Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

2020 International Consensus on First Aid Science With Treatment Recommendations

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.

Best Practices and Current Care Concepts in Prehospital Care of the Spine-Injured Athlete in American Tackle Football March 2-3, 2019; Atlanta, GA

Sport-related spine injury can be devastating and have long-lasting effects on athletes and their families. Providing evidence-based care for patients with spine injury is essential for optimizing postinjury outcomes. When caring for an injured athlete in American tackle football, clinicians must make decisions that involve unique challenges related to protective equipment (eg, helmet and shoulder pads). The Spine Injury in Sport Group (SISG) met in Atlanta, Georgia, March 2-3, 2019, and involved 25 health care professionals with expertise in emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry, athletic training, and research to review the current literature and discuss evidence-based medicine, best practices, and care options available for the prehospital treatment of athletes with suspected cervical spine injuries.1,2 That meeting and the subsequent Mills et al publication delineate the quality and quantity of published evidence regarding many aspects of prehospital care for the athlete with a suspected cervical spine injury. This paper offers a practical treatment guide based on the experience of those who attended the Atlanta meeting as well as the evidence presented in the Mills et al article. Ongoing research will help to further advance clinical treatment recommendations.

Smartphone apps on burns first aid: A review of the advice

AIMS

Many websites giving first aid advice are disappointingly inaccurate and at times dangerous in regard to burn injuries. With more patients relying on their smart phones to obtain online information the aim of this study was to compare first aid applications (apps) burn advice against those guidelines set by the British Burns Association (BBA).

METHOD

A content analysis of all freely available English written first aid apps from Google Play and the Apple Store was performed. The information was compared against BBA guidance which was split into 12 domains and scored appropriately.

RESULTS

61 of the 103 first aid apps included in the study, had information on the treatment of burn injuries. The mean score for all apps was 3.3 out of 12. 85% of apps postulated the need to cool the burn. However, only 11% of apps stipulated the need for 20min of cooling, while 3% suggested the burn can be cooled up to 3h post injury. Disappointingly even apps produced by reputable first aid charities scored poorly.

CONCLUSION

Burns first aid is documented as being poorly given in the community. With easy access to the internet and specifically smart device apps, more needs to be done to improve burn first aid information online.

Skyborn: in-flight emergency births on commercial airlines

BACKGROUND

This study reports the global occurrence of in-flight emergency births on commercial airlines. To date, no existing research investigating in-flight emergency births has been published.

METHODS

A retrospective study was conducted of all known in-flight births on commercial airlines between 1929 and 2018.

RESULTS

Between 1929 and 2018, there were 74 infants born on 73 commercial flights. Seventy-one of the infants survived delivery, two died shortly after delivery and the status of one is unknown. Seventy-seven percent of the flights were designated international flights, and 26% of all flights were diverted due to the in-flight emergency births. The gestational age at delivery ranged from 25 to 38 weeks with 10% of the infants born at 37-38 weeks, 16% born at 34-36 weeks, 19% born at 31-33 weeks and 12% born prior to 32 weeks. Physicians, nurses, the flight crew and other medical personnel provided medical assistance in 45% of the births.

CONCLUSION

In-flight emergency births are infrequent but not trivial. Commercial airlines are dependent on physicians and other medically trained passengers to help with in-flight deliveries.Despite US Federal Aviation Authority and Joint Aviation Authority standards, on-board medical and first aid kits are depleted and inadequate for in-flight deliveries.

An effective snakebite first aid training method for medics in the Chinese troops: a RCT

BACKGROUND

Snakebites can lead to lifelong consequences and is one of the main causes of death among military troops worldwide. However, few Chinese military medics know the proper first aid procedures for snakebites. Therefore, this study aimed to explore the impact of the Standard Operation Procedure (SOP) and checklist on Chinese military medics' ability to manage snakebite first aid.

