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4A ANNALS OF EMERGENCY MEDICINE 37:3 MARCH 2001 Joseph F. Waeckerle, MD Editor in Chief E-mail: [email protected] Michael L. Callaham, MD Deputy Editor E-mail: [email protected] Associate Editors William G. Baxt, MD, E-mail: [email protected] Robert K. Knopp, MD, E-mail: [email protected] Judith E. Tintinalli, MD, MS, E-mail: [email protected] Ronald L. Krome, MD, MBA Editor Emeritus Editorial Board William G. Barsan, MD Daniel W. Spaite, MD William H. Cordell, MD J. Stephan Stapczynski, MD Richard C. Dart, MD, PhD Robert L. Wears, MD, MS E. John Gallagher, MD Donald M. Yealy, MD W. Brian Gibler, MD Ian G. Stiell, MD Steven M. Green, MD International Member Arthur L. Kellermann, MD, MPH Brian H. Rowe, MD G. Patrick Lilja, MD International Member John C. Moorhead, MD, MS David H. Newman, MD James T. Niemann, MD Resident Member David L. Schriger, MD, MPH Consulting Editors Brent R. Asplin, MD, MPH Robert A. Lowe, MD, MPH G. Randall Bond, MD Robert A. Schwab, MD Jonathan L. Burstein, MD Kathy N. Shaw, MD, MSCE Charles B. Cairns, MD David A. Talan, MD E. Martin Caravati, MD, MPH Jonathan M. Teich, MD Theodore R. Delbridge, MD, MPH Stephen R. Thom, MD, PhD Marianne Gausche-Hill, MD Knox H. Todd, MD, MPH Keith T. Ghezzi, MD Ellen J. Weber, MD Philip L. Henneman, MD Allan B. Wolfson, MD David M. Jaffe, MD Abstracts Editor Evidence-Based James T. Niemann, MD Emergency Medicine Peter C. Wyer, MD Book Review Editor Change of Shift Editor V. Gail Ray, MD Bonnie Salomon, MD Research Methodology Editors Robert L. Wears, MD, MS David L. Schriger, MD, MPH Richelle J. Cooper, MD, MSHS MARCH 2001 VOLUME 37 NUMBER 3 Journal of the American College of Emergency Physicians Editorial Office Colin C. Rorrie, Jr., PhD, CAE Executive Director Elaine M. Jastram Membership Division Director Nancy B. Medina Journal Director E-mail: [email protected] Jody Hundley Editorial Manager E-mail: [email protected] Larene Schiltz Peer Review Coordinator E-mail: [email protected] Rosalie A. Murray Peer Review Coordinator E-mail: [email protected] Judy Ahlers Senior Manuscript Editor E-mail: [email protected] Penny Dietrich Composition Specialist E-mail: [email protected] Annals of Emergency Medicine is owned by the American College of Emergency Physicians (www.acep.org). Manuscript submissions and editorial correspondence should be sent to the Editorial Office. Annals ACEP PO Box 619911 Dallas, TX 75261-9911 1125 Executive Circle Irving, TX 75038-2522 800-803-1403 Fax 972-580-0051 Instructions for Authors and the Manuscript Submission Agreement are published in every issue. Annals of Emergency Medicine (ISSN 0196-0644) is published monthly by Mosby. Corporate and editorial offices: 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. Accounting and circulation offices: Mosby, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at Orlando, FL 32862, and at additional mailing offices. 2001 subscription rates are effective January 1, 2001, through December 31, 2001: Individual: $125, USA; $168, international. Resident, student, EMT: $59, USA; $97, international. Institution: $221, USA; $265, international. Single issue: $23. Prices are subject to change without notice. Printed in the United States of America. POSTMASTER: Send address changes to Annals of Emergency Medicine, Mosby, Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Business correspondence (subscriptions, per- mission, and reprint requests, advertising sales and production) should be sent to Mosby, Inc, at the above address, telephone 800-325-4177 or 314-872-8370. Copyright © 2001 by the American College of Emergency Physicians. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the Publisher. Neither Annals of Emergency Medicine nor the Publisher accepts responsibility for statements made by contributors or advertisers. Acceptance of an advertisement for placement in Annals in no way represents endorsement of a particular product or service by Annals of Emergency Medicine, the American College of Emergency Physicians, or the Publisher.

