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By: R. Torn, M.B. B.CH. B.A.O., Ph.D.

Professor, Geisinger Commonwealth School of Medicine

When the police are involved in the death of someone like Frank Paul antibiotic you can't drink on purchase panmycin in united states online, how should our public agencies respond I can provide several examples of how my interpretation of my mandate has evolved because of the evidence I have heard and the policy issues our team has explored 0g infection discount panmycin 500 mg with amex. In either case antibiotic working concentrations cheap panmycin 500mg with visa, the intoxicated person is released back to the streets within a few hours, and the cycle repeats itself with alarming regularity. However compassionate individual ambulance attendants and police officers are, the current practice of incarcerating incapacitated people and then releasing them back onto the streets and alleyways of the Downtown Eastside, with inadequate community supports and no assurance of safe accommodation, ignores the problem and must stop immediately. When this inquiry began, my team and I did not foresee the profoundly important social policy issue contained within paragraph (c) of the Terms of Reference. Now that it has clearly emerged, I must interpret my mandate with this new understanding, and address the issue accordingly. Construed narrowly, the terms invite me to stand in the shoes of a Vancouver police officer who has responded to a "man down" call, and finds a person who is clearly incapacitated by alcohol or drug use. If the attending officer concludes that it is not necessary to detain the incapacitated person for criminal charges or outstanding warrants, but realizes (perhaps with the assistance of ambulance attendants on the scene) that the person is incapable of looking after himself or herself, what health care or social services and facilities are available that will accept someone in this condition As I will discuss in more detail later in this report, the list is very short-the emergency ward of a hospital, the short-term sobering unit attached to the Detox Centre, or the Jail. Police officers are generally aware of what services and facilities they can access in these situations. My third example of an evolving mandate interpretation pertains to the investigation of police-related deaths. I recognize that there are other perspectives-there will always be other perspectives-and I do not pretend to offer the final word on these matters. Having gathered significant information on, and insight into, the underlying policy issues, I see no realistic conclusion other than to tackle those issues in a meaningful way. In doing so, I recognize that these proposals strike at the heart of two important societal values-police independence in the investigation of allegations of criminality, and the need for our police to be subject to civilian overview. It is my hope that this report will, at the very least, contribute to this conversation. The Annex Harm Reduction Program, by Art Manual, Seaton House Hostel Services Unit, Toronto. Depending on the outcome of the legal proceedings initiated by the branch, I will prepare a final report dealing exclusively with the Criminal Justice Branch. On receiving the report, the Executive Council may direct the minister to withhold portions of the report because of privacy rights, business interests or the public interest. The minister: o must promptly lay the report before the Legislative Assembly if it is in session or will be in session within 10 days of receiving the direction, in any other case, must promptly file the report with the Clerk of the Legislative Assembly, and must make available to a participant a copy of the report if it includes a finding of misconduct against that participant, or alleges misconduct by that participant. Russell Sanderson Corrections Officer Greg Firlotte Testimony during evidentiary hearings Cst. One area of the Jail also housed people who were found intoxicated in a public place and were unable to care for themselves. Provincial legislation authorized police officers to take such people into custody, and to hold them without charge for their own protection until they were capable of walking out of the facility. Such incapacitated people were usually held for about four or five hours-long enough to recover to the point of being able to care for themselves, but not so long that they would go into withdrawal. The Detox Centre (operated by the health authority) was situated about a dozen blocks south of the Jail, on East 2nd Avenue. It had two parts-a voluntary detoxification program, and a sobering unit where intoxicated persons could be given shelter and monitored until they were sober enough to care for themselves. In 1998, the Detox Centre (the term I use in this report for what more properly is the sobering unit) could hold 18 people in about six rooms. Saferide is a free, safe transportation service to the Detox Centre provided for clients with alcohol and drug problems, run by the non-profit Vancouver Recovery Club. As witness Barry Conroy described, the idea behind Saferide is to free up ambulances and police wagons by stepping in to offer transport to intoxicated people who do not have to go to the hospital or the Jail. Emergency Health Services (the Ambulance Service) was usually the first to respond to a "man down" report. Paul was drunk, from his slurred speech and glassy eyes, and from the fact that he reeked of alcohol. Paul from past dealings, and knew that on occasion he would try to punch or kick officers.

