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Gil-Anton J, Mielgo VE, Rey-Santano C, Galbarriatu L, Santos C, Unceta M, López-Fernández Y, Redondo S, Morteruel E. Addition of terlipressin to initial volume resuscitation in a pediatric model of hemorrhagic shock improves hemodynamics and cerebral perfusion. PLoS One 2020; 15:e0235084. [PMID: 32614837 PMCID: PMC7332053 DOI: 10.1371/journal.pone.0235084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
Hemorrhagic shock is one of the leading causes of mortality and morbidity in pediatric trauma. Current treatment based on volume resuscitation is associated to adverse effects, and it has been proposed that vasopressors may be used in the pharmacological management of trauma. Terlipressin has demonstrated its usefulness in other pediatric critical care scenarios and its long half-life allows its use as a bolus in an outpatient critical settings. The aim of this study was to analyze whether the addition of a dose of terlipressin to the initial volume expansion produces an improvement in hemodynamic and cerebral perfusion at early stages of hemorrhagic shock in an infant animal model. We conducted an experimental randomized animal study with 1-month old pigs. After 30 minutes of hypotension (mean arterial blood pressure [MAP]<45 mmHg) induced by the withdrawal of blood over 30 min, animals were randomized to receive either normal saline (NS) 30 mL/kg (n = 8) or a bolus of 20 mcg/kg of terlipressin plus 30 mL/kg of normal saline (TP) (n = 8). Global hemodynamic and cerebral monitoring parameters, brain damage markers and histology samples were compared. After controlled bleeding, significant decreases were observed in MAP, cardiac index (CI), central venous pressure, global end-diastolic volume index (GEDI), left cardiac output index, SvO2, intracranial pressure, carotid blood flow, bispectral index (BIS), cerebral perfusion pressure (CPP) and increases in systemic vascular resistance index, heart rate and lactate. After treatment, MAP, GEDI, CI, CPP and BIS remained significantly higher in the TP group. The addition of a dose of terlipressin to initial fluid resuscitation was associated with hemodynamic improvement, intracranial pressure maintenance and better cerebral perfusion, which would mean protection from ischemic injury. Brain monitoring through BIS was able to detect changes caused by hemorrhagic shock and treatment.
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Affiliation(s)
- Javier Gil-Anton
- Department of Pediatric, Pediatric Intensive Care Unit. Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of Basque Country, UPV/EHU, Barakaldo, Bizkaia, Spain
- * E-mail: (VEM); (JGA)
| | - Victoria E. Mielgo
- Animal Research Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- * E-mail: (VEM); (JGA)
| | - Carmen Rey-Santano
- Animal Research Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Lara Galbarriatu
- Department of Neurosurgery, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Carlos Santos
- Department of Neurophysiology, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Maria Unceta
- Biochemistry Laboratory, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Yolanda López-Fernández
- Pediatric Intensive Care Unit. Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Silvia Redondo
- Pediatric Intensive Care Unit. Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Elvira Morteruel
- Pediatric Intensive Care Unit. Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
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Organisation de la réanimation « hors les murs » en salle de surveillance post-interventionnelle et au bloc opératoire en phase d’épidémie de COVID-19. ANESTHÉSIE & RÉANIMATION 2020. [PMCID: PMC7311908 DOI: 10.1016/j.anrea.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nous rapportons la mise en place et l’utilisation pendant 24 jours de lits de réanimation « hors les murs » à l’occasion de l’épidémie de COVID-19 dans un hôpital universitaire parisien. Ces lits créés dans une salle de surveillance post-interventionnelle de 14 postes et dans deux blocs opératoires attenants ont permis l’ouverture de 20 lits supplémentaires de réanimation. Les aspects chronologiques, architecturaux, de ressources humaines, d’organisation et de matériel sont présentés. Les avantages et inconvénients de cette organisation sont discutés.
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Maqungo S, Kauta N, Held M, Mazibuko T, Keel MJ, Laubscher M, Ahmad SS. Gunshot injuries to the lower extremities: Issues, controversies and algorithm of management. Injury 2020; 51:1426-1431. [PMID: 32471684 DOI: 10.1016/j.injury.2020.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023]
Abstract
Civilian gunshot violence is common and concentrated in specific geographic regions of the world, consuming a significant proportion of trauma practice in those particular regions. Unfortunately, the state of clinical evidence is scarce, and it is fair to emphasize that the field is scientifically under-represented. In the current review, the authors point out key aspects and principles requiring attention when treating low energy gunshot wounds to the lower extremity. These treatment principles include the following management concepts: 1) Conservative management of soft tissue injuries if the projectile causes no discomfort. 2) Conservative management of non-complete fractures of the tibia or femoral shaft. 3) Prophylactic fixation of non-complete peri-trochanteric fractures. 4) Fixation of allcomplete fractures. 5) Removal of all intra-articular projectiles. 6) Treating as septic arthritis if the missile passes through large bowel (not small bowel) prior to penetrating a joint capsule. The proposed concepts are based on available evidence from the literature and expert opinion. The authors also highlight challenges with conducting clinical studies in the field, given the high rate of 'loss to follow-up' and compliance issues in this particular group of patients.
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Affiliation(s)
- Sithombo Maqungo
- OrthoBallistics Research Centre, Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
| | - Ntambue Kauta
- OrthoBallistics Research Centre, Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
| | - Michael Held
- OrthoBallistics Research Centre, Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
| | - Tamsanqa Mazibuko
- Department of Orthopaedic Surgery, Charlotte Maxeke Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Marius Jb Keel
- Department of Orthopaedic Surgery & Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Maritz Laubscher
- OrthoBallistics Research Centre, Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
| | - Sufian S Ahmad
- OrthoBallistics Research Centre, Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa; Department of Orthopaedic Surgery & Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland; BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany.
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Montmeat D, Gard C, Raux M, Constantin JM, Tilleul P. Shortage of sedatives and neuromuscular blockers during COVID-19 pandemic: The result of an overstocking procedure in French hospitals? Anaesth Crit Care Pain Med 2020; 39:585-586. [PMID: 32654910 PMCID: PMC7326429 DOI: 10.1016/j.accpm.2020.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Déborah Montmeat
- DMU ESPRIT, pharmacy, Pitié-Salpêtrière hospital, AP-HP, Paris, France
| | - Claudine Gard
- DMU ESPRIT, pharmacy, Pitié-Salpêtrière hospital, AP-HP, Paris, France
| | - Mathieu Raux
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Michel Constantin
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.