METHODS

This study was a prospective single-blind randomized controlled trial conducted in a military medical university of China from May to June 2017. A questionnaire-based survey was performed to collect the participants' socio-demographic profiles before the baseline measurement. During the baseline measurement, participants were requested to provide corresponding first aid that was responsive to the simulative situation portrayed by the SPs (standardized patients) and the evaluators then scored their performances according to a checklist for snakebite first aid scoring table. After the baseline measurement, they were randomly assigned to one of three intervention groups after stratification according to their baseline performance scores: group A received a self-learning course with textbooks (n = 27), group B received a self-learning training on the SOP and checklist (n = 27) and group C was engaged in an interactive discussion panel regarding the SOP and checklist (n = 26). After the interventions, participants received outcome measurements about snakebite first aid key points capability from the same evaluator and SP for each group to avoid observational error. The reviewers were blinded about the grouping in the trial.

RESULTS

The baseline measurement yielded no significant difference (H = 1.647, P = 0.439) among the three groups. The post-intervention scores were higher than the pre-intervention scores for all three (A, B and C) groups (P = 0.008, P < 0.001 and P < 0.001, respectively). There was significant difference of the post-intervention scores among the three groups (F = 8.841, P < 0.001). Both post-intervention scores of group B and group C were higher than that of group A (P < 0.001 and P = 0.001, respectively), but no difference was found between group B and C (P = 0.695). The acceptance questionnaire score of SOP and checklist was mostly very satisfied, as the final scores of group B and group C were 4.62 ± 0.61 and 4.82 ± 0.45, respectively.

CONCLUSIONS

In this study, the implementation of an SOP and checklist for snakebite first aid was shown to update and improve first aid treatment concepts in military medics. These intervention methods played an important role in improving the medics' cognition and understanding of snakebite first aid. Therefore, this finding suggests that SOP and checklist training should be further implemented in Chinese troops for snakebite care.

Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait islanders who are experiencing suicidal thoughts and behaviour

BACKGROUND

Suicide is a leading cause of death among Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is suicidal. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander persons who are experiencing suicidal thoughts or behaviour were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions.

METHODS

The Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non-Indigenous frontline workers can take, and information they should have, to help someone who is experiencing suicidal thoughts or displaying suicidal behaviour. A panel was formed, comprising 27 Aboriginal and Torres Strait Islander people who have expertise in Indigenous suicide prevention. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important.

RESULTS

From a total of 301 statements shown to the expert panel, 172 were endorsed as helping statements to be including in the re-developed guidelines.

CONCLUSIONS

Aboriginal and Torres Strait Islander suicide prevention experts were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal or Torres Strait Islander person experiencing suicidal thoughts or behaviour. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version, for which the panel had rated 166 helping statements and had endorsed 52. These re-developed guidelines can be used to inform Indigenous suicide gatekeeper training courses.

Consensus guideline: Pre-hospital management of decompression illness: expert review of key principles and controversies

(Mitchell SJ, Bennett MH, Bryson P, Butler FK, Doolette DJ, Holm JR, Kot J, Lafère P. Pre-hospital management of decompression illness: expert review of key principles and controversies. Diving and Hyperbaric Medicine. 2018 March;48(1):45е.doi.10.28920/dhm48.1.45-55.) Guidelines for the pre-hospital management of decompression illness (DCI) had not been formally revised since the 2004 Divers Alert Network/Undersea and Hyperbaric Medical Society workshop held in Sydney, entitled "Management of mild or marginal decompression illness in remote locations." A contemporary review was initiated by the Divers Alert Network and undertaken by a multinational committee with members from Australasia, the USA and Europe. The process began with literature reviews by designated committee members on: the diagnosis of DCI; first aid strategies for DCI; remote triage of possible DCI victims by diving medicine experts; evacuation of DCI victims; effect of delay to recompression in DCI; pitfalls in management when DCI victims present at hospitals without diving medicine expertise and in-water recompression. This was followed by presentation of those reviews at a dedicated workshop at the 2017 UHMS Annual Scientific Meeting, discussion by registrants at that workshop and, finally, several committee meetings to formulate statements addressing points considered of prime importance to the management of DCI in the field. The committee placed particular emphasis on resolving controversies around the definition of "mild DCI" arising over 12 years of practical application of the 2004 workshop's findings, and on the controversial issue of in-water recompression. The guideline statements are promulgated in this paper. The full workshop proceedings are in preparation for publication.

