcotics by injection, as emergency procedures, and 'pharmacists' mates' on warships without physicians were permitted to do even more. Korea also marked the first widespread use of helicopters to evacuate the wounded from forward positions to medical units, coining the phrase 'medevac'. These innovations would not find their way into the civilian sphere for nearly twenty more years. Pre-hospital medicine By the early 1960s experiments in improving care had begun in some civilian centres. The first such experiment involved the provision of pre-hospital cardiac care by physicians in Belfast, Northern Ireland, in 1966 .

This was repeated in Toronto, Canada in 1968, using a single ambulance called Cardiac One, staffed by a regular ambulance crew, plus a hospital intern, who was tasked with performing the advanced procedures. While both of these experiments had certain levels of success, technology had not yet reached the required level (the Toronto 'portable' defibrillator/heart monitor was powered by lead-acid car batteries and weighed nearly 100 lbs.). The required telemetry and miniaturization technologies already existed in the military, and particularly in the space program, but it would take several more years before they found their way to civilian applications. In North America, physicians were judged to be too expensive to be used in the pre-hospital setting, although such initiatives were implemented, and in some cases still operate, in the United Kingdom, Europe, and Latin America. Around 1966 in a published report entitled "Accidental Death and Disability: The Neglected Disease of Modern Society", (known in EMS trade as the White Paper) medical researchers began to reveal, to their astonishment, that soldiers who were seriously wounded on the battlefields of Vietnam had a better survival rate than those individuals who were seriously injured in motor vehicle accidents on California freeways. Early research attributed these differences in outcome to a number of factors, including comprehensive trauma care, rapid transport to designated trauma facilities, and a new type of medical corpsman, one who was trained to perform certain critical advanced medical procedures such as fluid replacement and airway management, which allowed the victim to survive the journey to definitive care. As a result, a series of grand experiments began in the United States. Almost simultaneously, and completely independent from one another, experimental programs began in three U.S. centers; Miami, Florida, Seattle, Washington, and Los Angeles, California, the first of these to go from being an experiment, to being a working unit, was in Los Angeles, with the passage of the Wedsworth-Townsend Act, other states would soon push their own Paramedic bills through, and soon, every fire department in every major city in the country had their own paramedic squads. Each was aimed at determining the effectiveness of using firefighters to perform many of these same advanced medical skills in the pre-hospital setting in the civilian world. Many in the senior administration of the Fire Departments were initially quite opposed to this concept of 'firemen giving needles', and actively resisted and attempted to cancel pilot programs more than once. The public discovers paramedicine In a curious example of 'life imitating art', television producer Robert A. Cinader, working for producer Jack Webb of Dragnet and Adam-12 fame, happened to be in Los Angeles' UCLA Harbor Medical Center, doing background research for a proposed new TV show about doctors, when he happened to encounter these 'firemen who spoke like doctors and worked with them'. This novel idea would eventually evolve into the Emergency! television series, which ran from 1972 to 1977, portraying the exploits of a new group called 'paramedics'. The show captured the imagination of emergency services personnel, the medical community, and the general public. When the show first aired in 1972, there were exactly six paramedic units operating in three pilot programs in the whole of the United States. No one had ever heard the term 'paramedic'; indeed, it is reported that one of the show's actors was initially concerned that the 'para' part of the term might involve jumping out of airplanes. By the time the program ended production in 1977, there were paramedics operating in every state. The show's technical advisor was a pioneer of paramedicine, James O. Page, then a Battalion Chief responsible for the paramedic program, but who would go on to help establish other paramedic programs in the U.S., and to become the founding publisher of the Journal of Emergency Medical Services (JEMS). Evolution and growth Throughout the 1970s and 80s, the field continued to evolve, although in large measure, on a local level. In the broader scheme of things the term 'ambulance service' was replaced by 'emergency medical service' in order to reflect the change from a transportation system to a system which provided actual medical care. The training, knowledge base, and skill sets of both Paramedics and Emergency Medical Technicians (both competed for the job title, and 'EMT-Paramedic' was a common compromise) were typically determined by what local medical directors were comfortable with, what it was felt that the community needed, and what could actually be afforded. There were also tremendous local differences in the amount and type of training required, and how it would be provided. This ranged from in service training in local systems, through community colleges, and ultimately even to universities. In the U.S. the community college training model remains the most common, although university-based paramedic education models continue to evolve. These variations in both educational approaches and standards led to tremendous differences from one location to another, and at its worst, created a situation in which a group of people with 120 hours of training, and another group (in another jurisdiction) with university degrees, were both calling themselves 'paramedics', there were some efforts made to resolve these discrepancies. The National Association of Emergency Medical Technicians (NAEMT) along with National Registry of Emergency Medical Technicians (NREMT) attempted to create a national standard by means of a common licensing examination, but to this day, this has never been universally accepted by U.S. States, and issues of licensing reciprocity for paramedics continue, although if a EMT obtains certification through NREMT (NREMT-P, NREMT-I, NREMT-B), this is accepted by 40 of the 50 states in the United States. This confusion was further complicated by the introduction of complex systems of gradation of certification, reflecting levels of training and skill, but these too were, for the most part, purely local. The only truly common trend that would evolve was the relatively universal acceptance of the term 'Emergency Medical Technician' being used to denote a lower lever of training and skill than a 'Paramedic'. In the UK, Paramedics are being developed further, so a basic qualification of a Paramedic is a foundation degree or diploma at university. Paramedics in the UK can now develop further to "Emergency Care Practitioner" and "Critical Care Practioners", providing extra clinical skills to their patients. During the evolution of paramedicine, a great deal of both curriculum and skill set was in a state of constant flux. Permissible skills evolved in many cases at the local level, and were based upon the preferences of physician advisers and medical directors. Treatments would go in and out of fashion, and sometimes, back in again. The use of certain drugs, Bretylium for example, illustrate this. In some respects, the development seemed almost faddish. Technologies also evolved and changed, and as medical equipment manufacturers quickly learned, the pre-hospital environment was not the same as the hospital environment; equipment standards which worked fine in hospitals could not cope well with the less controlled pre-hospital environment. Physicians began to take more interest in paramedics from a research perspective as well.

By about 1990, most of the 'trendiness' in pre-hospital emergency care had begun to disappear, and was replaced by outcome-based research; the gold standard for the rest of medicine. This research began to drive the evolution of the practice of both paramedics and the emergency physicians who oversaw their work; changes to procedures and protocols began to occur only after significant outcome-based research demonstrated their need. Such changes affected everything from simple procedures, such as CPR, to changes in drug protocols. As the profession of paramedicine grew, some of its members actually went on to become not just research participants, but researchers in their own right, with their own projects and journal publications. Changes in procedures also included the manner in which the work of paramedics was overseen and managed. In the earliest days of the field, medical control and oversight was direct and immediate, with paramedics calling into a local hospital and receiving orders for every individual procedure or drug. This still occurs in some jurisdictions, but is becoming very rare. As physicians began to build a bond of trust with paramedics, and experience in working with them, their confidence levels also rose. Increasingly, in many jurisdictions day to day operations moved from direct and immediate medical control to pre-written protocols or 'standing orders', with the paramedic typically only calling in for direction after the options in the standing orders had been exhausted. Medical oversight became driven more by chart review or rounds, than by step by step control during each call. Evolution in other jurisdictions In other places, the evolution of paramedicine occurred somewhat differently. In Canada, for example, there was an early, but unsuccessful attempt to introduce paramedicine. In 1972, a pilot paramedic training program occurred at Queen's University, located in Kingston, Ontario. The program, intended to upgrade the mandatory 160 hours of training then required for 'ambulance attendants', was found to be too costly and premature. While the program operated for two years and produced a number of graduates, it would be more than a decade before the legislative authority for them to practice was put into place. The program then moved in another direction, providing 1,400 hours of training at the community college level, prior to commencing employment. This change was made mandatory in 1977, with formal certification examinations being introduced for the first time in 1978. Similar, but not identical, programs occurred at roughly the same time in the Province of Alberta, and in British Columbia, through its Justice Institute. Other Canadian provinces gradually followed, but with their own education and certification requirements. Advanced Care Paramedics were not introduced until 1984, when Toronto trained its first group internally, and the process continued to spread across the country.

The current model in Ontario calls for a two year community college based program, including both hospital and field clinical components, prior to designation as a Primary Care Paramedic, although this is gradually evolving in the direction of a university degree-based program. Some services, such as Toronto EMS, continue to train paramedics internally (indeed, Toronto EMS is accredited in its own right by the Canadian Medical Association as an Advanced Care Paramedic training academy). In the United Kingdom, ambulance services became largely municipal services, with some exceptions, shortly after the end of World War Two. Training was frequently conducted internally, although national levels of coordination led to better standardization of staff training. All public ambulance services are currently operated by regional entities, most often 'trusts', under the authority of the National Health Service. Tremendous standardization of training and permitted skills has also occurred. The UK model utilizes, two levels of ambulance staff. The first of these is 'Ambulance Technician'. This role is not a paramedic, but more closely corresponds to the EMT role in the United States. Most services train these individuals internally, using a common curriculum. The second role is that of 'Paramedic'. These are practitioners of advanced life support skills, similar to U.S. paramedics. Initially, many of these individuals were trained internally by the services that employed them, with the step to Paramedic being a logical career path progression for an experienced Ambulance Technician. Increasingly, this trend has moved toward training in the University system, with the entry level for Paramedics being an Honours Bachelor of Science degree in Pre-Hospital or Paramedic Care. Some British Paramedics have been further elevated, into the role of Paramedic Practitioner, a role that practices independently in the pre-hospital environment, in a capacity similar to that of a nurse practitioner, but with more of an acute care orientation. Some Paramedic Practitioners in the U.K. hold M.Sc. degrees. The growth of a new profession Today, the field of para medicine continues to grow and evolve into a formal profession in its own right, complete with its own standards and body of knowledge. What began as a concept of simple 'technicians' with a couple of weeks of training, performing procedures that they didn't fully understand, has evolved into a career that in many cases (U.K., South Africa, Australia and increasingly the U.S. and Canada), requires a university education, and which is, in some locations actually evolving into a second tier medical practitioner. In many places, the practice of paramedics began as an extension of the supervising physician's license to practice medicine. As such, they were absolutely subject to every condition that the physician placed on their practice. More recently, however, paramedics in both the U.K. and some Canadian provinces have been granted the legal status of self-regulated health professions. When this occurs, the individual paramedics are certified and licensed by a College of Para medicine, created by legislation but run by the paramedics themselves. This body sets standards, conducts licensing exams, deals with complaints regarding individual practitioners, and consults the government with respect to legislation, policy, and regulations. Paramedics are governing and regulating themselves; the true measure of a profession. In the U.S., paramedics are subject to regulation by individual states, and the degree and type of regulation, as well as paramedic participation in that process, varies from state to state. Places of work Paramedics are employed by a variety of different organizations, and the services provided by paramedics may occur under differing organizational structures, depending on the part of the world. In the United States, a paramedic can be employed by government agencies such as the Parks Service or the Coast Guard. They may also be employed as part of a public hospital system; in some cases working inside the hospital. They are most commonly employed as part of a municipal Emergency Medical Service, which may be free-standing "Third Service" (municipal department operating independently of other emergency services) option, or a part of some other public safety agency, such as a fire, police, or the health department. Paramedics may also be employed by private companies, some of which may have contractual emergency service provision commitments to local municipalities, corporations, mines, air ambulances, or racetracks or entertainment venues. Paramedics may also work on a volunteer basis, receiving no monetary compensation for their services (i.e. Volunteer Rescue Squad / Volunteer Fire Department and community response units). Another newly emerging field in the world of Emergency Medical Service is the role of Tactical Medics. Whose responsibility lies with providing care to injured and wounded SWAT officers in austere and extremely hazardous environments while under enemy fire. Highly specialized training is required to be known as an Emergency Medical Technician - Tactical. This career field is open to both basic and advanced level providers. In the UK, paramedics are typically employed by ambulance services, as a part of the National Health Service Trust system. An NHS Trust is, in effect, a type of public sector corporation, and most NHS health services, including both primary care and hospitals, are organized in this fashion. Service organization occurs regionally, with Ambulance Service Trusts typically covering several local Counties, and with 12 such Trusts currently providing coverage for the entire country. Ambulance Service in Wales operates on a similar system, while the Scottish Ambulance Service and Northern Ireland Ambulance Service are single entities provided by the Health Departments of their respective federal governments. Additional coverage, particularly for special events, may be provided by Voluntary Ambulance Services, including the British Red Cross and St. John Ambulance, or by private companies, but neither of these typically uses fully qualified paramedics. In Canada, paramedics are employed almost exclusively by publicly operated EMS systems. The manner in which such systems are organized and funded varies somewhat from province to province. The British Columbia Ambulance Service is organized as a branch of the provincial government, with that government providing services directly through a branch of the Ministry of Health. In Ontario, the provision of EMS has been allocated to Upper-tier municipalities (like U.S. Counties). Each of these provides its own EMS, and is free to operate the service directly as third service or, in rare cases, as a branch of the fire department, or to contract those services to a private business entity or a local hospital. In all of these cases, the provincial government accredits the services, and provides operating standards and some funding. In the Maritime Provinces the provincial governments have entered into long term contractual arrangements with a single private company for the operation of their EMS systems. Other Canadian provinces use still other approaches to the provision of service and the operating environment in which paramedics will work. In Australia, paramedics work exclusively for the State Ambulance Service, including Ambulance Victoria service (http://www.ambulance.vic.gov.au/), among others. Public ambulance services in Australia are exclusively third-service option. These services are operated directly by each of the states and territories. A separate service is provided for the Australian Capital Territory. Unlike the U.S., Australian paramedics are not typically employed in hospitals or the fire brigade. While there are a handful of private ambulance companies operating in Australia, these do not typically provide what would normally be described as 'paramedic' levels of service. In some centers, some paramedics have begun to specialize their practice. This specialization frequently is to some degree tied to the environment in which the paramedic will work. One of the earliest examples of this involved aviation medicine, and the use of helicopters. Another was the transfer of critical care patients between facilities.

