EXHIBIT 1 - Death Penalty Information Center · News from The Associated Press ARKANSAS CONDUC'iS \ATiCN S l ST DOUBLE EXECUTION SINCE 2C00 3v ^rloFfa ftlrLlo lrs rti rr t r esE!

$Page 1: EXHIBIT 1 - Death Penalty Information Center · News from The Associated Press ARKANSAS CONDUC'iS \ATiCN S l ST DOUBLE EXECUTION SINCE 2C00 3v ^rloFfa ftlrLlo lrs rti rr t r esE!$
EXHIBIT 1

ELECTRONICALLY FILEDPulaski County Circuit Court

Larry Crane, Circuit/County Clerk

2017-Apr-27 09:15:2360CV-17-2102

C06D17 : 173 Pages

News from The Associated Press

ARKANSAS CONDUC'iS \ATiCN Sl ST DOUBLE EXECUTION SINCE2C00

3v ^rloFfa

ftlrLlo lrs rti rr t r esE!

Page I of .1

E8IG SIORY

oe eoo,o f]

rop NEyts sp€ct t covERAGE ARcHtvE EspAliot, vlDEo RADIo F;;:=---6'l

flIEEE3

r.. lt i r.!

CAN YOU RUN AN s.MINUTE MILE?Special rate life insurance for runners

106'RiEr.5Ar

s&

\'.A.E\E Art L-APr Alt6 6m6E&ir ll FE Mltnt adhnt mI:raF Arlne lb h& @.!i.dthR 6. Fs <Le sdudrE rx!

I&l 16B d*l \LNl ll'UIaElurtd Lliul rF<nft tiE 46lm \tsd- ruAhl ,usr .IslthR IeE.p.i lr (a rlE Btdd$i. mh6 h tiE Ltui.d

r\hi.lG t: \'6c!tsd orh.dul rlbldr .na : p h,lffis ld lllllllru 16 ..sr.erd. ,.d.r.l lud5. !ud6 LEr bbeft d.l4 h5 .IebdL 6!rffi.tei16 tlE.el,.rftLa crI l d TtB..l,rFt Td-'s-6 6rE lc hF d'd 6dIEg luE d {w ltE s.in. t .trffi'g.E.l dau.d tur OE ,udt ut6t

El*El= s"r"

OIJBfl

)TFTT

-tr,rI.

@IiAsc^nttASC^R st r D.b Eamha.d ,r. toretE at erld of r€.rd!

)lmE lotr.Egl grabs ar! A.tsrol *in.fte. Larson mlslEp

R h raslE out iIASC-AR re atadroi 6t l l,tdiaY

Enk ,oo€s mat6 n ? straqht thlsse6oo with xfinrty wrn

D. ,ers try"E to figure otn dte $d<y

3Ee-

x sc n sTAI{DrtaGs

http://hosted.ap.org/dyDamic/stories,'U US ARKANSAS EXECUTIONS?SITE=AP&SE ... 1t25t2ol7

News fiom The Associated Press Page 2 of4

lEnyldr-IErl&rdWII-Er-FcrEd&.drlOSpa

t!lbc8.F6bf, n/Ee'eE'Ed.dt "Jf!*rIEaa5dGFnf,!od&& Ivl!tthE trd D.aG d.6G,drt lE lt dtErd th, ltl&a!.,dD rdshr {D Frla. drld t Et&i.'El!!4'.b.ih b...e oa

tt Eu! lsE EF.cd bdc

laE €snrod.dtlqlri.rq5 rT. .d rd&f, .a Mdrlli!+ lL c.fhd tE xrb tE

lL E .l- dwr.t d oa

.tn,*V.li!PhnS. rl'F.!dd&{tErdi-qwldh{dErp. &d tll!'G b Eddr

Idslrd {&tllr !rd! niE r.!..& l6GutE lLrEd. in ddr& -d hah.d.Ls.n!.nd 6Fsl<-Ed

lltDE' 'aEtad .t iy i.L6 nIndr 6i rdE ltr l.ir dtd

First-TimeHome Buvers

Program

OL'.'g,.Ht?@

oRI\€r ,v eaxrclEEr.n a

L-tsrTGl. ,

,er l!e..E !

4..., L*do 3

l

itr,E N.116,.d 6 b tr abdr dre)-

Ai Ad*d h.. EFE *tE i,rnEd dtcer rdd ra6 Ewd ht tp.bE8r & lhBid6l&r ra.ddn-d.rd 6d&Fr.b6E d.Fi rt l!. @d! i6EdY h rtrb r.w Erdnt l|,rdEl..?p.d lEnt tFrrE .dElt6ffi.dtadEddE rdb.r- FqgIE d <b.d i 720 pa

A.r.d *rF IqE tF !Gd. Atr'g D.p!b!,.a Cdldi't+.}t.Bs.br Gr.E tid tt6d-!ro.d rtlj lh. !r& ,. +d.!utB to tt&pr6Ed &tl6. $radr f(rlr.r, rd li.lrrE tE6. ttE..n C. tted 16r

willre! w- dlt dv b tlr d.dr d!.d6 itB rb.Erpc&e a.y w- u!.t !t wa da.l di ot dE<n.&.d Ed th. trtd! n6 ra hqrglub.d a.tu th. rrE! Mld

&di.lh.C, AsH'rrdtldrdt(lrldtb6&.iU.G.6! G - lrnry pd.d 6 AFI It aEHGreu Eld h.EtGr t ldte.ll&it-d!.dT.?id FDd s lh U5. 9T.a.Cdli Bddd i!. (l.drFufre 6 Lc76 IIE st&rad o.cradEE ad b b. (&.d dr Ddo.r iB.+dydcldsl lFrneq; oFBoAts I

E i& !E rF GrrEullailr, Ai.a por b&dt aE d6t6& l, r,..L lrd lB. tk lc.&d.d b. rrE!i.? [email protected]

Bdc LdFt* [email protected] &ctutiE 26a. ddrbl. Grndt ic 199

Jcs. wtDd.tturd rhrlitt!&h dldkE d,UL.d b. p&6n &d! re. LE !'ld 6Enl! &rlEd.c. T6s?'.Itq.GtE Er- bEr t{tb ! ttltv6 -d I6td. !Ea-,'!r eldb ilE dr!tsv 2rtd.

$hUEB (I&Ed b d&.&!.1

TITERACIIVES

ao

EE ItC IE(AS IErl}IOITB

rB5lll6tEt]r

.IEd'ID5

J

oerEaTst!flEfif n ESD6ASIAY .f qE'IEI FOR

tliEt&, carefiDrs rEFtY ro -€s,EEglEXE(IET

- ooslnsrllrooEl ra*Et (r LEr}rr.

i6,E qrEcoxrs mrrc al ltea!crEornPiE

t ArEsr t€Yts

EXISaoarrllf,fi'.stsr Dcrf,E dEorIor 9t0a20A LO(IT llC PmAnES r,O

€,Ed'IBDC UtE .P(tE rr 6 tsgrt SqrdEED ro uiEcroilF(s 3€ElrrE0EE6

EE@FCCiCGF ra5r6SrES

EGCUI-fi ffiPIEi'B

IrIThttp://hosted.ap.org/dytramic,/storieJUAJS-ARKANSAS-EXECLTTIONS?SITE=AP&SE.. . 4/2512017

News from The Associated Press

You ay Lika

bc plaad 6 th.r ir *ill bc plfttd in (@., th6 cEin< tub6t nn.l ddate 0ikc tollap$d hut)," his .rdrEF sreE in o c,lis @rt 61i.8 astiry isric to

Sorh tm w(. $^t{ lel lMls 6 Mqday afi.fun. a(qdo6 lo G.ar'.s, |lE@dEti6r &p.nin r 5F)l6Dan. J(E had tried dn ko, Pot ro loEs with ttrt rs!ce, beef islv bnG. drk @idy b.6, a dlmlare rilbhate od r'uil Purdrwilli s had ti.d .trict6, t€ME puddin& md6, No sodo ard porato loSs with

ln tt]@r pl€dinF h 60r state dd fedsal @urrs, l}k imatlE eid tlE thN dDtsArkans us tocx@lc pnsftB - midaalam, v$mnium brcfri.le and Pot siomdildidr - @ld b{ imffGtit b€@u* ot rlEir poor rralrh.

Williatu Mi8if,ld {& pounds, we diat'eti(.nd had ( (reN th rh( (a.tutid tcam

midt mt b. able to tud . sir.ble $in to $PPort an intG\tru lih.

Ttp por tEalth o, bolh me, th.ir l.r-1'6 .rai,Ed, oluld ele ir dif6@ll 60r ilit to

6pdtd duin6 a ffii@grs ckd ioll@ing a megade of mid&Lm. TIE 3t rc

stEuldn t risk tiviry ttm druts to srop their lags artd h.arrs ii ltB' .Bld.t,Eic, ttE,v h.E rold [email protected].

tlE lad sr.t ro put mo^. itEn (m imate to &arh o rtE $re d.y $ 6 Terrs, whidrl:t@t d lwo ldlLc in Au8rrst zm. O*latma Plm.rd a doble qNtion in z)l4but sapF{ pLc id ttE sqd m arr6 rlP d@t o ol Cla}ro L6kcn n(tI

Arkans e@htd tuur mo in .ightJay penod ii 1960. Ira 6ly quicklr P..eiElu(H qu.druplc cx($ii6 in 19?6 and 1930.

wiuiahs was sl to death 6 fo. the r9q raF and killi^8 of 22-yearold Stacy

Eri.kq, whoh t!'kidnapped frm a 86 $arim in .€nk l Arkall*.

Aurhonii$ said Williamr abdud.n ad raptd t 'o odEr wdo in lhc days bcloc hc

was arEsled itr EFicLs, death. Williams admittr.d BFfibililv to t}. stat Parole

"l wish I @ld tata n b&L bul I .d t,- r{ illiaro rold .tr board.

ln . lcttr 6rlid this !!Mth joE sid h. s'6 ready o be tiUsd tr.r tt slaL- TIElener, Ehicn his artomy Rad d@d ar his deffi r€dina, wdt o to ne "l stEllmr 6k to be forSivcrl ld I hamr tE nth_

lnduding ,orss .nd Williamt niR Fx?lc have b€r md in the Lnitad SLt.5this ye.r four in Tcr.r thN in AtkaBs and (N €eh in Misun and viBini.. t5tv€., 20 rEoplc &r !a($tli, dom trom 98 in 1999 Jd dE towsl truhbtt sire I4in 1991, a(sdint to ihc Drath PsElt-y Inf(mano Cdler

Asiated Pls qire6 Jill 6led diribut€d to lhis (Ton from Lilde R(k.

FoUN Andrcr D.Millo ar lw n s cori.lads llo and Keltu P. Kisl.tlwy iritlr co.n/kE€bp

O:Dl7 Th€ Asoci r€d Pr€*r At ngans rc6€n€d rhs matald nay mt !apuuist€d. !ro6(t.3t. rExrlidl o. rcdistituEd L€m rcc aboul @. Pnv&, Polit

Page 3 of4

sFor{s(nfD lI{(s BY Tê}An

WHATDiOTSYOURNET HEif'S wrIY GIAS AXE YOI,AE IN FOR A EIGWOATH SAY AIOUT IIOW OESESSED IdTII' TIIIS SI'XPRISE IN 2OI7I[ YOUYOUAIXETIXE! UNDINWEAR OI{IN A HOME IN PENNSY

EXHIBIT 2

News from The Associated Press Page 4 of 4

FAI\'ILY TAXES SAME TTIE ALL NEW 2018 fORD T. THE MOST AND I-EAST

ITIOTO FOR Z! YEAIS. T5O GETS A NEW IOOK ETPENSIVE DIAMONDIAST ONE tS A TEAR'ERI( SflAPES

3l!L \lLr' |r$Finr

http://hosted.ap.orgldynamic/stories/U/US-ARKANSAS-EXECUTIONS?SITE:AP&SE... 412512017

2 killers execuled horus apart Page I of6

7ArkansasOnline

16r,Et tnrd',tr,nn'"'

i'r:1r. lir :. i ,:: ir!

I-5ffiz killers executed hours apattBy ir &5ry , !s Hirc.-lr , ($. lft

72 S.zdr Art t3.#E*.*" I y

1r! r,,i. lr r! ii.r

\prir Pftd-r

TO9 ECIG

COI{GRESS PASSESMORTGAGE STIMULUSFOR THE MIDDLE CLASS

CqEress gwsho,n€owners whooE l6a tun L

ffig"***\xxi ,1,flrcftg4eTho6e wtDhovool m6s€d arnodgEgepoyrnent canqu8lify. TlleProgrsm ir tdaryf.ee and (bos.r'tadl ary eltra coslto tour ref. Th€prcgr€rn expirgstht3 srrnfl6.-Ewndsy pcQl€arB ftllalg o(lt filsfolm, vill you takcadvantage?

Tap Anywhere ToRccalculate YourHouse Paymenl

L\ECtrTIo\S: ln-depth look at -nen rvhose deaths .{rkansas

scheduled

GILADY h thc Erbnt fi6t doublc cxquimsin e ?0@, Arl.res doliverod ho:.t stoP9ing

does oi lcth:l d.u!t a{qld.y î8ht

to dothro* inm.tes Jxk lo.s Jr., 52, .rld Lr.C

JdE r.s p.o.rorkcd dcrd.r 7:20 p.m., lrmnutca :fid th. cr<uti6 bogan, p.i5on

Ihe rotrktcd nrurdoror mowd hit lipt fot

.bo!r trc minutos .fier thc firer druB cdtorod

hr body .t 7:06 p.m.. &cordin! to *itn 5e

tuldrw Der.rtto ol TIE ArqEtod pr35s. ltwr$ ! cterr tfEtts thc im.te r:s trying to

tpc.l. beerrlc th. ch:nlb.r mtrodto.. ,r,

'\j, ':.-r P' iPl l-\li

2 rtk i Gr.d ho,r a.,rtbr Oiki.6 r^n|' oa. 8-i, QErtttL L.t ,D surl, E!.d ,t p.68 b.rnhin. tLyit r4.r . rad&

td llLr, &dr at, .ei in b t r! h.E/d rkti: crdrEE r.ta2

L . t .r ti& aEdr 4d,.a 2 ,-dd

l.r.B ilta * R rdd oa I-r{ lYaj-6'liL; reqE, i4.eil

jlli,PPI\(i

http://m*w.arkansasonlirre.con/uewst2ol7 tarri25l2-killers-executed-hours-apart-20170425i 4t25i20l7

2 bllers executed hours apart

Click here for larger versioos

Arhnsrs exeortions

Click bere for larger versions

tl,tl.d dl .ftc. nb fh.l ltrtdrsrt, Deraltlo--

!F io i5(] dtS€e ,rEE tt*9

a- -!16 ru{. cx ! ro,rq

FE il-H.g,*-,,*Sqr.n n@ *rides

'ld P$ O* tr l&.in Utn.

Page 2 of6

DR..d i6r.d 6, Id!

Jons; co.E rol6rEs ir dElid .i 7r l r p.m.,

rld l,b ciest ro!. rd lCl utll.bod 7:13

Otftal5 do.t iihirre. lne rEo.ld Jld thi.d

drtr h the th..e+u! i.ro.tidr prEers l'ltllue ixn te n dete.mh.d to be ur.illcirl'.

h hrnyierl .fte.r.rd, Deralto.rld tyro ,rv6m.dir widEr6.6 r.ro.t d rE obvi:G rignr 0{

tufleriB o. prh.

&t i t d.r.l co(rt ffltl: L.nitt!d lho.tly.fte.m.d (b6..5ed -EE erEuti,l .6_ldt-rqlr,'rilh the irn le'nEvit hir tlp.rld grlt*|. to..f nue ttEr tiro mirn6.ltc. ttr l.d.tiir. dq, mid.Dtrn, wj

ItE ritil! by l'/'{lirtt3 atao.icr! iLd U.5.

Oi{r'<t Jl.rdlc xrbttE E&. to p.6tpdE

h r.?0.6., tlE slrt .ttoflley ldr.ft orffc.!.td d. fiti; 15 'Lr.(.lr.tC rd dut d.i|6oa .rom6 nEdq hir l9! rn t.rpi! wr.e'rn1+F.rad by Faas -rortrs 6 dE -curB

[*.rr podpdEtE i &Lyed wlli-|.'.rEllin fo. .bo.n tro hdrs .3 9F Dvirur.dtL (-r rd ldd. h.rtl by IC.CEE.

^rtel d. &clh.d lo lElt th..tr .l,till, tlE

curtaiB oa dl. &.tn chr$.r opo..d .t 10:15

p.m. -co.diq to nEdir witmrsor. Iio lvs

.pF:!.d to bo h@li<, rD.

,ri5.n *rd Llted tlE rit dq .! 10:16 p.m.

lYillirE .loed hir ey... witlE s6 s.r &ePb.e.lhiB. 8y lo:t9, hir he.d rolled to th.ri(b. rftr. cuncid,irE E clt d.t l0:2t,5crecutlooc mov.d tof,..d rdE pe.lon rdnErh.d th. rorltr. 'nn ,lot sr.,' eordl!b wii.rs fd AP ..ro.t.. rblly xis.t.

At m:2., Willirir' b.e.thir! #-.d ro rt"prd fE !rhrx.d. 15 r.5 p.uurrc.d de.d.t

^,l.,Ea lus er6ln.d rrrE iln tel in five

d.y: .t tlE Curmk6 p.trdt urtt .r Gr.dy,:b;l vr tnlor 5oilr..!t oa Pi. Bt!ff. Ith t'l' cdi/h.d kilb. Le&lt t6, 5t, dlThrid.y nlht.

Gor. A!. tr,t.nhsm iitiCty rdE.lraed e:hler..nirE oie. It d.yr, I| up.lc.del|ted

FEATI:RED JOBS

orlr 17 I Lie Ro.r AF

HICXORY H€IGH'S

0.r:t 17 I Llde Ro.t aR

L6c.l 5e.rer.ry/Sch.du&r

0r ti- 17 | Litte Ro.t. AF

AFX DEPI OF COI/T/IUNI'Y CORRECI

Crlnd.t(htb://firtr.!o0fr.cor .notc.ho

04..a, OLat tdffi aE-rdrlrEtEttrE,ll

n Ilt Otlp.J/dantaao.hc.cotl/. trlc.LtlolT$HntsEllr9rrfluE{lFBro{ xrr T/3r5592{mt7{$

P.al Y- orr L.drtLc. t tl-E Ptlltl ltntc.aOtE//rt-r.to.f !e.6vcrsf cd.eYom{rllta{ SIERP[cf,dr-Prxols+AtfTrf{TIu-n0citzt61tot/20t 7.0+25ro)

krr.t.doafrrrft.-eErlalt[tl,rl(hl$r/ t ns.!o.Ih..con/.ralc.Lo,

rta

nf,25

II'E

rlJa(lDea - lst6c, L@ asE55 &bClicl bere for larger rersions

Arl(lmos 'Ixdcr

victin's drug...

cdnl A6- A- 5*C.rd llb- a-ir arr

(d'!rEEtvn.

carrr AdqE PttrlrCEr.J ,.tE L-,rta,*l,.t E hl tttr.

http://www.arkansasonline-com/newJ2Ol7layl25l2-killers-executed-hours-apart-2Ol70/.251 4125l20l7

2 killers execrsed hours 4ert Pagr 3 of6

ttt^r[I) llrrlfs1,6EtRtdd6,rYlliE ttr.

J..r -trB rdy tr E atb

Gorrrd! Ioltltllrcotrrr-.r.a. iEd-lfrd11116rffibibdr C.r{y h t9?l.

lft pln +rrd l!-t|cr EE Ur U.l rdh drirrb rhd h.| tt d..th Frfty.IttE cdr rl srAy &6.rtcd tlr.fu.'Artr5'diro!,!.rLl .ttmer to rhh is&dr rfi h Cdd( eE r6bo.'

cd,rr !t ta -ld lri.Ea aord o, Mrt (fio.r3r hr.., lEvc 9@dEd lo, d th...tr sd.iti.d ci5.. Or.rEr trEa.rd cdnird liri&.r, ,ed|dr ltrI-E, irri b d. ffi iE {r, an lhrtd.y.

t{,rdrAr, {t rlr-h| EtlBfrdrl&h-uiqi d ccrEtoo rlt65,ltldtrcr crlld ttD qcrhr A.wbs,'adl|! to reoli6llf J.R- o.Yk

rao.6, h the qGrtbr dr-$.., 55 lnr.hb fh{ flglEtt clntr, ,lt r5.. t lr..p.a:Ett lo rne tnfy d i.6 nctitl.

^ llrdb Cofiy riry.!.amc$d rtdr h.

xrE f6 rrr. r9tt rI d liErS oa l+F--oad rry ,,LxF h d.lld r^d adrrf,afi.. *Ee tE ro.bd.

= E Ftd ha-a.rB

Fablt-Hln-E*rai.d-arrlEtFt!5dlErbrd,btrJtrlt Gl..

--r Hrre

btHrllJrl*EGhG-,lb-al-dF{tr.E.s!C-.HEEtb.rd

JoE rEo t .r Pfttrin I !-yo..-old dlla*s rIq e b.ay $d 9dL..i ff.lr durt dre radc.d, t@. rary Phtlid hrlb-d -d Lr.ry1f.dr., J..r6 rtttF6, 16.l t E Ftdt to wltEs

JcE h.d told dE Prde !o-d h. 13 .D.ty t ttlc td hA .th5, r.dE t|l-| tpcid rEe F-r

.\n {. r l6t rr* io ter dE J-r. ,rtrty rd lr.ry klr lE sty I .'d!. lrir. td erd.ynl.ht. 1 cf|r b{ero I dd ldn nfil tD lg. ... I lqe oE th Fr cd& tellr tlt t tL[y -r,-d I -i ,rot. nErtd.. ltErD rE. ,cdr rlry lrE lliifr h#n d tn d.y. I -n to 5tty,t q. Tr! to !rd..ird r lore Fr lte nt chrd.'

h . h-('lnltl{r th{ srrt E rt .!s !.Ye to lir.ttdrq, Jd r6dtt l, dE trt| t t u hc

dedk t d hh lf. h Firo.r to hdr rt r betls 9..!dr, rlarsdtt hb Pr-tke d ediiiltr -tdrbdydffi.1 n* dr ri|li Foplc -rd fi ltE rilt t fifr' th. !r.r-E* tdd. Thtc -c lb wG t Enld trly .E c nr, rrtrr. ,r dr p.h $.i I .-r..d.'

r-.ccy F flF !..1 tdd r.gdt's j. dtll rlr to dt rE Jo!!d la frlb.

'Its* itr tCy . dttcsa nr..d h dE n drt lDr,'trE i.U. 'rED t ddl -ld. ttttb htstcBbn h,rd{ Ey6. ... lm d.d ltl ft.. ..- fn lbd rhrt d*a.. b cbrd.'

icd[Ft.jd he tltE !.d Jac mcft oFn ittttf tn @don.bo, drE to filte tltEftun 7:t0 p.m. to 7:t! p.rE. lb cqr.rd n to. rn$ rith tB IEdr 00.ll rtd rrEl dldn0tll arb.X.'

'rb itd l.l.F- to b t*tB' b.tri !.1d.'lb rld ma .- to i.r. .lt{&r *.rwha ds ti-r li nEdL'

J.r..dd lEi p-t eff.r, EEr. rld, duih lr c.fu ria lE\ td d!, i.rrtale rErfl|.' ill.t iurS ldt... rdrr P.EE.d Pnr.

Jqrr rld fiI-tE Ht 5ih to Hl th.L qdrtldti dr frud rn r dr- lor ll.Ur Fot !,Ii.r r..rr rtt ro. botdEd c&E lnit Atlft- tl'-.iu! hrdLn ire.

Jqri *cJ.d lo di. rl.th$ idth.r .un rrl.l . Fio. ca d.t rtrhhl lHE ao l}r.isE

Ihe hr.te! try h6 -!u.d d* -!c'!t a- rEr.r llE rErt FF.t FG.rd drf:rb|. rll.in ae rs *o,ky6t [y r.{ sdt.b|'.d E. did. f.dy iEit .t t$.

Jd.t ,r..aid. A mel hdrcn t -a a p-li- sGy.a lrrE C*.6 d trLd dtdo! FdoloG r.X,i Etr sE, Ft, tit6 lrr- ladfr;r c-iy b-1 . .l@ab liflcldtctt!rrirfr{r pb.ct, ad tt pqd, O?It Ei d cdrEthlFfc.na Sddm Gr.r.t !il.

http:/Avww.aclonsasonlire.oomlwt*f2tnlqrD5l2-killers<xecrne&horrs-apct-20l7M25l 4125n017

2 killers executed hours apart Page 4 of6

Shortly after 6 p.m., the U.S. 9pr€me Court rejected Joi€s' t6t t$m app€als.

WitLiart6 w6 convicted in the l99a rape and murder of 22'year_old Stacy Errkkson of JactsorviLle.

H€ and Jor€s each hd spent mo.e than 20 y€6R on death rord.

wittiaryE had order€d a tast meal llorday afterrDon of tnre€ pieces ol fried chlck€n, potato togs

Mth ketchup. banan. Fldding, two Mountain D€lNs and nacho6 with chiti, chee5e and jalapeno

pepp€6.

At 7:,(5 p.m, the U,S. Suprenre Coun relected what appeared to be his tast wo p€nding colnappeats, and oepartnent ot Corre.tion olftials too& step6 to st rt hi5 execution.

But wittian|s- attorneyt t iere filiry do.uments with the U.5. District Coort in LittLe Rocl headtin€d

in red type: -UrEonstitutional exeaution immitEnt." Th€ lawy€r5 a5led fo. an immediate stay of

exe<utbn ba$d on problems tn€y saw with Jon6 lethal inie€tio.r.

witliams was on the 8urney in the exe(ution cMmber Lorday niSht wnen Saker is$ed a nay,

witn6se! raid. He was attov/ed to 80 to hB holdiry celt and use the restrmm. H€ rcrnairEd tlrere

until the stay was tifted.

A clememy petition to the Pa.oLe Board taid WiLliams was physicatty and s€rually abused as a

chitd. with his motier racilitating s€xualencollnters between him and older womeo in excharBe for

-On at teast orE cc.sron, lrarcet r mother pot a pot of water o.' to bolt. heated up enension co.ds

in the water, and then beat him, naled. with the cor(h untit h€ was coier€d ga!rEs,_ the p€htto.r

ray!, -tlis c&nns lvatch€d in horor as h€ tled the hdrte. stilt nat€d and b{ecdirg.-

Saker reiected WiLtiarE fiting ot an urcorEtatutional execlrtion shortly before 9:10 p.m.

when pnson officials as*ed for tast words, wiLliamr siook his head and mad€ no oth€r re5pons€.

The family of hisvictim, Ern.kson, dectin€d to comment.

tess than 30 minutes after williamr was pronounced dead, at 10:51 p.m. l oiday. a pnn of bLack

heane5 left the prison, wtrless6 said.

.EMOTIONAI ROLLER COASTER'Family of Joie5 and his victim w€re amon3 th€ rEady two doaen prot6teB drtside the Cummirrs

pnron gat6llon&y. anrorB them were Jones' sister Lynn kott and chitdren of Jafiri Phitlip6-

Zia Aihler, a 5tepdawhter of Jarnes Phittip6, said slE and other5 came to sr/ppo.t the PhllliF

Jone!' ex€.ution is \rhat was set for the trial, and this js wlrat th€ Phittips family exp€ds. 5o l'm

hopiry that for nry famitys sake, on<e this i5 atl over aM dom with, they lt be at peace,- she said

befo.e the ere.ution was caried out.

PhitLip!' son-in-[aw Robby JorEs. no ret tio.' to th€ inmate, taid after Jon€5 was dead: "ltl b€en an

eriotlo.iat roller coaster. We re ready as a famity to move oo.-

Antnd€ath pe6.lty p.ot6te6 were roirEd by Epis.opaLian priEts who tater prayed with Jack Jon€.

daughter. Glna Grimm.

At 7 p.m.. wtFn protesters rang lhe death totl, Grimm hetd Randy Gardner. a Utah rsident wlrc5€

brother wa5 the last to di€ iI the United st.tes by firing rquad.

koR sat in the p.sseng€. seat of a car, pEyiry and tooking at the tast pictur€s sh€ took with h€r

brotlE , ,un (hys before.

'l was letting him know that I woJtd be n8ht here untit ttle erld,' she s.id. 'lt was a pie(e ot him,

and it rvas rry y.dy ... of saFnB Soodbye._

kott ft€w in from Rateigh, N.C., on Thu6d.y and saw hin for tlle tast tirrE SuMay. ti€r broth€r

rar still in good spirits ad was t uty at peac€, sr'€ said.

she s.id 3he aslGd Jone. to keep . promis€ b€fo.e she Left him Sunday.

-lwanied him to promis€ rl€ that when he was on that tabte tllat he did not loa6 on tho* p€opte

behind ihe glals vi€w'ng him as a montter .nd antlcipah! wh.t ihey w€re hoping and praying for

on ttpir end,- she said, "that linstead] he rcutd be thinking ot me, ih.t lm riSht here and that lm

loving him tjtl the end."

Abdi 50 peQ{e protBted ih€ etecution out$d€ th€ gotemor'5 ma6ion lrooday €vening, hotding

flickerin8 wiite (.ndt6 arld p.aying befo.€ th€ executiol of Joiet.

http://www.arkansasonline.com/news/2017 /apr/25/2-killers-executed-hours-apart-201704251 4125/2017

2 tillers execrrted hours apart

IL -rErffi oa li cibn Ld flry oa d:r !. t r:. ri Cdl l+&,di.. d!d.ll-r,o. n c#lrb.o,tbH,..idLd&l t ta{e hr drc -D 10. ll.{trL

1dff d. k O|a d. ciic,rahn k r.idiit u! rd r(lrH[ vrhr rfi d brb-k ttttr.lc rfii &Ir ls. t fh 6 t,la tlEe b. rid l.td dte tbdr p.n{ty -0,6 $c crttry -_

r.i h rrbE- -id lDt h !eE_l rrrts -tG dD ladr,' lrpdrtdr !.1d. 'l rlr . prun l,lft.r|. I

le ny !ra. -d I td. dE sad!. It re're xrut dr itt.'

L rLr td ..tl'rt GabE orr rt &F E !T.r.!dcr.d tr art E5 CE a b.6r 5.9ts*..t'!!, E dht b og.trcr d cdrrtim rad6-

IlD dT.Ed dIda 15 rErry, Ftdt oficf.ft tdd, ma dE btrE tne fiel eFly o,

. !.(hlro .rq*.d fa. tt! dr*duf IriJ hr-tbn For@1, mil&lzr, iia et to.rDnD, brtDaE lrd (lq mlrrdrst .lalEc to !.U dd. FDdEts fE cc|tbtr. tlEta6 oa

rltulri -i rrE dr. trvo drBr h.!r ffi er6rtbE t*itride.

oqte dr. hr3 !-c Hrrdttql l.t, &dllt,r trt|a6 tEr tlart .r, hD $zd l! .aY.d

rqF-y rt rr lFt u.ir ttE b..k ti{ . p.oal U.! !.prct. Cart c... idtk.09ty tD dt }

^,rdr tfi{c .l:.ntf dc$r, fE, JdrEdl, r,no h- .f.ind frEE, 16 $.md nlrld.y

$lor(nrt3c U &Elib idE to dt rEIxAt itii.n ild.E h t6e.

^ t dr-.| lodle Je !ma.d . bd( to ..6gl E lr-. alhJt rffiLd ft. ocahr llrb

Ihrd.t. dr t unG rh.r artrlr[ cur5 rd t l hln qr lljl.t 6te ,idEn Tulih: .Int d dtc

FAe. daoa.rcy Foc6" IE t re Pflt fb.rd rcadYatsiad rirdltl'dr frlil ra6C!.e . iuatdrht.rtmce dl6pite .EornEr*f (b.th td t D (dt . td'l lln.t6.

^ft.. rad$ qdfd!6, I ltiat6, ,l nsr, r.rah dr lrt-6- (Iath

'lF.trrr..tbrrb.dr&rtkkEdro.odtltrrty Fl,f, tu M.n NM r- (&otdr! lrta- D.E-.t{Dti. d ffi, ffi d t Ib P*a ol u,'!5 odE-

A l<fidt a UtElArlA'i{ flndrr.: 2 trlL't .t.or.d larr Ora

:* G.r c i-ii-i tE-E {i-.'

)Morc.lvan s

rl.d!.rfr. c,t r. lE dr{a- rD sr Ht..

ti.rL i.d thb lndtrr (bdr d l,rrn.-.IUdEHlr3.r-r

JoannaoropsBombshell HLTHffi.ILfbrEGa-laf O..utctEatr!.,rdEotbdica.Its5E !r. th,.r trB' &g

'oE dE !'tit otitt-

,

Cmmcnts oo: a bllca! a*acobd h6rs rFrtIo,Et.h-r!b-drL.GkntE:aFHHitL r5&tEdih.--! Ldo,IdGoauir.lE .

Page 5 of6

Yo-d lothl..&crB.

DirpLyiEg r - 4 of a totd c@E nts

a AC,G taYs... ..,125,2olrr* .â '-rE!-rdr-Itrla rEqElrrbi-a-rdrtcli! lE-t r

- 1, d.-'--rb!E d! d-r b.Edl6. Ir.t-r*rrE6-.ffi tltr*ahE- tiuil.L-l-i Lqrbbrrh lbEt.rd.gdrtkhrEn-

(F!dtle.!rEql,

http:/lrvww.rtaosasmlioe.wlrew{20171ryf25/2-killers-executdhours-ry1-20l7B25l 4t25t20l7

2 killers execrrted horEs apart

drlrl s.yt-.-

tltlcfflO r.F.-.lo dt&-dr L-tLtpr -rt E tlErt

Tr.YBBlctb t ys..-H, rbE i b lb .E L {..ratdr-l!

I

HrldthtLdrdlLtil_lla.{rt!f,ltdtttb.Dt*itlb'rdtdF&|Hri!

Parp 6 of6

aarrl ZL 2Ol7 r r:1ll.4

oI

oa

IFrd( |raBrdE t)

r-l 6, lOlT - 7:l' ..-

(F ff| ra.!rr.E l)

lFl 15, 2Ol7 . *!2 .r

( Fran I edEd '6E j I

@EEIo,Er --riLaddit aCEfaiba!-btjIbrL.El6{-lc-.rqr! HuIrBdl,tF&y.

rexE

lFolMrllEdr.rB 5Ft 5.rLWU.fta-M 46.fttF F-a!fanrir! Or l4 to,tll-.aE Oi{qi(*a.F6rXri Fr.krrrPtE Ert ail,i5 LLrt&rar l di T6.iCdn! t dil lli' hd}

SIUI

,etlr6

rrtrlAt.8

rt6(ll

fI IIIts

ITII EITIAS

!E-r.amf,l-

rEE(It^ld

i4t

coarrcr

riirrrD6

orstE

rovgtEtG

(rrrri.r'.rlbb,<4Lfrd'-i4I.fr

ArkansasOntinelb ltG omrir laB EGlrEr F!ts Yh hB frirl3 clffi .B b.rai& 116 Dr!.d

tcls

E,saass

http:/Arww.uhosasonline.mlwwsl20lTlqr25/2-killers-execrse&horrs-ryt-20fiA251 4l25l2tl7

EXHIBIT 3

Arkansas execulions: 'I was watching hinr brealhe heavily and arch his back' I US news | -.. Page I of4

fukansas executions: 'l was watching himbreathe heavily and arch his back'fukansas on Monday . Jacob Rosenberg wihressed the murderer Marcel Williams being put todeath

Jacob Rosenberg in the Cummins Unit, ArkansasTuesday 25 Aprit 2Ol7 08.16 EOT

t 9.34pm we entered the execution chamber. I passed through a door with a largesigrr on its front showing two letters, "EC", and took a seat among a few rows ofchairs that faced four large rectangular windows. Some lights were on, but it was

mostly dim. A black curtain was drawn beNnd the windows in front of us.

Behind that curtain, strapped to a gumey in an even smaller room, was Marcel Williams.

In Arkansas, we do not get to see the placement of the IV for lethal injection. So, fromthe time we entered until the curtain opened, I saw nothing. We just stared forward atthose windows, waiting for them to reveal Williams, 46, who was sent to death row for

https:i/www.theguardiatr.con/us-news/2017laprl25/arkatsas-execution-eyewitness-narcel... 4125/2017

Arkansas executions: 'l was watching him breathe heavily and arch his back' I US news | ... Page 2 of 4

the 1994 rape and killing ofzz-year-old Stacy Errickson, whom he kidnapped from a gas

station.

We had done this earlier in the night, when a last-minute stay had us waiting in thechamber for over an hour. During that time, we later learned, Williams had beenstrapped down on the gurney. Now, as then, with the stay lifted, I simply looked at theblack curtain, knowing almost nothing about what was happening to the prisoner.

The curtain created a reflection of the room behind me, like a miror. I could see otherwitnesses, and myself, fidget.

At 10.16pm, after 32 minutes of IV placement, the curtain opened.

Light from fluorescent bulbs cast a strange yellow glow in the room in front. Marcel

williams,s eyes looked right up at the ceiling. He was on a gumey, tied down. His head

was locked in place and the right side of his body was facing us, the viewers. He said nofinal words.

At this point, the first lethal injection drug - the contoversial sedative midazolam,

whose expiration date at the end of this month has prompted Arkansas's unprecedented

wave of judicial killings - was supposed to be administered. No one announced that a

drug was being given . The process simply moved along. I watched and tried to follow.

His eyes began to droop and eventually closed (the right one lingered slightly open

throughout). His breaths became deep and heavy. His back arched offthe gurney as he

sucked in air.

I could not count the number of times his body moved in such a way, rising off the

gurney.

procedure dictates that five minutes after the introduction of midazolam there should be

no movements. But, at 1o.21pm, Williams was still breathing heavily and moving. The

man in the room checked his pulse and touched his eyes and said something' (The audio

was cut off for us.)

At this point, it is likely another dose of midazolam was given. I cannot be sure-it was

adminiitered. I was watching him breathe heavily and arch his back and then the

breathing began to shallow out. By 10.24pm, williams looked completely still.

https://www.theguardian.com/us-n ews/20lT laprl25larkansas-execution-eyewitness-marcel..- 412512017

Arkansas executions:'l was watching him breathe heavily and arch his back'l US news | ... Page 3 of4

Marcet Wittiams. Photograph: UPI / Barcroft lmages

The first consciousness check was clearly at 10.21pm, and then it seems the breathingsubsided, but the situation became confusing as the ofEcial continually checkedWilliams by touching his hands and face. At 1o.27pm, the official ran a finger acrossWilliams's eyelids again. Was this the second consciousness check? Did they determineWilliams was unconscious? Would the second drug be administered now?

These questions are crucial because the next drug was a paralytic, which stops allmovement.

I do not know when the second drug, which would mask all pain, was administered. Idid not see the IV placed. The audio was cut so I could not hear whether he wasmoaning, and I could not see how many times each drug was administered - meaning,even as a witness, I could not say if Marcel Williams felt pain or what happened duringhis death by the midazolam three-drug protocol.

The process is designed to feed me details as a viewer that suggest peaceful passing. Butthis will not have been the experience of Marcel Williams.

Protocol ensures that by the time the potassium chloride, which stops the heart and canbe excruciatingly painful, is administered, even if the prisoner feels pain, the viewer willnot see it. The paralytic is in place.

https://w*r,r.theguardian.com/us-newst20lTlaprl25larkansas-execution-eyewitness-marcel...4/2512017

Arkansas executions:'l was watching him breathe heavily and arch his back'l US news | ... Page 4 of4

Near 1o.31pm, they switched offthe IVs. The man who had been checking forconsciousness pulled out a stethoscope and put it to Williams's heart. He called in acoroner. I remember seeing Williams, there on the gumey, not moving.

And then, the one detail you can't obfuscate. That nothing can hide. The time ofdeathwas 10.33pm.

Jacob Rosmberg is a reporto with the Arkansas Times, which is also publishing a version ofthis article.

Sinceyou'rehere...... we've got a small favour to ask. More people are reading the Guardian than ever, butfar fewer are paying for it. Advertising revenues across the media are falling fast. And

unlike many news organisations, we haven't put up a paywall - we want to keep ourjoumalism as open as we can. So you can see why we need to ask for your help. The

Guardian's independent, investigative journalism takes a lot of time, money and hard

work to produce. But we do it because we believe our perspective matters - because itmight well be your perspective, too.

If everyone who reads our reporting, who likes it, helps to support it, our future wouldbe much more secure.

Become a supporter Make a contributionTopics

ArkansasCapitat punishmentfeatures

https://www.theguardian.com/us-news/2017/aprl25/arkansas-execution-eyewitness-marcel...4l25/2017

EXHIBIT 4

DECLARATION OF JAMIE GIANI

1. I am an Assistant Federal Public Defender with the Capital Habeas Unit in Little Rock, Arkansas.

Marcel Williams was a client of our office.

2. I was present at Cummins from about 2:40 until after 11:00 PM on Apr't 24,2017. lvisited with

Marcel prior to his execution and then witnessed th€ execution itself.

3. During this time, and particularly during the execution itself, I took notes as to what was Eoing

on, markinB down exact times whenever possible. The following timeline is taken from my

notes and accurately rellects my recollection of what happened on April 24, 2017:

. 2:40 Arrived at prison with kott; told only Scott was approved to 8o back, but that even he

could not 80 back ri8ht now

. 4:44 After repeated requests to see our clients, to no avail, and without being given any good

reason, I attempted to call lee Rudofsky's cell phone from the deputy warden's office.

It went to voicemail.

o 4:45 I call Judge Baker's chambers to let her know we were not being allowed to see our

clients at this crucial time and we had been waiting two hours. While we were on the

phone, Major Cyr informed us that they would now take ftott and Jeff back. Scott and

Jeff left the deputy warden's office to visit the clients.

. 5:40 Scott returned, and I was driven to the death house.

. 5:45 Began my visit with Marcel

o 5:40 They came to take Jack lones to be executed.

. 7:00 Marcel was given clean, pressed, execution whites and told to put them on by 7:30. No

shoes - rccks only.

. 7:20ish Father Harris administered last rites to Marcel.

7:5oish The Emergenc] Respons€ Team in full riot gear came to take Marcel out of his cell. I

asked if lcould hug him goodbye- They said no. 50 t reached through the bars,

squeezed his hand, and said SoodbYe. Father Harris and lwere escorted out' white

vans with witnesses arrived, and Scon was brought over from the Sarment fuctory' We

waited to be told when to go into the witness room.

g:03 we sat down in the witness room. we were the last to be seated as the attorneys. we

were seated in the back row by the door so that we could stand to see if we needed'

There were three rows of seats ahead of us, packed in a ti8ht room, facing four large

windows covered on the inside by a black curtain. The door to the execution chamber

was to the right of the windows. Light and movement of feet could be seen through a

sliBht crack. LiShts in the witness room were dimmed. witnesses sat quietly' 9 men

and one woman were citizen witnesses; 2 men and l woman were media; 2 male

chaplains; Scott and myself. An officer stood in the passageway in front of the

execution door with another female ADc employee.

8:16 I hear the phone ring in the execution chamber.

8:17 We are told there is a 2o-minute stay from the courts. Wendy Kelley opened the door

from the execution chamber and asks Will Jones (citizen witness) to step out. I stepped

out and called John williams. leventual\ reioined the others in the witness room after

a brief conversation to determine what was happening (there was movement in Jones's

execution and they were asking for a stay of Marcel's before Judge Baker)'

g:2g Scott left to callJohn. I r€mained in the witness room (with no watch or clock). During

the following 20 minutes, we hear muffled talking coming from the execution chamber'

I can discern what sounded like Marcel's voice and wendy Kelley's voice. I overhear the

female ADc employee talking with officer sayinS Jones kePt talking after his last words

8:49

8:50

8:55

. 8:59

and media is sayin8 we turned the mic off too early (maybe her name is Shelly?). Loud

laughter comes from execution chamber - clearly Marcel. "Shelly' whispers 'That's

Marcel in there laughing." Marcel laughs severaltimes, and lcontinue to hear voices.

officer asks "shell/ if 'we need to take these witnesses back out." "Shelly'' makes a oll

on her cell phone and is apparently told not to take the witness out. I bel;eve I hear

Marcelsay "seriously. Go look it up." And another loud lau8h. Continue to hear Marcel

and what sounds like wendy Kelley's voice.

Hear a knock inside the execution chamber

Hear ianBling inside execution chamber- something happening with shackles.

Scott still outside; continue to hear some talling in execution chamber but can't discern

voices; witness room is quiet.

"Shelly'' make5 another phone call - still no word; Banting sound in execution chamber;

witnesses begin to stand up and stretch.

9:o4 lt seems to be quieter in the erecution chamber

9:10 Officer and "Shell/ step into vestibule for about ten seconds and close door; everything

is quiet; the air kicks on

9:L7 The main door to the outside opens and all witnesses are taken back out. l'm fueling

hopeful. I ask if Marcel is back in the cell. Father Harris and I would like to go see him.

9:20 Father Harris and I are escorted back to Marcel's cell, Passing what aPP€ars to be the lV

team on the way in. Marcel said that he had been strapped down for quite a while but

that he eventually said he had to 8o to the bathroom if they were going to be there a

while. They then brought him to the bathroom and Wendy Kelley told them to just let

him stay in the cell until the stay was lifted. Hestill had his anlle straps on. Hesaidthat

they had ried to start on lV but had not actuallY stuck him yet. He sak, he had been in

the cell for maybe about 15 minutes. I told him we u,ere not sure the stay would hold.

9:25 They came back in and sak, the stay was lifted. Same procedure with the riot Eear and a

rushed se€ond Soodbye. This one would be the last.

9:32 We were again seated in the witness room, and the officer knocked on the door to let

the execution chamber know we were present and Seated. D€xter Payne is also in the

. 9:43

. 9:45

room now.

Hear talking from execution chamber- I believe it's Marcel and wendy Kelley; rolling

noise

"Shelly' makes quick phone call to say "be careful with that curtain." Don't know what

she was talking about. I had not noticed any issues with curtain.

. 9:55-56Continue to hear people talkinS in low voices in the execution chamber; othenwise

everything i5 quiet

9:59 Drawer-like noise and shackles noise from execution chamber

10:04 Dexter Payne shows "Shely something on his cell phone

10:09 More talking from execution chamber - sounds somethin8 like "do not cover it uP'"

10:14 A banSing sound and jan3ling from execution chamber

10:15 Hear a male's voice from execution chamber - don't think it's Marcel's

10:16 KnockinS sound in execution chamber; after 45 minutes of sittinB in the witness room,

the curtains are suddenly opened and liSht comes PourinS in from the execution

chamber. Marcel is lying with his riEht side fuciry u5, his riSht arm extended out,

strapped down, towards the witness room. The designee stands by Marcel's head on

Marcel's ri8ht side, at times sli8htly obstructinB the view. I see tubes Soing to the crook

of Marcel's right elbow as well as his right wrist. I see no tubes toing anywhere else on

his body. Marcel is asked if he has any last words; he sliShtly shakes his head no and

says nothing. The sound feed from the execution room is turned off. Marcel's body is

covered with a sheet, but his right arm is visible. There is some sort of board-tYpe strap

across his chest and his arms and hands are strapped down. His legs and feet are not

visible. His head is squeezed between a yellow, vice-type contraption but limited

movement of his head is still possible as evidenced by his ability to indicate he had no

last words. The medication is started.

. 10:17 Marcel,s eyes close. He is breathing very hard. His chest visibly rises up and down in

hard, almost jerkY motions.

o 10:18 Hard breathinB continues; Marcelturns his head sliShtly

. 10:19 After only two minutes, designee begins checking Marcel's neck, touches his arm and

hand. Not clear if this is Part ofthe consciousness check'

r 10:20 Hard breathinE continues. Designee touches Marcel's ritht fin8ers; I hear loud talkin8

comint from outside.

r 10:21 Marcel's head moves; hard breathing continues; Designee places pulse ox on Marcel's

right middle finger

. LO:22 DesiBnee touches Marcel's eyelashes and speaks into his ear (not loudly enouEh to b€

heardinwitnessroomwherelwasstanding);Marcel'sheadturns;hardbreathing

continues; Desitnee touches Marcel's hand and removes pulse ox (it is never replaced)

. 10:23 Marcel's breathing visibly slows; I no longer see the sheet moving'

. 10:24 DesiSnee checks Marcel's right wrist

. 1o:25 Marcelcoughs

. 10:26 Designee again brushes Marcel's eyelashes and touches his hand and arm

. !0127 Desi8nee just keeps lookinS at Marcel; his face appears to show concern

. 10:28 Marcel's right eye (l cannot see his left) opens sliShtly; I can see movement of his

eYeball

o 10:29 lcontinue to see eye movement

r 10:30 Desi8nee continues to just look at Marcel atthispoint

. 10:31 Desitnee brushes Marcel's eyelashes; the riEht eye is still open; DesiEnee takes out a

stethoscope and puts it on Marcel's neck and chesu appears to listen for breathing.

. 10:32 Designee says I think we need to call the coroner (this was actually audible even without

the audio b€ing on); coroner comes in and us€s his stethoscope to briefly check Marcel

. 10:33 Time ofdeath is announced; Wendy Kelley reads proclamation.

4. I kept waiting for the consciousness check to be completed. I never saw the desiBnee make any

affirmative indication that Marcelwas not conscious, and in fact, there was eye movement until

at least 3 minutes before the coroner was called. I did not think they had even pushed the

se€ond or third drugs yet, so I was shocked when the coroner was called. I saw no sternum rub

or pinch. lt certainly was not clear how the consciousness decision was made - if, in fact, it ever

was-

I swear that the foregoinS is true and correct to the best of my knowledge under penalty of perjury

under the laws of the United States and the State of Arkansas.

tl lts/t+

EXHIBIT 5

Declaration of Joel Zivot, M.D., F.R.C.P. (C)

I. Joel Zivot. hereby declare:

I . I received my Doctor of Medicine from the University of Manitoba,

Canada. in 1988. From 1989 to 1993. I was a resident in Anesthesiology at the

Universiry of Toronto. Department of Post Graduate Medical Education. and

from 1993 to 1995. I completed an additional residency in Anesthesiology and

a Fellowship in Critical Care Medicine at the Cleveland Clinic Foundation,

Department of Anesthesiology in Cleveland. Ohio.

2. I hold an active medical license from the State of Georgia and have held

unrestricted medical licenses in Ohio, the District of Columbia. Michigan. and

the Canadian provinces of Ontario and Manitoba. I also hold an active license

to prescribe narcotics and other controlled substances from the federal Drug

Enforcement Administration.

3. I hold board certification in Anesthesiology from the Royal College of

Physicians and Surgeons of Canada and the American Board of

Anesthesiology. I am also board certified in Critical Care Medicine from the

American Board of Anesthesiology".

4. I have served as the Medical Director of the Cardio-Thoracic lntensive

Care Unit and the Fellowship Director for Critical Care Medicine at Emory

University Hospital. I am an Associate Professor of Anesthesiology and

Surgery at the Emory University School of Medicine and an adjunct Professor

of Law at Emory University Lau' School.

5. I have practiced aneslhesiology and critical care medicine for twenq,.-two

years, and, in that capaciry. I have personally performed or supervised the care

of more than 42.000 patients. My resume is included as Attachment l.6. I am. by reason of my experience, training. and education. an expert in

the fields of anesthesiology and critical-care medicine. The opinions that follow

are within my field of expertise and are stated to a reasonable degree of medical

and scientific certainty unless otherwise noted' Ethical requirements prohibit

my participation in lethal injection. The opinions below express my medical

opinion regarding the risks of the lethal-injection procedure to be used against

Kenneth williams. These opinions are not and should not be construed as an

attempt to assist the state in developing a better way to perform executions'

7. Counsel for Kenneth williams retained me to review witness accounts of

the State of Arkansas's recent executions and to determine if Mr. williams has

any medical conditions that would cause a unique and particular danger of

significant pain and suffering during the State's planned lethal injection of him

on April 27.2017. I have reviewed pertinent medical records for Mr. williams,

and I performed a physical examination of him.

g. I have reviewed the State's lethal-injection protocol entitled "Attachment

c." I previously authored a declaration setting forth my concerns that the

lethal-injection protocol is insufficient to anesthetize any prisoners against the

pain of the second and third drugs and lacks safeguards to prevent a tortuous

death or sub-lethal injury. My concern was that the pain of death as a result of

the lethal injection protocol set forth in "Attachment c" far exceeds any pain

that might be associated with a natural death. That declaration is included here

as Attachment 2.

g.IhavealsoreviewedpubliclyreportedaccountsoftheApril24,20|.7'

executions of Jack Jones and Marcel williams using the Arkansas lethal

injectionprotocol.Theseaccountsprovideimportantinformationregarding

how the midazolam protocol works in action.

10. Based on the accounts of the April 24 executions, my physical exam of

Kenneth williams, and my review of his medical records, it is my opinion that

the state's lethal injection protocol. if performed against Mr. williams' will

cause him extreme pain and suffering due to his unique medical conditions and

in light of the manner in which Arkansas is performing executions under its

protocol.

I I . Witness accounts of Jack Jones's execution on April 24. 2017. indicate

that the lethal injection team unsuccessfully attempted for 45 minutes to place a

central line before eventuatly placing two intravenous lines. These events

reflect that the execution team lacks the necessary medical skill to do these

tasks competently. In order to be certain that these intravenous starting events

occur without needless and excessive pain. it will be necessary to allow-

observation by knowledgeable individuals. not otherwise under the employ of

the ADC. Obviously. in a medical setting. failing to place a central line or

taking so long to place an IV *,ould not accord with any minimum standard of

care.

12. Witness accounts also indicate that. after injection of midazolam. Mr.

Jones was moving his lips. speaking to Corrections Director Kelley. and,/or

gulping for air. As an anesthesiologist who has administered anesthesia to

many thousands of patients in my career. I can state that such actions and

movements are not consistent with general anesthesia or "unconsciousness"

and instead reflect the inability of midazolam to induce general anesthesia or

relieve pain.

13. Witness accounts of Marcel Williams's execution on April 24- 2017,

indicate that. when an execution team member checked Mr. Williams's

consciousness after injection of the midazolam. "the executioner moved toward

another person and mouthed the words, 'l'm not sure, "' according to multiple

witnesses. Mr. Williams continued arching his back and moving during this

time. Three minutes later Williams's breathing stopped. and he

grimaced. These events reflect that the executioners lack the medical skill and

experience to perform a reliable consciousness check. Further, the fact that

Marcel Williams continued moving after the midazolam injection and grimaced

when his breathing stopped - likely upon the administration of the

paralytic vecuronium bromide clearly indicates that he was not under general

anesthesia and was not insensate to pain at the time'

14. Striking in both executions is what cannot be seen. The ADC does not

allow a clear unobstructed vantage point to view the fullness of the

execution. Reports by witnesses that claim to have seen no obvious suffering

are utterly insufficient as verification that excessive pain and suffering did not

occur. The inmates are strapped down, from head to toe to fingertips and large

movements are therefore impossible even for those that have not received any

of the execution drugs. A pulse oxymeter was applied to Marcel williams for

unclear reasons. At some point. the pulse oxymeter was removed and not

reapplied. This device is in no way a monitor of consciousness although the

ADC has claimed it would provide some form of an aid in this question. It

speaks further to a lack oftechnical understanding on the part ofADC'

15. This information demonstrates that, in practice, Arkansas's lethal

injection protocol causes condemned prisoners to experience significant pain

and suffering, and that the State's lethal injection team lacks the ability and

experience to perform its functions competently.

I 6. I evaluated Kenneth Williams on March 23, 201'7 , at the

Vamer Supermax Unit in GradY,

Arkansas. Mr. Williams is a thirty-eight-year-old African-American man with

several noteworthy medical issues. Mr. Williams suffers from sickle cell

trait. erythrocytosis, and brain dysfunction with a history of brain injury' He

was also diagnosed with Lupus in 2013.

1'1 . Sickle cell trait is a blood condition that in this country is found

primarily among African-Americans. Sickle cell trait is inherited genetically.

When one parent has sickle cell trait, there is a hfty percent chance that the

child will inherit the trait. If both parents have sickle-cell trait, three in four

children will inherit the trait. and one ofthose three will also develop sickle cell

disease.

18. Sickle cell disease is a lifelong medical condition that causes significant

pain and serious health problems. The disease causes a chronic shortage of

functioning red blood cells, which are required to deliver oxygen throughout

the body. The damaged cells can also cause blood clotting and associated

problems such as stroke. Red blood cells that contain the abnormal hemoglobin

protein pathogromonic for sickle cell disease will alter shape from a normal

spherical biconcave appearance to a crescent or sickled shape. This occurs

whenever the red blood cells afflicted with the abnormal hemoelobin molecule

are exposed to lorv oxygen.

19. Persons with sickle cell trait. as opposed to full-blou'n sickle cell

disease, are not usually svmptomatic, and they typically can lead normal

lives. However. people with sickle cell trait can develop "sickle crises," in

which the symptoms of sickle cell disease manifest under conditions where

their bodies - and their red blood cells in particular are placed under

significant strain. This can occur as the result of intense exercise. being in high

altitude/low oxygen conditions, or other activities like scuba diving. When a

toumiquet is applied to the arm or leg of a person with sickle prone cells, the

resulting fall in oxvgen to the limb in question can initiate a cascade of sickling

cells. Sickled cells are ineffective oxygen carriers and the sickled red cell

clump is associated with progressive organ failure as a consequence ofobstructive vascular emboli. Impaired blood flou, will necessarily result in

inadequacy of circulation and uneven distribution of the chemicals set for

execution.

20. Arkansas's lethal injection protocol. when administered to Kenneth

Williams. is likely to provoke a "sickle crisis." The administration of

midazolam will at first cause a fall in blood oxygen and cause red cell sickling.

Once paralysis is achieved b,v vecuronium. the further inexorable fall in blood

oxygen will only serve to further lead to a severely painful sickle crisis'

21. Mr. Williams's brain damage and Lupus diagnosis will also likely cause

significant pain and suffering during administration of the lethal injection

drugs. Brain injury and Lupus are independently associated u'ith significantly

increased risk of seizure and associated complications. There is a substantial

likelihood that the injection of midazolam will provoke such a response in Mr.

Williams.

22. Alone and in combination, each of Mr. Williams's medical conditions

will complicate the State's "one size fits all" execution procedure and lead to

severe pain and suffering for him. After the State injects Mr. Williams

with vecuronium bromide. however. most or all of the manifestations of his

extreme pain and suffering will not be discemible to

witnesses. Vecuroniumbromide is a paralytic that will prevent movement of all

major muscle groups in his body and prevent him from breathing. but it will not

reduce his pain or affect his consciousness in any way. The only discemable

reason for including vecuronium bromide in Arkansas's lethal injection

procedure is to cloak from the execution team and other witnesses the extreme

pain and suffering that Mr. Williams will endure.

I certiff that the facts set forth above are tnre and correct to the best of my

personal knorvledge. information. and belief. subject to the penalty of perjury,

pursuant to 28 U.S.C. $ 1746.

April 25,2017

Date Joel Zivot, M.D.. F.R.C.P.(C)

EXHIBIT 5

ATTACHMENT 1

EUORY UI{NERSTTY SC'{OOL OF TEOCIT{ECURRICULUI UTAE

Revrsed. Apr 2017

I Name. Joel B. ZNot" MD, FRCP(CI

2 Olfcc Address..1361 Cliton Road, Atlanra, GA ?0322Tebphone. (4U) 6*./t11Fel (888) 9*5928

3 E-rnaiAddress.,,)zivd@€r7ury.edu

4 Cd€€nshipAnerran. Canadan

5. Cuneol T{les and Atfihatons

! Academrc Appontments.

l. Prmary A)point(rn:sAssoc/ale Polessor, De$nnenl d Anesf l'€,stolqy

2 Joint aod Secondary Appcintments:Assocrale P@,bssor, Deparinenl d gJrgery

3 Other academE appotntnEnt6Adlunc,l Prc//€s,sor Emoty #t@t al LawAdjwtct Prclessq. Enqy University lnstilute ol Libqat Ans

b. oiherAdnrn,lt.stt\€ AppointrIEn|s

lrledcal Advrsor Sot^rErn Cente. fd Hurran REh:s. Atlanta. G€org€

6 Prerror6 Acaderdc and Prorbssilnal Aorontment3

Fdonship Dnec1u, Cfittcal Carc *l€d/iane. Doryr'.me.i. ol Anest lesbrogry, Enuy Unlersnys{,frl d ltl€dcine. Jan nl J^Januaty m16. itt€,Eal Dfedol 4N5A. EUH (Feuudry ip13 -JutE 2015)- lrbdoal Diretu, 11s EUHM (JuE ??lhFa*uary nl3). Associ€le Professot, Dqanmenl ol Aresthasidogy. tJntves,ly ol Mant@a. Wnnru, Ma,,toba.Canada. 2@7-2010

lvbmbea Acdenic Ptomotions commilt@. rJnve$rv d Man 6a. Fac.tty or Medcine, vvrnnpeg.M&toba, CaAda, 2OOO-Membet ol s*dioo c-ofirnitee, Phystclan Assslaot ptqaat. T,E Unive$ity ol Manloba,Wintupog. Man da Cnda Z0Og- lvlenbeL Acaeditdon Revcw Cunm ee-AnesrhesroJ@,sl Ass,sra nta @mmBsion onAccred ali}, ol Nld Heatth Edu@tion *ogw s (ARC-r'!r'J, mE.rss,sran, Proy'essor, cF.lpadmenl ol ArP-slhesk,Dgy aN Crtical Carc Medbine. Georgewag,htvton unNe.sitty H6pitat. Dotnd d cotumbie, usA. 2&t2N7

Jocl B Zivot. MD. tRCP(C)Atril l0l7

10

11

sr,hc{, ol G.adudo s,ldi€s, Aevelaad. Oho. uSA, 2W2@5- Assistarf Professo, ot A,1F/dihesie. Sugory. and htensive Cae. lJnversity Hqtlels ol Clevdend.Case wbsrern R6setve Universny *hd d pledcbe, Clevela,,d, Orro. USA. 199&2@5

- Di/EXjbt Cttk:al AB Ncclcino Felo,sttp. OepdlnEd ol Nesrlresrobgy UniveA,ty d M,$aanMedaa! Cenlet, Ann kbo{, Michigan, USA. ,996 t998

- Ass6ranl Proressor, Depdrnent d Arpslhosiolqy aN Crilaat Caro Nlddicine, UnNeBiY dMichigan Mdi@l Centq, 19911998

Prgvlous Admlnislraue andor Clinical AgPdnlmdlt8:

-Wdical Oireclor, Cafu:a-Alota,C} lCU, ltttetls,,va CaB Cadi6 *icncaE Ptwam. w'nnFo{tF€gio,Et Heatlh Aulhotily. wbnwg, ManilcDa' Can,d€,, N7-n10-uiaice Di,vtor. C|ICU, Georie wdshiogron Udwsity Hosqilal. WesMngloo. DC, 2@'[email protected]*ladkd A,ec],r,r, Sargr;el l,tte^siv' Csrc Unn i&r,varsry Hcspilab ol Cbvdad. Case weslem

-D[ector. ao$ l,;ghosa Carc t)nl, Deff,dd:P./nl o{ At:€stttasl,oqY, tlnireBilv d Ykl*W Madical

C,€nlet, Ann ktftr. n. 199*1998

L;censure! / BoarG.