Assessing Mental Health First Aid Skills Using Simulated Patients

Objective. To evaluate mental health first aid (MHFA) skills using simulated patients and to compare self-reported confidence in providing MHFA with performance during simulated patient roleplays. Methods. Pharmacy students self-evaluated their confidence in providing MHFA post-training. Two mental health vignettes and an assessment rubric based on the MHFA Action Plan were developed to assess students' observed MHFA skills during audio-recorded simulated patient roleplays. Results. There were 163 students who completed the MHFA training, of which 88% completed self-evaluations. There were 84% to 98% of students who self-reported that they agreed or strongly agreed they were confident providing MHFA. Postnatal depression (PND) and suicide vignettes were randomly assigned to 36 students. More students participating in the PND roleplay took appropriate actions, compared to those participating in the suicide role-play. However, more students participating in the suicide role play assessed alcohol and/or drug use. Ten (71%) participants in the PND roleplay and six (40%) in the suicide roleplay either avoided using suicide-specific terminology completely or used multiple terms rendering their inquiry unclear. Conclusion. Self-evaluated confidence levels in providing MHFA did not always reflect observed performance. Students had difficulty addressing suicide with only half passing the suicide vignette and many avoiding suicide-specific terminology. This indicates that both self-reported and observed behaviors should be used for post-training assessments.

Your Metric Matters! Choose Wisely to Assess User Performance With Tourniquets in Simulated First Aid

BACKGROUND

Readiness to perform lifesaving interventions during emergencies is based on a person's preparation to proficiently execute the skills required. Graphically plotting the performance of a tourniquet user in simulation has previously aided us in developing our understanding of how the user actually behaves. The purpose of this study was to explore performance assessment and learning curves to better understand how to develop best teaching practices.

METHODS

These were retrospective analyses of a convenience sample of data from a prior manikin study of 200 tourniquet uses among 10 users. We sought to generate hypotheses about performance assessments relevant to developing best teaching practices. The focus was on different metrics of user performance.

RESULTS

When one metric was chosen over another, failure counts summed cumulatively over 200 uses differed as much as 12-fold. That difference also indicated that the degree of challenge posed to user performance differed by the metric chosen. When we ranked user performance with one metric and then with another, most (90%; nine of 10) users changed rank: five rose and four fell. Substantial differences in performance outcomes resulted from the difference in metric chosen, which, in turn, changed how the outcome was portrayed and thus interpreted. Hypotheses generated included the following: The usefulness of a specific metric may vary by the user's level of skill from novice to expert; demonstration of the step order in skill performance may suffice for initial training of novices; a mechanical metric of effectiveness, like pulse stoppage, may aid in later training of novices; and training users how to practice on their own and self-assess performance may aid their self-development.

CONCLUSION

The outcome of the performance assessments varied depending on the choice of metric in this study of simulated use of tourniquets.

Study of Tourniquet Use in Simulated First Aid: User Judgment

BACKGROUND

The purpose of this study was to survey the judgments of tourniquet users in simulation to discern opportunities for further study.

METHODS

The study design constituted two parts: questions posed to four tourniquet users and then their tourniquet use was surveyed in simulated first aid, where the users had to decide how to perform among five different cases. The questions addressed judged confidence, blood volumes, a reason bleeding resumes, regret of preventable death, hemorrhage assessment, need for side-by-side use of tourniquets, shock severity, predicting reliability, and difference in blood losses. The mechanical performance was tested on a manikin. Case 1 had no bleeding. Case 2 had limb-wound bleeding that indicated tourniquet use in first aid. Case 3 was like case 2, except the patient was a child. Case 4 was like case 2, except caregiving was under gunfire. Case 5 was like case 4, but two tourniquets were to be used side by side. Each user made tests of the five cases to constitute a block. Each user had three blocks. Case order was randomized within blocks. The study had 60 tests.

RESULTS

In answering questions relevant to first-aid use of limb tourniquets, judgments were in line with previous studies of judgment science, and thus were plausibly applicable. Mechanical performance results on the manikin were as follows: 38 satisfactory, 10 unsatisfactory (a loose tourniquet and nine incorrect tourniquet placements), and 12 not applicable (case 1 needed no mechanical intervention). For cases 1 to 5, satisfactory results were: 100%, 83%, 100%, 75%, and 58%, respectively. For blocks 1 to 3, satisfactory results were 50%, 83%, and 83%, respectively.