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Argo light Argo Intracranial Veins Superior cerebral veins infection quality control staff in a sterilization generic panmycin 500 mg, bridging veins Superior sagittal sinus Inferior sagittal sinus Venous angle Internal cerebral v antibiotic for uti proteus best purchase for panmycin. Straight sinus Confluence of sinuses Sigmoid sinus Transverse sinus Superior petrosal sinus Cerebral veins and sinuses Inferior sagittal sinus Venous angle Cavernous sinus Ophthalmic v antimicrobial foods order panmycin 250mg without a prescription. Cerebral Circulation Argo light Argo Extracranial Veins which anastomoses with the occipital venous plexus and finally drains into the external jugular vein. The pterygoid plexus lies between the temporalis, medial pterygoid, and lateral pterygoid muscles and receives blood from deep portions of the face, the external ear, the parotid gland, and the cavernous sinus, which it carries by way of the maxillary and retromandibular veins to the internal jugular vein. Craniocervical Veins Anastomotic channels connect the cutaneous veins of the two sides of the head. Venous blood from the facial, temporal, and frontal regions drains into the facial and retromandibular veins and thence into the internal jugular vein. Some blood from the forehead drains via the nasofrontal, angular, and superior ophthalmic veins into the cavernous sinus. The occipital vein carries blood from the posterior portion of the scalp into the deep cervical vein and thence into the external jugular vein. Blood from the jugular veins continues to the brachiocephalic vein, superior vena cava, and right atrium. The venous channels in the spinal canal and the transcranial emissary veins play no more than a minor role in venous drainage. The pterygoid plexus links the cavernous sinus, the facial vein, and the internal jugular vein. The numerous anastomoses between the extracranial and intracranial venous systems provide a pathway for the spread of infection from the scalp or face to the intracranial compartment. For example, periorbital infection may extend inward and produce septic thrombosis of the cavernous sinus. Cervical Veins the deep cervical vein originates from the occipital vein and suboccipital plexus. It follows the course of the deep cervical artery and vertebral artery to arrive at the brachiocephalic vein, which it joins. The vertebral vein, which also originates from the occipital vein and suboccipital plexus, envelops the vertebral artery like a net and accompanies it through the foramina transversaria of the cervical vertebrae, collecting blood along the way from the cervical spinal cord, meninges, and deep neck muscles through the vertebral venous plexus, and finally joining the brachiocephalic vein. Cerebral Circulation 20 Cranial Veins the facial vein drains the venous blood from the face and anterior portion of the scalp. It begins at the inner canthus as the angular vein and communicates with the cavernous sinus via the superior ophthalmic vein. Below the angle of the mandible, it merges with the retromandibular vein and branches of the superior thyroid and superior laryngeal veins. The veins of the temporal region, external ear, temporomandibular joint, and lateral aspect of the face join in front of the ear to form the retromandibular vein, which either joins the facial vein or drains directly into the internal jugular vein. Its upper portion gives off a prominent dorsocaudal branch that joins the posterior auricular vein over the sternocleidomastoid muscle to communicate with the external jugular vein. Lymph vessels joining to form thoracic duct Extracranial veins Transverse cervical v. Argo light Argo Spinal Circulation omy is variable, to the anterior and posterior spinal veins, which form a reticulated network in the pia mater around the circumference of the cord and down its length. The anterior spinal vein drains the anterior two-thirds of the gray matter, while the posterior and lateral spinal veins drain the rest of the spinal cord. These vessels empty by way of the radicular veins into the external and internal vertebral venous plexuses, groups of valveless veins that extend from the coccyx to the base of the skull and communicate with the dural venous sinuses via the suboccipital veins. Venous blood from the cervical spine drains by way of the vertebral and deep cervical veins into the superior vena cava; from the thoracic and lumbar spine, by way of the posterior intercostal and lumbar veins into the azygos and hemiazygos veins; from the sacrum, by way of the median and lateral sacral veins into the common iliac vein.