| | - Patrick Tilleul
- DMU ESPRIT, pharmacy, faculté de pharmacie de Paris, Pitié-Salpêtrière hospital, AP-HP, Paris, France
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Tambone V, Boudreau D, Ciccozzi M, Sanders K, Campanozzi LL, Wathuta J, Violante L, Cauda R, Petrini C, Abbate A, Alloni R, Argemi J, Argemí Renom J, De Benedictis A, Galerneau F, García-Sánchez E, Ghilardi G, Hafler JP, Linden M, Marcos A, Onetti Muda A, Pandolfi M, Pelaccia T, Picozzi M, Revello RO, Ricci G, Rohrbaugh R, Rossi P, Sirignano A, Spagnolo AG, Stammers T, Velázquez L, Agazzi E, Mercurio M. Ethical Criteria for the Admission and Management of Patients in the ICU Under Conditions of Limited Medical Resources: A Shared International Proposal in View of the COVID-19 Pandemic. Front Public Health 2020; 8:284. [PMID: 32612972 PMCID: PMC7308475 DOI: 10.3389/fpubh.2020.00284] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vittoradolfo Tambone
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Donald Boudreau
- Department of Medicine, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Massimo Ciccozzi
- Research Unit of Medical Statistic and Molecular Epidemiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Karen Sanders
- Department of Business, Law and Society, St Mary's University, London, United Kingdom
| | - Laura Leondina Campanozzi
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Jane Wathuta
- Institute for Family Studies & Ethics, Strathmore University, Nairobi, Kenya
| | | | - Roberto Cauda
- Section of Infection Diseases, Department of Healthcare Surveillance and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Petrini
- Bioethics Unit, Italian National Institute of Health, Rome, Italy
| | - Antonio Abbate
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Rossana Alloni
- Hospital Clinical Direction, Campus Bio-Medico University of Rome, Rome, Italy
| | - Josepmaria Argemi
- Division of Medicine, Gastroenterology and Hepatology Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Josep Argemí Renom
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna De Benedictis
- Hospital Clinical Direction, Campus Bio-Medico University of Rome, Rome, Italy
| | - France Galerneau
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Emilio García-Sánchez
- Department of Political Sciences, Ethics and Sociology, University CEU Cardenal Herrera, Valencia, Spain
| | - Giampaolo Ghilardi
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Janet Palmer Hafler
- Teaching and Learning Center, Yale University School of Medicine, New Haven, CT, United States
| | - Magdalena Linden
- Department of Medicine, Solna, Karolinska Institutet, Center for Molecular Medicine, Stockholm, Sweden
| | - Alfredo Marcos
- Department of Philosophy, Universidad de Valladolid, Valladolid, Spain
| | - Andrea Onetti Muda
- Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Pandolfi
- Fondazione Leonardo, Civiltà delle Macchine, Rome, Italy
| | - Thierry Pelaccia
- Prehospital Emergency Medical Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
| | - Mario Picozzi
- Center for Clinical Ethics, Insubria University, Varese, Italy
| | - Ruben Oscar Revello
- Instituto de Bioética de la Facultad de Ciencias Médica, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | | | - Robert Rohrbaugh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Patrizio Rossi
- Central Medical Department, National Institute for Insurance against Accidents at Work (INAIL), Rome, Italy
| | | | | | - Trevor Stammers
- Centre for Bioethics and Emerging Technologies, Institute of Theology, St Mary's University, London, United Kingdom
| | - Lourdes Velázquez
- Interdisciplinary Bioethics Center, Universidad Panamericana, Mexico City, Mexico
| | - Evandro Agazzi
- Interdisciplinary Bioethics Center, Universidad Panamericana, Mexico City, Mexico
| | - Mark Mercurio
- Program for Biomedical Ethics, Yale University School of Medicine, New Haven, CT, United States
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Skryabina EA, Betts N, Reedy G, Riley P, Amlôt R. The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2020; 46:101503. [PMID: 33312855 PMCID: PMC7709486 DOI: 10.1016/j.ijdrr.2020.101503] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 06/12/2023]
Abstract
Simulation exercises are an important part of emergency preparedness activities for the healthcare community but evidence of their impact on the response to real major incidents is limited. This project studied the impact of health emergency preparedness exercises (HEPEs) on the response to a mass casualty terrorist incident. The mixed methods study design was adopted comprising an on-line survey and follow up individual interviews. Participants were healthcare staff who took part in responses to three major terrorist incidents in the UK in 2017. Descriptive statistics and analysis of variance were undertaken with quantitative data. Content and thematic analysis methods were used for qualitative data analysis. The online survey generated 86 responses; 79 (92%) were from the responders to the Manchester Arena bombing. Twenty-one survey respondents shared their experiences in in-depth interviews. Healthcare staff who took part in HEPEs felt better prepared to respond than those who did not attend an exercise. The most commonly reported benefits from HEPEs were awareness of major incident plans and having the opportunity to practice responding to a similar scenario in the recent exercise. Specific benefits included: improved coordination of the response through adherence to recently practiced incident plans; confidence with response roles; real-time modifications of the response and support provided to staff who did not take part in exercises. Exercise recency was highlighted as an important facilitating factor. The study provides strong objective evidence that the response to a mass casualty terrorist incident was enhanced by training and service development achieved through HEPEs.
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Affiliation(s)
- Elena A. Skryabina
- Behavioural Science, Emergency Response Department Science & Technology, Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
- Emergency Response Department Science & Technology, Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Naomi Betts
- Behavioural Science, Emergency Response Department Science & Technology, Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
- Emergency Response Department Science & Technology, Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Gabriel Reedy
- Faculty of Life Science and Medicine, King's College London, Waterloo Bridge Wing 5.14, London, SE1 8WA, UK
| | - Paul Riley
- Principal Expert Emergency Preparedness and Response, European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
| | - Richard Amlôt
- Behavioural Science, Emergency Response Department Science & Technology, Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
- Emergency Response Department Science & Technology, Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
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Soussy N, Dufayet L, Rey-Salmon C, Gorgiard C. The attack on November 13, 2015: organisation of the medico-judicial unit of the Hôtel-Dieu Hospital in Paris. Forensic Sci Res 2020; 5:232-235. [PMID: 33209507 PMCID: PMC7646567 DOI: 10.1080/20961790.2020.1768629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The main aims of a medico-judicial unit are to ensure the examination of assault victims or persons in custody and to perform sampling necessary for investigations. Forensic examination is essential to describe the wounds and to evaluate the consequences of an assault by determining days of total incapacity for work (ITT). After the Paris attack on November 13, 2015, 121 victims were examined at the medico-judicial units of Paris. An initial forensic certificate was issued by forensic physicians with an assessment of physical ITT. A consultation with a forensic psychiatrist was systematically scheduled on the same day to obtain a forensic certificate for the psychological ITT. The average age of the victims was (33 ± 7) years and the sex ratio was 1.26. Most victims were in the Bataclan concert hall (78/121 or 64.5%). Of the 121 victims, 73 (60.3%) had projectile lesions (bullets, bolts and nuts, metal fragments, etc.) and 48 (39.7%) had non-projectile lesions (bruises, hematomas, etc.). The average physical ITT was 27 days (0; 190). The evaluation of the number of days of physical ITT was often complicated as some patients were still in medical care at the time of the initial examination. This experience enabled the Paris medico-judicial unit to anticipate the management required should any future event of this magnitude occur. It also reinforced cooperation between the medico-judicial unit and other departments, mostly emergency services and the forensic psychiatric unit. The Paris medico-judicial unit was thus able to offer a unique place of care by providing both physical and psychological examinations.
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Affiliation(s)
- Nicolas Soussy
- Medico-Judicial Unit, Hôpital Hôtel-Dieu de Paris, APHP, Paris, France
| | - Laurène Dufayet
- Medico-Judicial Unit, Hôpital Hôtel-Dieu de Paris, APHP, Paris, France.,Centre AntiPoison et de Toxicovigilance, Hôpital Fernand Widal, APHP, Paris, France
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Güsgen C, Anger F, Hauer T, Willms A, Buhr HJ, Germer CT, Schwab R, Lock JF. [Advanced training of general and visceral surgeons in life-saving emergency surgery : Results of a survey among participants of a surgery course]. Chirurg 2020; 91:1044-1052. [PMID: 32313966 PMCID: PMC7716888 DOI: 10.1007/s00104-020-01170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hintergrund Die geringe Anzahl operativ zu versorgender Körperhöhlenverletzungen erfordert ein Umdenken in der chirurgischen Aus- und Weiterbildung. Ein entsprechendes Kursformat wird seit 2014 über die DGAV angeboten. Um Berechtigung, Bedarf, Nutzen und Erfolg eines solchen Kursformates zu erheben, erfolgte eine Evaluation durch die bisherigen Kursteilnehmer. Material und Methoden Kursevaluation und zusätzliche Onlinebefragung der bisherigen Kursteilnehmer hinsichtlich Alter, Geschlecht, Ausbildungsstand, Fachrichtung, Versorgungsstufe des Krankenhauses, notfallchirurgischer Erfahrungen, der Häufigkeit chirurgischer Notfallversorgungen, Teilnahme an anderen Kursformaten, Erfahrungen nach der Kursteilnahme, Einschätzung der aktuellen Fort- und Weiterbildungssituation und Finanzierung solcher Kurse. Ergebnisse Insgesamt 142 Kursteilnehmer evaluierten ihre Kursteilnahme, zusätzlich beantworteten 83 den Onlinefragebogen. Über 90 % berichteten von einem nachhaltigen positiven Einfluss des Kurses auf ihr notfallchirurgisches Handeln. Mehr als die Hälfte konnte von konkreten Notfallsituationen berichten, die sie aufgrund der Kursteilnahme besser bewältigen konnten. In der Notfallversorgung erfahrene Chirurgen bewerteten den eigenen Lernerfolg durch die Kursteilnahme signifikant häufiger positiv als ihre weniger erfahrenen Kollegen. Keinen Einfluss auf den Lernerfolg hatten eine Ober- oder Chefarztposition, die Versorgungsstufe des Krankenhauses, das Alter oder Geschlecht der Teilnehmer. Die Mehrheit der antwortenden Chirurgen befürwortet die Integration eines solchen Kursformates in die chirurgische Weiterbildung und fordert hierzu eine finanzielle Unterstützung. Schlussfolgerung Kursformate, in denen notfallchirurgische Strategien und Fähigkeiten vermittelt werden, sind etabliert und werden sehr positiv evaluiert. Die Fort- und Weiterbildung in notfallchirurgischen Fähigkeiten und Kenntnissen liegt im gesellschaftlichen Interesse und zumindest anteilig auch in ihrer Verantwortung.
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Affiliation(s)
- C Güsgen
- Klinik für Allgemein- Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - F Anger
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - T Hauer
- Klinik für Allgemein- und Viszeralchirurgie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | - A Willms
- Klinik für Allgemein- Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - H J Buhr
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Deutschland
| | - C-T Germer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - R Schwab
- Klinik für Allgemein- Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - J F Lock
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland.