-Ltccn$. Cootolled SuDsraa6e, ONg Entor.4,/7lE,nl Aga'ty, igg+p,"senl4!can5{. Mhhilon Slole tH,calBoa,d, 199s2W-Licanr€, Oha Srale ltedbl goed, ,998-2012

-Licen* Disbict d Cdwltbid Mdieal fu td' m&p,as,rn-LEen*., C,ollega ol PrrysEs/rs 8nd Surgeoos ol ManitcD€.' 2Nf'U t-tbonse. Georga Compos de Medknl Bostd, 201we*nl

sp€cia[y BoarG:

+dtow, Royal Coltego ot Physrclsns ol Can€da, 1993+ressnt-Efdonat. Anasthesologry, Attr€than fuard ol Aneslhesblogy' 199ryaset1tAipOna, Critca Ceta lhAarr., Anarie,n Bodtd ol Anesthesiolqy' tggtp'tsonl+eltclr, An,ftrhan College o, Cl'og PhFtbas' 2O&2o1O-Testdt .tr h bas'lc rr,ri.qntue trans'*qhegPel €r,hcEardic{/rphy, Nalkxlal Boa'd olEc lrratdiur?r,hy. 20 1

',f,esenlEdtrdton

-Untuenny ol Mani(jt,a, Vtnntrpg, Manrt,ba Cryt8ds' ,9&l '9&l-Univetsii/ of lc,or/{o, Totdtto, OnlarE. cana@, 19u

-Doctat oi Mff,E,tr., unue$ty ot fitatutde, Wi,nnppg, nan @a Cat@a' 19Et)

Poslgraduate Trainrng.

-RolElt no lnlemshb. lroLrlrt 9r& Hosptid, l)nNettdy ol Toto'lttr. Depelia d Pd Gradu'leUeacd?ducatoo Torry*a, Cend?. 1 98,/i,' I 989:i;";A,r.y. Anesthestrfryi. Uniregily o! Toftnlo Cr,rr,dnr,nt d anes'hesiol'0ry. Dr Dav'd

lv/(&lighl. Toronto Canada 19Ey1 993j{;,4&,il;,r"bt 9v, Cleveland ainic Fa ndetryl, DqdfiBnt ot A"edies'o'ocv' Dr' Armh

*hub€d.-Chvetod, Oi,b, UnH Slabs, 1 993'1994:iefii,o, Crtti"a crn ilracin, ctwetand clng Fou6alion Depa4nent d Anesulosologt' Dr'

Uarc ryvth, Clewland, Or,o. Urrrod Slaras. 199''1995

Jotl B Zivot. l\|D. FRChC)April 2017

-Masra6 d 8belh,c.1 Enbry Canler lo/' Elh;ca, Ot l&y Sc,loaleu, p.cgmm dtcclo4 n12+r?6eai

1 2. Comrflttee llemberships:

a. Nalional and lntematronal

-Anpttcan *iely ol Aneslt7asiob,gy. Co{nmtttee otl Ethlcs, Al '.ryese,,-American Sociely ol Anesrhesif,bgy. Carc Tean Committee, 2007-2009

-Socbly ol @ilid Cae lvtdiina. Corrrlmitloe on Erl&s, 201 1-pc,srntSo,.ilty ol Crilical Cde Mdiite, Palient and Fanily Salisl*liut Coiltriltee, zo13+rcsant

-Societ,, ot CanJiLrvsscu/ar A./leslhesi,trg,l Co,l1ritl€E on Ethbs, 2012-2013-So,c,€ty ol Cdbal Cae Ane.sfiesrbfrgr'sls. Gractuele EdJr'elion Cmm,tlee zol3,,resent

b RegDnal and StBte.

-Pragdent Cleeebnd .srr,P-t! ol Aresrhesobgy. 2001 -M2-Ptr'silenl Eled. OC Soc,ety ot Anesrhes dqy, 2NC2N7

c lrEtiutional

-EUHM Com/,inee @ Ethbs, zot l-prcseot-EUHM Phamxy aN Thera'E.ulcs Cor/mift@ 2011-pE,sa.nf-EUHM Exedrtive Crilical Cao Coonllee 2llLgesent-EUHM CAU|I antl Ci./BSI Davenli(n mi,i,/'1,ihee 201Gryes8,:,t-EUH Executue Phatmacy C(mmitlee nl2grescnl-EUH Anlibklc UltEel n Sufronmittea 2012-pre*ntlUH Resuscil dtur btflnftee nllryset-EUH Atrtcull Atway a&|lcE g{oup 2013-2011-EUH Execuwe Ctttcs,l Cot t C.anm tee z?l?present-Dqartnenl ol tutPstr,,esidogy fk'sxre,6y Revbw Conmfitee2ol Upc,sent-EU|I/EUHM CTS A)afity o.tmmtteo. 2ot?-presf.nl

13 Peer Rev€B AdivitEs

a Manuscripts

-@nad Jotnd ol lrresrDeioropx (manu!,f'tr,l tgvieweO, ni3-Cr ,@l Ae MedblrE.. (manusngl F-]vf,l*fl4, 2n+20rs

-Mayo Ctf,E Prwc€dngq @a^r$nql 'Bvet,f,,a. 201,

b. Granl rettevet

. Revpr^/gd gant applba,oos,lor Tr7€ Enwl Goo{gd lech Hea tr;al,|e tnDvatun ptqrarn (Htp),(HtAACtSt-cSU) Sed Wnt

o Cqlterence Abstrads:

r. NatrorEl and ldemalional:

-Nne,,c€n SojFty cl Anesthesdogy. ZO|Z

Jocl I Zivor, MD. IjRCAC r

April l0l 7

Absttocl fuv,cw Co,,,tny',/loa a,d qagat Sossio^ tnodedrot

ii Regional

-Mkhtt-sle,m Anesthesa Resdarl Conle ,€/r.e. 2N1-m3Abgt4l rcvgw".r

14 Consulantshps:

-lristc* Pha'maceulods. Phys,cian advisory batd, [email protected] lot ll/rarelP-ss EKG lr|!o,rito{, b01'Ns-Masinp Cotwrd:an, ptducl dssgn and pllysiclan advi@ry bad, 2013-prcsont-Ooxtm,l'.. physr,ien adviory committee. 201''prc$nl

,5 Horio|s ano Awards-Rc[x/tt B Sweel Clh$al lnsfn,c,lq d li€ Yeat, Unyerstv d hch,qan, D@alnl€.n, dAneshstdagy, 1997

oulsl ldtttg Ctn cal lns1(I!rdc, ot llrc Yea(. Caso Waste/, Res'vo Unive/Ely, Master o' Sca"ce

n Nrostl1F'sdcgY Ptqtan, 1999

-c'ntcal loslnI;t(, ot tl:E Yoar' Un're$ity Hoq,,tats d clevel€.ld1 DoPdtlfllolt ol An€slheso,ogry'

MA!/5ile:T,iogCtinoetlnsrruciotollheYear,CaseWedemRe*r\EUni'e6,ity'l'ltasle(d*tercein Anes r-skiogy Prqnm. 2001

-M8ribrious Se/vre Award, AmariJn Aca&ny ol Anesrtesic,ogls, Ass.,sants' 204'

rhtsalrudwaswf,llornelotacademgwofuast|lp-nedi,ldirectolollheMaste$nSc,once orAnoslr,esrbrogy at Cas€ lr'/ef,ten ReseMe Univotstly aN also advocecy lotsc{peofprdclce,andc-anmttt*wott<totntr'o,vel,F-re,lali}].shlpbetweenlheAnBrEanSoirery a rlrnstrusAogy and Ameri:an Academy of Aneshs'blogisl /qseganls

-Qudhly and fulienl Saley Awad, l.)oiversily tl€€,tth Syslems Consulium' 2002

fh6 8t ,s/d wss giveo W UnNetstty li€alh Systefl C'l,nsEtlium lol. vedd/s quehly

rx,rcmal*Nr,ectswtanlvyasttpcanedicalilectqdtlEcatd,,cthole:lclntensi\nCarc l)ntl al lJnNarsity Ha0,tals of Aedatd

-Ddingu6,led sertrc€ by a PhystjjE,,l Awart. Afiercan kaddny o'Anesfiesbbgld Ass'sla"fr

n+5

Thb an{d was liYaa to nE tu wott tti'h lt:p AnBritao kabfly o' Analih€snlqy

develryd am lnsled aismwal 'le4,edy game conpotitbn tFIu€€/' e" o'tho Mss'6rs

ol Scienc€ in Aneslhesiolqy s{,tcp,ls emund lhe cdrnty

.Dslictolcofumbia,,nnualPd/ientsalotyAwa,Id,oisrrictolah.u,rtiaDeo€n?,nlo{Heahh,2006

This a,/ard was livffr. by tn DEnfl ol Cdumbia Dcp€,funanl d tlsalh ld qraftrv

mprotenent wti* an5 wD€tt , w8s tp madual dtr&'lot ol the ceraolho/?,cE inlensNe

c;G @tl al @Qe W6s,lt Wton Univetsity ll6,p et' I dawrqd s€verd collabotaliwquatrty proi*f Utvreen caldio-horccic su'gsty and c{ilkzl cav fit€drina

,cxl B Zivot MD. FRCP(ClAFil 2017

-P.€sldonlial CilalrJfl. S@ely ol Cnlaal Cde Mdicina, ni?This a ad vas gNen lo ne lo( wot* do/te flilhn lhe Soc,ety ol Ctilical Cerc MedE,Ethat indud wllit{, a Mt 6aplq, sP.rybe on 2 9cbty c1o.fitnittees. and n*alnq d,o- hne debale about lhe topic d eN cf lila dsasbns h pdbats wl t nndatndnechanicd cadi& suF,od devr,os

rO SocEly iil€mberships:

-Aflloncs,1 Acdeny ot An€sltasnlqtsl Assistan , zoosfreefll-Amarb6n Cdlege ol Clust Prysiciant , 20OO2@7-Anr€iican Udical Asociatiso t99t2w-Ai'€/ican llbdinl Assocrbrd, (/aet^€led). 2Ol Oprcseot-Subty ol Crlicd Care /qr,€sthesbbcriils. ,gg,plesenl

4anadr'an Arrsttevoiognb t Scf;iely, zr7{.rcsent-Distdd al Cdnnbia SocEly ofArEstDos ktqisas. 2A&2@7-i,*e/nela oal Aneslhesia Resoand, Sooery, 1996n@-l ,,ematnnal Extra-CopoBal Ua Sultratl Organzatu\ 1 997-2W5-Or,o Socrsty o, Anesf,esr'ologt6rs. ,993-?@5-Sacioly ol Cntical Ca,e fu'€dicioe, ,g95prBsen,-Ma/itoba Medical S@*, W7-2O10-Canadian trtedlr3t A&rocialba 2NE-n1 2-Gedgre Soc€O otAlEsltBtolrgr'sts. U1 AprcsF-nt

-Sof,,f,ty ol A*mE Anesilesologry.Assooalbs. 201 3*rcsent-tl€dcal Ass,f;;iali,n d Geoqia. 201G

l7 OrgenEaon d Naliooalor lnternalbnal Con ererE:-Ot tne Elh16s ol Dr.rg Shottges'Jure 2012 Jcinlly with tl:P- Ameicao spc.F'|ty of Atgsthesi.Xqy $rdthe Envy &olar for Ethc.s

a. Adnr,nistrtiva Poslbrls On dot. luboti,lg Ptemi,rg Commt/I{ee

b S6s.ons as cfiaI: Ovaftl crr,ferencc chair

18 Sesaarch Focus.

t/&!n4 fiotal Boty, fielotr, somanlGs. eN d life, dlystc&ns aN vutneE,de frPulatioos physician

care doc6lor'+,rafftp and tt@l@t vatuNity D*eq/sd @nomc n*t sptaining Ae natfrlalgenetic dnq sholages. Sfu1dird Ptwold *astqe n he gpf/tding r@m.

,9 Grant Suppqt

a Acl^re Suppdi

1 Olhec lean Eassd Sconce (TBS) gnnl trcm E Depadmen, of At,Estt:F,siolcE/y larEvalud*r1 o! cot ibl in the q,erali,tg t!gn. ,n,O@ N2. Tlrc Enwy

-G-eorga-T€rh HeanhcE,e tn@vattjf/ tuWnn (n4, (H,P-ACrSI.GSU, Seed

Wd, ns,W.N,ld 'Mat,a{,t E @nt ict aN Enor n a Op,€&g Wm". Awdfued JW2014.

,ocl ts Zir!( MD. FRCP(C)April 2017

20

b. Prevbus Suppon920.000.00 hofi tla Amaftea Scf,/E.ly d An€^r0,,3E,icbgv lo den E tnoeling'On ll]E Ethics dOa€ Srrortag8s" Jurc n12

Clinical Service Cortribdions

.ittedbal dieclotot 115ICU (EUl !r) 8N 1A/5A tgJ (EUH)

I crcald and chaitd a pnl pr,lcr,.l develqmont gtu)p willt Cnlcel Carc Medi:irre, Sugety'Nwgng, aN Respi@lcty Therqy wtfi lhe pu(Dos€ ol fiiptwlq qrdv mea,cs in cltbal caremdkit e. This gxqrp a@arrylidted severd ltings ittdding a dd consqvalbl drclry lu post'qe,aliva cadie s.tgety o€,fenls, inlra-aodic ballcp,t pu P ro,',ova4 Dvf $d Gl pmryaxb andtie &gtnning d a atrct frbnlat;a managenenl qot6;d. I ds wde and habod tmPleotenl a rqilextJD€,lion p,olocol lot EUH end AJHM cediec surgaty ,g,rienB.

- H osol al Com fu teo irv?lted,€, n

I was ii?votved rn serrerd Enwy cman ees lhal affossad a Droad tarrgB or Bsucs. (se 12c)

.GME involvonant, Fe,owsw Director, Ciruel Cate ttbdbi7a., &podnen ol Anes{heeo/ogy

I em tll€ lel,owslry dir8Ew tu citEd @e m€dicine. I cbvabN dE fi,'st ici Anes ?€,sircgy-

€merpncy Madkine cdtit t care tr:,edbi:E tetovtshb aa Efiwl aN I am expandng the numbQ{ al&y'lo$rs wllo wfi d& be ,r ned lo asJsl h providitg otcnighl coY€,mgo ld t*vray n?€nqon?8lt otEUH. Ovem9ht eirwey caloragB hes Doen a prcied ol ,te EUH ear,fg€ ncy eiNay co/,,milree onwhbh I anr e member My orpciry conllbl proiect l?€,s b€€,n enbraced by EnDry Heal,€ar.r' @ieo! Ouali y and lhey aE al{0 conlributi:0 lo ltiF- tt tding ad menogomert d the Ndecl on ett

orgDihg Dasis.

Community Oulreach

Cqnmun(y ServEa

lnternalional\sl roltrsDu€t &.tsiia. 2002. NOttlon,p- visits lo connuntty q1€/f,,l€.5 who were urgblo to trsval lo *e a Phygaan

Regbnat-Ht r.,,rr l/\ahns rt|f,dcal ResmIrE,Tsm. ffiSEflwy W Attanb ito/€/r ScP€d,ny Heallh Tonl Votuntaor. 2010

Media

OtrEd:

-'Babl's slalus ss lxrrsr is on trid' OPEd, F€,b 19. NrO, Wtnnlrag Fre€ P'ess. 2010rvvht I am fq 6 nualodum on lelral intarons'Op4d' bc 15 N13, USA Todav, frl3-'m6 St;Wsty S@e trcm Medicine to Lsthal tniecifi'@Ed, May 2, 2014 Tll'/8 2011

lnieryreu,3

Ane sf,cs!&gu tlews.zooz-Arrest osbbrlist Assrslanls

fiB Nb(jcel Pc6,l. N9

.,ocl B Zivot" VD. FRCP(C)Ar.il 2017

2'.1

-Wailng tot Cadiac Surye.y

TIE Heenh Reor,rt. CJOB 68 AM. V{nnF8g CBn&e. 2O1O-Caroiac CdEa! Care-End C Ue n the ICU-VlP :tyndrome

lnsktc the B,ark 1ox, VrREK91.1 FM, A anls. Geaeia,2011-Blng lhe Bullol: fha Tschnalqy ol AnoslrBs€

Nalio$l PublE Racto WAAE 90.1 FM Adaob. Aeo€,ia, 2O1'l-Phfs,cians and the bath penaly-DnE sho/ragDs

G€otga htblb Ba&sing, Atlanta GA, 2012-UW s,r,?s0es rcxh,tp cnlr,ol lewls

w@ge Teay. 2013-No l"dranlqe lot FEsh Bld n ICU Transfustotts-llen/rBits Outbteak Suspicbn 'peded lot nausca co/nptaints-Dn g ShortatEs sp t< us ol snpooders

,twfiW ti,€dircal News,20i3-Gl<ts to BlanE lot Dn€ Srprragps. SaIs PrrysrcrBns 6roup

Medwp fo6L 2014+ruet ffid Unusual PunishrpnlLelhol lniedbn: a cRd, painhl, teriffing executnn

Uiafli HonA. nrlOoclor geaks oL, on ae ol unlp,s,ed drugs n capilal punshl.7,enl

ttB Nen Yot f firs, m14-Lrndi?e dascaiDes lranltc scane at oklahoma oxscu on

TIP- Washinglon tusl . 201 4-Flonda's Gruesome Exsculiql Theatet-Anoihot excrLlioo gone awry. Now whal?

CNN wtlh Saryay G,pE. 2014-Dr ZNd. Lalhal @ef/.ton nol hunate

Ambus on Slale wrlh Oadia I ithwrk, 20r 5-Bokhe<t gtotorf,ls

Hutrnglon Posl, zot 5€.kkthut?€ y,anls lo .e.rnslalalhe gas chant€r atd cxpeds sy tt s a t adarea

Time. 2015-TlE l1,,s,, ,eehty ol execui,iat by lrmg qued

cl,lu.2017-Execrnions grl phystciuts n u{sit dtunma (Oryltd1)-Gors6h gratrles wth deeth a plrysciao's v,evpcint (Ogrba)

Lledpge Tday. 2017-Op-Ed. Ne Gotst]Eh and Assrslod Su.ode

22 Form.l ToEhi]g

a lelgd'cd Sludcnl Teadring

,ocl B Zivor. MD. FRCP(C)Ar1l20t7

i. Oiffiif,ty Awcl 'P@ol vastage m lhe lClJ' bHbal studed MttD f ran,

n1zn1e @d&l ltolrs 1M<,r St .9 llls ,e:rrle t urd menlot tot fi,9dca, studenls m areslhesnlqy eN ditr.el

caF- me(fn,tE 2ol^PQsen| canlacl houts 3 hrs,lv6ekid. togItudot 16 Futtddnenlal Crib.a! Ao fup0Etl (FCCS) lraining antse lot

n edical slu&nts. 2012-prescnL cdttocl houts , hrlwe*N. Fotgc MNkd Sltfunl ln,pvdion Gtwp, ibttot @tttar,thorrts: 0.5 hts1,ee*

b Gradude Ptogra E

I Trahhg Progirarns:ishdlor in llp lla*ers oI Sci:nce in Ane-alEsblq/ Ptqnm. I deve'lw<l thefrrs! cdrk a! cato na<bine rc/latictt lot all of tl?€ sludeDts aod arso 6 s€/bs o'&ddc tedu,es on tlre lcf,ic ol ct baf cara m€dhins the hdudod'Ctilial Cdtsbdi:r9','Hee,l FafuE . and'Acil'Base D&o,d,e's"

2 School of Law:Codrgl hs!tuclor ol IAW E19{,,,2, "12v, ,,Bdlcl//E atrt Huna Ri rts", a 2

ctdil holt *miner laughl in tte fdl nr6 soneslerrn the Enory Schof,/ ol Law

3 ResdencY Programs:' served as lnslrucor /(r rBsirerts tn al€sll:f,,s&l@/, eneryency meddrte, and

sutg€,,y in lhe area ot cr bd cue nEdiine / a'so sl oa the refioncy rcYiew

cfuea lr the Dry1r,tlotl d fu.E,slttosi,ogy' Lelure lopix'Sed'b shocr"thVrrt dtseese h ailk€l carc' '*bchgl,izl head suppotf, 'Pulmoaary dlerycattretprs' 'lrgundbs end bia$s ,n clnical reasoni'r" 'delirium

"nd sgl'lon in

./t ael ,ifraess'. 'txdqkd vadabilily'.

c Othet CdegP.i€s- - - ISG ngl.,lar lei.)utls on a variely ol cilqd cate lgp,cs W n/sprduy r,aqLit1(,"dit!g'fonqiahf ancl'oar:,lytrs I lrlr;turc studdrls a the-Emcry ctilcal ca'? NP.|A.

pt$ih irui Xo eOula;yitcd ca@ tcrlues to the IP/PA wrlt'irp.'s in uilbal caq t

ieJl frose guoenrs hot lo red chest x-rays I an ttricrl to Ec1urc in lho EmdySchool ol Law on tho lqpic 'Pt ,6tabn Assried S.'/ic'de'

EnorY nbl *ieocs lnlialive:I targhl bdogly to Buddhbl mooks al OrepuIQ Losaling hndsts'y

'n Soul,lem

lndia n Juc- n1 5 fib nilialive s a resull ol en iN e'bo lnm t's Ho'hess l:lp Ddat

LanE. b fung *rJrte &,[jati(nl to lha educatic,l d tlB flw*s and E,p,?senls lt'e fi/s,l

tinc i nO &s na he cwriaium tr€,s changEd / sperl 2 $€el(s d the np,naslrry

o*nng bi A mu,s per aa| idu<lng nicofiW lab teachng l nod{ed wlh I satbs ollr?tdalo/s.

23. SlrpeN6ory Teaching:

a R8Eireocl Plogran.- fenoisni atia'., q krlC a tttd/kirc. OcfE,tunenl o! A,r,slnf/si*,il n1.3'ry5,,^:'!

-,chiafry e*nstble lq tt18 d,fralio,1 alt btioing ol lhc cdlcal cerc felows in lhe DcQdnont o?

i;t:th;@y h7 *filbn lo a mutlude ol ctitr,c ceo topa:s. ' ass'sf the

'b"o's in absfiacl

*aGi.-ilura u icd cere nxxrtng' gnd -touty',s.tot.lho

Deprfitrrll ol Atrs'has'obgy

na i q.alily inlritovellrlrt g{ed lu Gialuale fu/rdli:al E&tallbn Day thd Garls annrdy nJutE

b Olher:- t i*r*w a

"umdr't tntemsho d ttg sr,uttum canw lq Humdn Rohts ond dlso lo8d,h lav

siJdooB on t e togtc ol ,athal nl*tw1.

Jocl B Zivol MD, FRCP(C)April20l7

c Emory Uni\€Gity, lnstiiute of lhe LiberalArts. lnierdisciplinary StudEsThesis advisr aN lnnors t €sr.s comrnille€ membr for studdtt Katy Mayerson for ttp pmlect'Trolsculurol Paltwals andlhc Lilenry lrrzgination: The l rancophotc loolprirrt in lmrytial Russia

and P osrco I o hial Art ico "

24. Lectureships, Semina lnvitations. and Visiting Probssorships:

'The Case of Samuel Gc ubchuk: Lessons abo./, endof-lffe decision-mahng2"A cbbale between Doctors Jel Zivot and Adiel Finewdnesday. 18 March. 2@9. 12h3F13h30. The Centrelot Prcle"Oo*1 2n4 Apqlbd Etlrics. TheUnvedty ol llantoba. Winni@g, Mar.itoba

'Cordiac oulpul afrertllP- Pulnarary Atery Colhetel Arnenban Academy of Anesl/,esblogisl AssrslanlsAnnual Meeting. Cleetweter, Floridz, lprl 2OOg

'End ol Ue in the ICU', Candian HosDice Palliative Care Conlercrcc Annual lieetirA, Winni@g,Manilobq Canada. Oclober mog

'RedL0tions in wait lrnes tor cardiac srrgery may b hamlul", poslet presentalion. CanadianCadiovasculat Sociely Annual Meetifi.t, Edmonton, Alb,-fta, Canada, Octobat 2009

'Bidogical Vana tt/ American Scf,iaiy ol Aneslhesidqy, 2@911 fomed a panel to d,scuss b,o/ogrbalvaiatilily. My parcl consisled o/an arasf,esidogrbt, a matlrefialbian and a physicist.)

'EN o{ lle io tl]€ ICU: When tB pdient and ddq disqree..." PrwirEe wide health care ethics gnnd,Dunds, Sr. Bonif*e ResF-arch CenlB, Winnipeg, Mafioba, Canada. JaNary 2O1O

'Mostly &ad is slghqy aliw, [1e ptoblem with the dyng pr@ess' Center lor Ethics Encty Universily.2011.

'Aneslhesiology Jeopadyf Anaican .^cademy ol Anesthesialqrsr,Assislanls Anruel Meeting, 20ff,2N7.2@8, 269. 2010. 2011

'Quedng Theqy. A,dhalprrs for,Anerlh€s blqy' American Acaddny ot Ar:F,sthesidogisl AssrslanlsAnnual tlcding, Destin, Floida, 2O11

'Cadiac Anesthesia: Mostly we hare- I wot1g" Amerban Academy ol Anesthesiolqist /4ssrsranls AanualMe€tinq, Oeshn, Florda, 201i'EN of lite in the ICU: tMren the pdbnl aN doclar disagree- Amerban Ac,adeny ol AnesthesiologistAssr.slanls /nnual Meeting, Destin, Fkrida, 2011

'Sedaling tl1€ ditrtcult patient'g Arnuel Southeaslem CritbalCare SL,,tmit. Emory University, AtJanta,GA. Merch 2012

'Etld of Life C e" llvlPACT 2012 Anetican Acdemy ol Ptlysbian Assis,ants Arnual M@ting, Taronto.Canada, Juna 2O12

'Biosimilars, wherc b wa slad?" Geceg &io aN the Georyla /Assoc/alrbn ol Heat r;arc Execulives.Septenber 2O12, Atlanta, GeWa'Drug Shonages" VUtitp Professor. Ryre€rs Eus,hess Sc l:rr,l, Newa/-,Vew Jelsoy, Not/embr 2012.

'Deactivaling a Fnmnent catdiac derice is rbt physbla, assr:s led dealh,, pro-con debale Webinar.Sriety d Crikef C{e l4dicine, llovembet 2012'Drug srortages: rh€ itvisible hand ol the Mafiet' New Hdizons in Anesl,l/est togy, vail, cotondo,February 2013

'Hey 4nosthasia is a condinant, nol on insult: lhe cas€ for prolocds'ryew Hotizons in Anesthesiology,

Vat, Colon&, February 2013

jocl B Zivot, MD, FRCP(C)April 201?

'Ptdcon: cP,ath Penets in End o, Lile Care' New Hatizons in Argslhesiobgy' veil Cotorado' February

?013

"llockey Violence and Kilbr Apes: Conlicl ManagefiEnl in the Opcotng Room" New Horizons in

Aneslhesiology. Vail Colorab, Febnnry 2013

"DrL4g Shortages, a laited natuer Amenan S@idy ol AneslllP-siolcgy Le{,NalMe Contererce AnnualM*ting, Apd 2013, Washington, DC.Lethal

injectio!1 in t,:c death penatty", Georgia Law Sdety and the southem &nler fot Human Rights,

Atlanta, Georyfi, JUY n11"t(lentifying errl managing itnite care n lhe lcl|". la Annual soulh Eester crilhd cere summil Mey

?016, Atlanta, G@rgia

'Capilal Punishrrgnl dN Lethat lni.clon', Gedgia Sale Schoo, o/ Law, A anla, Georgia, Seplember2016

'The Elhics ol DNg Pricing', GEM annud fizeling, Georyia Socety ol Ophthalnology, February 2017

'Bumout don't lhank n e lor nomal worf . Ameican Academy o, Anesltles,olog,st Ass,Slants anoua,n)€f.ting, March n17'T@ sbk to b execuled' Ameican Academy of Anestgsiolqist Assrsrsnts an,ua,,Doeting, Merch 2017

25. lnvitations to Ndidlal or lntematbnal Conterences:

llniveBity ol Rich,nond Law fuvew. Albn dtak Synposiun, 2014.'TlE Uath Penalty,i, lhe Un,led Stares'.

Yale Law Sdtool, March 2015-Lehal inteclion"

The Fodham Law Review, Fodhom Law S(,l,ool, Febru\ry 2016'Ciminal Bebavbt and lhe Brain. Wpn Law and Neuroscienc? Collide'

Aneican College of Corecliqat Phy,ciansF all E du catbnd Conh rcnceOdobcr 2016Las vegas, Nevata'Plrysiian Wlicipalbn n execulons: A discuss,on or lDe Elhical Ct:€llenges aN the Pros and

Cors, a pa-con &bale btween Dr Cado Muso and Or. Joel Ziwt

'Prescribing Price: The Elhics, Scbrca, aN Business ol DNg Dcvebpn8nl and Pticing'PetP-lislEtnw Confercnce Center. Novenbr 2016Atl ta, GedgiaEnory Center tor Ethbs

'The Frst lnamatanaf Emory nbel Sl/47]i,ES m: BndEng Buddhsm 6 Sc'€nceDrepung Los€ I i ng M@ asleryKamataka Slatc, ldia"ParE,lis| What is tle and whal aE ils digins?

26. Biblrography

,ocl B Zirot, MD, FRCP(C)

^,,il20l7

a PublEhcd and Acccpted RcsGlrch AdElG6 (clinral ba3rc acEncc. other) in Refcrc.d Jolmals

Pe|€raER,VdicDU,ZivolJ'Cartbtrgsedionwlhtwohghlrqwncyplvedildlddelive4lsyslerns-Canadist Jounal d Arenrresra Jan 1993 40(1) g-63 PMD A252as

Ziyot JB, Holhnan wD. PalMq,cal otlects d Lfldoloxin". New Hotizons. May lWS 3t2).267-75.PM|O 7583168

Pqovdt MJ, L@kEn JO, Ztwt JB. 'Na.sl bNle rcvuled an inpbwnen! tn UE techn,qB lo ptevsntuninlenli<yl€l tomoyal ol small.bon naso-enlerk f*diog luca.s' Critcd Grc fibdqir€.. March 1996;?43):4?*31. PMIO. tr.25630

Kuma K. Zarychdtoki R. Bell DD. t*ani R Zwl J. tylP-r*is AH. Arora RC Cardio,asEutar H@llhResearch h Maoilda lnvegilttd GK'up. 'lmpel ot 214our in-lro'rse mtensivis, o., a dedrated cudiacsugery inlansvo ca/€ unif . Nn ftorac Surg. Ng Ut88(1).1153-61 doi: 10.10160 arroftcsn2@9 U.070

Ziwt JA 'nE Casc- d hnte,l &lubchuk", AJOB Volune JP lssua L&ard n10, pages 56 - 57 @1 a. 1 0w1 52651fi903681 8fi

'fJpuolepfic nahgrrant syndtone ve//sus Serolonn synd/ome.llre &arch lot a diayloslc tNfT- AnnPhamacd\eL ?o1l sep:45(9).efi.d<n. 10 r 34ya9h. 1P7E7. Epub?Otl Aug fi.

when pauonl and Mor dwtu+ zwt Ja. CMAJ ml zJan t 0,tu(1).7$a bi: 10 15p3/cm4. 112-2@8

Zttot JB. 'Arc$l?nsia dGs ,rcll rcducd suieing al lhe eN o{ life', Ctil Care [tbd. 2012 Jul a47):22659dai. 10. 1 097/CCM.N1 *3, Aqcl 2b.

Zyol J8, 'T|?€ absencj ol ctuelly rs nol lhe prBsence of lwna]ness dlysrtsns and the deafi penalry nlrre Un{od Srsles'. Phtos Ethts Hum,roit Med. ?o12 Dec 3,7(1):13. ctot. 10 116/1747-5341-l-13.

Mazzffi, M, Zlyol J, Btrchman T, Halkos U, 'ln h*ptal malality €llot cadioc suqary: patenlcharactarrsrrcs. liming, and asffhtior, ,tilh rr"stgp€,,atiw leoglh ol hrensue cde unt aN tlosp at slay'.Ann fhoac 9rg 201a AprBT{a).122O5. &t; 10 l yf.ellpt*clr 2013. 10.010. Epub 2013 Dec 21

Zivot J8. 'Tll€ vrdNnwal o, teatnl€r,l ts glltrcalnenf . Can J Aneslh 2011 of,1:61(10}89fi

Zvot J, 'Lelll€l njf,clnn lhe salss mad,ca/rz e ex*ulion' 49 U. Rich. L Rev 711 (2015)

Zvo, J, 'Et&( carc ,n the lCU. Spn bavety?' Cril Care t d 20 rS Juty.13(71.15267

Js'es L,( .Jonnings BM. G@E RM, tlailwn KW, Zi@lJA, & Waal FA 'An Et@am lo OuanlilyOqmting Roont Bohavbl Ann Bahav lvled 2016 Jan 26. IEpub ahaa<, ol pnntl

Zfoot J. Aro|ason K,'Lessoi.'s leamd lom physican pa reahon n blhal iriedk]fl. ls Cenot v Canadea death knell lot medkal sefi-,egdatno?' Cen J Anaesth 2016 March:63(3) 246-251

Ziyot JA. Ereiy ,€,tbnls n ,tE ICU' Wdlh il. or ndr Cril Care Med nl6 Apn,:$(1):U2-3

It oll V, Wad CT. Zit d JA. 'NttrycltolicJdu.Ed Neumlepac Malgnant Syndrune dnet CartbcSurgcrt' AA Case Rqp. 2016 Jtny 1,7 (1): *8ztut J, 'T@ SEk lo b Execaed shcrkng PunishnP.,7d an<t the B|ain- No/e/Ii,Dp,t &16 vd 85, pp 697-703, Fotdlan Law Ra/ier/

,(xl B Zi!or. MD. l-RCP(C r

Aprill0lT

b E)(amhationAclivities:

Ccrnmiltee lvl€,nbot, 2@5, Nationol Anesbesiorogis, Assbte nl CetlilicetiutExa,rindioa Develor/meni. @mm tP,e

Orpstff wrrl4 20c6., Ctilicel Cale lffiEne, Nalrc,nal bad o{ lMbal Exa/7r,ine,s

Qt,lsliqr Enf,,tf,r. ?015 At lorcen B@Kt ol Anesthesblogy-Mdnlettaoco ot Cedifcalto,tn /rtosill€slc,ogy (MC!CA) C cal Carc ttWEiE

c. Book Ch.pi€rli

Bojarl Pe'rt,o\tc MD. FRoPC' , Rtzttton Manji MD' PrrQ FRCSC?' Rakesh Arua MO,pr;O, FRCSC' Johen Stl0rnpher ND. FReCt, Ro,tit g,E,hal MD. FRCSC. Jo., ZlvotoD, FRaN. aN Enc J*ct,sohn MBchB. it lE. FRCrc''Dirynos,! eNMdlryflont d Seryts 6nd S€ptb Shock in fhe Cadiac SuAtul Patienl" Seidy otCdd vascds, AnasthesE/Egv lvl qtaph' fulerch 2010

zkot",fB, What An Actvan@ Ditsctives?' CdtiAl CaG Etics A PE,clbe Guidg, fhirdEd Cwrigil nl4 S@W d CtitbalCare hthclicine.

d other PLbllcalbns:

Ztrol J, Holtman W, Lockrem J,6standal, S Eodocs N, vonali C, tuPa/Eh M 'ChangBs ingos/rrc intamucosd pll aE nol prcdcted by lhet6p6t tic *ang€, s n @nvenla nal hamodw$mic-veoables

lor *pli srtgtce parcAs' Critical Cde Pldr;ine 23(1) Suflefllp.nl A' 1O7. Jsn 19e5

Wabstet J, Ihornsofl y, Zvoa J. 'Excassn€ en&uadE.al lutE cull PE,lsues ata @nflbrl bul

are Nt dir*l,y stgttfbsr,l' Anesfi€srol3{ly e7P Sucpl) AgA 1997

B,@h tlg, Zfvot JB 'succesdlr, traspranr d 11 d liret and N,Ey drJgafis lwn a dmotnEbr/€ittod on vat,o€,tetht exa?{,t!f,rlaf nefi,/Er,€ ox|/geneful' A'Es&e3a a'd ADa&Es'a'

9425 Sttppbnenl) Sr04, Feb W2Wo, J. Pden'f,l,P,l<zs 1. aggaotdl S. Rcl,lttr,tto/f,. J 'Di enntd lurp c4oqtaphy afret sngbl)ng ,rany/ut". W Cate illedJci,2 301121 s'4|plen1€,nl Afi Decentur N@

Vdtr D, Airc,l J, 'Ola Elss rh fhe Srspoc l,.al tndex &mg Deep Hy,o Emic Ckc"lapc,ry-Aflasl 'S(l(lr,i ot Ctiticd Cae-filedbine Annud *lo€ling. Son F,a,c,.tco. Cdiluria January 2003

Ravss R. Zirot J. 'Bkflcl @n*Nalkxt De6iignnq a bettet A&ct b3{'' Oepaturlp,nl olAtqst|Esdog/. Un vers ry Hogrlars ot ctevdad, Casew-eslom Roserue Univats,ty Wla(td,Ohio, M*f'fla;ler. An€sfr,8sE Rosffi.rt Canlerpil,ce (MARq, Chi(Bgq, lllhtp(s, Ndnh 2@3

Hzrjket L. Ztwt J 'L@, snest r€lr $ra d lq stun infllntiut', Depadnanl d Ane-stt'osology'

Uiiergy nospiats d c/ewtad, Cssq waslBm-Res oNe Uniwrsity. Oe-w-land, Otro'MiO!//eg5n eiestlpsb Resdarts Conrorend Chicqo' lit1E,is, Mad1n03

Fdk S. Zivo, J, 'P6,l<po,?,tive S*flefiI lot Pdn onaty tlyry'ten$gt ldl ing mtltol '/dve DPe"'lV Asia P*fs Cs{dene on DBeesas ot the Ched. lstantutl Tutloy. Atgttst 2@3

Aggarwal S, Zrvol J 'l,rew o'tsot srnon(f, s{/ind atlaty syt dtone altgtr lun?t€lr drain rcrnot{otri.bnl A a,restt*siaogy, Unyetllty tlolf,ib,b d Clevdaod' Coso t't'bslora f&stn'a

.rcl B ZNot. MD. FRcP(ClApril20lT

Untwstly, Clevebnd, Ohtr, Midweslam Ar€gr,esia R8sderrs Conlercnce, Roch€sl€r.Minnesda, March 20Ol

Sletz J. Zlwt J, 'DextrytFlhoryhan masqtet?dng as ploncyclidtne'OeoadnE.nl ol AnegDestt ogy, Uriwrsny Hos€itals ol Cleveland, CaseWestem Reserye UnNarstty, Chveland, Ohio, Mtdvlesiem Anesrrpsa Rasdenrs C-oalercnca,RcDesler, Minrresp{a, Marcn AOlPeleh,E K, Zfuot J, 'Ellaletal BIS mon,,o.nng n unilete,al bain irylry", Dqarlment ofAneslhesbJogD/, Univ@sity lfs{,itals ol Clet/elafi, Cas€ weslem Resen€ Unive6.ly. ChvelaDd,Ofio, Midseslam A/resrhosra Resdenls hnleQrca, Cf/6ap, lincis, March 2@5

Arora RC, Zary&.ynslci R. Bell D, ZJvol J. Lee J. Kunet X. Zhang L lrteokis A 'TlE Menlobattl./Jd d rt.sr-Ope.ative Cad)* SueBry ln ensr,y.e CaE' fi€ Card,ac Scbnc€s Ptogtam. StBotlla@ fbsf,ld aN llp Unhe E8 ol llbnilct,a V14n ,cg. Canada. Torcy1./lo Ailical Ca@btrrtng, Oder 2007

K Xuma| R Zuychandt, DD tsell. J Z.W, J Lee, R tulan1. A bbnkis, RC Aurua, 'Tho lmp*l dhe Arant&a Pbdel ol21 bar lrJ?ous€ intensivtsl on a &dcded cade surgery ICU' CanadanCadrbvasa/ar Socbly Annubt M*fu,g, Tdanlo Ootario Canda. Oclobar 2fr8Ferctusson DA l#bed rc, M;uer CD, Fremes S, M8€Atams C, liturkin JM, redt K, Ouke PCAretaoo R. Blajchmaa M/, Eussrers JS, COe O. KarskiJ, M lircan R, F€t,Hoe JA, R(dger M,Ws G, Chnch J. Pret nus R BART lnve.3lbalo/s.'A cqno€,risoo ol oprolinin fid tysitBenelques n higLnsk cedi& srrgery-. N Engl JMd 2008 May 29:358(22) 23t931 ENb 20OgMay 14 Eralum in: N Engl J ,ybd. 201O Sep 23;363(13):129O

M Riwl, S Challand, G HeNy. ,rcS /Vurses, RC A urora. DO Bat, A futsntis, J Zllrc,'," F"\ Manjr.on the GRACE, GRACE? lnl//c,sligalots, 'Bunk Beds in ahe ICU - Can Tvo C{dDc Sugerypsli€nls O@upy Ono ICU Bel?" Carcdian Cardiovascular Society Annusl Meoting, Toronto,O nlatb, Caosds, Ocloo€., 20Oo

RA Mary, E Jacd,s{,hn, O &ll RK Slngal, J Zwt A llenkls " hlnum and b€d rnanagement n

Catda, OcloDet 2@9

RA Mani. D Bell C Sl?€w C Wtran. P Nbker$n. AH lde,*is, J Zlwt E JacoDsoinIt arragoment Sqpesliyrs ld Cadi$ Sngety Patienas filh e Posilive Hqain hxhbedThonwopno (Hlf) ELISA. hndan Candicuasattu Socity Amual preelrtg Ednlon]o,nAt|j€tll cdt8dl od&,t 2aBRA Mary, E Jrjc0.sotm. J Zivol H Gtlrptt Nan Maahis, P7olo.{Bd ,.}f,osp{a/ wai 6imes doesnol afrecl oulcr,n,es tor ueeal cotwlary ad6ry bypass sug€,ry. Candiar CadiMasc;ula, &cetyAnnual tt|€,./liry, Edns on. HMa. Canada fuLober mgJ Zivol. RA Mery, E Jecobsor,4 H G.c{,olL A ittenhrs.. R€d]lrtons in wa,t tirrEs lor cerdiecsurgery nEy b lBmfil Cenaden Ceftto!-asarlet fudy Anruet i&,eing, Ed,nonton, Albda.Ceo*.OdotumgRA Manji *D PttD FRCSC MBA, E J&sotn MBC\B FRCqC, H Gtu;od MD FRCrc, J ZivoaMD FRCrc,, Nl Maokb OOI; MD FRCSC. LotBet tfthoJf,ital wajt tiot66 &s rcl afractoubomes lu urgonl c{onary a oty by6ss gls,ni,]p suBety, Anen@n H@d As&cialion AnnualUe.ting, Orlando. Flside, Novembat 20@

zlvol JB, when the ls,aiont aN lhe ctutq cttsaf,/Be. eN d ltte in the cu' (mN,tet wsentatan)Ame lan &rieay ol Anosil]EsiTqy Annuat Meeting. Sao Diqo, Catitunh Octobt 2O1O

.bd ZM. nD, "A cure in se'arch ol a dsoasa. @mfl}8n/s on: F4un an Ethrcs ol Ralanrg lo anEfnics o, t46stE /4r/odarE€'. N Et!g, J ttbd. 2012 36:19191951. lray 21 nl Z

Mezzdi, Halkas, Zivd'Timre end characlenzafbn d ,psrca'di* sugety it-l:D$,,tol ,tartalty.Wiety ol Wl Caro Ann/aal l,bt e socbty ot Cdficat Cate Anm.al ttutiry. Jat nB

.lo.l B Zivot MD. FRCRC)Apil !017

Neamu, HalkoE Zvol'Right yenticular La@ration Duiog Closed Chest Compressrbn rh aCedi* Surybal Pat:Ent" $cpty of Ctitical CaE Anruel Meetng Jan 2013

Cadi-Scheible. Zivot- Paciulb, Connor "Succassfu/ lrcatfiEnl of pulmonary-renal syndrome*@Nary to q-ANCA vasculits using ECttlO with Argaloban', Scbty of Citical Carc Medicine

Annud hleeting, San Fnncisto, CA Jan 2014

.,ocl B Zitot, MD, tRcP(C)Alfrl iUl I

EXHIBIT 5

ATTACHMENT 2

DECLARATIOI\ OF JOEL ZIVOT' MD

I . I received my Doctor of Medicine from thc Univcrsity of Manitoba, Canada' in 198t.

From I 9t9- 1993. I was a rcsident in Anesthesiology at lhc Un ivenity of 'loronto.

Department of Post Graduate Medical Education. and from 1993-1995, I completed an

additional rcsidetc] in Ancsthesiology and a Fellowship in Critical Care Medicine at the

Cteveland Clinic Foundalion. ftpenment of Aneslhcsiology in Clevcland Ohio'

2. I hold an active medical license from the State ofGeorgia and have held unrcstricted

mcdical liccnscs in Ohio. the District of Columbia Michigan and the Canadian

pruvinces of Onmrio and Manitoba. I also hold an activc liccnsc to prcscribc narcolics

and orher conrolled substances from thc federal Drug Enforcemcnl Adminislration

(DEA).

3. I hold board cenificalion in Anesthesiology fiom the Royal College of Physicians and

Surgeons ofCanada and the American Board of Anesthcsiology. I am also board cenified

in Critical Care Medicine fmm the American Boird of Arrshesiology.

4. I hrve served as rhe Medical Dirccror ofthe Cardio-Thoracic lnlensive care Llnh and the

Fcllowship Dircctor for Critical Care Medicine ar Emory University llospilal' I am an

Associale Prr:fcssrr of Ancsthcsiologr and Surgery at thc Emory Univcrsity School of

Mcdicine and an adjunct Professot of kw al Emory University law Sthool.

5. I have pracliccd arrsthesiology and crilical care medicine lbr 22 )ears. and, in that

capacity. I have pcrsonally performed or supervised lhe care of more than 42.000

patierts.

6. I am. by rcason ofmy expcrience, training. and educalion' an exp€n in lhe fields of

anesrhcsiolos/ and critical care mcdicine. The opinions that follow are within my ficld of

expertise, and are srated ro a reasonabl€ degree ofmedical and scientilic certainD- unless

otherwise noted. I believe that my ethical duties prcvent the participation in lelhal

injection. fie opinions helow express mv medical opinion regarding the risks of the

lerhal injection procedure designed by the state and should not be construed as an anempt

to assisl rhe state in developing a better wa1 tc pcrform execudons.

7. At fie request of counsel. I rcviewed Arkansas's lethal injection procedure, tirled

'Attachment C." Bas€d on the review ofthat document, and my medical training and

exJrerience. I offer the follr,wing opinions.

8. The slate of Arkansas uses a three-drug protocol involving Midazolam, Vecuronium

Bromide, and Potassium C hloride.

9. I he use of yidazolam is an inappropnate drug for lethal injection. ln a surgical setting it

is used as a sedative and in combination with other drugs. lt is not used on its own to

induce general anesthesia and is not capable ofrendering a patient unaware or insensate

to pain. The company that crcared Midazolam never contemplated that it would be used

in the cxccution of prisoncrs.

10. Midazolam is prepared as a liquid and lhe solution is rendered at a pH of2.5-3.5 Strong

acids like Midazolan risk precipitation when mixed with weak acids or bases. The pH of

normal saline is 5-6 and the mixing of Midazolam with normal saline runs the real risk of

the formation ofa salt precipitate. This precipitate compound will risk the obsruction of

thc inlravcnous prcycnting anv furthcr drug administration. Midazoiam prccipitatc is

pharmacologically inactive and will Iower rhe lotal amount of Midazolam delivery in a

completely unpredictable lbshion.

I l. Midazolam injeqion in large doses as contemPlarcd in the Arkansas lethal injection

pmtocol has bccn associated with paradoxical hyper'rcactivily reaclions. This

paradoxical rcaction will be seen as intenr agitabn and movcment. ln this sate.

increasing lhc dosc of Midazolam will only furrha exacerbatc this agitation.

12. Vecumnium Bmmidc is a paralytic thaL when administercd. blocks the capacilv of

movcment in a particrrlar group of muscles known as skeletal muscles. Paralytics act onll

on skelctal muscles and have no effect on smooth or cardisc muscle. The inabilit) lo

brcathc as a conscqucncc ofvccuronium induccd musclc paralysis would bc akin to thc

expcrience of suffocation. A person would still have the desire and need to brcathe bul

would bc complctcly unable ro do so. Midazolam will not in any way block the sensation

for the need to breathe.

13. Potassium. availablc as Potassium Chloride. is a mturally occurrinS elcmenl ncccssary

for normal bodily functions in a number of human physiological systems. of importance

here is $e eflcct of Potessium chloride on the heart. As potassium rises outside of the

heart cell. depolarization is increasingll blocked unlil a point al uhich lhc hearr cell is

csscntially hcld in placc and cannor contrirct. At his poinl. rhc hcart ccascs to funciion in

anycapaciry.Thelackofheaflmuscleconractioncauscslhcbloodprtssuretc'drop'The

lackolblmdllow'xhichcarriesoxygentoeachcellinthebody.ceasesandprogressive

and rapid multiorgan failure ensues. Potassium Chloride. when injected into the body.

produces an intcnse buming sensalion ofthe veins. Midazolam is not a pain reliever in

any dosc and is insulficient to pr€venl the experiencing of buming by tre prisoner'

14. As a general ma[er. my review of the protocol shows that lhe execution process involves

multiple complex tasks that to be done without risking serious injury to the prisoner.

require a high-level ofskillend training.

15. I am aware the Arkansas Department ofCorrcction has a supply of Midazolam that lisls

$e expiration dare as April 2017. My undeBknding ofexpiration dates and drug potency

is based on my years of medical training and practice. An expiration dale is an estimate

of the date at which the drug manufactur€r expects that the drug will either change or

transform into something that l) loses its efficacy or 2) hecomes poison. As a

practitioner, I would not use a drug in the month at which it is stated to expire. I do not

feel confident that it can bc relied upon to perform its expected function.

I 6. Arkansas's lethai injection protocol calls tbr the preparation of s) ringes at a diUbrenr

location in advance ofthc e{ecution. In my opinion. this practice creates a need less risk

of contamination or degradation of the chem icals- An ampule of Midazolam, or any other

sterile injectable compound, is steri:e while ir is in the ampule. As soon as the seal is

broken, it is no longer stcrile. ln my pracricc, I would inscrt thc syrinBc into thc ampulc,

draw the solution into rhe syringe, and inJect it immediarely. The delal used by the

protocol creates the risk that the drug will be rnislabeled. conraminated, and at increased

risk of falling our ofsolution as a precipirate.

17. Sening of IVs is crucial to dre successful delivery ofa subsance into the circuiatory

systcm. Multiplc or unsucccssful attcmpts to scl an lV can causc pcrforations in thc vcins

and infiltration of the tissue surrounding rhe vein. When lhis happens, rhe subsance that

was meant to circulate throughout the body will instead pool in the tissue and not reach

the systems ofthe body necessary for :t to have its intended eflect.

18. Insertion ofa central line is a complicated mcdical proccdure that is not done by nurscs'

or EMTs. A physician's assistant may insen a c€ntral line underlhe supcrvision ofa

physician. The central Iinc accesses lhe circulatory slstcm through a large vein in the

ncck. ch6t. or groin. Thc vcin accessed rhroug.h a centrrl line is not visible lo the eye

through the skin. In ordcr lo safely place a cottnl linc in a clinical seoing, I xould usc an

ultnsound machine and a central line kil. Tle lclhal injection prorocol allows lbr the

placement of a ccntral Iinc with no way of determ ining where thc prisoner's vein is and

no clear expertise within the personnel ofthe execution team. Blindly sabbing at the

ncck, chesl" or Sroin could hit 8n ertcry or a nerve, causing pain and blood loss A

misplaccd cenral linc may bc hard to verify and an individual placing this linc ma1 bc

under a hlse imprcssion rhat the line is pmpcrly Positioned. ln a clinical sening, a follow

up chcsr x-ray is requircd prior lo using a ccntral line that has becn placed in the chest to

lcrify thc proper placemenl and rule out the prescnce of a collapsed lung' Such lung

collapse when occurring can lead to a tcnsion pncumothoBx that can be in itself fatal.

Dcath in this circurnstancc rf,ould bc as a conscqucncc of suflocation and cardiovascular

collapse.

19. The amounr of liquid Midazolam called for in the protocol is roughly a rhird to a halfof

thc volume of liquid in a sundard Styrofoam cup. The plan calls for it to be injectcd in

two syringes. Thc syringes will have to be quitc largc' Puslring that amount ol liquid out

oI such a largc syringc crcatcs a grcar amount of prcssurc at lhc Point whcrc thc liquid

exists the syringe. A vcin can onll' withstand so much pressure' when a latge amount of

fluid runs into a yeio, cspccially at a rapid rate. thc vein can rupture. ln a clinical setting

2-4 mg would normally bc administcrcd over a minutc. The Arlansas lethal injc'ction

protocol intends to injecr l0-20times this quantiry over rhe same lengrh of time. A real

danger exists to vein patency and serious pain on lnjection. ln a clinical scnin& in order

to modulate the speed ofthc injection, and prclent ruplurc. I would sit by the sidc ofthe

patient and look at their vcin whilc I was plunging the drug. I undersund that the

Artansas lerhal injedion prmedure calls for thc person plunging thc sl ringc to be in a

separirte room from the inmate. Viewing a vein through a window uill not allow a penon

to havc odcquolc sight ofdre vein in order to prevent rupture and prop€rly modulate the

injccrion.

20. The prolocol purpons to require that the inmate be determined to be "unconscious" afler

thc administration ol the Midazolam. "Unconscious" is an exceedingly vague lerm in

scientific circles. Thc protocol does not provide any guidance to the execution team to

judge *haher the prisoner is "unconscious.'' Crneral anesttEsia is not same thing as

"unconsciousness." Ceneral ancsthesia is a staE in which a person can undergo noxious

stimuli and l) does mt experience it in the moment and 2) does not rccall it. ln contrast, a

person csn be secmingly unresponsive and still expericncing stimulus. Cenain noxious

srimuli will lift a pcrson ficm what might at first glancc appcar to bc a statc of

uresponsiveness. Many p€oplc have had the expcrience ofnor bcing awoken by thcir

alarm clock but hcanng the alarm clock in their dreaming srde. An outside observer

would have no way ofknorving that rhe sleeping person was hcaring the alarm clock.

This examplc shows that simple observation is insulficienr to detcrmine levels of

anesthesia and har no capaciry to confirm lhe sorl of unresponsivencss contemplated by

thc lethal injection prctocol.

21. An anesthesiologisl is as much ofan expert in consciousness as you can find. However,

neither I, nor my peers, would ever allempt to assess anesthetic level by visual inspection

alone. ln a hospital setting, I would not give the okay for a surgeon to cut a patient just by

looking at thcm. Instcad, I usc cquiprncnt to mcasurc physiological signs such as hcart

rate, blood pressure, brain activily, belorc allowing painful procedures to proceed. In

addhion. it is imporlant to continually monltor aneslhelic depth as it is dynamic. There

may be subtle physiological changes in the body thal show that a person is reacting to

painlul stimuli. For example, if the heart rate increased from 60 bpm to ?0 bpm, that

would bc a signal thal I may need to give additional medicine. The protocol provides for

no modification based on inmate signs and symproms afler lhe 500 mg oll\tidazolam has

been injected. The well-known ceiling eff'ect of Midazolam renders addilional dosage

completely superfluous.

22. lt is my professional opinion that because the protocol uses a sedative ralher lhan an

anesthetic, fails to use personnel trained in assessing anesthetic depth, fails to instruct the

personnel on signs ol'consciousness, and fails ro prov ide equipment neccssary tojudge

anesthetic depth. ther€ is a serious risk that the prisoner will be able lo l-eel and

experience the iniection and the effecls of the Vecuronium Bromide and Potassium

C h loride.

23. I have a great concem tiat the protocol does not provide a plan for resuscitation or

anddote oflhc chemicals in thc cvent that the execution lails. Bascd on my training and

experience. I expect lhat the prisoner will never reach general anesthesia with the

iniection of Midazolam. I rhink a likely scenario is that affer the fint injection ofthe

Vecuronium Bmmide the prisoner will move, gasp. or otherwise show signs of

awareness. lf this happens, and the Vecuronium Bromide is not rcversed, the prisoner

will su ffocate. Vecuronium Bromide does have an antidote' Sugammadex. A safeguard in

lhe event that the prisoner shows any signs of movement that will indicate awareness or

"consciousncss" would bc an injcction ol Sugammadcx.

2rl. lt is also possible thar the Nlidazolam may need to be rcversed. Irlidazolam on its own is

not a fatal drug, but it can cause airway collapse or cause confusion and lack of

awareness in the patient that would cause them to fail to clear their or.ln airway and

choke. Irlidazolam can be reversed with Flumazenil.

25. Potassium Chloridc can also be reversed through the sequential injection of insulin, D-50

(dexlrose and water), and calcium chloride.

26. In order to maximize the efl'ects ofthe antidotes, the prison would also need to have on

hand qualified personnel to start life-saving measures and have immediately available

oxygen and a mask, an Ambu bag. a nerve stimulator ro measurc the degree of

neuromuscular blockage. cardiac monitoring, pulse oxymeter and a blood pressure cufi

lf thc inmate is a diabetic, the prison would also necd er.;uipment and medicine to

measure and treat abnormal blood sugar.

I swear that the forcgoing is true and conect to the best of my knowledge under penalt) ol

perjurl under the laws ofthe t Jnited States and the State of Arkansas.

Match24,2017

Date Joel Zivot. M.D.

EXHIBIT 6

Nitrogen Induced Hypoxia as a Form of Capital Punishnrnr

Michacl P. Copeland, J.D.

Thom Par, M.S.

Ckistine Papas. J.D., Ph.D.

East Central University

Nitrogen lnduced Hypoxia

Preliminary Drafl. Do Not Cite1

Ereortive Summary

At tbc rcquest of Oklahoma Statc Reprcscntativc Mike Christian, thc arthors of this study

rcscarchcd thc qucation of whcthcr hypoxir induced by niuogcn gas inhalstbn conld s.rve as a

viablc altcmativc ro lhc currcnt mcthods of capital punishnrnt authorizcd undcr Okhhoma law

As per rhc abow, this sludy do€s not crprcss an opinion on thc widcr qu6tion of whcticr

Oklahoma should continue to administer caPilal PunishtDcru in ggncral. Thc scopc of this tttdyis limilcd to thc assumFioo thal caPitsl PutrishrEnt will cotrtiouc to bG administercd in

Oklahoma, and giwa that assumPtion, analyrng u/tcther hypoxia via oitrogen g6 inhdauoa

would be an effccrivc and humme alcruarive to thc curr€nt rDctbods of capitd putshment

pracdced in Oklahoma law.

This study was conductcd by rcviewing thc scieotific, tdhnical, and safety litcraturc rclatcd to

nimgan inhalalion.

Thc studyJouad that:

l- An exccutioa prorocol thet induced hypoxia via nitrogen inhalation would bc a humanc

me0od to cerry out . dcath scntcnc..2 Dcath scotcncc protocols carricd out using niuogcl iohalation uould not rcquirc thc

assistancc of liccnscd nedical pofcssionals.3. Death scnacrtccs carricd oul by nitrogcn inhaladon would bc simplc to adminisrcr'

4. Nitrcgcn is Eadily available for purchar and sourcing would not pose a difltculty'

5. Dearh-scnrcnces carricd out by triuoSen inhalation world nor (tpend rpon oc cooPcraion of

the offender bcing cxecuted.

Accordingly, ir is thc rccommendaticn of this study that hyporia indrrcld by thc inhaladon of -

niuogcn b'aoffend as an altcrnerivc merhod of administcring capital p[ushrmnl in thc Statc of

Oklahoma.

The views exprcssed in rhis study arc solely thosc of its authos and do not ncccssarily rcflect

thos. oflhc univcrsity rt which wc are rffiliated.

Nitrogen lndrced Hypoxia

Proliminary Draft. Do Not CJt€

2

Nitrogen I nduced Hypoia

lntrcductiol

Nitrogco is an irlcfl gas that at room tcmpcraturc is colorlcss, odorless, and tastclcss. It is

thc most clmrnon gas in thc carth's atmosphcrc. comgising 7E.09% of thc air that hurnans

breathc on a rcgular basis.

Wbcn combincd with thc normal 20.9596 oxygcn found in thc atmosphcrg nitrogen is

complacly srfc fc humans to inhalc. Howcvcr, an cnvironmcnt ovcrly cnrichcd in nitrogen will

lack thc appropriatc lcvcl of oxygcn oeccssiuy for hunan survivEl and will thus lcad to hypoxia

and rapid desth. (U.S. ChemrcalSafery and Hazad Investigstion Board, 2003, p- l).

Nitrogen hypoxia has bccn suggestcd as a mcans of admi[isrcring capital punishmenr in

the popular mcdia on previous ccasions. For examplc, inl995 thc National Revicw fcatuted an

aniclc by Stuan Cregue titlcd (il[n g llithKhdtcss: Capital Punislvtuttt lty Nitogcn

Asphyiation ( 1995). Crcque's articlc was wlinen in responsc to a th Circuir U.S. Disrict Coun

dccisioo that California's gas chambct was an unconstitutionally crucl and unusual punishmcnt.

Thc articlc suggcsicd nitrotcn could providc a sfunplc and painlcss altcrnative to thc gas chambcr

that wculd r€quire no elaboratc medical procedurcs ro adminislcr.

Thc idcr of adminisrering capital punishment via nirrogen hypoxia resurfrcd mon

recently in a Tom McNichol Slate magazine anicte ritled Dearh oy\ Nitrogcn (2014).Thc aaclc

was inspircd by thc sray of cxco:rion issued by rhe U.S_ Suprcmc Corn for a Missouri rrun

facing exccution via lethal inicaion. Again, rhc author suggcsrcd nitmgen induccd hypnxia as a

painless altcmaive to uadidonll mcthods ofcxecution, adding rhat ir olfcrcd the additionsl

bcncfits of rcquiring no medical training ro adminisrcr and lackcd any ofrhc supply issucs that

erist with lcthal injccrion.

Prcliminary Orall. Do Noi Cltc3

Ni,fogsr lndt.E€d llypoxia

Ttr capital punishmcnt prorocols cited tlnt utilizc nitrogen to administcr a d€ath scnteocc

do not rctually rely on tlE nitroScn itsclf to bring abou dcalh' Nitrogcn simply diryhccs thc

orygcn nonutly found in air and it is ttr rasulting lack of ox1rycn which causes death. Without

oxygcn prrsarl, inhalation of onJy l -2 brcaths of pr:rc nitrogen will ctusc a sudden loss of

consciousncss and, ifno orygcn is provi&d, cventually dcath. (EuroPcan Indusrial Gascs

Assaiarim, 2009, p. 3).

Sincc nitrogen has nol PrEviously been used for capiul Punishmcnl lhcrc is a lack

scienrilic literaturc that spccifically addrcsses its performancc for that purposc. Howcver, rrc

havc bcen mcdtcal expcrimcnrs which involvcd human subjccts bcathing purc nitrogen until

they became unconscious. Beyond *rosc cxpcriarnts, most of thc data rclated to nilroScn

induced hypoxir conrs fron docunrcntcd suici&s in humans and rcscarch in high altitu& pilot

reiniog.

Author's Notc: in sone ctscs hc lay press will inndvcrtently rder to hypoia as

asphyiation. This is technically inrccurote in this contcxt, as asphyia is hc irubilitl to

bicathc in olrygat and the inabiliry to cxtnle carbon dioide' Hvpotio is rhe pothologv

relatcd o thi inahiliry rc tnta*c oxlSe cacn tlr.ugh onc may still he able

to exhalc carbon dioxtdc. As utitl he seen later. the ability to exhale cathon

diotidc is critical to thc proposed nethod oJ erccution' as it Prevcnts the

acidosis tumnllv associated with asphyiaion.

Medicel Litcrature

The adult brain uscs abour l5 pcr ccnt of thc heart's output of oxyScnatd blood

(Graham, 197?, p.l?0). Hypoia is thc condition of having a lowd-than-normd amount of

oxygcn in thc blood. Anoxia is En cxttcmc form of hyPoria in which thrc is a comPlctc abscncc

oforygcninthcblood(Brierlcy'1977P.181).IfrhcsuPPlyofoxygEnhthcbldisreduccd

Prdiminary Draft, Oo Not Cite4

Nitrogen lnduced Hypoxia

below a critical lcvel it will result in a rapid loss of co0sciousncss aod cvcntually ircvcrsiblc

bnin damage will occur (Graham, 197?, p.l?0).