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Protective equipment is required for those who come into contact with exposed victims antimicrobial xylitol generic panmycin 250mg line, and should include impermeable clothing and respiratory equipment (ideally air supplied) antimicrobial diet panmycin 250mg mastercard. Responders should be made aware of the fact that symptoms efficacy of antibiotics for acne order panmycin on line amex, incapacitating signs, and death can occur within seconds to a few minutes of the start of an exposure, and thus rapid action is required in the context of a well-planned response; this is critical. Speed of recognition of intoxication and appropriate intervention are highly important and lifesaving. First-aid and medical management stockpiles for on-site and hospital use should include masks with manual ventilators; oropharyngeal airways; oxygen cylinders with masks; in-date ampoules of amyl nitrite (kept at, or below, 158C); sodium bicarbonate for i. The choice of antidotes should be made in consultation with relevant experts in a Poison Control Center. Cyanides: Toxicology, Clinical Presentation, and Medical Management 335 Ballantyne, B. Cyanides: Toxicology, Clinical Presentation, and Medical Management 337 Dugard, P. Cyanides: Toxicology, Clinical Presentation, and Medical Management 339 Klimmeck, R. Cyanides: Toxicology, Clinical Presentation, and Medical Management 341 Robinson, C. At one end of the spectrum of civil disturbances is physical assault by one or a few individuals on a member of the public or an officer of the law, and where self-protection is needed against the malefactors. At the other extreme are large-scale demonstrations by protestors in which law enforcement personnel may become involved, and where physical violence occurs that could result in damage to private or public property, and where there is likelihood for injury, or even death, among participants or bystanders who, by chance, are present in the area of the disturbance. If many individuals participate in a civil disturbance involving potentially dangerous physical activity, this constitutes what is popularly described as a riot. Such riotous situations occur at differing locations and are precipitated by numerous and varying factors; for example, civil unrest, dissatisfaction or gang conflict in prisons, escalation of a civil demonstration against political dictates, disputes at sports meetings or social events, and indeed any gathering where there are likely to be conflicts of opinions within groups or where emotions may become heightened or distorted. Demonstrations having variable degrees of conflict with security personnel and law enforcement agencies and full-scale riots have been and will continue to be an inevitable consequence of dictatorial, demanding, and ethically suspect political regimes and administrations. Indeed on the day that this paragraph is being written there are reports of the following large-scale demonstrations and riots in various parts of the world, with markedly differing causations. These examples emphasize the variable causations of civil disturbances and that the outcomes may include widespread publicity, accusations of excessive and unnecessary physical force by security personnel, claims for injury, litigation, public discussions, and official enquiries; such postevent implications are discussed in detail by Ballantyne and Salem (2004). Peacekeeping operations against individuals or protesting groups may, depending on the nature of the disturbance and whether there is violence between demonstrators or between demonstrators and security forces, necessitate the use by law enforcers of various devices and substances to control and quell activities of those participating in the disturbance. This chapter reviews the nature and effects of chemicals used, and proposed for use, in peacekeeping operations. Particular attention is given to their operational uses in various circumstances, pharmacology, toxicology, evaluation of safety-in-use, delivery, effects on humans, consequences and medical management of overexposure and injury, and the need for preparedness planning. Historical aspects of the use of chemicals in peacekeeping operations have been presented in detail elsewhere (Ballantyne, 1977a, 2006a; Salem et al. The following characteristics are considered appropriate for chemicals used in peacekeeping operations against civilian populations: (1) have rapid onset of incapacitating effects even with the most motivated; (2) easy to disseminate and subsequently decontaminate; (3) have long shelf life; (4) are of low cost; (5) should not facilitate the escalation of the situation; and (6) do not produce short or long-term adverse effects when used against a heterogeneous population (Maynard, 1999; Ballantyne, 2006a). The physical equipments and chemicals used by law enforcement personnel can be categorized as outlined below. Physical Measures for Close Range and Remote Incapacitation this category includes physical measures intended to deter or incapacitate; in some cases they are deployed at close range and with other measures at significant distances. Included are truncheons, nightsticks, beanbags, plastic or rubber bullets, and tasers. Clearly such procedures are intended to incapacitate by physically causing pain and immobilization, but equally clear is a potential for soft tissue and bone injury, and several deaths have been associated with the resultant trauma. Contrary to statements that the risk of serious and fatal injuries is very low from ``nonlethal' weapons such as tasers and baton rounds (Cooper, 2004; Buchanan, 2005), there are clear indications that this is not true, and documentation exists of serious injuries and deaths from the use of baton rounds (Metress and Metress, 1987; Yellin et al. Tasers aimed at the trunk discharge electrode needles that remain attached to the projection device by fine wires that carry high voltage pulses (50,000 V), which cause muscle spasms, weakness, and incapacitation. Also, it is difficult to agree with statements that those with hypertension, cardiac diseases, and arrhythmias are free from risk. The working range of tasers may be extended through the use of shotgun shells that combine blunt force trauma with the delivery of high voltage impulses (Myers, 2006). The pharmacological basis of their use is that they interact with sensory nerve receptors in skin and exposed mucosal surfaces, producing local discomfort and pain at the site of contact together with related local and systemic reflexes; local reflexes are listed in Table 15.

