The Journal of Emergency Medicine

Department of Emergency Medicine, Hazrat Ali-Asghar (p) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran REFERENCES 1. Aslan S, Cakir Z, Emet M, et al. Acute abdomen associated with organophosphate poisoning. J Emerg Med 2011;41:507–12. 2. Christoph RA. Organophosphates and carbamates. In: Manual of toxicologic emergencies. Chicago: Year Book; 1989:626–8. 3. Makrides C, Koukouvas M, Achillews G, Tsikkos S, Vounou E, Symeonides M. Methomyl-induced severe acute pancreatitis: possible etiological association. JOP 2005;6:166–71. 4. Lankisch PG, Muller CH, Niederstadt H, Brand A. Painless acute pancreatitis subsequent to anticholinesterase insecticide (Parathion) intoxication. Am J Gastroenterol 1990;85:872–5. 5. Robey W. Insecticides, herbicides, rodenticides. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency medicine: a comprehensive study guide. 6th edn. New York: McGraw-Hill; 2004: 1134–8. 6. Hayes MM, van derWesthuizen NG, Gelfand M. Organophosphate poisoning in Rhodesia. S Afr Med J 1978;54:230–4. 7. Exner CJ, Ayala GU. Organophosphate and carbamate intoxication in La Paz, Bolivia. J Emerg Med 2009;36:348–52.

, RESPONSE TO LETTER , To the Editor: We appreciate the opportunity to respond to the comments regarding our article (1). In the context of costeffectiveness, it is certainly irrational to recommend ultrasound (US) for every patient with organophosphate poisoning (OPI). In the present study, we recommended US for patients with abdominal pain in the course of OPI. It is well known that US is a low-cost and repeatable modality performed easily at the bedside, without untoward radiation in the acute setting. On the other hand, it would be more reasonable to proceed with abdominal computed tomography in patients with persistent vomiting and high serine amylase levels, with a thorough search for pancreatitis. Mustafa Serinken, MD Department of Emergency Medicine Pamukkale University Medical School Denizli, Turkey REFERENCE 1. Aslan S, Cakir Z, Emet M, et al. Acute abdomen associated with organophosphate poisoning. J Emerg Med 2011;41:507–12.


, COMPLIANCE OF THE AMERICANS WITH DISABILITY ACT , To the Editor: Revolutionary, technological advances have been designed and implemented in our country, which have increased the accessibility for people with disabilities. These technological advances include: Telecommunication Devices for the Deaf (TDD), handicap-accessible parking, cement ramps from entrance of parking lot to the facility, and electronic door openers. On July 22, 1990, President George H.W. Bush signed into law the Americans with Disability Act (ADA) of 1990. Under this law, no individual will be discriminated against on the basis of disability, including deafness. With the passage of this law, the Civil Rights Division of the Department of Justice became integrated into ADA policy to enhance the enactment of the ADA legislation. With the employment freeze of the ADA and the overwhelming number of complaints filed yearly requesting compliance of the ADA, it has been a challenging problem for the ADA to ensure that people with disabilities in our country are not subjected to discrimination. During the last 40 years, leaders in our country have designed and implemented revolutionary, technological advances that have dramatically increased the accessibility for persons with disabilities. These advances include the following four components: Telecommunication Devices, handicap-accessible parking, cement ramps from entrance of parking lot to the facility, and electronic door openers. These components have been carefully integrated into the Americans with Disability Act that ensures implementation in all states. Once the ADA was passed, the Civil Rights Division was integrated into the ADA to ensure optimal enforcement of the law. Dr. Richard Edlich was appointed to Director of the Emergency Department (ED) at the University of Virginia Health Science Center (Charlottesville, VA) in 1974 (1). One of his first accomplishments was to work with the gifted scientist in internal medicine, Dr. Dan Spyker, to develop a Poison Control Center (2). After they developed the Poison Control Center, they naively thought that all Virginia citizens could contact them for guidance and advice regarding drug overdoses and drug reactions. This momentary naive overconfidence was shattered when Dr. Edlich received a handwritten note from a deaf disgruntled mother of a patient. The mother’s note was a cry for help because she could not contact the Poison Control Center for advice regarding her son, whom she suspected had taken an overdose of medication. She indicated that neither the Poison Control Center nor the University of Virginia Health Science Center had a TDD.

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