The European Trauma Course: Transforming systems through training

The European Trauma Course (ETC) exemplifies an innovative approach to multispecialty trauma education. This initiative was started as a collaborative effort among the European Society for Emergency Medicine, the European Society for Trauma and Emergency Surgery, and the European Society of Anaesthesiology under the auspices of the European Resuscitation Council. With the robust support of these societies, the project has evolved into the independent European Trauma Course Organisation. Over the past 15 years, the ETC has transcended traditional training by integrating team dynamics and non-technical skills into a scenario-based simulation course, helping to shape trauma care practice and education. A distinctive feature of the ETC is its training of doctors and allied healthcare professionals, fostering a collaborative and holistic approach to trauma care. The ETC stands out for its unique team-teaching approach, which has gained widespread recognition as the standard for in-hospital trauma care training not only in Europe but also beyond. Since its inception ETC has expanded geographically from Finland to Sudan and from Brazil to the Emirates, training nearly 20,000 healthcare professionals and shaping trauma care practice and education across 25 countries. Experiencing exponential growth, the ETC continues to evolve, reflecting its unmet demand in trauma team education. This review examines the evolution of the ETC, its innovative team-teaching methodology, national implementation strategies, current status, and future challenges. It highlights its impact on trauma care, team training, and the effect on other life support courses in various countries.

Use of benzodiazepines in the general population and their involvement in acute self-poisoning cases

Benzodiazepines belong to the most widely prescribed group of drugs and are involved in a large proportion of the acute poisonings seen in emergency departments. The aim of the study was to examine whether a relationship exists between the number of poisonings with different types of benzodiazepines and the number of prescriptions for these benzodiazepines. A significant correlation was found between the type of benzodiazepine in cases of acute poisoning seen in the emergency department and (1) the benzodiazepines used as apparent from a sample of the population of the province of East Flanders (Spearman r=0.70, P=0.002), (2) benzodiazepine prescriptions made during a period of 7 weeks by 131 general practitioners (r=0.66, P=0.039, (3) the number of packages of the different benzodiazepines sold in Belgium (r=0.69, P=0.001) and (4) the number of packages sold in Belgium (expressed in DDD; r=0.58, P=0.047). This correlation was found despite the differences in age and geographic characteristics of the populations we studied. We observed more poisonings with diazepam, flunitrazepam and lormetazepam than would be expected from the data on their use in the population. The reason is unclear but the faster onset of action of the benzodiazepines may have led to more frequent hospitalization.

Gradual withdrawal from benzodiazepines in residents of homes for the elderly: experience and suggestions for future research

OBJECTIVE

A randomised, controlled clinical trial was performed to study the long-term effect of gradual withdrawal from benzodiazepines on the daily functioning of residents of homes for the elderly. The planned sample size was not achieved due to recruitment and follow-up problems.

RESULTS

The results in this small sample nevertheless suggest that gradual withdrawal from benzodiazepines is possible in residents of homes for the elderly, and that it can have a positive effect on their daily functioning. No major withdrawal symptoms were observed, although there was a decrease in sleep quality during withdrawal.

CONCLUSION

The findings are promising for further research, but researchers should anticipate the problems inherent in executing a trial with institutionalised elderly subjects.

The effect of industry-independent drug information on the prescribing of benzodiazepines in general practice

In order to measure the effect of industry-independent information on the prescribing of benzodiazepines in general practice, 128 primary practitioners were randomly allocated to three intervention groups after stratification by year of graduation. One third of the participating physicians were forwarded written information about the indications and limitations of benzodiazepines, another third received both written and oral information, and the remaining third (the control group) obtained no information at all. A comparison of the number of benzodiazepines prescribed per 100 patient contacts with prescription before and after the intervention showed an average decrease of 3% in the control group, of 14% in physicians who received only written information, and of 24% in physicians who were given additional oral information. Post hoc pair-wise comparisons revealed a significant difference at the 1% level in the number of benzodiazepines prescribed between physicians who received both written and oral information and the control group. A follow-up survey conducted 4 weeks after the intervention showed that the oral information campaign positively affected physicians' attitudes about the value of oral drug information from an industry-independent source.