With the ever-changinglandscapeof our natioris health
care system and, in particular, the {ield of emergenry
medical services,the needfor baccalaureatepreparedEMS
professionalsis critical. To meet this growing demand, the
University of South Alabama, Department of trMS
Education recendyimplemented a new Bachelorof Science
degree program in Emergency Medical Services.
"Baccalaureateprepared EMS professionalsare being
actively recruited across the country today to work in
leadership and supervisory positions such as EMS
managers,EMS educators,and EmergencyPlanners,just
to name a few", said David Burns, Chair of the
Department of EMS Education. "Our faculty and staff
haveworked very hard over the past few yearsto bring this
new program to fruition and are extremely excited about
finally starting the first cohort of studentsthis FaJ12007)."
The University of South Alabama offers the Bachelor of
Science degree in EMS for graduates of paramedic
certificate and associatedegreeprograms. One of only 12
programsof its kind in the country, this degreeprogram is
designed to prepare graduates to assume leadership
positions within trMS and EMS related organizations.
(Bachelor's Degree continued
on page 2)
From Left to Right
Back Row: Ben Jernigan,Josh Ramey,Melissa Sutton
Middle Row: Chuck George,Tina Maloy, Linda Oldham, Philip Creighton
Front Row: TeffCarter. Mark Turner
New ContractAwardedto USADepartmentof
EMSEducationfor EMSRegion5 Activities
The University of South Alabamq Department of Emergenry
Medical ServicesEducation is oleasedto announceit hasbeen
awarded a new contract by the Alabama Department of Public
Health (ADPH), Of{ice of EMS andTrauma (OtrMST) to
continue in its role asthe regional EMS coordinatingagencyfor
EMS Region 6. EMS Region 6, alsoknown as the Alabama
GuJf EmergencyMedical ServicesSlstem (AGEMSS), covers
a sevencounty areain southwestAlabama including, Baldwin,
Clarke, Conecuh, Escambia,Mobile, Monroe and Washington
The contract this year calls for the trMS Region 6 office to
ensurethat a number of performance-based
objectivesare met
forFY 2007-08. Someof theseobjectivesinclude the following:
' Ensure that 98o/oof all licensed EMTs in the Region
are in compliancewith NIMS requirements by
September30, 2008
(New Contract continued on page 2)
Spotliqhton CharlotteHarlan
EMS News in Brief
Major Core classes,suchas EMS
Systems,EMS Administration,and
DisasterManagementand Event
Planning, will enablegraduatesof the
program to fi-rnctionmore effectively
and efficiently in EMS management
and leadershiproles.Graduatesof the
program will work in avariety of
settings, including fire departments,
ambulanceservices,state and regional
EMS agencies,and training institutions,
among others.
In addition to a well-roundedgeneral
educationand pre-professionaicore,the
curriculum requires a 32 semesterhour
oaramediccore and a 34 semesterhour
EMS Mulot Core (seebelow). Students
who have completed all of their general
educationand pre-professionalcore
classesand who have akeadycompleted
their paramediceducationat USA or
at another institution can complete the
trMS Major Core requirementsin three
to five semesters,
dependingupon the
student'sdesiredcourse1oad.In order
to accommodatethe typical adult
student,the EMS Major Core classes
shown below are offered in an
"executiveweekend" format. Classes
meet on Friday afternoon, afi.day
Saturday,and on Sundaymorning,
approximately every third weekend for
six (6) weekendsper semester.
EMS 410:Concepts
of Paramedic
P r a c t i c( B
e r i d g e ) . . . . . . . . . . . ... . . . ( 6 )
EMS 475:EMS Internship
EMS 440:HealthInsurance
M a n a g eC
d a r ei n E M S . . . . . . . . . . . . . . . . . . . . . . ( 3 )
E M S 4 4 5 :E M S R e s e a r c. .h. . . . . . . . . . . . . . . . . . . . ( 3 )
EMS 460:IssuesandTrendsin
. .....(3)
EMS 495:Comprehensive
Individuals interested in starting the
Bachelor'sdegreeprogram in the Fall
EMS 310:Introductionto EMS
semester2008 needto contactthe
. . . . . . . . . . . . . . . . . . . . . . . (Department
of EMS Education
trMS 315:EMS Administration
............(3) (251-437-641,8)as soon as possible
EMS 320:EMS Law andLegal
in order to schedulean advising
I s s u e. s. . . . . . . . . . .
