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Drozd A, Wolska M, Szarpak L. Intraosseous vascular access in emergency and trauma settings: a comparison of the most universally used intraosseous devices. Expert Rev Med Devices 2021; 18:855-864. [PMID: 34325586 DOI: 10.1080/17434440.2021.1962287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Obtaining successful vascular access is an essential component of the emergency and trauma setting. The modern practice of medicine advocates IO access for patients in a critical condition, especially when IV access is problematic or unobtainable. Various medical devices allowing for IO access have been coined and used in the management of critical patients.Areas covered: This study aims to review the literature regarding different intraosseous devices used to obtain vascular access (Bone Injection Gun (BIG), EZ-IO, NIO, Jamshidi, and First Access for Shock and Trauma (FAST-1) and discuss their clinical and experimental role in the emergency and trauma settings.Expert opinion: The development of medical technology contributes to an increasing number of intraosseous devices facilitating vascular access in challenging scenarios, including cardiopulmonary resuscitation, anaphylactic, or hypovolemic shock. Each of these devices provides an effective route for fluid resuscitation, drug delivery, laboratory evaluation, and shortening the timeframe for established vascular access, provided that the person obtaining the access is acquainted with the use of the device.
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Affiliation(s)
- Anna Drozd
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Marta Wolska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Warsaw, Poland
| | - Lukasz Szarpak
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland.,Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland.,Outcomes Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
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Milwood Hargrave J, Pearce P, Mayhew ER, Bull A, Taylor S. Blast injuries in children: a mixed-methods narrative review. BMJ Paediatr Open 2019; 3:e000452. [PMID: 31548997 PMCID: PMC6733323 DOI: 10.1136/bmjpo-2019-000452] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/06/2019] [Accepted: 08/08/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND SIGNIFICANCE Blast injuries arising from high explosive weaponry is common in conflict areas. While blast injury characteristics are well recognised in the adults, there is a lack of consensus as to whether these characteristics translate to the paediatric population. Understanding blast injury patterns in this cohort is essential for providing appropriate provision of services and care for this vulnerable cohort. METHODS In this mixed-methods review, original papers were screened for data pertaining to paediatric injuries following blasts. Information on demographics, morbidity and mortality, and service requirements were evaluated. The papers were written and published in English from a range of international specialists in the field. RESULTS Children affected by blast injuries are predominantly male and their injuries arise from explosive remnants of war, particularly unexploded ordinance. Blasts show increased morbidity and mortality in younger children, while older children have injury patterns similar to adults. Head and burn injuries represent a significant cause of mortality in young children, while lower limb morbidity is reduced compared with adults. Children have a disproportionate requirement for both operative and non-operative service resources, and provisions for this burden are essential. CONCLUSIONS Certain characteristics of paediatric injuries arising from blasts are distinct from that of the adult cohort, while the intensive demands on services highlight the importance of understanding the diverse injury patterns in order to optimise future service provisions in caring for this child blast survivor.
