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Figure 4 shows percentage inhibition expressed as percentage facilitation for PP2000 ; values at the different prepulse-to-pulse intervals under the three drug conditions. A two-way ANOVA with drug and prepulse condition as factors revealed a main effect of prepulse condition F3, 42 11.85, P 0.001, e 0.565; linear contrast F1, 14 36.35, P 0.001; percentage inhibition in the four prepulse-to-pulse intervals SEM was: 59.165.93 PP60, 56.467.27 PP120, 21.1320.87 PP240, and 19.89 12.65 PP2000 ; . No significant effect was seen for factor drug F2, 28 2.88, P 0.1, e 0.938; linear contrast F1, 14 4.89, P 0.05; percentage inhibition SEM across the four prepulse-to-pulse intervals for each drug condition was: 16.0714.15 for placebo, 32.718.57 for the low dose.
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Duration of action of thiazides is much longer than this t1 2 would suggest First-line therapy - this should reflect drugs with a proven ability to lower BP and reduce disease end-points. The original MRC trial of the treatment of mild-to-moderate hypertension demonstrated the efficiacy of thiazide diuretics and beta-blockers. In the past year further outcome data with ACE-inhibitors ACEI ; and CCBs Calcium channel blockers ; has been published. Hence a drug chosen from any of the 4 main therapeutic groups of anti-hypertensives can be used as first-line therapy the BHS recommends a thiazide ; . Note the following points: It is reasonable to consider trial rotation of a patient through each of the 4 classes of anti-hypertensive to discover the class giving maximum BP reduction with the minimum of side effects. Typically, only 2 3rds of mildly hypertensive patients will respond to a drug chosen at random from the 4 classes. Beause of the convergence of action of the classes ACEI Beta-blocker through renin-angiotensin system and diuretic CCB independent of it ; the choice is in practise reduced to: ACEI or Beta-blocker VERSUS CCB or Diuretic . the 'ABCD' Rule and glucotrol. ADMINISTRATIVE PROTOCOLS FOR PARAMEDIC SERVICES A200 Page 3 of 8 These requirements apply to both primary responder units and back-up units. Scheduling for back-up units shall provide for the availability of two paramedics to respond just as with the primary unit. 3. If unplanned circumstances arise where only one paramedic is available to respond, the paramedic shall call for mutual aid or back-up response, if needed see a-h above ; . When one paramedic is unexpectedly alone, the paramedic shall perform life-saving paramedic skills as quickly as possible and transport the patient to the nearest appropriate medical facility as soon as possible. 4. In those situations or services where the two 2 ; required paramedics will arrive on the scene separately, the following provisions apply: a. The required two 2 ; paramedics shall be dispatched simultaneously; b. The second paramedic shall arrive on the scene within a reasonable amount of time under all of the circumstances; c. The second paramedic may be called off if the first paramedic determines that reliance upon the Protocols and Standing Orders for Paramedic Services will not be necessary; d. It is the responsibility of the Emergency Medical Service to document dispatch and response times for all paramedics in all situations where the two 2 ; required paramedics do not arrive at the scene in the same unit or simultaneously; e. If ten percent 10% ; of the runs in any month result in only one 1 ; paramedic on the scene where care must be provided under the Protocols and Standing Orders for Paramedic Services by the one paramedic, then scheduling and any other changes necessary to correct such problem shall be made. Documentation of the problem and any corrective action shall be provided to the medical director and shall be included in the annual report to the EDS Committee; f. An Emergency Medical Service may obtain an advisory opinion from the EDS as to the reasonable amount of response time for the second required paramedic under the particular circumstances confronting the Emergency Medical Service requesting the opinion. 5. In any situation where there is a single paramedic on the scene intending to act under the Protocols and Standing Orders for paramedic services, communication with a base hospital physician shall be established, if at all possible. B. 24-Hour Paramedic Service 1. Each emergency medical service that chooses to provide paramedic services operating under the auspices of the Academy of Medicine shall provide paramedic services on a 24hour basis. 2. Each emergency medical service shall be required to show that it has sufficient certified EMTPs to provide 24-hour paramedic service. C. Voice Communication Capability 1. Each unit used to transport patients shall be equipped with appropriate voice communication capability. D. Continuing Education 1. Each paramedic employed by an emergency medical service to provide paramedic services under the auspices of the Academy of Medicine shall be certified by the State of Ohio, and shall meet all continuing education requirements. 2. The Academy of Medicine may request additional training that it may deem necessary.
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