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Usero-Pérez MDC, Jiménez-Rodríguez ML, González-Aguña A, González-Alonso V, Orbañanos-Peiro L, Santamaría-García JM, Gómez-González JL. Validation of an evaluation instrument for responders in tactical casualty care simulations. Rev Lat Am Enfermagem 2020; 28:e3251. [PMID: 32321042 PMCID: PMC7164920 DOI: 10.1590/1518-8345.3052.3251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 10/23/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE to construct and validate a tool for the evaluation of responders in tactical casualty care simulations. METHOD three rubrics for the application of a tourniquet, an emergency bandage and haemostatic agents recommended by the Hartford Consensus were developed and validated. Validity and reliability were studied. Validation was performed by 4 experts in the field and 36 nursing participants who were selected through convenience sampling. Three rubrics with 8 items were evaluated (except for the application of an emergency bandage, for which 7 items were evaluated). Each simulation was evaluated by 3 experts. RESULTS an excellent score was obtained for the correlation index for the 3 simulations and 2 levels that were evaluated (competent and expert). The mean score for the application of a tourniquet was 0.897, the mean score for the application of an emergency bandage was 0.982, and the mean score for the application of topical haemostats was 0.805. CONCLUSION this instrument for the evaluation of nurses in tactical casualty care simulations is considered useful, valid and reliable for training in a prehospital setting for both professionals who lack experience in tactical casualty care and those who are considered to be experts.
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Affiliation(s)
| | | | - Alexandra González-Aguña
- Universidad de Alcalá de Henares, Facultad de Ciencias de la
Computación, Alcalá de Henares, Madrid, Madrid, Spain
| | | | | | - Jose María Santamaría-García
- Universidad de Alcalá de Henares, Facultad de Ciencias de la
Computación, Alcalá de Henares, Madrid, Madrid, Spain
| | - Jorge Luís Gómez-González
- Universidad de Alcalá de Henares, Facultad de Ciencias de la
Computación, Alcalá de Henares, Madrid, Madrid, Spain
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Wurmb T, Kippnich M, Schwarzmann G, Mehlhase J, Valotis A, Firnkes T, Braungardt J, Ertl G. [Complete information technology blackout in hospitals : Development of a concept for maintaining patient care]. Unfallchirurg 2020; 123:443-452. [PMID: 32270220 DOI: 10.1007/s00113-020-00797-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The complete blackout of information technology (IT) in a hospital represents a major incident with acute loss of functionality. The immediate consequence is a rapidly progressive loss of treatment capacity. The major priority for the acute management of such an event is to keep patients safe and prevent life-threatening situations. A possibility to channel the uncontrolled loss of treatment capacity in order to achieve the aforementioned protective target is the immediate organization of an analog system for baseline emergency medical care. The switch over from a fully operational routinely functioning system to a reduced emergency state occurs daily in hospitals (night shift, weekends, public holidays) and reflects the controlled reduction of the treatment capacity. This process and the procedures associated with it are universally known, the functions are clearly defined and planned in advance by duty rotas and the interplay of clinics in the organizational schedule is regulated in detail. In order to accomplish this strategy analog instruments are necessary. These must all be conceived, established, practiced and evaluated in advance with the clinics and departments. Ultimately, all isolated IT blackout concepts must be amalgamated into a compatible and functioning total framework. This structure must be maintained for as long as a partially or totally functioning IT has been reinstated.
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Affiliation(s)
- T Wurmb
- Sektion Notfall- und Katastrophenmedizin der Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Deutschland.
- Deutsche Arbeitsgemeinschaft Krankenhaus Einsatzplanung, DAKEP e. V., Köln, Deutschland.
| | - M Kippnich
- Sektion Notfall- und Katastrophenmedizin der Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Deutschland
| | - G Schwarzmann
- Stabsstelle Qualitätsmanagement, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - J Mehlhase
- Servicezentrum Medizin-Informatik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Valotis
- Stabsstelle Medizinsicherheit, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - T Firnkes
- Geschäftsbereich Logistik, Einkauf und Liegenschaften, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - J Braungardt
- Geschäftsbereich Technik und Bau, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - G Ertl
- Universitätsklinikum Würzburg, Würzburg, Deutschland
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Emergency response to terrorist attacks: results of the federal-conducted evaluation process in Germany. Eur J Trauma Emerg Surg 2020; 46:725-730. [PMID: 32206880 PMCID: PMC7429537 DOI: 10.1007/s00068-020-01347-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/10/2020] [Indexed: 11/04/2022]
Abstract
Purpose Rescue missions during terrorist attacks are extremely challenging for all rescue forces (police as well as non-police forces) involved. To improve the quality and safety of the rescue missions during an active killing event, it is obligatory to adapt common rescue mission goals and strategies. Methods After the recent attacks in Europe, the Federal Office of Civil Protection and Disaster Assistance started an evaluation process on behalf of the Federal Ministry of the Interior and the Federal Ministry of Health. This was done to identify weaknesses, lessons learned and to formulate new adapted guidelines. Results The presented bullet point recommendations summarise the basic and most important results of the ongoing evaluation process for the Federal Republic of Germany. The safety of all the rescue forces and survival of the greatest possible number of casualties are the priority goals. Furthermore, the preservation and re-establishment of the socio-political integrity are the overarching goals of the management of active killing events. Strategic incident priorities are to stop the killing and to save as much lives as possible. The early identification and prioritised transportation of casualties with life-threatening non-controllable bleeding are major tasks and the shortest possible on-scene time is an important requirement with respect to safety issues. Conclusion With respect to hazard prevention tactics within Germany, we attributed the highest priority impact to the bullet points. The focus of the process has now shifted to intense work about possible solutions for the identified deficits and implementation strategies of such solutions during mass killing incidents.
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O’Connor P. ASPiH Conference 2019 keynote paper. Quality improvement through simulation: a missed opportunity? BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:193-195. [DOI: 10.1136/bmjstel-2020-000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 11/04/2022]
Abstract
As the use of simulation has become more established in the delivery of healthcare education and training, there has been a corresponding increase in healthcare simulation research. Simulation-based research can be divided into research about simulation (answers research questions in which the focus is on simulation itself) and research through simulation (simulation as a method/tool for research). However, there are barriers, particularly for smaller less well-resourced simulation centres, that may prohibit participation in research. Therefore, it is suggested that quality improvement (QI) through simulation may be a pragmatic way in which simulation centres of all sizes can contribute to improving patient care beyond education and training. QI is defined as systematic, data-guided activities designed to bring about immediate, positive changes in the delivery of healthcare. Although not the case in healthcare, other industries routinely used simulation to support QI. For example, in aviation simulation is used to inform the design of the working environment, the appropriate use of technology, to exercise emergency procedures and to ‘re-fly’ flights following an adverse event as part of the mishap investigation. Integrating simulation within healthcare QI can support the development of novel interventions as well helping to address heretofore intractable issues.
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Smith D, Walters EL, Reibling E, Brockie D, Lee C, Neeki M, Ochoa H, Henson T, Fisgus J, Thomas T. UNIFIED: Understanding New Information from Emergency Departments Involved in the San Bernardino Terrorist Attack. West J Emerg Med 2020; 21:382-390. [PMID: 32191197 PMCID: PMC7081877 DOI: 10.5811/westjem.2019.11.43437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/18/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Emergency departments (ED) are on the front line for treating victims of multi-casualty incidents. The primary objective of this study was to gather and detail the common experiences from those hospital-based health professionals directly involved in the response to the San Bernardino terrorism attack on December 2, 2015. Secondary objectives included gathering information on experiences participants found were best practices. METHODS We undertook a qualitative study using Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines by performing semi-structured interviews with physicians, nurses, and incident management staff from multiple institutions responding to the San Bernardino terrorist attack. We coded transcripts using qualitative analysis techniques and we delineated and agreed upon a refined list with code definitions using a negotiated group process. Final themes were developed and analyzed. RESULTS A total of 26 interviews were completed; 1172 excerpts were coded and categorized into 66 initial themes. Six final categories of communication, training, unexpected help, process bypassed, personal impact/emotions, and practical advice resulted. CONCLUSION Our study provides context regarding the response of healthcare personnel from multiple institutions to a singular terrorist attack in the United States. It elucidates several themes to help other institutions prepare for similar events. Understanding these common experiences provides opportunity to prepare for future incidents and develop questions to study in future events.