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Affiliation(s)
| | - Phillip Pearce
- Centre for Blast Injury Studies, Imperial College London, London, UK
| | | | - Anthony Bull
- Department of Bioengineering, Imperial College London, London, UK
| | - Sebastian Taylor
- Global Child Health Programme, Royal College of Paediatrics and Child Health, London, UK
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Campbell K, Naumann DN, Remick K, Wright C. Damage control resuscitation and surgery for indigenous combat casualties: a prospective observational study. BMJ Mil Health 2019; 167:18-22. [PMID: 31227598 DOI: 10.1136/jramc-2019-001228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Specialist units that assist indigenous forces (IF) in their strategic aims are supported by medical teams providing point of injury emergency care for casualties, including IF and civilians (Civ). We investigated the activities of a Coalition Forces far-forward medical facility, in order to inform medical providers about the facilities and resources required for medical support to IF and Civ during such operations. METHODS A prospective observational study (June to August 2017) undertaken at a far-forward Coalition Forces medical support unit (12 rotating personnel) recorded patient details (IF or Civ), mechanism of injury (MOI), number of blood products used, damage control resuscitation (DCR) and damage control surgery (DCS), number of mass casualty (MASCAL) scenarios, resuscitative thoracotomy, resuscitative endovascular balloon occlusion of the aorta (REBOA) and whole blood emergency donor panels (EDP). RESULTS 680 casualties included 478 IF and 202 Civ (45.5% of the Civ were paediatric). Most common MOIs were blast (n=425; 62.5%) and gunshot wound (n=200; 29.4%). Fifteen (2.2%) casualties died; 627 (92.2%) were transferred to local hospitals. DCR was used for 203 (29.9%), and DCS for 182 (26.8%) casualties. There were 23 MASCAL scenarios, 1220 transfusions and 32 EDPs. REBOA was performed eight times, and thoracotomy was performed 27 times. CONCLUSIONS A small medical team provided high-tempo emergency resuscitative care for hundreds of IF and Civ casualties within a short space of time using state-of-the-art resuscitative modalities. DCR and DCS were undertaken with a large number of EDPs, and a high survival-to-transfer rate.
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Affiliation(s)
| | - D N Naumann
- Academic Department of Military Surgery and Trauma, Birmingham, UK
| | - K Remick
- Department of Surgery, Uniformed Services University, Bethesda, Maryland, USA
| | - C Wright
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Haverkamp FJC, Veen H, Hoencamp R, Muhrbeck M, von Schreeb J, Wladis A, Tan ECTH. Prepared for Mission? A Survey of Medical Personnel Training Needs Within the International Committee of the Red Cross. World J Surg 2018; 42:3493-3500. [PMID: 29721638 PMCID: PMC6182760 DOI: 10.1007/s00268-018-4651-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Humanitarian organizations such as the International Committee of the Red Cross (ICRC) provide worldwide protection and medical assistance for victims of disaster and conflict. It is important to gain insight into the training needs of the medical professionals who are deployed to these resource scarce areas to optimally prepare them. This is the first study of its kind to assess the self-perceived preparedness, deployment experiences, and learning needs concerning medical readiness for deployment of ICRC medical personnel. METHODS All enlisted ICRC medical employees were invited to participate in a digital questionnaire conducted during March 2017. The survey contained questions about respondents' personal background, pre-deployment training, deployment experiences, self-perceived preparedness, and the personal impact of deployment. RESULTS The response rate (consisting of nurses, surgeons, and anesthesiologists) was 54% (153/284). Respondents rated their self-perceived preparedness for adult trauma with a median score of 4.0 on a scale of 1 (very unprepared) to 5 (more than sufficient); and for pediatric trauma with a median score of 3.0. Higher rates of self-perceived preparedness were found in respondents who had previously been deployed with other organizations, or who had attended at least one master class, e.g., the ICRC War Surgery Seminar (p < 0.05). Additional training was requested most frequently for pediatrics (65/150), fracture surgery (46/150), and burns treatment (45/150). CONCLUSION ICRC medical personnel felt sufficiently prepared for deployment. Key points for future ICRC pre-deployment training are to focus on pediatrics, fracture surgery, and burns treatment, and to ensure greater participation in master classes.