A completc imnrdiatc global loss ofoxySen b tbe brain, (a scenario in which no rcsidual

oxygen in the lungs or blood is delivcrcd to thc brain), will rcsult in a loss of conscioumess in

eight to ten scconds, and a loss of any electrical output by tbe brain will occur a few scconds

latcr. Thc hcart may continuc to bcat for a fcw minutcs cvcn aftcr thc brain no longcr functions

(Bricrley, l9n p.182).

Ernsting ( l96l ) performcd a study on human volunteeF that hypervcntilated on pure

nitrogen gas. The subi:os pcrformed rhe te$ multiple times. varying the length of dme they

inhaled thc nitrogen. When the subjecrs inhalcd nitrcgpn for eighr-to-ten seconds they reported a

dimming ofvision. Whcn the pcriod was expanded to fifteen-to-sixteen seconds, rhe subjects

reported some clouding ofconsciousncss and impairnrcnt of vision. When tbe tests were

expandcd to ser€nreeo-rc-fwentl scconds, the subjecS lost coosciousrrss. Thcre was no rcportcd

physical discomfon associsted with inhaling ttre purc nitrogen. (p. 295)

Unlike asphyxiarion, hypoxia viathe inhalarion ofnitrogcn allows rhe body ro cxpcl the

carbon dioxidc buildup that is normally associarcd with the respirarory cyclc. This helps prevenr

a condition known as hypcrcapnia - an accumulation ofcarbon dioxidc in the blood. The result

ofthis buildup of carboa dioxide is respirarory acidosis - a shifting of rhe ph levels in thc blood

to bccomc morc acidic. This is thc pathology many pcoplc associarc with suffocating. Somc of

the symptoms of rcspiraory acidosis ale erpecrd ro bc prGenr in cascs of asphyxiaim. bur nor

expccted to bc present un&r pure hypoxia are anxicty and headachcs, (Menick Manuel, 2013).

Preliminary Oraft. Do Nol Cile5

Sricide Datr

MtrWa lnduced Hypona

krhap ooe of thc grratcst tcstamants to both thc hu[Enity of nitogen induccd hypoxia

as wcll as thc casc of admioLtration is is npidly gaining popolarity as a sclf-sclcctcd rrans of

suici&. Suici& by hypoxia usiog an incrr gas is ihc mos widcly prormtcd mahod of human

eutbanasia by right-to-die edvcates (Hower4 M.O. d. at., 201 I , P 6I )

Tbc trend toward using rn "crit bag" fillcd with an inerr gas such as nitrogen or hclium

likcly startcd with E publicEtion of Finol E,,it: The Practicalities of Sclf Dclivcrance atd Assistcd

Suicidc lor the Dvrlt. Thc authors of tttc publication sough( to idcntify mctiods ofdcarh fiat

ucrc swift, sinplc, painless, failurc-proof, incxpensira, non{tsfiguring and did mt rcquim a

phpician's assistancc or prescription (Howard, M.O. et. al.. 201 l. p 6l).

Tbis mahod of suicide is indccd simplc. It involves a clcar glastic brg fittcd ovcr thc

head. lwo tanks filling the bag wirh helium via vinyl tubin& and an clsslic hnd a thc boliom of

the bag to prcvcnt thc bag from slipping ofr the hod. Thc Pans nccdcd to ctcate the bag ere

iocxpcnsivc and availablc locally without prerription (Horvand, M.O. ct. al.,2Ol l. p 6l-62)

Reports of &arhs obscncd via this rrtthod suggrst thrt it is painlcss. Jim Chastain' Ph.D.

Praidcnt of thc Final Exit Nctwo* of Floride dcscribed the Proccss this way:

In thc scvcral evcnts I havc observcd the pc6on heathcs tttc odorhss, tastcless

hclium dccply about lhrcc or four tirrcs and thcn is urEonscious. no gaSSing or gasping.

Death follows in 45 minulcs. A p.accful proccss.

Derck Humphrcy, currcnt chsir of thc Final Exit advisory board is quotcd as seying:

In rhc apProximatc 3O0 cascs which havc bc.n rcPoncd to nr rbcrc bas ncver

bccn mcntior ofchoking c gagging. wbcn I witncsscd thc hclium dca$ ofa fricd ofminc itcould not hsve bccn rDorc Pesccful (Fnal Erit' 2010).

Howcver, it should bc mtcd tlut deviations from thc abovc pmtocob havc not alwals

bccn as suctcssftrl. Whcn mrsks were plrcd o,rcr thc fre (imtcad of using bags of hclium ovcr

Prrlimirary Dralt. Oo Nol Cil.6

Nilrogen lnduced Hypoxia

thc hcad) it has becn rcponcd some problcms have occun€d. This is t)?ically a result of0E

mask not raling tightly to thc facc, resulting in a small amount ofoxygcn bcing inhalcd by tlrc

individual. This cxtcnds the timc to bccomc unconscious and cxtcnds thc timc to dcath. This may

rcsult in purposeless movements by thc dcccdent (Ogden et al, 2010. p 174-179).

Research on Hlgh Altltude Pllot Trelnlng

A gcat deal of cscarch on lhc cffccts of hypoxia on human beinSs comcs from

aerospace mcdicinc. Pilots that tiy at high altitudcs arc subject to bccoming hypoxic ifthcir

cabins losc air rcssurc. Altitudc hypoxia has similu cffccr as lhc hypoxia onc gets from

brcathing inert gascs although it is causcd by the inability of the lungs to absorb the oxygen in

rhc air rather than a lack of oxygen in thc air.

Thc Rdcral Aviation Adrninistratioo (2003, p. I l) statcs:

Hypoxia is a lack of sufficicnt oxygen in ttE body cel.ls or dssucs causcdby an inadcquate supply of oxygcn, inadcquate ransponation of oxytcn, orinability of $c body tissrEs to usc oxytcn. A common misconccptioo amongmany pilots who arc irrxpcricnccd in high-altitudc flight opcrations and whohave not bc cxposcd to physiologica.l training is that it is possiblc to rccognizc thcsymptorns of hypoxia and to takc concctivc actions bcforc bccoming scriorslyimpaircd. While this conce6 may bc appealing in thcory. it is both misleadingand dangerous for an untrained crcw nrmbcr. Symptoms of hypoxia vary frompilot to pilot, but one of the earliet effects of hypoxh is impairment ofjudgment.Othcr synnpoms can include one or more ofthe following(l) Bctravioral Changcs (c.9. a scnse of euphoria).(2) Poor coordination.(3) Discoloration rn thc lingernails (cyanosis)-(4) Swca ng.(5) IncEascd brcathing rate, hcadache, slccpincss. or fdiguc(6) Lcs or dctcrioration of vision(7) Light-hca&dncss or dizzy scnsations and listlcssncss.(8) Tingling or warm scnsations.

Preliminary Drati. Do Nd Cile7

Nitrogen lnducrd Hypoxia

lndeed, hypoxia has causcd several airlinc accidents which ae often fatal. Thc onsct of

hl,poxia is typically so subtle that it is unnoiceablc to thc subjcct. The effccts of hypoxia arc

oftcn diflicult to recognizc. (Fcderal Aviation Adminisration. 2014' Ch. 8-l-2 (A) 5)

Ancmpts to irain pilots to noticc hypoxia are condudcd using a hyPcrbaric chambcr to

simulaE high aldtud6. OfEn a raincc will bc asked to rcmovc his or her rnask and Pcrform

simplc tasks. Ai low lcvels ofh)?oxia, trainccs tvpically fccl linle mort than euPhona and a

scnse ofconfidcnce. At highcr levels of hypoxia, trainces will quickly bccomc unconscious.

Timc of uscful consciousncss at allitudcs abo\€ a3'000 is 5 sccords (Rdcral Aviation

Administration, ?O3, p. l3).

Findingr

Bascd qr rhe rcview of drc liararurc relarcd to hlpoxia induccd by incn 8ascs. this study makcs

the following findings:

l. An execution protaol that induced hypoxia via nitrogcn inhalation would be a humane

mcthod to carry out a dcath scntcnce.

2. Deadr scntcnce protocols cartied out usinS nitrogcn inhalation would nol requirc lhe

assisrance of liccnscd mcdical profcssionals.

3. Death scnrcrres carricd out by niuogcn inhalation wolld bc simplc to administer'

4. Nitrogcn is rcadily amitablc for purchasc aod sourcing would not pose a difticulty'

5. Death scntences carricd out by nitrogen inhalation would not dcpcnd upoa thc cooperation of

thc offcndcr bcing cxccutcd.

6. Usc of nitrogcn as a m.thod of execution can assure a quick and Painless dcath ofthe offender

Finding l. An erecution pmiocol that induced hyporie vie nitrogen inhelrtion r'ould be a

humane raeihod to crry out r darth sentence'

Rationale:

Prdiminary Dratt Do lJot Cite8

Nitroga I nduced Hypoxia

As an irEn gas, nitrogcn is odorless, colorlcss, tastclcss and undctcctablc to human

bcings. It is ?8S of the air wc brcalhc oa a daily basis, and thus therc is littlc chancc that any

subjcct would havc an unusual or allcrgic rcaction to thc gas itsclf.

Bccausc thc subjcct is ablc to expcl carbon dioxidc, thc anxiety normally associatcd wilh

acidosis in asphyxiation would not bc pEscnt.

The liteIaturc indicat6 after breathing purc niEogcn, subjccts will cxpcri€nce the

following: within cight-to-ten secoods thc subjccts will cxpcricncc a drmminS of visiotr, at

frftcen-to-sixrccn scconds they will expcriancc a clouding of consciousncss, ard at scvcntrca-to-

twenly scconds thcy will losc consciorsness. Thcrc is no cvidcncc to indicatc any substartial

physical discomfon during this preess.

Therc is a possibility that subjccts will fecl cuphoria prior to losing consciousncss and a

slight possibility thcy will fecl a tingling or warm scnsation. Aftcr thc subjccs arc unconscious,

it should bc expoclcd somc ofthc subjects will convulsc. Most clcctrochcmical brain aclivity

should ccasc shortly aftcr loss of conscioumess, and thc hean raa will bcgin to incrcasc to

varying dcgrccs until it stops bc{itrg 3 to 4 minutcs latcr. Obscncd suicides involving incrt gas

hlpoxia are dcscribcd as pcaceful, so long as caution is takcn ro climinatc thc possibility of rhc

subjcct inrdvenently rcceiving supplemcntal orvgcn during the process. lncrt gas hypoxia is

considcrcd such a humanc and dignificd proccss to achieve death thst it is rcomrncnded as a

prcfcrrcd rncrhod by right-todic goups.

I-tnding 2 Derth sentcnce protocob carri€d out usilg nitrogen inhalrrtion would notrcquirr tle rsistrnce of liccnsed trEdical professionals.

Retionele:

Preliminary Draft. Do Not Cite9

Nilrooen lnduced Hypoxia

The administration of a dcath sentcDce via nitrogen hypoxia dcs not requirc thc use of a

complex medical procedurc or pharmaccutical produc6. The process isclf' as demonstrated by

those who seek euthanasia, requircs little more than a hood sufficiently anached to the subject's

hcad and a tank of incrt gss to cteatc r hyPoxic arrnosPhcrc.

Whilc a state cxccution would likcly havc a morc claboratc mcchanism to crcatc hypoxia,

nothing in the process would requirc sPccialized mcdical knowledge or thc use of rcgplated

pharmaceutical producrs. Accordingly, exccpt fof the Pronounccment of death, the assistancc of

licensed mcdical proftssionals would not bc rcquired to cxecurc this protocol.

Finding 3. Dealh senteoccs csrrld out by ritrogen lnhdetion would be simple to

administcr.

Ratlonale:

when considering a substitute method ofcapital punishmenl it is important to consider

more tlnn just what happens ifcverytiting goes according to Protocol. Thc likelihood of mishaps

must also be considcrcd, as ucll as thc conscqucnccs trat would flow if thosc mi$aps should

occur.

Because the protocol involved in nitrogen induced hypoxia is so simple, mistakes are

unlikely to occur. Oxygen and nitrogcn monitors may bc placcd inside thc containcd

environmcnt to insuc the PIopcr mixcs of gas aE bcint cxpcllcd into tr bag aad inhalcd by ttr

subjcct.

Howcver, the prorocot should be carcful to prcvcnt the possibility of oxygen entering into

tlre hood, as that can pmlong timc to unconsciousncss and death. as wcll as incrcase thc

possibility of involuntary movements by thc subjea.

Preliminary Draft. Do Not Ote't0

Nirog€n lnduc€d Hypoxia

Thc nsks to witncsses are minimal, as any porcnoal lcat of thc nitrogcn would not bc

harmful in a normdly vcntilard envimnrncnt.

Fiodin3 tl. Mtrogen ie rcedily evrihbb for purchere rad eourcing world noa poee r

dif,iculty.

Rrtiomler

Nitrogen is utilized harmlcssly in nany fields within Unitcd Staa6 itrdustrics. Nitrogen is

used in wclding, hospital and mcdical facilitics. cmking, and uscd in thc prrparation of liquid

nitrogen cocktails. Nitrogen is uscd as a process to eraend thc life of fmd producrs such as potato

chips. Nitrogcn is used in doaor's offic6 to r"move sr(in tags as wcll rs othcr procedurcs.

Accordingly, sorrccs of nitrogctr to bc uscd for administcrint a &ath scntcncc should bc casy to

find and raadily a ilablc for purchasc for such purposc.

Finding 5. Deeth scltenc6 csrri.d art by nitrctetr inhaletion rvould not dcpend upcr the

coopention ofthr ofle d€r b€ing executed.

Rrtionele:

Somc forrm ofcapiaal punishmcrt require thc ofrcndcr to subm.it or comply to somc

dcgrce )n ordcr to assurc an cflicicnt and hununc mcthod ofcxccution. With Fopcr prgrocol and

ulilizing such dcvices as a rcstraint chair, rurrogcn intElattm can bc admtnisErcd dcspitc rhc

prcscncc of a non-compliant offcndcr. Thc usc of nitmgen can bc us€d by non-mcdical pcrconncl

and a dcliEry systcm crn bc ddiSncd ao cnsurr thc qecution is carricd out without issuc.

Preliminary Drsfl. Do Not Cite11

Nitrogen lnduced l'Irpoxia

Conchrion

As pcr thc abovc, it is thc rccomrncndation of this study that hypoxia induccd by thc inhalation

of nitrogcn bc offcrcd as an altcmatirrc method of administcring capital punishment in thc Statc

of Oklahoma.

Preliminary Dratt Do Not Cite12

Nitrogen I nduced Hypoxia

Rcfcrcnces

Bricrlcy, J3. Erpe rinenral lrypoic Brain Damage lowal of Clinical Pathology. 1977'

r I, t8l-187.

Crcquc, S. A. ( 1995). Killing with [iodncss-taPital punishrncnt by nitrogcn asPh)4(iation.

Natl Rev,47(17), 51.

Ernsting, J. Tlrc Eflccr of Bricl Profound Hypoxia upon tlv Artcrial and Venous O4-gen

Tensions inMan.J. Physiol. 169, Air Forcc Imt. of Av. Mcd. l-23-1963 9p.292'31l.

Fcdcral Aviation Adminisration, Dcpartrrnt of TransPonatio[, (7/24114) - AcronauticalInformation Manual. Rclricvcd onlinc at:

hnps://www.faa.sov/alflraffrc/publicatioovatpubvair/airn0Sol.ht nl $ 9lI4lzJ14

Ftderal Aiation Administration, Depatuncot of Transportation. (UA2N3) AC 6l-107A-Opcrations of Aircrafi at Altitudes Above 25,000 Fcct MSL And/Or Mach Numbcr (MMO)

Greater Than .75

Final Exit Network, Thc. (March 17,201, 20l0lium Dcatt6 Do Not involvc Gagging Say

Obscrvcrs. Rctricved on 9/14/2014 http/assistcdAying.orglblogl20l003/17lheliumdcaths-do-not-involve-gagging-say-obscrvc rV

Graham. D.l. Pathology of hypoxic brain damage in nnn, L clin. Paih., 30, Suppl. (Roy.

Coll. Path.). 1977. I l. l7Gl80

Hazards of Inerr Gases and Orygen Depletior. lGf,. Documcnt 44l09/E European

Industria.l Gases Association. 2009.

Hazords ol Nitrogen Asphyriarian. No. 2003- 10-B, U.S. Chcmjcal Safay and Hazard

InvestiSation Board. lune. 2003.

Howard, M. O., Hall, M. T., Edwards, J. D.. Vaughn, M. G., Pcrror B. E., & Wincctcr,R. E. (201 I ). Suicidc by asphyxiation duc to hclium inhalation. Tle Anerican jounwl ofJorenicnrettic i ne ond pat holo gy, j2 (l). 6 I -'l 0.

Humphry, D. (2002). Final eit: tlv practicalities oI self-deliverance and assisted. suicide

Jor the dying. Random Housc LLC.

Mcrrick Manucl Thc. (2013, @tobdr) Repertory Acr'dosrs. Retrieved from:http://www.rpcrckmanuals-cofirprofcssionaycodocrirE 8nd mctrbolic disordcrs/acid-basc rcgulation and disordcryrcsoiratorv acidosis.htrnl oo 9/14/2014.

Preliminary Drat! Do Nol Citel3

Nitrog€n lnduced Hy?oria

McNichol, T. Dcath by Niuogen - Slate Magazinc.14 Scp. 2014

hup://uurw-slatc.com/arricles/news and oolitics4urisoru&nce/2014r05/dcath bv nitroqcn gas

will thc new mcthod of cxccurion sayc thc dcath ocnsltv.html.

Ogden, R.D., Hamiltm, w.K, Whitchcr, C, (2010 Mat) Assisted suicide bt orygen

dcprivtion with lcliwn at a Swiss r$ht'to'dic organisation.l. Mcd. Ethics: I 7'l-9.

Ogdcn, R. D., & Wooteo, R. H' (2002). Asphyxid suicidc with hclir.nn and aplesticbag.

The Anlzrban jountal o!lorensic nedicine and pathobgv,23(3),23+?31.

Prsliminary Dratt Do i$ot Cite14

t," | ",0",r I

Appendix DDclrh by litroSan Sias lffill ihc ncw mctbod of

tleeth

sol h

ofll

Wil fl"is i.lew tlbthod of Execution Save tlp Death Penalty?

Deeth by l{trogenIt l.lhal hjoctm fel! od of hvo.. dEth p€rdty ltalos codd tum to a nau nEtho6: rfiogafl gss.

.E trrrâr t- r r- nxa'g ln. E-! d.

6 rrtraatr ir( ar lir.r car, ar-rl tr crtr !y lli hI6Er llr 6tn! !La, cfr it-a irobr. a.ra tt ia ! iidclcrtr.i€B tatlr! frrql|.ra. trhfr..-rEl,|.oltr-.r .bllrt.alha.duBntttorlr o( Ttr.out tld Or!ri-l ,- .a *..-irt .l ,r 5 i-r-. r,Lr.-r.rrr -r

irr rrrrr Br.ar &..r -,a .l- oar.nfit 6. .- o-l b a. b.r.out r.aa aranr tcrut a rrt! riti afft*trE s.a.rr cq,t ^- a llla lr.lx.rdt !,.rri tid ldcrr)ii3 a,l Ldthl.E|

- oortitbu, it!!d..o qratsr lin tr..rlE6g rt.aEn rt

-.orc.tEr i'dGr l.!-'' t n.E-.-E!.q.ED-r,Er^rdE

,r n !5 Urr nE rll'ftr.rrr. 'i,rtr+ R.l ur.a, irr 3r3a.!a tlr Er or.Ir g!. r-a laraatc-r :{i.i. aaa- E,-rl.r Er ,! rroid ,r.u c liL t -trr. !- . Et ,Ear r! rrrrr itr tEE d lcrtt -a t! nr t/ttn cefi irrrr,i6 r rcor,ahl,lr5 rb<.itt.fg,& rr! - llr.'irri b rl c,hr!.r, ot3rra 6. srllrrr lE.d t6na cet t.r jr-rnra'rr ianca, ti6.. rt.t.r td?ird6,.* rr c..!a.rrrd h - -t!i arrlr F!t!.a td c.a.ot-!-. --!.t 5t. Erol dygr. l.rorr g.ll._F b E pua tr t.l. t n.tid dcel rlltrrr.--fl cart'orrrarr-r itr.t airfura rrl,tr ier.rF.a e -crtna, Crnca.r #rE\ -n sarlrf,tE ff,!n tlln Fr.r.;.daG..ta.rr ar,a..t-F;,r{tr;i!..O-}l-.}ir.rEd b r.r6t 6r,*!0.t 6d$, .rcd, cdcirt hdr - iArrol n rf-.'ft t6aj.;B o ,tir o*

Yqrcr!_eca lra flr !'rt t!- - It lar -.'-tc arG-t rlur hrilE lrts rt r! (!t r,r.t t|g-r! 3- *r!rr cllr. -rh Ertr.S,rqnrv rlr r- tia nE as.d..!, ?r!rt tE Jtii - u.! d:rg,rir6 ra rciEc oa aiin rrrlitrri-trrfrrc.crio$r sEhr.ErEr{r.5,5tnlcErE .-dtrEtritttarrruEr Itha.;-,sE_Er-tr',.r6oact.r.arb ht . ad.-t-{Praqlr, n !.i n-rrrd,.fn t!9*-d..--. lt!...*rti t ria- t rrtdla rr s.d r.J'l!r 'lr...;ha rrirqE:nE"rE oErir irEE: trr! rr c-\

-

i-\ - E!,Er r-!a rr rrrr a4-E.r lrE^ -Ei. Gar- !l a!t'ha.acrErtbl., rrrr-'r. rrr'' Erc aE-h ta att ra.5. DIrrt a cairqrgEarrr lrB !a!-! rttt - ror a-tqE r orrilr G.(.!-. rrnt E ito {-!e^lrqr F a a..1n!UrGt\ lsxl hf*it- Er -Gartrbr rft Eaarra a'ql tr!aaa|. b rElt rorr. Ufric.r*.ab t lqlak rlffiirb.,oiat r-. c.i.rr'raoa! a lr ts ,tJr' !-r !! tr 6i - tr. e.lb rrtbla A/a rEnt- rE rE lFi ld4ltt!r..'li.cori*. trhri-L.a-.b'-E--rrGar.a-r.n .-E itrrr'ryiE L.r.ir. r- #.r--i.drii +- d|-E -.r. r h,!E.'r.F-El.bt!r. ?l|1 nr-r, lr -!t rarrraa! ccrtil.rE coEda. !ErEr.trnaroiriirrqrln t-! - -r !L.L aa -l rb r,

-l aa'

htF//r.wwshtc.cot /!fliclcJrEr'!_ud_potiricr/jEisFudcncc/2014/05/dc8rh_by_nirogcn_... l/V2Ol5

Dctth by oitrogan 8ag: WiIl tbc rew rnclhod of fircutist !8r,c tbc dcrth pcoEh:A Pagr 2 of I I

A|ErraIn.6hac.tsrrtl crtrErETTEEEaEd-,titrnrl C BG/Er !!.t -ll tiEat\ l -ra l,I Dtr..-t1t-r i .!r- a. a. E rd lr!!r. *H r-t-- qr...-t'-t L..rEO.t1i-rnlitriEClt-.rF.rfb t lryrcaaG ttr arq, .ht^ b dr!-!ol ll arS *rl"8.-r-rrrr-Errt-Jl..rEa.8.EsE!tr-t{tsrtr}rGEE-r ;c!r rlta!rrr}*-iafriE'iirErrEtrrrrol.In!E-rrlrtlErtrnEllt r. tEEt nilr clrt a :.t,iirC.'|inl:.r.l.erdlltd.:rnatElat-^L,D-cr-irlrtltt-ralltt!.. iEir*nrtr,t-ait.ltlcr.f rffl r! rttrlt r! -ai C-. Otarbn rrltnf .i-. raa tEitdn laltal

iaqatf, gta t rl Jvt rrrla.aE tr!5dr r rad.t tE. fir. c.l t aa dllrrh l,.lliu!.lli -!!E bddo iicrid" rrrr rlr. r-lo ttr lrqrcaf rr rrrotrt'i.F tbr lt.aairt Laa rr..ry cli o'|lta l,ia r.|, F-d.aqt .illrrrxrcg grrrrr lrrt ltuaqtG. j lra. LnqrrF l.tt'tocdrrtlt rflalhtraairaar.t.! vdn ? r i6 *-t asy& F c-tt E blc irdt Yarlt{rtol5.a I tdal lftolLal hfra.fit llft- ,-F

ir.it-L bL r*-\ tE irE.ElEf.]! a t or,lorirErdn-laa !" ''o' xE !L i!!trtdlrtr t"ir tdi"et h'r!-Errrrlr tE tr lEO3 nte. al-aaaaa-r,ttot ltta rrt llTrdlt Eal{FE.'ni4,elE(tErnl trEiE a lr r..r rr at Lt .lsrlt .. -tLE d th. ...daa, os hr hJ.GLr !.lrd sEdr-tdltt Lt o-ctirio..GrEr h itt ug.6n E-!E n ttd fa alt ol lF !c... ll,rlqmcFtlt l. ra- c.ttl'-lEll.br. ro;1,;;.b,,- r..i.at.5\ r ctrrr. '- rd I !. rdr3t rrd nlr'. llillt1.ltt? Irl i 6tr b a.rrrr Cgnl!rlll.,srroE?il,|rEtc rlr o,dEfar l,tnif| rs{. aat artil nl'atI t-! lt rtrat Lr Eta rtc'rr* Er arrirc{- tat.nr ,t rd h rl -G,wrrri nry rn or r r rto,r. brlrft b cttorl. lnr.rrr rai

Ton lu\add rs . fltts l.l S.n fr-ab6,

?lEIrcTl l'GI Id'B ir^ll

5 ga. slt s,r r& nr r,tl ot YorP.r.tEr h A ConServative Judge Anrfil8teErr,trra.rE l\bnh Carolna's utbaEqlrd

Requirement5 Ery To OCt .,bb Ib Pry ilal lltl rare

r5)b( Frd. A$ab yuhotc o.y Fflr.r Fsn'- ffigHtrtr'o' H' tt'tFo'Ht

$Ls F.vclt! SnrrtshdE AP. d 20la4 $rgra. bAY(arrt

THs Przzld! Si.nC. D.rtn h (bga'ra .nd rrd'q,|fr/tirq! Sul,ilrf oa{ATdrE, Eoggtorg

Thls Ngw App B Repladng Hutnan AP T*G' Do'tr ?k' ffi r'n'er ^l'

qtd-{tFhancial Advisors ro*r. ADo,. D.rb stctd

Ford. tSrG rarird Sdl! olartbar (}-5l6dt

httD/r1r-sshreJoEtnict6/oc'rs tsd oolitcoiurilrudcocalzol4/ft5/dceth hv nitrnoan l /R 0l (

Killing with kindncs - caltal prnishrcnt by nibogcn asphyxiatioo

alLaii(b.r€thds

Kilfirp wlth klndness - cadtal Brnishmenl by ribog€n asphyxiation

Phllb..t

httr/Amr.|r.f hdff tlcbs,cflydatuc yri_m1 ?Ws _n 1 7 _v47 ld_17 37.+u149

C4ital Brirhment rEedrl be cruel c musual - especia$y tf you useritrog€n asphyriatqt lo BIt people to sleep.

LAST Octob€r, ldge iriarip lkl Pald of the tth U.S. Clsfict Court nledtlnt erecriim in Caltor.ias gas chanter is a fqm of crud and unusualprnishment, th€ fH rdhg evs by a stal€ or fedorC iudgs to invddatea method of execr.rtbn ar Eighth Amendment grourds. She mted that heevijsnce showed lhat the condernned nlan milht rem*r cqlscaqE for rcvcralrlnut63, experlenchg the erbtbns o,'autsty, parlc, te,ror,'as we as'exgrBitely pahfd muscle spasms' an<l intsEe viscerd pan.'

On iB hce, Ju@e Pat€rs rulhg appli€s only to the gas cfiaflter, bu e€rynEthod of ereqjtbn h crrrent lJse nvolves tqb ctEni:ab ff 9hysi5trauma to hdr.Es &.th - and every method ca go alrry. &t Ued hanfhgBnap8 the cqid€rmed ma's n€ct( dearry; a botctEd on€ either streEles himsbu,ly or set ero the head enti+ from the body- A fiiE squa6 that r*Bsits nE t Laveslhc cordcrmd ma corBcix.E a hc blccd3 to dc.th. h th€electrb cilalf, accorcE to q/ervifEss accotrlts, sqne conderrned rEn iEvefterty bc€n cok6d mu rlei tb!fi w6 ctEred and loosened from thebone: some hat spats eti flam€ emanatirg frqn fle, crar{al-ce electro(hs.

Besbes societfs cocern for the conderned man's physical *fferlrg, all ofthese metho& irplkltly rqdre a executioner to hflct some degre oftrema upoal the clndernned Cficem fct lhe ereoltbrEis cdlsdsre div6g8lcfi c1lstoflB as loadhg cn€ of th€ guns for a fiirg sqrlad with a blmkcrtid96, so th.t c.dr mcmb€r of the sgtrad can imaone that t*r wll b6 th6nq|{elhd sapt. And wilh lett|al hiectix\ ttE exedtim€rb us€ of sktlsand procedr$ norrnaly det/oted b |te-savhg pos6 et td qriesuons tamedcal careglvers.

Cjivefl these d€rec6 abolticrists wtl prosum$ly lress to tBve eadr ofthese metho& d€daed 'c'ud and unusud.' The i,rtended res,l of ttrese€ffcrt8 iB to rd€ th€ &.th pcl.lty unco.tstitutbrC h Frlbe, err€n itit rem€hs cqEtitutirld h thBqy.

I ls h lel possbts to cq[dv€ of a nEtpd of exeonim Urat wodd carserEiths pah rE phyni:al traf,na ,Bqr€ no medcd rocedrre (other r nprmounchg d€ath), ard Lse no hezrdorB cfiemi€E A case of accitntal

Pegc t of6

(lo dd to ndr)

I y€a8 ogo

httpc//dtsuicitcsnhodsmrtivacom/GTtrrrslir/lilling-with-khdDcss-cEpital-punbhmcnr... m/2015

Killtn8 vhh kindncss - capitrl Fsdshtrtol by niEogco.tPhyrirlio

d€arth sJggpsls sr.f,tr a m€thod

Early h ttE Space Shuttle pogran a rivs*r at Kemedy Sgace Cater v,rakad

hto an er(,snal tu6l Enf (a vessd nealy as tig h3iCo as a Bo€ho 737)

to insp€ct iL He was nol aw'€ tllal it llad been grg€d with pue rittogdlgee to pr8t/drt oxlggt h the af han oroeE irs hidb Shcs ritroCgt

is tip mai, cor?pon€nl of afE y ;i prre drogdl has no dsthdiv€fe€{ srrcl, d tastar lha wo.tc. h.d 7E indcatim that ,lyfirg wB out of

fie 6(flay. Ans wakhg a stu"t dstalce mo ttp lank, he lost

c(lrcinsngss ad cotlapsed A cwor*s, not realztrlg fiat hB Golap$had er €DdsnC caiEe, ran lntoaid lh and $ccumbed also. Byth€ tlneotlrer wskss re&€d whet was h4per*Ei th€ two npn wer8 dead

l/bre rE€,ttly. a ba2arB accident hvolvhg ribogen k ed t\tro Fode hthe Bay Ar€a They lied stol€n fto.r a hosrital a gas cylH€r conEldng urhai

lhey tlFrrght wss laughhg gEs. llowevo, the cyhdei cont.hod not ttt

anacslh€tic nittqJs oxirr but Bre ritrogerl vvhefl thc trro rnGn sbPPcd thcicar to ftake ol tlr€t booty, the ttlogsl gas dspbced Ole at ln the

car, leavng them willlq,t oxyg€n tbd ttEy had any indi:atlon ot thepodem, hey cald ha\,8 sarrod th* Ives sirdy by opeohg the ca, &oG'

These deaths wse sifar h cause to a rebfrvely conmm dorfii1g accidefil

known as shallow-uats blackqit rrentlqred spedficdy in ceriflcatlon

dasses fcr rscrsato.ral sa.6a d^vhg Whefi e perso is skh dlvhg (lhdb. wathod sdna gotl ti6 borto,n l}ne b linibd by how lorp h€ cd1 hold

t*r b.eath Occali,o8ly, r Cfi dv{ wX atteflpl to lengthen tie lkne he

can stay l,lder by hypsvsrtlathg befqe a dive. l}lfqtulately. this can

tsad to hls lctlg conBcbt,s,t€ss underwatet, solnetin€s orly a few feet

beroe reaclhg lhe qrlaca

THE c(rlEtion betw€a .ifoggt asptryxbtio md shalofl'wat€] bhd(ofl lag

in hwnan t€ptatry ptrysiology. v\h€n you hold yotr brealh yo{J beCl bdevelop a porerfrl trgp b b€ath€ ThE is cased mt by [|e d€pletbn doxygrar hon yo.r body. hrl by tle braldt^P of ctbdl dotid€ in yo(,

bMrcan\ whirh dr!'lgps the PH of th. blood The artitkx,S sl(h dvs"blows off rnost ol th€ cabon doxldc in t*s ffitream wtlql he

hyperwnti18168; at8 a resdt, he rElic8 the rgg to ree[E mJch Eter fielhe normdly rnould, et a pdrtuhgl t[e Uood oxygEn ']s dangeroGly bw. fiis blood oxygm ,alb too low betsB he r€adEs th€ srfacs, he Uadts otlad drowns B€caj3o tho Ksnedy $@ Ccnt€t Yrott(ss cmthJed b exfidocarbon doxil,e wtlh sactr b.eth rdlrrd of fhern notlcad an trusr-ml ugB to

boathe, sven tlEugh lhey wea conPletely daprlved of upen.

t{bogen asphyrbtlqt b ! uiqrc wey io &' T?E vicfm i3 ,pt r.d(€d by 'chokttg salsalbn d a burftg l,gB b besthe, b€6Ee as fa as tis body

Pegc 2 of6

l'Q'r'l/ok o,i.;.la aahaJr art'i6 aa,A?1l.r6ir/t'illia-'-htr-L:-'l.-" '-i"l dt':'l.--' 1 /c tr^t '

Killing rxith kiad[css - capitEl trurish8cor by nitosEo sspbyxistioo

kllows, tE B breathfE normdy. Carbm doxlde b rpt buldlng tp h l' sbloodslr€am, so he never redzes that anythhg is r /ron$ nq does he

exp€rience any disccrnfrt he sirply passe3 otlt when hb Uood onEEn f albtoo bw.

i.ltroglg1 asphyriallon is tterefae a psf*l melhod of exeqlion. lt uses acrr€ap and uiversally evailebl€ world1g modium that req*es m special

envtormental Fecadions fa its gtorsge and disposal. lts ftEt 8)rrptom is

loss of conscious scnsatixl a primary goal h a lumarE exccutioar lilrvolvB rD physlcal lrauma, rp toric tugs; tle executed man's orgBns wllle\rear be sdtable fa donation, a fda cited h a reent stay of exa.fixrfa a Georda kler.

Assuming that the prbone/s gdt has been suflijffitly proved, ritrolEnasphyxiatim is p€,hes the rnct gentle way to deal with him. A condermedman awdting death by nitrog6 asphyrtstkn wodd experiqra rrc rnore pah orsuffriE than hs cr€ted in lis ou,n mind.

i Dell Printers

Page 3 of6

9 yea.s ago

9 years 40

9 ysars ago

lddldrdPttnGtqtsqa PnfcaioorlErd.IC-o t !.. Adltshridlltr.-jnubbin3

x-no-archj,ve: yes

l{ayce even go out laughing-

- nubbins -

iH.y, S.ndr" guUock Lied r-lllfecolbeauty.cou/sandn*rret \ i' tler tans Are ln Shock. Her HuSe Secre, ) ',

, Is [inally Exposedl l

Phiben

I h D/ rrJDb,trs

I x<n-actrive:yetI ilayb..v. go ort LrEhlnO.| - ntDbnr .

rubblns

x-no-archive: yes

lpctr,upnatI I m, orrroo,,r"I I iraytc arer oo ort tauqhho.

Yourro thinking o: nitrous oxidg aka J.aughj,ng gas- lh€ articl,e is aboutnitr09.n.

hq://sltsuic,ide8stHs.n8kivacoe,/CzbumjD/ki[iog-witbh'vlncss-capital-puniskn.ot-... UE/2015

Killing with kinducss - capitsl punislmcrt by tritsogro tphyxiltidt

I Yclfe of*ng ot r&o!! orkt ar. b(El*le g.s Ttt rtbE l! sbqJtI droo..t.

Iou are abgolu..e]y correcc, 31r. I lras not Paylng due attentlon. Getsme in trouDfe in class all. the tine. Iho would nind if a doctordiagnosed onychonycosls as cryptcrchidisnr. really? Details. detalls.

- nubbins -

d-@hot mll.com 9 Yers agp

Awelome articl,c. I think you just solved the Puzzle for mc' Thank yc,u.

philbcrt g yers sgo

coogle nitrogen suicide for a Lot of stuff. Baslcally PeoPIe find thateuthanising anj.mals uolks pretty wel'l' using nitrogen, pl'us it's safe touseunless j.c's in a very high concantratioo.

Rabbits donrt Like nitlogen because chey have adaptfve traits for Iivinginholes !{he!e nitrogen can buifd up, unllke other anj.nals and hunans.

on 4/6/06 3:25 Plr, in articl'e|ftdDyf-GDdzrdcor,,I A{,€3qr? slie. I tfi* }fl irst 3on ed tE puzzL ra rla That yql.

slunky 9 yacs ago

Thanks for finding an artlcle on it. I've been gaying it fo! ueek!, and

ua9 startiirg co uonder if I had just j'tr,agined it o! v'hat'

-cr*y

Ccsar 9 ycrs ago

Thanks for the great post and :t wrs interesting and informatlve' Ihave concern that trhen the death penalty is ruled out as cluel' and

j.nhuhane, it }eaves the Potel|t].al thet the Prj'gonere on death row couldat lolt.e point gec release and rc-enter society' Then Prisons becottrc

coo full. 1E can be ruLed that a certal'n atlount clf Prlsoners be

re.l,easec ea!1,y. In the years to cone, laus could change and see aprisoner sentenced to death instead getting a I'j'fe senlence of 20 yeats

then getting out. Of coulse, it uould hefp those that were uronglyconvicted in the filst place.

Jimmy I Yss ago

Pa8c,l of6

httny'/ah.sricidc rncthods.n*rkiva.crrm/(i?)hrrmiry'killinp-with-Lir!,ln.(s-.rnitrl-t.i'michh.nt- I /t/?ol (

HAZARDS OF INERT GASESAND O)ffGEN DEPLETION

IGC Document44l@lERcvide ot EC Doc,l,a,lDE

EUROPE A INo{.,siIRI AI. GAES ASSOCIT "Ofl

A'SAL

A\EI{E ESARTS 36 . B-1210ffi,JS(ESTd:+?2A77OS . Far:+?2298514

E<tC:lt@f3ear . tlrrd'tlFtu$w.er.ar

IGC Ooc 4UlPlE

HAZARDS OFINERT GASES AND

OXYGEN DEPLETION

PNEPARED BY I

ARRETA Angg

BECXELL PII

CATvPARADA VtEroFRY. Ctrtslh.

GAO€T. Rogs

LEWATSOWSrI J rzNELSETII AvU

PAIE lta.r

RrILe, Odiao

PRAXAR EINOHOTDiIG

rHE LI,OE GROUP

sotAN PROOJCTS

AN trcUD€

Lr\E€ GAS

YARA

AR PROOIJCTS

I{ESIER GROI.P

Oisclairner

Altaffi q.tacdootCxl^ a6da. OGAI ttaia. 'Elt(lB

C.n orfrir. Slatgdr..an n, or-l.d'rcalirlqlt bcdnaid b rdl ,ldc.lb.a rara ooldLdtrqr acron bCL{d b b. rd& ai ,. E .li Laital,frrirrb.if .ra.t -airarir,.v&. tr6!.ttann-t ot EfU..4 orlf,..l lb tI o' i!' a.,.r'

$L €EA raadirrit ,.i,rE b a, rx o, L r(l!bg!. !' L ,tin!a.l ldi ltl.rrE b r !- a, EEll n*rt ta.,i.64... dltllt Ft-t Fr.ay l,ot r, rd lsl *rr9

Trircq E|GA d na a-rEt lnra ,D eltrrra or L rasrt rrl atstn rEEll, o.,tldtial, r ailEloirll tararrE b d u.. o,ldrr.br d r,!g..lon .'ti- 5 AGA'I daa&r

EBA a.r ,p .s|tol ,as! - ..Cra. FroirE t r'l Faona. .rflrt .raE\ F9- d h99r ta. o' rr,Hdtrrb! 6 tltrg.ls.ra asJl- h EB I ,.*.tdr !y tY, F-r d.trrt (-rr.fr clc ,rrin l) fd mA ara-vd!.Iia ,r, ld, b.rrlatt tt |o

EAf rdc.lEr -. ra5b EC r.r d Itr ta c.,ird b ctr-r LE dirr

oAeA:O - AnAg.t! f,n*r bngdr, tli. o.&-.in rrlttdtr Adl lt.choi'ldld - i!..ortaaretl'l Eljalirlc^tel AlaoclatDn {Î.l

airaa.ran.!-5 ! t2rc &-.b ta+u2ar)!ea F.r.l22?ac5raE{i.ltrelE|tr hEIrt !lE[!E lllt I

rGc OOC.l4l€

Gsn€raa htorflEtbn ab(rll lned Gases ad Oxyga El€plelion........-......... .... ........................-.... t4.! Oxyg€n is esscnlc fcr fs

I2

3

4

7

8

....-.,........-,......,...1

4.2 lrErt gases dve no wrnhg.4.3 lrEft gases &l q.d(ly .. .... .

4.4 The ainbigrfly of iEt 9ases.............,1.5 Waldli.tre8€ with regrd to irf,t gacss and oryg.n dedotid| ..................... .........................3

5 Scme tyFcal $uauxE n th il€n gas andtr oxygEn dePletbo hazads.-................................. ....3

5.1 CmtiEd a pd6{ia{y srfined spes and andos[es ..............................................-.........3

..2...'...'.....,...........-...,...'2,..'..,..........-.-.....,..-....-3

3.2 TIE use o f irert clyog eaic lquids5.3 Are6 nGarwtEre fEf t gasrs irE rr€ d or flt3y @{ect.,.......-...............,..... .........................45.,1 Use ofinG.l ga! illead ofair.....5.5 D ger! ofirprop€. irfialalbo (abuse) of ined OEse!.... . .... ...... ...1

6 Ffelrd fiitig€tih ad trcvcotiw rrcasrcs........-.-.................,.. ....-...........-..5

6.1 Hdnabn, tramrg -., -.5.............................-..............56.2 Prqer lnsl#tlm and esatlon

6.3 l&rtili(:alhn and laEg$rdng otpoE tial, hazrdd,rs r6as.-.-.-...-..,....... ......... ...............56.4 Vmtlafdr md atllEsphric morittriE taistOases a.td orygen ddi*rEy.. ........ ....... S

6.4.1 vsrildin nbritoaiE of roomswhirr peoplc regdarly srtr or Uak in ........................-56-4.2 V€ntlatim, rroflitoring ptirto enlry hto confried spffi or&closues.........-..............66.4.3 VenflAg dsitoairg to, lntry hto otlE 8paceswiet. rf,.t gases lrlay b. tres.nt-....66.4.4 tloEs oo pi.rlirg rcqJicmcr{s ..................... .....,......,......., ..........7

6.5 TEstirg of orygsr cqltsrt..........

6.7 Lodrc.t Tagiout prc€duc...-.-........6.8 ftotelim of p3rsanael

................,....,...'..'......'..-8............8.

Csrfued spG entry

R6qre f|d h-ril . ....',8

6.1a2838.48.5

Baslc rU€&.Rescus plsn ebmsds

Resdl. trdhg.. ......... .....

.........,..........9II

10

-10

6

10

...10

RobcrEgs

AppandL A: Sunrnary tr Qeratr8............. .-...--......-.....12

App3 ldx B'l: Reso€ cdrsidcralirB flun rsmaly rcsble roqrE ..............15

Appendii 82: Rescue cfilldGraflms trsn C(rlliEd SFces.. .... . ....-,. .......-....... .... ... 16

Appcrxlx 93: R€q,E cqlidrrEtir! Irqn pit!, trcndia! t7

GC ooc44'l€

I htrodEtbn

EIGA lr vry cqEfi'ld .boUt ttr .ccir€rts t,d idJsttld gaa cqtP.ilr atd utas of hcrl garGr

co.ratrr to rprl edr y6., wiqe ttE irct ca,lt har b.tr bd ot oxyg$ r.tdtl{ hacClrrbtlon. EEA ifdfLd 0Bt ei ilo hfanatin dt th! heztds of h. Cst.t r€t notlffbirily Crafcd al tlt ulaas uio s€re most a riC( Th& &cun.r sols q.rl tlr rrsanllCHafllau(r| tlrat b ,Etty to Faf,nt asdtlAittbn accir.nt3 hdYhg lrrl !aE8&

I 3cA. rld p|'lo..

! b irl.i(H ttBt th. &curErt a used as a baiir0 pad(ao3 3ut* fd apc.vtoG. }]e maoaost&

fect rata3 a.id utart lrllclrtr i|e t {Fes a.e p(odlc€d, 3tad, us!4 or x,h€aG orygcn dcphtioncdrd otherwi$ ocor.

na &orrErt has 4 I'-tE

TtE rnah docuflt'|l is mad ta hc nlanaOrrs d slparviras dd e,ir"! thG b.ctoraJnd otth.sl$lect thc tyCcd dracth[dl ot oq€en deficirEy acc'dans flrd tE rGcfrfldad ]a!cr,cprep ailfis b be in phcc ln cese ot accitnt

Atc,rlir A l! c aiflpttird lurm!ry of ttr trdr docinrc'li' dargncd to bc ]Fodrctd l! a ps.nP ctta shrho urlthwqtrt and.od uscrs.

Appendx B {ivB , htrodrctsr to rutcLB cd}iittatirE ,aor rEmdy @34d. ?oant' cdtfmdspaces or Blr ad tlcnchaa.

Agpidt C atr rcm. .ct C Gt rlt thd tsrra t*.n pa.c. h r.cfll tst whb'! clr b' ut'd 'icxerdes to ulderlr 0la gol'lti{y ldC ha2 ds ol ircrt gales

Ap0€odx D Cv.. ar ue.nd. ol . wJr59 siln d pon€. to tigrtlil lnG lEa(l ol h. Ca3.3 Jd.Thyiathg atrptdElr

t Oeftrldorr

A?hFhthn: ihe dacl m $c body of iredqiratc ox!94n. lJsudy reelthg in hst ol coniciouEnass

aard &al]t Tli! rt aio tn n at gjfiffii q lnora..

ATfirdrt ,ry t?rtitl wHch radrc.i ,r atrounl of avatable oxygm €ith.t by tlnpL d&tbn dby r€*tioar.

h.rt Ft: A gat H a not todc. wlidr 6.t ml alp9ort hunan beatliE end u'ta,l rlctt tiu' o'mt ai unn-otlE rntt,lolr. ThG cofirrst hGIl gas€s a.€ rtllog€tl rd tlE lrc a6rrr lr hc'um'argor\ ncor\ xcion !.d trrPtoaL

FlarDaur !aa; a gat wios! maior hazrd a llImEb5ty. tlotc that { frer n*lc gtrtt C'o d aE

asphyda.rts

Urcr; fs tlE pt Potc o( ttt d€u'ntrt Uir tqm cotct5 'ry irdvid.tab' ooiTriG' a olh'

a9ffi6al;on. tH ,nC(. l! of th. fod.Ett rdd bt h&rbbl ges cdrEa6' Ua't rEy bq bd tenot necesEarly. c1l3icrt[r.

{ Gqr.ltt hfan lm rbqlt hcrt €.... Ild OrrFl O.C.fb.

h dte of th" **r oI arm.lqt av&, tuc,l bdlcts. tltt6 ad adlviand i6' tllc rcen'sr's,s ac{i,lla rlalalhe in elrhry:hlim car.d by th. hge.' !t' d irt 9r' a by

;rrgt d"C"tbt. r b tsdoti *soane!' ca.mE r cii .octrirl io thc tEz'ds ol rEl gtt'rani-orvg; o.datb.. A.dm dr b or'yFl d!d.t!d .rmcCEes re ucldy vry saiol.E

'Ird n

n nycase blC.

lGC ooc44/@

AlthqJfh crtql doxi,! b rca , iEt 9!!, rDd d tE hldr.Ln h Oa doar nl b .Facdae .! il16 wil ca.Il. oxyga.r dad.tqr ]brffi, f! $G'6c tE d. td clrytaoao*C a tacb ot csb('ldork !

'r ma. cfidar th EEe ol iErl Carai Tlfu dGrnit doar rDt corrlr frtc &roacts,

(Sa GC Doc 67 'CO2 crhda! al us€r/s ,rErlsG.' tr orr d.tear eboirt t't addtirEl lEzrds ofc{!dr doxih).

a.t OrtEll l]l a..nthl ta l"

Oxygit it th. dly ea llEt . fErts ,ta ]h. narnal cdErt'ali,l of oxygil h iha * un u'Ballc i!AorirlCy 2l t.' Cdt nb*orr lli*iE n''d d.cittidm*bC rB irpet€d Uhql thc oxylEncarrrfatcn t ! onl, Cgr{y bcbtx tiis rDrm. ]t.3. Gr6 era not mtlo8adr to th6 aftclGdhdvidraf

tl tha sygGn orqrtrathn h aa &c."aEs or, it G6 coraitratlon ol ..ry ottr lEsas i!cr..t., adtuatbn it ratily rsadld whcr. lh. ris&s of aghyxiatio ,G tirilizrt. Fc i]b r.asdl anydaplrabr ot orylan bcbr A ?. mJlt br feaH wilh cdlcrni

Aryrryrl. - E ict ol O, Cdlcrntrstlol (lrdn t(r77 C.npagn .gsh3f A!gnyd.!on)

W R rm' fb rardor is rE rdotls 6s !oor, a tlt_ oxtgdt @.u,t,r{in it,hr'd is lo$ then16r.WiG m orygJ| trBrsl. irr&licl ol oly 1-2 breafls ot rifolEn oa o0ler hat get wil cersa sudd.nbss otcdlrcint ras -d c-r caut death.

4.2 t-rl glt!. *o lx wr.raro

ll ir *3drt.ly cstdrtC to tndd3tdrd thst rvlh iEt gas€t srdr as dtrog.rr gst, traun .tc.a9hyria b iridour - tllcaa ra no wrrl.'rg signrl. lrt taEas ,a o(brts8t, coblrless and t6tcbss. TlE, ae uEctecteua ,t crl lrf,craG DG

r grc.t dcC moaa dang.ro6 than toic !E!G! rlc,l aa d{orrq IrltD.na. a ttdogit *U*f.wticrr car br dalGlad by thai odo.r rt v-y bY, cdEirtraliIl3

r The argyxbtlrp etld d iut g.s6 clrs w holt aty r*ril,y cl)lge*C algn hat ccrdalerl th€ vilin. Ld( ol o(ygan nlay canG yrtgo hea&ctr d sp.ach dfrfiat. hn tha *rinis ml c4a!c ot r.coen.tirlg lltt ryrrfldr! - a.phyEtin Alpk,xblb ha6 rqi,y to locsol cdlrcbutrr$ - for v!.y bxr orygrl csEltalilr3 rlls can oco, xttit s€cdt6,

aJ hrt g.....otqllotly

h.,ly &dr.nt wnara thc alpdy of oxygGn to th. E*l is ,bda4 tro.Ipl ilrgar, tcatnant lsctitbd fte- npdcd frffi (ranctstin) if dvir qi*fy ernugh ca fsvaf trirrUc tflrindmao! a

"Ya (bath h sdlt! iitlrEa.

FrnhcnEq a,i ili i! ottsr poat uda'tbod, thG irrgqEy rceqr Fcdr! io aava $a vic'tinmrt b. c-liry tho.{lrt q.a io iv't. to avoS a 3ecod accilat rir€ .rsttc,t of llr rc.o.r

01av6l .a! E'trt zd Synpto.r

r&allo .I$arn&t tt@too|3 can be (llccied W llla at(hrind.A rid( arscl!,If,nt mrst bc u.dertd(en b m(b!b.d tr ca!!r r|d ff.IriE xtrthait lt tatc to cq iue *!crdm-

fl.tt R.dElbn ol Cry*:d ard irldodld p.rbrmrEc rat En th. dt t, b.iE .u-.&,r r

PostiDaty ol t-rtag wtt.l a fsw riula3 litlr.rt fi, yfriE.Rld( ot thlh b&r I I t-

et Fd.tirE @rt rftr ! $al lha R.$cltrtbr poa3ah il arin dI hmcdatdy.

0{ F&iE .'lGtllrffrdala &-1 d.nlrg|., rrlr i, r!ad,Fd-

tcc ooc r!r/09

brrl ci bcoqE virtnr t pbn d iGrc'ltsta .esdi1i h frt f&ItEt ol rqrd{G reaarrs rrredy rol rnrsual

a.a lhrltl!.rUormi..!!ar.F.rc, prE.E! a sioncft ,rust bc aYt! ol m lltarurr ol llt rxprcaslo 1n"d 9?s'(lo.rrlLr. calcd '!e, gG'. rttcn it is ulGd b p.cvart rfe or arploddr), u,lEGby tr tlc'l 98J lsd, p..ccived ut b(llood trd wro.Ely lC.an lo ba . tt ltt3l gatl

a.g tirldrfulrrr wnh ngrd to hart E t t ..d orygsr d.datloo

caliterhg thc hazrd. rEibnad sove. rt ig elEs{ial io 9(ovio dl liosr tr,tE hendc o. usa kErtgalGr (g.3c€nlrry pl'rqnd as wtl ss qlsrrss) vrilh at tle htanEtkn ard bd{.tg rEcrsstyicar*rg rtay irfuaooa Ttit itdrdc! 5c m€t|l ol Prlvathn aard Focdl,al lo b. ]ary.d.dto-slrdr-eccidant!" 6 rEa r pl €d rarc1ra trocedn€s lo b! krClttraolcd in tta Grrn of ,r8cdrlrrt

6 Sam tyglcrl r,trtloor wlih ll. t g.3 rndq otygm &C.0o.r h.t rdt

6,t Csrltl.d or ponntHltr oonlbGd lP.oct .nd 3.tclo.l[.

Cdrtllcd rBtrtslcd s cncloacd $acaa ,r ptlirEly dalFou! itJafura *!! a Ilt,l gB tnay

b€ normally prtat tt (hrirh a proccrg rcsrdl rllty havs sqmdltad (trsr L*t a Y€nlt) aad,trOecarce rre iprcc hea ml br.n .d.q.tCy rt:tt d or Frgcq an a lh. ttffC ot .i b poo, qva Llbn b h.(bcl.n.

EErFae. d adr tf idrth. co.rfhad 3orcx lri(r. rrGsdt. resxi\ lia its h of 'cd bor6' d fqrf&r a+r9nstt,

colO rtoag: roar. radE Ca ulth E! e.gessa( atrECt{.3' ats. EfiBIE tElyli d irturE{ cdil3b, tm, sttr.gr $c6' terrFo.rtCltrld sdqtr€s,

c, rpac6 rlE! ud&19 trgltl0la ges rr lJsd, eE

TIE frlcr. oE ,q.itd ta salc E as b, F ldrd ril b. dt rrt h €ldi of haa cea6 aerdriEd h ADGrift B,

5.2 Th.ltrotlltct oOdcllsrLl

ll ir to bG ml.d. $al iha utG ol inrll cryogatic fquid! !!ch a! rikogon o, hdhm i! &ao,t9Iiad bytrro Fitl:.y hztdt. ite ttitt r: rW Gdd Gl6t fd rit ooil rd -20SC fd h.Ium) ard trn casr..dl(r. cd

llr'lt on cc|t-t Yl$ ltr. *kr. grc v+.ristd bh p'oductl w g.rsalr a larg. vdtm. of cold h..t 9.s (a4 't ff. d fqdd

r{to(l€n wf ybE CEO lrrr gtrrous FoCrd) tlat wi dtflgcl t .ed ' eau.ng dyFndelkttEy and may .carfl/bta h low p(*tt!.

h rG$er lrl}da aryqE {c lqurdS {G htldtd atn v4crhati(rl lal(ra dacc" t9cdd c'a trutl be

taken lo avdd sitlatlonsihrc aerrcnnd ,o !4ocd io oxylcn &ncE E . ThG!. mat b' h !9!E!stt peob rlauhdv srtct a, wdt ln.

E(aIFi.. ol J.Eh lpacGa tduda:. TlE r{€ na roon d I hrrdtrg rr|! . ayqsic llrd qfi63'&!.tr tl frd 'ld'd

3ta€d'. L.bdatry rdnir Eleuatfi (lftl) urcd fc ttQdt ot d.rtr. Fars wtrre fcrit tflrolrn tood ltt zrs,. StJGd OulEl. cdid). RoarE r*cm itronctc Rcrosrca ht gi'{ (inl) scrtnt d o0€r rqi, h.at t co*d

cqliffidi3 'rd. nur fr rfiar oyq* 6netm9 qFrE l E Qctstd

r@ ooc 44lGl

i.loteci O/€ to lrra axtstrly bw tgnp{altr. ol liquid haun . ieo.tduy trE d nay exl{ ulhre lh.fodd b noirhg tiroueh holsr a f*rs. h lrt css! [ E pG!&b f6 lha cdr!{si! c, * loDCuely gl [E qrtd(b ol lrt hos.rlbc p6ribly le.*t9 to po(l.lE d lgid cstlrinhg bv* oterrtlEdorrFr lsa R!f. 4Af A'ta.

'rar wlta.c irrt gr.c! r. vqrt.d ot ltrll coaacl

llE .at o, aCryx€ dr cm b., evc,r drt&st, n tlp riiit, d:. G6 l8*3. Venl edartt. qjn { o, sday vdt/!! ad r[pl,urG dltls. Op€{atCr d lt€cltincr h wtidr lqJi, rikolen i. ur.d fd trrczilg. Efnd flrE .. ib, mawaySr-oai8 io vrirrlr oa purgd encberes (o.9. ASU cold boxca, dsclrhsl

encloqrer)

Arry cold 93s oa lEr,ir.urgl-t g.s u{ ra,g a 'lbi' - orEl ,rse6 - ind c&ct even ouEocq altslggEs iudr .5:. Oirrlr. Trurrrrs. ff.dir Cls. Eaac]lgits. Elaald (ti) Grtrr

Shaa.ty Eld ,u.t ao &e€roudy Ehtor-th i ai e!!.r (..{} h.Iu6) rX raa .d oda6i hlMlEEr[bbh.!0tB rldr ar:. Eetind tahE clillgr. l-hd.r a rd

5a t,te ot ll.rt 9lr bt.lld d .tPL.n.d t r.h ,rEry rdr(Fr!:, lrlra ,! oltgr ctrlressd iE t ec &trbJtin rEtirsl(! t et rc used lo,FG apC€tiarr, t lit d irtnrIlltatirt trrfFa.t a.gi rElrlg prrFtg oa retrr a usmgr{ro9en as a FEst G lqrEr to oFatE Ftqrmtic squtsrE tt (slEft as FdtEr'nars) g. asitlrurErt ,litr.

Addtiirdy, dtrogeo b ol!.n ut6d a. elBs a bd(lp to, c auMUa d. an irst urE( ar srsEm.V\,iere il is us€d as a bad(up ruply h casa o, ir ru.nrnt .ir conFlsas ,ires it a qitc cc,rrllmto fhd a rllrogen rjprt, c('rrcl€d to aft .n arpdy q m!!o! ol Bobtin vrtE, ll rnu.t bcry.chcd tEl mort Farnatlc{, *.eted it trumrlt3 wnt cdth.rody ed H ti. vri.drtro!.,r may accmdat. ln pot vsrtlated coattrd pentreJbldB o, Crn rdrB. fta csr fatd{I r€.iqrs asphyxiAbr rut . tdtl.,! rit olEr is ulGd tr,Iporty to r.bfltJte fa cdll,esscd ai h t isxer. t lt E doo. urd!, tiiy clrltoad csldtidr rrdi as r gaanii lo wsL ad C r*diFso tl sftal ba h,ctrE6.

h ait6om yficr! paed EcA, tg srrtrrE .rbt O!.r L &art lhc pdlntd fs .fldot€?4 wllo r!lr:siur.dy t aiEd r not tr r wrth lE syrlms, b ocrri.ct tha !.aeuiE .rE.trd lo a rn ogcnsFt!.'r.wi$ ted rurltr ll&i sylims llllst Dc dsry rrrrird rt Xraa, m f€eBtlg at tFlrfishodd hav! a &dcatGd cqrrstion ryE rEt ut d ct!.*E . h itr p(Gflrlt...

3.3 O.nlerr of hFroEr lohdtbo (rbu!.l of ll.d errtTlEa has b.!i irared of t'4D.tiR md pfr.cnt llont h TV-gogrrrrE3 m th€ cr*ss*.oac'l ,n 6aE€aq.B nltuaa 0( rrr*lg h ors.3 rri a! ha.hm rld ot q lEt iae 9a.6. Tlrricdr (rpalc h praqi. ialtc $. fu ot.$-rg tra.tn b acltave a r,Ey lit t-dtdr.d tdcalrEttr d Hun cz| led b l,Esrrcbira.r!-s. cescafirr d Edliro aad rrdden dadt[8ca Rcf. 6 fo nu: drne tlort

rcc OOC 44lG

6 ]5rrd nttlftrdqt rd p.Cvc.rtlvs ]llcdrs.

6,1 htBnrdql. irlnang

Al pescl5 wno h{ldg or uho use iErl gases shai b3 hbarned ot. s8fety mEsl,es f€t $qrE b6 aoDted rten u5il9 g6rae. TIE lErd rctrclc,llod by thc rdcae ot itcrl gEG. h to tE xqtiE rp.c. td fic potrnitl ta

ox!€st d.cetiqr. Prcdres to be &erved $odd an eiJonl ocar.

THs htarmtirl d fdr$g stE d be syderuficdy ttd perirdcdy rcvtswed h cda, b €rlsreUlat it ,c.n rs up to dat and #oprbte fq ttE tEzrds k Ellifisd.

5.2 Progcr hrt.tLti.rl .nd q.r.ti]lt

EquirEni fa ttE flErfactrre *ffLjtirl fiu!3of itst gG r rst ba kBt#, rEhtiEd t|d usrdin *c derce wllh. Al lpdi;at e r.gddkrs.. Tlle recqrrrsd.tiqrC ot tlt rupdier

' lndosrrid gas hdjslry stadrG rld codas olre{na

erity assamdod eq(irEnt ta insl Fs servka run undotgo a Fot 6 d b! led(dEd(rdrEhg sUtAF p.a6(re5.

Eadr i!€rr Es phelne ateting a bullE sttodd be tro*E lrith an eelty eesslJe iadalir vd!,eorti& ttE buiidh$ ldealy srfr vdves should br rtrEta &liralad by E Ct hitb.ls or otlE lr€tyflidildi'lg eqllixn€rt

Eli!€ontinEd iErl g!! In ! lt|!l bc phy.lcaly dlcqrtctcd frqri ihc !t!9ly cyddn wlEi tEt ir u!!.

Ai t E erd of .adl wk p€rbq al vdv€3 that aoLtc ttr h€tt las $oqld b€ seqrdy dot d to evciJposriue Lc(agE betreen uo,t p€(irds.

6.3 ldcndtlc.tbn .nd ..rsgurirg o, Potrld.t, b..tdou. rr.

MeElrEs shanld b. td(6 h identify pol€ntid, haadous ,cas' r r.stri:t acE€ss to thtm. '.9.. wedng sigru $oqld be CC.y.d b hfom d Il *tuC o. pdenti| asptryxldin h.zd

(en crirptE is Crrrn n AFdr D) Ih. vrrmg rign shodd bo asscated wtfi m6ues totrcEt uButlsbrd alt, te ttle ae6.