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Vertebrobasilar system (extracranial; plane of coronal section) Lateral branches V1 V0 Medial branches Basilar a virus scanner for mac effective 500 mg panmycin. Cerebral Circulation 15 V3 Argo light Argo Posterior Circulation of the Brain cuneus (parieto-occipital branch) infectonator 2 hacked buy panmycin 250 mg fast delivery, the striate cortex (calcarine branch) virus attack purchase generic panmycin pills, and the medial surfaces of the occipital and temporal lobes (occipitotemporal and temporal banches), including the parasagittal portion of the occipital lobe. Its course lies within the interpeduncular cistern, which is demarcated by the clivus and the two cerebral peduncles. The postcommunicating segment (P2) curves laterally and backward around the crus cerebri and reaches the posterior surface of the midbrain at an intercollicular level. The precommunicating segment gives off fine branches (posteromedial central arteries) that pierce the interpeduncular perforated substance to supply the anterior thalamus, the wall of the third ventricle, and the globus pallidus. The postcommunicating segment gives off fine branches (posterolateral central arteries) to the cerebral peduncles, the posterior portion of the thalamus, the colliculi of the mid brain, the medial geniculate body, and the pineal body. Further branches supply the posterior portion of the thalamus (thalamic branches), the cerebral peduncle (peduncular branches), and the lateral geniculate body and choroid plexus of the third and lateral ventricles (posterior choroidal branches). Postcommunicating segment (P2) Posteromedial central arteries B C D Anterior choroidal a. Undersurface of cerebellum (showing arteries) E Branch to corpus callosum Temporal branch Lateral occipital a. Calcarine branch Posterior cerebral artery (green = peripheral branches) Anterior cerebral a. Argo light Argo Intracranial Veins the great cerebral vein posterior to the brain stem. The anterior, middle, and posterior veins of the posterior fossa drain into the great cerebral vein, the petrosal vein, and the tentorial and straight sinuses, respectively. Thus, the cerebellar veins drain blood from the cerebellar surface into the superior vermian vein and thence into the great cerebral vein, straight sinus, and transverse sinuses. The deep cerebral veins (central veins) drain blood from the inner regions of the brain (hemispheric white matter, basal ganglia, corpus callosum, choroid plexus) and from a few cortical areas as well. The superficial cerebral veins are classified by their location as prefrontal, frontal, parietal, and occipital. Except for the occipital veins, which empty into the transverse sinus, these veins all travel over the cerebral convexity to join the superior sagittal sinus. They are termed bridging veins at their distal end, where they pierce the arachnoid membrane and bridge the subarachnoid space to join the sinus. The superficial middle cerebral vein (not shown) usually follows the posterior ramus of the Sylvian fissure and the fissure itself to the cavernous sinus. The inferior cerebral veins drain into the cavernous sinus, superior petrosal sinus, and transverse sinus. The internal cerebral vein arises bilaterally at the level of the interventricular foramen (of Monro). It traverses the transverse cerebral fissure to a point just inferior to the splenium of the corpus callosum. The venous angle at its junction with the superior thalamostriate vein can be seen in a laterally projected angiogram. The two internal cerebral veins join under the splenium to form the great cerebral vein (of Galen), which receives the basal vein (of Rosenthal) and then empties into the straight sinus at the anterior tentorial edge at the level of the quadrigeminal plate. The basal vein of Rosenthal is formed by the union of the anterior cerebral vein, the deep middle cerebral vein, and the striate veins. It passes posteromedial to the optic tract, curves around the cerebral peduncle, and empties into the internal vein or Extracerebral Veins the extracerebral veins-most prominently, the dural venous sinuses-drain venous blood from the brain into the sigmoid sinuses and jugular veins. The diploic veins drain into the extracranial veins of the scalp and the intracranial veins (dural venous sinuses).

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