. . . . . . . . . ( 3 ) appointment. Inquiries aboutthe
EMS 325:Instructional
programmayalsobe e-mailedto
in EMS..........
. . . . . . ( 3 ) Ms. LyndalCurry,BS DegreeProgram
EMS 340:DisasterManagement
Coordinatorat [email protected]
& EventPlanning
NEW CONTRACT @ontinued
' Ensure that 50o/oof all licensed EMTs in the Region
havereceivedCPR training by September30, 2008
' Ensure that 500/oof all licensed trMTs in the Region
havereceivedprotocol educationby September30,
' Ensure that 500/oof all licensedEMTs in the Region
have receivedrequired continuing education training
' Ensurethat the number of licensedEMT Basicsin
the Region (basedon 2006 data supplied by ADPH)
is increasedby 25 by September30, 2008
' Ensure that 25o/oof all permitted ambulancesin the
Region are equippedwith an approvedclosed-system
CPAP by September30,2008.
' Ensure that one meeting will be held quarterly with
reoresentativesfrom each of the medical direction
hospitals and trMS provider servicesin the Region
to discussmedical direction and relevant issuesby
September30, 2008.
The RegionalEMS agenciesacrossthe Stateare
funded to orovide technical assistanceand servicesto
EMTs and ambulanceserviceproviders in their respective
in trMS Region 6, please
regions.If you need assistance
call David Garmon, Region 6 Director, at 251-472-781,0
or 251-431-641.8.
2008 USAContinuingEducationSchedule- OpenEnrollmentClasses
M a y 8 - 9 . . . . . . . . . . . . . . . . . . A CPLrS
May 22 - 23................PALS
ACLS Refresher
June 72
25 - 26 ................PALS
- 1 1 . . . . . . . . . . . . . . . . A CPLrSo v i d e r
. .A
. .L
. .S
. Refresher
J t t I y24 . . . . . . . . . . . . . . . . . P
Sept.11 - 12 ..............ACLS
Seot.25 - 26 ..............PALS
O i t . 9 . . . . . . . . . . . . . . . . . . . . . . . . AR
Ocl 22 - 23 ................PALS
N o v . 6 * 7 . . . . . . . . . . . . . . . . . . A CPLrS
N o v . 2 0 . . . . . . . . . . . . . . . . . . . . . . PRAeLfSr e s h e r
Jan.17 ................Hazwopet
Jan.7 11 ............Ha2mat
Feb.7 ..................Ha2wooer
F e b .1 8 - 2 2 . . . . . . . . H a z mTaet c h n i c i a n
March 20 ............Ha2woler
M a r c h l 0 - 1 4 . . . . . . H a z mTaet c h n i c i a n
April 16 ..............Ha2woper
A o r i l 2 1 - 2 5 . . . . . . . . H a 2 m aTt e c h n i c i a n
May 22................Hazwoper Refresher
May 12 - L6 ........HazmatTechnician
Jl:ne 72................Haawoper
- 6 ............Ha2matTechnician
JuJy24 ................Haz;woper
JuIy L4 18..........Ha2matTechnician
Aug. 14 ..............Ha2woper
Aue. 4 - 8 ............Ha2matTechnician
Sep1.Z5 ..............Ha2woper
Sept. 15 - 19........Ha2matTechnician
Oct. 16 ................Hazwroler
t echnician
O c t . 6 - l 0 . . . . . . . . . . H a 2 m iT
Nov. 6 ................Haawoqer
N o v . 1 7 - 2 I . . . . . . . . . . H a 2 m aTte c h n i c i a n
Dec. 3..................HazwooerRefresher
t echnician
D e c . 8 - 1 2 . . . . . . . . . . H a 2 m iT
For more information on these classes
or to register, please contact our
Department ^t 25 1,-43 1,-6418.