. Tcnp€e.y o. partll. rrnt bttiades, fq cxar,pL phylicol lod( qr tlsd itanway o. brti,tda8ord trrFaty €lca,atbns.

. Coirnni:atir ro site 9€rsdnd to elstre atE€tEss td uterstadtq-

6./t Ycntt.tirt f,d rtrDl?rltic mddtahg tor h.'tt 9r..3 md oxygan d.nclglcy

Tyt cry thdc ar t aa cftJationE tttse tlr naGd tq r,aiaiirr a alriEc9hdic nldito'irg ttr/Gt bg

aiicssil a aaer to an*l aGClyxbtbo uirdts frdn hGrt get s ad,or oxrgen &C'tim

6I.l Vantlalicrl monltahg ot roatrt wtlcrl PtoPL Ggfftdy itct or Yeott h

Exrndct h tti! crtcgry vodd 'ndudc:

. Rooma co.td.iE f,r.t g.. Phr&.a vvith possaa hakt rucfi a8 co.r?aesso. hguse1 c ttdrodr|s (uflh confdran4y5g Pandsl

. Rooms wtlac ltttcrroglric [quld is usld or sr.,ld (sa 52 *ot e)

Bufirhgrroqn sEe r,€. atlan c4dty, systlan Fscsrtq Ac ,rlt3t E dclermh€xt fa eaci Ef illccaa ir tofowfg guidc:Es cr| bG rFlcd b vdrtllti(n tyltrtn dclign:. VentLtio rtr,.lst be cq ir.lqrs llt& the h.z-d exats. ni. c-l be d*rred by h€tlocklE tho

v€nuatidr slstem with lhe p.Gs po[er 64Cy.

rcc DOC 44/(B

. Ve'|flatill syslar d€sign drcdd ensue ahJate aaflou aorrd the nonnal eeraono eaa

. Ciood s'tgirEeriu f&lir hdcatls a mhinum rrerdatbt c4aity of 6-O * dttEEs p€t hour.

. fhe use oa de*:es to hdcate canBci systgn qratirl srdr as:- War*19 nghts- StloanEs' h ttE ta oJtl€t- Fbw swtldpr h tnc olcuql ciam.b (ruitqing .ior^5 rct rc, c.fy rpo.t 8acord..y

drtalssrah a lof,sm'tothefer ]mtd).. Erharst lrEs cslt:*iu il6l gG.s shd b€ chart itntifie4 ad dl(tld be ti)od to a sefq w€l

vs lated aeaoutside thc building aray frdn frG6 * h e3. Cmdderatim $ou5 E grven lo the usE ol walqlace afito8ptEric rIldtarlg. e.9. p(rdrC

orygEn ardys€a gr an rElys!. h thc wgrk roa. hcaiixl to ba b6ad oo assc8s[Ent ol t rcaeas de8c.ibsd in 5.3.

o Peopb rakilo in or e.rteriE lhe ,ea dlal bG awa. ol adifi rqrLod in av€nl of darrrs traiatrno€CErh rndiltrs a loss ol r/€ntbtiol.

6.4.2 V.rlllrton, moitorhg Drloa to srty lrto ccrtll.d rp.c.3 or €ocb.ur.r

AE (bc.bod in 5.1 abow, t l€ac cpacas vodd ircfuda andorurlr o. v6seb wtiJr. Ar" not rcutirdy ent€.ed and. &e trEt,n to }lar,e cmtaiEd iE t gEs fr. May cdltain lr€rl gas tr low corc€ntration of orygEno Any vessC mt krwn erd v€rifiGd to cfilah atmEpha.t aa

h theae cas€s tlE fdoIvirg guirrelincs aedy to Fr9ar! a Ed. atncptE(e Fi, b gtrf. S.uces ot iEt gas mrst bc is&bd frcrn tha lpc !r s]cEure by poslive bard3 a by

(bcom.clim oa lines. t€rrer rdy 6ty on a clrred vdnr Tha wssd or erdosre nust b. *qlatdy Orgad witn aa (ra. rernor,/e lrE iEd gas and

sigihne xidh a?I. lt b rEcessay to have rt lBst 3 csrybte i!- clEEEs fiUn tllc ildoqre hvdvcd.. Plrgirg $d cqltirle lntl Elysls cooaimE that the ql.€Ity ol ttle vesEel at mEphere ic caf€

b perrdrEl eriy. lf there b a., (hnl tH lff..iive IIrdE has tdcn Cace. $e andyirshouH b€ made in tlE ht€ri., o, tha wssd by tathE a saflBe e sevcral locatt E by Fob!or if Uis is mt possble, by a co.rpotant prson ulhC a self contaaned b.!atl*E apratus.

. Tha prg€ systern mrst Elsrr€ trr0ucllc. tcr a&qra!8 mixhg 0f alr and hrt ga! to talaplac. (to avdl'pod(ct!'of dGnsc oi hht l |qt !E!r! rc(rriri1g or to av(a 'chamc5rg' olgasas dua to he&qr.b plrgrrg).

. RarD\/alol agl orcdd nltrooEr fr r hroe vBssab aid &€0 aits can b€ drll tdustottEEbhrdy high dendy of lrr 9s ccrprsd wlth *. h that case be gas struld be orhalst€dlrdfl t E bottqn of ti. spacG.

. Veitla oo strould mwr be crrled ort rllh gJrs orygeq UJt €xctlsitdy wilh ai,. &Ettc. orthod ot ,cnrcvitg iE t g6rat i! lo fil Or vclrd with waicr a.d dovr air to q!t!. ?hatr

the vatr ir dail.d ofi.. Oxyosr cf,ite,lt of he almosptE € in lh3 sdosrerrve8sd shafi b€ rnaitred codi]rrougy d

rep€atd e rrgd, intBrv*.. Conddcratim shorrld alto b6 give'l to t € usa of persmd oryg6 rE ritqs.

v\i}|qG a saJG atnplFhcrc ca.not be crEtcd a.rd cortltr4 than thc iad( rrlt,st qly ba F carrld bycqrp€teni pe.sdrd pro\rided with a pcaitivs tr€alt5o ai supdy.

E 4.! Vdldatq/ngtibdllg tor cnty hto otha6p.st3 xrr'c ilart 9t3.3 m.y be Fesdlt

Thls typG ol canfhed spc is qE tha ,rG ary ot fr foaowiE crE el€rirtt=. Linitcd Scrtug lr cntry ald .xit. tHarol,Sla rlat C verEatirr

Ex pbs ae lstcd in scclirB 5.'l and 5-3 ad hduds:. th&9rol.Ildrq,l(3. Trerlch/prf de€per lh t I rr?tra. &nal roqns vtlia galcs

'.c stcrcd but mt dalignad fq cfiti ou! wqic. ocoupI|cy.

tcc ooc 4lu@

h Or ml.rty ol tt-r c.ra th. trssiE d irr oE€. b lEl rltc586 wfn drhe srn!D-ar lL$atr, irc ql. aatafllbl tJ.fltd h d carG it lo szrtPaa fia afnoa6-a h

'la ?odrf

icb.tr!, lrca.rr dl. alc ,r srgan p.id to rry lrtry. frfr! qdrr t cfiliuoj! ficd Fottmqilrhg (5,tt $l(r/ts Da tEd

Trr t-t iral, dy!.i dti€rr ann6Frtr! b mt rldmCy Grpacrld i! lt? graatcat dtlrr.

iaa LoL. o.r E iht rarlrtn-tr

If! giara b af dE{r3 .rsriiqEd in lccrioo 0.42, is rald wtE r rilroea$ L th. trt 9ahrohrsd bccaJ.a if nraf, i3 vry mr lo t€t d * urd orlion.

It tl. gar b ba prrOed hat a dandty eiy fisatrt frctn lhe dadty c, *, arcfi aa haluta' tedl dcstoiOxiOc, ie tha r,dllltlhg air may nol adeqlatdy m,: ald th. tr 9ct yb! had.qrslr.

F6 itd ear! ot ta mc thc volfic ol go! io be dsplerd (ni 6ong3.) |ttri bo !t 5rt l0 lirttr.t d lhe vofrrr iwdild lh3 fefrd nrthod of r€rrcnd ot ery drtsa !D3as (a g ,!dl or oold

r*lrooEr vspou.) ls b tuct oirt tna 93r trdll tlr bottan d t t sp*a

h ll}g pf.rcncG ollolc s 'Etmello

gs3e3, i t tllairalry ro rltm s,l d0sr.l tEarg o, rr9!..t pruaat in tha co.rlittcd rpa. Uct ?ltt, oI Pa.ao d -Fa .olviot toaro.rt. l,rmr.t r;nt tt d only ttrr oryOrn ccrt.'rl is .Et lul'cbn in iia c.!e. Al oiE dr.torq! btic o'llaJlmbh e.r.t nrrrl abo ba trdytcd

h ttrc lpdtc casc ot tlaltrt|aara oalq s n?ogm pulE rrLrSt bc lrEd llsl E Fa;i tt, l$qllslf ir( grd tEr ebladJc.l0, FrlB !,r ti vgi-lttg i.

6.5 Tithe ot qrsll csi.,tt

lBtsi:dy. thr nd to d( thal al 8lnoapneaa is rcapi& tur bsl cddffrd t0 ba ol l'la,dtst f,ipalIrc!. h t E pat, tirrple nEarll E. errylorcd. $rcft !. l(, cxtrgG, lh. hhtcdcaCa d tha crl'y tad

Otrtltlv- vth,3 lyD.s ot orvgr tdysars tG avrt da, rtidr aae dta rel*L ''d

drsh alx' t0gaa'nc rtaAii, ol lh. itp. ot +-.tr3 d€p€txr8 on lll€ nah.ae el trlc wort h lhc ptsc! to bo

mU d (ft.c,t! ol Oul, tlrpatrra r{ hrd }' tndtiplG dslrsl[r' porl*b cqsfnpnl atc.)'

. onEr rdvEtta d aa a.5.ttslt r$ ,trBt bG gQady md,rt# d c&:6 n ardrr iin"irfv rXUc n b -o'irpdrr b G.Erro ttBt tixd d|d pdt& &tocla. rB mdtypcitorO td nrcanrc a fsFat{th/r safiplc of lhr atnosCEB'

. A *rr w8Y €h.Cr( lO C{lltm thet flr oxylrn 'lstyst

i3 cPrsure prqe.ly larca tj.a L t0r"eieic tr ayrsr cdirtt ol l,r op.n .l (2t x)' lt. Glrdt lrrqr bc Fr ot

'! rar Fmt

rtqrilllft... A'ory!:,i siaayGr sbuld ba lBld wlh ,l &m 6vta to Mcats po.tiu dEf (ag 10ry

Ht€ry).. n" riiint-, tda ol,!.n c.rErlt.bn ,c rltry iio-. lpec. ltat -' t'ire c"d'd d

msiea oacsnr oi -ue arl lt lO5 f orrgln. TtEr! ,. !9Co0.1r wl'r qrgc'l

cqlc€ntdafi b&rr I e.3 ra rt ,r tf, lr Fr ltsd 9.ovtd lhd t'it" ,alo'! 13 t*ttit EOir"tn fopr r* arrasriat -d nrtlinc rulddirr (a3 fre r.rrdr} isctu41

6.E fVffF nft

F cr.tii tyc !, wat a&, erdsr ai o ?adC rqf F!6d,' mrt b' r'l [P h lr tqttrlra r-r rJfti u gurti rtr to r, ftrtt dcsrftrd $a enn - tsr Rdqn*sro;dr.f tE y aifre rt* ceriet or t suffis h - rp.rddl cd box'( arrEr w.sd dt, a tlq..rd

t@ ooc 4.{/G

6.7 Loclflt Trg€ul procrdu.

To srsrrr an, sdrcqs gf iEt gas haw b"en Foprfty itobl!4 'n€ klplcnrGnt tin of a sfing€.rt.fqmC loat-qd and tagFqJl Focedr,g i. n€casrry be{ar rafe eriry hto a coolird Epaca.

6.t Prot ction ot prrtorncl

TIE rype d wat to be tE tamsd, &e larol ot the pr€rnE€l a.! tnB a$€sment d polalal rescuelccrlaio! uX dctcamirc tlr Fovit*,l ct cd<ltiood FotElirc rncalrru. TH! additiond FotcctkrtshoLad iEtldeag'lis3tirC nrSrtres rdro. tat€ty rqJgrt.n lucti ar

. Fix€d a p.rsdrid oxyg€n mmndiE eqrildEnl

. The wsing d a heness so 0lal th. yvorter car be oarty ad reldy trk6 out of ar encbsed€pace h ttE case of al €rn€rg€ncy. Pratarstay, tH3 hrrrss ls to be cdnected to a tDlst tofscftste rerEr,/iE thc vlrim. (h prac'tioq it is ertglEay drlbrrt f6 dle pe.sdr lo lll up fiothc.persm in the *ssrca of a medl,icd dd ot sdrE khd.)

. TI|e pro\rioirr otan darm system in casa ofan anrgarcy.

. The wsiE of a Edf carianad haathiE mratu! (rEt catsirgE ,fl*t wlidr re l Eff€clirc ina casa ot lack of oxygE U. ln the ca!€ orwqt inside a c(,lriled space a dan6y Frss| *lofi be Caced on wdgh o{tsi&tha FcaA€rE€|.. Havho a lalf cqlaiEd treatlirO 4pratu3 on stzd by.

. The wea.ing of otht' prlond trot€ct,w eqJprnent sudr $ sdety booas had ]Et Ooggl€s orgloves, dep€fiIng dt the hazads ot the locatin ad tast

t Corrlr.d rprsr aotry

The erndoysr 16 rl ovaridiE dlty to ensrre tiat tad6 in cdlrhd spees trith potertialyhazt&ur atnEEph€r6

'r pcrfcrmd wlthout .dry wicncver Ois .t tracli5L orly if it thqe 6 m

p(aclicd elarrBtive lhal p€ogc be reqred b €nt€f dtrrEd $acas.

Any €,lty ho a c( iEd ipa6 g..ndo3uD rith a poitilirly hezrdort at nosrhc.c rhC bcc efdt csfioted lrd have:

. A Ulrittsn ,rElhod slaEncnl rd th€ wat to be uaert*€n with the lpace

. A doqlnc.ned rd( aEEr8srstl la pdftrnitg tit td( h tlis prtiqrr voss€l

. Fo,mal 8rf€ena bct-out and tao-om trocedrer. An a!$alrncrt gf potcntitl sccnIlo! vrhc.. rclcuc mq bc req.tcd. An -i-gcncy (r€G(rre) pbn to d.C with any poEtu. acdr.ot .ce,tdo r€bt.d to .ii.y h totlE sdoere d v6Ed.

. Rcaot persrd ald equFn€nt CE Jad be a\ral3bb aE r€quied by UE relals pbn.

. Tr&!d ad cdrp?t€nt Fssr|Gl h mles o{i €ntrai, st xr{y yy6tdr, resctre t.€In (vdseroqfcq an g.peMldrp€artl Est€r.

. A calc wok pcfnit ir$cd ad rigtd lsfqe qty iE loyvcd

Ttis dcurE{t is mt a det.led red.re fa cdrired s9a 'ltIy.

bul folr6 gl the cg|silratidlsut*t re ir(slr wtl€{E tE e is a acttC or potentid haad from isl gaaer or oxygEndetk ency.

I R..c0r.rd frt!-.irt

AwrerEs trahiU h tlE hards of iffit gsses rd qygEn d.rbs atno6par." ts ot viEiflportsEc lc everyur rdE might er8 a rc c xfE mifht dscotcr zn dl€l*j pcrsan h alpaca wnfr potentiJy alptryxslt aunolFnare in r(E lo f3vsL sublaqllrt ,adtea as reatt otlmdarncd rcrcuc' danpts.

rcic DOC 44lG

Tr*hg h rc6cur wofi ls tudarlcntel shca qlcldy ltrpovlsed raaq.E $rfiqrt lla fandty ot a

Focrdta, ofta Fovc. io ba irfEfvc, if not c.doC{q Lc. thc ru.ql3 wqkc bddE taldghtbacarca a iecqd d avlo a tid virim. Ths it o.te of tia t'nolt cf,iq! causar d mltita taa[ibsh 6er irvdviE ehyna&rr

E.t Brdc rd..

lf a pr8sr €uddc.ly c&pEas and no lqrgs irE6 {|y ign of ffe wltgr x,or*i!g h a vr8E I a

ptriXy aeed Epaca, a f€ttdr. a dl. a srJ sizad ,oalt etc- il MJST bc Gstmcd hei thc

ir.or,' ,ay l&k oxygcn &c to thc p..6arrc ot an hcrt gas (wl*$ i5. rEntdl.d. odolrbsE,cdar.rbs8 and lastd€ts}

WR trnc: tr, dwafir rxrd ls?rru tid ,Jt na b ., rlt< d,.''i E th. san,r &d

TtE risk is tEl tE r.sdret xl h€coflr tE secfi, viclitl, *fah dviody nrlsl ba avdr€d at alcct( ldeaty he shqjd rais€ an alatm ad cal lr assbtrte so ihat 6 p.eptEd r€soJe c bcctriq, out.

Resqre,a inte.l on seviB a posrble .spiyxiatidi victin thould qi, do Eo it J|a, lreva tha nec.3se.y

e$ipmglt, have baan edtauy f-lcd hav. trQe asds'lrca and slfql.

8, R.rq.p plar d.ltLnt

Tho oreiod ol rotqx tli b. d.tJ,rii€d b, lha cc.ss to Prtaut 8p€ca. lf p.ectl, a ,rqr-qnryresqle is trcf€ned AF.tdr B lEts {re colrrdidB uticfi dtoub b3 drl!'t b tesole plels flunttree dlterai situafEE:

. Rescu frcn narCy ecss&b loc

. Rescllc fftrn Canfhed SPG

. Rclcuc frun pits, trcndrcs or esvrtonl

ln aach calc the Rascue dal musl have daflurls which addess:. Hou the drn is rai$do ktenlifrcaEr o( pcs5L r.3qr scdsbs (not dly fd l,rv oryFl Gllccb). Any s€€nrbs h the srtouttng w't pbcE t ich may s fiEy noi 'eqi!

irrtEdste e'tfroin tt ?@ (.g. slc avaldixl h 6/Gil o{ fr! ehclitEre)

. Siardw rab$ ttit€d to ka+ Ybual ,td wrbal cdltet vtltr tha grt rlt ttd b €'fl't lh€

iltr rt ;xits [l. lpecr if srT rpians of orylen dcfdrEl fl suspcclGd or oE'!'ed. Any asisttrc! wt*n may ba mcdedrgi\r!.1 lrorn outsira tha spacc to tlcF ctrtr'lt escap!

fEm ulc spacq uit')dtt flrfia lnlrY.. Rc-crEEkhdcsrhlauq| oa atrm€CEc Fiq tq resqre. uanpqnrcr ano equipo!.nt reqicd to opw urponrcouc [prccn fifil that ?e. Provbbn of lh dirmrdcd beatmat (e.O rasulcitaflon erd,q oxygan ttctffi) iGiJ' ttE

spsce if n€c€6sry. Setr ffia by 1r30l. rdror rEdcal ptao.rd I mcr.say. lbw to make th€ sFc! ldGtrevcnl tuilc hjuy dtr hG rcaqlc

t3 Eqdpirrni

A srcaasfit rasc1l! acaql may rEed somc of t E tdori|e eqrim€nt. Ttr- &'ttC nGcG llxlst b"Jiseo a pari oi tte rr.anc'pbn ad n€& avaib& ad accssu€ d[hg the cfifmd lpacewdlc. A po.t& audith d4m dlvlces, e.g.; pcrsqd hqt\ vrttbE kJaxo etc. to atstl nerb, peqb

tEt asdttanc. h r.qitd. TdcphqE or rado at thc ld dle so thtt an d-m ctr b€ Eisad h ev€rn c' proualts. A sefety bdt c hrrcsscdEted lo a he. tletfraical ail srdl as tr,ey, ll(isl to €xf'et Ule vitin.. Possitly a soucr of at or oxygil to vildaae the carh€d spaca' 3udl as:

- A drp.esscd aia hose cqrEted to the pbnt cqrpass-d ai ,Eh,qk- A v'lLtbn dori;e

rGc OOC,l4l09

. Addtirtd oryggr rrpfllqs t(r rerclE tc.n for rEdrGddrg c{.dtiooE insid€ tha sFc!

. tudliE p,e.rrc b.laiiif * sfgay. nt rEy b an qte.n€ty red bcatliu *sy8tgr or sdt-cdli*lQd br.atliB +p-atrr (SCAA).W,f,,rc Ctn4B zasts d lorb gasss ,! ,rd srlaole as t ry do nor rDd€rr'sr, zr'ssrBoxwcn.

. A res8cralirl tit suptfiGd ryith oxyg@ ,6 m vi:lim. h gasa( $rci a tir irclr.doE a $n loxygen crindc,, a p.cssrr" rcguato., an hltat& bag, and a mas* to cov!. both tlE ,psc arldrmofh of t! virrn.

. Sfdds to crrt hir€d persm oJt ol the 3peq alYay tranwat Caa ,rda lo enbJlelcr.

ll shodd be mtrd thal ery aqdpfisn idarilied as rrcsasry to crry out rflEgercy resd.E frcrna csrthed space stsld bc (Ht!d m tlr b6ls of a td rt* asg6r.rEnt r! tlE €rnergrncy plan&vlfoped ftqn it. \rltse tia cqr4xrEflt i! rct avalal,lc, a rc6clE rhoiJd iol ba l'|dc.tak.n

&l Rrt.rr tr.Hog

\,Vhcrr an amrgcnc-y dan cdBirrrs thal a rlsclle is to be F qrrlq is recdtInai$d [|al tirar! isan annual Fog.arrE of taiiB irE*Jdhg F..ii, .!.clt drl.. lt is dso a gpod FrctiE iocoaaidf a rasclt arcaa bafra strt ol cfifinad $act wqL

&5 Fi3lAts

WlEre ltss is a pol€ntE tBzrd kan lnGrt gBsero:rg€n (blbarEy lt ls advlsde lo haE persorrd

'rrsaatt ttto re tdnraly qiditird b give lilt ai, tdror parrarn t! Eclt tbn in the evqrt d {r

&aidlrn lhe sirdeC frC aid trratmenl fa sone(l€ irflrriE lrfii ellccts of oryger! daficjsEy is toFiE ttE af,edcd Fsoo hao lrarh .l?- as long as it safc to do sol

h mst cor dcs adthoal tr*fE is req*ed so that fu *lers a€ q.dtird lo proyile Orygon asrn€dcal tEatmeit foryErb and otlr€. cmdlbrs.

I concllrtbm

Thsa ara two €ssentid pdntr to remember r*td to oryg:n defl-E, ffiirc,lts hvo,ving h€rtgr!.t;. Acci.rrit. ..fl/tiig f.crn oxt€al Oficilry d.n to irt gr..s hTgl

',lpeclady and th6fEclims d perrqmd may be itaret To avd, th5, d gefsdrd r.rtD rnay w(rt uit \ o( rnaybr a4os€d tq init 9!rs nrjsi hevc routirr ew'erEss lrCriE h reEpEl a[ the haardg oflh€se gas*,

. Ac&lts hvcaviB asphrxi t atmcpheres ae dwayr scriqrs, il mt ,atal n ia *sotltdynso*t'y to ca'ry qrl bolh .€r.l. .nd pa.iodc awr(r.8a traiitg t3r3i(xa lor J pf rqra( aiwca 3 resdr dls

l0 Raf.rcnc!.

[1] CGA doc{rrErt Sa-2 2m7 Oxrgr.Foafi.ral AttEpascs

t2l EIGA Aspnyxbtin drpaign dosrnmb 2m3 - hduding &ngss of Asphyxiatim leafletOxy!.n Mdrrcy traitrg tres€rnatin ad tbysatisr nhq

BlfuE_ditsallq-hEritdt Vilco t4. EtcA, r9s7

hl EIGA Polnion Pap€r PP-14: Dfritins of Oxygcn E ridmcr Dcfdarca Sdety Oit€ria - August20(b.

[5] US clErisC Salcty and Hazdd h\restiJallm Boad weDsite Vtlso Roo'lt reg.gq![6) EGA Fsilho PA€r PP.24: Ahrse c, GGes

m lGC Ooc @4 Fac lbzr& ot Oxyg€n ald Oxyg.n E ridrd Auneh.fc.

,0

rct mc44/@

lSl IGC ooc M0 wd( Pe,mit S'yEEnE

'tl

tGc DOC.l4i(p

App.ndlr A: stlrlrlaty ta oporrtorE

Ithy do Yrr ]tad oxyg.n?

wlTltouT E ougll oxYGEl{ wE cAulor ulrE

Whcn the mtird cdrpolitirl ol .a b changd. ltE hunan dO ir.n ca b€ atfEl€d or even

seve.dy irp*ed,

lf !ESeS Oth€( tmn oryg€n ,e afited , dxed $lth breetrrng , rE oxy96 csrcetnrall6 brcduccd (dbtad) and orylpn GfEi.rry gccrt!.

I oxyg€n &ficisrcy ocdrs dre lo ths prcs€rt€ ol ist gEes (ag rirogEn, helu,n, tgq\ €tc') adop-ir ysaaum;nd €ficjsrcy ecrrrs wiulol.d lhe p3rsdt's knglvl+qE; at aboJt ll % oxygetrctrierrhi:n ln air (rBtsed or uE mrmd 21 't cD,Fonr'atar) trlthg ocqlrs vrnhoJl afiy p.raw6rring.

B€bry $is 11 % cdEsrtratisl th..e is a vety fiiqlr rist that death due to asCly alh w ocur dt&l. few mhuler. udess re$sdEtirl i! crri€d qJl immedatdy!

S€a allo EIGA SEfcry Ne lk{tet tfi cittP.ign .g.h.l Alphyxbtion

Z C.t!.3 ol oryga deliclrtY

a) v\rlEr lqrelEd gas"s ($ch as lqrd dlttgsl lqE egm, cr lqsid helltn) ev+aate ofE re' ol liqdl prodJcG! TForffidy 6m to 850It!. ol 9ar' Tlis cio.tno.r! 9t \otnlc ca wryqul*t ga to crygen &tlCcrEy ur{6! tt€ae is ed.quate v€rltildid1.

ln lrra et,glt o, las€s olher t}€o oxtg€rl leakhg out ot ppe vrorl' cy €.3. w$eB, €tc., oxygltldcl-rcirry m,rsil*ayr !c srpcctcd. Chactt slrqjd bG ,irdc p.tlodctly fd. FostbL E!k3

soaccs with frited o. in*auale l,tnfHilr (e-9. vlss€b) ]Ilrst mt be alt€red udesa draElyr'E has been made, safe condlioE are csrM and 8 wdt perril has beal isstEd-

t2

tcc EC 44lG

c) I rui lras to b! czrtd ot h tlt !ti{y ol t t?tilstb op!t*tg.. vsf lbea (, ve!6d nr.n wayltq arridc, lrlotld ,ntt !e 9rlpaaGd to rEortd 9at€a wlt| low orliEt qaD.nkatan orei0ull oryOll.l at bein! dscnsoEd ,ror ltr€3e aetiEs

d) oxtgsl d.ridrry sil drey! riac wtff gErt ..d v!3t ls re Frg.d $lh ,liroFt or aly othriEl ga€s.

3 octlctin of qrlrr d.fkbrcy

lt A}t SErgEs c^l or rrEcT ortoEr{ oEFlcExcl

i,baturirg n3tung{r (ive an alrIbb t vaual atern ol olyOt l cdEe'rtratill td crn irbte l}torygar coat€nt.

Thes! IBIrlrI:' t 3noud *Yays be te*6 h UE op€n .r berclE ut!.

llihe p.e8€rEe of tott d ltarnfiau€ galr3 13 Fosltlq lfcilic iEtrtrE rts snodd be Us€d.

a Bt t *r9 t$iFprl

B.lat'liE .qiFrtrt r st b! usrd h iiurtklt wir?. oxvgEn oficiJEy he3 to b' @rctsd atdrl*$ 6rDt Ds rulr4d b, adcqatc vatlalirfl.

Cfltrbg! gas mcf: lEcesE y ,r uss h lhe Frll€tlc! o, tot gEsas (tuc'l 8! arndla' dhdrEctq.)

'r t6dG.s l(' fit Frpot '

Racofirsdad ttpat ot b.t ltftg rqqmeot ta. Se[ cd *ad bea0fig aFratjt itritrg cdrfe.ted * qfitdrtf. Fr$rc ma*3 wrii relriBtr cdrrctld t,IoJgh 8 hGt to e f,ldl r 3ppry.

NOTE:

13

lGC OOC44E

> I rtpi.5 br bn h rltld lH iE illitg |tro. ryr.tul prthll, int * a.d syft(bs, fnlght gnatirra ba diql io rtlr rianardat

, Plrbdc irp*fion o, ilr ccnld ftrElditg d llr G0inrent ,ha ba cItu orrt il EddrE!u n bcd rrgd8tixB-

> (lrs shd b. f .rrd ,6 shd p86a haofrig ot lrr rqgrunl raslaly.

I Ooartrd T.Eaq vcladl' cte

An, l€!.d a cdfricd spaoe ulr€re oxyg, dcf(irEy i! cre.clcd ard yl#r it carrctrd b a gasrorrca iraa ba (llco{llcled frol srh a 3are:

By lhc rrrEvd ot a lectirl g, t pq o.by ircnlq a Utti€ pbtc te{q! aid drilrg the ..ity pa.iod.

Retanca dr t ! cloclra of lCvas do.E ntighl bc talat

A tpact or vr$d ltrolr.d bc throogHy vstdatc4 ..rd lha oqg'| cqitsrl ,{ ba nxlrrcdpa.lodcry bdq! rd driE atry p.riod.

lf the atmorClr in tudr a ve.sd or sp&r b lEt bralidlq . $.aEd pi.dr rH r't hdiE3qu9mt'lt.

lo cnlcr rudr o Sac. $al be $ven qrb.ftrr lhc atir ot sr arlr, ,arnlt 4f!d !y a

At lqlg .3 a piadl it h a v€6rd c cfili'ld Sl-q a wand, ,rJ b. Fcr.nt and ltatirrdxrmadalc, orr!& ot lrr corlrE{, rrr:rr.lb dtd ha,. a tJ.cqirhrd br0ttg Fetlt r.d, avdd..

Ih. Dctdl hti,C thr csfird rFr lo fadtere reaa.. dtd y.r a hsrt$ a.d ropa Thr dty otItle relct3 slEIr, ba clc y dettted A trist nEy ba oaclsart to an an hce&t8bd prfrdr

a Etlfg6rcy Xaaarro.

h it Gird o, a prrcr havire t- d dr b oqg't dcadrrr, tr czt df, ba r.rord ! t r rcrpcrsrd r. rqi)9Gd wilt E!8!il9 Tp-enrs crEbt! trtl b aE tr d}t n d.tilt ?ErluE/l rur

RlrrEva tltr pirbf b Oa *di t d adritf, q}{ i rilh., (b, trqn an rrorribr.3rcitriq it.y&r or rrgly -tftia re|F}.lin Gu*fEs ad iEtlE!.r! ta rtr.Gl.fsr crrbs .blrrd ,rurh. ErroF& Rra.ct tr Cord Orffi Hdriryec e!tg'!E! )Ccrlnr u paurrt n!h6 o. ivr.d b top b, qaftd rlrdcc p.rtcrrd.

lil

t@ ooc 4al09

Appoodk B'l: Rc n conridrndo.r. ttfir nottn{, rccor&b roonrr

ArA"@C-b

Plrrd Rarar tc,lttkfItsqt i! udilaka! o.t tr.rt ga. ot G,rogodc BqddOrtatl3 rltl*r an ando.od rodn ll la sueEctled ttEt:

. Th. :ntErt crr'ra 8 oa(ldC oryeen mcdla ine.dtirt lo &y ft(.d ayltrnt .r thc qygcncsrglffilm mayvrY lltlS tha rodr i,vqrlbtlm lt ab..nl q h!dqs.t. ls lllr lcd(raL.

. The ainD6draa. r.itt5 ttt roc it cE.dbrfde srtry

. A stad{y u.tdr b p€tcd orttld. tha rE, lckc4 visud gld vrbl cdlttt li0l Ur Griftttand to GrsrE tE.nbrtl bSra tha roafnuEid h c.e. otort rFPfcria o, orlFldaidtE,

. Tl€ slrrft, ml('r ca rff tt aEI! b,tdq!(r r16otarrtdrrurt

Iha dad-0y rrr.h ha. sd ctffi rceoliog Agraus(sc8^) rtdy.tq $1 hc c,ts.tdy Gniq ih. lncloaad 7dtr to Eo b tic Eistrlca ot. d !o stu ihc ncfti t

oaogt3ry.l,rl€ss. i.n E h *c.tofdltrlrt c.l bG saldy r'tEEd ty lt nfiDf-}.tiaonq lllan t a r-;t rar tlIlt lt vB be€n rsEd otttt cdtr rd $&a rrty v'sr hsooi*

'o uc racy rih Sd ColtsiEd &e.Uire AFalJ3 FC8A) Jd ot !

iqip.rrnt r tot uli ctr E cy rit 0E cotltEd .Pa b 9p to ltr -.btrEc of' qto rtlrd lrr Udn ll nGEY.Harr3 trrw ban made b Oltt fEtrllrbe3$lctll ttun qdi.d maatcd 9fio dlor fE rhh at sr aa gcsita S, hG b lefirr€d lrqr lia tooi.

urptrm.d R..a 3crltkItioersr t tq.rl c&A h a,6tl *Ea trra i! a ptsnti, iEt gsa E

'oxrfF 'l.6cstlarr;Eohia ttfi Oa .ti:or.rt mEt alrrna thal hb nt. b n rEt t t'r[ Itl lrn" rr'lb !*r6ard fio s, *n rE c' ta agattEr $ int a F!9cd reasl! can !' c'tH q'lL

ONLY ilthe coa+ad pt5r c, !. rtdrrd. tton qtlb tle .stt- dtdld ,ty.cdffiirt b'&er, m ""aaii

Ut" vicnr fqn frc frco d biEirg tir qJt to Hr * Jl(, mdcd dlado'r

Ftt rtlltl hat d?t dtrranlo,fr orylrr 6ffi at]rlcgtE?dtGl tElt"any:tgtr G, tir. r i! v?; l(d, orr it b d.td lld th. &.ovar."r le it tir€d in vri!

l5

tGc w,4t@

Appariilr 82: Rarcrr cdrddGr.tbm lrqn Confnod Sp:ccr

PLnnad R6csc serlrrlo:It wak h undql*ln rr{tth a Coothed SO.cr such as av€aEcl a a dmcllt*ctls tpacs,wlthpole !f he 9G,o)ryCen Criisl stnoeptsg Il b e6s€ntd tlBt

. The atmopaEe rrilth t E sgae is made srqv60al!d rtd cffi hfqe €rt-,

. Tho.ntft cr.i! I pcradlrl or'go .ruitq.

. f p.&trrl th. r1tzri rr!ft a body hrrra3 l,lhlre lino, $ lhal h. ca !a rmved trsrtlErpace by frtd! qldda A ho,n or ot s,Decia0ac6l Cd nra, ba naaed

. A d-6by watch b p6H qltde Ur spao., lof..0 vl.uC ard \,rbl qit ctwth irr .rtrrnad !o iE C the strd crrB th€ CafitdSpace , tlrrBdE ot orygen 4Egrcy r€s,apelcd q darr"d

. TIra sttlay wth azr r*a an JJfi to c.a afaiEd ras|. tsrr by lalqftsB q ra6 dr.!u d fotllorr

Ita ,aacQ l.-n thqrd h.t e bee.r ?,rld c, t,| corfu rpaca cnary rdt h fogre'r.rd b? rcdyulil sel cmtahed Beati{ ABr.rus (sc8}c) ld ot: lqirrnt 30 $arClcy c,l srdy .rn.' lb Co.fned spa b gp lo llt l3-t'r d, d E ar(td the vbtilrll riclaary.flr drdnrrrcfi sfqrl rEv! crta OE CqrriEd Sp.c.-PlIt hlvc bc€. riadc to obtiS be€trnert at.etlrsrt lrqi qrldad ,rl.6cd prsqnClc Ol. virhr aa sodr ra Fc.ft dt' he ic ret illlrd lrqn tha .oom

onpl.rncd naru Sc€nlrio:Al CgnriEd Spaclr ! D€ c.loced a bari€(hd to Fer,lrl lrlarlluird r€!5r TlEe ltard b.oo FrlSaty f o. lrio.ttoacd rrt y lnto tlr Confr.d S9aca, so tha .l,pfa.trad .oaqr. rtt aia.r$ould rctoccrrl

I howtvcr-a pe:or b ,o6d coa$aad h . Cdfird Spaca wtEstt?a ir a potrlB rul !r /oryllt1 (Slcl'tt .tnECprEq osr ur ('saovrr rtrlst as,lr tEt lra! tta tr .t rx

'ltrhg uE

tinc !.e.. llc ,r!rt rri! oo &fi m6 ci la ..*!trEG ao h a Fq|eGd relclc car b c-icr,oart.

F f! yunr nd coa+aad e . rlarl d an orygrn &bcri aillo.pals rr, bcr t l,. ro ,yEng$ ol !!tr I l' v.,y Xdy fial ,r a (le6 r! tlE llcolnr€fi ata ls rbtrrt h v*r.

t6

ric ooc 4{/@

Appcrrdk Bil: Rcrar conJdeatlcrr lrun ritc, troach8

PlrfiIll R.laI. Sc.fdo

ll r.rk ir undtld(6 h trarcaYrtloo, a,t Eh. prl, sottr6 oggr sprl wi0rpol6ri:i lEt gaE ,/ oryofi.hn&f, stmotCEar i csuongly rdtrri|fi 0€t

. rhs *noOlss wltl5|h.tp.c. b di.d.dDatga si[y

Tlr antr,ltcarbs a 9r!o.C ory!41 naita, .r tha oryga cor r&l ,lr y vsy tl5rr tFc. lrlhs. L Silrd fte6 ai ciqralinA 3t3$ay nat r I oclld crltlde llle spe?, !o ko€p rrbld a.n vgtl cantd rllh thcatrrtt eria to arrri tttc ct .,rt qfu lhc tqs t,lti.rcd it ryr?E o' orygri dc'ld'Eyaa turFcd or dG\radTtr stsir-Dy r.ldr c{l r& a Jtn tc c, a lraid rGscrt l..r by tCsplsr' { radodi rrui oap.our aTrr rted{ retO tlr Sd Cmilrd B.afag AFit s (SCE ) .tady r I lr FeEdfo f*n srtci Urc cnaorcc roo,n to gp to tE 83i3tte ol, aro qrd OE !i:lh &'lc OF

tha r*a tatn thodd lrrt b..l vrn d olfho cqrthd t9a-s ttlvt n Uar..',ana b. ,aay trUr S{rf cd|tid B!.fitg ABratlJs (SC8A) and oltr lqi,Yrr{ !o flattq c-r sday dc. $a ?-a to ertel th. riritt It ltce*tys"it! rrrw t& nao to ;ltrh reanruru-se*crFt lro.lt qralhd lrtedcc p.ta(ma toir tblll t todr at gotalta afi!, ,t t! rurh,ld frdn ItE toan!

lhgLmcd R-a|r &anrr5:rr.--"- t tt r cm.o m. rqdr Cr o. oOE tP itE" tlsr i5 a Pcrt dit"tFB';;-d.ii .rlrrri-q lrur Acolu, tttrl.. r'Erlit t" rr tttN( r'itrg utiairi ana xa *rr-ro ;aa

'.t ia,ltt ..n cJ to -lHtc ro tlEt a t,!r.d tlt.rt ctt E cJicd

oll

f t t r,Btl ]Bs c+ad.a a tril o, 'l

orrgtr.bfenf .tlrEClqsand be'l t'EE tci -ytr,*r oitlr. t ro "-i l.fy orc h. a oad rrd rh dradt tf' b rlt''l n vat!rt ilr*ir-t i

"rf Oct'tqir 3.t tc !.!C! to r6rove I vht'rnftstr tlrs. kB d sa'!'

l,

t@ EDC 44/(B

Apgcndlr C: Accldsitr hyohrhg orygm rhlldency

lha to5frig lst tltr,hrnr red acd(5ts ,rcaG !y EGA, idnc ol tlEr very iectrlL fhr I.tItfa&r ,Dr alstl il i. to rc$lrly a. tir alb.|ltr o, o, pnromcl a! l.€l 6 lrrat a, ouroralotrr, to tha llai of iEl OaE! ad orygo,r &fi&Ey

1. A rrr 9lp.h in e tri|c,l re b.ng trod lGaE th rilDlrn. A chrga hsl(, .lltrrd ,f, t rldllo irrGlig.t" ttE calla of ar .udblc l"*. l-lc wrt or?ccm !y ri egan rd dEd,

A $/artmsr we3 ontcsne by lack of oryga atts €rd€rng s lagp rlraee tfa*. whid had baarifild wilh ritr€ri. Tyvo o, his x,slsrd66, who wrrt to lir Cd, wihort yerir! t 6!*tgcqlFm t rvlre olm overcqrE ad al tr.c d€d

A flrn wcr o\rarcoflE ca qlterhg I stal tii( rt{a,r lrrd bccn !h!t l, tt la\rcrd ycr1 thast lErrhara it3ld! tht lrtt w.as no bEer c4al,a ot crpo.liio ItG dlr b rrnold o, orygentrmr thG dr by the ruslinE cf steeN.

A worr(r lrcn a cairada corp y had to czry oulrd(h hrda a vrtrat Tha w!!d nad ba€nuodct a rJt ogl| bd(el !lJ| w- vrnlart.d vlttt * !a{d! rqt ttrtd h qdcr to b. q| thcrr. tll,., iha wald.r wtr ed(.d to xro. a El ea bldiE E .!f . Ldatud, a ,ab!r v,{'Lrtcd'nEc'lad lrE tra rc a rifolan tE ad $a rG dcd ,ran *lyrCstElrtl* ,l&t* ltwd D.c1se l,i. ,rrorDn dtld *l vs td lblld ad hd a md at,r carrcrira

5 Weth! Nd* xilh en rggl Einl,! y.s Flonl:d H& a rgd t *r. Our'rl! Irtcitin th.

7.

yalltt frcn w- ltl trtb U€ tirl, ard as UE vdrr! rsr rFt FFly cbs.4 alm "rc.prd.r ,h.o thc rddr.a-crnc.ed thc t..*, h€ l6t co.ldolErdf b(d e llrcud in timr.

a@t Arhg lu/r,h D,rdhs. cta. ,€t , croJ,9 tb ,!rtt's ,r aoa r lu'rrtE rrdrr6{ 3a osqaro6l ga ll ry vd* ,G1 itzl 9a ts c,td our ra Essars, Cc. l*. c.l! tt,,l. dep/ud.. vr.ihlldt/rlD. uuot goFr,,ati/,g qtla'Ert.

A aivr ol a sm*3cale tqrd nafogar rha\rcry ss{ca vetrldc ra! rEkhe a dCvlry. HecE rrcfcd itt lr,rttr holc to tha (rEtoflE+lglicd tlrlq yitidr vat -tEtcd h a !qri-bas.'n nt Altr hr had rHrd b fI, gl0 ot th. crrlifia/r GnDbFr tdd hh th, . dod o,vF.r, w83 trrrrg romd iha ir*. fhe dhrr ltoepod $r Ohg opiatlar sd returtd b 0!,a oa lha tr* to irv!3tE8ta. Or rradt{ ltr bondn ol t I st.rr, hr caaapc4 hn tafulaldyia w- til !y cra d lrr cllEtmrt {afi !€t mf|sgEd ro Brt cn ualrhg ?r.tra oo h

d dro ,t! mln lo aarcty. fhc divr ,fy.crovrcd.lr*mwn to lE dirr, tllc h,ltng d.c c, ur 3ta80a trt( ]st t*rt FE, !o tr 3m o, hn iaand as 5ooo .r hc rtrtcd n*rg, dtogrn {c cd h ttr tdtfy ol lha tio..ec tr*. ?h! oxrgrr&fEirl .tnDctiua o!,Jcar lit $!r h! fqrf do{it to in -tlgd. r,thart f,.rr! }i!9on*b qyggl msitd. yl*rh ro!5 lsv! y'Ird himotlh. drcqr (IfEiEy. Tn. hat*ficlhad b.cn coxrirnad srd x.t oo Lrgi bclrg uscd tU crfy ra6 tr t't( dtl.Blad h a rlli-baair!|t hn tha r# da/c! yas Cso rEt tirod to a sdr rtgOlrhg r,qrth. olrt8J o(an ![ rcatrir Ca.l, a rl- 'trc tael'ica-r trt.r tr td( otcrr.,rtilg f'ra ,tr al nl oi e lqtd ot)lEl Ot r. tti Fni rI lhn (hrn rrd a rrut D.rE1lE irrd -dr Oy ir ldt dllE drot- h ldtc dtr.! prEliqE, th! tffiincc-Fad t|!r hG han/irdy Etd ar iie flts r a tEd bc.n Frlad wilh ntogarl. TI:lillr coaarsl lprrlr, #ry!et!d by rnrogrr a dtst3 to rtlî! tm ,sh(l

18

rcc mc 44rB

8 Al ! aroFto t*tth,I lhc c$imstl Fllrta r{ct ltlta bc.acd -q| tha aq/Fr.nt hautltla ha*tg eaicd b.cr* th p.!$r,r h lrD tld"aes Itt al$n tgeard $ova tharclthg ol rha .qirrnt trassre rEaal €lt,a PcrtoYld about lo c!$e lh. toqr lha rrxtmcr59 nra trand by lrr lmsild eer ce td dd nol arlat.

9. A qSrE E r# r{lt 2 low ttT.rttt?irhetg tra.r*tt, r,l€t rtrc boltld in thcratr ,- h th. tacE . Th. clsto.rr hti.bd . Fe{ ,Jbogan arlriclirt ayttm b.le,t n lh€tm net*lr O! ,n clir wa6 ttiLfiart .fl fa derif ulls th. ouc, mrdim Y8a Hlruri{i O! of $a eG.sEr $tlo hrd cnltld tr mit ftr daarw ld uncotdou ,ld wasaaCrynEd Ucn hcf

'rirrd. I1l. Inbd Gx6on sy3L.n lrr, aM a)fiaualGd rltroott

llrn tlr lDrsthg EBarir b fbt hb tlE utl lo !. dcansd

10. A aiir?r I.a l-ay aaFatnalad dttti.tg cdrflti!.lai{ 6t I daaoerr atndllr dadon. ThaoJlt t? rlaEr ttt rvat bceled in 3 lit that w83 IEt ielr{rad as s cmfhrd sprc! b, th!6G3hn larrr d.trauffor oFA'Er laeo d ttE divsr. Tha fitucf wat lrll b (h tli!cg\trrrsb.Irt Dy ift.|l.Arhe tr! cqnnf*orirg thG dtvar nr& r r*tslc h opqiq rha lqad ttFty fne v*alnlrad oa lha e. v9nt vcva. ,q pl,.grle a.!d cod thm o, fi. tr.* I 13 bda.d hc dd .ElhflEdrl.*, iDb! $6 yCvhC argr pelelt d,e b a t|odtta ntifd tl'l &r!d ! lo vltttLm g1 rraryBd d*l ln thc lqid sLPd, kle. wfrtt l,l. diYr ryLd o!! vdr€ ga. ,ltdvmtng at $orx rEmry @, !6aF

'tt n nt xu! bcaEL onca ,t ,ttd llra ttlrd

rathtitgr gs .rr|lirg, hG rcnl hto lha Fl lo ccrucl lh. YCrhg r.tu. Al Uil gotrl lr. tJ.qdhto a drogrr rii/olygao &tldqrl cmolohcra

11. A grq+ ot mrtaa yvt'. rorHy ral&g al fr i}te.d :nd d a tfid l nt & [rtcnpritn d ,t turrrd mr aFoadrle O! d.siq, s€l p ( a tr optslr ,Drrcad flalrr't 16 a ard d r$ il.t oqrthg qn d d cd ol thc tttlzt . il! addcr!'y laccd thatp..d ., lh. acrd ,'l h onb o rarve ttrr g* f .rit b trodjct GttttE. Tlr efie,3l tdsd trls wr! nrr*{ on mt Jd fto&. Ar 3 rEdl, ll! lq &d lrloued b trdrl tttac.ard ltra sctlt rrb vat $dl*!g ,ord ot bafig & pard .rn F6ltralCy, t E! uflrE rrs.B hlrbr -d rl ol lr:r lGlrrE b 5t( 4,t, tsttlo . rlal

t2. Oo rt ASJ ttl h clnrttt dq*tg th.t. ir- ,I-bs ftgn a rb{bco,t-to. u/r! wqtki qr

a la6.r b c(rrdea crE rl 9daffie rut3 oa t foe{rsaF tosr. To co.nCat! lhc allllmo olhp totrr racton . x,oon! p|s* va Frl EG tt G)&a.61 !.&l to atnoa6ra Onc-p*ltucirt€d or! tl,la crr, rrrdfiG6 Dy llr t tqgl stam, arn tsl d r!l& ln bxr.a. rha lwoolrE p- E r n;hcd trrn Or tsrlb b tE C-* to r6,G thci. Ern nEla Both cdrpld hbh. lo*r as w-. Tia ltr- p#-r d.d Uqt lrt y cdld b. r.c.rrad

f 3. An Grp€.irEad cultacba uat ut d b tr 9c s rEluC asr dFh., orn drnct? O ft btt'dh riatoFr Ea! ru{t. t$ran o1! cdttda arTbyt3 5d tro qrltqls G Pbr.6'|t.,.d

lrt tenptdy bc.bd G tt..t, $cy w'! .#t€d td Llt tc,n o'd h otcfrartcr.lwo bfrd flarp; uttale€Ihi td lt qygsr mo.ib. }I,lol u..d.

14. A crrstomer riuolgr trk \roll,t!! tO ttl al t PSA C.ot ra b ba iEpctrd by Or c.rl!.tqrlbody. Thc ii.padd rtH Ua !.nf ad btl caldrlstc hrlldaE . TIo Fams lrdo tlroar cqaryP{ocf.urg h llr hapaclhn ttgqD., io EiE otG irpGcra ort r,otoul airrElr ta* Tha naractoa.Hvrad

15. A lqn @, ffi rsr htra.d fh. t'a( lhold t. E eld rl l al hrt ilrlltrlv th. i!l. rEcdrd to dfolrl flE lr* mrtob t- dn.td a m rtol,r Itqrd Fo ?aEt utcDrvlla clrllad .,npaqi. b.qdil s bddd, rlEld nr tfr .n rE s6Cryrald. Ptlvn y t,ulnror*rg rr*rica hd bGt toE rpl to crlct the l.* 6l th .!nsrE! r.. oltir,crla.fcd

f6. E rdoFe rep9.d hlo a cdrd crrud. r$r! lrr irEUurE - rfas ErPatly rCad rlht{2 drhg difiiol,fl Tlt !'.Gt lglt qrta.b lrt doc ua dl ixftshg tCc *rorgara Asrsr r lre lrycO tlo dt aE lt f*ne Or fiEitq eftlld rdcditg A* Or q lel|.Att, crilirg itey nc ogooO nr .r@. ri rArtr q bvd t- ol( (*t.ra.Gd t r t8r nlrrdlafar rr! rra! tol rurria! TIE aghl vas wroEl, wiad

19

rGc DOC,t/U€

t7. Th. fic h a slaeE larl( u|de',dicn E lo b. aptad by a dfada cdrp y, fa ,wrln 0& jd OriE tis rak dE ot tr wsl(2r3 f€. dosr h lra p.rfia, defh Tp(o:ineEy &tr,rrd lrat aTn rbtr.t

f8. OriE h" cb.fig srd p.artE arairtt,laEc ol r,l. ilc.rtl dtd erle,nal rrfas a, a wsttt .l( ar c9ralt rrfs.d tori. drc b dtqlo tr.iro utEd to !(,g, Ora va3rl htLad d ai .

Tyro Grebycla ti}d lo ret.rr tr vixin rn ,-ltrd fhGE lwo e6.atcrr wat! resded andfsllparLd to ho{*tC 16 i ecive cre lroy3rr{ hr o.iind opd.ala dcd.

ll. Olrirg lhc iutalalin ot. ncw LIN ph!!. s+{.t6 on LIN ,ipc wst d ! a.ElofiE ib, at.cn i.l, l{fit hlo the rooi sFc.. tls pqsqd oryesl-.nditaitg davbr bcaz! io *.n1trmldatdy. hdcdhg bw oxygEn bvrb' TtE trcttidn l|'l fr! ,oof lgEr ltmedddy adirtfllrd ltE cualqlrf. Lal€. h ,le s{lG wed(. thr otrtome, orrr{ fudltrrziR rEd'th.ryrat opa.aliE ard a trclsl aBioe€. rB$urld cqf,ststiqr fr bcbru tg9a h lha p.odrtianr€l1 il" lrl tr rE4 alted al s,&cqrlr-to3 b dq w(rt ard bava lha roq[ rd hfqrrEdtho oJ.lgr! . lrvertiDdqr showed liat thc GirlctE hrd .lot ocrrrdod tln €rrlllEl rLotiE tonr l6fn zh9 macrilr ltd t,?y o.,rrd rd irtl5. Tna elhrd S.r cndrd h lE atlbeac., nol b*rg .xtsn&d to lh3 alrm.phffe. Cll3l(rr€, had t Ugrtr irr &Ir,ti .r$ol soLJN x.pdy wu& ml bc 6irn d by bv Or cdErnfatbns.

20 An crec.incd ilc .olblcc *a .d b t*c sdtic phologr4h. !o !d6 lo . .sto.l co.Ecrrargtrodrcta.r Fobllrr rrartittg io p.oblrni rft l€*r h tta rgdr cddc a. h lhr cdrrd r@r1tE d(ed r Cd{r&r6 lo slleny hkn to tat4holoorTh. of cqilnnl h tl. cdd box. Onehour blt lha lwo m6r ,trc fqj,ld trlccooui h e martrob -€s lo lllc cd bor &mrg.rEyarUribt srta caE lld (t(E!d tE two llsl da-.

21. TwoFoC. cr . qralqrl l il. u!! a$y,.iC.d ed -d uifd .lrr9liE b utlocl a p10.,uiile &e.n 9D3 h I cdilird !pa. Ttr ure ot Arg.i e.3 h lli. lCcdsr h ml a idhcdThs irtc.f lod( re h a l,Ip 2 ,Et€3 b€5u g,orn bve( !r,ni, tr lrsd to 4ah vatcr frfir

22. An .i cqrp(-to.ltrt ForriLd hsburli * to .l el!,lrrr C.rl end lc ilalr€ * latd ADacf-$ rtroecn a.!Cy frqn a lo,i, crffi ras cdrclld lo lh. firil syrlcr b rc9tsc2 [!afuiCin lrltr - cgr?,erad. An Csralq Frton a f

'!4iaEy ta lEl( b bd CCdm

CtU&hlou.lrwald 5n*d roorn He l}O

20

r3C ooc441(E

App.ndr D: llztd dMgm rlgn

DANGER OF DEATH

Potenti al Asph yxiati n g

Atmosphere

21

T'hirs.tety Adl.dn b pubI usua o uriqaaitord

.it itiat to theqrtindrBh.za& of nitotEr.ephfrirddql. Nitsqar i wilrty ur.d (rr-

sEd.lly. lt Ir dEn',rcd bkea? Errtrrid ftlc a{ c6r-rni.,'rt' (rurh I syg?r) th.tm.y corrode cqE FmLpreent a 6t hrzerd, c bctodc

. Mtrl8an .rphyxhtion hezardrin indulE, rsulEdln D da.hsfrqn 1992 to 2QZ Theleincn mE curd h ! vrti€tyoI facilitic, irduding iodu*ridpLnE, hborrbrlr, udaredical fadutiec. allrai hrlIinvolved .onhEtci

o God gract'tt= ard .r,.$glcttoI trlardc E\i&ihire tlr rirLolnitrogen esph gief ionGi6re l).

At.ny brd&rE rarl",lrcd by CSBn3rc.us.db,i dcqrEteInowLdg! of th. hrzard or

hldvrrtmt lr3€ oI niEoter r.trctthrn bE hing-.e &liv6yq,!tlsu'

Tht bullrtir {atg ooly on th€tEz.rd d lsphydlddi. tuughnitogar ebo prrartr cryoganicrd figh-p["rsur! hud3

ComrnercialUses of NitrogenGlc of dta dr6t isrpodrntcootoucirl us of nitogen is am herrnrt rSht to lmprolrcsfety. Nitogen i! hert tldetEr6t cGldltiollt (trit dcs notlact witr or aflrt other naterbt!

It b qlEr u.*d to kccp uutctldtcc ol coatrmirrnf, irrludhgoxygco- whiir cr.o curodccqdpalcit s prccrt r fLc EtdsxpLrdon h...rd tYhcn ia cqttlctrv&h fuoaublc\ui& oroEhltiu. tolidr lnsuc[ crrcs,r Oorvof nitogan ir orinr.hcd in. e.d to Lcaporttar qrrNit]oSrt b rb utd to pud. &ecrqu+ertFabintDduring !r.t ri.L b FlrtrIIrDEtebb or tdL ar.t ri.l prl.riro op.rdry .quiFsrt fotEirintarE-h hdulEirl snd cmrlratcid-rtnF -h!a . dEo[eD{ldch.dltrvirqura mly ptltcnt ah!z!r4 tuch a! what utlBlupplid !& o, workhg h or.round rp.c.t th.t .rr €onIh.4

I h ll9e rt. Us. Ordcd S.lir l6rd(CSq ntr..dt ..d ! nfroF+ftrd.ai.. hdLr. afr Gt rra !rlbhrviL, tadda. Ar Fn o, U.lnv.rt da, CSD Evi.,r..a tlrFtrrrE o, -pbd.ra! h.il.,lr,

F.oudor! Butbc t Lar toensu" hrt suri(int oxyten i!plpvldcd to FsmEf

Nitrogen k safe tobreathe crly when mixcdwith the appropriateamount of ulgen-

Effects ofOrygen-DelicientAtrnosphereNitrotcn lt nd ! -poira' in thcEldidmd slsa llp(EtE !tllz.d wh.n tt dbh<ls dlEerLor*itB th. sErospiEt h.z.dor.lso huuunr &athh8 rn aygen.d.fi.i.it d\6dE! on hlrt

GESJnBftd|rollrJff,i{6rtbr qrt@d Frdlarr{htdrnldFC}EdC.I llfr Fqrt.O9tiitirarrEt. SJry &/Lifr ,r-,'rri Gf h,i{far IFa hdrx arf do .g cryip*dy.wi, { aa aaa ol, hciltt'

0U5. Ch.ti.f Sq rd ld

frq|njrt lddOfio ot |n4.d!.. rd SJ.q

2t75 ( lur. tilt tb {(o\rfirttl.n DC foll.lliS201.16t.73Drrrarrar{lot'

I

t

:l

:rix$ md irur€di!! drrarr,irrudngucmsciouera rfurmly ar os two br6tl3 Tltarpoa.d Flon ha no wltrrtngurd cauDt smle thrt th! orlBm)awl i, b lotr,.

Thc Ocoryelional Srlety rndFle.tth Adrdnl$ndat (GHA)llquire3 .arplorcrs to Errhtdnworkplre dySen !t lcvd!bctlvrat 195 !!d 235 Frant Arttloti'n h th. trbh or prgc S. trchoun body is rdu:l; eff:<r:db, loDrr cglcaEltians

Ar thc c6cn corurodar tlrbelot{ 16 Frc.nL lhc b,rrin rndrcouruuidr to tfie brsaihing cor tro.l

cenhr. crlrrhg the vtcdn to

ln indutrhl and

conmercial setthgswtre a ritrogen-erricH enviormentnay pesent a lazard,. . . precauticrs nx,rst betaken to ensre dtatdere isclfridentoxySenin the arp+here-

bt tt!.1&.rddc.F. At th.oxytan l6d coat[ruaa bdcrrcuc, 6l[ rwcry b lasc!rt!i! An .tlroaPh.tr o, oilY Ito 5 Fr(G,ri 6y6cn<.u6e6 thretcdri to,rnhto r co in Lrrhn a0 rcoo& Oxygur ururt bdafnbrrd rithh ailuB boffrr r drrncr of rurvitnl Esrlelrar r vk{or is rcsnrd ald

rlsusitrtld, h" d tlr! rbfrc[dk rlrlst

Ntrogan... pres€nts a

lazard when it displaces

oq8en.

Statistks onNitrogenAsphyxintionFttBl rrponed drt! lor th! UnltldStrtls, CSB itctlnod tS ntE%"nrsphfxiltion ircid€nb tlr.tcurred in thc worlphccb.tsan 192.nd 2@, In tlt*irddErtr g) Foplcw?sG lilcdrid 50 vcre iaiucd. I

hof,o of Afiactodlndurtrlcl ard AdYltb.OI th: 85 trcidenc rportrd 62

Ftct'tt rfurled in ch.E itlCens md refneries, foodproceschg erd storagt friltler,aad md uuruiacttrhgopcrrtbns. md othcr ind[Jthturrithc md arnolrtrhgic1 irrhrdhg nudcr plentr

ApF(qiEt.t.ly 13 perc.nt o, th.f addrnrrr hvoltd arirtauncr

I Dt Bttrr fa d. CS8 ?n l.rr iidld.nf c!!ry lard, &d. nF.t1dndc. FrU.t+ !a qr-n ith.ra, pr6i.t hoi-.r. a{t 8rchd&ll th.l rt'. ,rPsH .d....tdfaat r?ir-raa Alho.t! rr Etltltat,.ha. rFrd .t6,r rr rE r! &rcblr.h rErbt d-1, trdd Al lalofnqlrtdib Ftr. sirlt h3.dit6. '.clpte 5r.dr6ol Etri. ir 1...d.. rrJirL f,d irdo.ri-

E.tctr o, OrrSo DErcf on dE lf'rlt.r EodtAtno+nrk..

Orlr:.Catqtlrl6o.t(*) ?cih trafir

20.,

- lt.o

. . 16.0.

l(,0

. tz5 :

.:

.:

<10

SCLRCE Coip.....d 6. Ldirr 2g'1.

CSB identifin 85

ritrogen asphfxbtionincftients drat ocorrd in*e wakphce between1992and2002...80people ulre killed and 50\ rere inlured.

rctivitrr, 3uch r! nJlcrr rnd Erltru*cl€[rin&printil&mrinttllrlrcc, rnd Ppair. ltcrircid"nta sta crt"torizrd a!-mr.irtcruncc- bacru.! inddlntEpola do lrot ind[dr

"not8hhrorBrdor an tr tyF o,tdular.l !.tdnE ihey csuld hrvtGurrrd !t ttrour..turirg ritc!,whklr would hqrrr tl:62plrccot..tLEraf . rborc.

Uf.wisa nt!.h.r udlrrttollr-tdsFcifcrE

ida.lttard Ebeing in sunu-hcrrhg ,..ilti€s - accoqnt totrbout !l pcrrltt of tlE iffidarETht rtcrain&r of thr hcitensacutlGd in bbo[rrorix rtldmirctlhmous krdu*ies, srrh rsdralt(ll and trsportatiorl

Tli d.t lhow that€$ploylc! and(vib-tqs rlik .r. victim! o,.rp hfxi.tioo. OI the 85 irddeatrrrvicwcd, rl2 involvcd cq\tEc.tort,incudhg corrtructior worlrl$

Of dre 85 hcidensreviewed,42 hvdvedcontractq3. hdudingconstnictirr wtrkersdese 42arcidensaccdrt f6 0\rr 60

Percent of tE faa[ties.

tqrr rrrrd<..blG d\rtrtc phFhfofkd cn.6ln(l...rd pra. rd btrdS! dq flPrr.d.