CONCLUSION

For tourniquet use in simulated first aid, the results are plausibly applicable because user judgments were coherent with those in previous studies of judgment science. However, the opportunities for further studies were noted.

Adapting the emergency first aid responder course for Zambia through curriculum mapping and blueprinting

OBJECTIVES

Community members are often the first to witness and respond to medical and traumatic emergencies, making them an essential first link to emergency care systems. The Emergency First Aid Responder (EFAR) programme is short course originally developed to help South Africans manage emergencies at the community level, pending arrival of formal care providers. EFAR was implemented in two rural regions of Zambia in 2015, but no changes were originally made to tailor the course to the new setting. We undertook this study to identify potential refinements in the original EFAR curriculum, and to adapt it to the local context in Zambia.

DESIGN

The EFAR curriculum was mapped against available chief complaint data. An expert group used information from the map, in tandem with personal knowledge, to rank each course topic for potential impact on patient outcomes and frequency of use in practice. Individual blueprints were compiled to generate a refined EFAR curriculum, the time breakdown of which reflects the relative weight of each topic.

SETTING

This study was conducted based on data collected in Kasama, a rural region of Zambia's Northern Province.

PARTICIPANTS

An expert group of five physicians practising emergency medicine was selected; all reviewers have expertise in the Zambian context, EFAR programme and/or curriculum development.

RESULTS

The range of emergencies that Zambian EFARs encounter indicates that the course must be broad in scope. The refined curriculum covers 54 topics (seven new) and 25 practical skills (five new). Practical and didactic time devoted to general patient care and scene management increased significantly, while time devoted to most other clinical, presentation-based categories (eg, trauma care) decreased.

CONCLUSIONS

Discrepancies between original and refined curricula highlight a mismatch between the external curriculum and local context. Even with limited data and resources, curriculum mapping and blueprinting are possible means of resolving these contextual issues.

First Aid Preparedness

Having trained personnel ready and willing to render first aid will reassure other co-workers and make them feel safer themselves.

The impact of post-resuscitation feedback for paramedics on the quality of cardiopulmonary resuscitation

PURPOSE

The Guidelines place emphasis on high-quality cardiopulmonary resuscitation (CPR). This study aims to measure the impact of post-resuscitation feedback on the quality of CPR as performed by ambulance personnel.

MATERIALS AND METHODS

Two ambulances are dispatched for suspected cardiac arrest. The crew (driver and paramedic) of the first arriving ambulance is responsible for the quality of CPR. The crew of the second ambulance establishes an intravenous access and supports the first crew. All resuscitation attempts led by the ambulance crew of the study region were reviewed by two research paramedics and structured feedback was given based on defibrillator recording with impedance signal. A 12-months period before introduction of post-resuscitation feedback was compared with a 19-months period after introduction of feedback, excluding a six months run-in interval. Quality parameters were chest compression fraction (CCF), chest compression rate, longest peri-shock pause and longest non-shock pause.

RESULTS

In the pre-feedback period 55 cases were analyzed and 69 cases in the feedback period. Median CCF improved significantly in the feedback period (79% vs 86%, p<0.001). The mean chest compression rate was within the recommended range of 100-120/min in 87% of the cases in the pre-feedback period and in 90% of the cases in the feedback period (p=0.65). The duration of longest non-shock pause decreased significantly (40s vs 19s, p<0.001), the duration of the longest peri-shock pause did not change significantly (16s vs 13s, p=0.27).

CONCLUSION

Post-resuscitation feedback improves the quality of resuscitation, significantly increasing CCF and decreasing the duration of longest non-shock pauses.

Tourniquet Conversion: A Recommended Approach in the Prolonged Field Care Setting

Life-saving interventions take precedence over diagnostic maneuvers in the Care Under Fire stage of Tactical Combat Casualty Care. The immediate threat to life with an actively hemorrhaging extremity injury is addressed with the liberal and proper use of tourniquets. The emphasis on hemorrhage control has and will continue to result in the application of tourniquets that may not be needed past the Care Under Fire stage. As soon as tactically allowable, all tourniquets must be reassessed for conversion. Reassessment of all tourniquets should occur as soon as the tactical situation permits, but no more than 2 hours after initial placement. This article describes a procedure for qualified and trained medical personnel to safely convert extremity tourniquets to local wound dressings, using a systematic process in the field setting.