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Affiliation(s)
- Dustin Smith
- Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California
| | - Elizabeth L Walters
- Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California
| | - Ellen Reibling
- Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California
| | - Darren Brockie
- Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California
| | - Carol Lee
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Michael Neeki
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Humberto Ochoa
- Riverside University Health System, Department of Emergency Medicine, Moreno Valley, California
| | - Travis Henson
- St. Bernardine's Medical Center, Department of Emergency Medicine, San Bernardino, California
| | - James Fisgus
- San Antonio Regional Hospital, Department of Emergency Medicine, Upland, California
| | - Tammi Thomas
- Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California
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Motreff Y, Baubet T, Pirard P, Rabet G, Petitclerc M, Stene LE, Vuillermoz C, Chauvin P, Vandentorren S. Factors associated with PTSD and partial PTSD among first responders following the Paris terror attacks in November 2015. J Psychiatr Res 2020; 121:143-150. [PMID: 31821960 DOI: 10.1016/j.jpsychires.2019.11.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/10/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
During the evening of 13 November 2015, the deadliest terror attacks in France in recent times occurred in the Paris area. Overall, 130 people were killed, 643 were physically injured and several thousands were psychologically impacted. Thousands of first responders, including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on first responders in terms of post-traumatic stress disorder (PTSD) and partial PTSD as well as associated factors 12 months after the 13 November 2015 terrorist attacks. First responders who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of PTSD. PTSD and partial PTSD were measured using the PCL-5. Gender, age, educational level, exposure, first responder category, mental health and traumatic event history, training and social support were all analysed as potential factors associated with PTSD and partial PTSD, using multinomial logistic regression. Overall, 663 participants were included in this analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers and prevalence of partial PTSD from 10.4% among health professionals to 23.2% among police officers. Low educational level and social isolation were associated with PTSD and partial PTSD. Intervention on unsecured crime scenes and lack of training were associated with PTSD. Special attention should be given to first responders living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes. Education and training about the potential mental health consequences of mass trauma intervention should be developed.
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Affiliation(s)
- Yvon Motreff
- Santé publique France, Direction des maladies non transmissibles et traumatismes, F-94415 Saint-Maurice, France; Sorbonne Université, Inserm, Institut Pierre Louis D'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012, Paris, France.
| | - Thierry Baubet
- CESP Inserm 1178, Université Paris 13, Paris, France; Psychopathology Department for Children, Adolescents, General Psychiatry and Specialized Addiction, APHP Hôpital Avicenne, F93009, Bobigny, France; Centre National de Ressources et de Résilience (CNRR), Paris, France
| | - Philippe Pirard
- Santé publique France, Direction des maladies non transmissibles et traumatismes, F-94415 Saint-Maurice, France; CESP Inserm 1178, Université Paris 13, Paris, France
| | - Gabrielle Rabet
- Santé publique France, Direction appui traitements et analyses des données, F-94415 Saint-Maurice, France
| | - Matthieu Petitclerc
- Service Médical D'urgence - Bureau de Santé et de Prévention, Brigade de Sapeurs-pompiers de Paris, 1, Place Jules-Renard, 75017, Paris, France; Université Paris 13, Ecole Doctorale Erasme, Laboratoire UTRPP, F93430, Villetaneuse, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Cécile Vuillermoz
- Centre National de La Recherche Scientifique (CNRS), Équipe de Recherche sur Les Inégalités Sociales - Centre Maurice Halbwachs (CNRS-UMR8097, EHESS, ENS), Paris, France
| | - Pierre Chauvin
- Sorbonne Université, Inserm, Institut Pierre Louis D'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012, Paris, France
| | - Stéphanie Vandentorren
- Sorbonne Université, Inserm, Institut Pierre Louis D'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012, Paris, France; Santé publique France, Direction des régions, F-94415 Saint-Maurice, France
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2015 Paris terrorist attacks: Care guidance for the massive influx of psychologically traumatized civilian casualties. Helping victims to develop their capacity to create a safe and protective environment by leveraging social resources like family, and inner resources like mindfulness should optimize global resilience. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
INTRODUCTION Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed. METHODS Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs). DISCUSSION Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and "tactical triage." CONCLUSION Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.
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van der Wal H, van Dongen TTCF, Vermeulen CFW, Bruce JL, Bekker W, Manchev V, Kong V, van Waes OJF, Clarke DL, Hoencamp R. Developing a blueprint for a civilian-military collaborative program in trauma training for Northern European countries: A South African experience. Injury 2020; 51:70-75. [PMID: 31400810 DOI: 10.1016/j.injury.2019.07.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/22/2019] [Accepted: 07/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent terrorist attacks and mass shooting incidents in major European and North American cities have shown the unexpected influx of large volumes of patients with complex multi-system injuries. The rise of subspecialisation and the low violence-related penetrating injuries among European cities, show the reality that most surgical programs are unable to provide sufficient exposure to penetrating and blast injuries. The aim of this study is to describe and create a collaborative program between a major South African trauma service and a NATO country military medical service, with synergistic effect on both partners. This program includes comprehensive cross-disciplinary training & teaching, and scientific research. METHODS This is a retrospective descriptive study. The Pietermaritzburg hospital and Netherlands military trauma register databases were used for analysing patient data: Pietermaritzburg between September 2015 and August 2016, Iraq between May and July 2018 and Afghanistan from 2006 to 2010. Interviews were held to analyse the mutual benefits of the program. RESULTS From the Pietermaritzburg study, mutual benefits focus on social responsibility, exchange of knowledge and experience and further mutual exploration. The comparison showed the numbers of surgical procedures over a one-month period performed in Iraq 12.7, in Afghanistan 68.8 and in Pietermaritzburg 152. CONCLUSION This study has shown a significant volume of penetrating trauma in South Africa, that can provide substantial exposure over a relatively short period. This help to prepare civilian and military surgeons and deployable military medical personnel for casualties with blast - and/or penetrating injuries. The aforementioned findings and the willingness to shape the mutual benefits, create a platform for trauma electives, research, education and training.
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Affiliation(s)
- Henk van der Wal
- Institute for Defence and Partner Hospitals, Ministry of Defence, Utrecht, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Defence Healthcare Organization, Ministry of Defence, Utrecht, the Netherlands.
| | - Thijs T C F van Dongen
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands; Division of Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Defence Healthcare Organization, Ministry of Defence, Utrecht, the Netherlands
| | - Christine F W Vermeulen
- Institute for Defence and Partner Hospitals, Ministry of Defence, Utrecht, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Vascular Section, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - John L Bruce
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Wanda Bekker
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Vassil Manchev
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Victor Kong
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa; Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Oscar J F van Waes
- Institute for Defence and Partner Hospitals, Ministry of Defence, Utrecht, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Damian L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa; Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands; Division of Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Defence Healthcare Organization, Ministry of Defence, Utrecht, the Netherlands
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Kashani P, Saberinia A. Management of multiple traumas in emergency medicine department: A review. J Family Med Prim Care 2019; 8:3789-3797. [PMID: 31879615 PMCID: PMC6924209 DOI: 10.4103/jfmpc.jfmpc_774_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/16/2019] [Accepted: 10/09/2019] [Indexed: 11/04/2022] Open
Abstract
One of the main causes of adults' disability during their working age is multiple trauma. The process of medical care of patients who are injured seriously is still a challenging job. The primary treatment of these patients in the emergency medicine departments is the most required choice after the wilderness first aid and also would be very required before definitive care in the hospital. The main aim of emergency medicine departments is quick recognition and treatment of injuries which pose severe threat to patients' life in appropriate order of priority. The procedure of primary evaluation in emergency medicine department with the help of medical routine examination and ultrasonography is based on the concept of focused assessment with sonography in trauma (FAST) for identifying spontaneous intraperitoneal hemorrhage. Emergency patients who suffer from massive hematothorax, serious lung and heart traumas, and penetrating traumas to the chest would undergo thoracotomy and patients who have few symptoms of perforated hollow viscous will undergo emergency laparotomy. Based on the trauma severity, emergency treatment could be the way to fast recovery of the structure of injured organ and its function. The subsequent goal, in the acute phase, will concentrate on preventing and stopping bleeding and secondary injuries like painful compartment syndrome or intra-abdominal infections (IAIs). However, the main aim of emergency medicine department in taking care of severely injured patients is the management of airway, protecting circulation and breathing, identification of neurologic problems, and whole body clinical examination with the help of healthcare providers.
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Affiliation(s)
- Parvin Kashani
- Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran
| | - Amin Saberinia
- Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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McDonald Johnston A, Alderman JE. Thoracic Injury in Patients Injured by Explosions on the Battlefield and in Terrorist Incidents. Chest 2019; 157:888-897. [PMID: 31605701 DOI: 10.1016/j.chest.2019.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 09/02/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022] Open
Abstract
Thoracic injury is common on the battlefield and in terrorist attacks, occurring in 10% to 70% of patients depending on the type of weapons used. Typical injuries seen include bullet, blast, and fragment injuries to the thorax, which are often associated with injuries to other parts of the body. Initial treatment prehospital and in the ED is carried out according to the principles of Tactical Combat Casualty Care or other standard trauma management systems. Immediately life-threatening problems including catastrophic hemorrhage are dealt with rapidly, and early consideration is given to CT scanning or rapid surgical intervention where appropriate. All patients should be given lung-protective ventilation. Treatment of these patients in the critical care unit is complicated by the severity of associated injuries and by features specific to combat trauma including blast lung injury, a high incidence of delirium, unusual infections such as colonization with multidrug-resistant Acinetobacter baumannii complex, and sometimes invasive fungal infections. A minority of patients with blast lung injury in published series have been successfully treated with prolonged respiratory support with high-frequency oscillatory ventilation and extracorporeal membrane oxygenation. The role of newer treatment options such as resuscitative endovascular balloon occlusion of the aorta is not yet known. In this article we review the relatively sparse literature on this group of patients and provide practical advice based on the literature and our institution's extensive experience of managing battlefield casualties.