Spotlighton CharlotteSmithHarlanUSAsNew EMSClinicalCoordinator
CPAP, or Continuous PositiveA\rway Pressure,is
currently a promising technology for the treatment of
emergent, severerespiratory conditions, particularly
congestiveheart failure. In patients who are struggling to
breathe, but who are not to the point where endotracheal
intubation is classicallyindicated (unconsciousor severely
low breathing rate), CPAP is finding great successin
improving lung compliance, reopening and clearing
distressedalveoli, and avoiding the necessityofprehospital
intubation of severemedical respiratory pathology. The
processinvolves placement of a mask, similar to an ambu
mask but sealedairtight in a systemwith a CPAP delivery
device. When the oatient inhales. the deliverv device forces
oxygen enriched air into the lungs at either apreset delivery
pressureor one selectedby the rescuer.Pressurefor
ventilation is derived from the oxygen cylinder and exhaled
gasesare ventilated through a separatevalve system.
According to Dr. T. Douglass Bradley, a professor of
medicine at the University of Toronto, in his treatise
Continuous Positive Airway Pressurefor Congestive Heart
Failure, the positive effects of CPAP come from several
The beneficial effects of nasal CPAP in congestiveheart
failure are probably due to 3 mechanisms.First, CPAP
increasesintrathoracic pressureand lowers left ventricular
transmural pressure(afterload). It thereby acts as a cardiac
assistdevice to augment cardiac output in patients with
elevatedleft ventricular filling pressure.Second, in patients
with congestiveheart failure who have central or obstructive
sleep apnea, CPAP abolishesnocturnal blood pressuresurges
by eliminating the apnea.Third, CPAP reducesactivity of
the sympathetic nervous system by alleviating apnea-related
hlpoxia and preventing arousalsfrom sleep. Becausethese
mechanisms of action depend on the generation of positive
intrathoracic pressure,they differ fundamentally from, and
are additive to, the effects of optimal drug therapy for
congestiveheart failure.
Journal of Academic Emergency Medicine, found that
CPAP utilization by EMS was associatedwith marked
improvements of dyspneic patients in the prehospital
environment. The study was conducted on fifty-six patients
who otherwise would have ultimately required intubation in
the fie1d.The study involved 47 congestive heart failure
(CHF) and 9 chronic obstructive pulmonary disease
(COPD) patients suffering from severerespiratory difficulty
and hl,poventilation. The 56 patients comprised a group of
approximately half males and half females and with an
averageageof 75 years.Treatment of the group with CPAP
resulted in marked improvement of 54 patients (evidenced
by much improved pulse oximetry and other physiological
markers) and only two patients ultimately required
endotracheal intubation. This result indicates avoidance of
intubation in 960/oof the patients due to improvement of
underlying ventilatory compromise. Use of CPAP by EMS
personnelalsowas not associatedwith extendedon-sceneor
transport times and was recommended by the researchersfor
use in the prehospitalphaseofcare.
To review the complete study: Lauder, C., Barnes,T.,
Fitzkee, A., Bailey, E., Schnyder,M., O'Connor, R.
and Megargel, R. Out-of-hospital use of Continuous
Positive Airway PressureVentilation (CPAP) in Elder
Patients with SevereRespiratory Distress. Journal of
Academic EmergencyMedicine Volume 8, Number
5 525,2007.
A 2007 study by Lauder, et al, of the Christiana Care
Health System of Dover, Delaware and published in the
The State of Alabama Department of Public Health,
Office of EMS and Trauma has embracedthe CPAP
technology and has adopted the use of Emergent
Respiratory Product's Proto2Vent CPAP system for
prehospital EMS use at the Advanced level. The
Proto2Vent has an advantageover many systemsbecausethe
amount of pressurecan be adjusted from "0" (essentially
delivering the same as a non-rebreather oxygen mask) and
titrated to the lowest level that produces positive results,
(CPAP continued on next page)
CPAP ftontinuedfrompoge4)
such as an appreciableelevation in pulse oximetry levels and
decreasedrespiratory distress. Other systemson the market
require that the operator start therapy at 5-10 cm/H2O of
pressure.Alabama protocols (seeProtocol 6.11) maximize
the amounts of pressuredelivered to a patient at 10
cm/H2O for congestiveheart failure/pulmonary edema and
5 cm/H2O for other etiologies of dyspnea.(Pleasealso
review the protocol manual for a list of contraindications for
CPAP.) Another advantageof the Proto2Vent unit is that,
if necessary,an albuterol nebulization (breathing treatment)
can be accomplished during CPAP therapy by placing a
common nebulizer into the circuit during administration.
The circuit is designed to achievethis without the necessity
of special equipment for the updraft.