While some jurisdictions still use physicians, nurses and technicians for this purpose, increasingly, this role falls to specially-trained, very senior and experienced paramedics, who perform this role as their primary job function. Other areas of specialization include such roles as tactical paramedics working in police tactical units, marine paramedics, hazardous materials (Hazmat) teams, and Heavy Urban Search and Rescue. Still others work in physical isolation, on offshore oil platforms, oil and mineral exploration teams, and in the military. In some cases, one can even find paramedics working on cruise ships. A new and evolving role for paramedics involves the expansion of their practice into the provision of relatively simple primary health care and assessment services. Examples of skills performed by paramedics Skills by certification level Although there is a great deal of variation in what paramedics are trained and permitted to do from region to region, some skills performed by paramedics include: Treatment issue Common technician skills Paramedic/advanced technician skills Advanced paramedic skills Airway management Manual and repositioning, Oro- and nasopharyngeal airway adjuncts, manual removal of obstructions, suctioning endotracheal intubation (in some cases, naso as well), advanced airway management, ETT, LMA, ETOA, and combitube, deep suctioning, use of Magill forceps Rapid sequence induction, surgical airways (including needle cricothyrotomy and others) Breathing Initial assessment (rate, effort, symmetry, skin color), obstructed airway maneuver, passive oxygen administration by nasal canula, rebreathing and non-rebreathing mask, active oxygen administration by Bag-Valve-Mask (BVM) device. pulse oximetry, active oxygen administration by endotracheal tube or other device using BVM Use of mechanical transport ventilators, active oxygen administration by surgical airway, decompression of chest cavity using needle/valve device (needle thoracostomy) Circulation Assessment of pulse (rate, rhythm, volume), blood pressure and capillary refill, patient positioning to enhance circulation, recognition and control of hemorrhage of all types using direct and indirect pressure and tourniquets Ability to interpret assessment findings in terms of levels of perfusion, intravenous fluid replacement, vasoconstricting drugs intravenous plasma volume expanders, blood transfusion, intraosseous (IO) cannulation (placement of needle into marrow space of a large bone), central venous access (central venous catheter by way of external jugular or subclavian) Cardiac arrest Cardiopulmonary resuscitation, airway management, manual ventilation with BVM, automatic external defibrillator Dynamic resuscitation including intubation, drug administration (includes anti-arrhythmics), ECG interpretation (may be limited to Lead II) Semi-automatic or manual defibrillator Expanded drug therapy options, ECG interpretation (12 Lead), manual defibrillator, synchronized mechanical or chemical cardioversion, external pacing of the heart Cardiac Monitoring Cardiac monitoring and interpretation of ECGs 12-lead ECG monitoring and interpretation 18-lead ECG monitoring and interpretation Drug administration Limited oral, limited aerosol, limited injection (usually IM) Intramuscular, subcutaneous, intravenous injection (bolus), IV drip per ETT, per rectal tube, per infusion pump Drug types permitted Low-risk/immediate requirements (e.g. ASA (chest pain), nitroglycerin (chest pain), oral glucose (diabetes), glucagon (diabetes), epinephrine (Allergic Reaction), ventolin (Asthma)). Note: Some jurisdictions also permit naloxone (Narcotic Overdose), nitrous oxide (for pain); considerable variation by jurisdiction Considerable expansion of permitted drugs, but still typically limited to about 20, including analgesics (narcotic or otherwise) (for pain), antiarrhythmics (irregularities in heartbeat), major cardiac resuscitation drugs, bronchodilators (for breathing), vasoconstrictors (to improve circulation), sedatives Dramatically expanded (up to 60) drug list, Note: In some jurisdictions advanced levels of paramedics are permitted to administer any drug, as long as they are familiar with it. Note: In some jurisdictions certain types of advanced paramedics have limited authority to prescribe. Patient assessment Basic physical assessment, 'vital' signs, history of general and current condition More detailed physical assessment and history, auscultation, interpretation of assessment findings, ECG interpretation, glucometry, capnography, pulse oximetry Interpretation of lab results, interpretation of chest x-rays, interpretation of cranial CT scan, limited diagnosis (e.g. rule out fracture using Ottawa ankle rules) Wound management Assessment, control of bleeding, application of pressure dressings and other types of dressings Wound cleansing, wound closure with Steri-strips, suturing Skills common to all EMTs and paramedics Spinal injury management, including immobilization and safe transport. Fracture management, including assessment, splinting, and use of traction splints where appropriate. Obstetrics, assessment, assisting with uncomplicated childbirth, recognition of and procedures for obstetrical emergencies, such as breech presentation, cord presentation, placental abruption. Management of burns, including classification, estimate of surface area, recognition of more serious burns, and treatment. Assessment and evaluation of general incident scene safety. Effective verbal and written reporting skills (charting). Routine medical equipment maintenance procedures. Routine radio operating procedures. Triage of patients in a mass casualty incident. Emergency vehicle operation. Medications administered Paramedics in most jurisdictions administer a variety of emergency medications. The specific medications vary widely, based on physician medical director preference, local standard of care, and law, but may include: Adenosine, which will stop the heart for a short period of time (up to 45 seconds) Atropine, which will speed up a heartbeat that is too slow. Sympathomimetics like dopamine for severe hypotension (low blood pressure) and cardiogenic shock. D50W (Dextrose 50%) to treat hypoglycemia (low blood sugar) Sedatives like Versed, Ativan, or Etomidate, and paralytics such as succinylcholine, rocuronium, or vecuronium to perform rapid sequence induction (RSI), a procedure to quickly induce anesthesia prior to intubation Antipsychotics like Haldol or Geodon to sedate combative patients Albuterol, atrovent, and methylprednisolone to treat respiratory conditions. Medications to relieve pain or decrease nausea and vomiting. Nitroglycerin, aspirin, and morphine sulfate for cardiac ailments. Antiarrhythmics like amiodarone to treat cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation. Narcotics like morphine sulfate, pethidine, fentanyl and in some jurisdictions, ketorolac to treat severe pain, i.e. burns or fractures. This list is not representative of all jurisdictions, and EMS jurisdictions may vary greatly in what is permitted. Some jurisdictions may not permit administration of certain classes of drugs, or may use drugs other than the ones listed for the same purposes. For an accurate description of permitted drugs or procedures in a given location, it is necessary to contact that jurisdiction directly. The material included here is, however, fairly typical and representative. Different qualification levels across the world Australia Main article: Paramedics in Australia Paramedics of the A.C.T. Ambulance Service In Australia, the Paramedic Practitioner is a health care professional who responds to and treats all types of medical and trauma emergencies outside of a hospital setting before and during transportation to an appropriate medical facility. Paramedics also work in the inter-facility transport environment where a paramedic will continue or upgrade medical care to a higher level while transporting a patient from one health care facility to another. Under normal circumstances, paramedics transport patients to a hospital-based emergency department, however, this is not their only option. When it is clinically appropriate to do so, paramedics can also choose to treat patients requiring simple primary care or procedures in the out of the hospital setting, without the need to transport the patient to a hospital (e.g. a paramedic gives a diabetic patient 50% dextrose in water). In Australia use of the professional title Paramedic is not restricted, registered or licensed. Prior to the 1990s most Paramedics had the professional title of Ambulance Officer. Recently there are various new professional titles depending on which state Ambulance Service you are employed by. Some titles include Paramedic, Paramedic Intern, Paramedic Specialist, Clinician, MICA Paramedic, Intensive Care Paramedic. Academia and publications relating to the profession in Australia are using the nomenclature Paramedic Practitioner. Paramedic education depends on the entry requirements for employment by the state based Ambulance Service. Ambulance Victoria, SA Ambulance Service, Ambulance Service of NSW have Graduate entry programs.