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Affiliation(s)
- Andrew McDonald Johnston
- Department of Anaesthesia and Intensive Care Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK; Birmingham Acute Care Research, University of Birmingham, Birmingham, UK; Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK.
| | - Joseph Edward Alderman
- Department of Anaesthesia and Intensive Care Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK; Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
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Showstark M. Mass Shootings and Health Care. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Analysis of the medical response to November 2015 Paris terrorist attacks: resource utilization according to the cause of injury. Intensive Care Med 2019; 45:1231-1240. [PMID: 31418059 DOI: 10.1007/s00134-019-05724-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The majority of terrorist acts are carried out by explosion or shooting. The objective of this study was first, to describe the management implemented to treat a large number of casualties and their flow together with the injuries observed, and second, to compare these resources according to the mechanism of trauma. METHODS This retrospective cohort study collected medical data from all casualties of the attacks on November 13th 2015 in Paris, France, with physical injuries, who arrived alive at any hospital within the first 24 h after the events. Casualties were divided into two groups: explosion injuries and gunshot wounds. RESULTS 337 casualties were admitted to hospital, 286 (85%) from gunshot wounds and 51 (15%) from explosions. Gunshot casualties had more severe injuries and required more in-hospital resources than explosion casualties. Emergency surgery was required in 181 (54%) casualties and was more frequent for gunshot wounds than explosion injuries (57% vs. 35%, p < 0·01). The types of main surgery needed and their delay following hospital admission were as follows: orthopedic [n = 107 (57%); median 744 min]; general [n = 27 (15%); 90 min]; vascular [n = 19 (10%); median 53 min]; thoracic [n = 19 (10%); 646 min]; and neurosurgery [n = 4 (2%); 198 min]. CONCLUSION The resources required to deal with a terrorist attack vary according to the mechanism of trauma. Our study provides a template to estimate the proportion of various types of surgical resources needed overall, as well as their time frame in a terrorist multisite and multitype attack. FUNDING Assistance Publique-Hôpitaux de Paris.
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Abstract
Anthropogenic disasters may be defined as any disaster caused by human action or inaction. Natural disasters occur without human interference. Injuries caused by terrorists and related criminal activities may be broadly grouped into 3 categories: blunt, blast, and penetrating trauma. Most terrorist and criminal activities that create a mass-casualty situation are performed using the weapons most readily available, such as firearms or explosives. A consistent pattern, comparing terrorism with interpersonal violence, is the greater severity of impact on the victim.
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Bruckner TA, Lebreton É, Perrone N, Mortensen LH, Blondel B. Preterm birth and selection in utero among males following the November 2015 Paris attacks. Int J Epidemiol 2019; 48:1614-1622. [DOI: 10.1093/ije/dyz089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Background
On 13 November 2015, coordinated terrorist attacks swept through Paris. This large stressor, like earlier terrorist attacks in the USA, may have perturbed the health of pregnant women. We test whether the attacks preceded an increase in the risk of preterm parturition among live-born males as well as excess male loss in utero. We focused on males on the basis of previous findings of elevated male frailty following population stressors.
Methods
We examined live births in the Paris region (n = 1 049 057) over 70 months, from January 2011 to October 2016. Interrupted time-series methods identified and removed serial correlation in the monthly risk of preterm birth; these methods employed non-linear least-squares estimation. We also repeated analyses using month of conception, and performed sensitivity tests among females as well as among male births outside Paris.
Results
Males exhibited an elevated incidence of preterm birth in November 2015 and January 2016 [risk difference for November 2015 = 0.006, 95% confidence interval (CI): 0.0002—0.012; risk difference for January 2016 = 0.010, 95% CI: 0.004—0.016], which equates to an 11% increase in the count of preterm births. Females, as well as males born outside Paris, showed no change in preterm delivery. The sex ratio also fell below expected values in December 2015, January 2016 and February 2016.
Conclusions
Among males, more preterm births, but fewer live births, occurred after the November 2015 Paris attacks. Future examinations of perinatal health responses to unexpected stressors may benefit from sex-specific analyses.
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Affiliation(s)
- Tim A Bruckner
- Program in Public Health, University of California at Irvine, Irvine, CA, USA
| | - Élodie Lebreton
- Perinat-ARS-IDF, Agence Régionale de Santé d'Île-de-France, Paris, France
| | - Natalie Perrone
- Department of Sociology, New York University, New York, NY, USA
| | - Laust H Mortensen
- Department of Social Medicine, and Statistics Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Béatrice Blondel
- INSERM U1153, Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
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Renard A, Martinet C, Cungi PJ, Combes E, Gasperini G, Cazes N, Carfantan C, Faivre A, Travers S, Kelway C, Benner P. Is E-FAST possible and useful on the battlefield? A feasibility study during medical courses in hostile environment (MEDICHOS): preliminary results. J ROY ARMY MED CORPS 2019; 165:338-341. [DOI: 10.1136/jramc-2018-001102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 01/06/2023]
Abstract
IntroductionThe extent of the French forces’ territory in the Sahel band generates long medical evacuations. In case of many victims, to respect the golden hour rule, first-line sorting is essential. Through simulation situations, the aim of our study was to assess whether the use of ultrasound was useful to military doctors.MethodsIn combat-like exercise conditions, we provided trainees with a pocket-size ultrasound. Every patient for whom the trainees chose to perform ultrasound in role 1 was included. An extended focused assessment with sonography for trauma (E-FAST) was performed with six basic sonographic views. We evaluated whether these reference views were obtained or not. Once obtained by the trainees, pathological views corresponding to the scenario were shown to assess whether the trainees modified their therapeutic management strategy and their priorities.Results168 patients were treated by 15 different trainee doctors. Of these 168 patients, ultrasound (E-FAST or point-of-care ultrasound) was performed on 44 (26%) of them. In 51% (n=20/39) of the situations, the practitioners considered that the realisation of ultrasound had a significant impact in terms of therapeutic and evacuation priorities. More specifically, it changed therapeutic decisions in 67% of time (n=26/39) and evacuation priorities in 72% of time (n=28/39).ConclusionThis original work showed that ultrasound on the battlefield was possible and useful. To confirm these results, ultrasound needs to be democratised and assessed in a real operational environment.
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Chanzy E, Gentile M, Nahon M, Paty AC, Stibbe O, Tourtier JP, Petrovic T, Goix L, Adnet F, Lapostolle F. COP21 – Organisation et bilan d’une médicalisation sous haute tension. Rev Epidemiol Sante Publique 2019; 67:201-204. [DOI: 10.1016/j.respe.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022] Open
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Ventzke MM, Kemming GI. Der Aufwachraum als Behandlungsplatz. Notf Rett Med 2019. [DOI: 10.1007/s10049-018-0474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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The 14 July 2016 terrorist attack in Nice: The experience of orthopaedic surgeons. Orthop Traumatol Surg Res 2019; 105:505-511. [PMID: 30928274 DOI: 10.1016/j.otsr.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND On 14 July 2016, a terrorist drove a truck through the crowd on the Promenade des Anglais in Nice, France, killing 87 people and injuring 458. The objective of this study was to evaluate the management strategy used to handle the osteo-articular injuries caused by this attack. HYPOTHESIS The management strategy used ensured that open fractures were treated within 6hours. MATERIAL AND METHOD This single-centre retrospective study included all victims of the attack admitted to the Pasteur 2 Hospital in Nice, France, for osteo-articular injuries, and treated between 14 and 31 July 2016. The following data were collected for each patient: age, sex, type of injury, Injury Severity Score (ISS), whether the damage control orthopaedics (DCO) or early total care (ETC) approach was followed, time from injurytotreatment, operative time, and surgical revisions. The primary outcome measure was the injury to treatment time for each lesion. RESULTS Of the 182 patients admitted to the emergency department, 32 required admission for osteo-articular injuries, including 18 with severe injuries (ISS>15) and 11 with multiple fractures. Their injuries were of the type seen in traffic accidents. Of the 87 fractures, 45% involved the lower limbs and 25% were open fractures. Surgery was performed in 14 patients on the first night (14 to 15 July) and in 19 patients overall. The approach was DCO in 12 and ETC in 7 of these 19 patients. All lesions were managed within recommended time intervals, including the 21 open fractures and 2 closed femoral shaft fractures. DISCUSSION Injury-to-surgery time complied with recommendations in all cases. In 25% of cases, ETC would have been feasible during the mass influx of patients without hospital capacity saturation. LEVEL OF EVIDENCE IV, retrospective observational study.