Do special constables in London feel that they are adequately prepared to meet their first aid responsibilities? A qualitative study

OBJECTIVE

This study's aims were to explore the views of special constables in the London metropolitan police force concerning their obligations and skills as first aiders.

BACKGROUND

The metropolitan police force provides police officers to act as first responders to emergency calls made by the public. Special constables act with the same powers and responsibility as police officers and are required to deal with incidents involving medical emergencies.

SETTING

West London Police Station.

PARTICIPANTS

Fifteen special constables entered and completed the study.

METHODS AND OUTCOME MEASURES

A qualitative study involving semistructured interviews, participant observation, and reflective work. The outcome measures were the themes derived from the 'thematic framework approach' to analysis.

RESULTS

Four main themes were identified. (1) 'Our responsibility?'--Special constables felt they had a responsibility, but were unsure of the origin of this responsibility, with many feeling it stemmed from public expectation. (2) 'Confidence'--Special constables had mixed feelings regarding their confidence in first aid scenarios and many felt that more could be done to improve their confidence. (3) 'Training needs'--Many felt the current training system was lacking in several ways including regularity, teaching and content. (4) 'Personal first aid knowledge'--Special constables were disappointed with their past performances.

CONCLUSIONS

Owing to the small size of this study, the conclusions are limited; however, if the findings are confirmed by larger studies, they suggest the need to improve the confidence of special constables in first aid situations.

Water First Aid Is Beneficial In Humans Post-Burn: Evidence from a Bi-National Cohort Study

Introduction

Reported first aid application, frequency and practices around the world vary greatly. Based primarily on animal and observational studies, first aid after a burn injury is considered to be integral in reducing scar and infection, and the need for surgery. The current recommendation for optimum first aid after burn is water cooling for 20 minutes within three hours. However, compliance with this guideline is reported as poor to moderate at best and evidence exists to suggest that overcooling can be detrimental. This prospective cohort study of a bi-national burn patient registry examined data collected between 2009 and 2012. The aim of the study was to quantify the magnitude of effects of water cooling first aid after burn on indicators of burn severity in a large human cohort.

Method

The data for the analysis was provided by the Burn Registry of Australia and New Zealand (BRANZ). The application of first aid cooling prior to admission to a dedicated burn service, was analysed for its influence on four outcomes related to injury severity. The patient related outcomes were whether graft surgery occurred, and death while the health system (cost) outcomes included total hospital length of stay and admission to ICU. Robust regression analysis using bootstrapped estimation adjusted using a propensity score was used to control for confounding and to estimate the strength of association with first aid. Dose-response relationships were examined to determine associations with duration of first aid. The influence of covariates on the impact of first aid was assessed.

Results

Cooling was provided before Burn Centre admission for 68% of patients, with at least twenty minutes duration for 46%. The results indicated a reduction in burn injury severity associated with first aid. Patients probability for graft surgery fell by 0.070 from 0.537 (13% reduction) (p = 0.014). The probability for ICU admission fell by 0.084 from 0.175 (48% reduction) (p<0.001) and hospital length of stay (LOS) fell by 2.27 days from 12.9 days (18% reduction) (p = 0.001). All outcomes except death showed a dose-response relationship with the duration of first aid. The size of burn and age interacted with many of the relationships between first aid and outcome and these are described and discussed.

Discussion & Conclusion

This study suggests that there are significant patient and health system benefits from cooling water first aid, particularly if applied for up to 20 minutes. The results of this study estimate the effect size of post-burn first aid and confirm that efforts to promote first aid knowledge are not only warranted, but provide potential cost savings.

Closing The Gap: Improving Trauma Care On The Ukrainian Battlefield

Since early 2014, Ukraine has been involved in a violent social and political revolution that has taken more than 7,000 lives. Many of these deaths were due to limited field medical care and prolonged evacuation times because the Ukrainian military has been slow to adopt standard combat medical processes. We deployed with the US Army's 173rd Airborne Brigade to train soldiers in the National Guard of Ukraine (NGU) on combat first aid. We discovered that a major deficiency limiting the quality of trauma care and evacuation is an endemic lack of prior coordination and planning. The responsibility for this coordination falls on military leaders; therefore, we delivered medical operations training to officers of the NGU unit and observed great improvement in medical care sustainment. We recommend systematic leader education in best medical practices be institutionalized at all levels of the Ukrainian Army to foster sustained improvement and refinement of trauma care.