Students will undertake a three year pre-employment Bachelor degree in Health Science specializing as a Paramedic Practitioner. The degree title varies from each University. The Universities offering programs include Australian Catholic University Monash University, Victoria University, Flinders University, Charles Sturt University and Edith Cowan. On completion Students can apply for employment with their respective state Ambulance Service. After successfully meeting the entry requirements for employment the Student Paramedic will complete a twelve or twenty four month internship. Upon completion of the internship Students attain certification to practice as a Paramedic. The Paramedic Practitioner can then advance clinical status to Intensive Care Practitioner, or undertake specialised education and training in other fields for example rescue, aeromedicine. Another method is to apply for employment directly to the state Ambulance Service and undergo an internal Diploma of Health science program. This program will generally take up to three years to complete with the respective employer. The Ambulance Service of New South Wales and Queensland Ambulance Service offer this entry pathway. The Graduate pre-employment entry model is becoming popular, and there is a move by the Australian profession to continue this pathway. Canada Main article: Paramedics in Canada Toronto EMS Ambulance BC Ambulance ALS Unit In most of Canada there are 3 levels of Paramedics: the Primary Care Paramedic with limited pharmaceutical protocols, the Advanced Care Paramedic with full ACLS qualification, and the Critical Care Transport Paramedic with very advanced qualifications. Several variations to this system occur in the City of Toronto and the province of Saskatchewan, which uses a four level model with Level I (Primary Care), Level II (Intermediate Care), Level III (Advanced Care) and Critical Care Transport Paramedics. It should also be noted that many Canadian jurisdictions do not use multiple levels of paramedics. There are many smaller and isolated communities which, for reasons of potential skills decay, medical control issues, or costs, operate with Primary Care Paramedics only. In Canada, paramedics provide the most advanced level of emergency medical care available to the general public outside of a hospital setting. Advanced Care and Critical Care Paramedics are able to perform more delegated medical acts than any other health professional besides physicians in the pre-hospital setting. In a number of Canadian centres, paramedics are currently using a 12-Lead ECG to diagnose ST-Elevated Myocardial Infarction (STEMI), a specific type of heart attack. The experience of paramedics from the City of Ottawa with the use of this procedure was recently a topic of an article in the New England Journal of Medicine. Ottawa paramedics were the first paramedic service in Canada to have this STEMI protocol, which is now being implemented across the world, available to treat their patients. Colombia All health practitioners in the Republic of Colombia are regulated by a standards for Law 1164 of Human Resources in Health, the Confederation of Organizations of Health Professionals (ASSOSALUD). Colombia has the following levels of training in prehospital care (paramedicine): 1. Technological level in Prehospital Care Coordinates prehospital care and provides advanced life support. 2. Technical Level Training in Prehospital Care Assists paramedics of the technological level and provides basic life support. 3. First Responder Assists other levels and provides community level first aid. Additionally, a Prehospital Care Professional level is being developed above the technological level of prehospital care. The only institutions in the country to obtain prehospital care qualifications: University of Valle University Ces University of Antioquia University Tecnologica of Pereira Europe In many parts of Europe a different paradigm is used for pre-hospital care, in which doctors, nurses and occasionally medical students function as pre-hospital providers, either in conjunction with or instead of paramedics. The following are two fairly representative examples illustrating the differing approach to the idea of paramedics in Europe. France Main article: Paramedics in France Paramedics, as we understand the role, do not exist in France. Within France, EMS is provided by means of an organization called a SAMU for each French Departement (county). Emergency response may be through the use of a fire department-based ambulance, such as the Paris Fire Department (www.pompiersparis.fr), or by an ambulance (labeled SAMU)staffed by a physician-led team (SMUR). The French philosophy is to provide more definitive care at the scene during life-threatening emergencies, and a SMUR team, consisting of a physician, a nurse, and an ambulance driver, may elect to conduct the majority of care, even resusctitation attempts, at the scene, prior to transport. SMUR teams are typically hospital-based. Since 1986, fire department-based ambulances have had the option of providing resuscitation service (reanimation) using specially-trained nurses, operating on protocols, in the role that we would normally expect to be performed by the paramedic. In actual practise, however, such units, and nurses, are extremely rare outside of the City of Paris. In France non-emergency and low-priority ambulance services are normally provided by private companies, with no formal requirements for the training of their staff. Germany Main article: Paramedics in Germany German Emergency Ambulance In Germany, the closest role to that of paramedic is called Rettungsassistent. Although there are others working in EMS in Germany, this is considered to be the only professional role, and the training of subordinate staff can vary greatly - the most common next level would be Rettungssanitter with a three months training (1 month theory, 1 month hospital training, 1 month practice on EMS) based on an agreement between all German states (Lnder). In spite of this agreement with a lot of possible local specific differences, the professional title of Rettungsassistent is regulated and protected by federal law. According to that, a Rettungsassistent is required to complete two years of training, the first consisting of theory classes at the post-secondary level, and hospital-based clinical experience. The second year consists of a 1,600 hour EMS-based preceptorship. At the conclusion of this training the Rettungsassistent will have an advanced life support skill set which is roughly similar to that of paramedics in many other countries, and will function as the crew chief on an emergency ambulance. Other possible professional roles are EMS leader on scene, emergency dispatcher, shift or group leader, supervisor/trainer and EMS chief. One important difference, however, involves the manner in which EMS operates in Germany. In the German system it is much more common for emergency physicians (called Notarzt) to respond directly to high priority emergency calls. A Notarzt is a physician with additional training; although no specific medical specialty is required, the majority are anesthesists. But in more than 50% of all emergency calls only an ambulance with at least one Rettungsassistent responds. The role of the Rettungsassistent therefore is to be the responsible care provider and team leader of an ambulance crew as to assist the Notarzt in the treatment of the patient; they may perform most of their advanced life support skills only under the direct supervision of the Notarzt. In exceptional circumstances, when there is an immediate threat to life, and when the Notarzt is not present, the Rettungassistent must be able to unilaterally perform all of their ALS skills. Not doing so places them in violation of federal German legislation (Handeln durch Unterlassen). It is common practice that the Rettungsassistent utilizes his skills while the emergency physician is on route to the patient, this is often covered by local medical protocols and guidelines. If the Rettungsassistent has to act as a sole care provider under these circumstances, federal law in Germany will normally provide the Rettungassistent with legal protection. (32,35 StGB). Hong Kong a type of Ambulance of the Fire Services Department, Hong Kong Hong Kong is currently progressing toward a system staffed with paramedics. Different from United Kingdom and Australia,ambulance service is run by the Fire Services Department, Hong Kong. St. John Ambulance in Hong Kong A charitable organization with a long history stretching back over a century and has been serving the community since 1884. In Hong Kong, the St. John Ambulance Association was established in 1884.It provides ambulance service,first aid and caring training course. Auxiliary Medical Service An independent government department that trained, committed voluntary medical and health services provider in Hong Kong. Its mission is to supply effectively and efficiently regular services. South Africa Main article: Emergency medical services in South Africa All health practitioners in The Republic of South Africa are regulated by a standards generating body (SGB), the Health Professions Council of South Africa (HPCSA). The Department of Education has initiated the phasing out of short course training. This is to be replaced with a mid-level worker, and a prehospital clinician. The mid-level course is 2 years in duration, and exits on a level just above what many know as Intermediate Life Support (ILS), but below Advanced Life Support (ALS). They are placed on the Emergency Care Technician (ECT) register. The clinician qualification is a four year professional degree in Emergency Medical Care (Bachelor Emergency Medical Care), and is placed on the Emergency Care Practitioner (ECP) register, which has a separate protocol list. The only four institutions in the country to obtain the ECP qualification are the: University of Johannesburg Central University of Technology Durban University of Technology Cape Peninsula University of Technology United States Main article: Paramedics in the United States A typical Paramedic/Rescue Unit of Palm Beach County Fire-Rescue in Palm Beach County, Florida. In the United States, there are 4 levels of emergency prehospital care defined by the U.S. Department of Transportation, which regulates prehospital emergency care education federally. From the most basic level to the most advanced, they are Medical First Responder, Emergency Medical Technician-Basic (EMT-B), Emergency Medical Technician-Intermediate (EMT-I), and Emergency Medical Technician-Paramedic (EMT-P). The paramedic is the most advanced level of in the field medical care provider.; however, in order to avoid confusion about the level of care, in practice the term "EMT" usually refers to Emergency Medical Technician-Basic and Intermediate level certifications. Official paramedic insignias and laws that designate level of care have codified this custom in many places. In the United States, paramedics working under the direction of emergency medical control physicians provide the most advanced level of emergency medical care available to the general public outside of a hospital setting. Exceptions to this general statement include those physicians who sometimes operate with air ambulance services, and some jurisdictions with specially trained Critical Care Paramedics for inter-hospital critical care transfers. Medicolegal authority Paramedics normally function under the authority (medical direction) of one or more physicians charged with legally establishing the emergency medical directives for a particular region. Paramedics are credentialed and authorized by these physicians to use their own clinical judgment and diagnostic tools to identify medical emergencies and to administer the appropriate treatment, including drugs that would normally require a physician order. Credentialing may occur as the result of a State Medical Board examination (U.S.) or the National Registry of Emergency Medical Technicians (U.S.). In the UK, and in some parts of Canada, credentialing may occur by means of a College of Paramedicine (http://www.britishparamedic.org/). In these cases, paramedics are regarded as a self-regulating health profession. The final common method of credentialing is through certification by a Medical Director and permission to practice as an extension of the Medical Director's license to practice medicine. The authority to practice in this semi-autonomous manner is granted in the form of standing order protocols (off-line medical control) and in some cases direct physician consultation via phone or radio (on-line medical control). Under this paradigm, paramedics effectively assume the role of out-of-hospital field agents to regional emergency physicians, with independent clinical decision-making authority that is typically enjoyed only by expert clinicians within the hospital setting. In some parts of Europe, those in the paramedic role are only permitted to practice many of their advanced skills while assisting a physician who is physically present, except in cases of immediately life-threatening emergencies. In certain other jurisdictions, such as the United Kingdom and South Africa, paramedics may be entirely autonomous practitioners capable of prescribing medications. In the media The 1970s television show Emergency! was a very popular series which centered on the work of paramedics in the Los Angeles County Fire Department, and the staff at the fictional Rampart Emergency Hospital. Emergency! has been widely credited with inspiring many municipalities in the United States to develop their own paramedic programs, and has inspired many to enter the fields of emergency medicine.[citation needed] The show was a top-rated program for its entire production run (19721979), as well as in syndicated television reruns even inspiring a Saturday morning cartoon series. Mother, Jugs & Speed is a 1976 comedy film, starring Bill Cosby, Raquel Welch, and Harvey Keitel. The film depicts a private ambulance company struggling to survive in Los Angeles, and, while not necessarily showing the profession in its most flattering light and taking some real liberties for comedic value, provides a fairly honest illustration of the state of the ambulance industry just prior to its professionalization as EMS. Casualty is a long-running BBC television series, depicting the staff of the Accident and Emergency Department of the fictional Holby City Hospital, and the English paramedics who work with them. It provides an interesting, human, and realistic view of English paramedics.[citation needed] The show has been filmed on location in Bristol, England, and has run continuously since the mid 1980s, spinning off another series, Holby City, and a number of made-for-television films. It has been described as 'one of Britain's most beloved medical dramas'. Paramedics is also the name of a show on the Discovery Health Channel, which details the life and work of emergency medical squads in major urban centers in the United States. It is also the name of a 1988 comedy which highlighted the lighter side of EMS. Paramedic: On the Front Lines of Medicine (1998), by Peter Canning, is an autobiographical account of a paramedic's first year on the job. Rescue 471: A Paramedic's Stories (2000) is the sequel. Bringing Out the Dead (1999), directed by Martin Scorsese and starring Nicolas Cage, is one of very few films about paramedics. The main character is paramedic Frank Pierce, who works in New York's Hell's Kitchen. He's become burned out and haunted by visions of the people he's failed to save including a little girl. The film is based on the novel of the same name by Joe Connelly, a former New York City paramedic. Into the Breach: A Year of Life and Death with EMS (2002), book written by J.A. Karam, is the true story of paramedics, emergency medical technicians, and heavy-rescue specialists fighting to control trauma and medical emergencies. Parts of Third Watch (1999) were devoted to adventures of the fictional 55th precinct FDNY EMS unit, created by ER executive producer John Wells. Saved (2006) is a TNT series centered on fictional paramedic Wyatt Cole (Tom Everett Scott), his partner, and their chaotic lives on and off the job. Black Flies (2008) is a novel written by Shannon Burke, based on his experiences working as a paramedic in Harlem, New York City. Trauma (2009) portraits a group of San Francisco Fire Department paramedics and EMT's and a fictional medical helicopter transport service "Angel Rescue Services", working in concert with of the fictional trauma center San Francisco City Hospital. The high-action medical drama stars Derek Luke, Cliff Curtis, Anastasia Griffith, Kevin Rankin, Aimee Garcia, Billy Lush, Jamey Sheridan, and Taylor Kinney. See also Emergency medical services in South Africa Paramedics in Australia Paramedics in Canada Paramedics in France Paramedics in Germany Paramedics in the United States Paramedics in the United Kingdom Paramedics in Colombian Colombian Association of Prehospital Care Technologist National Association of Emergency Medical Technicians National Registry of Emergency Medical Technicians Flight Paramedic Critical Care Emergency Medical Transport Program lksjdb References ^ Careers: Paramedic science - Faculty of Health and Social Care Sciences, Kingston University London and St George's, University of London ^ National Reregistration and the Continuing Competence of EMT-Paramedics DOT HS 810 577 ^ Brouhard, Rod. "The difference between and EMT and a Paramedic". About.com. http://firstaid.about.com/od/emergencymedicalservices/qt/06_EMTBvsP.htm. Retrieved 2008-07-26.  ^ http://www.etymonline.com/index.php?term=paramedic ^ Toronto EMS Website ^ Br Heart J 1986;56:491-5 ^ Le May, M. R. et al. (2008-01-17). "A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction". New England Journal of Medicine. pp. 358(3):231-40.. http://content.nejm.org/cgi/content/short/358/3/231. Retrieved 2008-03-27.  ^ Harlan M. Krumholz, MD, SM (January 16, 2008). "Reducing Door-to-Balloon Times: The Transfer Factor". Journal Watch. http://cardiology.jwatch.org/cgi/content/full/2008/116/1. Retrieved 2008-03-27.  ^ {{cite web |url=http://www.acotaph.org/Dedinicion de Atencion Prehospitalaria.pdf |title=Prehospital Care; Paramedic. ^ http://sunzi1.lib.hku.hk/hkjo/view/22/2200010.pdf American Heart Association (January 2006) Meisel, Zachary (2005-11-08). "Ding-a-Ling-a-Ling Ambulances can be dangerous places.". Slate. Washington Post. Newsweek Interactive Co. LLC. http://www.slate.com/id/2129684/. Retrieved 2007-01-25.  "Tribute to R Adams Cowley, M.D.". University of Maryland Medical Center. http://www.umm.edu/shocktrauma/history.html. Retrieved 2005-12-30.  US DOT "National Scope of Practice Model". National Highway Traffic Safety Administration. http://nhtsa.gov/staticfiles/DOT/NHTSA/Communication & Consumer Information/Articles/Associated Files/EMSScope.pdf. Retrieved 2007-04-16.  External links Wikimedia Commons has media related to: Paramedic National Registry of Emergency Medical Technicians National Association of Emergency Medical Technicians Colombian Association of Prehospital Care Technologist NHTSA Emergency Medical Services National Page v  d  e Emergency medical services Paramedicine  Basic life support  Advanced life support People Emergency medical dispatcher (EMD)  Certified first responder (CFR)  Emergency medical responder (EMR)  Emergency medical technician (EMT)  Paramedic  Medical director  Combat medic Vehicles Air ambulance  Ambulance (History)  Ambulance bus  Boat ambulance  Combination car  Fly-car  Light horse field ambulance  Dodge WC54 Casualty lifting & movement Gurney  Kendrick Extrication Device  Litter  Long spine board  Scoop stretcher  Stretcher  Vacuum mattress  Weevac 6 Other Ambulance station  Rescue squad  Search and rescue Related fields Emergency medicine  Aviation medicine  Diving medicine  Military medicine  Wilderness medicine Categories: Emergency medical responders | Healthcare occupations | Protective service occupationsHidden categories: All articles with unsourced statements | Articles with unsourced statements from November 2009

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The first time I visited Bombay (now Mumbai) was when I was 8 years old. I went to visit my aunt who lived in Dadar. She lived in one of the well to do multi storied apartment complex. I was born and brought up in Hyderabad. Such big multi storied apartment complex was a rare sight during that period in Hyderabad. Everything I saw in Mumbai surprised me a lot. Big apartment complexes, local trains, taxis, overhead bridges, shoe park, children museum, never ending list. 