Alabama's regional offices are encouraging the state's
hospitals to adopt the Proto2Vent units so that exchanges
can be made with prehospital EMS crews for the masks and
administration circuits. The ability to "swap-out" equipment
will saveprehospital servicesmoney while allowing hospitals
to simply retain the initial equipment utilized in the field
with the patient until it requires discarding and prevent
unnecessarywaste. Equipment grants facilitated through the
regional EMS systemwill supply the state's EMS services,
specifically 25o/oof all certified ambulance units, with the
Proto2Vents over the next year. The regional of{ices will
attempt to evenly distribute the equipment while placing
them where they will have the greatest benefit. During the
distribution process,the EMS regions will also conduct
classeson the proper use ofthe units.
If you have any questions or comments regarding
this processin the Alabama Gulf Region, please call
David Garmon, EMS Region 6 Director at 257-437-6418
or e-mail him at [email protected]
Respiratory Product's company website can be found
at the following address: http :/ / www. eresp.com.
2oo7'sMassCasualtyDrillwas an Extraordinary
interact with one another aswell as
introducethemselvesto USA EMS
studentsfor recruitmentpuqposes.
This year that opportunitywas all the
more pleasantwith Charlie Erwin and
Unde Dave Faggardcooking up and
servinggrilled hotdogs and hamburgers
Everyonein EMS in the southwest
Alabama areais awareof the Mass
CasualtyIncident (MCI) drill held every
November for USlls basic and oaramedic
srudents.This year'sMCJ drill, held at
Mobile's Batdeship Park, was an
extraordinarysuccessasitwas larger and
utfized by more respondingagencies,
sfudentsand rescuersthan in anv orevious
years.Approximately130 EMS-students
and greaterthan 50 rescuersparticipated in
the drill. In addition, this yeals exercise
was adminisffated by USA's new Clinical
Coordinator, Charlotte Harlan. Charlotte
took the reins as Clinical Coordinator in
August after the former coordinator,
Charlie Erwin, was promoted to faculty
member and reassignedasthe Basic EMT
The MCI drill has traditionally been an
opporhrnity for areaEMS and fire
agenciesto participate, network and
on an especiallynice wood grill suppliedby
SpanishFort Fire Department. Our
department haslong recognizedthe
associationbetweena good cookoutmeal
and a successfirlMCI ddll - this year more
than proving that point.
Units from Mobile, Daphne, Foley,
SpanishFort and Orange Beach Fire
Departments aswell as ambulancecrews
from North Baldwin EMS, Mobile
County EMS, MedStar, Newmaris and
AMR Ambulance Servicesparticipated in
the mock disaster.This yeals scenariowas
a structural collapseof the "BayWay''
section oflnterstate 10. Also participating
were North Baldwin and Daohne Search
and Rescueteams. Daphrr.'r SAR t.urn
alsolaunched their boats for the simulation
which took placewithin yards of the Bay.
Wilson's Towing Serviceprovided three
wrecked carsasprops for the exercise,
which, asusual,took place after sundown.
Air support and transport were provided
by helicoptersfrom the local Coast Guard
unit and from Gulf Coast MedEvac.
USA Departmentof EMS Education and
its entire factlty, staffand student body
wish to thank all of the departments,
servicesand individuals who worked so
hard to make the 2007 Mass Casualty
Drill such a great success.
EMSNewsln Brief...
elind Rirway lnsertion Removedfrom Alabama
Reassignmentswithin the Department of EMS
In November 2007, the Alabama Department of Public
Health, Office of trMS and Trauma removed the privileges
of Alabama's EMT Basics to insert blind airway devices.
Blind insertion devices, such as Combi-Tubes and other
similar airways, are used to secure an unresponsive and
apneic patient's airway when endotracheal intubation by an
EMT Intermediate or Paramedic is not available or
achievable. Whereas no official explanation was given, it is
possible that changes at the national level encouraged the
from EMT Basics and that Alabama's
ikill'r ..-oval
Advanced Basic level will have the skill re-introduced along
with severalother advanced skills. The decision may also be
in responseto incidents where non-licensed Alabama first
t.rpond.t. and rescue squads acquired blind insertion
airways, which require off-line physician oversight to
ourchaseand maintain. Alabama EMT Basics continue to
te able to place oropharyngeal and nasopharyngeal airways
when needed.
