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spontaneously within 1 2 min Depending on the experience of the medical team, options for securing the airway may include: an appropriate-sized endotracheal tube with laryngoscope placement; a cuffed tube that can be inserted blindly with in ation of the cuffs to isolate the trachea from the esophagus (eg, Combitube); and a selection of laryngeal mask airways (LMAs) Some LMAs now have a double lumen which is designed to allow vomitus to bypass the LMA (eg, LMA ProSeal) These are easy to insert with a little training and do not require the use of a laryngoscope If the athlete is unconscious because of airway obstruction as in a severe laryngeal injury then a surgical airway should be provided Needle cricothyroidotomy is useful if high pressure oxygen is available, otherwise a formal cricothyroidotomy is indicated.

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Node. An AppleTalk node is a device that runs the AppleTalk protocols and is connected to an AppleTalk network. The device might be a Macintosh, a PC, a printer, a router, a gateway, or some other device. Socket. An AppleTalk socket is a unique, addressable software location inside an AppleTalk node. It is the logical point at which upper-layer software processes interact with AppleTalk's networklayer protocol, the Datagram Delivery Protocol (DDP). Network. An AppleTalk network is a collection of nodes connected via cables (or wireless

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Cricothyroidotomy kits can be purchased for the sideline doctor s bag, and the technique is taught in ATLS courses While the medical team leader is attending to the athlete s airway another member of the team can check for circulation by feeling for the carotid or femoral pulse If this is palpable the systolic blood pressure is likely to be greater than 60 mmHg and adequate for reasonable tissue perfusion Pulse checking is no longer recommended as part of the cardiopulmonary resuscitation (CPR) protocol for the lay person, and for medical staff should take no longer than 10 s to do If pulses are absent chest compressions are commenced It is best to have one person perform the CPR protocol doing 15 chest compressions followed by 2 breaths and maintaining a rate of 100 compressions per minute and 10 12 breaths per minute (American Heart Association 2000a; Bruzzone et al.

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Hospitalization and Coordination of Services Team members work to prevent hospitalization Team continues to work with hospitalized client ACT team consulted prior to hospitalization Treatment Goals and Foci Team works with family Assistance with living skills Build on strengths Service Elements Intake assessments at admission Clients involved in treatment planning Clients consulted prior to major decisions Client Characteristics Severe and persistent mental illness Program Capacity Limited team caseload size New clients admitted at a controlled rate This work was a great resource in examining the relationship between program characteristics and outcomes associated with ACT programs (McGrew & Bond, 1997; McGrew, Bond, Dietzen, McKasson, & Miller, 1995) Several organizations attempted to further clarify the model One such attempt was the States Helping States meeting in 1996 in Fort Worth, Texas, that brought together national experts, researchers, policymakers, and advocates to review the work of these practitioners.

The meeting helped clarify the current state of assertive community treatment in the United States and confirmed the need to build consensus regarding national standards and to define practices necessary for model fidelity A number of events were happening at the same time on a national level to encourage evidence-based practice in mental health In 1998, for example, the national ACT standards were published by SAMHSA At that time, NAMI had begun strategic planning and commitment to ACT dissemination in all states by 2002 NAMI commissioned the writing of the PACT manual and mobilized their local advocates to push for inclusion of ACT services in all state plans In addition, accreditation agencies and individual states adopting the model established standards, although these vary from national standards.

The Rhode Island Department of Mental Health, Retardation and Hospitals was one exception as it committed to replicating the Madison model by developing standards for its Mobile Treatment Teams and a process of certifying programs in the state for Medicaid reimbursement It was estimated that at the time national standards were developed there were 400 teams in the United States that called themselves ACT, but only 75 achieved adequate.

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