Out of this big list of experiences which amazed me, one experience which stood apart from others was the slum area. The bedroom I was sharing with my aunt in that apartment on the 9th floor had a big balcony with an overview to the slum area in the neighborhood. That was the first time that I was looking at a slum area with such close proximity. Even today I don't know why but that slum area used to pull my attention more than anything else when strolling or relaxing in the balcony. I used to watch the kids there a lot. They appeared to be happy souls screaming and running around and play until the last drop of energy is exhausted. Have food in open ground and sleep under the stars (It was summer time when I visited). Maybe since I was a kid, it must have caught my attention as a different world of freedom where there is no homework, no school, no exams and just play and play though I remember feeling bad seeing there unclean sometimes torn clothes. The slum area then was like cluster of individual huts I used to see in Hyderabad but with better roofs. 

Days passed and almost after 20 years destiny brought me again to Mumbai as a married lady but this time for staying there and not visiting.  I and my husband used to travel daily in car to our work place from Navi Mumbai to Andheri. On the way we used to pass Powai Lake. This was a very posh locality with all the sophisticated buildings and shopping centers on one side and the beautiful Powai Lake on the other side. Immediately after crossing this area, we used to pass through a stretch of nearly a mile which was slum area on both the sides. This again re-kindled my childhood memories and as I kept watching this slum area daily in the morning and evening, slowly this started to fascinate me a lot more on there life style. Being a vivid observer of nature, buildings and anything I come across while traveling, this slum area grabbed by special attention because of the life style of this slum area residents. 

The road passing through this slum area always had traffic jam. This gave me more time to peek into this slum area more intimately. The houses here were something like real size match boxes. Most of the residents here used the small space in front of there houses as part of there house space. Because of this most of the time the door was open and gave me closer look of the things inside. As I started observing the furniture and other electronics in these houses, I did not find much difference from what a middle class family has. They have a TV, refrigerator, double cot bed, dresser, air cooler, grinder, two-wheeler for commute etc. These are more than minimum necessity for a living. The difference may be in the brand they use. But as long as you get good sleep what difference it makes if it is a costly branded mattress or a local mattress. And yes, I agree that the woman have to get water from the public pumps or fill their big tanks/tumblers when the water tank comes in. But most of the apartment complexes are no exception to water problem in metro cities. 

And if we dwell into their daily routine it was not much different from what a common middle class family does. Everyday I used to see most of the ladies getting ready to go to work. One lady putting lipstick, the other tying her hair very elegantly and putting clip to it and the other adjusting the dark colorful sari as she is stepping out the house, other putting something in her beautiful pearl like studded hand purse, other eating something while watching TV and talking to her other family members and yet other pulling the belt of her high heeled scandals. Not all the middle class woman dresses up the same way too. Again the difference may be the brand and quality but if we for a moment forget about that, it is almost the same life style. In the evening while returning from office I used to see the ladies cutting vegetables as they are watching TV and some washing clothes chatting with their neighbors and some others feeding there infant kids. They seemed much relaxed after the day's work and ready for there family chores and spend quality time with there family members. Whereas I was still in the car/bus on my way home which might be take another 1-2 hrs based on traffic. By the time I reach home I used to be so tired that I have my dinner cooked by housemaid and go to sleep. In the morning get up in a rush to reach office on time and sometimes get ready in car while my husband is driving. The thought of who is spending quality time with family used to linger in my mind. 

All these observations bring in the question in my mind as to what is the definition of slum area? What is definition of being a well settled middle class family? Is it just the type of house we stay in and the locality the house is situated in? Is it the brand furniture and dresses we use or the costly restaurants we dine in forgoing the touch of house made food due to lack of time? Is it the vacation places we go with the micro family, spending lot of money forgoing the bigger family get together at grand mother's house? Sometimes as these questions linger in my mind I keep wondering who are really. Is it these people living in these slum areas with almost all the facilities or the people in the sophisticated urbane jungle who always have to struggle to get quality free time or maintain the status in society? 

To add to this I was totally astonished when I came to know that some of the people living in these slum areas owned the small land on which they have there houses and that they cost more than a medium sized apartment owned by middle class family in Navi Mumbai. Yes, they are not able to send there children to schools with all amenities and they cannot afford to continue there children higher education and we don't see many of these kids becoming engineers, doctors or collectors or flying abroad to work in techy companies. But at the same time seeing them from outside I cannot over rule the fact that maybe not all of them really want there children to excel in studies but just get some decent earning. 

My objective here is not to squabble on the life of people living in slum areas. But want to share my thought and bewilderment I encountered each time I passed through the slum area. And also I completely agree that in spite of having similarities, we cannot lead there lives but they can always lead our lives. That is another privilege they have vs middle class family. The point I want to bring to attention of readers is that the slum area is not as pathetic, un-hygienic as it is presented in international journals or movies. It is a place where families with respectable earnings live in decent furnished houses. At the same time since my exposure has been to only slum area in one city, my statement may not be valid in all cases. But with the analogy I drew from my observation I awed each time to myself saying "Wow!! What an urbane and classy slum area of 21st century."

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Bed Bugs

Bedbugs - what's the score?
Wall lice, bug flats, crimson ramblers, chinches, Norfolk Howards, mahogany flats, etc., etc.. The humble bed bug (Cimex
lectularius) has gained a place in world-wide folk lore and is universally reviled. Many years of onslaught in the UK had
reduced their populations significantly, but recently this troublesome pest has had a resurgence, both in terms of numbers
and in several instances of pesticide tolerance. Why? Let's begin with a review of the pest and its habits.
As man moved from a hunter-gatherer to living in urban settlements, many insects took advantage of this localised
situation. Initially, flies and beetles were attracted to food storage and preparation areas. Bed bugs moved in as the human
dwellings improved and became more permanent. They are closely related to the bat bug (Cimex pilosellus) and probably
first became associated with man when they were living in caves in Africa.
Humans (very much as they are now) were sought for a blood meal whilst they slumbered on the floor of the cave. The
bugs would locate their host by detecting their body heat and the carbon dioxide given off in their breath and through
their skin. Interestingly, there is still a species of bed bug (Leptocimex boueti) that still feeds off the blood of both humans
and bats in West Africa.
As civilisation evolved, the bed bug became our bed fellow, moving into our homes in ever increasing numbers. Sanitation
and personal cleanliness were offered as a defence against lice and other bodily pests. In 1602, Ulysses Aldrovandi, a
renowned social observer, reported that bed bugs were much more common in houses of the poor than in those of the
rich, because the rich had the means to keep their houses cleaner than those of the poor. In the late 1800s, bed bugs
were regarded as probably the most serious urban pest. Commercial pest control companies began to form in the larger
cities across Europe at this time. Their preparations ranged from chemicals that we would run a mile from today, to several
that we still recognise and use today - mercuric chloride in alcohol was regarded as an excellent treatment for bed bugs,
and pyrethrum and rotenone were beginning to arrive from the Orient.
In more recent times, the success of pesticides, such as organophosphorous compounds and pyrethroids, has meant
wide-scale eradication of bed bug populations. We realise now that dirty housing is not a pre-requisite for bed bug activity,
but it is thought that the unfortunate decline in social standards in some areas of the populous, coupled with an increase
in close-packed communities HMOs (houses of multiple occupancy, student accommodation, bed-sits and not forgetting
down-and-outs) have led to bed bug populations increasing significantly.
So what exactly is a bed bug? These insects are members of the order Hemiptera, the true bugs, which includes bugs
that attack house plants and pond skaters that live on the water's surface.
The bed bug has a simple or incomplete metamorphosis. Mating is a rough affair, with the male actually puncturing the
female's abdomen to inject sperm directly (a process known as "traumatic" insemination for obvious reasons!). A female
can lay up to 200 eggs over about two months. There are five nymphal stages which take 35 to 150 days to pass through,
depending on conditions. Adults are able to survive long periods in unoccupied houses or in furniture in store. In
desperation, they can survive on other species, such as poultry, sparrows, rats, mice and guinea pigs (which may explain
some long-term continued infestations). Adults that are well fed can then resist long periods of starvation - timescales of
nearly one and a half years have been recorded.
Nymphal instars take about three minutes to have a blood meal, but adults need over ten minutes to become engorged.
The mouthparts are adapted to form two pairs of stylets that puncture the skin. The outer pair is provided with barbs to
saw into the skin, and the inner pair form two tubes, one for sucking up the blood, and one for injecting saliva containing
an anticoagulant. A fully engorged adult can be 6-8mm long.
For many, the bite is painless, but some can detect it straight away. A typical red "wheal" is left by the biting insect,
caused by an allergic reaction to the saliva. The location of the bite(s) is very useful to a pest controller in diagnosing the
biting species. Flea bites are most commonly on the lower leg or ankle, whereas bed bug bites are often on the face, neck
arms or hands, and occasionally around the waist.
Where do they live? Within the urban ecosystem, there are three primary components, the human and non-human and
the physical structures. The habitat that is made up of human settlements is known as "Anthropobiocoenosis". Probably
the biggest word ever used in Pest Control News, this lengthy term means the part of the environment that has been
completely changed by man. It can even be sub-divided into "peridomestic" habitats, which are those outside dwellings,
and "domestic" habitats, which are located inside dwellings. The bed bug has invaded most areas of the latter category,
but principally those areas where we sleep. This is because time is needed to take a blood meal, and unless you are a
couch potato, humans do not sit still long enough for this to occur in the sitting room!

Control of bed bugs has always been relatively straightforward, although often a great deal of searching and a thorough
treatment or series of treatments was needed. However, in recent months, reports have been appearing in the national
press of "super infestations" of "resistant mutant bed bugs". This situation needs explaining.
It is known that the incidence of bed bugs is increasing, especially in London and in some of the university towns and
cities such as Cambridge. It is also known by a number of pest controllers that several populations are becoming very
difficult to treat successfully. Expressions like "pesticide-resistant" are thus bandied about. Such a term is not warranted.
True resistance is a biological term, meaning a population which, over time, has become "immune" to the effects of a
pesticide. This can only be conferred by surviving adults to their offspring and so takes time and several generations. The
instances reported in the press are more likely to be ones of "tolerance", whereby the bed bugs are able to tolerate a
pesticide and survive. (The offspring of these survivors would therefore be "resistant").
Like all treatments where a given product appears not to work, the selection of a pesticide from another group of active
ingredients if often the answer. Currently, the infestations that are causing some difficulty seem to be able to tolerate the
use of pyrethroids, and some are also carbamate-tolerant.
Nigel Binns, Biologist for Killgerm Chemicals Ltd., commented: "We are receiving a number of phone calls where
technicians are experiencing difficulty in controlling bed bug infestations. If they have used pyrethroids and/or
carbamates, a return to the use of organophosphorous pesticides usually does the trick. The down-side to this is that they
are often a little 'smelly', and so the customer should be advised. Organophosphorous pesticides that are approved for
use as public health products are perfectly safe in such situations, providing the technician follows the label
recommendations."
Finally, the bed bug does have predators. T. Pergande, a Union soldier in the American Civil War, reported that Pharaoh's
ants (Monomorium pharaonis) attacked and dismembered bedbugs in an infested quarters in Mississippi - perhaps this
is a novel form of biological control that we could choose to employ. Two infestations for the price of one!