Developments, happy and sad, within our Department
have resulted in some reassignments.The initiation of our
Bachelor's degree in EMS program resulted in the
reassignment of Lyndal Curry from her position as
trMT Basic Coordinator to the new position of EMS
Bachelor's Degree Program Coordinator. As stated above,
Chadie Erwin, after promotion to faculry, has been
reassignedto replace Lyndal as Basic trMT Coordinator.
Upon the departure of Vince Parker, Gary Varner, Research
Program Coordinator will be promoted to Paramedic
Program Director. Gary, who came to USA in 2002, is an
epidemiologist and will retain the duties of Research
Program Coordinator and will simultaneously perform the
role of Program Director beginning inJanuary 2008 - good
luck Gary! As this issue of The Responder goes to print,
David Burns and our department's faculty search committee
will begin the search process for a capable faculty member
to fill the position left vacant by Vince's departure.
CharlesErwin Completeshis Bachelo/s Degree
from USA
Charlie Erwin, who for yearshas faithfully servedthe
EMSEducationDepartmentparticipatesin Health
department as Clinical Coordinator, graduated from the
USA School of Continuing Education's Interdisciplinary
Studies Degree Program in May 2007. As a result, and
reward for years of service, he was promoted to full faculty
member of the department and reassiqned as the EMT
Grrrr.ry,"so call"edby some of us, is
Basic Coordinator.
a combat veteran of the United StatesMarine Corps and is
currently a reservist in the Coast Guard with a specialty in
port security. Never (ever) one to rest on his laurels, he is
now actively involved in earning his Master's degreein history
from the American Military University. Congranrlations
Charlie - Semper Fi!
Vince ParkerLeavesUSADepartmentof EMS
Vince Parker, Paramedic Program Director at USA since
January2003, recendy left the University to take on a similar
Dost at another institution closer to home. Mr. Parker had
been with the University for over T4years and servedin many
different capacitiesduring his tenure at USA. Over the years,
Vince has had a significant effect on hundreds of trMT and
paramedic students at USA and probably had an even greater
i-pact on the many patients that these students have cared
for since graduating from this program. Vince is an excellent
educator and a terrific mentor, not only to paramedic
students, but to young faculty and staff. We will certainly
miss his expertise and we wish him all the best in his new
In November 2007, department clinical staff and students
participated in the Mobile Chamber of Commerce's annual
Health Occupations Career Fair. This year's fair allowed
more than a thousand area high school students the
opportunity to participate in realistic simulations of healthrelated processes,such as prehospital emergency medical
operations, hospital emergency department and surgical
operations and pharmacy operations among others. In
addition to our department, participants included USA's
nursing, radiology, respiratory care and physical therapy
departments and the Mobile Fire-Rescue Department.
Hospitals participating included the USA system and
Mobile Infirmary system. Also participating was the
Auburn University/University of South Alabama pharmacy
pafticipatesin SchoolShootingDdll at
BakerHigh School
In October2007 USA's trMS studentsparticipatedas
"patients" at the city's mass casuaky drill conducted at Baker
High School. The scenariowas that of alarge number of high
school students wounded by gunmen while in school.
Clinical Coordinator Charlotte Hadan participated as an
evaluator of rescue operations. \Arhere it is unfortunate that
such contingencies must be anticipated and practiced for, we
applaud the City of Mobile for its efforts to provide more
efficient medical servicesto its citizens in the event of such
Newsfrom within the ParamedicProgram
In its consistent effort to orovide a better education and
service to its students and the community, the USA
Paramedic Program has made some noteworthy changes
during 2007. Severalclinical rotation siteshave been added to
the list of servicesand facilities who host the clinical education
exoerience of our students. Additions include Mobile
County EMS Rescue Squad, Mobile Infirmary System,
Thomas Hospital. North Baldwin trMS ambulance service
and North Baldwln Infirmary. A changewill also occur in the
clinical rotation phase of paramedic training beginning in
Summer Semesterof 2008. At present all ciinical internships
are comoleted within facilities in the next-to-last semester
(EMT 455) and all {ield internships in rescue servicesare
completed during the last semester(pUf a9fl.To lessenthe
physical burden upon the student and enhance the clinical
skills practice process,clinical internships will be divided over
an additional semester(EMT 455 is now trMT 465 &.466)
with field internships in rescueservicesremaining in the last
semesterin its present form. A process added to the clinical
skills practice process to enhance the successof computerbased National Registry Testing is the introduction of
Platinum Computer Adaptive Testing (EMSCAT) into the
training process.The service allows students to either take
online tests within the department under supervision or at
home to practice the processof computer adaptive testing
utilized by National Registry at both the Basic and
Paramedic ievels. The service allows our instructors to
evaluatestudent's progressby review, allowing counseling of
the student so that an optimum amount of time can be spent
reviewing areas of knowledge where the student is least
is highly
proficient. Statistically, success in EMSCAT
correlated with success in National
further ease the burden of USA
University is in the process of gaining certification to be a
Pearson\rUE testing center so that graduatesofthe program
can sit for National Registry testing at USA.