...130wa'kpbcehtalths and hjuriesocc1rred frorn breathhgritroSen-enrided ar.Over 60 percerrt of these

victlm wrrc workht i1or rExt to a conrnedsPace.

dEr.12 tEid"nrr rcconnt 6r orrct60 Fr"nt o{ tlr f.tr}dct-

Caural HonratbnFrEr h€ C:iB Cat!, a coltbm.dbtd o, B0 rvdple frb&iarand ir,lurics occured hrrbstrthlry dEoSEn-.tElchcd alr.Ovcr @ Fttlrt o, thar. vlcdErwGtG worlbg in c. nqrt tg.conlincd spxc.u

Orre dunctri:dc of r cqrftxdiP.ac is ib clFbrDty to cordrh !n.tsncphctt th.t Elry br totr[]dilfrEt fr@r oubHr rl.Canftrd spro in mnolaoriagsit6 typk lty tndu& Gqulptnatsudr rs nrcto:f rf,sds, hl+md bilcrr. Olh.r rudr rP.cla rr?rrlc!6, tr,achlt, md a[atvr.Gbh b, lirnl|oL3

' 'Nct I r cq{rrd trr, tE n dlt ap.!od. b.r..ii{.a i frGa b, A.aa!4halt a r|dl trEi ir faaLlD.FEErbfiairtb&Ed!r-IrEEratyr6.

'A.io.dh3 to GH^" . .aJki.d rp... .rlLd.droFr(llrqf.h.litdd! ol.g€r ed b !C d.rt .d dod,rler aoplrraa G!,arcy. A'FEn..qrird.dlird.pI.' lirfudo. ?...durc! rhr a lraa rta Fqad.tto.at.it . rrirEt rl.ry a h..ldr lrl rd.,rdr!aLaradc!aEqhrt.

Felrrc to Deect o:rySelr-D.fiGhrrt&ro.phqrFdluE b d.tEtrn orytcr>&fi'ia* (ritsoFr€ridrd)rtnorphclt r9ls . sitnlficmt,actq tn rvlr.l Lddents

tn th. d.t .v.lu.tcd Ic. tldt.tudr.6? o, th. E5 t ridrl.rtnvotead clrctrrnttanc.t wilrtpcronrul rrTre ln ot arourd ,confbrcd rna- such rr a nikar.rour, proctsr wrcl or tu*(Figurc 2)-.d nitsogEn rlrrinitially prcsent ln high hv:b cIaEt colLcEd tn lh€ alt!. I}c-incident accounted fs 52

fiielifi!, and 30 inirka In actrof thr O hcid:nrr FrrlclfaiH todctlclcla,rtld lcrcb o,nitsotcn .nd t*!.p(opr;.rap!.outhufrrhrtr htrDtler rrd hjurioqorrcd in "cpa ercrs-(irrludhg rerr riih ec!rdld,.n.lab!to8i6. bildirgs, rldoside in lh vtirdty dequipEuntl &.h.rird ofaryhyxLdctwas nolcrp.ct d ddpersonnel w:rctypizlly oughtoft guad tnsGre cllellpersorwelu*not,viglyd€atld anitsotra-Gfiil.dlho.phat€ tYFid.lanlyrEitg ntrotcttitEiad ot air b

,fsh c+dporntfktr D 6Ey. Ineithcr iiu.iiorr hrdGqurEtcroelcdgr o{th. h.zrrd rtdfailur€ b deilcr rddltldrlniEoBa r!3uH in ! ,rt{(! ctrtsatinof tts,

When fatalties and iniuries

occrred in "open areas". . . dre t?r2rd ofasphyxirtion was notexpected and prsornelwere q/pkaly cauSta offguard

th{.b of Nlrocgt edErett*r3 AlCcrrlustg nitogm gar with rhend prdlrars wfh brathisg.ri&lrery sysicn3 actoutd for12o{ rhe E5 hcldcarE, rnd aPProxi-

nrttly 20 Fttrnt oI talr[der

Thedrt! Fo"idc allpL! dwor*en inad'nrtndy usingnltrtcn irt!.d of rlr b:ceuse ofhtarhrng:abE coupligr oa lhcrrndpoor or ndlodtent hbllin&

ln oli€ hdctl r i rorleteidel.nly ulcd nfEo8rn kisarrdd.& to port . (oa6n d tp.ce.An ilert rtEioaph.n t^,rtunepcctd end un&trctrd Onawoter wu ldlLd. ld . colL{ueelso dicd rhlh rttrorFng rt!cu.-ln rrorlrr cerc. wolenirudvateatly cuur(lrd thc helr th:t b'nathiagrir rldntor to. Frt! nlbotln lha

ln one incident, a worterristakerty rlsed ritrogenirstead of ar to plrge a

confnedspaco,..lnanodEr case, workersiradvrtendy cmnrtedthe hose fa theirbreattfig-af resp[?tato a prre r*trogen line.

Fetatthr ed lnlrlarDrrtrg Attcnp,tcd Rcro*On. ddic Ed dlfiicrll isu.s<uEsmi4haztdous lhod:l!curcrgancics ir th huEu! ltttitrtto dd rlacooc h dbncg.ApFqiE ttly 10 percma ofIetrlitbr &or thc CSB drtr wtndrr to rttamptt b r!r1r. hiundFmrr in conftred sp.c:t

]tr vidb urd. ltft to .rcllr lhcrrtrrC .l!! of iha uppcr tlrll"t{hldr wls tlird wttr r ernwly.A! hc L.rEd hio rh. onlop.ntn& ItIs colvGtsr netlddllt ha w.s not tE pordht tothct cqrmunbtbr. Thcy lo.rndtlre virtiB urcqEcigu., !"1d hchia died as a resdt oI oygcndalxieacy.

Enploya OtactlraffiilcTesiog Atnosflae

At! oF.lr wlr cmdEctint rflrltluua tas tart on r towrrfr.dlh! tt t dirhlr8cd into !low-prrscue llue gas herd:LIhc t€t wls reqdrcd for r hotwork p.rmit b t*c nrsh phot6.

Th. dri:l opcr.tor irucd r wqtl ,

p.tlrlt thrt riqtriFd . ruppli4ir rrFreigr. Two conk..talipditkr wor. rctir.tcrt .dr?rrDv.d Cp..rrty t lv!. Th"oP"r!t6, horrrel"!, wq" nolllp&rtdy Fote.tim Atlaclurbing thc oflold, hc wrovlrton€ by nitoSen tE fnslth. op.n 0rl! liE beftoe he coddconplct! rhcpt.lt !.npllnt.lk og:retor bxtcd rvry,rstl.4 .rd rluswd ro hi! LrE,Hc wo dioicntd rd ttic8yld canrioorss. At hr,G*i-trt'Er Gltd.d tl'rdth. irci&itrar drlt b d6..tcd LrrcL drllo6cn gu tbt lrdhrdlr.rtody nria.d ih. fl.rrry.trsL

r ln.deqste lrlorjtodnt o,Atmcpharc

Corrrocu AShf potcd lraidehnkkWltte ltrer'l oI h r trnl ErI 6an dl r€frr€ry r'!s d0adcd byhJectLng nib%€n tls hb th€ c.r.Al eaployee o{ r rrllcer cleuu'l8coorpany wo aplryirtcd rh&d..ni$ lhc nit%6'6lbd hr&att.

Can"t Brcattdng AhStpply

Tvo L&raslfunaneCott@tl'l4/l,4xtotcd

Two F&ltint cqrbrdori t^,t'cebrrsive-blaing tlb6 indte rbof,€, at. .l6iat p{rn! i1t€yeadr loe srppliatrir t!+drrtorrronrtcted tot U-Fd dero,conped air cylrdcB. Andcrrubcontrrto( Eorid dt rrctorsi&ihecfhdrPc.Work procceded ncmdlythroughout thc nlghtslrlf bhowa,!., .t3O0.ar, th! .!ctdr!ttot no r,c{,onsc dtlr rqFtedyrorrdin6 thc eir honr- Whcn|rBahar.qt ctor crlpbrrce r,rsltt tnto rh. b.ikt io u.E rhadir.t!o& ha torrd rLa tro Erarlyhg or orppodtr ardr o( tbElfoteS-WhrD OE fllr* h.dtr !.IGty,.rdernrbsrueotat depar6rst tandth. cdrptess€d rh 12-FIL tb.yfonrd tiat it contrined lc.. rirtr 5pa.lnt qG€rL Tlrr -!tr hrdbcan oanEhdurtd ytdr t6low I

Approximately l0perccnt of frt hies franthe CSB daa rvere dueto atcmPts to rescuehiured persas inconf}Ed spaces.

A+|ry:datim lhrzrds(lrtJdc hdu.try .rdEf,et on Germl PrtlicA?hfxltim hrzardi ruy a&o bc

F!.glt outd& ildusar,espccidly rarorg peoplc who usrbuthiry rir, rudl 15 freEthE*diwrr, rnd mldrcd patient!,Si.tidcs on th!s. tyF ofiltlllntr u. dfrhlt bcoilcrt.rd !t notirrlud€d in thi!bEtlelin, Elorlth oreJuch o$. lssuE urt2ld Hor^r-

Selected CaseStudies

Falhre to RecogrlzeASfdedon lhzrrdrt*ar Corfircd spacec

EnfloyaDiaAftrrDtrrdd/,yEtrrl'ing o l,lkrqavfixldTaa/r

Two cor,eotl€B rnd $e victiDw!t! clerl€ 616 in r hydrotenpodlyirg lrnl! thctant rerp.rUy Fttcd rih oiEot€n toremsv. ht tl|l durt Frtlch!,

A sdftt r diw.tcd ql. p.d o, tltgr iraur to te dr lramacr udthG oth6 F t to 0E airEst ttt-pnat6. Orct EE rcrpiratot wasin plrcc, the worter henthcdpurE niEatcrr and w.sasphyxlrtc{

Fatr Kllad otd 9x lnjured in

Mning Fbrrc

Anulsin8 hoBe louthelyordered lrrge pure cygcncmrprascd ges cytnders forrtsi.r€n! with re3pirrtdy sl8cEdisers.r the tuplict uri*rf:ttrydcliv:nd ore <ylh& of purtniEtBa with thre€ crlindrrs otci6aua nusing homcE rintlnlna aplorcc

"islrk$ly Ecefd AE nitogc!

E*.Anc&a ma&rErace crrpbgeetot th& cyEndnr, whi:h hed rrnEog€lt l&l Pltdly coraingrn oxySan Ltel, b conned it tothe oxyg:n supply syttsE, Thetlll wa 6thd with nitm$o-comp.dbh corplhSr TIEearflqrcc rnoved a fitirg ftourlr ezrEy cygea clirder and

uled ii l! an drPta b conmctth€ nikogar trnl to th. oxytltl3ysLEt four derths ud sixhiuri:rcturred as a rtstdt of

Fre nltotllr beht ddiv.red toihe prtilnt!

6

cEncab.tim o, ory6"& (iliotgThfr ,!bl l&ddlnr F6pr.doStIA to i$rc. tl"ty &rt qr thcbatch ol bathhg dr)

Htx{h EcttrccnHtrogen ad Ak

Ttua Erftploler' t+hlxtdfrd tflCutiaglol,k

The .Er6phet3 kEidc . clrt rtte wrr t6tod gd rnnttLEd thrday bdqr wo* rr.t b bcperlorurrd On 6c ldlorring dey,r (!nt-rdd €rlEld tha trrl ioclerll it and colllpr€d Two pbntemployees atlrcd b rttlmptrcsu€, tut Eu, wlre rboo\rercome

The tarrlhd br*n vcnlir.td wirhwh.t iv.r tEutht b b <oo-grsscd & Dut rrc xurll;nilrotc!! Thr.EEoPha{c r.t DCte*ed prior to lc6lruirq wcl.All three uun wec rrp&y{rrrd.

Enfuyemd\Ot€rc+oinc to Arre lJittotcal

A cortraE phutad to ut. rn ri!.porered hruncr lo drip rrslducfroar r furmcc ln m rluninuntfoudry. tle won rn aidlrt€ipilstq. OI two canprcsed gaItre wilh flttings, oe wlt labeled

'Etural gas' .nd thc otha had anold plper tAt atdtld with -dr-hrdwdttar qr ll Hsh,r't tt, hblh! xfirXy cqttrirud filt!nitloterr

Good Practicesfor SafeHandling ofNitrogen

lmplcmcrit WarnhgSyaar end ConthnsAtmocptcrk ?.todtorhSof EndqrorTh?.taqha€ h r c6r6!cdspacr o sodl encloced errr nrybG tm6t rc brc.d$n8 prio tocnE), G it mry chr!8t orrtt tiEr!,drFdntfitneryFo,cqupG.lltot wot DciuS

Rc<lgntztB tl'd3

hrzzd, tod pr.cdcc ctll! tot(rrthrDu3 msUtrhs q, rcql.&Ed sprt to dctrct orytcn-derrdltrL tcntr, or caploslvc.Er6phrr* The entirc cqrlincdrpccc:fuu.ld bc croaimrtd- not

iurt lh. cot', pottal.

The arorphere h aconfiEd pace 6 srurllencloEed arsa rrllyb€mfr fcr brea$ing Priorto entry, or it tnay

dange ornrtime . . .

Wddr6 6d FoHis! tyrt.a.hclldt rbhiu lidtr udiu..Lrmt, rd $iolo.LirgGrkyt

^yrtoptnut.ac.3a. Such

d6ri.€., if plvfdy klrrlhd and

7

srdntartxd. wrtr r.Eltr! ofha:ardots atno+hrrcr Pagdmmit

''crn sE.3rtr cytm

cor:nErtim rrd giw rn asdiblcor vikatircn alarm for bw cygencorlcartltidrs.

C'ood practice cals forcontinuqls monitoriBof a canfhed space to&tect oxygan-deficiqt, to(ic. orexdosive &nospheres.

Ennrc VbntLdon WIt r

F.edr AhEe(.qr" rh. !6oiplEa c, !Glfjlr€d iprca c taltlt rcntle{.r!r ofta chmg6 durtrg tll€courr o, wul, it B lrcltiql bmahlrtn aorthufis ffi dnftfrts}t.rfr vtotiltiq! brrE th. ,obb€tins dEauth to cErptrtlc'l.Arr.5 wilh tlE poc-ntid to cor{.inellv.Ed kt rdr of nlfro6"n t.tshorld bc contiruorly vcntilatrtdprbr o rrd dr.rtrg thc ouDc oI*t i"b.

VatilstiGr b dlo lec.rdtld itrroomr and chambas into whichnitot€n mly hil6 vc[L ln rfew o{ tP nudy c!sa, FopL whowere simply wrling da to th.nito8cn<lltiaini't con hGdsp6cq, r@trr o crdcuG lEa.sphldlt d.

Syit€G! Eruc b! in pLct toprop€rly &dtn, ar.lulE rndmrintain vadlation tyrt.os, Awrming sy:tcar riII alcrt rrqleoof a dangcrous atnoephae

Persornel shouH be traincd ontrw o popcrly nspond udGvrurte in the ev?nt of hihur dthe syst.sL

lmplement Sptern fcSafe Reccu of Worken

Rescuc may be necesory in thcevmt of continuots mqlitctr&r€ntibtion 6-ihrq, c &oth.teslcrtency corditlm Ibc rbtttyto isrmedbtsly rctravei.s.nohilized t,ckrs is a slticllco srponent of confrtcd srtla" suryF?pLr[lll&

k is essental to mahraitcoritir.rorrs forced draftfresh-air venulhtkxrbefore $e ft beghsthrough to cornpletio.r.

One urthod lr to rttach a bodyhrrncrr rnd llelinp to psrcnnelcrrttrhg <ol6ned arear Tbisp,rtdurp elso bare6ts potEi d!lrerorer3 because trry do not hlveto enE ihe (ur6,lrd lrla toIttrla/c $cvictiE Hogwcr,wher r wort€, enEs a pipeltre,score fumacs, ductt, or oth,nanow.diaoaet calf ir:d spaccs,pirluag m I lineatt cH6abodyhemesr urav causc thcFsr b blrEh up lrd b€comec,xl in{dc.

D.pqdintqr tlE silqltiqt"$rlrdat! or .r*ht! dtachcd to !Efcl& and o ctncral Ecclr.Disrdbr the conf,led cF.. nttlid.ntto p,ull thc pe'ror out by th. dEre

or legs, Iha atErdant rnd resueFrronnrl should be .vdlable .tdl dmer Rglcrs uust h.ve ane{cctiw ryrtem to comnunicrtewith paEonncl inslda :lrd6ure3No qre rhqrld enera dangetousltnGphcrc without Foperpatlo l protcctiv€ €quiFl€nl

T}tc lest arcarrt o{ &frn*rcqshc, F loand to rdualtycntr thc cqr6ncd artr to trtsLr,rth! vicri-6. This appcoch rho dbr urd only *her prronrll rrrpF!?rLt Iy tr.ir.d, h.t rdsuEd r*i, cqdpdratt. andhrva drperrlebla bteathi ng a ir.

A@la€lr l0Frc.nt oftltrlhieJ frcl 0la curv?y drtrocurr"d to Frsonml rrcnptkl8rt cua Tha= dlr0u cluld hlveblen Fsvrntcd lr! Elhblerltrisv.I lytttar w.rtn phceSuch a lyrtsor woutd .!rc ps"vcrtEl.nI rnEy worlcl htdltlc!b.€!s!c tt provldc, fq quicHyrcrrovlng 0re worlen frour ed.ntltour .bncplr.ta to . t raona.

Ensrrc tlnlnErrr?tcdHow rnd htcarlty olErc.thhS Al&ta:hing rlr rrurr tr supplialr,lEr xrfilfitadtr anvbtc,na€nt3whcr ox11at lr or arey bcourcd.6de . WorlEr m.y ur cifhaa sdi<u*rird brcrthhglpFrltr, (SCBA) c ltl rlrtncrt pirttos, wlridrconsirs of r lmgtr connrctht r bttllhlnt rit$pply to the rrrpir.to, r hod.Bccau.* t worlcr qint .r .lrlin€.ctpitlbr der notaonbol thc

fttings ce ddidonal rturhd.6 ofwhird gs is cmhhd hcdaCotos odtg Cto hdF b itrndrysy3tesli

Ocnbp and lmphmcntConfrr{pndvc TrahhghopranrThe Sood prldice3 for 5!'ehtndlint ot nitotcn, dcaoibld!bow, re dfrcntr otUy itpafiafirtEl sre Erirtd on ti!hpatlllc€ dth. tdlowtry:

. Ula o( vrnthtion syrtrEu,tttievd syrttt6, and.E Gpharic monitodntGquiFErmt-bothhow b u3€

tlE[lmd luw b d.fsminwh;r tlray ut not uorlingprop.!ly.

o Dengrtr of nilog.'mnriched.tDaph.r€ rd tht.ytt dl. to

Breathing ai mrst be

srppli# utren workersc{rter envioimentswtere oxygen is or rnay

becsne delicient.

sourcr of supply, air mrysuddcnly o foidverutly behErnptad Fortxrmfle,a povnrf.ilult mly ttop sr sircomEiard, th risupplymtyrimply run olrl o! ti. nply ho*m.y tacomr twir*ed or obrtrucd(eg. by r vdticlc) Whcnsuplcddr ir u!.d, h.iity minrgEmmtsy*em! mult p(d€c1 lSainstinterupdar oI airflon, mdprovHe rltcrrute sourcts of powtrfor thc compesson

A colrprlhanit . uun+ldrertrystear krcludcs 6c following

. Canthuqu! mq tqtEof aitsupply.

r Rnrtir: inspccti,on adtr?ll.lflcnt or tuppl€d-aithce

. Rr.tsi(don o, v.hlculer trrlacinthc rrer of rupply horec.

wtEr using $ppli€d &, r t{clltshorld tarry r sodl brluPqHa (cscrye prcf.) -rttadEdb ! drfftnnt tuppbcd{bsrsrrlr - wtth arEugh tr€tthht.ir l! btt 5 to lO EttnuE

B.€dhing & is Erltuftctur€deitha by pfilng rndcomprelsint rir ot by nixingnitsogan lnd oxlten to th.appropriat rrtio- A brtlthrnt{itcomp,ttls md its hc shtpldbe spccincr[y uunulrtued for

end dcdicrted to breetldng-rhry3ttE'u Thecodrp..c ahouldl5rre a rnoilturE E p, rn oll brp,end e crrbon mqrorida scng rnd!hrm. Wheo bnathilg & itElnufrt rcd ty mixint nlboglnand oxygcn t: pnsurcof thccylind€r during fillint mull b.loown b ans.tr that tr cctldamouns re mired. Th€ 6ndfoduct llust ba t6tcd b Gtl3ula

it3 int grity.

hcvcrt lnadvrtent lII-Up o, l{troegr ldBradftg&To prerEnt irnEtchrn8int corn-prtlcd nitsoge! with cutprcsdindusrriel grrde air or coDp!!3rdtrlihintqlulny rir, lFcilafitthg3 should be us€d Icr e.chcllindcr. Cylindclt fa nitogelLtululan l Srde !h, slldb!!.ihhg{uinty dr h.t ! dtsthct,kMlp.fl bL f ittints ihal cuJlotte osgtnccted

Persomel shouH

understand dBt thelnrinp are irnendcd tobe inconpatble toensre saf€ty.

Pctrnnd shouid rmdcttud lhrlthc Etttngr arc iarardcd to bcincGrFtibb to qrut! r.f.'ty.Cyllndrtr rhould br dedyLb.Ld; typbl cytind63 .!.lhqwn h Ftgun 3. L.bdt drgilng 4atear+ corpreotr, rrd

References andAdditionallnformationAsrericrn Nat'rqul Standards

Inst'tut€ (Al\lsl)/ ArEricanSci*y of Srt€ty Engineer3(ASSE! 20@. s$tyRquir.ncnts Iq Cmlwd Src.,2777.7-?403.

ANSI/ASS$ 20C. Crit rb lotAcc$.A Pr,,'icr' in hfcty,Hdlh, atd Envi'@,',,&,'ltlTmiring,219[l-2ffil

ANSI, Zm s.a,d,or.ls on Sig,ag,od L,Hrn& 2535 s€ri€r.

Courpr*sed Gas Associatbn, tnc.ZOL Stt tdfrdlot Conprc:lzdC* Cylida VttrOci.ld otdIdaf Coaractr-ons, V-1, 10thdltiorL

Courprtsd Gar Assai,ation, lrr-,2(AL SeFy lrlldin, Orygn-Dfriett ,\nacry'rrz.a, 5A-2" 4t\edition

Coarpresscd Gas Asscirtion lrrc.,7994, HotfuIolC-sn F.ssaG.s, {th Gditiot! Klulr€rAcr&ldc Pubtlsh.rs.

Haral Avtation AdErinisErtim(FAA), zm N L9APhyndqlTtui/'ing,www.f.aa,gov / aw /crro/coa/PH-TBhtmI

FInld, Mardn ri, Zm Guidrlilssfu Hdl,lo*in [email protected] SE;PccanwndhaticlwI ndustrid Hy ginis/; and SSyPro/rssioruls, ASSE

F,rev€nt int rch.nSing br.athingalr !d niEotln

. tmpl€lrclrttrg good tnzlrd(lnnunlcaiqL whldr tndudcssal tEdlllg of .t.dnitotrndettvcry lystedls

. Mrdltory sd€ty p,nctl:s rndpmcedurB foren&y intocurftred sprces, such as

p.rsdb, p!,ovidfug lll attcrd&Lmodmhg vctrtilating re-ue,and contrrctor owEighL

r Preceutiru wirn worhnga rourd cquipE€nt that mrycontain elencd lcvds cfnitosun

o Tte reason for sFcial fitfrrgs oncomprcscd gac cylirdco.

o Prsper use of air supplyequiFl€nt

Tninitrg slrould covr. rPw atdtevised prardures for cqfinedsp6c. €nEy, and €strblishElea$tlfrcnB fa elldoycepofidency. Cotsactors as well as

enpioyees should bc tained.

Cqrtractas as well as

employees should betrained.

9

H.rris. Mkhrel K.. Lirds.y E-

Bolrer, and Steptrenic Carter,1986 Fidd Guirtditu foTatrywyVcrtibion 4Co$rdSFc?s, AEErlcan Indulki.lHygime Assciation (AIHA).

Klet?- TEvor, 1995. Il,',,ar'/nllAhoag? Ce tlitoria olPtwPlard Disst?ru, GuIf PublbhintCompany.

Institution of Clsdol EndrEs(Etun$, 2m3. Acrn at DdqBasc, sh€Ol'Ime.org.ul(

M.rtin, [:wrence, 197. 'Effectsof Gre Pressurc at Deptlr.NiElBen Nrr.o.ir, CO.d CqToticity, Qyten Toricity, rndShallow-Wata/ Blackort'hthCtviag Ezy'atud,Phpidagy and Mdkd As@soffurh tlur'rg, Bcsr PubtrshingCotpary.

McManur, I.leil,1999. $ty orrn

Hcalth in Ca$ncd. Sprr:a,LcllrisPublistrr:/ CRC Prcss

Nllional lnstitute for OmrpticnalSaf€ty and H€alth (MO6H),2mz "Stlte FACE hves-tigatior of Frtal Conftred-Space lncile s,' TrarnrdicOrrl;diolollniry,*rmu.dc gov/nish,/ (rct, Gt-Ilov 2(m

Occupe tionsl Slf€ty .nd HedihAdninishation (GHAI 2(tr3.

kfty olnt H althTogictCafnd Sp. www.oshs.gov/SLrc/confuspeces/hdc*hurl.

t0

O*lA, W- /,rcl&1n lw6tlgc,laSu'''r',,.! lt tb, &.$r,www.6hr"gov, Ocl-ltv 202.

OSHA, 19d'Pennit-RlquitldConfncd Sprces,- FdadLSdra, 29 CfR 19:0.U6. Mry79E1.

Rclu+ lolm F.,1991. CarldcCa$ud STear Hanbo\I-lwbPublLherr/ CRC Prc:s

Sd€ty Engtr.rh& 2m1 DeflyI rrj.l?r, t+lctt Ardm6,wwwsaftang-net, Oct-Nov 20@.

Th. Bur.ru o, Nrdonll Alhirr,kE (8nlAL 199& Ocat',ttnalSelay oUHd,,h ntprta,V&O,No.44, Apnl22" 7998.

BNA,199^6. O<!up,,;ioad iftty a

H.d,h Rc,'ra, VoL 25, Nq 17,tt4 L t9%.

U,s. Alr Fdc.,2003. Hpda,wt w.bahatcoql/rntwrthvhypo{drbL

U5. Chrldcal S.rty rtd HazldInwldSrdon Bard (USCSB),

200Z lnt lan D[dt,,6.,wwwcsb.gov, Oct-Nov 2@.

Th US ChaU SJry d lbd hnrds.b 8cd (G8) a .t d.Prl&tt FrH 4rry vtror otrln I oar'r| rtr dry of ratrr rrr Faf.. d dr lrrtgtrtt by inrtrtf rn ftt,rtthf chttE l hdfi,ra C58

b rtchrft hddv. ctrnlltb.r lt b rclr ! E citL.lt o',!ttt!!r, bodt E rlil$ad by rr CL.. AtAalArrqtrEr. d |tn, C5! f .t+q!* ,6 d -nffrc dr rq -d cdlrtn o[ cr.!G d t dd.ilr birtE !.,.ryG.s lqlAilqq loi)/irt ffil !.tty htt.., td ddathf tl!. dv.dv.E o, ortr to\rrrrtrr tandaatn 6lv.d b ctr.nb.l d.r.Ab F d t . G(,i.l!lq!, trartr c, r.<odrtEtAlE! c, CS8 r-olt !o a7 ffi h.ldtit ltry t .ffi -evirc.rG a td h n, t&r (. rft tr ntt!.. .tbtI qr oa rt, nrtt- ln.rl&n d h -r fh,.rt d.i r?ar (t.a2 U.lC, t 7al2(rXaXCD CSB i*.. pda. f! rcdE.r -d d.cbb.tldrErJth ti.ttlh r.F.tr .rrrE trcadli sr.<, b&ttL tariy r.cornrod.ddrt' 6..n d!t, lrfr.rlt 4i8' tpacl t # tr rLttloi!' Idr&l ln,ic,va l1q. haqtt ilon abqr CS8 my ba,qrrd.tlttr*drdllr.lov'

CS! lri..t tddr rcF.lt aot bc Frd,El ftett

tqdoorl TcHcrl htqmation Sa.vkllt!, Fon RryJ RdsFLni.l4 VA 2:l 16l(8@) SSINIB or O04 4!7-r@Crrrt rfo@tdrFA,tld{wFq htilrr-arl ar,rs t caf.l,lt,t'/l',tPE @,r,a.b,l

Sdur PoP.d, En ltx s,,tFerrEProd.'t lat t,b tlr llgt:rt ter

lr{(ng'lon bt odld/, F/,,kqJott itf b.o,cirFd bl.o.to.d.E:

U,S. Gacrlcrl $f*y rd Hurd lw.ttlrtbn Sotdtrl.c of h6,qiioc O.rrtdl !a P*y2175 K S!r.. in q ie. .O0

l.fr{iojtorr DC 2m37- I l.l8(2U2) 26r-7A0i

.a

Experimental hypoxic brain damage

J. E BRIEN,LEY

Fn tb tUd pt&a Cot til LfuaqLt, dehd\ St It,

Tbc oeixiy d hyDon cCpdtr ttrt rol to[itobdcally Dorca a-'tc b lh. huE .! b.I!@ bc rd{or!.ly d!6d io Dhydolosic.l tcro!,Tby rrr unlrly rcdrhc ao tht b.ric idoErdoerb |3 tb Fldts dundG ofr crr& rncn c t!.hbod EtsrG lld hl ntc dtatq| r Flod d rhc a..rttory ofr.btL rttqy.t vrr hJDoado ir vry t-aly rvrlrbla Io lrl".-, E todtol^tFl aaioOoo' tarlcl,rt cr- 2 oLloaEraIcbrdr.c Ery vdl .rFb tls &rl mrwyohtrt A Dductbo io blood loe h thr krb rt r whob otttrt8 of tb fh bu cr .t bcat hdhr mb sltu! tb a(rlory of r dltb rrr.ry uy o.qrtttorldlrry & orEr oa thc cotodc lodl.

T[o cxfatd .pDrq.L L irdi.d il h ..iidicdc sDdb drE|r of r xrtbuler bmc IrEUIE.I r.ad i! rhiE ErttE b or ir ool . ditldcorrqrcofr prttuhrblo*Glts rdr$rEly Tb ualrhl orlF ld6 itoDDHt.lt occE ilddbt tld h Dbldolodal rtrE! bcr 1a rrc bhelod lt (EE lt totrl obinEb! ot

At th. orE ii Eurt b. lqll.d ttrt tb cll lh. rtpG r!4atdo.t rtrc ot io tf,. .rrd ola.ddcofc thc ooEd ltmthior ofth: cdnl urron .rrrto l! rhito& tnr.r th.! romfr (rh.slriGo b d.dr.d troo tt oddrdec dbollo of cmthcd t oiG! of ntc3 rrDour rd ctto!sfr. A 6dtoc, d olrtlo or ]Ir rilhfhIt&.!d f -ttrl.!d EoElcrdm{Lldn bd io bEiuc trrb &Ef1 lltrrulabof t[G or},tco tsDdy FodrE thc tDd rrddhD.ir"'rt of bia! tdoa. Tbu cooriqloct3 Ild .boot lo E rlilr dlcuLtcy rrr6t Akuf,uodr rllaD0larl t,' bDdrth of r! hGtr tr andd.o [email protected] to l! .ldau&.booc ,oo0ft lc.& to 16 of codorB.ttr tllittyboGthtcslrl (n.20 EI ThB n*l locr of coor&rsln l!ra&c.r of rofold hFoxir Ely tt[ bcrrlDdblc ta rb rldy LEld vla &rr .odrblbrb &i-.c tD., b.tlo too rfre coriounc irb.L

TrF oftt odr

Efq! oadddha 6c .lLtlE$lF bdr! o tthoEa GllFllolodc.I Ftt.i!! i! tbc brnrab(rh ttrt E.tqr:bcd to hyDodr ed tt t ODrtot

rt . t slt ol r 3rtu! Eduaad c.db ouPur otorjc rfrrob hyfotodoa f!6 .Ey .rur3 exoxtc

J. drr Pertn tl Euppl (Roy. @lL Etl ), !t, ltl-lt7

thc[aba d$tqEat btqEr&o fr6 hqs lrdcrfrhcool uheb rtner s folb*:

I EcnarxtcElood 6os t3 r.dGd i! tDc bnb rt r sholr o! i!

dlodd.sfihh tL. rulDorr dta[ tb ('c..dth.Eu.saFrulr ud EorytlocacoElhclun )4 xYtottcTbr t!lor rdoaio ia r norrhortof rorailTbb ooorr b chlodc trlhoa4 dio rld bcolfEdre hfl dia.t6 rtro tb l!t@ oryll!b dtrcd bt u hct 1p (rr ir rc r' ttd.trd6) rld iD la q$ClF. to rltitud.r hs ttr!50@ fr,.lxattatcTL... ir t@c rldrEtlE I! tt Eorlt of .irqbtbr[rcoorloth ultrblcfc mtiartbo wltL uyjcaIt ca! Gr .fta rrs3 honhfg b -rccbyoocbut uuo! bu ttc commre lDgcetcrutc oarlad hris d.nt & B Cto modatclltcliadoo.

6 nrEToroxtccorerrt hrb hh olcrrrhcotrl.'r*\ it tlir bDlb ttc poirodq ol oddrdE Goa@ellt b. utdul t0 cht{y tbtcvsrl tyDc! of tyDodl trthh Elod tDltocbodlr CrrDld..!d dd.Horrvtr, it rilt Dc rbom rtrt th... i! !o i!ril..- lr @tLrtb! for tb trrltDpd6 tLrt c.cl tyDr of byDorl.r!, r.r rc, fivc iirc to b(& (brfr. fr. af&d ? urooLtc^lr.ladltdfuitoo ollnrdl (19I, Eutt bc ditld 6 a d.a"r-", of thc Dftcb.l srbtrrtq Cucocc, r.t

lEr

LZ t. D. U,l.,r c rho dvl rhc ro idraric cdl dnj: cu if Driridc rt tl|lD rtltttdlB tha tlch

"nodda' crn-

Oc lad orlrllrb! qrtrldb. ia mrlrd. ad provitc iro of thc tEl itlrornrll faal it| th.tt tr3violr corr5lqn io Ob tctb! of thc raiotofr of lrotc'h mlll TbG uttdlc imp.ir'

Sympdurn trE da&d tb oatur3 rttat tirtr colf$ mant io catd.lc fuBlbo (hrdht lo totrx rrduc,ofhdr.a* e dl.fE rd trtc roilrcd our tD.t ir i!c..!br.t blod fue) rod tqll. d.gr. of ehdwir tha FtldFl Drooat raDq!, to r! OD.. of rarorhr dis|.a Th.r. frairl, d!al, ot qtrh.t.hyDqi. io thcbdnt of rodrdrswcl.tiD tllac of .cc(rn fa lh arcr.ho of thc hl.rc hlo thptinrrcr iltlurltl3 marl. In ahi n!vr, of lic brrir cq rllm tsdqrL lld .!ir! ido $G wioL of tl:dltlr.t3rttdh.l[h b hr"odr lo rtl ha,art3,oly rtrtmkrl codtd &rrltry' ll folotr, tt t ia th.r* fncrr! ol dtt lluthr of Hrcrdc cc! chu3c hlrtlo bth. bctatn* Hqt lo sr Podlo of$ll lecqridcccdwiu.oEbait oo lh.cqtantudooa !n sr-Ll lftllay..n r&l bo cahirafrun crp.rinqttd ltudlc.. t tidtcro.ily eithout crdd crar l|rir of lhc

mroc.rdut|L rt orfiary rtrtlb rld lhc rnairt L&lc rrE bof rb !.d td bnh.

Ov.rrl or t obsl rrclt of tic Etb dtgrhllo!Alrt.l of cimrbtiq! rtrhin. tidth b.rh .n t, lc.dr to r lo oaco*iollE b.lhlrolotcarldr.aul io l! &furi ehldt c.r rro& h th. fro|r thc ttc EEG ir Lnrkic I k!, tca& hr... R.atirr'torrl icsrtEt' h lo edqrilrl !4. to r tm.tr rir fiib rl rb lbclrla tir rhlc ttc tcrn nyvoh.ur of tblx cba. to ria pobt of atttirl cotitoa to ba.t fa r mlat o, ttiturB. l'acltDcchrio. WlEs thc car.r of crGkum a clrtb+ Dahdodcrt bipdc d lh. 6418 dtum i! cqEd ahr Grrrd d Hugloo b A.t' cneirqy lrltr odudjlt $ 9.'tqrl ..5) 9(qnincd ty rtr t.id olrytdc blood prrrc rt ud viL rt b..r rer4fr o, tL. hroh.rd ot iLd&r th; iltir't of ocddo r!d. b D.n qllr, by tlfc.ritdv ulhc bL' qbE of tbc hh httc fu[c{iort Gibtsy d tl* lcfoncdrfcet vcr. hrpori.. Ftrqrsdy. [ttlG of tlc c.rtbrd cctcr it t lh! .!l,rarc rlb d!. catbl ba& d oat[d hr & ar tutlrDygt ltt i! rlE pcr.drd$tqldat lIE tL tl lte ear.qmlc rlr@ hdt of crd crrrni ktiTIEt' h dE ttoort oa.d t[. nrjd tr:b i! rb !.d. .td lb. #. of eid rdls ltr oca rlt ('c oa Dd rld io ahwillr rrc En t tb carbf idrrtr rul b. sDrL If ilird. 6fth rd filh Lt4ls notlf ahm ln lhc sIqldcnc or tcl rrt ttr: lc of o.ruvr Y|t fit da$, tld folrtL Cttlir poni6 of thc hlrpocrnDltG. i{lltr ri! bc br|rt (zrE hJ-SclEsc-ld lrt't-at olium)

It lrlt3r tc tac laolod O.l rb D3al srsA ld rle nlbctrblc ls uc tltc PusfhJG cclr ol Orthc in6El c.Fll. h Fdl€thr, l,r rupglird by c.rctdht" L.!y t .roty lucH h li. bt-! nrnar+.nrria tpantf ctrrllorthucborrL rt vuh!.nhb in Ihc inft !d !'ar.l d{ld (nrEktlrhr ctrlh.t rflrrial Occndm of ro rnctll rld Widc 1959i E lctlcy' 1t65, 1916). -, . .rnit forirrd lo tlr aaUcic trrncU Fofrs wLtr circuhtay ur! r hr! b..n trudicd ia tlrtD bfira in o|rrc eDU plcra rtftor of frc, .d qpcdttffil rnLlrl ll lt ltDD(lrnt ao rt.ot!ts!vhitc rD.ttct trco lo rtc h.rfhy Gxpr.trsd th.t .atlt rrrdcr *tcc cooaltlad io drit rbDrinara Evi.larity th. rarqndc iow of blood fiun nruinm pctbd of .trtr of rh. c.ttrl dt.daibo

!lrndu.. bro ltr .rt.dd argll bcy€.i vlich rsoc dtglc o( Etsatrllblc tr&riy ootr-cotct rl tu lrnl[qrk br.!6ct or, lf L droerp rould o.cur' Art'l!D" lo dciE 3udr -roi ro, ir tEy u too Unf lld r@ LrG lo rrst'anrc3!o5' hsE EGn nntilcd by tld., d (txtl

drsuc fintrG Tlrrq fq .r.nplG. Mcrtt (1963) .rd Ei.,Ly (t,6I thc lE ldiviin of tlc middb ctrthrf urry cb. lo ilr cdidlb frul! rlE trult tr b@ nrld boridn ftottr ihc htcmdero'dd uEv la lh. b.boo s&aittt (t9t!) rs folorr: A casDlst! ruilrlteia thc rancy ui rEla csrar httct rd u lott wdojtd a thobatrl dldfc @rcqLrl itfrrciritcoflld to tca prtirt of $c !G tsorfl[ rDor .fiE r omPE dop ot t i!hrut " A v.ri.bL b.oiftaL invoi.cr mty &c ci.qbrioo of Er iiai foos ro itt tio dE iE '.c ...f fs ud ubrr It b !!d b ;!q ttt @lrl. b tL @i6 sruurbd rto*'D.liolodol b.ti t|. ba tbr! to L ctdv crrrir tt !d.tldb-hlt .!Gt!'d lo- dcftc rIelia--ffG mrn., h io ih lau rad egr' nuch ttctEDctiod dcttlltry lrttl

"ltt rhkb

rmifcrr rcnio of ih. i*s!.J car&ulstrfu ttsc cr E !q!c aidcoor d r6vrty lorltlllri .orinl-* t .. fo.,' tls! b i rharDb ci.,D- anr'trdoaoaic.bd..ldhiioloai4srrnio.tion..ra.d ctrd. ifsi 6ynn ..d B!r;t, 116l qro rllor lh{ to(E Fr! d lht b'rh rrr nonn'lTh. E i-&n ;roto&t dtd lod rtrc gnrq n'r HffiE Id sdo (19'o) cLin'd rhrt&crtt ,bc!d ifrtg-thrt ,ofbt divirbo of tti '... uEqdvocrl3i@ ofrcuool r:covsry crn tcnf&ic

-oc*rt arEf h r hc..lb qD.ttlt l Cit rcd rfE cqrglar itgh&ob of mqc lh.! 6c

drcr or to ab FFcr(r rd rs!ry l'tr' ro &3 (.tlErqialh) I EGlCtrb |hE lr-L'i'r.*d.d D.rlod ol th rc rsr.. h.E ctEi.al tt$dhrt..t) rad ftr t.6rF dlrra! daodrtrd.ruq 6t tt reoroco rtrO&rd6 b. b6 rpo gcnrin ,l!rrrr. Th rrdrnin io !o irnrd b tbc rEc&ld r6h.1 d r,..L. 8t tst io tbC rlcl o6t t@G flE tb trEidurolodot rsr, irf ba& r'lft ttdrl r.m, L, rt tb. b.rlDdrry ol crch rnrtbl dory.rudha, o[ ti3 EEq b.r b6 !r.tc dnlof r! I! lE cthlcrl dturdoo, r rduda b br.brdrqrrlE ,..ird of rurvid AJ lhc lr! c.*otll F ld6 ftrerc rulc .ntri3t qyt.!.rbotqr rb.tul.gFdd of-r*o{rry'.Fladlydts rtrurb ual b rirtdy codn d to ri. n&l{E,rHit, Fdrbo-6xriir oa tb brlh, cr} dbrDoedvcrE rt {rlttcon&v.odhdoO.tholodcd crtrrh.lin o, rb hrb dr b3 rdtb ol, rta pafuitn mlrc rhoqb rtcmFttdre Udqtardt ditbf,ffitid Eri! b brrGt b, gr-!c bc.d.lp it (i:trIy

ErFlrytdb,!.*tutdartotr 3 durrtloo'.I{irD.rrr(lr5) tiL.l to codEtDa- tlrdtt rd ttEh.rcd trcpYtry' .tf.r rrtD.ltrct.d Lcr6L io 6..rFlEdofl lc.!a.nd Srto 0y,o 6d lltbqrEr tllldb) ro rtc Fo-Eircdlc! otrdi rld tb Flgrrlic tllb troFl!,' lh Eut Glr lr lb bo&d hdalrit rr.i Fbdt ottnc'

ItEtr bc-r.ur-dftt qFiEt l idc. of6. dcl! otciorhta, urrl (or &V dh.r latlt oftyEi) oo tic hd4 rrtcE rli]lccd torrr& rbdchhbo of r tcbld for r ptlcdrr hlpdc

fribtccqdhl toqrdt DtrdrbcotF bocporrod lo rprt drhddr thi tEv.r:/ of tbcFd rEac 5 a0 crD cr rfE Drrbdr ofiE Ltory rraa ts h :rcr of rb bikro]c(t9ard rt '(fidrl rh! lb iDa0do o( Eilhdffirtttqrbffildf2 (Irr-c lrrdrA rcdxih ot bl6d ftn i! r dosh ri.r, d tLrho!a! krh b txd, dr ro r c btbo o(.rr.rL byrodo rol ocdlvr O..- i! tt.d i.td. Il lor h dtdc@ h6ttrt ttc cn-cC ,il b3 r! trIl, brolvirr ttr, .d ?lircnnE erct r locrl rducdc io lot c.! Gl, bcdlrrd [tir6bdrlalcoloitoca! tccrdrff.TlEt lt!' .. ,.a, Do crFiE.ll Dd.b d tiiperricuhr dtudo.

Gloh.l otr,r'rr' bDLs m rGorctiE h lholctdl lor oa bbod fun ltc hb. ErFl-ffil orl.' h lhc REr trdc, hrvc thomfh.f, if .rcrLl oryF.do.t r!0.b oqE lG.rlhd Dqfido F.rrr. ('! u rr.rlJ bfoodFCrar!E - E|!d!8frlrc)dl. b3lGduclrtb2J Ds Et fa rl bt ,, ,io bdr.66s a-..f irDreducrd (ffi, ct d, l!I9i l.&un lldEbt , DOL lbrrit., h r.. ob FrdH. rodc{. rhc L.h f i}. Flaod hmo& r.tcdd b3Fd tu pe o( .r rtc!D.ch&l trdlhdc rn nqrtd b odc, totnai$rh r Eual rElI cy!!a Eari(r!. TE

tt3

U rqDktb dq u d. Io ri.tc ufcrl| tyd..l&ch.r!ic El'ad dtsrdE rrrG oor Ctitdfrrihrcd i! rtc clr.hrl crr.r hn EC tr.ticldto tt adt [email protected] r G ot thc cats of tbcictrlo od rb of 6c catbr&D. Ttry *t !vl bLhlLb..l trdr. TE p'irbtbl hi3o, LrbE .ht rrttrlrt touarry rDE bt ba&ard ty ZobS .d ..hrd (196!) rod bytt cl&,D rod eiab (197t). Whco pcrfurbo rt+!r frlb trbrr ll'.10 En Et 6 -ft of 6crshr bd to rrhb r.sidi..{rkd lH

!d CoF, D62I tt tE ddtior.l fE(r ti.aorrttd b bd! &01. rlbr fbd ofrfrthdyno&llr t Dcfu !r sB drglc oft,porr.oi ud toccLa.otof ocstdr3dr.rc hlb .*trrd/or ifricndrl u6, Ib tDqrE, o,t tb trc L.r@ h .ddltbo E lf,cEducdm h t rb Hood ior dtr !o rL Uthlryrrdc bg.i3Gi! h btlu trrEita. fr tttr.r 6rt HEft dl[t! rboa uEirl tqllda,E dtb dra dcrrlt]uo rld cEcDrtrrEit tb@ ErsFthhicd qrca!. oabrdbb lt tau. tl h bDod.st to .9r.Gdrts ll.r oosFtffil roodd D.rllnbr tb htrotrcio rodcGtrol o( ote.oL hyDolt nf d Fdi.lvrarlrr ocdrdo ir yr MlLbh.

Itriioll (otribrorl to alt la.rioo oa ahsltDPdlE bE -Il-.--r tlu 6f todrtyE Fnrr! d br& drrr: o mb De itati&dif bbcfr fc bilogfd cr.ildt'r zr *crd,tb.! rruE of tb r8&l ditributin otttcorfbl lrElE d (trrtll! rod qEbhE

3l8d.A!d.r b.hca by hmS lilrG ritlotrar btb.to rff lo Ll.a! volt,ltq! l, (tarrrr a a,(196t) ..d E -r-a (1963). lft r l-r !@d. rLEEO thort h Elrt! .cdtity rt ll !o B cr! l.dcodouc it loa rr n io 2orc,IlaDGdGtd.!hrl, looFs DCrbO of EirCGs had!fu liA.tEs rs bill btD.rEtlhhot ro &riu olc-pail-i dcrrb d-cnrr lt.r t! 6c rAindot h&<.tdr rad e itlor bbod rr*

h..ftty tD6ruEd, klirhi{ D.lmrr., tiot l in?, [email protected] thc lHDhr|G rEGot cotrrr r h ullt ly to b.d to bith r.-rG Nood f:rrc L litr .DFGd.* (120 8.E Et) rl

rtlthc lftt dnutc (Srer .!d hEt, t a9l I! lbcnh.ltr GtGr, G.rcIca b dtloGs btt dtl.rt ffir rd lr oG.lrd..l BdrdE b tctD!o@ db lhc'har b.c.tti lh. lSod fqrIlti.*l9aaranr rcr*erlor lr ram:d ud th. EEG,

t. A bledq

Io tl! burara djctr cxpocd lo hrDorL mt*atc rDati b brh, $our fdllG of rGCntb.Dd Or hGarl, ah. ldtLl btr lo ccrlbr.l tleodto* qy bc !o G.aiccd ty occttdr vuohtdLltc io thc rrllrtr ot th. b.do rid/a ncc& thri

SArt.kTtrrt L !o cavild4 .vl&ro. 6rt r rioplcrcducicr io drol*iu br.rloroio dlt !o w.tChypoctrodc ur:oir Gre{c0d.d r frduc)or !o haGmlll8G car rlrlf, h t ab r' tt.,ClIbo aG& dcub rtorl[ 6c lohcxroplc of rDEichtDorir(drr ro dl. for tio! of.abb c|rboryhctEdoti!) tht cea b rcird

Erriody boclc.nlc. n|trnt o ruorL $bqta idtstic bri! dlttllcrary calcEtroFttobdcd urtrliBth rwG.L oo b.iDdre{r (B.t*y rd M.ldruq ElFrbltbcdot .rvttbltl Evl&rtly th! Frbd of l,pllctDir.!d of rcold.ry c&crthtry lnFh!.Dt i. too h.afb L.d b hcL.tr c E od rlllltlos D thra it6un b. dd.d thr Dl[G rErh rmrh c.o.DtfodrEbnh&D.|a

a Hrrdc

h rDodaml, brathh3 GrFiffil rdD|b. ri6ldr6Lcd drdr lld rb rhh drorrc hinctodilt FlDrlr, ltlG ohtorl lcrel of rttctil Ttltc dtE TbG FtobG, bth.buola brrh h.rorytrD acdo ahrt dG d Ld b crrl, .Fq bocn rcviclod t, liL r (p6l} trp.c.L rdsrd qdl.c f.Iblr lt .bqrt 20 Eo X3 Ai thi. lcld F.rc.lt (t96O rtn ffi, 0t 6). L6..64rho oab.rt v{o!l' tri hfdly &rr4 rllcl.lot rllendo ory b. Ei! rh. vubt$L rt|ior ofA.Y dytro d crc b rcalEd (dE 6 r! lald thc cctcr of ocnbo lDd qtuhE rad of thcoryFo cd'lrD9d@ .d hard Uood lo) hr hOpqogr N€odr b anc fbtut Fndu. h Dor

6c EEC ir DaErt thlt Ftc-tn irE c.o b db irrriruc O[c,G., D2* trfrt* rod Frdc.0'ottrd b, r .ttlr tul la F'do ftrrc rd thc t 67) lld a-'i{c iD sti3c tDrncr vrrlt co'i6-.dat .tcclb. h lh. EEG lr rvidcr o,E .ids$lr.rothain h crritrl blood lor. Tlt ory s er r Thc rcacc dtc ltcacsr d Efidm frlu,rrGl@ d r prdod oa (.d.c rrtttffi. A i! lb tatd d, rl lcar, rlE co.ttcd &tr{p_rf,ltD.oririvG fll io tc.rr nrc rld blood Ft.lrs rrErral b, h. ttDa! ot runhr. ct ol (l9t5t. AqrttE xlttl dordlt d tr.gtrdoo lErJd thc x,om, rtd 13 ,r.tl' lhiGd 26drvr .fE r8qtlPcdcdio{c.Fra6y c.!lr tlrt ro alc li-ir to thc rddd. ?if iuEnr&l trt b h.s bt ln' Lah.rtcaiod durila rilci lia atrttla crn toa.ttt llir Ecrodt w.t dinr&Ld llorl rrtqLl boudtyLn l d htDorb. $lEt th. dtofibrt ldtrc lr zmcr bur ifcrortin creflnat t€ptrbry radcssrrd thc ilrf bn4mfl rd fdUu blood cudi.. fidirr c.rl, in th prvhel lcriod vgFsr nry mt bG r (E cfd diypodr oa thc lctin|: Ti3 c.tG of Nofirrrt rd Clrrfr (lfiloyqrdiro lutr coqrrc d rhG tdrDuLiioo of dyrq 13 drn.IE G..tQ alaocddg Dobo-ta.chraortcrpto.r in thr cerodd hodlrr or bril .t ttr .lhitil.d Fdty rnyqrdij ifrtri(n lrfarrdrit r(46 a ,. LgGt). Ar blood Brrlrc coadn[ct lo drcd Gfca1 otcarbo Ddr o lb e]Erdinfal icgidkn clrrc. rad tL EEO bgac: bo- Aromr cryim*d ldir r d lrrt, rdcLctric at rbqrt th3 trE dc. Adqultc rcoldtr- Drrbli! (px) i! 6a do3 vlt lapard bcaalt-'tbD G(m!!GEd t@ rIE ttc 'lra brcrrt' cro. r. .f!c. idc.rolltlar G:fttla to c.Ito @msl& fa.fE rErlc rmxlr, dlo!, th hrn lo raq, rDto I I ql..trrbddqrdioantrEtrhatcltgartl8 rrr ttqirdo. b b. rttlDd rd dE EEO 8d lb. hbd.t |'rll dilttd to b. dtDLr b6 Itirn lo llrort. Brrh denr t nnb a od thrt E i! D! brl rrt !d &s&!d ln &niLool, utlctr rh.tc hl, ba r gdq:d glod ol car- FurtctdclriLo,Gh.rrgsdicrrlhtrtoaru&43Olc lodrm rna ro cvco try Flod of bo- rs! !tt!.d t, Et i(t ., a (t}lf} Reccay

criirt *idrmlc anut.Esrlio do3 6G ah ?ith I Glttarhcabbb *lot726n Etlrtcsll borod.ry rc d iE crrtrn ead crd tD. thorr Odr. .nnrrhrht rd ?IqGc!r!b.{ua.!d r(iErlc h rhcbrnl rrdh thb d:rrrr of hypc& rB! GqlDlDoo birt th' EEGFrb.. or rh.r, hd.t'lrdftbL fr6 6.a rE vr. oU ina.rEh.lau i.rd.cr.L Gtr, t! trrrt ofrrat hveorir, rdrrEs ir fd ltrr drilrr Liota Ela! rd hhgocun) r,rt srylrdc-hyF&of clo cl, brhf abor bnh h lcr then r6flh of ltr brrb whlL lti: t!.tEr

.Lctri. EEC (&L.Lr, P!io., CrH.t, udBrcua- G&3., d(lgX).ry.d 19 R|gootryr tomn$lidEd rrOtlf int a.d: h rrh r- h (}2 al}3Ectotabaorllcfc60 o l2'jlru$lidrGd rcdt+ &'rrf h rxi r'i'r-h (}2 a l}3 Dlr ctot ab aorllc fc 60 o l2'jl

&!IsG third tttc ncdbE of r !cdr, rcdF rl3 rboooul tD tbc m.ixty. Algarcotly oG dcStlcti! i! Ffurior Ftrrtr. of htqic.tira trs lol ]6&!l rodts

Bsturl,d lvmdcbt; tlzrryit

DraCrEiYC ttl, D{rcr drDrt! D dEa E i!lbbud!br&

Fulb elrort'p olr dina du d ce6orm&o ttcbrtrrFurid b, Eodld rd(D?O rb irtrld ttc crtLrl drultioo of orcdot toE oc crtotia rrE, d r dor r!iE{ Am cJbqb@dob l6d ot 1l Fr @l b rb&oo. drt Ld b t .dtcrdr, bp.aldE .od frd..tt b ,0 io l5 lnin All tbc rEiti.Db rrvitcd.

5l{ltolorl

C),rdC, tD. t - to.rD c.!I o,lbrobd. hrDqirr.rt by 'Ed!t cttoc[roc orI.! b oi6clo&ir rtiL tt dtrrE & d crEt oflrlail blood rab udl Ttc ls brs --

th &ff.t d..l! .d 6id@ ot Ern (h!cbrrt h rtii:rd t, Eilt 0161 1A.tr irla d lru b ..rtb.l cqr.r rad cartl0Drad r trdc cr- 6ord trt nbrri rdr lo

IItclr4r wlr rcfttd to iDc rtirND of r &dcriLL Ia tL Ln . tL.c brd bo r fiod oJbrArrdh' ttpoado !d rll.d catstl w!trtrrlse lt ?lt oodr&d tbt la th: tbt.cH rld rgc.rE dy hElElt nt.lrtmbt u is lh ni, lt rr i! !o Gvld@ fc tbacltity of brrodc *-1 a'-f of gurtllhidodc rrD.

7 HtDortEdHyDo3lrEr.o! ,l-..t. b lb burDl! hdo L'--lry .rd.a.d nth iEr.r$b or lld M.rc(196!) lbad tf,st 6c Erqr{hobatd fudst'... cblyrablcthc

"6 o@ lo orh

t rrr d rerl'. M6t of tb rhivcf wbcrbLtt ororyt btolvtd Urr tr l...r-i.t b ErrtL dotc prlidc d qlbIrE Afh$ h!'rqttl'd @ ay tc r-iud df, c.rdbnslr Cltrbrs .d cDla9lt rilnr] fu

tclld& llar.r, tL s.eon ot I,iD. rd dr ro htr.baucrd tfeo.l,trrcoif fdOy

c..i ddu. rlDd!. H,D.ilrrolrod hr'r-rtrra rblLy dhnodf*nf ,, r toFdr i'b.oiccrrEd io stiE ErnC'.

N@or. crFh.ot l *dig trE egr*qttt i c:r&id., h Ey lqD rd .da&&i.t d t, rrytout!, ca! ds|r Eluaa rdl mdh rlFrlr. I!.b. h crD.dErrl ady Olryer, 1933) $bcrtlE! iriEriE d DOdD c,ldc b &!trld nbadtt prodrrccd ttCol hi8d.ltlcrtloE lDralrl cal.lr dohr Ffidq LlrDooF.!dcrtrta}o, TtI! @r a.-r nr na rr&db ttc corpr cdbnD, $tb.Crcli i!& rrr.m eorr! d,ll lrtitc & d-fit? b-uFd la .rFrrd lhildv ro OG DL$E orEdtiplc

IrEr&ol:ld 099) r'r ffirht baa it sr-frsttd ihrrtrr ErtGrdulr$ iD ab rd bnh dE& rdlnrnht-nF d cyd(l x|r bt.b dlr tocoafiltua ldah rot byFrlc hypodl&i.L, ., ., 0916) ,!. FdD Grr'llll. to trrt b,btnvdr ifrrioo. Tb! mr ful Ariobtt{Dodoriq b ea rrrftahrd gurp rd tttiC.doodtofuf h tb'a-tr6at-l no!b.l'. WDtcErtlrr, Frtculst & caF cal@, rrr&-a.a b rb ol t! rtul rd frtt rc.irddfbrtl h o! c. Io rb Lrts lllodt'rdt3.fili, *dc riEttrrd hDoEao ErGpftufr! rttcd rd I 18 ccldld rtrt ttErru.l a-tF rl3 lfol|bt rtolt tlroufD rhodu oa ltc rcodrry d*r! o, OElda o! tbcitcuhdoo I! r rEl lrly iD l/ ,r,larr, (Eirlt., 4 trTr) rditE cydd. x! tivt! br lGrv@o3itftlo!. Tb 6cc! of th itldoo o ncDantbo,Lrlr rlE,bl€drtarc bbort rErd rbEEOrq. EoGto.td b rt ftE ..r.6d..d rfuL.Errb dlrt rs ta I! toor o, lt -i r ni!r.H rldt ErtE iD r[ far hor hhd cd

enfa. b pl,lbbfbrlt rDduqt .rD.rlr!.drlFiLtr. Lt' ba! dffi-'rbd 6ry rqry.

Xrho rd MFt O9rD ad MF ! rrd X-tu(t9fl) rtudlGd lbc lq€E 6cc! of irux!.irdEd brDotlF..rh h Rh.lr EootG,r Bl@dtircfcl ao 20 D!fXD Dl dE c rd r Ldf to6sch rld r.t Drbldd.tthl H ra tqr ao l0h sfb oaDl blood qnraliE Il :p ol llaip.l thc nr mrul bs ril! r [email protected]&-Dr! !*d6 b ifln r, ca*nl ccrer dHmo..Dn!,

ID qdcr to d&c rLa c.rl.t lrrltq! .Li hr!ah..!d Rh! mfcrt ncdvld br|biltnvmuu rtlc EEO, Ef,,O, hn rod tt lir.io.y nta urrr rE{d tfll Dloo.l trt Ed6r *Irld al'EG omlcla ilrB E..f,|trd rf iotlryab(M.l&uo ,, .r, l97I)- gb.a blood tllEorc rlrtdo, 20 odlo el tc ur thr! tro h rd thlnb ftt9 lrcd b, Fndoo, tyt'cel h,banic cc!d'r".c (to ttG q, of E&Drrdia) rrttrE! b tlc oclG. .d ocofult b ttd..tE,Epor!9rr .od c{tt lE' Tbrr r ah|Eirt b $kttc tbc c.r FodE tb ertFof Erod dn .turd*ryof qrto'CdItril bc lvt&aatrorbtridrtr'ETrtraih&dcE I ch.ot t atr rytqttohaicrt oo.t.inr &oEiDS b rll qF ofhylodr- NcrcdB tb.,r lr BoFnEi! or ltt dbrlbuloo !D*6c lr ceci cetcrrrxll lt GrFio d &ohcf rr- (tlob.lifu d trn htgoatE.si rrk to& ofi6 6.d !'rrul rftrr&E Ery occ[r

rt6

unirandy eilhin lhG schcrivcly wtla(ruc' tc3bnsof rlE brttl. ls rhc rcr lri[crr{qi.. of hypod+iG, obe.tn , rnodc' hrFrh bitoloric .adprobtHy rnrcrnic (cubor nqroride), rn iritldlyDurc hypqic sulss i8 lhc intrct rnd sgontrtrcot dybicrlhiu rnild irtr ri:c, tooa.r ot brct, rotlrminrl tlccdtry imDairmlnts of rcadrrtill lrldplrdqr|rlt, of drrulrtioo In thc hcdthy rxptiroorrl rrirnJ, to*!t!r' it i only rrrdy thl lhcrr.ocidd paiod of rctlrrd ccrlhrl Uood llow isloot mlth ro cusc h.io dlIDrlG but ool loo lanSto FGdd.rrcoaEy.In sdl inlarncq hrh dlttqrod|*a of a csErrttloo of kdtramk cd dlttIEdolf thc rrr.sid botrridet, zoilr

Erpaincrtl ordcs hrrc rhort rhrr the rcntriarlhyFric crrdio{s rrtory dcrcriartioo or ctisisconirt of r 3lodns of r6l*rtin lo thc pdnt ofrtrtocr rith a frl in baooal FErrc tlrd h it.i ntc(but rhc h9.rr .tt.y csttitlr to bcl koj rllrt tltc'b.r t !arh} Th-t it . rnd! or L.. DaldLl dadin.in EEG bcfrround ralvitv rnd rn bodcctric 3trtcb ttlctcd.t rboor thc tinc of lbc 1r!r brclth'. Th.!is no ctircto $gri lhrt 3,3rsoic hrpolil of .oyryDc c.o lr.d to tnh drmriE tr lrs dE EEO lEs*sr tctcctric fc rn rgprcirblc Flod h rllcrnlyrcd rnd mcchenicellv vctrildcd tnnldcrpocld ro 3ynata hypo{1 hidd hyFrY! fr&ns- rcn u tllc 'l!tr brutb' Gamot ocqrr ud thG

dur ho d hypqh mry E cqlstscrrbly FdooScCFq tf,i. rq.or 'thnabolds' fc tirin dlrlcd.lhcd h idr p.Gp.rtrlrr mulr bc .DDlicd wirhcar3lcrauc c:u{o! ro thc 3Ddrtrnto3ly bttdhiUcrDarlrlcrnd rnlmd rtd ro .ra[

Tlsr ir not rmDlc cYldcncc to 3ho? tirt in Drhua hcalthy, !d rp..h€oo.lv b!.rhht .dltldtoLr.trct to hyDoth i. liinitcd t'y th. .! tilrldy rddrculeory sysrcnr ud not bv thc htindc a*,tvrr..'rq of tb b.dtr itd. If ftcthlc r6uldnioo bb3eu som rfilr thc 'trn Elrth' lhc EEo villrcrrr.n ltd thc br.i! will bc u.drnl€d. Thl! ad.4.t .io! of csuatl tr€ir. ayi.lt fcrrfu uD tolnd rdrc lime rfaa rbc 1t3l brltlh'rJd thc rD9..r'rncc of nseirtly boclcctrt EEG rcd brrt norltuctsd caltccuclct3.