Cockroach and dust mite

Many allergies are well-recognised and understood, but insect and mite allergies are still being examined. A study in 1997,
supported by the US National Institute of Allergy and Infectious Diseases (NIAID) conclusively demonstrated that the
combination of cockroach allergy and exposure to the insects is an important cause of asthma-related illness and
hospitalizations among children in U.S. inner-city areas.
"Some of the most vulnerable of our citizens, children in the poorest neighbourhoods of our large cities, suffer
disproportionately from asthma," says Anthony S. Fauci, M.D., NIAID director, in the report. "Allergy and exposure to
cockroach allergen clearly play an important role in the alarming rates of asthma-related sickness among these children."
"Reducing exposure to cockroach allergen, as part of a multi-faceted approach to asthma management, may be a cost-
effective way of reducing the burden of this serious disease," says Daniel Rotrosen, M.D., acting director of NIAID's
Division of Allergy, Immunology and Transplantation. "Simple and relatively low-cost interventions that have been explored
in the NCICAS, such as patient education, roach traps and child-safe insecticides, are potentially important."
The first five-year phase studied 476 of these children. The researchers measured levels of cockroach, dust mite and cat
allergens in the children's homes, and determined with allergy skin tests that 37 percent of the children were allergic to
cockroaches, 35 percent to dust mites, and 23- percent to cats. The investigators then assessed the severity of the
children's asthma over 12 months.
They found that children who were both allergic to cockroaches and exposed to high cockroach allergen levels were
hospitalised for their asthma 3.3 times more often than children who were allergic but not exposed to high levels of
cockroach allergen, or children who were exposed to high levels of cockroach allergen but who were not allergic. Children
who were both allergic and heavily exposed to cockroach allergen also missed school more often, needed nearly twice
as many unscheduled asthma-related medical visits, and suffered through more nights with lost sleep.
In addition, the activities of the adults who cared for these children were frequently disrupted. Researchers also collected
dust samples from each child's bedroom with a hand-held vacuum cleaner to measure the level of each allergen. While
most bedrooms had detectable levels of all allergens, 50.2% contained high disease-inducing levels of cockroach allergen
compared with 12.6% of rooms with high levels of cat allergen and 9.7% with high dust-mite allergen levels.
Even when families do all the right things at home, though, "...the biggest cockroach problem, in some cases, is at the
schools themselves," says Dr Jean Hanley-Lopez, Los Angeles Breathmobile Director. "In inner-city L.A. schools, students
have a high level of cockroach exposure," she says, "but I'm sure the school district is not even aware how big a problem
this is for students with asthma."
Dr. Thomas Platts-Mills, one of the NIAID researchers, mentions several difficulties. "People don't always understand that
they have cockroach allergies. Cockroach dust also disperses 'all over the house,' making it difficult to eliminate. Sprays
make a lot of asthma patients worse," Platts-Mills adds, "and you can use all the bait traps you want, but they won't work
if the cockroaches have a supply of food."
"It's all very well to have ambitions to decrease cockroaches," he concludes, "but we need more understanding of how
to do it." Dr. Richard Evans, an asthma specialist at Children's Memorial Hospital in Chicago agrees: "The one thing I
would do is help people get rid of cockroaches."
Dust mite allergy is an allergy to a microscopic organism that lives in the dust that is found in all domestic dwellings and
places of work. People are slowly recognising that dust mites and their droppings are perhaps the most common cause
of asthma and allergic rhinitis.
House dust is not a single substance but a cocktail of potentially allergenic materials. It may contain fibres from different
types of fabrics, feathers and other stuffing materials, dander from cats, dogs and other animals, bacteria, mold spores,
bits of plants and insects and other particles peculiar to an individual building. House dust also contains thousands of
microscopic mites which live in bedding, upholstered furniture, carpets etc. They thrive in summer and tend to die in
winter. However, in warm, humid environments such as a centrally-heated house, hospital or office, they continue to
thrive.
Each mite produces about twenty waste pellets a day, each containing a small amount of one of the most dangerous
chemicals known to science. Not only is the allergen of the house dust mite the usual cause of babies and small children
becoming asthmatic, it is also the commonest on a long list of irritants which cause existing asthmatics to have respiratory
symptoms.The constant presence of house dust mite droppings in the air inside homes keeps the lungs of asthmatics sensitive to
all the other factors which trigger asthmatic symptoms. If sufferers can avoid the dust mite allergen for a few months, then
usually the other factors lose much of their power.
Because mites are so tiny, their body water regulation is critical. As a result, the droppings they produce are very dry. The
average population per gram of dust is believed to be from 100 to 500, but can be up in the thousands. Egg-laying female
mites can increase the population by 25 to 30 every three weeks. Mites are equipped with sticky pads on the ends of their
feet, so they are able to burrow deep in carpet fibres and furniture where they hang on and are able to survive vacuuming.
Proteins in the dust mite droppings, called Der P1 and Der F1, are severe instigators of allergic response. When these
floating pellets are inhaled, they cause problems in the mite-allergic person. Even after the mite's death its faecal particles
remain in the home, and the mite's disintegrating body parts are still allergenic and easily airborne.
Although no environment is free of dust mites, there are specific steps you can take to reduce the number of these
creatures in your home. Many of these emanate from old wives' tales, but have their basis in fact:
Mattresses, box springs and pillows should be encased in non-allergenic, plastic-zipped casings. The zips should be
covered with adhesive tape. Wipe with a damp cloth or vacuum weekly. If there is more than one bed in a room, each
mattress should be encased. If bunk beds are used, the allergic child should sleep on the top bunk. Avoid using canopy
beds.
Use washable blankets, spreads and polyester or dacron pillows. Avoid feather pillows, down or padded comforters, wool
blankets and chenille spreads. Wash all bedding frequently in hot water (over 60 degrees centigrade). Don't use an
economy wash as mites survive in warm water, and you just end up with clean mites!

Ants

Understanding Ant Music
The ability to communicate through infochemical means, including pheromones, is at its highest among insects which live
in homogeneous communities - social insects. The ant in particular is distinguishable by its numerous exocrine glands
and the various chemicals it secretes as it relays information among its groups.
The largest ants have eyes located about 5mm from the ground whilst the smallest have eyes less than 1mm above the
ground and are unable to see beyond anything more than 5mm tall. Eyesight then, is not their strongest point. Ants
evolved from bees and they have developed acute olfactory senses which enable them to forage for food even in the
darkest situations. The ant senses environmental chemicals such as odours or non-volatile matter through physical
contact via its antennae. It then reacts according to the information the chemicals convey.
Chemical signals for species recognition
Insect species consist entirely of males and females with a male and female from each species reproducing. Sex
pheromones facilitate mating encounters however, how does an insect ascertain that the potential mate belongs to the
same species?
Dr Ryohei Yamaoka, of the Kyoto Institute of Technology has evaluated the important role infochemicals play in individual
identification among ants by observing their behaviour in their fascinating world. The team sampled cuticular waxes,
particularly hydrocarbons, from more than 500 species of insects including ants. They discovered that the composition of
these substances was species specific for all the insects sampled. They also discovered what happens when two ants
from different species meet and fight savagely. Only when the antennae of one ant actually touches its opponent's body
will the fighting begin. No matter how closely the two pass, unless the antennae of one touches the body of the other, no
fighting will occur. Ants do not recognise their opponents by vision, but by non-volatile chemicals on their bodies and they
also seem to confirm membership of the same species by detecting like-for-like hydrocarbons in the same way.
Different species of ants can live together
In order to live together, different species must change their previous recognition of their cohabitants as belonging to
different species. Slave maker ants (Polyergus samurai) invade nests where so-called hill black ants (Formica japonica) or
forest black ants (Formica sp.) live, attack and steal pupae and cocoons from them and bring their booty back to their
own nest. They attend to the pupae and cocoons until they hatch as well as nurturing the slave maker queens' eggs. In
the nest, slave maker ants avoid productive activity. They walk about lazily prompting slave ants to feed them.
Dr Yamaoka's team sampled cuticular hydrocarbons from two species of ants which live harmoniously in the same nest
as previously mentioned and discovered that slave maker ants can barely synthesize hydrocarbons natural to their own
species and receive the cuticular hydrocarbons they possess from slave ants through bodily contact. Accordingly, slave
maker ants take on the same hydrocarbons as those of their slave ants and are thus chemically camouflaged, rendering
them recognisable as cohabitants by their slave ants.
Signals which allow ants to identify mates from the same nest
The chemical discrimination ability of the ant is so great that it can distinguish not only ants of different species, but ants
from different nests (colonies). Cohabitants from the same nest are generally offspring of the same queen ant and share
the same kinship. However, other ants, even those from the same species, share no common kinship when they inhabit
different nests. Instead, they are intense rivals, competing for common food sources.
Ants from a given nest are believed to use individual or group odours, distinctive to the nest they inhabit, although the
composition of the chemicals involved remains undetermined. However, the composition of the hydrocarbons, which act
as a signal for species recognition, must be identical between residential and visiting ants, as they are members of the
same species... you would think.
The tests the team conducted bore interesting results. The profiles of composite hydrocarbons showed great variety from
one colony group of ants to another, or were distinct in each type of ant tested. There was also diversity in ants from a
queen-less nest. But samples taken from ants in the same nest with a queen were identical. This is due to the queen which
will entice nearby worker ants around her by use of a pheromone. In approaching, the workers initiate physical contact.
Accordingly, cuticular hydrocarbons are exchanged among a swarm of individual ants, leading to chemical consistency
of ants in the same colony.
Grooming
Grooming also plays a major part in "spreading" the same hydrocarbons among ants in the same colony. They use two
methods. One is to remove cuticular hydrocarbons from the partner by licking, then storing them in a special gland. The
other is to secrete them from the same gland for use in coating and grooming its own body.

Psocids

Psocids
"Sosids," as the proper pronunciation is, are booklice and there are over 3000 species of them to be found across the
world, although less than 50 are associated with human activities, including food storage and processing. But, their
significance as pests has increased over the last 35 years, which has been a matter of considerable interest to the Society
of Food Hygiene Technology, which ultimately led them to sponsor a survey among their members.
The results were published in 1984 and, although they helped to define the problem, they highlighted the need for further
research, as many questions about them still remain unanswered.
Psocids are widely distributed and typically favour dark places. They infest domestic premises, raw material stores,
manufacturing, distribution and retail premises; museums have also been infested and a wide variety of commodities may
be infested, including those which are of animal and vegetable origin, particularly farinaceous materials.
A four-fold problem
Nuisance - Psocids are a nuisance in industry because they interfere with production and threaten the integrity of
products, so reducing the quality and wholesome nature of the food.
They are typically associated with newly completed homes - damp building materials, plaster, etc., foster the growth of
mould on which the insects feed. Also, they are regularly encountered in food cupboards where they infest cereals, flour,
sugar, gravy thickener, etc..
Direct feeding damage - Psocids are not usually associated with damage caused by feeding activities, but direct
damage to commodities is possible and particular problems may be experienced when valuable articles, such as furs,
books, etc., become infested.
Transmission of micro-organisms - Micro-organisms and their spores will survive passage through the psocid gut and
may be carried on the surface of their bodies. Psocids may therefore, disseminate spoilage organisms, or even possibly
pathogens.
Health hazard -There is no evidence that psocids are vectors of disease. Nevertheless, they may eat tapeworm eggs
and harbour their larvae and so act as intermediate hosts for such parasites. Despite this, there is increasing evidence
that the insects may be a source of environmental allergens. The main impact of psocid infestations in homes is regarded
as psychological, with reactions which are occasionally disproportionate to any real threat.
Major Pest Species - L. bostrychophila is the major psocid pest encountered in domestic premises, accounting for over
90%, and is usually associated with consumer complaints. It is not generally found in commercial food handling
situations. The various psocid species tend to be associated with particular situations.
Environmental Factors - Psocids are vulnerable to dessication at humidities specific temperature and humidity data, coupled with data for the intrinsic rate of increase were considered, L.
bostrychophila ranked amongst other major stored food pests in terms of adaptability and pest potential. Egg laying
ceases at temperatures L. bostrychophila thrives on a yeast diet which is typically regarded as a rich diet. It is generally accepted that psocids
are most successful on a diet in which micro-organisms are present in moderation. The fact that L. bostrychophila is
parthenogenetic means that under suitable environmental and dietary conditions, populations develop rapidly and
certainly much faster than those species restricted to sexual reproduction.
Monitoring - Effective methods for monitoring psocid infestations are essential if prevention and control strategies are to
be successfully implemented. They can be monitored by visual examination, trapping, filth tests and the pallet "knock-
out" test.
Control - Psocids are difficult to control because they are small and can hide in cracks and crevices, so avoiding pesticide
treatments. They can survive long periods without food and are ubiquitous. An integrated approach to control is desirable
which uses all suitable techniques in a compatible manner.
The aim should be to manipulate the environment to the maximum detriment of the insects by denying them access to
some essential requirement. Little can be done to proof buildings and denying them harbourage is difficult although this
can be an option in small kitchens. They don't like cold, dry conditions and cannot survive at humidities application of dry heat with temperatures of 50-60oC will control psocids. As already said, freezing will kill them. Clearly,any reduction in humidity will also deter moulds which are a significant food source.
Control can be effected by the use of fumigants, space and surface spray treatments and a wide range of pesticides have
been shown to be effective for the control of psocids. Products based on the synthetic pyrethroids permethrin and
deltamethrin and the carbamate bendiocarb are well established in the control of psocids. However, there is evidence that
certain strains of L. bostrychophila featuring mixed function oxidase enzyme systems, which can detoxify and reduce the
effectiveness of some pyrethroid insecticides. This can be overcome by the use of the synergist piperonyl butoxide. PCOs
must therefore, be alert to possible variability in the control achieved using synthetic pyrethroids.
Conclusions
Psocids are ubiquitous pests which have the potential to cause a considerable nuisance, damage stored products and
pose a hazard to health, especially in sensitive individuals.
Evidence shows that complaints to the food industry have increased over the last 35 years, although the reasons are still
unclear. It is likely that psocids will continue to pose significant problems to householders and the food industry, but much
has been achieved in recent years developing a better understanding of the pest which must contribute to improved
control in the future.