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Riou B, Vivien B. S’organiser et se former pour faire face à l’afflux massif de victimes à l’hôpital. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Franke A, Bieler D, Friemert B, Kollig E, Flohe S. [Preclinical and intrahospital management of mass casualties and terrorist incidents]. Chirurg 2019; 88:830-840. [PMID: 29149359 DOI: 10.1007/s00104-017-0489-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Due to the recent terrorist attacks in Paris, Brussels, Ansbach, Munich, Berlin and more recently Manchester and London, terrorism is realized as a present threat to our society and social life, as well as a challenge for the health care system. Without fueling anxiety, there is a need for sensitization to this subject and to familiarize all concerned with the special kind of terrorist attack-related injuries, the operational priorities and tactics and the individual basic principles of preclinical and hospital care. There is a need to adapt the known established medical structure for a conventional mass casualty situation to the special requirements that are raised by this new kind of terrorist threat to our social life. It is the aim of this article, from a surgical point of view, to depict the tactics and challenges of preclinical care of the special kind of terrorist attack-related injuries from the site of the incident, via the advanced medical post or casualty collecting point, to the triage point at the hospital. The special needs of medical care and organizational aspects of the primary treatment in the hospital are highlighted and possible decisional options and different approaches are discussed.
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Affiliation(s)
- A Franke
- Klinik für Unfallchirurgie, Orthopädie, Rekonstruktive- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstrasse 170, 56072, Koblenz, Deutschland
| | - D Bieler
- Klinik für Unfallchirurgie, Orthopädie, Rekonstruktive- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstrasse 170, 56072, Koblenz, Deutschland.
| | - B Friemert
- Klinik Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - E Kollig
- Klinik für Unfallchirurgie, Orthopädie, Rekonstruktive- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstrasse 170, 56072, Koblenz, Deutschland
| | - S Flohe
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Städt. Klinikum Solingen, Solingen, Deutschland
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Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Rossaint R. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care 2019; 23:98. [PMID: 30917843 PMCID: PMC6436241 DOI: 10.1186/s13054-019-2347-3] [Citation(s) in RCA: 695] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/06/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. METHODS The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were re-examined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. RESULTS Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient- or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. CONCLUSIONS A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.
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Affiliation(s)
- Donat R. Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Bertil Bouillon
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109 Cologne, Germany
| | - Vladimir Cerny
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Socialni pece 3316/12A, CZ-40113 Usti nad Labem, Czech Republic
- Centre for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic, Sokolska 581, CZ-50005 Hradec Kralove, Czech Republic
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, CZ-50003 Hradec Kralove, Czech Republic
- Department of Anaesthesia, Pain Management and Perioperative Medicine, QE II Health Sciences Centre, Dalhousie University, Halifax, 10 West Victoria, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
| | - Jacques Duranteau
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud, University of Paris XI, Faculté de Médecine Paris-Sud, 78 rue du Général Leclerc, F-94275 Le Kremlin-Bicêtre Cedex, France
| | - Daniela Filipescu
- Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Sos Fundeni 256-258, RO-022328 Bucharest, Romania
| | - Beverley J. Hunt
- King’s College and Departments of Haematology and Pathology, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH UK
| | - Radko Komadina
- Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty Ljubljana University, SI-3000 Celje, Slovenia
| | - Marc Maegele
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109 Cologne, Germany
| | - Giuseppe Nardi
- Department of Anaesthesia and ICU, AUSL della Romagna, Infermi Hospital Rimini, Viale Settembrini, 2, I-47924 Rimini, Italy
| | - Louis Riddez
- Department of Surgery and Trauma, Karolinska University Hospital, S-171 76 Solna, Sweden
| | - Charles-Marc Samama
- Hotel-Dieu University Hospital, 1, place du Parvis de Notre-Dame, F-75181 Paris Cedex 04, France
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany
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Borel M, Damm C, Debien B, Akodad H, Dolla E, Bouhaddou A, Lamberdière F, Raux M. S’exercer à l’afflux massif de victimes hospitalières… Comment faire ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La capacité à accueillir un afflux massif de victimes au sein d’un hôpital fait partie des obligations de tout établissement de santé (ES). Les modalités de cet accueil sont définies de façon réglementaire par le plan blanc d’établissement. Chaque ES doit s’entraîner. Les exercices sont un élément clé pour apprendre à mieux faire face à ces situations sanitaires exceptionnelles et inhabituelles. Ils permettent de tester les dispositifs et procédures en place, d’acquérir de l’expérience, de déterminer les points forts, les faiblesses et les axes d’amélioration. La conception d’un exercice nécessite avant tout la définition de ses grandes caractéristiques (contexte, type, objectifs), la détermination du cadre et du périmètre de l’exercice (convention d’exercice), la détermination des ressources humaines (animateurs, plastrons, évaluateurs, observateurs) et matérielles nécessaires. Il faudra aussi écrire le scénario (initial, cadence, évolutions prévues), organiser les conditions d’animation (dossier d’exercice) et d’observation, définir les modalités de briefing, de débriefing et les modalités d’évaluation (outils et critères). L’exercice devra mener à un retour d’expérience avec propositions de mesures correctrices si nécessaire. Il doit être piloté par un comité de pilotage multiprofessionnel sous l’égide du directeur d’établissement ou de son représentant. Il doit être conçu comme une étape dans un processus d’amélioration des pratiques professionnelles au profit des patients.
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Gregory J, de Lepinau J, de Buyer A, Delanoy N, Mir O, Gaillard R. The impact of the Paris terrorist attacks on the mental health of resident physicians. BMC Psychiatry 2019; 19:79. [PMID: 30791878 PMCID: PMC6385411 DOI: 10.1186/s12888-019-2058-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND On November 13, 2015, terrorist attacks took place in Paris. One hundred and twenty-nine people were immediately killed and 302 needed emergency care. Many resident physicians were on the front line of the medical response. Our aim was to report the frequency of symptoms of post-traumatic stress disorder (PTSD), anxiety and depression among resident physicians after the Paris terrorist attacks. METHODS Anonymous questionnaires, including the Impact of Event Scale- Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS), were emailed two months after the attacks to 2413 Parisian resident physicians. Exposure to the attacks was defined as having direct clinical contact with one of the victims up to one week after the attacks, being one of the victims, or having one among close relatives. RESULTS The questionnaire was completed by 680 (28.2%) residents. Eighty-four (12.4%) reported symptoms of PTSD (IES-R ≥ 33), 76 (11.2%) reported symptoms of anxiety (HADS anxiety score > 10) and 16 (2.4%) reported symptoms of depression (HADS depression score > 10). Exposed residents had higher IES-R scores than non-exposed residents (18.8 ± 16.6 versus 14.2 ± 12.0, p = 0.001), and 40 (18.5%) of them reported symptoms of PTSD, compared to 44 (9.5%) of the non-exposed residents (p = 0.001). CONCLUSIONS There was a high frequency of symptoms of mental distress among our respondents. Dedicated screening and care strategies must be considered in the event of new attacks.
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Affiliation(s)
- Jules Gregory
- Syndicat des Internes des Hôpitaux de Paris (SIHP), 17 rue du Fer à Moulin, 75005 Paris, France
| | - Jean de Lepinau
- Syndicat des Internes des Hôpitaux de Paris (SIHP), 17 rue du Fer à Moulin, 75005 Paris, France
| | - Ariane de Buyer
- Syndicat des Internes des Hôpitaux de Paris (SIHP), 17 rue du Fer à Moulin, 75005 Paris, France
| | - Nicolas Delanoy
- Syndicat des Internes des Hôpitaux de Paris (SIHP), 17 rue du Fer à Moulin, 75005 Paris, France
| | - Olivier Mir
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Raphaël Gaillard
- Department of Psychiatry, Service Hospitalo-Universitaire, Centre Hospitalier Sainte Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France
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Massalou D, Ichai C, Mariage D, Baqué P. Terrorist attack in Nice – The experience of general surgeons. J Visc Surg 2019; 156:17-22. [DOI: 10.1016/j.jviscsurg.2018.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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86
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Graham SM, Wijesekera MP, Laubscher M, Maqungo S, Held M, Ferreira N, Harrison WJ. Implant-related sepsis in lower limb fractures following gunshot injuries in the civilian population: A systematic review. Injury 2019; 50:235-243. [PMID: 30551865 DOI: 10.1016/j.injury.2018.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/16/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of long bone lower limb fractures secondary to gunshot wounds (GSWs) in the civilian setting are complex and there is currently no consensus regarding the optimal approach to managing such fractures. This study aims to address the relationship of implant related sepsis in fractures secondary to GSWs. METHODS A systematic review of the literature was performed on both Pubmed and Scopus databases that look at fractures caused by GSWs in the lower limb. A total of 14 studies met the inclusion criteria set in this study. RESULTS Current literature suggests that low and high velocity injuries managed with internal fixation, such as intramedullary nails, may carry a low risk of superficial and deep infection, with no obvious risk of osteomyelitis. However, infection was poorly defined across all studies and no study used a validated scoring system for infection making it difficult to draw any valid conclusion on the rate of infection following internal fixation of lower limb fractures following both high and low velocity GSWs. CONCLUSION There is no clear evidence to confirm or refute that internal fixation is the ideal method of management in these complex injuries and guidance is needed due to the high and increasing proportion of patients presenting with these complex injuries worldwide.