TtE rd.tiE fiqrEEy of rI dcrrco of irctrcoicdrar4c la ttc tu!.n b.rin.ftt hygotic tliaod..dG od. lD$trs, Eril, iBdY . tralcr$diblllv of thc brh ittctr Thc abhcc of r:iuti ryr O typote in hullr! D.riqlrt b nrt ItrbooE ba $rlssqi th.. lcErd aypcsdlypodr' .r.hcoutitutia3 r rtlrtivdy mild .&.. c.D. in cdnbi'nrtioc ,rcducc b.rh d,l,rsc' ThG rdditid]dftdcr rEr probrbly rttDon:Uc foa thc iDctcrtcdrxd rd frcquaEy of bnin (lrrrr$ in lEn rrltrrfold. hc.xiniot c.rdlc dia..t eil lrnfia lhr6D..iy to mrior.in r hiSh la'd ol Uood ,bs

t. B. Ddqlct

rhrqr8h r c.rctrrl vlscrdl' bq! iniiirlly fuly dtrlcdb, hygoxl& It wll dso lmFir tlE rrpld rc.ronrlond rEtnd cct.Lrl Uood ior rfi.r .ny lc.dr.lceidio-tt4inrc1 ctirir. Sccordly, 6crirrhj ocdu-rirc rliscrrc in thc enaics of hrio ltd rrcct md rnyiofirlca ol tb rrnd !4liril, of thc trlrlcrclrcbml Ess& ?iI funtra rdtE ccrcbrd blood,tow dudru ltld .tts hrpod..

ln condlsin h ph$dortcdYmodtoc4 sDootlmddy bcrthant rfolrL crndlorthlr hmrn siycarbc to m i cfrdcd3crbofTt3DoEB in thc ]csrilrtd, rrd circshlfiy sylacos|rt(t h rhc rErqE t 3!tn l!af. hltidly lh.sc rrvcto Erht.ir br.h funairt rrd rcqintho in

rrtrcrrhr. IjltLutcly thcc sr+atrrry crrdir>rt Dintfiy tctDcttas mly fril ErDcdmlats h8wlko 3horo rhrr ull.rc thc lrr l brrh i3 carct cdthc cdllrroralt ctt !. of dlt[.|c tnuil bc loq hlqrtc friu.c d brrh gcfutioD.

Thcrulhor b fcrtly irdctGd to Dr P.md. F. PriorCntc EEG DcD.rtnriq ift Loidon Ho.fir.I, fCrEny [d!fd r8lrstio6 rtd coru na in tbc

Flo.rrtir of tha rnnus.tlpa.

LaarELrrrdl. J. (l92Jl fk R.rl.ao, Fltrl.' of tb ,ld.

,at I.Irtatfr,f Eirl lrrirtda. Ctr iqt, ttil. tiyPr..+ el!*riat'.

Et rLy.r.8. (It6rIth hiu* crk h.rdlh|,.t tldi!,Ddindart coolr iL D!!.fir oI c.tlhl drnratc hlr;rorh. fit'E U.db ,d.r{dd C.ra,a *,16.t6.21-21

lrlg|Gy. J. E. (lro. C.t&.I hr,or... ,. G.r..r.{a,X.r;r.rfr&.r. .dtitL .dLd b, fY, Ehch.ood .6d,. A. X. cct r* ,r' allr. At .l4 Ldd(ri.

]blr. ,. E- Eortl A. wr id c.r.tlr' ,. (lr75lc".i& inori.idr h d* tac CDlirotbl nd Bt,DDilFbaid t FB r-t l af Nt''dou, Nttqctt./ lrr<*r.^ ,, 129-l.p.

Irirtcv.,. 3- Lcrn ,t. w. EsdL l' ,. .od !tLl&l,|\E. s, il969i &.i dilr.t. h lh. R sr lErtc, n ullhtfrur roabrrd ,Eil ivFrttltin t- lB nrr+ &rri-ttrioi rna rsf pbldoaitlc-rtl&r' DJ.I1I.r.l,r!,61-100.

Lirhv. t. X- .lrd C@. J- E (1961) Cachrl cao&r'rknr of hfonndyc rolrrhae io a hadiradtll Jc.d4..J.aoi rn t d fu t& h \ 2.-$,

S.r.rr.18 rllJ2!.E riL ,. (i9a!). SqD. dlan ot bic, ta.foltd .mrir

uooa-if ciarri ncrour ryrrn h S.l.<d- Ydntaflitt.! tb Da. i. Arr.'...ia.drd bv,. P. $t aa riit

Expi zrltt ol ht pl c bd n d cragt

w. }* tlcx.,xrr.r! DD. al-r3. 3!..trdl Scir*IL,do.(

G.tt u, tl. ftrE 14 H. .d M.F.. J.5. (lt6l). CdEll.Jo.I ., .L lrr-mdnl C.alladu m ArsrL lrd .Erf;* b Catd lnrh .d * E.a'erf, tu4?c,.rt!d b, lL G.L.l .ri J. s. ,.r.r. DD. ,t 6lr.TlE6.., SFhardd, nhoL.

Gn!&rt M. D" Mrr.r t E- .rn McDoat\ l. F. 0t ,ll.Ep.ttradal carlqr lrcEr5c .ncapt lq.U, h Uatritt.tt. lr. diri.rl q..!t ttt,qrlnlo3!,. .d ghFblotk .ott.hlbr .lr.!r., qf Ndrlor,. fr, ,sA216.

H6, tr. Ot rdarr.., Or ZlmE L- L.It . X. tl ..dL&t R. 0rtl Th. l! onry ol ft. daatro.d.oa& ofnariati.rric c.ri. bt! rrl.r coodcl. c.a.toll6.,,'L" .1 .*t . la ?rr.lc,t. .,a N.n*,.'llr,,.t,,1, t .t19.

Hodi.i. H. D.rtrt E. Md|t D..!' C. Goldb.ulr. L L..nd Abrbo. X, i. (lgta} Cra-dlc|lrio. .T.rirti.ill doc &fitu dr l|If.r 6tra of c.rtoa lrdEriLb|oridaL (A!crq-)

'rlt ttn lot Sr3tty,6\ 6*LH , E. C.. Orlr.L R C. rnd Fdrdr J. F (lgaJl t6no-

pauEloty of &. c.nfd raarola rrttfi .f]{ .rp6r. roii, rfitt 6.1 hypoalrrrd ar{ ctxi coortiloit ttto.L.rcd rih ..'xnl rl|orir. lr.dLl- (,E/rt@.\ /, 16l.2ll .

H6rl.!a, X. l'...d S.rq X, (1910). n6rry ol E o.od fqrtbr .tt!a ,roloqtd cttrhr, bcn lnb S.L.i.r, t6a.!?'!16.

X.t , lc ,- .d Mrlrt 1,. E (lrl). l6dibnEdhrDoftc..la i. .h. Eo.tlld. priBa.. I. Oi.Jc.lcaltlE 3 ln ,rcb Hrtd4 dh,d by .l- 8, Bdolrr..d l.s.,{ddn r, pr. llt-tx. (Cltir h Duilogr.ito!ll.d.i. ,,/aO, Sr..l€ tn rldiod H.d..! A.aL.-ti6} Hcirltla,lA Lo.l(lqr

L.rDrEl, ,. .lr( Fd.aq M. (P6O. L.a lgrE-.rEathato-DdH.i d. f.rori.dior oryc.6o..a EI.!d. & ..it.otsE{adr! Eloiro.eiqrra. k. x..,!,*loai.t a'.!2r.!a-

L.E!.L. ,- rrli F.rd.\ l,( (l9an Th c.arrd Erot4narn and a.rtor noocdda ta&d4, lL Alat@lcalnd, of b.b biod folorhS hrdi..aio. rirt c.rt6lrqtorlh O:l c.-} ,rrfr.r, lr N la,.t {,1A tl-1+

Lvb., t Dd n}'r*or.tti rv, (t5r). Et€ o, td.d.o. G}l.dd. cit6.LFAr. N.alq, Wh..rtr\ 9,aor{ tr.

r.*r, F. ll., .n.l Dnblrq D, L oraa} Eir.riir.|!|d.a'h crrtdr lrdtr.lr. p.Itdi.r! ol 4L /,-.t.r.tad of Y& SC.-.. ,[. ,&1.! I .

X.ldl'r' B. Sr .!d !.*r. ,, ! . (l9at). !r.h det. loli. Rhe! rE*., rrolth3 ft6 ,ro6||.|d l'r.fLl h,Frdc I rr'..fr h ti. t6!6ta .ra ay*.dcLriri!.l rdt i, d alE EEr &d. Lr..r.t, 11 tol-I[.

Mtlcoe, E S.,..d B.frb, r, 8. (19?l). grE{rtry fdrt.ra ..rtll..l loudrry E lcir61 16 bd, AtF.aq&d b, ,. t. Eblc, ,r, !. 3 X.ldr!r, tp. 20!I

It7(CtiB b D.rbr.i..{.1 tl.dich. ,/ao. Sp.ttitLrt..ndoal l|.d-.| Putli..lid!). H.ira.an l.o.do.

Mddn tL L 3- Honoc R. W. rd }l'fr, r. L (D?l).ltttdh.hd|E d lrrFttc..rdr ln tlr.r?ir.rG rddontli,banEaa Dlrdolofical ctaat.t aad Elrlr.tHotl,. In,r* ,t pti,'.d&,,btt.l. E H.t Jld B.3, Irfcldu,en SLZrL (cliir i D.v.lo9i|.dd M.aLi!. ,/40.SD.Ib loardio.rl M.6&.1 P|6Ic.d.n3l H.h.n .cLodqrll.F, f O 9rt Ob.r d.. V!.hta d.. Hrr ttlrrr.rtrtd d.r !r..dld- Xo ..ovd,aintq,. Z.hatrd,la,dk ,.roa. N.'roLr,. d trrcht ok, t,,.t lr2.ta6-

XOrr. A" (lt!l). ErD..idd.t V..!nrrrnul.[ tII.Uba cdarrr.r&drtEro !.i a{'aritE !.r ihu-{[email protected],IlD!,, Zdrstfi Ib dt. t '., . N.g:dori/ .dArrf'drr.. t l tll-lraL

M.r., A (lrar} AncrlcAraroo! .ad !h. FobLlt. of .roal.rrd t L.dt. vr&.r iar. h Carda, N.ar&at,d .d!' dcd b, ly. BLdeood 4 1. ?r,21r.20,Ar6Lr.Lo6d.

Mrrr R- E- -d X.la, X- ,. (l9rl). lDx&lnrrrc.dhrdrEarf. h ale mo{tuua prl!!rt.. lL Loia{a6rcrQdtdofial aoaaaltaq. h D.ai, E ,ori,' &adbr ,. l. iirLr nrd E. l. l{cldru'\ pD, u.2o6. (OhlBia DCdF.l lta.t{.n ,/40. St nit lrt .r.ti6dMq{..| lralk Uoor). H.h.naaq Lorltls!

NairEt t, K. T- .nd O.rt.. E. L 09451 Sobr.rrE!art6 llccil. Doloobt rirh caEbfll rr.Ilotattvr.d rdritlc lrrlc.rdt , .Ecrlt .. H., tldd.LlCtc/ td,tC" 1\ /rr5 .nd 19&

PcriE , Y. Al& ,,. ..d fot . X. (1956I Arr. d.laj.!. dri.L. d'u. ... dttoric.aiq! .rr..rboGaGR ea t ll ttdqQI c, 91, D 1.1 ll.

Rrnct ,, L Jr" |!d WLrdL, w. F. (t9J9l Br.. tlllrr hlha iroot r. |,ca. -1d,., b, .i!hni. lrdt.ton'rr.Esprfid N,',dorr, r" l*-,l1.

SdDdl., M. (15!I CrU.d blood DrGrlt h rh. clrrtr.ldtohitn l. Sd..ti* yttt rialitt .f * &?ir a.ed Y, t. P. td.da bd W. M.Mcr.Gn rn Dp. 7-2O, BL.trcU. Orra(

$rrd. tl O. rn BnE, l( (l9at] Tl* ..riiort !a..to(yrd Uodariql .vrdr auaht mDil .no!& d.{b, LFuhhrii|f .eori.. t.* ,.pra a D*r, .tafdHr, t tll-5!1,

Srra" t- rnd A.irrly. r, l. (l,76} McrDiobfkd Enrof.!h ..t.Lrl blood vrcL h drGic i.chlri. ifrralor:ior draLri! cbtir.d b, rh. hr{ot 6 C!.rrrEffi. ln t b Cered Y.t .l * 1 8 at t. @i,{rrrrro, drr- D. l6J.l . iry.n h.3!. N.r YorL

ZilcL lC.r, lld B.hq4 & C. tL (196t). th. Ftro&cnrld rtosl,h, or .en, lrrot uC ird.rn d tbbrrh h !|&. b C.mard Lori..rl tk f,t<rrfa"?,,/r,r..1 .it a t, l|. O|rLll rrd J. S. lrLF, Dp. laa-16J.Trrol.t,lEhrL4 tlboi.

tgl J. .!bd.r oeat). lat ,r. lt{rr,lle E r,rHantuIhldr

?HE EFFECI OF BRTEF PROFOUI{D I TPIOXIA UFOX THEARTARIAL AND VBIIOUS O|EYCEN TEITSIOIS IN IAN

Bv J. ERIISf,ING

?rot tb fuyal An Fra ltdflrr of Atiabt Id&ilc,?otdooql,Ea*,

(.Rrrdrrd 93 Jcrry l9G9)

Thc pr{id pcure d cySol in thc rhalrr gl mly bc rduocddtLc by <icnriry thc toal pralrc of thc covho.ut cc by rcplactngthc orygau acodly lrd.at in th. hrpind & by ea bct jrr Itc rvrrcruo*b iaduai by np[ <taopdm frou !61 to 156 EtL E8 sbrlutarli!* harhiug rit, ury bc trraiutd by tlc ilaEvryof l0o% oxylurto thG r,4e$(y br.L thc cfrc.rr of ruh bshf Fofmd raodr upoa thc

druh,r rd rrtrrirl gu t.llimr md upu tba oed Davoot !y!t rbrvc bco *did cdorircty (PlrtUg & lr[cBtdy, 1908; frarting,Grdyc & IoErrdn r90o; ELctiD& r96f). ftc dd of ttc nrultrnirran b,ut rbct livaal rrtrrbl hypo:rair upou thc mpply d ory8ll tovr^dour cgor of tf,c bodyir of cmdlanbL irtrrct Tbc otyScu oubtof t'hc wrtnt blood Scring fr@ r rcgfm ltdrr. th. b.blcc bct;rlan trbc

mpply d o,ryga to lt rrd it DGtrbo[. oxygo oorunptba" Ootiumuluoutmatr of thc oay8ctr oc[tat of tb vtoor blood foshS fioErranl rcgbnr brvo bm nedc ia rubidr cxpccal ta blca brt Fofordhypodr In thc cpcrimontr ilaibrd in rtir prpcr r dat pcrbil o( ovrt'voUIrUoq nitrogro i--8 urcd u tLa hrpind gr' rrr toploytd ilpLo of nld d*otoptuirn to iDdu typda llir rc hoil rllomtl notc6rtd!fv. obsvrtinu to bc ur& thrn tcrc 6D$tr!d pndicd in rtlcoonprudon cb.labct

IIIEOD8Iral.,a- C fr..a. tt - bltlt 6-..a.4 tt6 tt rc ta t-tt tri d- It -L

,..r Lt @ . oB! ed brE tltral . ili tdr ro rD. ilaa dtlLl t'c t Ft-6dd b -b lt iLicoftbtqr*ttotLbn qE 5 rb.a@Pt-l6r ro of rb ad a.P 'r. ldd b . dE .d rdv. 'li!5 'r qdi.d 'r't!ir!an, rL:L rf. ih ..c t- c...d b . nna ac.!a dt. agffd c*qre SJ.r $. qt-iEt tr .a..t d tb t- t-5 tL Lo dea iadr...oi-tfr aa ree ro fEsd -rf, rb ,. if.tvrrd b, tb odrwdbl r.td.aa.1tda.d +.- bE !b |to t Fra tdtd daf !iLa- laqr rlr lOtr ttr taa.fdr-.d dln alt *. I'r ap 'r .Fsd. D!i!a rA t- Fi.a tL A- aP t .Fara-d - il.a tt. rbl* hrrH &. XITrlaE tr rM.rd tt !.a.dl!a ttertla t rqtr adotty *tb-dof .ffil EPitaat*..d.a ili. brr.attb kt.p trlE d- tba O. abilrt ..rU i6rt rloroltltrhlolaPPlldrlt .f-.

AAIE? PNOTdTND EYPOXIA 293

Iruriat th! Ftod o, b6-Oina liiroao tL rublact taa lollnlcrd ta Er.ll. - d-Ply r.palbL .r . 'tr. d .to$ l) b.-.b P.. Elar.- lfb 7-tO E oE-w.aiiLrt6 ri6!itrq3- th. 6trr rrD r... rr'totu.d t6 ii. ..tin l pditior .o th4 .b t.. b..!hd {rinAi lb. -D. CrDa tD. .objct rr. lold to c.- ovt$ t -ttrir&

furr*ad fl labr.,lac prttid Faut. of cylr rod c.rboa diorii. ia !b. tr.Fr.iof ib rrbict't liF rc rcotdd cotlnoarraly b a! l,ba GFie-ta by E.Dl of r.-pire, rr rp.ct oE ,- (t 'r- e guahJa-, le6?). PrdiEiaa, .hrdir rhond.ltlt iL dr*ul of, tlr. iDttrot[a! r.r lhithr Elrt d L !h. Fiirl FE of -.ft oa

tb- 8r5. lt d.Ly bdra r tldd.o.6&t of Fllil pcu't of .ittrr ri tb.oplia3dp lld rb. b.gialiq ori.h r+- of tt r6ocdiEt F Dot<r t . O, : tod e0% ofth.tot l tr+.or eanltd l' . furib- 0.1 tc. C.libraa6, .DployiDt tra Dllrur or l@r!..ocF.il,ia rt i!...v.b rbouflosr eL EFir! Ov* . 30Ei!F iod !o dgni6 crD! ch.n3. o.!srr.d in rh. tutitivity of thr lnalulDoL Th. pultoorttvEliLiih rr rc6d.d h toD. of tb. aq..ib-r. by colLctjag lhr GFrrd t a la r.6rdilt lTst DirorD.t-.

,ld 6?}nt- ID t F,rL 6FiE-L blo.d r.. raDpkd colliluourly fr(.r v..iout.it- i, .t c..diw.EuLr rrtr.@' Bboa r.. ob!.in.d froE th. hE lit .nry .o.t th.f.rE l v.iD UruSL.edrnrd D..dh iDt odu..d iDro thr vr.l rtl- bc.I .D.lr.i. h.dL- FdEd ri6 I X ttno..iD, A c.th.t- rr. ilttodE .d iato tL rthl ril. od th.b-rt lhlor8l a L'3lbo.. [.rdlo rli:h ted bro iirt a irto a e.ia iq tha oi-utitalf-. Tb. Faila o{ tb c-rth.t- r.. d.l-da.d dorlat t lnr.odutloo by '-adht tb.F-r'. .! t[. ttp t, d-6. of . irr.ir-a.r3. F-l'r l rdlr G. lt ctL.- '.. .J]raod uEUl it rip L, ir.lL. [email protected] ri.!t Eod CoriDS lhrqrah rt btrD.l ,oaubvdl r.r -Epbd tt u!. of . ndio.?a$r. ..tL.t- rhi.l '. i.Lldlu.d bto r ldsrhah h.d b- GF.d lhrq{h.. iEiiE b tL. ritbt rat-rrbit l fd. ltl c.ih.a- rrdvro..d oDd- rlb-t iud!-adc c@lrol rltb !h. irbl*!'i t-d h.ld {lbt Ur ldr.L.uld-, TL.6dL.r& ot-.d tb.ti8bt iat r!.tJujulrr vria rnd rr ptrard to tl.t it GdLt.tov. th.ln l dth. tip of tL. liff,t,D.r.n F!c-. ma i! plt q th. Fl-.t di.b.C.nrr.!d E.dL a th. irt6E.uLr c.tba- rr uiat ia.d rt- -adiDi ra. Ea, ioF8r- by r ,or of tt-iL phf,idoi.d ..ti!. (LCl Ge f/foo Dl.), rprrGiE t tt,, ElbiE at hnr t+.la 800 l.ulroo EL).

P,'db,g .l Ud orrr.r .dt rdi.. d.d ,I9, ltr. bLod f6 th. bt'rw.-ulr mrdb orc.!ha- lor.d ltt(rrsh . trrbc!.r crr.iL oitD.t- (n:. t) .ad r.. t5- dilut d I : l0 rirhodrril lhyit gLl -li!. ro tti.h hA..b hrd b.- .dd.d (8h..roodJoa-, n biotot eool.. l9a0! Tb.dilutadtrqn$o dbloodr.a tb Fnd lbran3l. Ei(ro6or.fh*rl*trcd..-bEl-td-!!c.-Ierftd..F.d.. G. t !io. r--voir.ad Di..!o6or..ld.od..fr*- E l6--rd ir r trr.r-b.tl rhi.h rrr rndna.in d .t 3, C. Tr'. 66r ol tl6odrad llr d.ird tlilutil oft6. bl@d titb aalila tr. Foduc.d by E-!. of. ttocylodiFap rilh r drsL !i.!... th. vdocil, of rLLh coold t i.ri.(l TID poDp rrr dlrolt dD tb.t rL cr6.rtad.t .t- of oa. cyli.ldr, tlhb r.t ctatttd rilh r.lio., raa lolu of.h.t oa tL o.b!' cylb& iolo 'bi:l' tI. Eirtur. of -Iia. rad Uood '.. &rrn .ftc L h.dFr.d.rr6gh Ol. Sll.}.1-!ro& rr m- Ia dl th. dFrirn-tr.

^ blc6d illtdina nt o,f

,a D\ldo t . ut.llt. ootFrta of tLc diE tr.6plii.rrad oftb. pE aat-rr. fd oa to tro d!t.pG

ldaa d r ttco.d-. PtraiEb.ay aFiDaa $ard !h.a ll drEut d tb qiD.t-.Eplil- 'l. lb-.ly '.Lt d lo .lr 6tra.E -h,rt&a of rh. bl6d ,o'ba lhtor|rh .L.a!e.$.. l.t lh. h3inrhj ed od d ocb lniad of .*ddior tb. ouBri of lL. di!&r..tib.ai.d by d.dca. fdly -tsrt d -EpL o{ llood od r aad rapL ol. }DotDd..r- of qD-!Er&D tf,rqrfb 16..rlvltaG A li!-a raLti[ r...!ao 5[bd b.aro t!.pE aa tb blood .8! tI. ourFrt .lf !b pE D!c. lt €!.rto{ ah. trtr r.a aaLbt .d r!b.rr.L ty !d{ tro A6.?h... btr. (I'E sl{ Ed ?.60}, r1!. dD. 6rI'D !f lL r}p of lh. -iln Ecrbf .],te lo . rdd- GSES. i! !t. orr'3- -s|'rtin ..d DEot tL blood ddla lh. Eplilt {ltla r.r dd..Eb.d .t tL. -d ol -cb GFiEGt.

2gI J. ERN6IIINA

Sb r@g r.. rqird tb tliP of L.Filbd ib trrE!.dd.!d tf. .F dtb raplb3 pnap rrr bd rdl bhodt . tlbi.rD.a l) &llEi!. S.E!'IES trdud fai Di t{a! rb.obirtr h..rL.t libar .od tr E&t'tod laitr

'u tb

dffis- ptoduo.d tt ttr poocdlr td pfidr4ttt''(,rbr,{'r't l..t.l .t dl,*rx,dbrr' (Gar.) ""1't'' LE E&, G' r5'

*prlootr t r.f. r.r rcrl.a aro do d..lh. D.d .lGr!cd- rrr drqd oa t$rJb octtrfrotdrd o.dDL! tr.b.of rttlf3id. oatt b...L lt FratLl 'h&a-froi rch p& of rlctrodr lri roplfrri rod tudrd .a. hl3b FF 'F.d'

I! 'dditioo'Ld tI oC ti. ..ca. t . tEtdtd.

vl.SlGFd

rt . l Alaarab fc !b.Gd$ll ur5@! otil. dya- aa![.$oa 'oilpi of tl.;i E .a b llt tr bio !l..?t'.rrst rfqt . -rfd- rd OG-irD.- tb!,Etl ib. G|Ev.li. o:iffi. s.trn .1 tf, C &ira bv thc tEt il rLr'df.db ba-Ld b, rb ..rorr Eis. t h rb blcod .d rb. dltd U6dCrt rtr an tt. DE.l-Lod..Ftl, L.L t lt. Fo*

,

/^t,,,i,, foa.t d 4!5.JroG It .tr.i.Iblod pr-r ru rrotdtdtbo'aL'Rllli adio ty ro.n on.n [email protected] a.rtD.f.Ea. F5. i.dil- rtlcl t|. Glld

'lrh- dri.hi.t db. 6t&ina bFh. It d. t . o..a.d ro tb ftduc

Wdir*if ca nAU d Fl'r.Lrh. hltalatnl.4 bt !d d'd of lr,- PI}#..., --*i. d6ot .r.d rt l tb otoCa. tto.ldEt ryt'E fdlblirlltr.E e&.d rb '!.t t{d. .ad P!- o( -rrca.l F-t! io'bd@' 'r ltqu-d_ 'f"p

to m or" ft. nO.y r.r0. t- i!-td hto rD. h.slirt .'l-Y ud lta l. du'- r"pirort oo tb ror bolteoatd Ph!. .. iba dP of lL. ad. lt drFt d tL 'oPEfr;@..4..1 to tL L-..h...' ttLl t- d to @ a"-J oa rb rr.ai, tr' r'[t..r"b, Eaoa d. E-qlt, t!EoD.lr uqr .rrl a{f a.L d- of E@i' Eo"Sor tlm6b tbcll ;r !...!.a bt E E .aio.t o..Hd rL$ttG'a"PL9' 'ill 'or!r, .b*!bb a..l! ltoa. (gLfo.t' tBlfo E.&..bot- h tb-cd'G oftt. c.li, lb br. IEt i. agglrd r tlrt lur b* tad- d ab all t" iBt 'b"r'tb ht I br.l d rb. fod -fl O. AmfU b tlt foo' tr' c'.hdd br 40d.dU.! i lb adq d*f t- 6ad ro ,:! @ Et I Eb Dda' th' c'ttloodtoi urur tt dr.l.4 tt F oF ortlrt tr6 tL rl. tr' otdntLlfr 5 F d .f!, fO E 9-fod bt bf.&t ib @i ta.ad .!ood tt lot- Fr. d lbtUff o X-'l-ariho 8l' 6r ec fcEtlt-d L lb Yaa odts 'di'rdrl -tlr b3b&j of rrb q-b-t - rid rb drrlofir.. o( lht 6'f iac'-'d rt 'eC.ot rrr. d,afq rob .olL.ib Fba ?b.olllF$ of rb tNa. tr rlb"td tE lir.. h FlrJa b, F&&a .l@t! tiiocrld d tr. lcalL TL..icof,.G of tf,' clta! rLa L(.l .t tI.h tL lrup rrr trri lr oroll! at rL -d d 'A"f-t!'d'

BNEF PROFOTJND EYPOXIA 295

Ir .f, rL cFi@a lt arlFa r.. rldltrt ot .n a dlti!. l.d fdlortrt !L.Flod of ore.votibtld rill dtrqE lf a,!, ri6 dlirrt !r. d ccioc- ortt Ftrah @!|r. l drfr lr..dririLiA

ltgirlatEfid ttptotr onx*tul.ttt- ltc insruco of puhoDlry ycDtihii.rn

tchlncd by aoh rubiot duing aitrqro h-tbiD8 vrr mrarcd Aomtba qlircEct r r:ordr. Thc EaE puhonrry vratilrii.l of th. tharubja:tr war inctcerd to S l.inin it b.t.pr. during thc pcriod of ovcr-vatihirl- Wbca tlc durtim of over-vcutilrtion with ultrogcn wergratd thr! 8-10 c thc rubirt rcportcil 1 lrr.nliit dinF'iag of vilior-Ir thc cqrcrincotl iu wlich nitrogm brcrthbg a. osrrial out fcr 16-16!6 thc rubirt arpr{cud aomc Blolrsl douatinS of mroiouocrl andinprimcrt of vision- Vhirn ws Acqucutly bd h tho cq:rincotr fore ehort pcrit' In tha fcr cqriucltr in rhioh nitrogau rls brcrthcdfa lr-r0 !a umnriourncer euprvaocd rod wrs ,o@p.!iGd on m6toerione by t gto€olir&.d oonn eioa Thc durtion of thc iut<rvrlbrrtr*n thc ct rt of oesF"rDtilr': u rittr nitaogrn rrd tlc ourc0 of!yEpt@! rra 12-14 reo.

Ed&al tct ,airr.. A tygic.l rrod d thc prrtirl Irc.ur!. ofcygeu rud crbm dioridc in thc gera f,ovhg th$uSh thc uouth-pic ie1rt .'nt d iD Fi8. I Thc cad-tidrl ry3a tarrioa fc! vcr5r npiilly vhcntrhc cubirt oonrncoocd ocsr-ylotihtb! rith dtrogru It raoLcd rvrlur oflcrs ttrro l0 nra E3ri tbc endof th. thitd caphttiotr rod rGorindbclor thl lca.l rmtil rb vel inrpircd rftr 16 rcc of uitrogcn bathin8:DurinS tlc o"lE-yrDtibtiD prai:d thc ead.tilel csrbou dici<b tcnebneho fdl repftlly. 1Pi6 ttc ratcrtio of rir brcrthi4 rnd tha srtiou ofcar-bracthing tlc cnd-tidr! cygcn rnd oarbtn dicidc tcneioe r*greduelly to ngrin thcir mtrol vglua, 3lch of thc tbme rubictr ova-vsntilrtc4 ybiLt br..tbiEg nitrogcn for r paiod of 16-16 ra ol ritlprrt @.irnr. Thc iimc orrre of thc ohrqa odthc cDd*idrl LDrio!of cygcurnd orrbon dhriilc hrr ban ocrgacal for-^f, of tlcc l8 atFri-EcEt ud EG.r qrvc. for ceoh of tha vrri$la rrt pracotad in Fig. 8.

Arlqial M qpt utttoclln ord pE. Blood ver u,nplcd Aom tlcbnchid utary d c. h cubjalt ou thcc rcpr,rrto maiu durhg vbiohtlc arb|:ot owr-rdiLtad with nitrogcn fc 16 roa Thc wrdr of thcr*por of thc catirc ryltro to . s16il6s ahrnSc h tlo ouporitim ofblood rt t&a tip of tlc Couarnd accdc rLorcd r rcu &lry of G? ra tothc bc5inaiog of tlc !c.!oe dthe Fn notor rcordiag cygcn rtur.tineud r finttc O9 c elrprcd bcrfco $ o/o d ttc totrhqot hrd ecrrrcilThc ocnryouding tioa forthc reqnc of tbc pE rcordiry lFtrE rcrGl.l a ud 2{ a rrlootivcl5r Ccrcttmr fo tha delryr b ruporrvcn r1ryi[cil to th. rloddd velus of cygcr arturlirn .od pE A

396

lr

J. BRNA?INO

illltui ,'" P'*u- -

fE, ," A..f'l'..dt t . t do-.!d.rrbEic .rt ti.l ctaB -iE .tt a ../t PEUcq dtsfla auf .tE L aa otctodLaLo tnb duoit.. Th. t dd otc,a5..a *ta di.EiL tr. t. dd.d.r rL.liP, tELr.L. Uc.a '- -rPLd!6g!r@iy &oE ff. tndal.nGy. Ir.lrt !b. of ctit! .atta.ti@ tidd.0.? c of EE tto.d 1.5 E

Tha fr..r rt a, r*rotar lr.adht (*)fta. S, Ef.d d oltlodbti.. lt er.aG trP@ .Bl.tidd todd of6rt$ (a) sA..rto didiL (Ol. E .D Pohl t+St tb r.-ot tltavrir- n@ $.! tlbtGt l -A b.!.F-. tf a'r o(rD.!tr.D.1bEdddornFvrt.LllE liL di.oa- tr LdirtA b7 tlo tettrd lrr.

l0

{0

0!'giF,--E r!8e o

d8 ro=l ,tIi so<E

2s

IIE

t

a?

l0

ao

anIBE P&AFOOND EyrctrI.r. s97

typird cxpcrinotrl record of tb art sisl 6ygc! sttretirm eud pE irpn*ntcd in Fig. I Thc erteriel orygrn lrhrretln rod hy&ogut-brcolc.ots$im bqtn to frll *.5 uc rftrr thc concncacnt of nitmgorbrlsthiry !d bcah fall vcry rrpitly et frtd !,:rd th.a Ed! rbvly uatil ehbaf,hirg ru rtrrtcd lgtin li tO c, llc or5ryea utrrrtbntlcaincrcrrcdrrpilly rhikt tlc pE Stdurlf rrturod to it @bol vdua The mcatinc 6nns of thc "r,.'rga d derirl cygm retmrtin aud pE brvc bcnodcobtd fc the ninc cxpcriucotr rarl ttG.6 y.lE togrt,hrr rith theirstedlrd cmq6 erc abowa il Fig 4.

?st a-+,rl Y\I '" l- t '4-.-!,..L-l{ -4-4 -{

010r0lo.ototalkra kEr rt.ft d darott r braadht (r.al

Fi8. a. Dtd d or.nvEtiLtbG rith litrt,3E !po! .rl-i.l q'f.. -Usrtb(O) lad.i.rllPE(A). L.h Fidtr.Fat tl. rD ot!b. e.lEtro@ tht..bjrctri *l hrr rplrota t I t.t of tL D..E

Ycpt bbo<l @!ga aAlrdtbi ard ?.[I Bl@d e.! rr-phd t(E thcfr@orsl v6iD" tbG p[hotr!ry !rtc!'y rud thc right iugulrr bdb on *prntcoccisioDs i! {.b of ttc aubirctc. ftc tlclry b t&a napo.r of thc ro[dilglJnt@s . leugtLcocd oe.idcrgb}y vbcn bfrrv.rulr,r cttbct r! Tar.anployrd. OD Dm. of th.r6 c.stoD! did .l1y ligdfic.rt cDlrus of pEoor duing thc pariod of nitrogsD br.lt&iru. TLr Ecru !'hc courld oft'h! cy8@ lrrl,tltb d thc voql! blod &rrn a.o ttoc tbcc dta rrcpruotrd h fig 6.

8a.I!ao

{.o

<20

,er t. ERNSTINO

FE'a,eflr&lto cfory!. Th. n*lng q.c.g. fun r rpoo cohctrlcrl rodvtty rod no chragc wurrod ir .oy crlrriEt oltll l&'18lac dtE tb. boghrbg of th. Fsisd of ovor'vtotilatiro rlnh nlt ogto-Wh.D dtrogo ovcc-btctltag ,l. ctdcd out for &u E lor voltr8c

4 t020 Ia l00lh. t,cnr tlrs d .ltot- t dq (rl

tia- r, tt .a d e.Ett tjo titt .lEC- oDG tll .rytE -Ldb dbtod a.'rl{ rt!,..G lb brl ( r ) d b|.rl iIrlt (A} '& d lL'puborq *c*f tCi E h Fiat iFrr t . d Or- v'b' ot"i!"tt6 llr- arbrd.

.rtivicy.t U-lf 0/t rpprnd iu botD domb of ttr c.r.g- r, E r{tath.t.ghsfog of tb F{o.dr!c .d p.Elltd fa ?-e t6. Wt o tb dE tLrd-Ditloglo ov6-tudlr&D ,t cradrd to lr-I0 Er fulllr oh.!t!rro in-tb cr.g. h th.y pdd fa dlslttr lotE Ocle.try tt

BRIEF PN?AAND ETPOX,IA IO9

U-fA c/r lrtivity v.. Eph..d by high-voltqc ,J c/r r.tivity, tbichrppcarcd 16 rcc r{lc the bdirning of th3 chmgc of thc c.ag ltir dosrctivity $BGnIy pcrriared fcr {-6 e. Whcn nitrogla bte t.tnrg e!.€rt o&d to 18-20 !a tL. ilfid f!!t, lor-voltegc r.tiyit, ru drrFrcpLcd by high-voltr$ t-4 clr artivity rftar 5 !Gc, rhich Lrt d fa rboutl0 rcc Control experinotria rhich r robitct over-v:ntilrtcdfore rinih'rp.ri pbilrt brc thi"g rir produccd no cLanga d c.e.g. rdivity,

Tln ,rci !rrr! c, crar-vrntb.lo. (=,li& 3. Di.d of ovI.rrGh-Lgc -ith Dit olrE fc vuiour Fi& uF th.h-t !.L A,tiL.i3fc Ur.i o| lit BEf.. ll-c; O dlrqGf6tE;x,riftrltro. EaaL !li!t trF.-ta fD. Daa dtlr! rrl oba.b.a 6notLr- aobi.cta

Csdbee& cfailgrr. It priod of ovu-votiletiu *ith nitrogeaprodwcd r ttrrEicEt eocdcmfio of the hsrt !ste. TLis c@Drncd rt thcbcgirning of tb. p.riod of ovccvcotilatin rEd rr..htd ! EraiDuttt rbout30 lcc bt r. Thc E.,nitrdc of thc inorcea vrdrd dirEtly rith tbc dur}tior o,f tha DittoglD ovcc.vratilrtion lte ncu c.heoga of tn hirt rrtfc tha thrcc ruUlco0a rha tlc5r ov..-vtnflrf.d pittr Dihog€n fc vqburFriod! irc F$,trd in Fig. O thac ;*! oo

-3is1669 .ngre in thc

shrpc d tha c.o.g. in thc crpcrimrotr. I! oG .ubr6cg hors"r!, tlrrcfi. s tsrriGut iatt lirry d t5r 'T' ;rvq rbioh d,r&d 5 E r.fta tb.bcgirrEg d th. rit ogra ov+ilntfuli@ ud pccdatad fa l0 !.c" Ir

eE:lotl20

I.!g +10

u

$O J. ENNATINO

Grt(r! c8p.ttu ot! tlc lubrd! ova-vcotlbt d vl{bt brrtltag rlr.Itb o.urd . rrtrtivclt Edl ![d t[.D!hot lBd{r d hGrn rrb tU.hhrd &bddcd lo s tft.r t.bc cnil of tt o"E-vatLtb Pclod(n& 6I

ltc pcrtod d ovc,eratibtioD podued urfcd nqirrcy Ylrlrthtd thc rrtall blood p.c-Ga Ths un tDd Fb. pUlrt ;ac btthiuorcrrcd dEiag thc dEp Gqirrtay cfct rDil dEuaad durbt a.biollltrrtim. Thc maa blood pma rre iDo.td ty rb@t l, EE Egduri!8 thc p.riod d ows-bE rn D8. Diutly thc mb{rt anad crcr'EoiibtbE the l,rtl8hl prffiG fdl rld tfcbcd . Eiab[E rftlr bllG16 H froE th! b.giriDS of litlogB halhhg. Ttc udnrl vrloc rulo thrn thc mcn bhod praEc b. @t tb. o"*lcotltlm p.dod Tb.fdl of m*n pcrut vu emupobd by r rrduaio of tlc poba prcroraIt r.t fdbtcd by r reodr.ry rir of prcxrc rud .D irtlr of Prft.procg both of thich lc.chcd. DtdDoE tf lb6i Aos {ttr tf,.b.grDDiDt d tlG Fid d ovcr-ruibtin tith dtrlSlD. ID r[t ttotGp.srt Friod. of ovtr-vrotilefio ith Dittlgs! tGs! sttrdi.d fc aoh ofthG tbtrc mbja*. rld t'bc ED vdE d rrtci.l prltrc bcfotl, duliogrDd .ft ! tfc Friod d o"lr-vatibfu ttth Eit[o8@ lrt Psc..tttcd intri& ?. Ttc btood 0op thloogh tbo cdf t3r c.bobtcd &oE thc rstc r0rhich tbc ci'corfco dthe Frt inG...Gd duritS ..d YBnouDESr!.tho Fin fiVEtry, l95S). The ucra vduc for thc o.f bbod 60robt bGd in trrlvc lclrr$c p€tiod! of o"lr-vdilrtho tltb DitroSED irt,hc ttrcc eubjctr erc Sora ia Fig. ?. Tb. 0ot of blood into thc o.tr v.!borrtrd drriDg ibc Frlod cf srccvat'[trloD, fouothg rbloh lt tltrrt!.dto thr rltitrg bvd, to irlcrlle rgdn bctvoo 20 rad r0 E dlE tbcU$adng d ovBr-v.oubtloD.

DupolErox

eUuiDlry crFiElattt! in rhhh tbc rubintl otBvroulrcd vittrnitrogcoforvrrluFH! lhotcd tlrtumoEirolo Epcvcacd if tbcrlrrrtion of tbir p,roocdun .rc.d.d l6-U 6' In thc rrinity of tbcrpcciuotq tlcdcc thc Fiod d orccvcotibtin vit& aitroga nsUuita t 16 a, ftb prtiil d tdtmgE ovebcrtfng poduocd oly e

tnnrdrnt dirtubooa d th: aa.g; fhc ba-roltryl 8-ll o/l rttrity rug@rUy rfrri.trd tit[ r tm.drt ,rrrthing of ddoa rad osts mt bc

froE tbt prodroed by cborc of tta cyctdr tr\cthcr,rFrt hc r t rint 0rtt Eing of rha'T' rrm o oc mrioa, uo rig-dfiorat ohrogo vr. re i! th. ac.&, dthmgb oly I crudrd [ob lcd(II! vrr noodo Ia rLr d ttc Eldiry it tt oddatd tb.t lbod.gr! of bypodr iduo:d by owr-Yoilbtin tit& uitroge for 16-

16 lco rt vith rcptlbb limitr fc rcrtiug utb{cota

zr3E

rE

BBTET PNFUJND WPOXIA :IOI

Iha cpnmtrrtb|l of caygco io ttrc gar o<striood withia thc rEpir.tcJIt'at it tt bdt-.i.t of tbs aitrogco brcothing Friod rac rcducad veryrepilty by tlc rry lr'rge volutrry inrac of p.lmoia., "**Ool. *.reducdm of tuc hmg roluuc to ! Dllimul! tafoe thc frst bllrth ofDitrogc! rr. ..Ldr dr(t6!.d tbc qurEdty d qytGr to b. tr.hcd outlhc coblardm of thdc tro DAnoanvlB rc.ult d ln r v€ry Epid fel ofco&tldrl cygra toorh to lo DE Eg oftcr E rcc of over-vcotitrrtie ltcIst of rh. of tt€ Gnd-tilrl cygea tcnrba follovlng ihe ccrutlon ofdtrosGo ovrr-vGatibdco aad tbc rstura to brerthiag ah wu mdtcrruylea tiln tb. rst st wLbb tt hrd frlhn TEir ditrGteno ndcctr thr rrduetioD of rlvolsr v€ottbdoE lllodlt d sltb tlr r€suDptioa of I mccucDrl bGrt&8 Ftt€.Ir

TLn. iEnl t r.! ol droF t.llHq (G)

lIt t. Ef,-r ol orr.EdLti6 riA Eia.ol3 EF|! rb q! .y.teqr dcilp.rm (A) .od rb blood ior rhtoqsbtl. o! (aI ftr rrrltr rtr &o tlDrbiG* *! F-rr. pdlt rqn-E!8 ti. d! d & rltr rLI! r.l bao.d60' p.br L r5. us oa l'.h. rnluG -.L h.r d.d.t +l u. .f rL qs

blaiol cggra rlllllarir ad 9ETLc dcl,ry of 4-5 roc bctrer tho of Bttlqglo bratliag aod

tbc rductirE of tL. ost8.a ifiErfira of tto tmotial stqy blood ral orofcin of tho cilrubldo tiuc Eoo tbo prlnoarry ootillrria to tbs*pliug poitrt b tbo ryrtcolo rstci.l t oc. A lirDilr dclry mncd

rEDS

li:au>g

Ptlnbl. lag

3o2 J, ERNA.IINA

b.trr@ tLr! tit'u6oo d & tmrAing ad tlc rubcqucotincrc of tLc

ertaill ca,8ca orturtio. Itc rrdrtba of thc cad-tilal cyga trointo balm tb-nm 8g crr rmLtcd rith m r$aEll cygo artcrtio dla tber O f,,. Tba iacran of tlc pE of rbc rrtcGirl blood t ! tclrt d tot,hc fr[ d chc dvalar crrbodbri& t Dfu rDd thc rtduct n df thcbtood syga 8stErlim (ChtbdlDlto, Dooglu & E ldrac I9l4). IhcuoiaourcoCthc r.rtccid pEpcoducd by tbc ovrr-vrot rtirmruoutcdb 0.f 8 uaiL Thir grw r oJcobtad vduc f61thq rrrirrirrrd grtdirl c.rh-iliridc tario of ,2'6 n'n' Eg !. olaprrcd vith thc obecvrd cod-tiielyslu. d u EE Eg ltc cbroga of occir,l cyglu trorirn produocd byovrr-brcathing ritL Eit[o8Go hrva h.o olsdrtad fto tbc siroultrncorum{rruc.Eats of tLc cygro rtunticn rnd pE of ttrc rltcrirl blood bymcrr of d.odard oxyScD diimiltion suv€. (D'l' l9{{). TLc uotiuc coru d tLc otygta teuin fo rll tLe eEP.siMt! b Pr€t d i!Fig: S. togctuar *ith lhc crvc fc tla cod-titd cryg@ trnrbo. Duingocr-r*tOrtloa tU" ad-tirtrl cygcs tlErio! Ely bc t LrD !. rqc.mt .tivc of t[c mcaa rtvah,r ttogin of tbb ger. Wb:o dtorrue h ordc fcthc { a ilctry bctrcu t}l cbrag! of r}valr. gra oapcitio rd tllrrultlat ohru8. of thc cgco tcorior of tlc rrhril blood Dt thr !.DpliB8pcriut, it ir rpperot tbt thc rrtrrirl oxygrn tcnrin fdin ttc aEcItr^Mu tfc *"rott ..yg.D tcnrin untll tb nr la than f 6 -- Eg' Elyondthirr Filt thc ryttroio rrtcrirl orygcn errirn rre orircoab gllt sthu-tLt of tt. dlcdls gra rm6l rh bcething rrs ratocd" Tbcc rrr rltrtltiirlly .iino.!t rliGcclc (P < o'oli t - 9l bctro thc ot gpo

trorlr! of thc 8tt tbl bhod lod of ti. dtdlrgar ftr tf,a Ld 7 c of tlcFiod of aitrog@ kttthilg. ltc cryga tdIin d thc mircd raos-tboa ariog

"itto8@ b,rctbing wea bstvca !6 rnd f0 um Eg (Fig 9),

aad hcooc thc otygro tcorirn of tbe elvalrr gre ru lca tlrn thrt of tlcblod otoriug Uc pUonrry cpinrria fcr u'rly tbc vholc Fii cfnitsogro ovcr-votibtbu. DEfog thi tLenfcc, thoc ru rpwrrcl of tio rcoel cryglrttotri[ 8rrd.!tt bcttatt t]c dralrt gaa

od thc raircd vcnour bbo<L Eiac t,hl cygcn rr,tcr,tin of thc syrtenhlrtaial blood rrr oeidanbly hu thra tbrt of tlc mircd vtaour blood,

orygco muet btvc prrrcd ton thc blod f,oriug though th. PdmD.ryorllleric hto thc Cvcol* grr dEirg th! lrttc Frt d th6 nitsogto-UirtUlug pcli.n Sooh r rv?ud d th! EEll dhatirr d praa4c oforygcn rrra! thc llvalrr opf,rry oobrrnc hu Ecu tl@nrtlrtdfo[oning rlp delopari@ to tiSb rltittrdl ftftr Oror,r:r-& Adlct'l9a9; &rdug a ffcErlAy, 1960) rad drring trPU tent frllowilg ibcthioldiry divc to r vrtccdcptt of 6{Ft00 ft (18-30 n; Bahn' 1968).

I! both tt6. a:tu!6.nr tlc otyga tanin of tla dvolae 9r i! rcd[odrrpilly balor t$rt of tbc uird vraou blood.

BRTEX PRAFx]ND EYNXIA 303

Vau 98 aeilagg. ah.r &tr

Ihc ltrooc of roy dGtat blG cLrogc of tto pE of tto btood ruplcdtolr t5r ttr,6 vroou ritca fotlorilg tb. priod of ovcr-vcotibtioo rithdtrogo dcnoutcltod tlc mrLcd carbon diorirtc tutrcdog prcr of thcpcriphonl thau rod ttc npid ditruriblity of tLir gu, Ito coortaocy ofthc veocnre rE was uacrp*tad, riu tbc rcdctba of tAo ox;rgeo ratrrr.don of tlc vorcur Hood vould of ltaclf hrvc producod ao imrcaro of 1iE(Grifiurencrct. l9l4). At. aoDrt,Dt crrtondisdalc tcDlioathcgEotctiocrcarc of pE du€ tp tbi! roehlaint1 sod.tcd wltb tho ilerrac of

llna ,idlr ttri ofilrot.n bra.dtht (t .llia. t. Itcr d ot.r.eGll.rioa litl nitt6g- q'6 ad..i&l 6rJ'tG l-&E(al .od oroic llt-Ll .rysc t-&! (A t E .L Doi.r ttprat tt I ofrijhr o4tfdrl rlcr -d riD..rEi.t vrlu-. tcl bsd-- t l t.!oft5.cnh..

'G'

aII

d

! 10 1l U, 2J ! l3 ,O 15

so4 J . ERN tlTI NA

oEygro lltllrtim of thc qehrel vuour blood by '7

o/" vra odsubtrd tobc of the orda of oolt uDlt. ltc ovcrrll uilivity of thc rye,tan uacd

for tlc uruacnt of tlc pE of tLo vour Hood vu rucb horavrr'thrt r obr,agc of tbir rgritudr EiSht not hevc beal dctcctcd-

- O 3lOt5 1025 ! 35 'S {S S0

Tbr. ,ro.r ant oa drrotrn l.edfa8 (-fFif. e. Efd ol oEFli$.loo 'trL dloaF Efo !b orta- lde .a ttrryrtab ltr-Ll (A). fcG.t vet (+). iDr..!d fu*t trl rDA Fhd.t..rrirt (Ol Uood. EA E&r ta.EL tb ur of tb Eb- oDt b.d t@t&- obi.6tr

ltc prfica of tic rtdlE'tio cf ttc oily8lo rfhrrtblr of thc vrrtou!bl@d produod by thc Fln cf tittogo brG.tbi[g Yrrir. D.rkldly titnt&! litc of ltDplbg (Ilg; o). ltc cygcn @tat of ttrr irydr: vlmortblod *!r tbc 6t!t to chrng! rad it callbitld ttc 8tatd rodu..ioo rrdtlc Et rrpid I.o"rry. I! c@tlr t th! oxyFtr aturtbl of thc fmelrrooo! blood ataatad to fr! brt' ru rcduod by tla olc.t !.D!Irt lodrurrrcal tbc EGt dotly. xirld

"crou! blood 3hotrd ohengre wbich

3EE

Io

BRIET PNFTNND ETPOXIA :D6

pq! ht @€di.tG bctwa thc of thc jugubr oud fcoral vonouabloodr frc prrtarl frll of t&c orygen cturrtioa of tho fcoqal vcnouablood rre brlf tLrt rbtch eqrrrd in tic blod soplcd fto tlc pl-Eo!,ry rnfy, ,Hh tbc maxinrl rtdwtlou d tbo oxyga mtcut of tb:F8trlir blood rll D(ro tttB trlcc th3 btt c, lLo chrogr of th! orygut do d th! bl@d llDplcd frorD th€& va6! slta bs"c bocu cdcdrt dfrG tbo EoaEod vrluo of c56cu dmredm lod pE fDd thc mcercurea r,!r Flcot d h ng, C togotbcr wfih thc EaD curvo for thcEt rbl oryg@ tcuriou It is EpFrlot tbst drdq tha griod d avcmhypotrb tbc 6yg!a tdoa of tbc blood 6ovbg to th. brur liDt!, tbcbr.ia !d tbr vholo body wee grcetcr then tbet of t&a .,rtGrbl bl@ddoring bt tha. rcSioDs.

Cudbw& fre olpotoad typblta UEit d E!.5l[@tot8 Erd. in tb fidy drEcltrltc tltt tb.

pcriod d orc-vadb,tlon rith Dltt€ga Foducd dgdtcrlt cba,a3cr lnthc cirdinvrmdar gFtet!. Thc mtrol crycoilt1eb ln *blch tbc eubjctoysr-tnc.th.d rith & ErLo lt Frllblc to dlthg[bh t o t)hr86 b &cordlovrmler nrpom. ftnt, dudry tb Fdod la wbtch thc pohmrryvadlrlim yr. ircEr..ad thaEc r!! 8 Eodrarr. rha of h.art srta rrd thcrrtrrid prcuoo rd calf Uood aow w![a rdd (ng. 7). rhhrltrt ly thcoyl!-rEdbdoD cd..d tnc rrtcrirt pauro rad cdf blood 6or rotuncdto thre r6tht vrle ltc chaoga occurod vha dtbcr airor uiEot !rrr bort&od" Whlo tbr srrr-Drctbhg rrr prfo'-cd rlth Dltogtn tblrhr of h-$ rrto prai*cd fc oo "lolsr'ly bnglr ud tbrro vra r rocoo-da,ry ioqtc.e of artcrbl lrrccsrc rud crlf blood Oow. Itaocbauga rcrc rtcat rbcn rir rac aubstitutad fc litmgto rnd wcr duo,thtrdqr, to thc rvcrc hyporir iuduccd by tbo uitrogca. tbroughoutarch upcrioat tbc calf blod 0ov rrr drwtly pcopctional to tho accuryrtaoic artcirl pra ro. Itu! tbo oborv.d ^h..to of call blod 0owrqp r Esult dthc coocoBitoDtcburyuofrrt rllpntaurE 1tacmdrrychragc! rhich ocurrcd rft s ovclvatilrtin witl oit<ogm wac gotr,blyths nmlt d ao bocano of crrdirc outprt ad of rygtcrlrio triErblt @u-stristion wbich woto goducod rclcrly by .}.-or*s6c dlmuLatio. Itb rplrrcot tbt t'bG rrtcriohs of tbc calf rld nqt otributG to tbi! yr.ocotrtdsli.rD, rod ttG !D6t ptoDrbb Eitc. fq ttrc brro of pripbcalrciatraco wao tla aphlchb ratl cotauu! gisulr€or. Tb! rb of tb!o,rygo shnti:o of thc juguLr rooua blood rbovc tlo ofrd yrlucwhcl r& trcrtblug vrr EltqGd. (3i& q s$nt tbrt thotc wra uinccaac of thc ovcd! scbcrl blood fsr $ tbia tiuc. In tlc rtady!t t EodE o ..trcll hrfn&Di1 qvoo rhoo !.otlFrid by hnncrpnb, ia Laon to prodncp. diLt tiolr of tbc crlral voala @oey &

36 J. ERNA,TINA

&hoilt f gaE)" ltr rat tt rbi& thc otnforl varodilrtrib dercbpr,b@ !,rt rrd b fDdEEd luddcaly I! not boY4 brt th!prc.Bt crp.(fucnt !u88c! thtt tb! clltbrel vclr rcpoud to r fdl ofrfi.rlrl osrga t@d@ Titth ,O 3.c

fuhotwy goe a,lageil PoldhYTrcb1!r trt rbl cygo-toebn velu ffi il tf,i ldy daaonahetad

tbtt dEfng oer.-vlotdlatiG rith nit oss thc oxrS.o t ri@ of t'hc

rrtrbl blood vra ngn;eo..tty gru,i.r t&ra tlrt of ttr3 dlal.r gl!. Itcthc fc rhich thi Etrtr ldct d tl. only 7-t roq dttouS! dltlbg ihiFriod tlc ratc. d ch!,a8! of drular rod !firril ory86 taDli!! TrE!mtrti"ty tloe. ruhcrDcc, tIi fogtl of tinc i! brgq lcLtjv. io tlcr"Erg! trr,rdt tiDc d 0'?8 E (Bf,8hto4 19{6; Aought@ & FotliGr'f95?) for r rrd ocll thoogh tnc puloonrry tllFndr! lbittgst"coli It tarH .plr.r, th.!dd.g tb.t ibc ob.Gttd dEcraa bcttr.oryrteo& rtcirl rd rlvolrr orrygo. tadne o'naot bc lountad fc mth! b!.ir of thr lhrt pcriod fc vhich thc ooditim crirtad. Such Iditrmcc cdd bc produocd by thc pncao of cithE I rhEt of YcEulblood irto tbc ryct rt tic lrt tll t r. a i blghcc tcr*n d orygeo in thcblood lcwiug tb. pDhotrlry otpillr,ricr tlan b thc elvobr gee Mircdvcaour blood ootin8 iuto thc ryrtml rrtcdrl t .. .itboot hrYingtrfD!"Gt!.d tlc crpillrriC of ttotibt d d"oli tould rric the cygcatcoeion of t,hc ryrtemi: r*tcirl blood ebovc thrt of tlc rlvabr grr TbG

cG@l of tlc DorBrl qorDlity of vcno dEirhrc lPo th. rft.dCoxygcu tafu 9o[ld bG ihr'Snif,rrptr bour of tbc rcbrivc ltaFa oftAc tboaorygca dilEatir! (EvG ora tha nogc cocoraod hcla I{borcr"c, tbc ptolrati.)n of tbc c.dio output prftriug vtntilrtrd rlvaofrr! rcduccd duiry nilroglo tlottrilg, lbi cfict codd h.mEo dSDiEGsEt

Il odc fc ibi! DocbroiE to .ount fd tt tot l obcr?cd o3y8oD'

talb gtdiallt tDa ?ooolstarid rLrDt ?odd hrva io lDo[lt to rih.!t b.lf of thc td.l c.lde. outPut ltr!. ls $ Fat no tnidoc laf.voE d rwb r dcgra of ![Etr'g ilnbg cwrc hyPdr' It ,oDldrppa.r probrble tlardol., lbs tIG t DlioD of oryga btbc Hood bvbgttc pnloor'ry crprlrrir b coDddtlruJr gra,! tblo titiiu tlc sholagr. dEirg oats-vu6bth witb DitroS@"- Smc uo DaaErEota rcrc nredr oI tL! l3ta of pau ctcblagcdufag thc Fiod d orFetrtibth ritb nhrogca it b inpodblo tocDniac quaatitrtivdy tb! fi.t :t dcctbg tlc tcchmgc of cygcnb.trc.D th. pllrb.o.r, crpillrry btood qrr tha rlvalrr g!.. It it d"du.,

!otc"cr, to ccmFrG thr 6.ct of orc-vrodbtlon ttth Dltrogrn

ritl tbc Fodu!.d by Eod.altr brPod! b tf. ltady lt ta IXUA?.fimibsL rury, fr.s-..a & Frralc (19{6} foltnd t}rt $.n 3l"ah

BRIEI P&O?AAED flYPON,IA 30?

orySsD. bDdoD of {6 -- Eg st rrrt tbc difrcsaac bteca thc tengbu ofcygu. in the dvcolrr gu e.nd tbc syrtcoio r,rtcrtl blood uountcd to9.1um Eg. lley odculrtd tbt nder trlco drcorsteno the orygcurcngion of tle mircd vooru blood wu 19 urn Eg lec then tbat of ttrealvoh,r gea r.nd thrt tbr orygeu ten:bu of the bl,ood lecviug tbe pul-uour,ry ce$lleria rrr about I mn fu lca ttau tbat of tfc alvolr,r gra.Alttrougb iu t&c uitrogrD ovcr-vcntilatin crpcrircnte tLe orygan tcaai:agradiat bctven ttrc alvalrr grr rad tb mircd veoour blood va^c

rcverc4 it rrr of tlhs raoc cdct u ttat whioh ecidcd in tbc €rp.dnatrprfdod by Ulicottd d d. (19{6). huthcmorc, thc ncr.n di0ccurobetyclo th, cygcn tcnairrr of tlc artuirl blood rnd ttre Cvola garoblrired h tb F!..ot ltudy, whiob romtrd to lI rrs E6 wrr olydightly grater thlu thtt forDd ia rlodcnt hypcb by Lilicatbrl cl cl.(f 9{6} lte arterh.l-rJvtdlr oxygoo-tooaio diEcrcoo obmvcd ia nitrogen over-vcntibtlm crpaAeotr wr.c pmbably dug tbadore, to amchenlo r,rrlogoue to tili *hich l'lr dGduocd by Lihaf;trl a aL [9fO)to bc rcponriblc fc tt; crirteacc of an olvcolar to cad-pulooary orpil-lery bloodorygra tanicn dif,ercocc il noderrtc hSpcir" ltc linitadratc at vhic.h oxygro vrr inda-ed ftou chcoicel mliretim h thc

blood into t$c rlvolu gar undcr tlc tircrortraa vhiohcrirted in the nitroga-brutting .rFiElat! gtyc !i!. to e brgc oryga-teoain diEcrtoc bctwn tLc blod brving thc puhmrry copillr,ric eudthc elveolrr Err.

Ec;btgcof eggatbu*ltlotl, otlld pigbtl tittrt it potbr;rd foptktltr rdtltim iD tb. rtlc rt thirh ory$n ir crricd to e prrt oror:d by

a rhct pcriod of r,rkiel &pcod! upon tLc clcgru caddurutioo of tbG dGlrtulrtioD of tb. !il.rirl Uood rod the e.rtrcid 0or toth. ;:,rt In thc rutirg drte tb. tot l bbod 0os to thc taain ir ovcrtsioe thrt to thr loEE linb., ltur i! thc ptatcapdincof! tbc adoitof tbc orypo aupply to tbc brain rrlr twioo thrt to tbc lowca [nbs. Thccf,et of curh a dG6cit h ttrc orygo ruppty to a rrgin upo thr cygamtat of thc blod 0oriag fioE ,t vill bc iknarind in Frt by ttrrcbtim bctwm ttrc mrgaitudc aoil artue of itr cygro std! lld itmctrbolic o:ygro onruptioD. lgLcrc tbc rvribblc oayg.o rtur irlrdl in !.bti[ to thc orygco upta,ke, tbc vcnou. ot]/ge lt'tErtim ?illbc rcduocd to a gutrt crtattha,n whcn thc rtorc h \r in rclatim to thcotygro ouno$io. Quatitr,timly thc @t iE!.rt rt c56ca etot itt,bat mtaincd by lbc blood, rod tbr grrtor propcdo of tbb rcitc intb aodl ud largc winr. Xulc pcc ia additin l rpecifc cygmltclrgr Ecabrnie in tbr fcn of orynyoglobia. Thc r,uonot of cygenstorcd in thir r'.rnrrr in nro ir bovcaGr, rtlrthcly orll (Dnr*;., 19601

!o8 J. ERNS?INO

ond thc orygco. t oli.rr tE EE&lc Eltt b. rduc.d b.lot l0 ED Egtcfotc r dgniflcrnt proportll of ttrc o:rygro hcld in tli form b libr:r,tcd(m, t936). tr'inrltn ell tiru contrh oxyga iE riBdG phyricl olufioo'rlthoogh qoautitrtircly tlir rtoo ir nbSvcly uIL llc bnfn' ia outrrdto th. bils liEb ud ttra body u r lhole, bl r high rrtrLl io0w, rLigh orygcn orumptbu ud e rorf olypa rtora For s rlxifcdlrra-tcat rttai"t lyporL-ir llt thc frctce ttnd to prodoe e grctrr fell dtbr ory8ro $trlrti@ iu tl. iugdc blood tha h tf,c blood Boring frotha lovcr limbr.