2 cupschoppedwalnuts(or pecans) ',
1 package(18.25oz)yellowcakemix
1 package(4 servingsize)instantvanilla
4 eggs
combinesugar,butter and
Meanwhile,in a smallsaucepan,
water and bring to a boil over medium heat; let boil for
5 minutes stirring often. Removefrom heat and allow to
cool.sli$dy; Add,,remainingrum (I use at least,1/3,,.cup).
, ,.
'tir ,,rAllow,thi,
iake to cool slightly then pokCrhofes,'in,
the top with a fork or ice pick.nd pooi the rum sauceover
the top of the cake.Allow the sauceto soakin and the cake
to cool completely,then invert onto a servingplate. Slice
and serve.Sprinklewith poweredsugarjustbeforeserving.
lf you haveaccessto a turkey bastinginjector,that works
much better to get the rum sauceinto the cake.I usea large
% cupspiced,ryndivided
/z cupvegetable
1 cupsugar
% cup(f stick)butter
Preheatthe oven to 350". Coat a 10" Bundt pan or 2,loaf
panswith nonstick cooking spray.Spreadl/z-of the nuts over
the bottom of the pan and set aside.Combine the cakeand
pudding mixes,eggs,nuts, l/: cup rum and the oil and mk
well in large bowl. Spoonover the nuts and bake for 45 - 50
minutes until toothpick comesout clean.
Chef is an annual article in The Responder
dedicatedto recipessubmittedby trMS personnelwith
whom we are acquainted.The recipescan be usedeasily
by personnelin fire or ambulancestationsto preparemeals
for hungry responderson dury - or by individuals to
providepleasantand nutritious mealsfor growing families.
W-e encourageany ofiour readersto submit recipesof their
own for considerationor to provide feedbackconcerning
with publishedrecipes.
their experiences
This year'srecipecomesfrom our own Lyndal Curry.
Of her many talents,Llndal is especiallygifted in making
This rum cakeis ALWAYS a big hit at facuity
fi,rnctions,especiallyour annual Christmasbrealdast.
Theoretically,the ium's alcohol denaruresduring the
cooking process,however,experimentationhas proven that
dependson how much you put in there - usethis recipe's
proportionsifyou are going to serve"on duty."
or feedback please e-.rnril
[email protected]
Universityof SouthAlabama
Departmentof EMS Educationand
Centerfor EmergencyResponseTraining
2002 Old Bay Front Drive
Mobile,AL 366'15-1427
DavidW. Burns,M.P.H.,EMT-P
FrankS. Pettyiohn,M.D.
Crr-it rrro-SOOI
SteveWhite, NREMT-P
€orey Biggs,NREMT-P
DavidW. Burns,M.P.H.,EMT-P
David Garmon, M.A.Ed.,NREMT-P
ProgramDirector/ EMS Region6
Lyndal Curry M.A., NREMT-P
ProgramDirector/ Bachelor'sDegreeProgram
Rob Maxwell, M.F.A.
Instructor/ CERTProgramCoordinator
Gary Varner,M.P.H.,NREMT-P
ProgramDirector / ParamedicProgram
Reggie Norton, EMT-B
Charlie Erwin, 8.A., NREMT-P
Faculty/ BasicEMT Coordinator
Paul Phillips, EMT-B
David Faggard,EMT-P
Bryant fohnson, EMT-B
Charlotte Harlan, NREMT'P
Clinical andField InternshipCoordinator
Ron Morgan, M.S.,NREMT-P
leff €arter, NREMT-P
Gail Knox