Pests and Allergy problems

Other pests which cause allergy problems
Fleas
Heska in Orlando, Florida announced in 1997 a revolutionary breakthrough in flea allergy dermatitis (FAD) testing. Heska's
team of immunologists has been carefully studying flea biology - the result is the development of novel diagnostic
reagents and detection technology.
The HESKATM Flea Allergy Dermatitis Test is the first test specifically developed for detecting IgE antibodies against flea
salivary antigens as well as whole-body flea antigens.
Flea allergy dermatitis is a common dermatologic disease, and has been traditionally defined as an allergic reaction to flea
bites caused by injection of saliva as the flea feeds. Insect-associated dermatitis is a hypersensitivity to whole-body flea
antigens. Cross reactivity has been shown between whole-body flea allergen and black fly, black ant and cockroach
antigens. Redness, inflammation and itching are caused by the various protein components in flea saliva that can
stimulate an allergic response. The clinical signs related to FAD depend on the degree of immunologic sensitivity and the
level of flea exposure.
Wasps and Bees
A few people are very allergic to things such as insect stings. When exposed to these items they may have a severe
allergic response, also known as anaphylaxis.
In North America and Europe, nearly 100 people a year die from insect stings. Death usually comes within the first hour
after a sting and is attributed to insect allergy and not the toxic effect of the venom. It is thought that heat stroke or heart
attack may be given as a cause of death when actually it was the result of a sting. More children are stung but in older
persons with complicating health problems such as coronary heart disease or chronic bronchitis, death occurs more
frequently. Most of the victims of fatal insect sting have evidence of specific IgE antibodies.
The severity of the reaction depends on, among other things, the amount of venom injected and the degree of
sensitisation. Some sting victims have been reported as suffering 2000 stings and surviving while others receive a single
fatal sting.
In general, honey bee venom allergens are distinct from wasp allergens. Several more suspected potent allergens have
been found solely in Vespula and Dolichovespula (the so-called Euro- or super-wasp). Clinical presentations include large
local reactions which may extend to the limbs, with disfigurement and swelling.
Highly aggressive honey bees from Africa were mistakenly released in Brazil during the 1950s. These bees colonised
nests of the native honey bees. Africanised honey bees are very much a threat in South and Central America and it is
predicted that they will be colonising the southern United States. In one study, venoms were compared biochemically and
immunochemically. These investigations concluded that the higher morbidity after sting by the Africanised bees was due
to their more offensive behaviour.
Honey bees are the only stinging Hymenopteran that nearly always leaves its fluked sting in the skin of the victim. The
venom continues to pump into the victim until the venom sac is exhausted or the sting removed.
Wasp stings are often more cause for concern. Among the Vespula species, Vespula vulgaris (the common wasp) is
responsible for inflicting the greatest proportion of stings and has a nasty disposition. They live in large colonies, with 500-
5000 individuals. When a colony is disturbed, the sentry wasps fly out, find the intruder and begin to sting. The venom
contains an alarm substance which tells the other wasps the location of the first sting. Then they continue stinging around
that site.
Whether stung by a bee or wasp, within moments susceptible people may have anxiety, a tight throat, shortness of breath,
and low blood pressure. These serious symptoms require prompt medical care, as breathing may stop and death could
occur. If you see someone having these problems, seek help by calling the emergency services. Watch and assist the
victim's breathing if needed.
If people have ever had such a reaction, it may recur if they become exposed again. It is wise for them to wear an ID
bracelet to alert doctors. The use of anti-histamine tablets will help in the short term, but further treatment should be
sought.
Birds
Allergic reaction to birds is also possible. Pigeon fancier's lung (PFL) is a form of extrinsic allergic alveolitis (EAA) - an

allergic reaction of the lungs to some external allergen. In PFL it is believed that small particles of dust containing pigeon
proteins cause the allergic response.
Professor Chris Feare of Wild Wings Bird Management in the UK said, "The allergens may emanate from both the pigeons'
droppings and also from the copious quantities of dust produced as pigeons shed wax from their feather sheaths, and
that any concentration of pigeons can be a source of allergens".
There are two distinct but overlapping phases of EAA, namely an "acute" phase, which may or may not be followed by a
"chronic" phase. The acute phase is the most common and as the name of the condition suggests, is principally of
concern to pigeon fanciers. However, anyone who is exposed to a high level of "pigeon material" is at risk - so pest
controllers involved with pigeon proofing or guano clearance should take note.
Typically sufferers experience intense 'flu-like symptoms of fever, chills, muscle ache, cough and/or breathlessness, four
to eight hours after exposure. The symptoms usually pass within 48 hours, but may persist for a week or more. Although
this attack will probably pass without treatment, it is important to visit the doctor whilst symptoms are still present,
preferably on the day of onset, as if you delay there may be no visible symptoms for the doctor to investigate.
It is important that the condition is identified as early as possible to prevent progression to the more serious chronic stage
of PFL. If detected and appropriate measures are taken early enough, acute PFL is reversible. If not detected (or ignored),
the acute phase may be followed by the chronic phase which is characterised by a type of irreversible lung damage
doctors call pulmonary fibrosis. This is very serious and in extreme cases may be fatal. The major symptoms are
breathlessness on exertion, coughing and weight loss, which can be considerable.
It can be seen that many of the symptoms are general to a number of "chesty" conditions, so it is important for sufferers
to recognise that there may be a possible link with pigeons and mention this to the doctor.
Chris Feare emphasises a further complication - similar 'flu-like symptoms may be produced by a pathogen commonly
carried by pigeons (and other birds) and also present in their droppings. This is Chlamidia psittaci, the cause of ornithosis
in man, and it is therefore important that the diagnosis of the "'flu" is correct. Like a number of other conditions passed
from birds to man, in most cases the symptoms can be passed off as "'flu" and recovery is quick and complete. However,
if you happen to be one of the unfortunate few who are susceptible, things could get very serious indeed. It's not just pest
controllers who are at risk. Even those whose houses, flats or shops have resident populations of pigeons are in danger.
All encounters with high levels of "pigeon material" must be regarded as potentially highly hazardous and precautions
should be taken to minimise the production of dust and suitable personal protective equipment should be worn at all
times when handling such material.
Stored Product Pests
Many stored product insects can produce allergies. Even the humble grain weevil (Sitophilus granarius) can produce
allergic responses, although the importance of allergy to grain weevil in grain to dust asthma has not been fully evaluated.
Grain farmers can become sensitized and develop asthma because of one or more of the organic allergens in their
environment. In the literature, at least three cases of asthma in laboratory workers were described due to the grain weevil.
This brings us to the topic of ingestant allergens, that is, eating or unintentionally swallowing allergenic insect material.
Since we are not a nation accustomed to dining on "bugs", direct evidence for allergies to food insects is practically
nonexistent.
Nonetheless, entomologists are sometimes treated to nebulous accounts of people getting sick after deliberately eating
insects. Since almost everyone can name at least one food that turns their stomach, it is not clear what role, if any,
psychological factors may have played in these illnesses. We can, however, gain some insight from controlled
experiments on human subjects done with preparations of common food-infesting insects.
A classic study by Bernton and Brown in 1967 utilised dialised extracts of seven of these insects in skin sensitivity tests
of subjects with and without known allergies. Test extracts included those of the rice weevil (Sitophilus oryzae), fruit fly
(Drosophila melanogaster), Indian meal moth (Plodia interpunctella), saw-toothed grain beetle (Oryzaephilus
surinamensis), rust red flour beetle larvae and adults (Tribolium castaneum), confused flour beetle (Tribolium confusum),
and lesser grain borer (Rhyzopertha dominica).
Of the 230 allergic patients, 68 (29.6%) reacted positively to one or more of the dialised insect extracts. Surprisingly, of
the 194 non-allergic subjects, 50 (25.8%) showed sensitivity to at least one extract. A total of 333 positive reactions were
observed. The degree of overall sensitivity was practically the same for both groups, with the Indian meal moth extract
eliciting the most positive reactions followed by the extracts of rust red flour beetle larvae, rust red flour beetle adults, rice
weevils, fruit flies, confused flour beetles, saw-toothed grain beetles, and lesser grain borers.

The question arises as to where upwards of 25% of the general population might have acquired sensitivity to these
insects. At one time or another, most people have had to clean out their cupboard as a result of an infestation by one or
more stored-food pests. If the problem is bad enough (and recurrent), sensitivity could be related to inhalant or contactant
allergens of insect origin.
More likely, however, these allergies are the result of ingesting small quantities of insect material in food over a lifetime.
Despite proficient methods of production and storage, trace amounts of insect material are going to find their way into
our food. The Indian meal moth and its relatives, for example, can be persistent and notorious pests wherever sweets are
manufactured or stored. Stored-product moths will also attack flour, pasta and dried fruit. Grain beetles and weevils are
a constant threat to stored whole grain, and who hasn't opened a box of cake mix or corn meal, only to discover flour
beetles infesting the contents?
We are not inclined to eat food showing obvious signs of insect contamination, but we are more than likely getting
occasional small doses of insect material in food we consider wholesome. For most people this level of exposure is
medically inconsequential. For people with known allergies, especially those of the food and insect varieties, the matter
becomes problematic. In the case of food insects, does the sensitized person exercise strict avoidance of this novel
cuisine or take his or her chances?
For most people, working with or accidentally eating insects would pose little if any health risk, especially if they have no
history of allergy to insects or other arthropods. Nonetheless, since sensitivity can be acquired with repeated exposure to
an allergen, a measure of vigilance is in order. Any person with known insect, arthropod or bird allergies would be wise to
exercise some caution.

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We find ourselves in the midst of Olympic Games fever once again. Our top athletes are competing at the highest level and strive for top honours in their chosen fields. Most of the older will remember the rubber-soled plimsolls that were traditionally worn in PE lessons throughout most schools in Europe. These were available in any colour you liked as long as it was black or white.

These have been replaced by air cushioned, gel filled capsules with superior technical performance. They come in a variety of colours, shapes and forms and are purchased as much for their appearance as their performance. The ground-breaking manufacturing technique that allowed the development of the plimsoll was called vulcanisation, which is still used today. This process uses heat to meld rubber and cloth together. Sulphur is used during the process.

Plimsolls were revolutionary at the time as they provided comfort, were lightweight and allowed the user to move around silently. Plimsolls became known as sneakers and were sold on a mass scale in America as early as 1917. In the four years since the last Olympics in Athens technology has moved on somewhat and has definitely moved on since the plimsoll days.

Trainers and clothing has evolved to be lighter and stronger. But what part has technology had to play in enhancing the performance of our Olympians? Trainers and sport shoes have evolved, we have different shoes for each event and each pair of shoes is manufactured from a variety of number materials chosen because of their individual properties to put strength and flexibility where it is needed most.