Thc pttan of thc fdl of tlc rteriioa of vcnour blood olurod by rtnuirnt ertanirU Uyporrni vill bo nodif,cd by cbrag6 of blood loriato thc rqim end of tle ctproity of ite vrmbr bctl In tba pat"rF.hot thccc rrcc trr.nd.ot chEg.. of calf Uood for during ead

dt E tlc p.riod of hypouroir. ltcrc vre d.o cYiLGE rhiol mg8!c!dihrt th ..Gebd bhA 0olr d!ag!4 rlthoogl no drct uanorratr ofthit guutity tcro ueda If ra ioorc of blood 0or omrcd duhg ttcpcriod of hypxrdoir' thc ilaficit of thc olygcu rupply mdd hrw bonincca.GA if, horavct, thc iasrcar of hlood 0or diil nd ocu: uatil thcrrtabl oxyga oturlin trr rilDg, it pold hlvc poduod r utnliil rowry of thc vlmor oxygto -tcrtioB. m gvo I rira to rbovo tha.oitrot rrtui Atforsh no alltGct D..lurGocrt of tbc ceprcity of t.hc

vcL of the c.U *rc rnrd!, il tll BoaGd ttrt thr volumc of thb tcgiru*er ilccracd by trbc pc*iril of ovcrvcutila,tim titL litrogtn. &htdD'E.r-iltol & illClunotld (f958) h.vt dotD thtt thc rcdcr rcductiou ofthe rlirtanihility of thc €p..it, Yt b pmduocit by oct-vtod$im i. inport duc to tbc hypoctpair lud h Irrt r rcrnlt of tho intrathorecicprccurc ohrnga todttod ritb tho otr'vratldiou Euch r rrductinof thc blood qttot of thc cdf lould hrvc tardod to incan ttc vaouribetorrtim Foduod by tbc rtcrid hSnrrudr

During thc P.dod of otu-vatibtlm .,ith uibogto' th. cJtrGo t orionof lh: ertrrhl bhod rrr ndoccd to &$ tlD Eg bclottbt of thz YEooDr

blood naortly 0oring non the rcgior etodicd" lhur the cygrn trmrionof the rrtcdd btood duing tldt Pciod t!. loccr tnrn tic naa crltillrr;toxyga tc8'im (Ba!(roCt 1938) tbiah crlt d trforc nitrqo hcrtnbgrrr orIrueiL ftrtlcrmc, drriog tlc prin of pofod hyporuoirlhc ory83!r t@rioB of thc blood fforbg hom thc mgior urdct i!"t!tigt.tion rer grala thao tlrt ofth. utcid Uood pcrfidug tht@' Althoughtfu oaySro mt ot of thc bbod lcrriug thG tirE caPilbria Tt ryFblynla Uy rauirtut tith thc blood .tEdyFr.GBt i! ttcv.oub rsd vCE!of thc lDrtr it it lPFrlnt tbrt dlEiEg tnc Frid of rYtst bypo:oir thcoxygld- tcrrim of tAa cpiUrry bl6d tt urtdly rtduocd- ltua thattifiruioa of oryga iDto tLc vtrirE li!$€. A@ tbr blood floPbg though

BRIEI PfuTOUND ETPOXIA !09

t$co sar cwrely rcduced by tbc pcriod of hyporir. hdoarl, ia roeercr+ ccp6i.ny thoc rith r rch,thcly high omillrry blood 0ot, thccepdlrry orygcn teoaim mey hrvc bccu rrduood bclor thrt oftbc rr-roundng tiruc, ro tlrt o,ry3m ecturtly diftrd into t'hc blood es it0orcd tfroryh thct!- ThE dir6t Ec.slrcm€nt of thc cygca tmim oftbc grcy mattcr of tfc qthd cortcr in eainrlr bmrthing rir hevc gtvcnvalucr of tAc order of l&-25 "'r' Eg (Cetcc Glr,retdli Urrior & Slvcr,lger), ,tilt in thc pc*at crpcrincntr thc rrtrrid cyga t Ebn t srcdrrcd to rbout u -'m f,g lLc dcc0 of r giveu rrduction of tbe ntc rtwhhh orygen ditrua iato r tirsuc upo thc cclluh,r crypo t olio rillilcpcnd upo tbe rrbUon botren the cctrulu o:ygrn ou:a1*im endth€ ctrtysedrr cypo ltaa frae is ouiilcrrblc crilcnc tirt thcellulrr oridrtlvc .otyr qi.tGD! rill contiuuc to fimctioo uoradlyuotil t,hc locel oryga trndm i! rcducd to bdry 5 -- E8 (Koi[D, 1980).Itur tte calluhr aetrbolh cygen uptrtc rill pobrblyrc.nrinumhrtglriuntil rvcnc hylcieir inducd- Ia tlo hrin, rhcrc thc only cttevrrrrle,rorygcn do: ir cyga ditrlvd i! ti.uc luid. rad t'Lc rctlbolc cygcoupteb L t'tgh, auddro rrtcil hypoalcnh*ill produoc r vary reptl fdl ofthc odtder orygro tcorion-

Ia thc pncnt rcrir of eapcioccrtr it vr.r fcnnd t,hat uamriouurcnrucd if ovcc-vcntfrtin vitrh nitrogcn rre mtinucd for lmgcr than l?!cc. A Eott r.*l frl of !r,t cirl crgco tlrrion crn bG prodrod b,luddla r€du.tior of thc ovitmcotd prt nc to bclov 140-'- EBrNlrt rir ir brcrtbcd. llru in ouc uia d crpeincoh in rhifr tlcertabl oxygro tardoa rrr rcduad to bdor 20 un Eg in r,bot f !.c.,uacoleinnc eDrucd E E dtc ttc inductbn of rrtldd(eo*iug a d. f960).ltcdclry bctvcca e cudda clulirn of thc ucbelcirrulrtba ord l,u d oou*iournan io mra rho lmont! to bctran ? rnd8 E (Borrro, (rbri & Audcrroo, l9{3). Gor t}c tiuc rhich .hpcabctrcco r otldcn rrdutin of tbc rrtcrid cyglo i.arbr to b.bt $ ".'nEg rad tle ort of rmo@&iou!u! i! vory tirrdllr to tb. intarrl vhtchmun betra rudca mbbn of thc ccrcbnl citlolrtln ud lor ofcdEioulodr. fety 0950) hr. crlsulrt d ttrt rt ray c t!@cot thctotrl orygro oEtGut of thc barh sod of tlc ccnbnl o.Flt ry blood irrbout ? rI llur d tbc rcoel lcrel of urbd o*ypn mrrrnptln tbccygcn tanelm of thc bmin foloving cctba of thc mgply of tli rub.!tao6 tould bc Eduocd to rao in rbott t scc. ThG rc.ult rugcrt thrtsbeo umrburoo olceroc folloring tLs rudilca idclim of :wrecrobnl hypodr tb olluLr cyStn t olion h Erny rcgbDr of tla bninrill bc viturlly rcro, ltL mdrunon b in clc rgrwcot ri6 tlc roltcof calculrtiru nrdc by Thnrr 0969) rrth rc pat to htpcb o, iloto:t Eir c,lcdrtior arg* tlat vha thc rn:all o,ryga borftn ir

3ro ,. SRNEIIINO

rcdrrod to tb. b!.1 wbich pcoduo uooneaiorner.' th. oargu tdtdoD od

ttc ncupor rbioh rrc frrthd A,@ ibait vrmlc npply *ill bc of tho

odcE of ,J -- E3, grErlrr. Bricf pdouail hypoda rrr inducod by voluatsy ovu'vtotila,tirn

whilrt brattrbg rdtrogoE UmrEioulDa ocutd wbcn tln porccdurc

waa porforood fc loogc t&ao l0 oo' Yohmtr,ry oY.Fv(BtirtioD tit'hnihogo fc l0 o rrduood tlo cod'tidrt orygotcnrio to bcbr l0 uo Egfor 8 rc.

,. Cootiruot! rxordiag! woro prdc d tlc gy*oaio ..khl Grgcor&mt&a roit pE drlry 16 E af dtt!88 ovtt'vootib€o Tb or}culEtod Flnlhrl trlDrirl oxygou torlou wrr l0 mm Eg; Thorc ru tbcefqr e rcyGn l of tho rcroal dvolsrrtctirl or;rgcn taorion ditroroaoa

3. It orrpr rtr.nlion ard pE of vcuou bbod ioriry thtough tbrjugulrr bulb, t.ho f.mc.t votn rd thc P"t*J +nJ YA r^!.oEdGd

eir.buoualy, Tho c;rgoo t D{'ioa of tbo iugulrt bbod qUtit d tbo rtrrpirt rad Edt prdouDd rdutio vha nitrogoa E ! btt t'tod- th.bDonJ-vcb orrga toin crHfntail oly I vcJr lrruioi cod rEght ill'rLilrt tho cygco tonalco of thc blooil fovbg tbowh the pulmmrJrlrt rI crbibltrd 3 Eodorrt fill

1t .dtd r6i lo ttat tt Dirltc (l!a.l ldial 8GUi!-, B.rrl An F .a, fatt- o !o Ed t$ FF fc Ftu..rrd-

ll la!!lc!8B^rcD|E J. (rg$). r'!$r.ar'.4 PlU,i&'&d li.tdio ,rd.d. F t" Idaa:

c.lHds.Irtit Jt, Ptr.c^!E It E-. Orr G!r. s' IrrD..,l. & &rE L L (fgail 6.{r of oryaa lEb-;-EG -;d-

-.tL ili- iaori- :v 'lraiirrc ia wrira

't!' rra

Ir. 8c S lst, U&r5?.coirrrxs. J- Dogcer. c. C. f E^!D.ia J. t' (le ta} Ih. .b.."66 .rd di.6i.

to of csbia ilddr b7 t@- t Lo& J. Plr.io& ag tra-Da.

"H3,}igifi bffiD-E:;tEH"sffi 'H.ilis.?IE.HE**Drr.E. D. L (r$O! TL d&ltndo d lb cb!6.,0.d.i$ LG{lobr E qberad-cvi:tlrooi h tirfrE-o(dit6r.Fc-..!d 6. t.LtidiP dtb ralc.ot atoa ril cLrooorot& to bdy o... J. lid. CAr* lll ttr-tt&

rccas. J.w- Er.Eror, w.E t LlcrErD' J.r' Ollt}- li'at'-Yottr'-JiEia irj i-r,- '.- of -.! aaioa htp-i,-rtr d6. J..'ir'

'i'", e6c c'L

m * g:gl,g#. fJH"$.H'# fff,}Std?E ,$rOdot& B.Gr'd.

*';i.S%"rHi5*a'el*#L*ffi "-"rifl %af fn

Ib,.tt.hrrrd; J. ! tLErrDt. C.J.B- O0GOI E i.f .Ei. dlo'ila EPA dcq,t-..

fr@ 61, to llo @Et, J. Pft-.f la1?t .

Erlrldo. J r ta.Arroi, G J. B. (r0ar! Tb ql!6 -tErrb !E t PE o(th..Ercil-*r,"'r#.f#r".e#"HHfi*.ffi ##HHO{orG EaaLt iL

BRIBT PfuIOI]ND ETPO'II 3llFovrrt, E. t. t EuorJoltr P. (1e57). t{r-.t-r.@n ,' ^85.d

io clioid Frcllrrd rsrcL ,tl, 'nd, J. L ltoElrll.

EEr. B. Oela). Ort!- drod.ti(! cuwr d Drrl b.@cgloti!, t c. ,lor. A.a &l3a. art-43t.

Eta.o., D. (lO0I Cltoct'lE .ad brtr...Ut Lr.ddr. Pr6.. rrr. Soc. B, 101 al8-aaaf!tt, & 8. (!l5ol. CtErLi!6 rd rt.$ofb d aL. lura|! ba.b i! t-&b eod dlrr.An.J.Ud.\i'-rn,8t*t, & S. t &@r, C-r. (reatl tL. {.!t .a .ltcd .tbti.I }--.6- of, o.rto

did. rld ctt- o! citbll U..d 60r rld c-.lrrl r,|E loEolao d ld!.lyoES E-. J. d.. lfl. At *rea,

Ia.EE &, J. I^, BBtr, B. L. bo@r D. D. & E rtr, B, tr (lota), f! EpciEtl E lyib B! of th.cl|- p qr DIdidt Aoo r!relrr & ro rr:tl bLoddEbt trt .od.u!i. & - Lr'.l .!d .!.lGiod., il*. J.

"l'ri4L l,,lta-'Ia.

Lort 9. G G.uerr' E O, e AEri,E.l. (r 0at} Alr-Lrrr- i! !.eidd-oeErioorto hltL .lCtudr t. .pC. Pb.i,L \ n-{8

B^r, E 0eGl). Ie noE h.-6 boui!& h CYrl@ra & D.J. C.adLtoD, B B.,b ,rg&r qt l',,6 rrarirraG. (HEd: E .krtn.BdE n, E^r !. E. t lrDr.-r, J. ?- (leau &ur..rd of tt 6k l ailcnin!

i! Ds. ,r{. .rrC Pt.Iti.l. C&oto, tl alo-5l|.RovoEor, l. J. W. (l!a6l fL. rv68. tiE e-t by tb. blood i! tL. lua! IES

G.pllbr, ..d i. rrr.&a .o tL. r.b of @ !9r.L. .Ed .lbir.So i! Ea. ,,i.r. J.' Pba.a raq atr-at8EosoEor, tr J.W. & F..ra, R.E (!e67I B.L6F bpat !o of (liii! rod

chci.d !-.ii6 lrL b drroiri4 rrto ot rrclrojr of str.i.E r5. Lre.6 hor" rilb,t-al t{-E ta tto. dinriEf -f.ily ol [email protected], mDcror rorl vrlrur d tbdir tt h{ aFil.rb. J..r?f ?fi.&a f L

'tO-lO1SE rDrorts L X.rrEr., ir. 8. & Ooo.r, w. E (lelotr A &vir for rb c@-tbooo mr!@i .Dd t. odila of btl.i-uLr pEL Ia..t ,?l. fut,

IBtr G. al$tl looEcrdor d rtr oLrrid..v.Dd Btlohyof cyE ditiao.t6.${bry bt L! lr4!ryti!! r tl_rrE .Dt l.t. Ftat'rt,utanq 4 q&ritr ir grF .tir Orf6d: E .Lr.[

WEUE , B. J. (106ll TL. mBt olylhE GbD!- b hlE .IEt ,. ,ftr&at2t, l-?.

f. dre. Pa[- a SupDt (Roy. ColL P.tL] rL lTGlO

Pathology of hypoxic brain damage in man

D. I. GRAHAT'

F,a * lraqrt , It prrra of NqoFhlorr, ht tt,4 cl NtCodd Sdaoc:, Sd,,.n MHqlrd,dqq

Tfr ssly rcqutratarB d lb hrh dct drmoar:r uh:r liilr dalurc $Ffrc d o(Yltlud rlre Tle rrc Fsvldcd b, thc fulcd@ drrpllltioo .!d cLc'rhtlorr Ncutuu rrc perdculdytur(tdlt lG to hyDorh t&rcc ttcy hrrc rll obttrtlvc'rcrouc, rtycotyrt mdrbolLr. Thc rdult brtbrcttjvt3 rboua U Fr ccol of th cudirc odFtl' orr3 rrFtaa.d ln Grlr|. oa baood iot rbr 45 d/l(x) ti ttia h rt .d& ar!{ .borr t'ict a. rlrtlchln cfil&gr (facllrd\ l$6! Thc rc$idavou& of lbc hrh b rhd rey r.d tlrc. ir rn.int rorcr of Gt, bt qrtrordr" If fu

urpdy ot oryfra or droG B lt luccd b.5r rctid.et fra curaourr b loot rIE r la rccodrud irs!.rt5L ba.h drttE ltr, ca if tlia'htaodr'N lgc ftacr:dEde0Tlt etd, d ryt.rt ro rh. hrh d+rrdr o ticcatrt Uood tor (CBF) !d lhc oryrla coD6ld rh. hlood. Ccttbtd t&od iot h iurn dsp.ndssr ltr ccctrrl F{l!b Fc.irc (CPP) whicl idcoatd l' Utc (tr ttrr tata ah€ J!c.o t rtqni.rrrrld ,a-&rrt (sAP) .ti llc crt t vctDua

blood rs$r.a Blood fuY lo lhr h,r.h shoxE rrE lrrhb& crDaciy for rcmritrt cqrgrrr' oolyhlD.rcrFi., hrporh rnd crrqnc hypots!*rlrtlrrhj h ro rny rnrrtd cxtcrl. fhc prEcvlhrof CEF h !!eo.L to dt trtr. h .st i.l UoodrEsr b b.oltsh rbout tt riar!&dn Ylktao b &hcd rt th. hultrEoc. of r r&ahd,cqr rnt ttood 0o? h lb fE of ctrr[ri h P.'ft]!b Ftrrt' (HrtF, tr2} Ttc r! dl.drll olrB.tioacarrri[ b alt uda.nat! bul it .9r{r. lo b.lorr or rr lcur rtrtU tlFhc.t in I Pi.rG not! ofrolls coadltlG Err.ndts h*t dltr{e (EnE dd,lgTriHltrltI,r ., d,lr'} Tbtt rt rc rt rrn,3huriior b ,ilci cattarJ raat|lth l!l, tEirFild b{q! .. .ra.d. oa lyrtod. tL l6d 6a

CP? rl rhlch t h .lrm.arc b Fodr.td it ocrkDr[t h oa.a bu h lha F€.a.t of dfirl rurorCuhtbn ih. cttic.l H o{ SAP i! rbod $ mntt OLtDGt, rtn) b fltlrlct thh I oorm.l hotit *.6rld rt- rLr ta.b da!!{r do.a rrol occrt

untl th CPP fr& to l6t lh! 2, rlm Ht (D.ttlcvd ol, lr69L

Thc Ga/ xrc d rtc b.rio rn y.lto h. .Grttltrdlcrd h ttr: pcrrocr of nald aurrli.. d oryrErod dca.a by lrtllE rBr Polocr tic oidrrlve nrrynrc o( nrrr: c& Tlrtr cm..d.trtiEf6ts ttc barit d rhc vrrint crtc$iir] of blriohyPrh (E Lrlcr, lr?6: Adx6. 1976).

d.t!a.oIHfD.rfI rtacxlNt(r) ttcbclr& i3 dlr to locrl or tdEdhcd arEn ofbd rurrlri &) oaitrqnlc L dsc lo lo.d o.jann.Izcd rddr'a ln blood .uDDlr.

2 ANortc axD Httorlc(a) Amdg rn rbcarca of oryao ln rhc lu[t shttrL.d. lo 0.lr rtorlr; (b) hyPoric . rG&E d ayar.rr. doo i! lhc hl!t! etld! Lrdt lo l.rt hyDori.-

! AN^trarcAmctdc i3 rt.'r dHt tr hfldai.ar ir@rottnin drc blood to cariy 0r or<1ta lo c.ffil cso-tiartlon.

I BrsiotoxtcHitoroftir ducto rd.6ntof rEr.rul nttillCyan trrEa

5 xYtocr.YcAELlcHnolbornic i duc to r &lcttc, of lh$i.rrrlcltre.6 tEtrr!t cot{vulaloxa IND ararut

ItlLlr?lcut

H,'dcH&rHypodc b(.h &[l, |nry oc.lr h rr!, .llutlidr?llr rb.'c b .t! inrdcqurE 3uDCy of drtgl ortbc b Err (.ll! It it tHot r Potafidhat r{ to rtry rrt t$iElGd io &ocd ulC+dEri.r r lcicrl cpto& ol hyDoactlL.' crtdi.cltarll, rlatna cribFia'ua, catbd mdrorlda a

t70

Pa *o of lvpdcfua doet h,ntbarblErt. lntqlsrdoo gd hypoftyceern. coor-Thc cvstdsal &trca of clhical rccllry vill tadacrn ocd by vlghrr 6 ]pt !ditf.co., r.ercfu-tloo can ta r.$a,rd bcf6! gcrnrrant bnh dragrcr'uE Gh.r d l|ll Hd arr rd u@roooo itdt i.d fade h,l thc carrd qucllbo r io \rhrt&rdbo otrBL or idl.ara dctrct lhc p crthcdba*can rccorry ol tfic tirqr rnd .rtrn ivt pcfinr-,s{ hiqrl hrt d bGt criGtlu &lhcd h r!!.nekr 971). Bc.s! f(] E krb.l. thc hct offcc& phydodcrl datr tbo{rt r p.li'ntrr c.rdlo-r|ltcirhr rnd rclDhtto.y ttatrn at th. ilnE of r cridrdlE th3 lnrncdac pdalt, b rlsuschtrlon, rrd thciird.{urtc narrofthobfhd crrmimdon ol thchdrE troln ftd crsc!.

Fodmo.tsl cumi dolt o, pethott wilh r.,,trchygorlc barh danrta lt uaurl, crrri(i olt rrndcrwrrnnl b, thc forrfiic Aatholrdd yho dEn fcltoblld ro tlcc lh3 unlL.d bnin in rh. monulrr.Ui.L ttBC cooddor! it i lipotalta b rBorrcrlclrr hfDoric brrh i.mp lp io rrld lnchxfnAfrlot ccrcbrd ifarclh cvrr wtEn $blrqtrchlrlobshal qrmir|ltion tlprt lai,rrc ard .raqrdrtrE ord rEoir Whcn ihc boin hat baan foparl!/dissrclcd drr ldc{l.rtc firrdoo (W ro ttrc wlr'irrtEr,i.Il ln hfcttd l0 !C' cltr ta a r.L!)m &rrrd d lbqrt I t to 2,1 lurr' dntioo nry il'rba r.cotnizablc brlt c{tn tn crFlarc., tlq.rrDD.lhobfkt mry f.i to idrndy c atir,. ffuttJ,Dora brrh nll|tr U h it Llr 0r! rqE rlrc lofor &F Atrrihn (nt' I d 2l Th. crLot .!d!.vcrit, of hyDdtc b(rh d'l.3r cra bc idcr ilicdsrd b drlrullio.r .nrly8d oo1, bt $" ruicrqsoficrl crunudoo ol , n, br.C, tilrrcrrl radrqlarrlt.drr tccdq8 d thr bfri,l.! tl L, lurtrtr,dlcri Do.libL ro crrrt{A ahlt r Fd.ir h.r rf.rtdhyDoric krh A|!rt. o.r t ra batl of I rmrcrc*iacd hbtob3irl c[oio.rioo p.aircd ahr] rhcD.rtolotllr Lrcr,r thra cqtdr parn ot rh bnh rr.ldccritdy vuhrnttl md b trmllrr wlt[ tlr cyrehiad lod tl{olotkd lD9.arancB of ird[crrtarrvc c-ctr chlnja

Tlrc Hanlfi..lho of ltclucrdc cc! ch.ru! igrrl.& dfrcult in th. iuni.r brlh bccrurc of thctEqrs c{rcrrt of hinobthrl lrdrc. Thcco{llrtF.rcat rt{rcg |rr 'drrl cclb', 'hr&odc srB'eod'pctharmd rnd frhrscrlrr !Drcr!' (Crlnrnrr.nEyls, 196l). TlEy r'3 duc Fnl, to podnEatctohrndlil8 rld io thc rbrr D.n rn&o of fuaivtSrudlcs In crDcrlmul pdttlrrrr rld b tdttldhutirn rD.&.irlh.r..!torn dfl lhrclrm i&odfiobhprrlsl lrnd,, itct c,tt ccl charle wlidr it rlrra[opdhofolirl col'llEt drroo{adq in r[ tyFotr hrDori..

TIE !.rb linobficrl ,rr|r d ,E nt hrpqicnruro.d AlIt h rnladlratlrt r.tigr.b h F.

Hal M 'ccrllor

4 H, td. Ft.,t .bt # aC b.t 4a .',ta tr. . Tba ,. a,ra,e*ffilrha

Ar2 Sor. Ftt.fl o, h ttt. t . cla,$/,cdflot i,w) rlr','i, ol tb ,&t, tlrt ud d,,l c-,tldtarat ,ttt t ldr. ,pl,4 a{ tb dd dl{rlh1*t Ql*b ad//,,{), Crorl i*t, x a.

fuion fud rn t6id h nticrotrcrrohthn (E oioud Bricrlcy, 1966; E bb, d d, tt?h md b;Mc5runr ud Bri.rty. 193). Thb r.rh rrLLldrobsrcrl &mtc t docrff to irorr0 b hu]lltDmatarhl !o thrt parlrF thc.a ctt hao.trot c.duccvtlEE in rtx d tyD lc hri! d.srSc b Ortlcq|d atSq rc, hCrl.ct cd ch|lr|a Th. c![hody ard ntchr. rrr drrrta !!d b.cotn! trl.s8llhr h !trf. Thc crr@lr!, rHt l.rr r!, rdIco.rlaiE mlroirrsk1 nrhr itttndy ?ni 6it|ad fr@ Lishr blE 1o d|rt tttuvr elrh ria vrryr!.td Lurol tlt t&,clG'r,l vioht t dltthw (Adrnrtrd Malcr, !970): th. tluchtr nrht h.n$ly PithLSclldlilc dF . ft. rrccrG&starG ot ird|tctni.cd dlr|. virh h.rutrrriG ir ciriachrd by

D- I. Grhn

Firl !d,t* n d.'rL U d E \ lXL Tb: ,fu* cdl &.. Tb ,Brr' dtt u. t,idl eDdr.-Ernti* cii, t;r',cuac d.t (r,lllr> Tb .rofu tt ttart tdr*t,a 7b.lr.lto u,r.di*rtu c! tb aiidl. d E t tlto. tq iM, l*d c.4t cbttc ,r,, lE,8,c,dir tlcE tb ,td"c.,b ttdolrb 4 .E,tdE x 5N.Ftaa E6/arad4 (,l, bt . ,td. ,b P,ytri* dh vttl dlca btolct* clai@t d t F?'boE/,tctd.l ('t'.rl C,',rl ,lol.t. | t,0.

flrti.i drhlr|E of 0E tE\,. c.I c,l@btm rd lhcderctoplrrnt oa md. rctrilrtD d!r$. grt|tlcr Mnson a cbc. to thc rrdrc3 o, rh. rstc cc! (6f 3).FiodD thc tGnon ud3rtG hanqrtthiot ccllchrrt3 wtrrl lhc cy]opb$tl bcconB Fo3rtllirttrtr rnd hoEEfarcotr lttd thc nlrhr. trElca-Thb tyF of chnt it ttE[r cos|ttEr y ra h ttcPu.fh.i. * (it a) of rt c.rcb.lurn Tlr rir*courr of &chaladc cd cnanac b rlltitdt cdrlltd Bsrqtl rccadht lo thcir lire lld ilc ! lh.lrhc iotEv.l b.llqr r hrprt.dtodc .d &rlh itb.twrao trro aod I t to 24 hoorr crn bG l.!.cd silh.!.rodbL !.srl!r. tf thc prtiIrrrviu lc rucrhll! 2ia ro !5 hr! rnar rdvrd Ct.ttE @8 brElrd+ ud crr' crydvr dlatl.Ea tf..r i!r3lo(,laa, mbofl. rd coddhttal cctri Afitr Ifct dayt lhc dcrd rEtt caB dlta99..t rtd tcaciYc

ch]rat3 bcGqE tDa. irrcr itldtdllt fic fam}ti.rl ot lbid DEtocrr6. Glgr lhoid! rhc Lttc. lBynoa t9f.r if &,rl.le b nrrhd to rEroo.lncarqti3. lUH rniYal b tc Et lho ! r,c.l ato th! dl!l.t!d titxr b.cottE rtrt bd dlE io loaa

of mFLo rd lhcrc it r rt ditr diotit Colh&nlld rlaio b ibct s! rho ldd osq rhc rhobr9F.aitr3 B a di}atraaodattlal rraarira.

f hcrlflrha5tlqr&alry of o(rvtcdbro hrlorhh.sb..r lE*!fal! !y yrt!. Acadiqa torrcd(l$3\ 'h fE'd tha Et cct tlc thc m6l!.rr&h," folo*rd b, off|Edci&odt .Dd ursocyEwhn rhc tt*roda rtd lllc ccfuhr cLflElt3 of tlEt ar.S arG ilE haot wtE rttL'. RGc. ?dtr{f.33 ah.l lq! rrtdolic rrlllcr thm Yltclrllrf&iar hrd, dcrcmtr thc fn.rn of tclcc vcwh:nbihy (&icby, 1976I

ft3 F8a

Palolqy d hpoic Ma dmgc la toa

Fa5 Caad sci.' .f bitt joat 2ctlca tb,,'aiJal tbc bt, olb dht {E]ok -Tb. ira bgctat ,frllat l.loct b tdrlEb cI bt, ,&.b etotdtq drM tGlcs. ro, ol tb ldta lt'.t!.nldotd Ft b'La,,ftbgk'. Nd. ,b sr-rrt oI ,bIdaol**Aatb&tltdd,b iattrtr,D., ,o ,b rlrl. tb qtdld bzta tc tbirb (Uat ar,f) d bp raha ('.[tc sr*t)dnt tb tua oludad Errdtd b ia.

F,8c Radta hltdl- l, ard *rar. Tl,c ItiE ttb ,olla (ir,tadqt o{ d,ia, olrb.ttr.d-r,.t. ,t erd E , l5-tt.

173

I traox^Nt HYtoxtc llarN DAraoBThl it dvidcd inLo teo t i! trpc+ via idllanhlnd oltrcnic

l*lutJcf dE blood ,o!, Onodr ra utrr, ir rsrcs&{ cjb, thraihrr. o( trl qnbolul rt hflsg wit &rEhpwithh pln or thc f,lloL o, thc dbtribudor of thcocdndcd vr.sd Ttc Garl6t

'l.caolcopt chntc b

s*cfiot of rf. hf.rc{ lnd h: cdg:r my be jurtdtccfltlbh h thc i,r!d br|h within 12 lo lE hou$.Thc hrion r y bc tatnoriluliC or 'rnrsdc'(& 5) rrd rll crru mt. thcrc k irtGtuLr,Uordry flos ol rhc af.Er.d catrr (Ga 6l A rllrrp

F.S1 Rlrcld ,{odiqn tu ,Src Nr.?. Ibt i, .,blr 6d dn ,.t'E.r rkdtcrnlud.l arrdtwrid rttt. t dtcr. H alrd E \ 0.

lnd oflcn vrry irrquhr tE of dcrrtt'cr&,l bctrr..nnormd rd rbnamd mycla .to rprs cerly, thc.blto.nrd myetr .t irint ftdy (fg ,), A brfcinfutr mry txal luEcatuly ro cdatiruE r T.csLoccl+yil| rnsr eithia 2a io aE hqt'r (Ad]rE, !966)r!3uhitls in t.r orid hlrnirtidt with !.cordrlydbronbn of ttE mld+arin lnd Infrgion in rhencdd o.ditd (ceteritE) concr. Ttc rEotictit3rc k ulilLtaly ltmorrcd rrd llpbccd bt rr lE d[uol.o rsd cFric slonEodgnral $u-

A &n tfrcd lrrrn of blood ioe to th. b.lan irrnoil qrrrlpot aha.!.d of c.rd.c tirt L Thir i.uorlly e ccplctlioD of rolrrc g[lirl groccdurrunda aarcnl |nacdHr- Mlldctr (1950 csrtrrrcdfilt .bqrr l(I) d..[r. in thc tJaitcd Kiradom *crccotcd by crrdlc lrrca ]thlld to ir!&ry hr by190 thc runrbcr of soch .L.thr had dsogrcd 1o I @

D.I.G'ttut

Flj0r tlorad fil ,&atrcll', br ,o dtD. ai,lfrpc ,L

fl,h ttald drb ,E,rbtlt bt. To dap..irtlt r 9t Tt dtdr adb*a!. tb So.fir?., t ctu.Oatl dd.t. x 9.

Fl,ft NrL r|,t,D "

b^ N.ctdt b. ,b Sa.iKrqitaGeddr.

FXgb fr,f; ,!ffir" b. ,bt , r.a.t tddl*ft-qd r(,i7ql, ct S*" *ctt l,.,taar 't'.r)ot l. ardollfr. Catl lolct. x 9.

F unum h Elthd nd Wr}! (Wrh frr), tlE tlr blriq rFlr fru! r tltLuc d$!. of !wdn[.difarncc ln monrlily bci,lt rtrihicd 1o bdtct rnry apDcrr tEtttd stlatnaly rt on EiIl c$ttlrErllo& of rcrlldrrrlotl.

lf crrdhc t'rlar h of rbn l q!r.t .nd occlttt i!r p.tictl at tDtlnd body icfir.trtutc. corBDlacclinicd tEvt y It ur{itd, if lh. pcrtod of rtrc{ i.mor. thrn fo.lo t yqr ttlinnct (Bri.rbr. 19,2! Arhqr Filod dc.trlbc .rts, cqnurEd tith Fi.td.of rdrcd clrrbrl frti$i! gsGnrtr bdoa! o. rfL.E rrtta rE, E ts llrpqdrDr .s tlt dur.tbo d

comrLtc srtd (Millct gd ltlFl tm) rn oryh.d ro rccantrrlbn of ti3 itd|rtnt drtr.t! in lh..rtcrLl bqri.r, torE (hky, f9?6I

lf d.ati Grt rilhi! 2a ro 36 houtr oa th. lrlt$

.ftcr .&qualr 6|rtbr \falir !6 b 4t hqr.r h i3tottrciE ,ordu. lo idsnly hmhrt or Fr.ltydshnridr h rh d.rah! of 3llct D.ido&rl, lnthc polttrlr hdr€olltcbcrbrndr.le{ir! rr(roCcin tlE Sod!.r lda of orc A!!moo't ian (t ltrod b). l,0crccryf rcvtrl dftr rurqd ,tcraireith r darrr.rilri Ddrlrn of,..Lrivc wtEnbitly.Lchrcmh &mqp i commooly t]t Ir. $lhi,| nrldrh.n tr thc c..$ of D/ri llld b t[rimd in thr thitd.trlh rnd rhtb lytrr ot thc Frlct.l rnd ocdptitllobcr (lls 2I lo lh. Ammon't hoin thc Sosuttctr!€r6lnd !fidolirm lIG ahc rrd n Erbh (rli 9a

Padop ol typoxic lrdn batc ta ntrad b) Tltr drrajr r,l sDdi!.. .id.i.d *'ihEd of rL b$llr.tl grrirr of rh at6.drload rr&lr' Ib Ftr m of &tmtp is &. hlrltr4fr h h..co.drd td Ett bb dftGqu.db b orE hlvcr oI .b Ed rd ldt d tEc.u&lcoiELu!,rld io lhc qnrr blf gaihcAsLe.o.ffur; lo ttc glohr pdlidur El.y occr i. rlltyE .ahtDorir bor lr crDciE, coonc h crrbmmmih htodcrtioa Prin ry byFrlc dllll|r inrhc thahd! i3 rld cGm6 io lh3 racfir, (hD-lrcd.l ud vlouohltrd ndcl In th ct ctdlun6or i. enaltdcdly ffr! r.rodr of Puttioicc& llrllfr io lhc trrh lrm lrru kadr lo ballorc rvac h hf. . rod yoont dlildrco lhrn inrdrdtr

Prdcna vlh trrsE dthE brrln d.tn{r doc locardiaa rrrcB rarcly nraiva fc rnort than a fawdrF (Ecll rnd HodDoe 1974) hll ocq.iqullyrbcy rlry rcmrh rlivc i! r pcttidcrn ElrrlivarlrG fc sD b tir nodbt or hrtC, (&lzty ., d.197U Icrfrtr rrd Plltn lr72} Whl bt.tbftllwiv.l, lt. nqrrd. tbrl. b tlDLrd by a ttbnsodqnlll rrr. \tha dir EIrt iEr l[y h. rorDtrribE ttdrth i! rb r.iGr of tb trlb rodcvilm of rrqh, of both th. qricel lrd rldccrlbclrr folia. lo cororl dkB vcalodu cd.str.nEna !ll, ba drddc'rtlc. WLrt.r lta cqL drh. frbd rd Gipitrl bb.. rll h. rlduc.d to rrhi! b.nd of ditcolq|ttd ritag db rili r [nc ofdc.t,lt tarc.! it rld tt ud.dyhf rirt olntr,rE of rE fraad ud rttrD'll bn a Ery SD..rc*ily ranl wblc tlc fdbpocrlnt ryri|r. ulrlry rttlrl tL ltmnd ny rlrcr rhcfratutrs of Aro6'a har tctrodr, Ert[ rtE[

11t

crrlcel rco& ir rY.o rad ervtvrl i for ooly rfc* tEClt thc th.hmi n y rFC.r fr6ly nenrlB.cdrdly r|Ylhcs of Erroarrd. dc|ffi.tld| wiUbc s io ah. car.garet o[hrlic rttod.datuEli (it IOI

dirarlc&russof rutorc&Ltbr r m&nc f.l h clrtbrl,arfrd6 FGrsrG da3 rlol Lrd to r ttdlrtiqr inclrchd blood 0ow. llo*rrrr. f,ian vuoanrtrurlr rrrrilrrl rutocjuhtloo cas rod thc ccr&dUood to* *i[ fd F rlcl !o tL rcfrd6 Ftt rcoirrcoic brlb durrc dr to t,rtadlic rrki.lhyDotcfirio0 coofolr to olr of tirE prtErr!(Ad.nB ., d, 1966), of rhii 0! fis3 l$o lyD.3 rtctic mod cqltstoo.

I Lch.qni. Arlrt. L c@r ratld rlona th.boad.ry G bctra tll. rr*rid urritci: of Occlsrhrl csrs .!d h tb cr,3bdtl'l (6f ll). f tfcLsils uc Lrtc rod of *Gd dryr' .lrrlio lhayc.! E ttqEtrd Err(co9.crl, Fqvllcd thrt ahb.i!bcut h rh.co6d tLn (l3 flr) m.yvrryh sizc ton foci of rcd i! llc corta !o hrterd.3..t.td Lds .da.ht frol rha crttrrhd ro rb ultb of tt bEd v.ei*. I! li36rcf &D{r b uld tt$nt ud tnotr tvrrc io

F,{,ll Irqt,,,i ro tbt orald &, at L

c.rrlrd.d sdta H*.Llb rltb ar*.lHrrb".l! rbr t tbc.Lrd* rl\ I - fi.td,2 - tdarpd od 3 - ad rlrd. E.Et Motd ,t irltol. EA - dclq aGabd urrr,MC/ - ddt a't{'d rarr, PtC,l - pstctloar*d st rt, SCI - srab a.Ulo rtary ,rdPEI - Naid hfuG&toQr.

Fi,o Cqd,..Lt of d,t htad.t *

BubrLG Fri.rDcbatrl nalG, lG, b thc mtoro&ry rcbctrea tb errltcb dlhsutair,oiddlc ald ,cEbr c.ntarl rtllrb: it &Gl!.ato[rra lb troot dc .loat lbc hlrrFrlcd lldth. xrFla ttBart srbt h tclE tDc dlsicrod dddt crbd rErld E rtd.r, rld lorrnb

DLGmlw

frl C''dxrtn{turaFta*d*t lh n An da t ataiu ika.Ibr@y lfidqk t{eat (rtqr) b tb *,s, .,,f,,t rb *rluttt r lcs,t,'ld Gdrqr.t,d bt ., tltn lbdPobq*d-tqd E !l.4 Cag..ret&a ctt,,'|!/,hft''.ll.FtIIb Sa.,|.rMrd rrar. r2.. fuof qdb lxS,&rr t b&tlffr*k\batt blqbcldldtrbq&"h bffirr,e,rutbe..b d Daara r.fr. a.fu -raLl,arrda& CqrrF' rtrtpt tl.

gram. Thc AES! bot! l8d hrb $cE rlcuqrt, d bvohrod Wt& irsdb i! lb co(ti.lbo[daty zoG D, Glt b tL..bc oa a:f,!-dcbi! &hdfr{|.rldct t!.&re 6.c6vr-Lod@

Oo tb D.n d cbl crvihcc (AdrE3 ,, C,rhc r--cd oob rlmr ah htt.b r4ai |'I!r, tr56; AAE+ !' a) rd crfrrb:ol tl!d.. ooIc bci*E! tbr dd& raa poacdr cr*mt ltr.8ll FiErB (B*, . d, !S, tlb t Fd t(lbEsno(|... ?bbfu. Etur|lrrrEdtdr!.l drrtE lDDtr:o ta crid brl uial lld rtmDaory bc ulrc t rDc Ftc<D o0 id..rdc.'-{. or&o& d DyDde fdo,rd Ut r rrDid r3E!*tio Uof laaiinO- tt rtDct@. d lrtitiE to r rE I Uoort Ftarta Ir L olrtso !r! dEr rf! tb (rh.3 o, tbc rtct tarilS lb.iEL d co!!6lr Ftid tl. coLFod...tladl of udbfmf. h rbc crnb:Dn tb toraAry zc tara lcdldG lo Gld.G oirDltt viI. du3 ao hctraartG ErlEi. ot ttc rltsb rd peb ifrrh hfl dsr. rld lr rv mr b tlo rurdcdzcdc.86.Lr drb b.ia ltld'e &tj &aL tlDjlc tuhf tlod or urqqlcd e!o..q{c*o. a l4Urt iir trt). fUc a tlrtLc nnbfdv t Gc rffir- DCIbo -(r t!.bv, rro)hrdiu ol-:b hd eoffr fctorfrt i lb Lat r..tDtu h br bo (hcsft.drdo?hf rl! stird drb cet|t e&r lclt GarDp.rFn oltE d E rbh.rfE fc ho!3 o.oal (Alrd ., d'

Fl r2r

PtMoO dbpdcbCa betc h anl9r2! itr Fd.sb nodcrfolsf ssfsy t!.mta*tlt.!&Ddrdr,.l|c (CrbE, lrt rdi!Flifr dri[ It6 Urot ba.d iri[y (Grrhrn .r"r.l9r5! &cru: of tt ,.tdClrE dEar io .riEidfrrer,! tbt i r tdrnr (dhrc of lddrStl&rld. F,r!E rd8rb b Ctr b tb

'rdc Dod

rwrrcd fro tb. F aat |rlci, dta, i., dELDdrry tocr.

2 Lcb:ri drnrf: b tEr$r.d b lb calcrof tb ctrckE ald dr-aho. t plrq q rtrcab tb tiggooC rld b dlta srrlb tb rh'hFiTt onatce of rcpancd G b torl (&tcslsy radOooF. l96t Adry!. ,, or, l!166) bot il rqid s!6rt tbir tyF of dlDrfr r9p..rt to ba s!od.t!dsith h}?d.rdo.r ot r nLdlcly 3btx @td hn dht duttthc.3 ldlld drt!.|r ir tcscnlhd i! lt. oat?r

ol tb ca?ian rld clrlbdlum hx rilh vrtrbLrccrotudG rloot tha Srthl b.[rodlry tooca. Thchtryqnd n rsu.fy rF d ud lhr ir FEhy&rutc h tb b.rd trlttlr" TB gDG of ,r" !.rrp..E b b. rGibd wirl ihc rbua od dhrpor.sri.- ehlb lt E$orita fd lh. rc..outiEq( &'r|t vithh tb tousdrry rc tdorrcd tf rsIltriDd Fiod of lcrr li,rra \Ddradoo rtiL

rE ttr (6u! &etfE

2 aNoxrc axD xYtorlc tlllra DAraGtTbc qE !!ply ttlt rlc Uood LrvhS lD.lr]t Ldtb.Lrn d c br r frr4l cdcd ry;ac6tcal 8yf.rd ol rtb Grrsb lO m llthr b obloctbo o, tt dr Fllratt dtr tb!irbrhair oI bcn 9s rod b rtLdo r.d.lEltraor omrsto. Evco tto$ lt i dlriddyb.H aba krb rtur; cea tt8l &m rinDCa rqbcio io rbG orttEo corcaa o( rrrtrldHood, lit c - r bct of ctlcel C?dotodcrl drtrrbqa Grs.r pqrF.riot torhor r carrbdoa barcocuUodot dtnctioo.ad tr& dtatr rs$.d!o th. trfrr*. hdod tL.rG i fsod c&.sltEtd ci&oca lo Rhr! ml3yr rd b bh.E(&kf"r, Itt2) lf,.r tb :rEiy of lhc hrFri.ir(l[itd to ptdE b& dt,utr rfo foat.trol.rdirl dcptrrfu rd r rtdlrti! i! crrdiacodpst ?ib, &irly coddrd tbrt brrofthyDdr c.a Fodcc b.h dlort3 fi!, Grqh ttaocdim of r {codry &fcdo ot tb 6}De.tdnls, tb! fttc,! ddrD{r b{.rrrt ' b thrlo1 olt r-t hypdc t rh druar tl &rrf.drbova

3 axlELrc rlatra D^raaorThL @t"l..t.nt,h crsbG DooddC FisFi!& ltr mmlodc.t cGrfcada.. oa crrlotrdc Ddsoht.r" Er!, ((bhd ud hrq196I) boa lbr I Ea . co&rtloc ol o:grdqlel

fraB Cetut tm?drtrb ,oldtu, fb. ItWtt,iq of ,b tEFil' ,* of tt ab, tdlle(rro.)" C.lut,, *tlc,4rrdt, ,Ce, t 1 6,

rad ffuolcrrarorttrl cu Lrt.lrdd rr rL.rp.d0c coarr o(d fxitea tbe rhibryogro rad drB Ert hc acrtd rllcrarrdr rtrtd. tyFdycrattil rb.

Wh .L.tb @r! rittb . h hn rtlltFaarh& tb alrar r$lfry tE *rryttd colootdncrrili of c td!,bqbur. rybco rr-rlvd i ta :f ro at Loot!. tf,c brb rbtl crldcocrof 6!.dii. rnd F-tirc rlc lrqrntly ta iurb rtits orEr rld ths cqnr cdlom. Althoufhttrrc b r Frdcuhr DrldiLsdo lc hfrtrdd ottbtlot t D.l[dlt3 lo cltbo moddG Ddrmht (6tD), tbr b rLoo.oroat H6bi! otb.rlrL.dJdyrubctrbb rcfior etd u thc Anoo'r hora udlbc car&rl rd catbc[rr cattr.

Cteq:r h tLc rhic Ertcr rtr t g!!ro todofEu coiCopss moft&dcd c8tal6o!of c.Ibo rtrGoxllr Dob6h|, Dae{, lo ?tLtBtt b& i,o @n, fnt[hrly i! fli.tlE ltod.itbg &hy!d dtB d iotqtrt'x! rftu r Fiodof rdrtk aororfty foabrilt rrr|b D-6i!..

R.caat qD.dffil Hrl b tL lD.r! Eotcy(Obbcst d d, l97O b. uld.rlh.d $G nnfqtradrrttcolc ctuela, fdEs i! tL. ,rodlarbo ofb(lb &erf!, ,O

"-.-o.6- o1.r-f b rb

vb Ertlt( DGdU, bciu dc to r obbrtb olr tqh dd ol c[bo GGidc ba& rhh.lro&ra rdu& Io blod ior rod F!.F uddhhd riloirtl ntt?o?oxtc ttat}. DALlc!Tb tltacldc rf6 otltr clisit! lb Ed todiuEd&]!&.rolb iqli&i! ofcttockG. qih..lo rEr& Ed. h &16 @ rrCdy rrBErtlta, fiilEr, I! r.h EE &. tEh rbrr

178

hyDlrrct! r uld multlph prt drid haqtrrh.fB ltlh.l$i Irrvlytrs crE ncaEods hls bcsr k cad'tdh rt lqrdtrlr nucla! sfit h lhr cattr ot tb!crrlbnn .rrd c.rtblua (Bdat . !116I ErFtEnd tin&a hrrc mi Croi! tir.t kdn drDa3rodpd by dls srudc (Etrt , Unr) G rir(}lr lc, ld S,|r. t 2) crtnor bc .lillbdcd tohiiolodc hlDosL doilc brr r.'ui! lrur thdarrcurhry de on rclDhrdm md ctruhtloo.

5 EYrooLYcatratc llalN DAxacE IHypost cscnt ln man sny lcrd to Dt'rlrostrrio datlrrrg lt may bc drr to er crcBc o, irullndv€n .ittrcn ,or th. rrtlttllr{ of dbbctcr [rffrura Fldoda rod h ruc hrtlE ol h&, ccl lulnaof thc prmcrs rd h rrrtpha of idioFtithyDodlc.tni i. in mtt (8rl"ly, 196I

D.I. Gnlqt

h c o, &orl turdrd thc b(rh nry|Dg6r Hr f Srcrr.r.} d6, cffi r<dqol?3hoor.art- TL!.r dltr, t tttoohy of thc crrs rnd tl'-Ftd,,,,tatcAU *M hco/,E fu4thilg6egl rrd ibrr:mi- of th3 \tt&irtb, 4"".'*t ol .,'Jdlo,"L N* idaptd t.t,dare;l;--r. t-"iir fc r nurtcr oi rc*i 1Jqr1r y[1! lllrytu bL rkr' t' dD}Ltce, dElr rh.l tlr. bren dt EsG' i *t, y;jtt- "d

b h tb Mat OaN i*lsimr'Lr b tyF and dirrlhrbs to lh.t Er io - '-'ilclEctnt hy9o* kri! dl,ttalc, lc EE cdl hctand r dio'rlEdanrld nacio|l in lhc nairlum, thc

"otr- -a the hlpgoc.mpq crcepi d;'il;;; dtt @iod' ht'tns ot'6 rn halr whhoul m hlrtt+drqr rd.rrvc rriiirr or ir'.' nrsi; *r.-' ;,,'. iS'.iXH,LHffi. .Utfficr.cbclll[.

&rdi6 of hypodrq.rdr itt crp.d.Gr|t .alsir! 1?,,T.t-t-t,1t-tti-Y [- dnr r rD'drl Grr'l hbvllho*l rhrr kchrana caourt. it r'Jffi dt{!*. E}*.

="*blt' ir thrl d

rproprrhololtel cs!.a.no,o. or -;ffi;;E :ry1 ry_691,11fd d'drj3 of t'rsultri,Po|li,rri"i tr.r.rar,-''ir i, rgrr; D;;fi; ryry* !'Fi 'laF b rld'rp'c'd rE.on

Hs,# xtrtrrm [{Lpffq:"E} H.#*rr.cri.r h rhc rsitrlrr. tr,...*ul # ,tr !F-.]1 -ry^.'ry- ft tt"* F dcuhrr' h

ffitr"ffi,#,mg[k ffi,ffiffi"ffi;l$frll ro rbour t m,rlout (20 msrm mD iffiil :i-n!::ffr intrt||l or ncuro-

crrcd typodFrcrnb lt to ptodrE urii"-fiii[ b$-t-1111:'1!I-hvDor' brdn drmrr:'rhotrh;hiiGr b*r orrrlood rar tffi ,*?ffi* tff*',riilffi,#Hffi lllffiXf'flI'trft *fghLffi;*mffimffiT"l'3$ffurFi3i$ffi gg1:rm#m}ffifEr ttry trrc cqrnilucd l,o lh. btlh &E G ;ffi;;il;;; I ".r,t .ton of q(tlriE. ^

qfc]:d llf.of.rEnoe. iobrlcrl ct nrE t . ;;; ;;;y-ri il,rn rriw arcar a rcccra-

ffi ffi":* " hvpcir' rvpodF&'''r'

ffiIdfffh*,Ii*I.ii"1,ffoff coanutorrcrer, hcco arrcrcd thrl lh*rr9..t ncc..-E Hyo-ic b.|h drrltc r[y ffi h divcr* clinlcrtbc rrtrhncd ro rurolyi (&krLr, 19?6). il;rdr-rh;lE 'ir ii iorAcquir. npgry or6 rrtttla coNvultloxt axD a?^tut qyF q dr@ to tEv. c i Mroy Ftlcar rrlErtLltrrcur agbacc ra ddc of-rEr irporh db elllin rSr tr3 .'iLgriot3 !r, t d.&d bo.dtrr rcqtwL Ia lorn thco lhc D.iltobala rill rpr bc rblc to

Irl,ll/lo oI ht7llc b*t dorle h ru l?9

idaoafy tay ErcsoGoglc rloasrlLt h 6. brrh" ,Ytit-r. ,' .c..d b, o. vlhrr ,r- l!Gr,. E r.t'U rh

-pder rrtitB fc lon rba r trr uu'a *=5,m.. *----t'c;, vrrrt dc.r€ or d.r.s.;;;; Yg*&.0&*.5ffirr:t5HrY*.,rt6o4 p.ttlcuhrlyf tb h.h lrr b.r Fop.d, oG&r, ,. L. o,L..'r. .nd !. ,Gie( pr. ?a!2r2.

ddcd rfE deurt. inrb.! !i.q, L9!{!!'Tlrt&od[cdoa orc.d, hyports brh rLurr i: &?![l'.L!ll']-lc.tlFr.btLtrro"6ofro6t'd

or&d6.rtti!o.br6 5.a" c.rl;ffii. fl,ffi';j"?#?q'illii:'btica lttdrd. Tlr c.rlai dcrrl, lhdfuUc Irrdlr, ,. B. (lr?al e.th.l irroil h 6nqr.r,rturtd A*f L rdredw rnod rroir u xorbl.rr' ,.d d,-.d..a b, !'J. Laiod lndrro- r, hcrtr;t

''.n t .tr cl."& ,t.h- h.ru.rr: #I;.tTffirlfffi ffi". _*"do frortbo If thc hylorh nttrlr i ffii !rG.! -i. i:h;;1i;;;ii.r,.r-o,c.-,-. r-..

6ctr lrrrt if]& ry Gr. ln a.l h3tlrlc! ,.Iot5rrha tEodc rtra b rCl.Gd b, r t[o,EEdctErl B!4r.-,.-l-r -Lot\ a r. !r!.!' l,..rd x.E!ri\ttac|rq! B. & 09e I 8r|it d.rrr b rL rL{. lntt, nr.lht

fl!. dbrrrburbn orryporlc drmrtr is 06r c.rir, t"H,j$*.3#:ffiL!:ffirsard h lrrt: rcrrsrbth. *sti'lt of thc krin. tJ' 6+mIl i3 nol 6urtl, faduc lor lhc jacnl FlltobsLt &iaLt, ,' B- &orn' +. wr .d x.llllnt l. 3. (l,,lr).io udcrrrb i corerctcniw-nalopioao,rEa

==f.H{ffi#ffi.i:rfllydr h cvcry crt or rrgdd nygork brrln f,ii i;;i-.fle-51:[Ifi rr.d a s. xd.1{&6aS. F..tuaatly, hor.v.(, il ir Do...L lo tt- :a]}i.L (chl.. h Dnao--.! L.d&q ro'cttrbbh $.r r dca hrr cxpaicned ra coirodc lt{L8*t lg dal x.'L.l t.&dr. .dof hyroxir rfidcnrly rsr 16 roOucc ri&irrcea-

"ffiffi^. y-... x.lron., r.3.rrrb).

hDodc dr!{r b, llt litdo*rl cnsillin of n.'i.!;-.!d i*';; a rrr rorirr ilrin*iiUbtErl tor[ tlctt frE th. Urdtd, vuh6lHc E$b3 fra ot d .nd Lrr.&!..ra b 6. bnhrr-r', !lo.lr, lt r.td.l borolrry ro+ lb. - 9l.farqa-tfir*.E Lr.l,3' atHtteoaot rotiri oc ruror na uc-orctcfri tff;';\;l1$;l;i$ltt ffiTttMy th.*r .o P'dr J. H. A.rl'l fa bdDfdcrlbkE, lo Mn ArE Otollr ,q trDlf rhcunuEba .rd to Mrt !.Lr,rd !6rrry f(r ptorotnDe&EX--Ad.r. ,, H. Otaa). E tac.lbbarDfr. 0r.r.l

ta\\',4.Attq J, H. oral LU br.t t.rrr h .r&ri.lt -d.r, E h ri.. la ,ar*a, I Cad Nb;a,Etar, r&d lf ,. Coarlfrlrrq F, ,7"{0,( &(Ll,ri... LrL

Ar.-, t l{. 0t a} tt mrlFttob|lf ol !.rita.llrDd. L Gldr.fr Lrd X.Jld-, X .q Cilcd b,F. E CrS, A E for-* -a l. G. D. Lr.r, r'' lr.!4tyridr lSor

Ad.rrt ,. H. Etrt . ,. B. C..!a, L c. f" .d Tt te t 0taa! TL-6 .a.t-.rL Lrro..iL,r rpo ti.l-.! b..L CLt .l.!d EoratCodrl.t dr.acin ll ....a8, D,:J$L,

Aa.!r, ,. l|- O'|lr', D. l. l.n( E.. ..d lFr. T. c.(lr12} P.l.rr!.tr .!d c.r{r.l t .rrlb .rld c oflcn kh.rt& c.6,

'lda ndd r-dr \

t&ra l,Aa.q r. H. rd Ll}r, L (lrr0!

'{.,i,.r. Oa.r E!

nlqu.. ,6 & t ..rd Flbfoa!.. A..od.aL. oacfac.lP.tfob@ lo.it a, No. 7r.

toJ d Xt*s Ntr1o1 d lrtcbr,B,2a.,4.

t!r!, f w- rrd >U.t, J. a (lXal BvL.... to. rrl,c&i.t d..l d.q. h tL d br.b. &t ..d.1,.4,'"*X1.

E rrc., D. a- Lrti.r, T. w., X&r. J. D. Sclua H..rhFbhi. fa lr n&.t, A. .d CdlD.rr. lL L 0rrlfaabr.l carrial blooa !ar. hncn*l Ft arrc .rdbr.h !-.bol- h cqraL. Daa|. r. rcrd /rv.r-rFnir ltl-la,l.

C.-Err!.. r. 0,6 l). fb hFrc. of rroadta 'iL.t'!a raaa ln @all dd E oDdlohr. b N,'>,.baqr&.. L 26210.

C!..lIq r. A N. .!d }{.l&rr\ l, 1 (rr+ t IFr. l.hW, Na.rdLrr. rra d., Cbd b, w, E-lood r r, L X. CEtdl.' rg. 7,t.r! Arlotl La&..

O.tlla rL r'd t-rc., ,. (ltar) l.rolo*J co-r....rb d..rb Eia. #j bart, t-d 4Idrrr,16{aL5,'

Obb.t& ra. D- Xrtrr r. E.r/ facDdrrt, E F.0rO EfiEd cdo i-E!.-fr.!arrv hrL Fh.E It Ch&.| l.Fr EoFbOr .r,tt*bJ..rrd.lir. ..rdr,rrrL.Jl,r lD-21a.(}.hr D. l. (lr5l ldr.* tr.L rl-f. d .r.tLrtF & t-. rrF rlllr a.r.a-r- d rEt t rF.*.tblYdr-J.ttD.

G?tL.r D,l.Adl,E r. E-.d Dc/rL. D. (I,+ ld..ral, - ilI.. it ..riit t d.rt tx ir Edd..Hliilr. l. Idfr- d ,,,*,,'. b,b ht:I ,{, { tL Sa.J ,*rfr Sr4.b o,C.ad Drd n- ol Y,'*,/,r, l**4 *d btf- fa. A.rF, w. A. ,a, ,. D. XLr. ..a ,, O.LE rp. lL2!,DJ0.Ctr6rllfjiE.c,ldSurL

ItrF. A. L (ltDL Caol of ri. c..rt r, ctnblo, l!WFd.-1NoaLar,dlCl, l. Ot l*r,t. L e,,E, -d B. ,c.Gr r, a$:/G rkbrrrqtod...

Ai.la. ,. ra- r&.r, L D.E d.lrdLbdtffir,

D.ll I. A. mdrr at.}t-,Ear:tt, ,. L

,. P.oralc-. Jl.r.rrtJrdE& frt!..&--s!aELj

.d!.it\&r0t6r}

d rrqdLLaa.l .* l. Y&. tu h

,80 D. L Aolan

NjE A" X-rc. w. L Ll.t r- D-|!dloiar. O. X.&-' L !. Xar..' L Y' d iLlr' L i Orn).-aAlr'orii la-n' il i*b r. rk DraE tdb.b ffiqd h.b. rtb.E- ttblb,ra-ti; { b S'.i/l ffi St!,d- d E !fd.fd..l a.!.. .d r.i|.llolry. f!c,,*d-l; fb.tl ,t.rry/r,r ,a'Lr.r.. Gtr.LiI M' ED* *dbvr. I Lt tL, -d l.g. r,kec.LrvkEd. E thhrri ,r. ,,r',]:a. ((ti. i. ftdgdl X.ddE E

,..oL if Oiat), OE dr.- .rd ofr, Eb5o i! !r!i !0.{6 !c!.i.d X.d..l hiL.lk . -driebf,,dr rffitrcrrt-i, B&dr. r.&', .fitf 6 f !. llda- ild Y. B. fa.t-,IE vladotrt l,A. rad iH.r, r. E. (lr7r.;.!n, l!.ta!. Lid. dad. SyI-i. fddr .!d .'ara. bd! deF ,lrr5.r r.,raiaci. oo, l!.tat. td. dad SyLi. fddr .!d .'ara. bd! deF ,lrr5.r r/

,G. B- ..4 Pt., F. 09?t! Ha r.i.rh. qrr -bl),'oAr.ia;- fit ..n; . ;r!a;c i! n'tl-.f . !E L.!rG' F. A- ua !.+ D- a-t r11) c..a.t' -.onic.ltiia,n*ml d.acrdo d{ lo Br .:id.Doi onhl ttd4 ,. t}

ki!. I- ,- .!a Lrrtr L E (lrr). lECebb.td tl5.ri-d,;iia i! ri. ;6-LE i rL... ,, CH..t X r, ,. l,- &d Xrrt. R. E. (rr2! N.',!?dLbs ofriiis. fr mf,rr.u,.dad !r r. B. LL*, Dr.* ..tcd.r.rr.rr.i i. rauh Et r! Iv..dot '5d !.3. X&!. tq lt${ra. (CE i! D.!d@l 21 L}90a'ta.6&r E n{6} hd.a ld.ldaond iia.dc.l t.n..dt, E- B. (Df). C.tdt! .rt d rld tcird6.rurcroir a ddiaia. t ooo. dt{,b brd c.la. o{ suta { f,tld.g,a'

Xdtrli\ rL (lr} /l..H,, d tb caC drd l?.It r^-rd a Ci-cf'ff Lo.a6. tlu.i, F. (frr. Tt. .&tut FobLo: t r 6r.t .!.dD

xdtn B. L .!a L|.'br. ,. B. (l9rll Prolonrpd It l.dr &dl. tL b..tt1 ,Jct'tu ,c, Nedofr,,..dddril!rEl..ii.ddcbat.rna ht !t'l.o.itr*n to Iort ltyitoOcrt .!qt'- *cutct l ifutoloct, wvla w. D. (grtt -!ln hfottt.Gr- dcql...-.*tO-tl. tuotrb bracdl.r.{&ra{ball!'Ct t'

ll.E E L l,.!d Hdra. L. tv. (U7r). ttldoloD' d llo'r-r -aLdqa h 9r'EG. AnU,', { Nl,'darr.4:.9.

r sca alr. rElcx rat as

krok Ltlarl ' B!.nh Cas Prorcaslooab > ErdocrtE lrd Ltabolo lrlror(lrr'AddSl.. F.gublkr id Obo.rlGrr

Respiratry Acidosb

F8sCrddf adosi ,s ptinay il*s in P@2vnal ot witlfi)l @fii,r,rsddy itE's€s in ll@3-; pH is usrely lonM tay b ,Du tfr,rd. Carso is a docrass€ in ts€,d,d.ory tde, lm/unB (hypts laltd]t), or odn dua fo CrVS,

Nliday, ot lsfioEalic dfifi,r& R.sp rtry cruosis cu b ,.nle otffi; llb ctuoric lurn ls asym4o,idb,btl tla a,Jte, c nrysoring, ,am causgs h€dscrle, co/rusidt, d dr6vsr'rEs. &gns r'lrr.da llenu, myalodc

Rspiratory Acidosis Acid-Base Reguhtio nd flsorders: lv{crcl Mraud Proftcsiooel PrSc 2 of2

Treatment. A&g.gt vsrd.fui. iD{CO3 sfBi *rsyr cdt-dc.Ed

Traffi b Foidor ol &quab va.llatfli by Cltier €n(btrdEd htbalixl q nor*'wlaav€ paltlv€ Fa38rovloEatm (td tpadf5

'ldcabr! trd Focecrca se. @. A(bqIalC

varrl.ti r E I that ar TDt(bd lo oatGct |ttglday aGirGB, attltos9l crfdrc hypafc{.r8 !€rlfay rrust bo

cdrrcld dorty (.!. @{ svrfd hg[s q nss), b€ca6o loo{{id Pcq blEi.lg cxl clurc r poathn .e.ic'ot/3rrEt. eleld wlron lhe undatlyhg co]ITeftelry hyporucaltdLiltt$ brc€ntol um.ltrc the &upa rt6r ct{s pH lhal rasra cJr bad to soi2rrB tx, &8th- Any K* a.td cl- deftsit! ro c(]racLd

i{.HCO! i! .lno.l dl,ryt coitr.irdclt.4 b.c{,! HCO3- ctr bq cqlY-t.d !o lto2 h Er,i bli Iq.e! l!Uood-br-ah brril. alowly, thut tl. O.she tefum pH uittEst .tractiB Ct{S ptt Ona ercctirl tr.y b. h c...t d!6vde b.qEhagot,r1 h uriLd't Hcot m.y knpicrra r.3Fadvtr.ts ot tqrdLl snoolh t sda lo ts.!qal.'

