1618 Correspondence / American Journal of Emergency Medicine 31 (2013) 1612–1620

B-type natriuretic peptide and infarct size in non-ST-elevation myocardial infarction B

To the Editor,

B-type natriuretic peptide (BNP) after acute myocardial infarction has proven useful for prediction of prognosis and for estimation of the complex and extension of coronary lesions in acute coronary syndromes, but the value of BNP for assessment of left ventricular function and infarct size is not well known [1-4].

The aim of the present study was to correlate infarct size and left ventricular function determined by echocardiography Doppler with plasma levels of BNP after acute myocardial infarction.

We studied 50 patients with Non-ST-elevation myocardial infarction .

We excluded patients with ST-elevation myocardial infarction, heart failure, and shock at admission in the emergency department.

We measured BNP at admission and determinate the ejection fraction and the number of myocardial segments affected by echocardiography Doppler before discharge.

There was no correlation between BNP and left ventricular function in NSTEMI, but there was a linear correlation with infarct size in NSTEMI (r = 0.60; P b .001).

We could conclude that a single measurement of BNP at admission in patients with NSTEMI proved useful for estimation of infarct size but not for estimation of the left ventricular function.

Diego Conde MD Pablo Elissamburu MD Nicolas Lalor MD Leandro Rodriguez MD Marcelo Trivi MD Division of Cardiology

Instituto Cardiovascular de Buenos Aires–Sanatorio Anchorena Blanco Encalada 1543, Buenos Aires, Argentina E-mail address: drconde@hotmail.com

http://dx.doi.org/10.1016/j.ajem.2013.08.014

References

1. Nakagawa K, Umetani K, Fujioka D, et al. Correlation of plasma concentrations of B- type natriuretic peptide with infarct size quantified by tomographic thallium-201 myocardial scintigraphy in asymptomatic patients with previous myocardial infarction. Circ J 2004;68(10):923-7.
2. Omland T, Aakvaag A, Bonarjee VVS, et al. plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction: Comparison with plasma atrial natriuretic peptide and N- terminal proatrial natriuretic peptide. Circulation 1996;96:1963-9.
3. Bruder O, Jensen C, Jochims M, et al. Relation of B-type natriuretic peptide (BNP) and infarct size as assessed by contrast-enhanced MRI. Int J Cardiol 2010;144(1): 53-8.
4. Conde D, Elissamburu P, Lalor N, et al. B-type natriuretic peptide predicts complexity and severity of the coronary lesions in patients with acute coronary syndromes. Am J Emerg Med 2013;31(8):1282.

   Competing to the rescue–leveraging social media for cross border collaboration in life-saving rescue operations

   The Research Field of social media and emergencies is vastly developing. With each emergency situation, researchers are able to more effectively learn, evaluate, and understand ways in which they are used.

   Major earthquakes have occurred worldwide causing numerous casualties, often characterized by multisystem injuries [1,2]. Imme-

   ? Conflict of interest: None.

   diate medical response to Earthquake victims can substantially improve their outcome [3,4]. An example is the relief efforts following the 2010 Haiti earthquake in which social media was leveraged to assist in damage assessment and Search and rescue operations [5].

   Israel and Jordan share a border of 240 km, located in an active seismic region. Approximately every 90 years, a major earthquake¹¹ strikes the region, with devastating effects on the neighboring countries (Israel, Jordan, Lebanon, and Syria). Most parts of Israel’s and Jordan’s population reside within 100-km radius of the epicenter. Neither country is prepared to manage such a disaster independently [6,7].

   Despite the major risk for an earthquake, both countries’ First responders lack preparedness and skills in social media utilization during emergencies, although they have high Adoption rates of social media by the population; more than 86% of the online population have a social media account; leveraging these tools can facilitate regional cooperation during disasters.

   Social media has been incorporated into numerous activities of emergency authorities, but to effectively use these tools in disaster response, they should also be used and incorporated in routine exercises and training activities [8,9].

   To ensure the required level of emergency preparedness, exercises are a crucial component. Integrating social media in the emergency response has been scarcely exercised. A recent study created an exercise in which students simulated victims and first responders leveraging Twitter for the “response phase” [9].

   We developed an exercise targeted to test a procedure designed to leverage social media in response to an earthquake. The exercise was performed by actual emergency responders implementing search and rescue operations to locate and extract simulated trapped casualties. The participants were members of the Jordan Red Crescent and Israeli Emergency Medical Services working together.

   The uniqueness of this exercise was its dual nature, where 2 teams were required to perform search and rescue activities, while 1 team used conventional methods only, and the second team also used social media tools. This enabled to compare and understand the potential advantage of incorporating social media tools in the response phase. This exercise used both Facebook and Twitter as channels for Information dissemination in contrast to other exercises that used only 1 channel. The social media team found more mock casualties than the no-media team (95.45% vs 86.36%, respectively) and was earlier. The exercise displayed that social media may improve intrateam cooperation, interteam coordination, and better situational awareness; thus, it can facilitate a more effective response for emergencies.

   Tomer Simon MPH

   Department of Emergency Medicine Recanati School for Community Health Professions

   Faculty of Health Sciences Ben-Gurion University of the Negev, Israel PREPARED Center for Emergency Response Research Ben-Gurion University of the Negev, Israel

   Ready.org.il – Disaster readiness and preparedness in

   Israel, Givatayim, Israel E-mail address: tomersi@asonot.org.il

   Bruria Adini PhD

   Department of Emergency Medicine Recanati School for Community Health Professions

   Faculty of Health Sciences Ben-Gurion University of the Negev, Israel PREPARED Center for Emergency Response Research Ben-Gurion University of the Negev, Israel