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Affiliation(s)
- Frederike J. C. Haverkamp
- Department of Surgery (internal postal code 618), Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Harald Veen
- World Health Organization, Geneva, Switzerland
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Medical Centre Leiderdorp, Leiderdorp, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Ministry of Defence, Utrecht, The Netherlands
| | - Måns Muhrbeck
- Department of Surgery, Linköping University, Gamla Övägen 25, 603 79 Norrköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Gamla Övägen 25, 603 79 Norrköping, Sweden
| | - Johan von Schreeb
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Andreas Wladis
- International Committee of the Red Cross, 19 Avenue de la paix, 1202 Geneva, Switzerland
- Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Edward C. T. H. Tan
- Department of Surgery (internal postal code 618), Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Schauer SG, Naylor JF, Hill GJ, Arana AA, Roper JL, April MD. Association of prehospital intubation with decreased survival among pediatric trauma patients in Iraq and Afghanistan. Am J Emerg Med 2018; 36:657-659. [DOI: 10.1016/j.ajem.2017.11.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 12/01/2022] Open
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Sockeel P, De La Villeon B, Goudard Y, Goin G, Monchal T, Pauleau G. Medical and surgical triage. J Visc Surg 2017; 154 Suppl 1:S13-S17. [PMID: 28941567 DOI: 10.1016/j.jviscsurg.2017.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In terrorist attacks and industrial catastrophes, management of a massive afflux of wounded must adhere to logistic imperatives while at the same time taking into account basic traumatology principles. This implies a firm, unequivocal, and precise doctrine for all stages of care. Medical and surgical triage allows a logical classification of victims according to severity of injury, the necessity of treatment and the degree of urgency. Triage should be early, dynamic, and lead to a categorization that optimally utilizes resources while ensuring efficient management.
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Affiliation(s)
- P Sockeel
- Service de chirurgie digestive, endocrinienne et métabolique, HIA Laveran, 13013 Marseille, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France.
| | - B De La Villeon
- Service de chirurgie digestive, endocrinienne et métabolique, HIA Laveran, 13013 Marseille, France
| | - Y Goudard
- Service de chirurgie digestive, endocrinienne et métabolique, HIA Laveran, 13013 Marseille, France; 7(e) antenne chirurgicale parachutiste, 13013 Marseille, France
| | - G Goin
- Service de chirurgie digestive, endocrinienne et métabolique, HIA Laveran, 13013 Marseille, France; 5(e) antenne chirurgicale aérotransportable, 13013 Marseille, France
| | - T Monchal
- Service de chirurgie viscérale, HIA Ste-Anne, 13013 Marseille, France
| | - G Pauleau
- Service de chirurgie digestive, endocrinienne et métabolique, HIA Laveran, 13013 Marseille, France
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Bernthal EM, Draper HJA, Henning J, Kelly JC. 'A band of brothers'-an exploration of the range of medical ethical issues faced by British senior military clinicians on deployment to Afghanistan: a qualitative study. J ROY ARMY MED CORPS 2016; 163:199-205. [PMID: 27780841 DOI: 10.1136/jramc-2016-000701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 12/20/2022]
Abstract
AIMS To identify and explore features of ethical issues that senior clinicians faced as deployed medical directors (DMDs) to the British Field Hospital in Afghanistan as well as to determine the ethical training requirements for future deployments. METHOD A qualitative study in two phases conducted from November 2014 to June 2015. Phase 1 analysed 60 vignettes of cases that had generated ethical dilemmas for DMDs. Phase 2 included focus groups and an interview with 13 DMDs. FINDINGS Phase 1 identified working with limited resources, dual conflict of meeting both clinical and military obligations and consent of children as the most prevalent ethical challenges. Themes found in Phase 2 included sharing clinical responsibilities with clinicians from other countries and not knowing team members' ways of working, in addition to the themes from Phase 1. DISCUSSION This study has drawn together examples of scenarios to form a repository that will aid future training. Recommendations included undertaking ethics training together as a team before, during and after deployment which must include all nationalities who are assigned to the same operational tour, so that different ethical views can be explored beforehand.
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Affiliation(s)
- Elizabeth M Bernthal
- Academic Department of Military Nursing, Royal Centre for Defence Medicine (Academia and Research) Medical Directorate, Birmingham, UK
| | - H J A Draper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Henning
- The Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine (Academia and Research), Defence Medical Group North, Northallerton, UK
| | - J C Kelly
- Faculty of Health and Social Care, University of Hull, Hull, UK
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Which vascular access technique should be chosen during hypovolemic shock? Am J Emerg Med 2016; 34:1886-7. [PMID: 27352985 DOI: 10.1016/j.ajem.2016.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/20/2022] Open
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