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Affiliation(s)
- Simon Matthew Graham
- Liverpool School of Tropical Medicine, Liverpool, UK; Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Maritz Laubscher
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sithombo Maqungo
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Michael Held
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Nando Ferreira
- Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - William J Harrison
- Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; Countess of Chester Hospital, Chester, UK
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Terrorlagen in ländlicher Region. Notf Rett Med 2019. [DOI: 10.1007/s10049-018-0464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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88
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Bouzat P. Construire une filière de soins pour les traumatismes graves à l’échelle nationale : un groupe d’experts se positionne. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2018-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sharrock AE, Remick KN, Midwinter MJ, Rickard RF. Combat vascular injury: Influence of mechanism of injury on outcome. Injury 2019; 50:125-130. [PMID: 30219382 DOI: 10.1016/j.injury.2018.06.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/05/2018] [Accepted: 06/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Haemorrhage is the leading cause of death on the battlefield. Seventy percent of injuries are due to explosive mechanisms. Anecdotally, these patients have had poorer outcomes when compared to those with penetrating mechanisms of injury (MOI). We wished to test the hypothesis that outcomes following vascular reconstruction were worse in blast-injured than non blast-injured patients. METHODS Retrospective cohort study. British and American combat casualties with arterial injuries sustained in Iraq or Afghanistan (2003-2014) were identified from the UK Joint Theatre Trauma Registry (JTTR). Eligibility included explosive or penetrating MOI, with follow-up to UK hospital discharge, or death. Outcomes were mortality, amputation, graft thrombosis, haemorrhage, and infection. Statistical analysis was performed using Pearson Chi-Square test, t-tests, ANOVA or non-parametric equivalent, and survival analyses. RESULTS One hundred and fifteen patients were included, 80 injured by explosive and 35 by penetrating mechanisms. Evacuation time, ISS, number of arterial injuries, age and gender were comparable between groups. Seventy percent of arterial injuries resulted from an explosive MOI. The explosive injuries group received more blood products (p = 0.008) and suffered more regions injured (p < 0.0001). Early surgical interventions in both were ligation (n = 36, 31%), vein graft (n = 33, 29%) and shunting (n = 9, 8%). Mortality (n = 12, 10%) was similar between groups. Differences in limb salvage rates following explosive (n = 17, 53%) vs penetrating (n = 13, 76.47%) mechanisms approached statistical significance (p = 0.056). Nine (28%) vein grafted patients developed complications. No evidence of a difference in the incidence of vein graft thrombosis was found when comparing explosive with non-explosive cohorts (p = 0.154). CONCLUSIONS The recorded numbers of vein grafts following combat arterial trauma in are small in the JTTR. No statistically-significant differences in complications, including vein graft thrombosis, were found between cohorts injured by explosive and non-explosive mechanisms.
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Affiliation(s)
- Anna E Sharrock
- Regeneration, repair and development section, National Heart and Lung Institute, Imperial College, London, UK; Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
| | - Kyle N Remick
- The Department of Surgery at the Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | | | - Rory F Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
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Schäfer I, Hopchet M, Vandamme N, Ajdukovic D, El-Hage W, Egreteau L, Javakhishvili JD, Makhashvili N, Lampe A, Ardino V, Kazlauskas E, Mouthaan J, Sijbrandij M, Dragan M, Lis-Turlejska M, Figueiredo-Braga M, Sales L, Arnberg F, Nazarenko T, Nalyvaiko N, Armour C, Murphy D. Trauma and trauma care in Europe. Eur J Psychotraumatol 2018; 9:1556553. [PMID: 30637092 PMCID: PMC6319458 DOI: 10.1080/20008198.2018.1556553] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 12/22/2022] Open
Abstract
The European countries have a long history of exposure to large-scale trauma. In the early 1990s the increasing awareness of the consequences of trauma within the mental health community led to the foundation of local societies for psychotraumatology across Europe and the European Society of Traumatic Stress Studies (ESTSS), which celebrated its 25th anniversary in 2018. The focus of this article is to describe the current state of care for survivors of trauma in the 15 European countries where ESTSS member societies have been established. Brief descriptions on the historical burden of trauma in each country are followed by an overview of the care system for trauma survivors in the countries, the state-of-the-art of interventions, current challenges in caring for survivors and the topics that need to be most urgently addressed in the future. The reports from the different countries demonstrate how important steps towards a better provision of care for survivors of trauma have been made in Europe. Given the cultural and economic diversity of the continent, there are also differences between the European countries, for instance with regard to the use of evidence-based treatments. Strategies to overcome these differences, like the new ESTSS training curricula for care-providers across Europe, are briefly discussed.
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Affiliation(s)
- Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Naomi Vandamme
- Belgian Institute for Psychotraumatology, Trauma Center Limburg, Hasselt, Belgium
| | - Dean Ajdukovic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, CHRU de Tours, Inserm, Tours, France
| | - Laurine Egreteau
- Laurine Egreteau, CHRU de Tours, Clinique Psychiatrique Universitaire, Tours, France
| | | | | | - Astrid Lampe
- Department of Medical Psychology and Psychotherapy, University Medical Hospital Innsbruck, Innsbruck, Austria
| | - Vittoria Ardino
- Dipartimento di Scienze dell'Uomo, Urbino University, Urbino, Italy
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Joanne Mouthaan
- Department Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Marit Sijbrandij
- Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | | | - Maja Lis-Turlejska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Margarida Figueiredo-Braga
- Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Social Studies (CES) of the University of Coimbra, Coimbra, Portugal
| | - Luísa Sales
- Department of Psychiatry of the Military Hospital of Coimbra, Centre of Trauma (CES) of the University of Coimbra, Coimbra, Portugal
| | - Filip Arnberg
- National Centre for Disaster Psychiatry, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Tetiana Nazarenko
- Non-Governmental organization ‘Ukrainian Society of Overcoming the Consequences of Traumatic Events’ (USOCTE), Kyiv, Ukraine
| | - Natalia Nalyvaiko
- International Institute of Depth Psychology, Non-Governmental organization ‘Ukrainian Society of Overcoming the Consequences of Traumatic Events’ (USOCTE), Kyiv, Ukraine
| | - Cherie Armour
- School of Psychology, Institute of Mental Health Sciences, Faculty of Life & Health Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Dominic Murphy
- Research Department, Combat Stress, Leatherhead, UK & King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, UK
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Khorram-Manesh A. Facilitators and constrainers of civilian-military collaboration: the Swedish perspectives. Eur J Trauma Emerg Surg 2018; 46:649-656. [PMID: 30542745 PMCID: PMC7280332 DOI: 10.1007/s00068-018-1058-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022]
Abstract
Purpose An increasing number of international and domestic armed conflicts, including terror attacks on civilians, along with constrained healthcare finance and resource limitation, has made a civilian–military collaboration (CMC) crucial. The purpose of this study was to identify facilitators and constrainers in CMC in a national perspective with a specific focus on medical aspects. Method A literature review of recently published papers about civilian–military collaboration, along with a short survey, was conducted. For the review, major search engines were used. Results The results indicated many facilitators, but few important constrainers with a high impact on the outcome. The conducted survey indicated discrepancies between the needs and resources. Conclusion The current global and domestic security threats and challenges, make CMC critical and inevitable. However, there is a need for careful analysis of its consequences, impact, possibilities, and limitations to differentiate between our expectations and the current reality.