Materials such as Kevlar which is ten times stronger than leather, leather or canvas which is both thin, stable and of a low density, foam blown polyurethane which gives a shoe extra cushioning and thermoplastic polyurethane which make a shoe both strong and pliable.

As technology has evolved scientists have developed new composite materials which work together to produce a better performance than that of the two or three separate materials. Differing materials offer different properties such as stability; offering resistance to twisting and warping. When weight is applied to a material over a period of time it will creep (flatten out and spread).

Some materials are used for their elastic properties, the ability to flex and bend when force is applied and then retain its original shape when the force is removed. Finally, some materials are chosen for their density which can be explained as the amount of matter in an object has per measurement of space, these materials are generally used for shock absorption.

Polyurethane is a unique material that offers the elasticity of rubber combined with the toughness and durability of metal. The flexible type of polyurethane is used to make upholstery, mattresses, earplugs, chemical-resistant coatings, specialty adhesives and sealants, and packaging.

It also comes to the rigid forms of insulation for buildings, water heaters, refrigerated transport, and commercial and residential refrigeration. It is used in the manufacture of sports shoes because of its lightweight shock absorption properties as well as being pliable as well as having great torsional and bending strength. Kevlar is one of the most important man-made organic fibres ever developed. The fibre possesses a remarkable combination of properties that has led to its use in a variety of commercial products since its invention in the 1970's.

The fibres of Kevlar consist of long inter-connecting molecular chains produces from poly - paraphenylene terephthalamide. Kevlar offers high tensile strength with a low weight, structural rigidity, low electrical conductivity, high chemical resistance, low thermal shrinkage, excellent dimensional strength, high cut resistance, flame resistant and self extinguishing. Pretty versatile really!

Spiked running shoes have been around for over 100 years created by the British company Reebok in the 1890's. The spiked shoe was developed out of necessity. The founder of the company enjoyed running and wanted to develop a shoe that would increase his speed.

In 1925 a company called Adi Dassler now known as Adidas created a range of shoes with hand-forged spikes. They offered a range of shoes for different distances. The company used the strongest and lightest materials available at the time to make the running shoes. Adi Dassler's brother went on to found the Puma sports shoe company.

The involvement of science and technology in the 1970's sports shoe manufacturers employed experts to conduct research into how humans run. They also investigated the shock effect to the body caused by the collision between the feet and the ground. Their finding helped to develop new, improved sports shoes.

Their research found three types of running styles:

Neutral:

This is where the heel of the runner makes contact with the ground and the foot travels in a straight line as it moves forward.

Pronation:

This where the heel hits the ground but this time the foot moves to the side as it travels forward. It refers to the inward roll of the foot.

Supenation:

This is where the heel hits the ground and the foot rolls outward. In modern times such materials as foam, silicon, air or gel have been added into trainers, these have been used to create cushioning systems in modern running shoes. In the 1970's a plastic called 'ethylene vinyl acetate (EVA)' was developed.

This material revolutionised the construction of sports shoes. It was made up of tiny air bubbles that provide cushioning and absorbs shock. This material is injection moulded into shapes, which serve as heel supports. Nike's Air technology, which used a gas-filled bag of air inserted in the sole of the shoe to cushion the impact of running, first appeared in 1979. The pair of sneakers was named; Tailwind and these technologically advanced air-soles had provided a good foundation for which further Nike advancements are based on.

Since then, athletic shoes have become increasingly specialized and prices for various sneakers have grown in accordance to the advances in technology and its value-added features. Some shoes sold in the 1980's even included a pump valve so you could inflate or deflate the heel on your shoe as if they were bicycle tyres

Following the introduction of Nike shoes, a technical breakthrough occurred in 1972 when Bill Bowerman, while studying the pattern on a waffle iron, came up with a great idea - waffle soles. Bowerman then cooked some rubber in his waffle iron and glued it to the bottom of a pair of shoes, which he later gave to athletes to test. The athletes came back with great reviews and the sneakers were well received in the market.

The patented outsole revolutionized running by offering better traction in a lighter-weight, more durable shoe.

In 2003 American spent on average 50 dollars on a pair of sports shoes. Companies sponsor most top athletes. This means that they are paid a fortune to wear the company's products during a sporting competition.

The Olympics is the biggest sporting event in the world attracting worldwide television viewers. This offers an ideal opportunity for sports companies to get their products seen. As well as being finely honed athletes and sports people, athletes are now fantastic marketing tools for the sport shoe companies. Wouldn't it be interesting if all the athletes in this year's Olympics had to wear plimsolls, the only choice they could make would be the colour, black or white?

We'd see the real Olympic champions then.

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BMW 7 Series.
   Series 7 to see first from outside may seem Series 7 new version is similar to the old version. If you see repeated again and then will see a clear difference in both the front and rear. Plus details on the BMW tell the document to confirm that both external and internal redesign to get out.
       
        Style and design lines that apply to the new 7 Series is the application from the prototype version of the CS Concept Motor Show launch in China in April last year. Make it look front look showy He especially headlights slant edge design with style He Krahag page large double major as the ????? BMW. As the headlights of a 2-side double circle of light embedded within it. And turn a new design that is seized-tube LED 8 satellites to put a 2 rows of 4 satellites in each vertical

Finally, for the outstanding balance with the tail lamp L is placed horizontally in a large And designed with the overall look of the end can merge The next-power LED drop in a row 3 to shedding light on performance. And enhance the luxury expectations with chrome bar between the taillights and rear bumper 2 side as though to see a flat, but focus on sports with a penetration level in the box prepared for the end of both left and right exhaust.
       
        However, although the new 7 Series will revolutionize not unique at the same transition from version 3 to version 4, but the Series 7 (version 5) is still a new combination of the beauty of sports. Look to the typical luxury executive (Rich).

  The interior cabin BMW has a new design that will not be as well as enhance the luxury - Functionality. And the point is always unique for all vehicle models stick blade logo design is a blue, white panel, all 4 satellites are divided into 2 large satellites for measurements and the engine speed. And articulate left-right With fuel level gauge and a hot circle small satellites. At the same time series panel materials are selected for a focus on softness and comfort during use. Other details on the set of measurements. And a new central console panel.
       
        IDrive system that used the first 7 series with an earlier version is also the heart's main control system. Inside the car, but expanded the size of display screen for a larger 10.2-inch is also a size 8 Gb hard drive installed for packing materials or more than 100 music albums, while air conditioning system is fragmented. 4 point to sit in the padded section of the car by the rear seat ventilation system installed with the pad to rub it in unreel fatigue management during the trip. (There are long wheel base models only) and most important connection to the Internet from within the car. This system also does not have any vehicle. BMW has become the world's first connection to the Internet within the car.

The spacious and luxury of the new 7 Series still has a full response to the extensive internal bus Sit pad that is designed to embrace and reinforce the need to sit though comfortable driving distance, but in any of the pad members to travel together. "Managing Morton ??? the interests of the" hard to protest that small and not suitable for rich executives in home bar, we focused on the velvety soft padded casual up liking this more than a personal ???????.

  Replete with high-tech
       
        BMW is proud to Series 7 new compact models because all the high tech system which has not always see the cars before any of BMW Night Vision system which is alert to know if a pedestrian path on the front. The system can process and predict the dynamic behavior of the well to prevent the accident. The Lane Change increase security by installing Side View Camera System to eliminate blind corners that are not visible from the side mirror or two after.
       
        Park Distance Control system increases safety when used on low speed conditions, the route may have obstruction on the road. That when a button in the cabin. Cameras installed on the bumper of page 2 will display the address on the front of the monitor's iDrive system allows the driver to acknowledge the leeward corner of the front of the car especially when driving on the narrow, or Time to turn the corner from Soi Abraham.

   In addition, BMW 7 Series models also installed Lane Change Warning System to work with Lane Departure Warning systems for safety while driving. This system which was installed on the Series 5 and 6 before the work is to remind the driver acknowledge the strong vibration on the steering wheel lightly if the car starts driving deviant from their own channel. This may be caused by doze off or be careless is.
       
        If a change of 2 Lane radar installed on the rear bumper corner is a check to propel the car or motorcycle to the back 60 meters in radius, which may be in the corner that unfortunately can not see. from the sideview mirror or mirror back.

Over other versions of the installed system Head-up Display or display on glass lee page will be working with Lane Departure Warning System to detect and alert the driver to acknowledge that in case the path. These are the speed limit. The system will rely on cameras installed to detect buffer tag speed limit signs on the road. If it will have a display screen via the Head-up Display, which is on the production car the world's first notification is displayed and the speed limit based on information from reading the label on road signs.
       
        In addition to answering the train car with fuel-saving Efficient Dynamics concept reduces vehicle weight by using aluminum in the production of the trunk lid housetop next door - back And pieces of the side tanks. As the technology of energy loss from the gas pedal stop or withdraw from the manipulation of electricity to help accelerate the rate called called Brake Energy Regeneration is used with the new 7 Series.

Fully equipped and diesel - petrol
       
        Series 7 is the first coach to use a 2 is similar to previous models. Body standard wheel base and long wheel base body. Body has a first length and 5,072 mm wheel base length of 3,070 mm long wheel base version of the L word to end a code-length version is 5,212 mm and 3,210 mm wheel base length of the width and height are equal. 1,902 mm and 1,479 mm.
       
        While all the petrol engine and Turbo Diesel from 740i and Li-6, a pump, sorted WINTER valve cam 24 Twin Turbo with 3,000 cc. The introduction of the Series 3 is the first manual knapsack. But in place to block the new 7 Series is rolled up to 326 hp at 5,600 cycles / min power wring maximum 45.8 Kk.-m. the 1500-4500 cycle / min, followed by version 750 i V-8 and Li. WINTER cam 32 valve 4,800 cc Twin Turbo X6, which carried over from the maximum is around 407 hp at 5,500 -6,400 / min wring maximum force at 61.1 Kk.-m. 1750-4500 cycle / min.

The Turbo Diesel is a single 730 d long wheel base version does not sell. Sort 6 engine with 3,000 cc Turbo pump 245 hp at 4,000 cycles / min power wring maximum 55.0 Kk.-m. the 1750-3000 cycle / min every automatic transmission models with 6 matching rhythm section 0-100 accelerating rate. Km / hour speed is between 7.2-5.2 seconds late and 245-250 km / hour.
       
        All galleries - comfortable with new strains.
       
        After the substrate ?? you information about new 7 Series ??? moderately ??? then queue up to have a car? ??? real cars for BMW in Germany to host a joint experiment with foreign journalists. Model 2 is the version with 750 Li and 730 d of Thailand plus 3 release from M. B. Thailand based in Germany and 4 to the report we received is the first car sitting 750Li 2 cars 2 cars per person. The afternoon is a queue of 730 d.

The first destination from the hotel we stay at is called. Taschenbergpalais hotel destination until they eat lunch appointment Schlss Wolfsbrunn total distance is 190.8 km, together with all the afternoon another 131.0 km
       
        Path for the host to try to drive a luxury 7 Series is considered that not all flavors will be in town for low speed because the driver will need to route through several villages and the law here when driving into town. will require a speed not exceeding 50 km / hour. Add a label to reinforce the drive all the way through.
       
        While the path is uphill, downhill curve on a narrow road and on the Meeting can not speed-limited. If daring is concealed until the foot pedal ???. However, the maximum speed up to 250 km / hr only because BMW and it is locked. Type of vehicle that does not feel the symptoms? Lack confidence. But fun to drive. Steering wheel controls, but even light. Accurate than the old version The wind not only to be trying to interfere.

Accelerate the rate of the rapidly ??? not call it a delay. If comparisons between the 730 d, 750 Li driving in the afternoon. It must request that the driver nearby. But first the advantage over the sprint distances. Sanctuary or accelerated because of the higher When pressing the non-stop Many players take a frightful turn to look at number miles that needle. ????? to nearly 200 over the ?? unconsciously.
       
        But the diesel version is not inferior to the city from the accelerated rate be close to it instantly. Been pressing a little soft because of the new version of Turbo accessories to make driving enjoyable with particularly devious way uphill curve is quite numerously. Both models dynamic driving. No precise fastening Island symptoms that do not fall for that confidence is high or low speed.