Kay Polnt3. Ro!fratry .ddo- h$t/ca r d.tc h r.*ala, rate ,a volrtE 0rnor'|d.lbo).. Csrmdl ca!6 hdro hrp*ad ra$rEy dira (sg dJe to Els, O{S (t.L3a}. t'E tfor osrrrlst (ag dle lo

!.ttrnr, COPO, Jaap ryr... tiray c*na).. RElrfzs crrqlc tl,pt dt tEr O, lrE Fsr ot rs* qorfqE lEr (*Y.rE H@!-) rd cfrcd slgE ot

tfrrc (h$ tqmotrca ed cdilb $'l.4d lq nr ogrECo{ t Fcab).. T€t SE cu. ad FotS &!als vrriatlb\ t4nE radEd hrlbadql o ,Eilt,!Iv! pquvt Fall.ra vlrllb q'l

r nrdad.

tEt,c.rrr!vr!r fer, 2ourgffi:&sjt;iB

ai fur.. tllantd. gef,r Yab! lttsctlqn a 2OG2or. lfr git9 a Oc'r CsA . _'+-, ol LtEr a co- atc. filaar. t&r n.l U! ' trl*, Tir oi lL

T

hrttr'/rr,!,E h-.,{.no6r.l. M6/MG...iaol/adapi*r "'l _'^l^t:_ l:_-r^-'-'JJ r'-

OrrcnrAr Amcu

Suicide By Asphyxiation Due to Helium Inhalation

Motrbn O. Hwl PhD,' Maaia 7. Hdl, PhD,! Jottty D. Edwds, )utg9,'Miclwl G. '/aaghn, PhDJRria E Ptrron, PhDS ard nurh E trfuc*ct. PhDJ

,tb..G'S.i& lr."ttridin !.iltlfr a t rnoa rit rrFdrdoa oa

.g{dEE- l' rid-b.di rdrd.! Hcvr.. Ir. abDn .to. F-r .sini rla d.i& q rb *d€ -drllt. h tlirt Oc, rt .!ddd.a lrit iritt ot luiit6 b, r.rltri&rb ilr,ohtt iclillrt lrrr r.rir*d .d dr.rlu da.t'lb.d t, dE NdihC.r.l!. Onb. ol rE Ciaf Lqlr.l err.L.. to b. |IlltlD-lltcirt.d.rrtrti.l rsr.nr o.3rdi.t t .w6 Jollrty L 2eOO r.d D6ot- 31.

2(pl 16r ioclld.d i n. o.r o.. r.ti. .r.n*rd ir rh! &ti.l.. lll. l0qlrrbl tllid.r i.volvira h.lioltt iLdiid ir Ndrh Cl..5. Ea.d EGl, la.d .rAdir,, h !! XLD.d., $r lE a. Er..ldrd,Fr"a (U .r. - al I : llo h 6 o, I.r... d&t r. drrd 6mti3 h.l F,tbak dratalbq ir t o, {|.r 6 c.E, Frrrt i dlrr-&r llt FrrilGiEUir,riltfu.h!. L a rbcE rrrr(Hd. rrElt tE tas!a..IiaE. Lbr F-c.q*'.t di&'al t lra r,t tc dEni', ildr ir drd ltt. n)&ic .dr'(a$r-r. aa. SsrlanX., ll-d!3 lfiFh htu, lriik riara-lolt

lb J Ftd ttd ?rH 2qq)OC ao-ltro)

l)uuicrtln rD 1991, of :bc ritlt-tG& rEEf!8o rDd $dci&I 'b'.ao' pltq Fird Exic TL. h...i.li.r of S.lf-Ddivr-rc rld Atri.td $iilc fa tbc Dyn&r nrd . n .!Esn ofc(nltltnrry rqtdiDt tba rgqtita... ofruri& at r alapot rot .Dtt l a'le.Lrr- layi.l rlh... d .r!d 4!tbr riiblt. dah.{oli. .or@r iE{. l. rb 1990. rro, rihi-loLdlEtaa rq! 63rtod i! public adrcatioa rl @ tia Fnpat dviarE ol .dvrD..d dirdn t1 [uof utE rad ]frlsd pbyrci.!-arda!.d 9ri;ilc-' At tb !1c:itE, d.r &e{. of Ui! Evc-nrrt. irlu&nt tt S.f{)divlrrEc Nl' TEh-hO/ (NuT.d)G.!lIr, iE! dcvdotnA r! beta to rr.!.r.cr p..pL to di. oarbi! o*i Erlr by conlo0irt tbc ritDirt aod rElnar d tct oerd..lt,q (. n Nutei rEDL.rr, iDclrint D...1 ]l|,l,ky, .rrba ofFnd Exn. &u8bl to icnti! nulliDL imidr mctiod! thit u/r.!lvitt, p.hL.r, ,.illl.qFod, icxfalv!, rDd odfflSrir& Tbgur, .b cruiLrlil t viol rh! t!. r.rbt l. rrnpi., L1/! Urilo, ro itdir.d6 rtri ti. &rO e.r rDltfrl ,n i.nrr!. rnd m.itquir! t phrrti!'t alrigaaaa or Fc*riprior'

Wili irt d.t iLd a..aiprilr of dv"ri [i.idr r*b .dlFinc !6arrGrl of tba pbrt h.S rrpbyratn rstodr F blicrtioa of Frd Ern ht.lfh ra .r.], rD&r..d rd t.nErfy

dcciv! ruii,. odtod E lt o.c. Tb bd r..3 . corD|Eal3r...q r!?.r]t dl rb N.r Yod frr€ h.ardhr lra rld .!h8tEt th 1., niub ccpi6 io ti. d.a& 60orirt i! Fui.tinh zff , FDI Erit r.r r.td ac of rb. 5 nqt idbdal bdtof t}. Ft quer.rsn,, b, bool crinc. .lrd .da6t o, USATod.y.'

Coic.rrl. 6J ni:i(r6 i, ioltcrnilully ill dcprtr!.d FncBrolll fullor afrrc lo rEtB ctrodatd ro Filrl &it tltlcEr rri.d,' rrd drltrti irEr.r.. h ,f!E b| rlI'lFEl r!r.di!. r!.r! oEGlrGd io Ncr Yqt Ciq/ .d tL U.it.d Str..' in 6c)r.r blbsbt Frtt ri! of Fin l Eril lr\a.ti.rd .elu&dtLr lndt pa.a.rl. c:Faad ro fltr l Ed sa.! 6r tcrriritrlly ill &dbd o..a il rt r ririh ..!rrl -. (.nd rLo a h liLrly rbr rFyclitrt dicd.. vould brr b..n dirsDd.d it d ot rb

E a! by NuT..n .Dd oahs lo &rrlop . Eo.. .ffcciltlri.it li.rtbd rnd uir.ty disridr it b th FUi. hlr adrtit-lrd to tb Pt!*!t h 2m, r rrppLtD..r io Finl Erit *ugublirHtLt F6tlrt lh. ,tn d8iplir ot HuE{artrd pErE ht.+hrdaio6, ' Adv€r. .rn?f.drd rb .obno.d lrh.Ity of rfi.gFr.t rldudioa i! titrr rquind fc &th !o cclr ro h. hI5 lDhut.t' Ed llininr&)o of0. tr..d f.r r t d.liv. Fr..r9titrrPnFartt ot tta ,lartod alo !d thr trtarLb !a.d.d ro@tlr. nrch ri(*L..tr rr.dily ..c...it L lrld tlr rrrfiyti.tbo& E [llirrD iahd.ti! l! dtlo udlactod b, .uEgay (vh.l!ffif! rr. lyfidly nGFi6.) q td-oloairl rldyi (ta!r+..d r.Edila rd ey dl6dr rlc rquhdl Tbur, s&hlriciL. rl! lildy ! nrlli un&ard L crcr riac tbc l.{iurAiuy rgfrrar .!d pldc b.t s! rlroottd bdd! rb &.ltre lr craiuoad aaal b & E odEtrn a rvaihua anglrhtd-il t, h.tEa-.rid.d r.ttFitirn Modifcetirr of lhr ldiuordid rtrr prtti!.d iD 2rc'ud 269,' r DvD iEhdint .r.pbt{rp ibE rrio d rh! nahod B rvrilbl. fa Fr-(uc,'.!ld lBtu..lol vib dd.ig & rd rr!.cc..ilblco th. h@r A r.t rdic of 1f,. bli.lD d.liv.r, rF.arur irgtcrcotd in Fijurt l.t

Gira thc rctart &vcloFrar! hEd ditrmi tiq\ rd rot bL l.lh.liy of h.liue,.rridld rsiid., wc co&.vo.cd io bnc,ud.!(r!d dun r.rir:icr of oiitcr by rH3 lr.lah.d Fid, wrt! i.Iad ltD<IE! of antr n.db rdEhirt !ii& by .tpbF.itb 6. to bln! itrtalxin S@l4 f,! rt qtE$ ftdirr. nnB6c frja rri.r d thr* tui.rL t raofa! aeicd. Rlrllt! ofdi b'r.nifdo tdy Lrd rc i For.d irllrihtb of bliur!-ls.itld rtrii*. by aattel tafrial colracrd rea-j ud,rlEtb ddrt or t! Fn cf ptysalr .rd e Fd@ltair3 iadvia|l.f .r ril fr $iit, .ad rt d !.r ltlr arrni*'l &Ut'irlr c6..{ua6 of rit .F!.d di.*rB ridro, &.i!d tuiiL rffi to Sr S@d podic

MATERIAL5 AND tt fTHODsTb. cur n r?oi F-tt 6ndiD, f.G 2 rrLi.d lruda.

Tt ftt ir r rwb, of nrtti.h.d h\n titrti.fi of &aidcr by|llFitior dlc i. L.Iu6 iohbtib. Th. .o.!od it r cer ab ofruidl. by r+tyrirlo dra rc laluE idblrrbo €6..ritt l. NdrhC$cliu b.sG 2m (tr F.r ill vli.i rh. rEhad rl' Lnkru) rd Dr.rob !1.2G.

r.rEir Nd-a ,.-r, tl 2olL ....r..d racr l. ,OlOt6 b Sd.d .a l.d Urt l.kr d Xrt C.rdr r Cr.d rftlDgrrr. or t|rd ,!'.lt.. SdE/ d tl.tEr. ui'ii, d

L-4rr l3did .( trE H..b. S.l ki Udrr&i For|tl.rdItqirr.S.bl drr<Ea. f.Lt!-roarai4-ittElrOrlbOl- dll. Cai.f !E lqia

SFid b, NIH tr6 DAt92r, 041555.. A^0!.05 (xOJi.) ridD^6rr. OarIl.!

OitFac}Iri O Hdd. k DriL D-taiL H.r.T-t E{r{ Eil3 ]2, ttrhq CE 3rt0, U HL l€,2199.!u. Ed d.E ded.*,al

C4rrtIO,alo t tira.dlE t r **trsl{. ortlrro,llt @@mt lo.lt tAtIDo}! [ ldrd

hn I Fqa* ^l.d

,tdpl . Volrrr XX, aarrt.r X. /.fU 2010 vt$w..mid.rEi<rmdd,lcrqn I ICQyright O Lippincott Willhms & Wilkins. Unadhoriz8d rep.odJctin of ttis article b protibited.

k',I Fqcr*aH Ertd . vdrrt ,\x" ttu rbrt x. Dq 4lg

rlGtIC l. Sdsndc d C.tlt b.9 4hyaibr !tal& t&.! Hr,n F h fiid .rL l+.nt- rart Frtrdrt tt.rnFid Eft lh

'Eidahsd ',,ldd/rrr't,. o,t Btitd 9n

ci!.lo tt qitg.t (,.t

ldcntlfk tlon o, Ptb[ficd laporttA b(6d sr6 of lb sEd rdbl h.r.ttE r.t [*'

& fa rry r*rra t! dlt .&!61 riil by rrifyritb.llr !o 610 bbbh. Tli f.r .alrlH Etti{ lbFrbfrcd &d.i fa tL Fbd ,aty l. 195? to Notr iLt l,2!r9 udrs tL sti pbtr lriib tod blus.' Scrcn Ftidtnccds vqe idradE .t &llorr 6 EatlhLlt!.t! c.!. tt4i6tr_t' rod e f,tirlhr3r4c c... rdr.r' A arGr of EMEAIIEudnt th. i&6t-d.!trrd! ,t d!. p.tird ,&n ry I, l9l8 blio€rb.r l, 2flr9 r&nritld tL rtn. 7 ltDo.ra Tlt 6 Enslirt'htr$at! tllqB rcbvant to tb rwr* vatia Pultirbad bawql|@ roa 2OOl rd pt rcd . tot.l of la ..t .'rr-'' Tlt D.!iirudy iEtu&d r rynoflic rb.atcl in Ertliti indic.tiDs th.t tbc&ced.[t rns . ]5-r.!r-old m.n lto ltd cqt|mincd alicidc wilbr ghatic ba8 ald hlhirn uritl I _ll,w ald hllbly Lrial Ecb'aiquc.'r' TLc crrc regoctt indd.d it al,! .rvi.w conttiur.lt...tiray cf Frbl![.d r.r.arrh oo Lli.tt}{tdtlld nlEi] atd .nF...ntrd b TtbL l.lddfific.tix! oa Sdcld.3 by AghfrLtbo Our toHcllrn lrtrahion h tladr Ctoln.

AMtb (h.dti!.d by tb ltrt qtoa!. 06.. of tCti.{M.dG.t BorritE o,fOCli{E) lo tG r+fFI ti.ia.. & bbliln ilbtli! th srd tanto lo|.tv l. am ld D..crtnE I l, 200a, l,!r! ichd.d iD ttir rr0. Th.* -LiL. E!a.di6.d thuth r sfit oa t} G .d E t.dlblb,Ll|tlofit .Ldooi:.E& nrdE auy tir tlClCXE ttrpco..of hdiu. {a. otond tt raiddi.l Eri[ h 9 ot l0 id.di-

2 I $r*r.rtrqtldqntddrrqt!

6.d crE . Orly ti. &r !tD.n a c.r (l., 2001) ?u rEt t$irtrdb ronctFl rt.i[ la bfui Spenru fro rAccd hclbl! upt rida clarlllpd n tb I..cOGTIErt coll.ld h2! ra LrtFaa ri!.' h -aE c.-, 3it{rr ah.t oE c.ntrdfUlrf cdar aif fa .ll tnadc.l adtrb ..s h !brE bl@d tro?b rrl ddiv..d 5 lb NCOCME i! drrnrdcdL.d6 i& lnttdbtd, ryar .rritll , mL o( bl@d ltdn !brm&rd ruioFy ti.l ia rlu|tfrrd to t lEdrF.c vitl ffr Li.,r.lytir. M.dkd ltca6 .sci.tod wilh th &b w!t! nrr!rly rwird rd rM includht $. OCME bort d hrc+tilrdn, fut of Nqrb C.Etir. D-ih Cqiii..E, Rtpo.t of AI-rqy, Toricoh|l, &F.r, 6r &rcornrrr Fdri, Prtlbbtit'rNB.1 .td $pDLnEtlrl l,.9dr of Or: of DatL O. fdrl,, 5,2010, rlr t}ivrniry of N6rh Ordlr ldllird Rwiry Bad&rc.r.in d tbr 6. EF.t d rB.(6 dG d llqrh lduti..lR.vi.ry Bard r9g.ld ur& FriE ft&d rlatfd6. G.r-raai*ir of tic t 0 as ltntifld rrt ptrantd i Trt& 2

TEsUIT5

Ravirw of Publi$cd crtctTha tlr't lt.rl .rElbE ro rrlcl& Dy rtptyrbda d||C r

t lium ilhhtic. nFr.d i fu tr.abl lrtrn,r Grnd i.&pnb 2(m,rl ioray rilt tbdar.titrioo of tt matod w.!nuruE Scvrrrl inrciltrr .Ed th lriilt b, tlt lrdiulrrriH bd E! t .. rr. il dar lc.lli.. Fi,. rc Prubli(. offu m(D Sxr+LrGrl 6 Fnll Eriin'rlr' r'

Tb fl @ rta qla rrr. rrt-.d io tb 6

FtlirH rttult t.Eldi! I! noo 19.o tl (X .t - 5Or. s) '21.8, oEdi.[ - at4 E trc iL.. G.rqE, d.E d.G rqt.Fqird,d,.rularr.slb b tli. 2t !0., {0164., -d XL Mcdic.l.!d Frt iEa bnci. rtrtt rt q tdilrl,l!.Frd f(. @ c.g. h, rtrt ld r ra, ot d.rrcrinFE tlriil .at op(.I F'ldi, dit ph * or E l. .mti.'tin rLrof b a (216la) r.t 3 h { (25.6t() d.Ili!.I c{.{fyctitrt d:dtrtno uy h.tc 6rril Ed lo ttE tui(:idc, tittorbr ! otthaaa &.rd.ou u,rta (hrnofurd to ba itl tpod lEllh (t$ra9. a9, .d ,5) .ad @ ttntioa.d tlt t .ai d..rh of li. r,if. .a .rqs6 fd hi tuiii i! r lol! lcll rl lhc ddh t .oa ln 5 dEcrs (iEhd!! a d..qtna i! otit !L t 30.I D tEt.ll aFFtanE h.rtsi.. lyaE r.f..rd A l6ld.l diEr Fe!.t tFt3.' h ..ty 2 ot:4 (:a.3tt) l.B l. 2 (la.l!a).&tirl .a..iwolvilt! l! a t. ?l rrd 7t 'f.ili{ hhf' .id tt p.nHbhr F!tr&mr" rq! Fba cdtlolt h.tan i,&(bl 6sd..t xrr. !d iqlirrd i! l0 oa L (n.a*) rici|.3

ln ell rrgtd cercr rqrb toridotlrl t€rina dn dItlrl tb F@ of Hre rd mc rnd c.rc of ddadrilrt r!. rdin bvil, o A& st rlE ri|tiE At Fylbdi.!, .aa.d to b. .t- ., rr9.dc b iL E !.- tbhvoind rD ruGtay.

tr t os (5j.tXI . trii} d wr! ft{lA..d b 4 ..8(2a6i0 futs.ro{tc litanBt rrt tid ll lh 4.th Ltt

A suabd d t lit' d.airt, drwior rr. et4loyrd. FtrcrG inEh,rd lrls dr u.l ,a of ltc c.s rrt! .tFtld i! 2@a 2qB h.f6c ltra bt.*rrir-o (ttlorr c-of . r.l)EE pdarli b, .drGd oi b dll! llcldr &!.t r'irar of & ffna nltrt urd, rr of ttt*.t hrt .d l/d.toE F b ror. pbn t.D 5 lh t d., t F of idfuE|..ffiapb:rn!, ri c da$ Fc bt! . I .rr rrr! .od6l,6 iuiU a.*rtd or'Hiurrrrrincd rukida'

chr.(tcrBd(s of 5ri(idrl b, AtPiyrbtlon dt toH.lbm l.*t btidr h t{qth arolirr

Artf,Fil oiit t h }.art c.tdi.. i.!.lti!| h.lirn in}.'htb bd to @t .!td lac\rirdy in m-HiFtiq tti:

O 2010 LntEdr lY l!trj d |,,A$

@yridtt @l LipfnDtt WilliarB E Wtrkirrs. Unaultrcrized reprodtrtion of thas atticb ls prohtited.

F-(toCDo(t.c1N=e3,tIJ

Mt I rort,,* iac<t ,ffi . v&ii l* j$ttbr, ,\ r,*. !)10 ttfrk bf At,t4,*[bl D. o l2lNr lotu{bt

ii|l i, iii iiiilir iii iiiiii, iiiliiiiir'

ii #liiiiilliiii,iiiiiiiiliii,!lIII

iillilliliiiiiliiiiiliiltlililiit

iiiiii, iiiiiii,iii,iiliiiiiiiiiiiitiii iliiii

ilillii'iliiirliiliiiiiii,iI

; i'.lir

I:!r5t"

IJT

II

iiiiriiiiil'Jir;iiriii

I

;!i! r..

iitO fi10 LtP*w Wba A l llCo

Cogynqht G Lixinoott WilliarB & Wllkins. Unauthorized!.rrrry.tr{oalntloncdcinc.<oln I l

rep.ododlon ot this ar0do is prohiHt3d.

I;EiaIT,

i:iit

-9a

E

!atlo

t{!

I

tE!

6F

Atn I fc.,t* U.d D,,ral . Vdr[ IX, ]fnb.r x, X.X-X 2Ol O

ii,ii,iii'

iiiil,liiiiiiiiiriii

Ililiiiitill

liliiriiiiiiiiiiiiir

It i,,,

!itti ,t-lJiiE!

iliiii'

ilrillIlillir

llillt

I!iH

iliiill

illi,,l't,lr

t'liiia I llrvi..nitatrric,itcdciEcqn

Gopyrigfit o Upprlcot wlllams & \Mkhs'C Nro AParct lrflta, at L4llit

UnautErized reprodrrctirn c{ this article is protftited.

la I la..* ,it.d tld'id . Volrrt XX, ,.-rnb.' X, x)(x 2Ol0 9i . U Atdfridbl Ou. to rLt,,'. l,*oldio.1

iiiiu Iiiii!, iiiiilliiil iiiiiiiiiiiir I

iiillliliiliiiiiiliiiilllirilliii

II

!.tg;l1$t8lilE

;iiiiliilii itiiiiiiiiiiiliiiiiiii,

liiiliilliiitlililllillillitiiii,tlifiilili

iililiiil:iil,

I

!ilifillliiiiilliiii'

F

iI

I

iIII

iiiil!l$ ifi

r5

Iir!11IIi'iirp

O Nrg UdEd ]Cd6 & r b@Wighl O Lir,Eirrcot Wiltbms & witkins. unauthorizeo reproarc#;ffiffiil#,*.

ir

It

I

Ir

R

Iiaout2t--tE.9EaI3!l

IIe

.v

!I.i

F !=l

ooID

B(L(\t6l

sExul

tIsIdxI;e,

I5

ItiII

tttoerl a cl *tlfdas,r Hdtua,d. H.!rr XI, Nlllttr X, IX Z0f0

rllt:; !Itfu !li!rE:tiillE52

IIi

ii,ilil:i

iir

f rll!i!iri ii

*t2iiiiiiiillll*

rliiliiHjiiiitii,iiliiiir

8<

iiiiiiiliiilii:Iiiiriliiiiiiiiiii,ii;

iiiiiliillliiiillil,illiiil'

ii iiil!liiil iiiiiili' irliiiiiiltiliiiliiIir?!gt

TT!irtJ}:

E

iili!l=ri Ii!f;'iI

E

!triiiiil,

rfuiEi'-I tr

g

I:

It

I

ITt!

5 I wrr...tqrdrrlmedd t.crnCoryrishl @ LbpinG,t Wlllems & Wllfri&

O Nl0 li6i.ct f,llllan ll Vild,rc

Unauthaizad reproduction of this article iB p.oliuted.

a

:1TT

F

.t

:

::irt!!

;: r

Itowl a al lnI Fqt'li(f,/ld,!r,/,d. voLrrc I\X tlrnlc. X, XXX 2010

tltrdin i.li.Fhd.rlrrtFL$in i J P,jdrlr,. l9,l:l5l:[13-lara.

,. l*rr, D' stt.E fo Fid En. ?b L*a Kna,.4 *t,4E tult@a D.dL lr|cn[ or. 0& Ndri! l^c d Eacrcllm

I Brqf,', A fr..a€d ZL Pt-Mi*t {S4.,t,r'G..t Z ,'d'tl5*,L1. ,b Ofr- H d. N., Ydi. rt: q0{ l@1

,. tlrd., D' fr.drli rl, 24,,..&.. 4sJta.r36 d /dds,dr. k h Dht H n rdd.rdl!. ,rEta. CSr. R En@ ,fln.

10. Bt tkro.fr..rErro. DrO: fb r,t.ls4*rn*.Fta of-djlE hrd..r €rr. CR- El@ 4i lsalt f,t-r-lia&llr-a-1ll. OlLr RD. \too..r Rlt Asrlyrl niod. $t'l h.lirnt .trd . rLni. b!.

b J F'|dc ld Pabt.2fi!,jl},)1-2]1-E Ollte T. lirr !(), tuE8d Clrt. $i.& rhh iF t.r.s AtLtd. lo

rdE,,, t Jft * rtd PdrDL Zn]laJ6-:C-t!. Gdth! f E Sdlh Dt( M.lLn ,f. Sdiill .tDtrli.irl t utltt Fr.l&. tr *..por,Fi', ra &6d.n o(tl !r-E ordE.sB

,. J Frdc Yd Pcbl ,J/,i2+l,i-].lla. Au@ V, MrD lrc, X.orf J. a L Toxidotiol tdyd, .n ,

.tai,ri.l ..ii& riri i.t ! -a . pL.t. La f6,a S.i ,r. l@7; l7!:ll9-tal.

lr. e..!t rF y. (.dld A. S.i.iAl .tlrdrh 'dt liliur irFl olta.- * t?ta rfi. tletd..E. 2qrrl19jIE-!2J.

5. Lho CA r.da6 t. Arartnil r.iiL b, inh.bi.n o,lEltu! isi.L r,Eb.t.1. a. J For,d. Y- ?dbl7&12tY1-Y1-

t . !6rl113l(. f.d&i- c. s.i.td. !r idrlht n ilr.tliE. ,..d. !.8[lnDdr[! Ur.* IrtE. 2o+la51rr06-rJ0r.

1!. L.roPn"B.rll SE dklra Gql.ll lliil€ sij& ir(rditrdr6.iig1[. t Cb hlCity.20c.at:fra-lll.

19 TrE aS loitt, icitB \f.tr Prar di!r ,.rLita P.,rrE, I, 2O9.

E I www-rniforanikaDadki'ra.coan

C@yrlght @ Lipfincott Wlllhms &

20. wrl D. Hd-c h .n _.ra ba- r ctar ,t niik rl Ll l, ,..9Eh lc' lrv. rrd md.d iE 199. 7.r'x,&i f..cb 3. 2dlr.

21. 1...t Ai- /lEkrd drht.d&E--{trE d.6t r. riIENdhatc, uan Alre lr,2lfrr,

Zr gorrr t. F'-l ait .o.rF.d.. o(.rar.t.d.ia.? Ai Mrc! I rCnA

2!. t}!E a. hdi! d fotd..r ar.r...@. A!5!L * hF,rrrr.rlr6-dr/EryC&r.r-OL'ddo*ll.-tdro/g0owntQQC/n/rdi-lFJ.

^--d l,Lr-t- ( 2Or.

2a. lotl rL 6rd.t D. ryni Y.c d A $.IaiE droa fanrlEb ot Lk! in DdEE i(d d dr.E IE tlo..dttr ie'tE

sai.y orFdrld. ,6ioloai.E O.i!. lr-2l.2O0Ji ltln ai., lN2f hHl XX, Srft Ml{ Crd, AE .l.l tld dri.{. .tla|rFar.

Id fo-lt r.rt--t riEd$r... lSn-200l.Yl'',yotrlcd vdy,.r 70oa,33a7r.47a

25. Lutdl K)a, X.tlc S& Cr.l, AE,. i- $dl. !t t rdt ydr md,sI .n B rt.d lo.ta ,rJ}-Uru SG, 1990fia. ,Arlr radtHgdybrztl*.gJs-n

2?- Hu6. m.aUc,wb.rl-.r.1. xirif.'r#dc.lns.ritFttL. hJ. Swla.., lr9t-20J. ,. .rPr.r Ld- 20cL1Jl$.5u.

28- &rh.t c' lr-ar ..i.1 Lr- in rdEar .t .{id& Udd h. l9lt20.ilrrd hjlr, Cctd Rlrrd Cd.r (td.r0rtut'nddr) re..rr..a o|l iE l! rE w.Dl3r hi, sria.d rrraqa syrE!(w$QArltI Nri(El C.,E tr brr ktlr i!r.a Co|rd. C.cr fa,irar. Carrol rd Prtfrdir, Ul Vi.l Sndi.r Ar!.tL i: hP/.€.d.iot,t i./ri.q4

29. G-l XS, }Ir@ lA triEr I.ls.t.l. Erbrt .!!Fi rilr of,fltf $i:i& r.r..rirE Fores . riidit a ..rld.d Ei.r Jr[4

,1291r6tr-r6a!.!O ArEioa m&i. r xllb,k-b tuirdLrf-lb..EEr ra

rr.l|Etof Fd.ra ir dd A.tst ln Mc. Adb.lb tkftd-r {Pecldtic ,tatld CaFliB 2.1 4 arlr.4 v^:tEi... Prfli-d. A$od.n .q Aa:Br-1027.

O 20rO UdGdt nntarr l, mlEnt

Wlt(lns. UnautlD.tred reFoductlon of this article is prohlblted.

*i I tq',n* lH ,dl,l . Volm. PL

IlGr vho u..c rlLtivdy ,ql!t (M .fc,rl.l; 3D, Il5; rut,2l-Oi n dl4 aoo) In 6 of l0 c.s' d...d.dtt rfirtd n!.niSDi!..!t FFli.iic dyttidea it 3 oa dE 6 c.t 1 FychLBicFotkr rEc FtGn a..Etidy wnb obju .to!.. l,Ldic.llirqir. ilotittd ctroi Fil' di.hfiy, !d cko.h Fin .&carGd *rti ajEE !ficard m I eda rtbilc .caiditl lld(Lb- ('i6 prla.bL cdry rtE, di... h , d...d.6l Ond...d.nt?. fu Y t eG.di.frD L.d.nd b bbdr, brr doFy rtrd toridolid nqf!!, *!r! o.Dtit taDuafiit arrflllE tr lE Cr! dE h Hrll{rltrad !Fclda h oo of rh. I0 ..- 'rrGr.dEodr.E rrfr.bt tsr r. irliU6.

Ha[ra ddi€, &vlcc! {,E! cdltiiant rilh llt@ rtaaFnrcricd in fi{l trit (G!. 0r aa T-6lva+ 2 lcllrlt, ianb, Vclqo.d orh.. n ct fiia.t:rl). ud dl rac ...ocirt d virb ur. of .p.nt bat ndE Ortl r!a!L' In 5 .ata!, a tuici(k nola vr! fuotl4in 2 o!.., . will wu kfr; in I c.tc, iDglrlDc. p.F . rttt lcrt .din 2 G.*r, .ibl.@da rLt(irb Blrt fqri-

AltoFb rt . Ffo,trEd in ! ltlririy of crt 3 tttd ryPi:.1,rcv!.Ld o,idcna! of FhEry vasuLr caaaarin ald lriH cat!'t .l .d. Eld.rddiph.alyd.liE rqt cdiLttd cciyuri{ c.us of bth i. I ..* c.cL

. oltct stlollD.qrE ltFtt ibt'yi.f t ddt r of Fslcdc lnt t{

3.!. Fovitis 6bd isrdir b tsH dtuiid. iabal!haxurFa!,rtad atDhrrlro6,' lladi.a. a o( ltdlutn'arin.dcriciaa,rt{' end ihr rqrt en* o{Fi l Eri Nciiod.rrErh..tfd r:ht!dl! .r.itrh! tn rtgtyxirl sirilcr involviq hcliunru!.i.ndna hr,.rintin oa ilch $kid.. xt h.lrlt rbs ftqtl lLrrldic.l itararuts ?hb daalth oa hfqniado i! t5fqtlDL tiitaaE tnti cor.q6 of och t l! .!d t ..r.. ir i. P-itf thrcicit t, r! Hiltn ,EM rr! r.&t!irr.d rDd iEt titU,csrm fa rtro dcrcrihd hta t! tlE Lrt

Tlr r.rh.n bt rhid Llin_...i..d .triib r,r c..ridctt Ltt t a dt.ll, d.rdld ltd ,iHv Frbli.:ard t,d rl.rprodr n prosrd .. r! d., Fid.t , .td q*l' MlEi.haqU fc drn{eO rE&. ut r.tr, @tld td Egaa_rt . o!. rdl-bor.r i .rnd \redo. qrtatl, !b &P-UGhdiui rulr f6 b. rb.! 150, .!d Egcn dt.l cLtooq! rtobotli ldiutl trb.ltc on!! bllhtua b@t Find Erilrr t nt trrlE lii r bt! in&rof$tPicfo faahdiun inrolrt Eat in a daail\rh. d..th lnry b. allo.outly lltt'hrtcd to dtr{ Grr- o. E&_iyin. ilh-s tc.iur lai&rd loridqhtl al.rn at! unlitdy to,i.ri taiur .!d rutsy itdEt rt- jcrrnry tc.Fiicr'"ginard to.i(:obti..l ..r..F 'iot OClr6 GrnPb, lclltm l. rb(rt'ia tl! rd dattf(rt dr, &d hdiur! ullcri rtdb.t !..f.r i;rcal it rtailttsd fa ttt hdiu[ Alrwl.L ct rlx .rdGllSI r-cl .t" d€rd.r.d drl lffi of cdLctEa F!sY'it|. nd llfydla tr. rtlgbrrtEftq'la.c.d.rrr' ,a+.lird}.Crracab of hdino h rll Natt C.'oab cG' hdiuo-ddittvdcviE rtr! fqrd ltr blhtc, .!d tcir&tbl !.ril ritcoitlarad ln 9 d I o arG. ttotat4t n it iobL thrt e llbtn.!r$- oa .'l.l qiii. vrar uadrrrd. if rd rha hdiur-&livrry ddicaa rd Ffi btt $tt! rarva 6at tb drdtrccrr lrir o hvcrluir Tba rstlE of FEI Eril atrtca thal t1.'r@'t!.y cb..ac !o LaE riftr{o{ia lralttbl ro ba fold lo;ltk .6 Grli..l oErs. 6{ th.y .n dn,riint'r.tiocl gi-cr&' 6, coovlrtdy, t b Phnt to ltrt lbc halun ddiirtty.rBnol. .!d lbra bt rqiE"td folbvir| tlEi. ho if tlE,

"iJa ro ra rlc rlriill EE! of lt- 6lh co€Ld' Tdi.+iori"t t rini f - xn.n h! b..n c.d !r rb. NClo.aE iarrrocroO crq im ZOI tt rEld tdi!. Fo.d!t! utirt r &lacli l!c't|.l coddivir, &6..r

Of Frqh! c@t\ ft rE atiEl rcFra d dllirLrrartr in thc fcrale ., tuadc dc lo .rrf!..dn (. c.lllryrr.t iocli.. d..rrr b, plli b.S .tPbFhtio. wih 6 vldEnldirn rrd.i.r.! ! rdl .l btl3il| .trl it !€!Lti..) tiE tt1990. rd c.Fcill, iE 2m0.rF' gdr iF!.r. bvt b..o.!ql,!d h.r|9tr o, wndy vryiq 4e1ir]tl(fry ulol+..d. dd tdr Fad..r 6cvc.! h.tG -ad .bl ib ,Etd i(rb iE!.E l! Fa.ty uo&lro dll d..liDinf ,c .a rrii'..tGiGd h tb l9rlr. bt! b..n brtrf, rrG!.d, d ht rldiErasaa io rlr.iraa drc b dftaaE @l fa EB d ara

l! .d ovtrrl iEr.- ir ra.. cf tlri(iter L i3 f6.iblc tbltE ta r*t!6 cf & d.tnc hf rsptyrlti! lrd ltd a.&cd laLl'q d tlE rrabod uh ord ,in ltdiut! r[ya.6r!l 16 ttE ai&$Lrnt itrctcata, !n atlEl(ls ifrl. lo trtftaalinltFrd .iEc. 2000.

Givrr th! n tird trlurh ir r!gt!..nl' yd.t .tur. ndrdun $ffotb ttii&. rc:0o,"" tra rcLudy yulg rjeFyrbaiic 6Ff.tEb, art .Eca of 116l aUrt . cb!e'iti of nrry a.dii.d .i.c., it it F6ibh dur tily FEraccnaini4 oiib Ly t'i tdno ruH rrc alct tq.LGly E!rd!.[y it, br d.. FFLtirly dtad Ahhrth 6.rrtb of Fioel Erit c.l||i.rr. G.&.! to b clrtrlo rhcy t !ioFLatly l. rd tu iln d.Ftrtcd iri to br lo tlti &rd''dcrtrsiw ilhrs rod rd.trr deadaEy oatlo tnFlt cy;y crFrrlE rqrrrrd to tn*a ltrc* rt&arEltt rod uD&lrfc

PrlaBi}t ruh. rc n .&d n t rEr u&t@d th. Fw..t ..c hd&rcc, ,irfuq rld .hlr rlrbic. of t.ptyril rd-& dE to hatm hbLdq! tt it itiF(od lo llaln ttlqt atold..ldrntt t*Lil tld FFlt{ti liiaa. d tf. citc.|td.rEi! wii:b d., ta.!d utdlE $icilrl FD. @tEt d.Eiplb oftb. bdiun itlaH (ct, inl..ttd &tlo.m&8 d d|r Fr...) tuptr:al, prdcriroeb *rrtio. rnb FE I rii fE rrt&irodd ! tiEl, ta.at uk h.t Ft;rt h.!,C n d or vi.r.d;Gcid ulEib &iti6 $eift re cf riib ardi ubcbl-$Dr.d gtnc rS uFlrBE h4EE dtb !l.r doE iEr,. erl-ll.d ri* fd triid.l nd lra FdiL c.iidl,IEtatl {qtrre ro 3[rc rrlrrE Ett dEAtt &lc",6!r iDdic.iadEr lfcdi.l araniat ahld rbo iEl! .t. tlEiher oa rlpLbo tq rd&a by .rPltFltb .Et!d rltntdirn hLhti.n it dal alii.. td rlt ldd FUi. t'Ir .lovror to art!6aly vlith tL t oilEdad rdvrrr c@!E ofvid.ly ditsnir.t.d rriiL !'l.{td likcl, to .9Fl e tdedcFl.a.dFE (ir..P!aivc ofdEir PhFt l harlth taort or rta)ritid tt Fltrir,. h.6it rEdil.d !r,ib nllnt llE l'trho&rEr witl, lr!w! ud avaiblc.

ACkl.lOtlrLOC alrt3n o,,t,t tfr P. B.aat, Aaraed, Saria ll*

qa, d als ,r q h Yolt di'. Ob 4 t* Crutld EI,,'-,lo tk,t ogse.

lEFIRA{CEsL hrr O. fdli ,r. te o{YA0li,uE..l lra'tg/. b h Draa. lJe- Yq\ r{Y. D.r.. l'n.7- Ctl bd{d.b / tafrlior{tbvLt d-^ta

lb(lCCrbhi2U.,. tl.rd.Eait xoato(lhL!2rr.x!zrDooarlltlllav.rLaE .

Ad 9. ft. At-ll .r ltnr/'ilatr.clrlr.At2ltc&.biÊ

rd l{lrlib (:0.. ldr lO[ f\trF- L nli at ... nd lr ri& ! a.r.ca

@bJrtbr gr?J.,t L5. Xr.a lr( It{lx" Hid CS,.t .. 'Etc :! t d t taI.i&'

i ra.r trt Cl, .fd a. te.i- d d q( 2.al I 9.l9tll2' lJc-130.

6 L'r!t tt( t al r k- aC lEtr i. td -dfl ,L.n, d

O 2OtO UEaEd, Jini.d d *frat wh''-rlll6EEk'Ed<lr'(qr | '

Copyrigtrt O Liprrncott Wiliams E Wilklns. Unauthoriz€d r€prodEtlon ot tts articb E prohbltecl

EXHIBIT 7

Report on Study of ilethods of Execution &Reconmendatiorc for Prccedures

Subrnittcd by: Louisiana Dcpartmcnt of ArHlc Safety & Gorectlom

February lE,2015

House Resolution 142 of the 2014 Regular Legislative Session was enrolled and signedby the Speaker ol the House on June 5, 2014 to study and make recommendalionsrelative to the different forms of execution and the methods of exeolion to determinethe best praciices for adminbtering the death penalty in ihe mosl humane manner.

The Seoetary of the Loubiana Oepaftment of Public Safie$ and Corections' James Le

Blanc, chaired thb urcrk and held an organaational meeting m July 2., 2014 to

organize a study conmittee to conduct this rrrlork. At trat tirne, tE assigned thefollo\iling individuals to serue on the cormittee:

Burl Cain, Warden, Louisiana State Penitentiary\Mlliam Kline, Exeqrtive Counsel, DPS&C Legal DepartnEntSeth Smith, Chief of Operations. DPS&C Ofiice of Adult SeruicesStephanb LaMartinere, Assbtanl Warden, Louisiana Stab PenitentiaryBruce Dodd, Deputy Warden, Louisiana State PenitentiaryJanes Hilbum, Attomey, Shows Cali & Walsh, LLPJeffCody, Attomey, Shows Cali & Walsh, LLPAngela \A/trittaker, Ereortive Mgmt Officer, DPS&C Secretary's ffice

The committee met on the followhg dates:

August 11, 2014: Planning meeting to develop resource and research needs of thegroup.

September 2, 2014: Report and discussion on research findings.

Oclober 3'1, 2014: Report and d'sq.rssion regarding identifying experts and discussionon additional research mmpiled.

December 4, 2014: Report and discussion regarding ]esearch ad protocol options anddrafting ihe required written report.

January 8, 2015: Review of research and draft r@ort and oonsensus onrecormendations for protocol options-

January22,2015: Review and approval final report

Study Rcspons€ 10 HR 142 ofthe Louisiana 2014 Regu.lar Lcgislativc SessionP age l2

Background:

Capital punishment, or the death penalty, b a sentence used in the iustice processwhereby an offender is put to death as punishment for a crime he/she cornmitted. Thedeath penalty in the United States b a legal sentenco and siates determine whether thedeath penatty will bc used as a form of punishment for crines committed within heiborders.

ln Louisiana, the death penalty may be applied an cases involvang first degree murder, aviolalim of La. R.S. '14:30, in circumstances sudt as:

(1) The murder was mmmitled d.rring the commission of or attempt of, a specifiedfelony such as aggravated kidnapping, second degree kidnapping, aggravatedE8cap€, aggravabd arson, aggravated rape, forcible rape, aggravated burglary,armed robbery, a$ault by drire6y shooting, first degtee robbery, second degreerobbery, imple robbery, tencrisrn, ouelty to juveniles, or second degree cruetyto juveniles.

(2) The murder was committed nhile lhe defendant was engaged in "ritualistic acts."

(3) The murder was committed for peorniary gain or pursuant to an agreement thatthe defendant would receive somedrhg of value.

(4) ThE dehndant caused or directed another to commit murder. or the defendantprocured the conmissron of the offense by payment, prornise of payment, oranylhing of pecuniary value.

(5) The defendant has been convicted oi or commitled, a prior rnurder, a lielonyin\olving violence, or other serious felony.

(6) The capital offense was committed by a person who is incarcerated, hases€ped, is on probation, is in jail, or is under a sentence of imprisonment.

(z) The delendant was a drug dealer or has prior convictions involving thedistribution of a controlled substanca.

(8). The viclim \flas under the age of 12 years.

(9) The vidim \ /as 65 years or older.

t10) The victim was a fireman, peace ofiicer, or corectional offtcer engaged in hislawful duties.

Study Rcsponsc to HR 142 ofthe Louisiana 2014 Rceu.lar I-egislative SessiooPace l3

(11) The victim was a wihess in a proseortion against the defendant, gave materiaiassistance to the state in arry invesliJation or prosecution of the defundant, orwas an eyanitress to a crime alleged to ha\re been committed byhe detndantor pcsessed other material evidence against the defendant.

(12) The murder was especially hehous, atrocious, cruel or depraved (or invofued

torture).

Before a jury.may impose the death penalty it must cansrder whether thena urere any

mitigethg circumstances against imposing the death penally. Louisiana Code of Criminal

Procedure Art 905.5 prwiies for the follorving mltigating cirolmstances:

(a) The offender has no significant prbr history of criminal activity

(b) The ofiense was cqnmitted wtrilo Ole ofiEnder vras under lhe influence ofexireme mental or emotional disfurbance;

(c) The oftense was committed wtliE the ofrender was under lhe inlluence orunder he domination of another pers$:

(d) The ofiense was colnrnitted under circumstances tlhk$ tle oflenderreasonably belie\red to provide a moral iustification or exlenuation for his

co.duct

(e) At the tine of the ofiense the capacrty of the offender to appreciste the

oiminality of his oorduci or to conbrm his corducl to the requirernents of

law was impaired as a result of mental disease or defect or intoxiEtion;

(0 fhe youth of tre orffender at the time of the ofiense;

(g) The ofiender was a principal wttose participation uras relatively minor;

(h) Any othet relevant mitbating circlmstdlce.

Pursuant b te. R.S. 't 5:569 and 570, e\rery sentefice of death executed on or aftEr

September 15, 1991, shall be by lethal hjeclion, that is, by the intravenous injeciion ofasubstance or substance3 in a lethal quantity ino the body of the offender untii suctl

person i3 dead.

tncludlng Louisiana, tt|e e are @rrently 34 staEs S|at atfitorize the death penaltY. Most

all of t11ise siates ha\re adopted lefial iniectian as the primary means of impbmenling

the death penatty. \ rhite 1E Af thoBe states have solely a1horizecl lethal ini€ction as the

execution'rnethod, the rest of the stabs ttlat impose ttE death penalty have also sdforth altemative metho(b of execution sudl 6 electocution, lethal gas, hanging, and

the use of firing squads. The methods of execution for eadl such stab are sd forth in

the chart below.

Study Rcsponse lo HR 142 ofrhe Louisiana 2014 Regular Legislativc Session

Page l4

Research ftom Other Carital Punishment Statee:

Ernt!C6C=oa==<

t.9

.r. ggJio3J

Lethal injection, unlessinmate affi rmatively selects

elcstrocution

5m mB - midazdamhydrochloride; 600 mg -rocuronium komide; 240millieqdvalents -

Lethal injertion; inmatesentenced on or before1V15l92 may choose lethal

midazlam/hydromorph6re

Lethal lnJection, buelectrooJtion if lethalin.iestion declaredunconstitutional

Statute sp€cifiesabarbituate preceded by aben20dia2epine

Lethal tas or kth!linjcctionmay be choscn by inmate; ifinmate fails to choose eithe,

Lethal lnjection, unlessinmate aff inY€tively selectselectrocutaon; if bothdeemed unconstitutionaIthen any constitutionalmethod

Lethal injection; inmaress€ntenced on o{ before3/3V9E may choose lethal

or eledrocution

Study Rcsponse to HR 142 of thc louisiana 2014 Regular Legislative SessionPage l5

St te

coEa,E:Ia,J

co

tE

a,ltEocuou,

EeECIt

!a3E'

-Elt

!.ta,.!?ooqzt)ar=l<

tro

Eccl

E

Loulsiam .tLcthll iriection midazlam/hydromorphonc

Mb5lssippl x

Lethal lnjectionStatute specifies an ukrashort-ading barbituate incomblnation with a

oarahnic aqent

Mlssoui x I Lethal sas or lethal iniection

Mortana I

Lethal injection Stetute speclfie3 an ultra-fast-acdng barbituate incombination with e

chemical paratylic agent

Nrbraska I Lethal inlection

f{evada I Lethal iniectirn

NcwHampshir.

x x Lethil injection; but may be

bry hanSing if lethal iniectiondeemed 'inpractical'

Statute specifie! an

ultras hort-actintbartituate in combinationwith a chernical paralwcagent

Na, Merico x

Lcthal inicction, but only forcrimcJ co.nmittcd prior totuly 1, 20@; otherwire,caglral punlshment repealed

NathCrrollna

xLethal iniection

Ohlo xLethal hiection

midazlam/hvdrornorphone

Oklahoma x x I

Lethal inlection; buteledrocutio n if lethalinjection heldunconstltutional; lf bothlefial inlectbn and

dectrocution heldunconstitrrtional, then fi rinS

souad

midazlam/lrydromorphone

Study Response to HR 142 ofthe touisiara 2014 Regular Izgislative Session

Pasc l6

!.C-tt.E!t6C!r,arg=<

g-9

3.gg,

i62oJ

Siatute specifies an ult6-shon-acting bartrituate incombination with a

chemiel paraMic agentand Dotasrium chloride

Statute specifies anu hrashort-actinSbartituate in comtinationwith chemical paralytic

Electrocution, but inmatemay choose lethal lnjectbn;iffalls to choose elther, thenlethal injection; but ifconvicted prior to date ofstatute, then electocudonunless ch@ses lethaliniection; if l€thal injectionheld unconstitutional, thenelectrocution

Tannassaa

LcthEl injcction; butorfender, whose capitaloffense occurred prior to1/1,/99, may choose

electrocution; if thosemethods de€rned

unconstitutional, then use

constitutional mehod

lethal hjection; but firin8squad if court determinesirvnstc h8s a ritht to $i5altemative; if lethalinjectlon ls heldunconstitutional, then firing

Statute sp€cifi es that oneof the intravenousinjectionsshall bc sodiumthipoental or equivalent

Pennsylvania

Study Response to HR 142 oftbe Louisiaoa 2014 Regular Legislative SessionPage l7

Stete

co

,.E

-E!

ctE

E

tEC6r!(!,

Ec&5!

!a,oC

E

!ot.i6:EO6C=oo=E<

c.9

IgE'tOEa

vktlnla x I

lnmate may choose lethalinjection or e lectrocution; ifrefuscs to choosc, thenlethal inicction

WashinSton x I Lethal iniection, unless

inmate drooses hantlng

Wyoming x x

Lethal iniection; if lethalinjection is heldunconstltuti6nal, then lethalgas.

tlrayominB Senate rccentlyapproved legislation thatallows for the us€ of a firingsquad. Concurrence ls

oendinc bvthe House.

Statute sp€cifies an ultra-short-acting bartituate,alone or in combhationwith a chemiol paraffiicagent ard potassium

chloride

It may be noted that the basis for utilizing a particuhr method of execution is not

necessarily uniform ammg he states that offer mole than one execution method. ln

some states, lethal irjectbn's the primary execution method unless it shouH bedeclared unconstitutional, in which cas€ lhe statute ne:d provirCes for an alternatemethod, or a series of alternate methods in the event a successive method should bedeemed unconstitutional. ln other states, the condemned inmate is actually given a

choice between lethal injedion and ancdher altemale method of execution.

ln Louisiana, between 1919 and May 21, 1957, execations wele conductsd by the localparish law authorities. Prior to August 6, 1911, the penalty in Louisiana was canied outby hanging. The last hanging in Louisiana was on March 7,1941. Between August 6,

1941 and June 9, ,1961, executions were pe ormed by electroantion hr the elearicchair. Between 1941 and i957, a portable elec,hic chah was transported from parish toparish in order that the death p€ndty could be administered in the parish where the

crime was commifted. After 1957, the StaE became responsble for administerirB the

death penalty- Prior the reinstatement of capital punishment, the last death in the

elec[ic chah was on June 9, 1961.

ln 1S7, there was a rising tide cf litbation against he death penalty. Federal corrtssuspended all executions pending a final decision by the U.S. Supreme Court. ln 1972'the U.S. Supreme Court struck down all capital punishment laws as unconstifutional. Allindividmls under death sentenced al that time were re-sentenced to life in prison.

Study Response to HR 142 ofthc Louisian 2014 Rcgular Legislativc Session

Page l8

Effec{ive October'1, 1976, the new Louisiana d€ath penalty statute was adopted. Thestate's death penalty law was again revised in 1978, specifuing that lhe sentencingjudge must sign the death warrar{ rather than the govemor. Capital punishment wasreinstated in Louisiana on June 29, 1979.

ln 1990, the legislature approved ttle use of lethal iniection for those sentenced afterJanuary 1, 1991. ln 1991, the legislature provided that every deah sentence execubdafter September 15. 1991 rrvould be by lethal inieclion. Since the reinstatement of thedeath penalty h 1979, there have been 28 execulions performed,20 by elec'tfocl.Jtionand 8 by lethal iriec-tion. The last one was on January 7, 2010.

The death penalty has risen to the forefront of natimal headlines recently due to theshortage of drugs historically used in he lethal h,ieciion process. States continuing tocarry out executions have been forced to obtain drugs from other sources or substiMedrugs normally used in the process. The altematives have provided inmaEs with newgrourds for appeal as they request harBparency regarding exeqJtion methods.

To date, Louisiana has 85 offenders in custody who have been sentenced to death.

Study:

Thb study was conducted by reviewing available scientific, technical and safetyliterature related to various methods of execrlion. lt is not intended to express anopinion about Louisiana's larv for drninistation of capital punishment.

Lethal lnJectian Protocols:

Through February 2011 , Loubiana had in place a three drug protocol whicfi included 3gm sodium thiopental, 50 mg pana:ronium brornide and 240 meq potassium chloride.

ln February 2011 , alter lausuits, intemational trade restdctions and raw materialsshortages oomplicated the market for drugs used in exeqrtions and the lack ofavailability of sodium thiopental, a decbion was made to modifl the three 3 drugprotocol to use pentobarbital in lieu of sodium thiopental. This decision was based onexperiences in Oklahoma using pentobarbital and the use of it being upheld in theUnited State Oistrict Court in the Westem District of Oklahoma. Base m the change,the prolocol then called for 1 gm of Pentobarbitol, 50 mg pancuronium bromide and 240meq potassium drloride.

ln January 2014, the protocol was again updated to provide two options for lethalinjection. They are:

A) 5 gm of Pentobarbital or8) 10 mg of Midazolam and 40 mg of Hydromorphone

Study Response 1o HR I ,12 of thc l,ouisiana 20 I 4 Regular Legislative SessionPage l9

Recommendad Rotocols:

A. Lethal lrlectlan

We are recommending for consideration a lethal injeclim protocol thai calls forthe use of a one drug protocol utilizhg 5 gm of Pentobarbital injededintravenously (lVP). This protocol has been used in numerous statcs, includingTexas, as a one drug method. The amilability of this drug to Departrnents ofConec{ions is hou/ever severely hdnpered and liete could be issues obtahinga supply of Pentobarbitol or any other drug to be used for lethal injecnion. Drug

suppliers have refused to sell drugs to the prison sysbms for use in executionsand oher entities have refused to sell to Lolishna DOC. lt is this cornmiteesunderstandrng that suppliers have threatened porirJers with no longer supplyingthe drugs to their businesses if they in furn sell to conectional agencies for thepurpose of lethal injection. As a result, suppliers lear the backlash of badpublcity to their businesses if involved in providing the drugs tc conectionalagencies.

This committee also recornnends reconsideration of a bill that cornbines lhelanguage fom tE original and amended versions of House Bill 328 of the 2014Legistaiive Session authored by Representative Lopirto. The atached drafllegislation (Appendix A) anrending l-A R.S. 15:569 ouUines what is rpeded toallow for lhe ecornnendations within lhis report and will provkle for theconfdentiality d information related to the execution of a death sentence. Theamended version of the prirr bill stat€d that The narne, address, qualifications,

and other identifying information of any person or enti$ that manufactures,conpounds, presoibed, disPenses, supplies or administers the dngs or supplics

utilized in an exeoltion shall be confdential, shall not be subject to disclosure,and shall not be admissible as evkJence or discoverable in any aclion of an kindin any court or before any uibunal, board, agency, or person. The saqeconfid-entiality and proteciion shall also appty b any peGon uho participates in

an execution or performs arry ancilhry funclion relaEd to an execution and shafl

irrlude information contained in any departrnent records. including electonicrecords, that wold irientifo any such pemon-" Srch legislation would provide

some sea.rrity to troce tasked to and invoMEd h carryng out the state's order toexecute an individual I punishrnent for a qualiling crime.

It shouH also be noted that the U.s. suprerne court will consider in April whether

a rrultidrug protocol used h recent lethal injeclions in other states violates the

Constihrtion with regard to cruel and unusual punishment

B. lnduced Hypoxia via Nitogen

It is the recomrnendation of this study group lhat hypoxia induced by theinhalation of nibogen be considered for adoption * an aitemaiive method ofadministering capital punishment h the SHe of Loubiana.

Study Res?onsc to HR 142 of the Louisiana 2014 Regular Legislative Session

Pase 110

It is important to note that the recommendation uould induce hypoxia, which is adefriency of orygen reachirg the tissues of the body. ln nitrogen inducedhypoxia, there is no buildup of carbon dioxide in ttle bloodstream so the subjecipass€s or,Jt when the blood orygen falls too low. The research revieuredsuggests that this method would be the most humane method and wculd notresult in discomfort or cruel and unusual punbhmenl to the subiecl.

Though the exact protocol and nrlrogen delivery device have noi been finalized, ilhas be€Il deiermined that a Gas Chamber would not be used. Options for thenitrogen delivery device include a mask or a device similar to an oxygen tenthouse (vnall clear orygen tent covering only the head ard neck area). Researchas b the best rnethod of delivery is ongoing.

Oklahoma has recently filed sinilar legislatim to allow for induced hypoxia (referto Appendix B). Also, you will find attached fte Executive Summary (AppendixC) of the research conducted in Oklahoma that supports this method as ahumane method which does not require the assistance of licensed medicalprobssionals. We have also attached the documeflts (Appendix D) which makeup the research used in Oklahoma by this canmittee in developing thisrecommendation. Thb method is believed to be simple to administer andnitrogen is rcadily available.

Conclusion:

This committee submils fris study response to House Resolution 142 ol lhe 2014Regular Legislative Session to make reconrnendations to consider relative to thedifferent forms ol execution and the methods of execution upon agreement that treabove consideratbns epresent the best practices for administering the death penafty inthe most humane manner. There ale two sides to the debab on the death penalty.Proponents believe that the death penalty reduces crime and provides safecommunities, while also honoring tre viclim and those left behind who grieve a loss.Opponents believe that the cost of capital punishment doesn't justify the oubome, that ildoes not deter crame, and that there are socral injustices that are not addressed thatmake iustice sysEm inequitable. As a whole, this cornrnittee bkes no stand on eitherside of this debate, but submits fiis response based on the request for this study andthe research and matedals a\railable to the group.

We close reminding readers that many are directly impacted by the proces of capitalpunishment: the victim, the viclim's friends and family; law enforcement; the judiciary,the prosecutor, the defense attorney, the jurors, the public, trc offender, ttre offender'sfamily, and the staff tasked to cany out the protocol, to name just a fuw. We understandthat the decision to act on these recommendations for consideration is an enormoustask befote you that cannot be traken lghtly. We trusl that we have provided theinformation you needed b consUer Louisiana's options.

Study Respon- to HR 142 ofthe Louiriana 2014 Rcgular Legislativc ScssionPa-ge lll

Amcndmeut to ISA-R.S. 15:569

+rDelete current Sections A and B; rewrite statute to read as follows:

Section l. R.S. l5:569 is hereby amended to read as follows:

$569. Place for execution ofdeath sentence; marurer of el<ecution; confidentiality

Every sentence of death executed in this state on or after August l, 2015, shall be

conducted by either of the following methods:

(l ) têthal injecrion, which is the intravenous injection of a substance or substances iu a

Iethal quantity into the body of a person convicted until such person is dead.

Execution by lethal injection shall be pennitted in accordance with procedures

developed by the deparunenr(2) Induccd hypoxia via nitrogen or aa inert gas, which is the adrninistration of gas in a

lethal quantity upon the body of a person conricted until such person is dead.

Exccution by nitrogcn or incrt gas shall be pcrmittcd in accordancc with proccdurcs

developed by the deparunenr

A. The method of execution shall be chosen by the seo€{ary of the deparunert based upon

the availabitity of the department to administer tre lethal injection or inducrd hypoxia.

B. Every sqltence of death imposed in this state shall be executed ar the Louisiana State

Penitentiary at Angola- Every executiotr shall be made in a room entirely cut off from

view of all except those permitted by law to be in that room.

C. No licensed health care professional shall be compelled to administer the letlal injection

or bduced hypoxia.

D. The name, address, qualifications, and other indentiffing informatron of any person or

entity that manufactures, compounds, prescribes, disperses, supplies, or administers the

drugs or supplies utilized in an execution shall be confidential, shall not be subject to

disclosure, and shall not be admissible as evidence or discoverable in any action of any

lcind in any court or before any tribunal, board, agency, or Persc,tL The same

confidentiality and protection shall also apply to any person who participates in an

execution or performs any ancillary fi.rnction rclated to an execution and shall include

infomration contained in any departnent rccords, including electronic records, that would

identiff any such person.

E. The provisions of the Administrative Procedure Act, R.S. 49:950, a seq., shall not apply

to the procedures and policies conccming the proccss fu implementing a sentsnce ofdeath.

1

?

3

4

5

6

'l

I

9

10

11

t2

14

15

16

1?

18

19

20

2i

22

23

21

STATE OF OKI,AHOI

1st Sesslon of the 55th Leglslature (2015)

HOUSE EILL 1879 EY: Chrlstian

AS INTRODUCED

An Act relating to criminal proceiure, amending 22o.s. 2011, section 1014, which relates :o the nannerof inflicting punishment of death, providingalternative method for inflicting punishment ofdeath, and providj-ng an effective daLe,

BE IT ENACTEf BY THE PEOPLE OF THE STATE OE OKIAHOMA:

SECTION I. AMENDAToRY 22 O.S. 2C11, Sectlon 1014, is

amendec to read as follows:

section 1014. A. The punishrnent of death shall be carrj.ed out

by the adninistration of a lethal quantj,ty of a drug or drugs until

deat.h ls pronounced by a Iicensed physician according to accegted

standards of nedical pract j,ce,

B. If the execution of the sentence of death as provlded j.n

subsection A of this section is held uncon st i tut lonal bv an

appel.late court of competent iurisdiction or is otherwise

unavaj,l,ab.Le, then the sentence of dea'-h shall be carried ouE bv

nitroqen hypoxia.

Reg. No.6354 Paoe 1

1

2

3

4

5

5

'l

I

9

10

11

t2

13

l4

15

15

t'l

18

19

20

27

22

23

24

c. If the execution of Ehe sentence of death as Drovided in

€'ub€€€++€e subsectlons A 4_E of this sectlon is held

unconst itut iona I by an appellate courE of comPetent jurisdiction or

is otheruj,se unavailable, then the sentence of cieath shalL be

carriecj out by elect rocuti on -

g- D. If the execution of the

subsections A drd! B and C of thls

by an appellate court of competent

unavail.able, then the sentence of

sentence of cieath as provided in

section is held unconstituti-onal

Jurisciiction or is otherwise

death shall be carried out by

f:ring squad.

sEcTloN 2. This act shall become effective November 1. 2015.

55-1-6354 GRs ct/20lls

Reg. No.6354 Paqe 2

Documents

EXHIBIT 1 - Death Penalty Information Center · News from The Associated Press ARKANSAS CONDUC'iS \ATiCN S l ST DOUBLE EXECUTION SINCE 2C00 3v ^rloFfa ftlrLlo lrs rti rr t r esE!