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Affiliation(s)
- Amir Khorram-Manesh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
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Pruski M. Experience adjusted life years and critical medical allocations within the British context: which patient should live? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:561-568. [PMID: 29497890 DOI: 10.1007/s11019-018-9830-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Medical resource allocation is a controversial topic, because in the end it prioritises some peoples' medical problems over those of others. This is less controversial when there is a clear clinical reason for such a prioritisation, but when such a reason is not available people might perceive it as deeming certain individuals more important than others. This article looks at the role of social utility in medical resource allocation, in a situation where the clinical outcome would be identical if either person received the treatment. This situation is explored with a focus on the United Kingdom, but its conclusions have wider applications to any system where healthcare is tax-payer funded. The article proposes an experience adjusted life years system, and discusses its strengths and weaknesses.
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Affiliation(s)
- Michal Pruski
- Manchester Metropolitan University, All Saints Building, Manchester, M15 6BH, UK.
- Critical Care Laboratory, Critical Care Directorate, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK.
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94
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Konzept zum prähospitalen Vorgehen bei „bedrohlichen Lagen“. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0465-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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95
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Bernhard M, Wurmb T, Helm M. Taktische (Notfall‑)Medizin: Die Welt hat sich verändert, wir müssen dies begreifen und unser Management anpassen. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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96
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Wirtz S, Harding U. Terroranschläge weltweit und in Europa – Historie, Überblick, aktuelle Lage. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0457-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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97
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Wurmb T, Schorscher N, Justice P, Dietz S, Schua R, Jarausch T, Kinstle U, Greiner J, Möldner G, Müller J, Kraus M, Simon S, Wagenhäuser U, Hemm J, Roewer N, Helm M. Structured analysis, evaluation and report of the emergency response to a terrorist attack in Wuerzburg, Germany using a new template of standardised quality indicators. Scand J Trauma Resusc Emerg Med 2018; 26:87. [PMID: 30340516 PMCID: PMC6194622 DOI: 10.1186/s13049-018-0555-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022] Open
Abstract
Background Until now there has been a reported lack of systematic reports and scientific evaluations of rescue missions during terror attacks. This however is urgently required in order to improve the performance of emergency medical services and to be able to compare different missions with each other. Aim of the presented work was to report the systematic evaluation and the lessons learned from the response to a terror attack that happened in Wuerzburg, Germany in 2016. Methods A team of 14 experts developed a template of quality indicators and operational characteristics, which allow for the description, assessment and comparison of civil emergency rescue missions during mass killing incidents. The entire systematic evaluation process consisted of three main steps. The first step was the systematic data collection according to the quality indicators and operational characteristics. Second was the systematic stratification and assessment of the data. The last step was the prioritisation of the identified weaknesses and the definition of the lessons learned. Results Five important “lessons learned” have been defined. First of all, a comprehensive concept for rescue missions during terror attacks is essential. Furthermore, the establishment of a defined high priority communication infrastructure between the different dispatch centres (“red phone”) is vital. The goal is to secure the continuity of information between a few well-defined individuals. Thirdly, the organization of the incident scene needs to be commonly decided and communicated between police, medical services and fire services during the mission. A successful mission tactic requires continuous flux of reports to the on-site command post. Therefore, a predefined and common communication infrastructure for all operational forces is a crucial point. Finally, all strategies need to be extensively trained before the real life scenario hits. Conclusion According to a systematic evaluation, we defined the lessons learned from a terror attack in 2016. Further systematic reports and academic work surrounding life threatening rescue missions and mass killing incidents are needed in order to ultimately improve such mission outcomes. In the future, a close international collaboration might help to find the best database to report and evaluate major incidents but also mass killing events.
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Affiliation(s)
- T Wurmb
- Subsection Emergency and Disaster Relief Medicine, Department of Anaesthesia and Critical Care, University Hospital of Wuerzburg, Oberdürrbacherstrasse 6, 97080, Würzburg, Germany.
| | - N Schorscher
- Department of Anaesthesia and Critical Care, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - P Justice
- Emergency Medical Services and firebrigade alerting for the counties of Kitzingen, Main-Spessart and the city of Wuerzburg, Wuerzburg, Germany
| | - S Dietz
- Emergency Medical Service of the Bavarian Red Cross, Würzburg, Germany
| | - R Schua
- Medical Department, Government of Lower Franconia, Wuerzburg, Germany
| | - T Jarausch
- Emergency Medical Service of the Maltese Cross, Wuerzburg, Germany
| | - U Kinstle
- The Johanniter Rescue Emergency Services, Wuerzburg, Germany
| | - J Greiner
- Emergency Medical Service of the Bavarian Red Cross, Würzburg, Germany
| | - G Möldner
- Fire and Rescue Integrated Control Centre Wuerzburg, Wuerzburg, Germany
| | - J Müller
- Fire and Rescue Integrated Control Centre Wuerzburg, Wuerzburg, Germany
| | - M Kraus
- Medical Head of the Emergency Medical Services of Lower Fraconia, Wuerzburg, Germany
| | - S Simon
- Emergency Medical Service of the Maltese Cross, Wuerzburg, Germany
| | - U Wagenhäuser
- Head of emergency pastoral care in the diocese of Würzburg, Wuerzburg, Germany
| | - J Hemm
- Department of danger prevention and police operation by the police department of Lower Franconia (Chief Police Officer i.R.), Würzburg, Wuerzburg, Germany
| | - N Roewer
- Department of Anaesthesia and Critical Care, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - M Helm
- Department of Anaesthesiology and Intensive Care Medicine, Section Emergency Medicine, Federal Armed Forces Medical Hospital, Ulm, Germany
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Abstract
OBJECTIVE We aimed to evaluate the impact of the same-day GPs' strike and terrorist attacks on a call centre's activity. METHODS We compared the number of calls received, the number of patient's medical files (PMFs) created and the number of mobile ICU (MICU) dispatched per hour on Friday, 13 November, to the repository established on the five previous Fridays. As previously published, the variation criterion was set to an activity variation above 20% for more than 2 h. RESULTS On Friday, 13 November, 1745 calls were received compared with 1455 calls, on average, for the five previous Fridays. The number of calls received increased after the terrorist attacks (≤90%) and remained above the threshold for 3 h. The number of PMFs exceeded the threshold from 10:00 a.m. to 05:00 p.m., but was not affected by the attacks. The number of MICUs dispatched exceeded the threshold (>500%) in the first hour after the attacks. CONCLUSION The GPs' strike and the terrorist attacks did not impact our call centre's activity in the same manner. The strike increased the number of PMFs without increasing the number of calls received. The attacks increased the number of calls received and MICU dispatched without increasing the number of PMFs. Many markers are at the disposal of call centres to evaluate the impact of healthcare events.
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Preparing for the Surge: A Half-Day Emergency Preparedness Training Course for the "Second Front". Disaster Med Public Health Prep 2018; 12:121-126. [PMID: 29565241 DOI: 10.1017/dmp.2017.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose Clinical disaster medicine requires providers working collaboratively to care for multiple patients, yet many clinicians lack competency-based training. A 5-hour emergency preparedness training (EPT) curriculum was created using didactics, small group discussion, and scenario-based learning. The goal was to evaluate the effect of a short course on improving clinical-provider knowledge, confidence and skill. METHODS Participants were enrolled in a medical university between 2011 and 2014. The course consisted of didactic lectures, small group exercises, and live mass-casualty training scenarios. Core competencies and performance objectives were developed by a task force and assessed via facilitator observation, pre- and posttesting, and a course evaluation. RESULTS A total of 708 participants were trained, including 49.9% physicians, 31.9% medical students, 7.2% nurses, and 11% allied health personnel. The average percentage of correct answers increased from 39% to 60% (P<0.01). Following didactics, trainees met 73% and 96% of small group performance objectives. Trainees also met 68.5% and 61.1% of the mass-casualty performance objectives. Average trainee self-assessment of disaster-preparedness skill improved from 36 to 73 points out of 100. CONCLUSION A brief, intensive EPT course can improve the disaster knowledge and comfort level of a diverse group of clinical providers as well as foster disaster-performance skills. (Disaster Med Public Health Preparedness. 2018;12:121-126).
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Gurney I, Horne S, Wright C. Changes in NHS Major Incident management and their relevance to the Defence Medical Services. BMJ Mil Health 2018; 166:84-88. [DOI: 10.1136/jramc-2018-000988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/13/2018] [Indexed: 11/04/2022]
Abstract
High-profile Major Incidents in the UK civilian setting in the last few years have appropriately raised awareness of the principles and frameworks involved in the design of reliable response systems. The introduction of the Joint Emergency Services Interoperability Principles in tandem with increased investment in Major Incident Planning has supported practitioners to successfully respond to high numbers of incidents.Defence Medical Services personnel are increasingly being asked to deploy to resource-limited 'contingency' settings where much of the established guidance relating to Major Incident response requires reconsideration and modification in the face of severely constrained space, manpower and equipment.This editorial seeks to review contemporary theories and principles of Major Incident response and discuss how military medical personnel may need to adapt these to address the various Major Incident challenges that they may face on operations.
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