Why is this because BMW Carlo installation system Integral Active Steering wheel or 4 wheel system that will adjust the angle of the rear wheel in contact with the front wheel angle swerve from systematic plane by less than 3 degrees. When in low speed range. Rear wheel angle to be less in the direction contrary to the turn of the front wheel. Made more flexible. However, when used high-speed rear wheel angle to be less in line with the angle of the front wheel increases seizure island roads more efficient.
       
        The lower range can not tell at the mouth of a trial because the drivers sit and not feel anything no more symptoms, it still waving Or hardened. I not sure that the BMW range bottom is soft Est. Or because of good roads in Germany too. Because we run the route of the road very slick, he no dimple or to have even a little rude. But if the drive home, we will limp - or they still need to try each other T.

  Driving BMW features are fun to drive up the Drive Dynamic Control system, which was first used with the Series 7 this concept consists of a lower range level adjust viscosity of Cho. up automatically. Or called a Variable Damping Control can adjust the 4-Comfort, Normal, Sport and Sport +, drivers can choose to press the time mode, we would try to see the test easily.
       
        The cabin is within reach to broad recognition that only by sitting comfortable rear seat. Add a device facilitating full. Whether the location of the driver. Or the front passenger-side rear But I must confess ????????? trials for all categories. Because this is driving the steering wheel left. Mind is dim, but worry about driving more attention to features that BMW put to heavy But the equipment used is certainly because iDrive button before driving out of the Starbucks, to sit Est ??? order to map long (But it has strayed and that Easy button more numerously Other equipment to try to massage the system is padded , Adjust the mattress to hot because the air temperature outside is quite cold.

One system to another and try to play view. Notification system when the car change mire By driving out sludge It appears that the steering wheel will vibrate once. This event will be driving for them and then doze off.

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Camping out in nature doesn't always have to equate to roughing it. Whether you're a car camper or a backcountry minimalist, there are a variety of items you can purchase to make camping more relaxing. This guide will cover a range of items you can add to your camping gear to make trips more comfortable.

Tents and Sleeping : Having a restful sleep is important regardless if you're camping or not. There are varying sleeping pads and mats available to help you sleep comfortably in the outdoors. Mattress pads also elevate and insulate you from the ground, helping you stay warm on cold nights. Foam and inflatable mattresses come in several lengths and thicknesses, and in lightweight to extra thick mats. If using inflatable mattresses, consider purchasing a 12V or rechargeable air pump; they'll save you time when setting up your sleeping quarters.

For those with room to spare, a cot can be an excellent add-on. You can even get organizers to hang off the cot's side to keep personal items within reach. Don't forget a pillow. Camp pillows feature a soft casing (often flannel). Small models are available with the space-conscious camper in mind and can be compressed when packed.

Small accessories can help make your tent more comfortable, especially in rainy weather. Portable, battery operated lights and lanterns, small radios, and fans are some examples. Look for these accessories in models that can be hung from the tent's ceiling or suspended another way so you're not forced to hold them. A deck of cards, a small board game and a book are good to have too in case you get caught in a day-long downpour.

It's a good idea to bring some extra supplies for your tent, especially tent pegs. A mallet for driving in and removing stakes is another timesaving device. Finally, a spare piece of carpet, or an actual mat, is handy to leave outside your tent door to hold footwear and wipe muddy feet.

Food and Camp Cooking:I find everything tastes better outdoors, from strawberries to bologna sandwiches. Consider expanding your camp kitchen accessories and treating yourself to a little outdoor luxury. One of my priorities camping is a reliable coffee maker. Percolator models are the norm at many camps, but I've had success too with paper filters and a kettle. Drip style, portable models are also available. You can also indulge in a specialty coffee with a portable, espresso maker.

You may be surprised what's available to add a little class to camp drinking. For the romantic, there are shockproof wine glasses. A quality stainless steel, travel mug and/or thermos can be a real perk to keep drinks insulated and at the right temperature (either hot or cold) for several hours. Flasks are also useful for other adult beverages.

A variety of dishes are available for serving your meals. Utensils are items that can add some refinement to outdoor dining without cramming your pack. Make sure you pack the necessary utensils on a trip. It may be fun to pan-flip the odd flapjack over a bed of coals, showcasing your cooking talents to friends, but when your food supplies run short it's better to use a spatula and not risk ruining a meal. Also, pack a sharp, fillet knife if you plan on eating the occasional fish on your trip, but clean fish well away from your campsite.

There's a variety of collapsible tables on the market for eating and cooking on. These can come in handy if suffering from a sore back. They prevent you from needing to lean over to cook or eat your food.

The lines between outdoor and indoor cookwear can really become blurred for the individual with enough room to transport whatever they choose. Cast-iron gear comes in many models, such as: pans, Dutch ovens, griddles and pots. For pack-weight conscious campers, lightweight, stainless steel cook sets are available. In most cases, cast-iron is intended to be used over a fire, while stainless steel is for cooking over a camp stove as steel tarnishes if used over a wood-fire.

Don't forget an outdoors cookbook. They're filled with great meal ideas for the outdoors, that can be both entertaining to prepare and delicious to eat. Plan your meals before you leave, so you can pack the necessary spices and ingredients. Treat yourself to some specialty sauces in the backcountry and purchase small, carrying containers for them if tight on space.

Finally, you'll solicit a lot of attention from scavengers of all sizes, from ants to bears, when you bring food to a campsite. To discourage unwanted wildlife guests: keep your camp clean and properly hide your food.

Campfire Comfort:Sitting around a campfire during the evening is a classic camping image. Yet outdoors temperatures can quickly cool and sitting on a log can become uncomfortable after a while. So why not be prepared to enjoy an evening blaze?

Sturdy, portable chairs have replaced aluminum lawn chairs. The new models feature durable materials, stronger frames, and some even have headrests and drink holders. Better yet, many are collapsible, folding into their own carrying case for easy transport. To stay warm at a fire, a small fleece blanket can block out a night's damp chill.

Clothing:Without listing all the clothes to bring camping, some are worth repeating in this guide. Light weight towles must be a part of your camping gear..!. Carrying a vest camping can help regulate your temperature, whether you're stationary or active. Convertible pants are also extremely useful, letting you easily switch from pants to shorts. A hat keeps you warm and provides protection from the sun. A bandana should accompany you on every trip. These simple squares can serve numerous functions from head protection to a washcloth. Sunglasses are also important to provide protection from UV rays. Round out your list with long and short sleeve shirts and pants, and carry clothes you can layer.

Just make sure you don't overlook your basic needs when adding a little luxury to your next outing

If you have any questions regarding buying Camping Accessories Projects feel free to visit our site UltraLightTowels.com

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You may be set to go on a camping, hiking or backpacking trip, and you are already excited to go out into the sunshine, see the sky, smell nature and relax from a busy schedule. And you've already packed food, skewer, knife, jacket, sunscreen, ropes and camera among the things you will be bringing. Now comes the part when you have to choose what sleeping implement you would have to bring or buy. You would have three choices: cots, pads or mattresses.

You are better off looking for sleeping cots if:

(1) You prefer to be elevated from the ground when sleeping because you are afraid of being slept in with crawling objects. Or you want air to circulate under your bed to keep you cool while sleeping during hot conditions. In the same way, you want to keep yourself off from the cool ground when the temperature drops.

(2) Your idea of comfort is not being poked on your thighs and back with sharp objects on the ground like rocks and tree roots.

(3) You want ease in sitting down or getting up. Because a cot is elevated, you can easily get into or out of it like your regular chair or bed.

(4) For the above, you do not mind the carrying and packing considerations that are more tedious than that of just having a sleeping pad. Pads are less bulky, generally lighter in weight and easily rolled or folded.

(5) You do not mind having to set up a bed in a way more complicated than just putting down a sleeping pad but mind inflating a mattress mechanically or with an electric or battery-operated pump. Cots would have frames that you pull off to stretch a fabric you'd be sleeping on.

(6) You do not mind buying a high-end model of a cot that costs as much as a similarly sized mattress.

So when comparing sleeping cots, what should you look into?

Comfort. The only way to know this is to test the cot out by sitting or lying down on it. Get the feel of the material and the design and see whether everything feels just right for you.

Size. There's nothing as uncomfortable as sleeping in a bed that is undersized -- narrow or not long enough for your comfort. A good cot for you should enable you to reasonably move -- especially if you're one to move a lot -- without fear of falling off in the middle of the night.

Stability. Look at the framing of the legs whether it is straight and level and could hold when placed on uneven ground.

Ease of set up and dismantling. As you would undergo this process before and after sleeping, look for cots that are easily and nicely laid down and folded up.

Weight. As bulk and weight is a consideration for carrying your cots, look for ones that are as lightweight and as compactly packed as possible. Know whether the cot comes in a storage bag, whether the bag has a sling, and whether the sling is adjustable.

Durability and water-resistant quality of fabric. Inspect whether the stitching is secure and strong enough. Know whether the cloth is waterproof or is able to dry off quickly.

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Allergies are nothing to sneeze at. In fact, common household and environmental allergies can cause loss of production, loss of money, and can make you feel just plain crummy. The bottom line when it comes to allergies is that this world is filled with potential allergens and if you are a person who suffers from the effects, running from them won't do you much good. Instead, say "Gesundheit!" and attack the problem head on!

Allergies can be tested by a simple skin test administered by a physician to see what irritants will cause a slight localized reaction. Allergies can manifest as hay fever, watery eyes, itching, hives, swelling, and even if severe enough, asthma. The key here is prevention and control. Here are a few tips to keep the "Gesundheits" to a minimum in your presence so you can carry on in your hectic daily life when dealing with environmental allergies.

Remove old carpet and replace with hard wood floors or new carpet.

Carpeting and rugs are prime habitats for dust mites and pet dander which are major contributors to household allergies. By replacing old carpets, you are getting rid of years of dust mites and droppings.

Vacuum twice per week, deep clean twice a year.

It has been clinically proven in many studies that vacuuming your carpets and rugs with a good HEPA filter Vacuum such as Miele vacuum cleaners. Meile vacuum cleaners are a good choice for this task because they will reduce your levels of dust mites significantly. It is also a good idea to have your floors steam cleaned once per year to get the deep dirt, dust, and other allergens out.

Do your laundry.

Wash your bed linens each week in hot water and cover with Allergen proof slipcovers. Companies are becoming more aware of the health hazards associated with dust mites and dander and are making products to be anti-allergenic to be used as covers for mattresses and pillows.

Keep pets off of furniture.

The family pet should be not allowed on furniture. This allows the dander which is basically dust mite food, to really infest mattresses and furniture. Shampoos made for dander control may be another option.

Keep yourself cool.

Dust mites love humid, warm, moist conditions. Running a room dehumidifier is a good idea to keep the humidity down and the dust mites at bay. Air cleaners are another good bet for keeping a smoke and pollen free home.

Change your filters.

Change your duct work filters monthly and use a Hepa grade filter. Home air purifiers can also help to make sure the air pumped through your home is as clean as it can be.

Living with allergies can be difficult at times but with the use of Miele vacuum cleaners in addition to these simple tips, the only "Gesundheit!" that will be heard is the one you give the person next to you.

US Auctions Australian Auctions Austrian Auctions Belgian Auctions Canadian Auctions French Auctions German Auctions Indian Auctions Irish Auctions Italian Auctions Dutch Auctions Polish Auctions Spanish Auctions Swiss Auctions UK Auctions

Best Match Time: ending soonest Time: newly listed Price: lowest first Price: highest first Price + Shipping: lowest first Price + Shipping: highest first

INTEX QUEEN RAISED AIRBED DELUXE MEMORY FOAM MATTRESS    US $119.99

INTEX 67731 TWIN RAISED AIR MATTRESS AIRBED BED PUMP    US $49.99

Aerobed Guest Choice Queen Inflatable Mattress Air Bed    US $49.99

INTEX 67701 QUEEN RAISED AIR MATTRESS AIRBED BED PUMP    US $69.99

Mattress Genie Bed Back Wedge Pillow Queen Size Bed    US $129.99

Sofina Inflatable Air Bed Queen Mattress Camping    US $49.99

QUEEN AIR MATTRESS AIRBED AIR BED Built in Pump NEW    US $39.99

Central Vacuum 30 Kit Wessel Werk Dry Mop Flr Tool    US $319.95

2 SELECT SLEEP NUMBER AIR BEDS KING ADJUSTABLE BED    US $3,697.00

INTEX BLUE QUEEN RAISED MEMORY FOAM AIRBED AIR MATTRESS    US $89.99

Do check out a wide range of exclusive deals in your country (CAN, UK, AUS etc.) in the "Air Mattress Pumps Store" section!

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