Editoral Board

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4 A A N N A L S O F E M E R G E N C Y M E D I C I N E 3 7 : 3 M A R C H 2 0 0 1

Joseph F. Waeckerle, MDEditor in Chief

E-mail: [email protected]

Michael L. Callaham, MDDeputy Editor

E-mail: [email protected]

Associate Editors

William G. Baxt, MD, E-mail: [email protected]

Robert K. Knopp, MD, E-mail: [email protected]

Judith E. Tintinalli, MD, MS, E-mail: [email protected]

Ronald L. Krome, MD, MBAEditor Emeritus

Editorial BoardWilliam G. Barsan, MD Daniel W. Spaite, MDWilliam H. Cordell, MD J. Stephan Stapczynski, MDRichard C. Dart, MD, PhD Robert L. Wears, MD, MSE. John Gallagher, MD Donald M. Yealy, MDW. Brian Gibler, MD Ian G. Stiell, MDSteven M. Green, MD International MemberArthur L. Kellermann, MD, MPH Brian H. Rowe, MDG. Patrick Lilja, MD International MemberJohn C. Moorhead, MD, MS David H. Newman, MDJames T. Niemann, MD Resident MemberDavid L. Schriger, MD, MPH

Consulting EditorsBrent R. Asplin, MD, MPH Robert A. Lowe, MD, MPHG. Randall Bond, MD Robert A. Schwab, MDJonathan L. Burstein, MD Kathy N. Shaw, MD, MSCECharles B. Cairns, MD David A. Talan, MDE. Martin Caravati, MD, MPH Jonathan M. Teich, MDTheodore R. Delbridge, MD, MPH Stephen R. Thom, MD, PhDMarianne Gausche-Hill, MD Knox H. Todd, MD, MPHKeith T. Ghezzi, MD Ellen J. Weber, MDPhilip L. Henneman, MD Allan B. Wolfson, MDDavid M. Jaffe, MD

Abstracts Editor Evidence-BasedJames T. Niemann, MD Emergency Medicine

Peter C. Wyer, MD

Book Review Editor Change of Shift EditorV. Gail Ray, MD Bonnie Salomon, MD

Research Methodology EditorsRobert L. Wears, MD, MSDavid L. Schriger, MD, MPHRichelle J. Cooper, MD, MSHS

M A R C H 2 0 0 1VOLUME 37 NUMBER 3

Journal of theAmerican College ofEmergency Physicians

Editorial Office

Colin C. Rorrie, Jr., PhD, CAEExecutive Director

Elaine M. JastramMembership Division Director

Nancy B. MedinaJournal DirectorE-mail: [email protected]

Jody HundleyEditorial ManagerE-mail: [email protected]

Larene SchiltzPeer Review CoordinatorE-mail: [email protected]

Rosalie A. MurrayPeer Review CoordinatorE-mail: [email protected]

Judy AhlersSenior Manuscript EditorE-mail: [email protected]

Penny DietrichComposition SpecialistE-mail: [email protected]

Annals of Emergency Medicine is owned bythe American College of Emergency Physicians(www.acep.org). Manuscript submissions andeditorial correspondence should be sent to theEditorial Office.AnnalsACEPPO Box 619911Dallas, TX 75261-9911

1125 Executive CircleIrving, TX 75038-2522800-803-1403Fax 972-580-0051

Instructions for Authors and the ManuscriptSubmission Agreement are published in every issue.

Annals of Emergency Medicine(ISSN 0196-0644) is published monthly byMosby. Corporate and editorial offices:11830 Westline Industrial Drive, St. Louis, MO63146-3318. Accounting and circulation offices:Mosby, 6277 Sea Harbor Drive, Orlando, FL32887-4800. Periodicals postage paid at Orlando,FL 32862, and at additional mailing offices. 2001subscription rates are effective January 1, 2001,through December 31, 2001: Individual: $125,USA; $168, international. Resident, student,EMT: $59, USA; $97, international. Institution:$221, USA; $265, international. Single issue: $23.Prices are subject to change without notice. Printedin the United States of America. POSTMASTER:Send address changes to Annals of EmergencyMedicine, Mosby, Periodicals Department, 6277Sea Harbor Drive, Orlando, FL 32887-4800.

Business correspondence (subscriptions, per-mission, and reprint requests, advertising salesand production) should be sent to Mosby, Inc, atthe above address, telephone 800-325-4177 or314-872-8370.

Copyright © 2001 by the American College ofEmergency Physicians. All rights reserved. Nopart of this publication may be reproduced,stored, or transmitted in any form or by anymeans, electronic or mechanical, includingphotocopy, recording, or any information storageand retrieval system, without permission inwriting from the Publisher.

Neither Annals of Emergency Medicinenor the Publisher accepts responsibility forstatements made by contributors or advertisers.Acceptance of an advertisement for placement inAnnals in no way represents endorsement of aparticular product or service by Annals ofEmergency Medicine, the American College ofEmergency Physicians, or the Publisher.