AsMA Medical Guidelines for Air Travel: In-Flight Medical Care

INTRODUCTION

Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. All airlines are required to provide first aid training for cabin crew, and the crew are responsible for managing any in-flight medical events. There are also regulatory requirements for the carriage of first aid and medical kits. AsMA has developed recommendations for first aid kits, emergency medical kits, and universal precaution kits.

The Combat Medic Aid Bag: 2025. CoTCCC Top 10 Recommended Battlefield Trauma Care Research, Development, and Evaluation Priorities for 2015

While the list presented here is by no means a comprehensive list of all of the research areas of interest in battlefield trauma care, much less a list of research needs across the entire continuum of combat casualty care, it does provide the collective judgment of the CoTCCC about the highest priorities for RDT&E that relate to battlefield trauma care. Two additional observations should be made regarding that point: (1) As the landmark Eastridge et al. 2012 study convincingly documented, most combat fatalities occur in the prehospital phase of care, so research efforts that enable Combat medics, corpsmen, and PJs to care for their casualties more effectively will convey the highest probability of further reducing the case fatality rate and preventable deaths among US Combat casualties; and (2) inasmuch as the mission of the CoTCCC is to update the TCCC Guidelines as needed, this group has excellent visibility of the most important current research questions in battlefield trauma care.

Practice parameter on disaster preparedness

This Practice Parameter identifies best approaches to the assessment and management of children and adolescents across all phases of a disaster. Delivered within a disaster system of care, many interventions are appropriate for implementation in the weeks and months after a disaster. These include psychological first aid, family outreach, psychoeducation, social support, screening, and anxiety reduction techniques. The clinician should assess and monitor risk and protective factors across all phases of a disaster. Schools are a natural site for conducting assessments and delivering services to children. Multimodal approaches using social support, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions.

Improving First Aid Management of Epilepsy by Trainee Teachers of the Federal College of Education (Technical), Akoka - Lagos, South West Nigeria--Can Health Education have an Effect?

BACKGROUND

lt is estimated that epilepsy affects approximately 50 million people worldwide and about 40 million of them live in developing countries. Studies have indicated high rates of poor knowledge, negative attitude and poor first aid management skills of students with epilepsy among practicing teachers. However, there is paucity of such studies on trainee teachers to ascertain any similarities or differences (if any) and the effect of educational interventions.

OBJECTIVE

To determine the effect of a health education intervention on trainee teachers' knowledge, attitude and first aid management of epilepsy.

METHODS

The effect of a health education intervention in first aid management of epilepsy was assessed among 226 trainee teachers, attending the Federal College of Education (Technical), Akoka. This was done using a quasi-experimental study design. Data were analyzed using the SPSS version 15.

RESULTS

The respondents had a median age of 22 years with a range of 18 to 56 years. The majority of them were females (68.6%), single (79.2%), Christians (81.9%), Yoruba (70.4%) and in first year (100 level) of their study (69.9%). The highest proportion was from the Accounting department (46.0%). A consistent increase in responses to items on knowledge, attitude and first aid management of epileptic seizure items from baseline to post-intervention was observed. For instance, the proportion of responses that epileptic seizures originate from the brain significantly (p = 0.025) increased from 62.5% at baseline to 74.1% after intervention. Generally, slightly more than two-fifths (44.2%) and about two thirds (61.9%) of the respondents were observed to have poor knowledge and negative attitude to epilepsy respectively at baseline. Overall, giving health education on epilepsy led to a reduction in the proportion of respondents with poor knowledge by 15.5% (increase of good knowledge by 29.6%), decrease of negative attitude by 16.4% and increase of good first aid management skill by 25.0%. The knowledge scores were significantly associated with age (p = 0.001), marital status (p = 0.003) and department (p = 0.004) while the attitude scores were significantly associated with teaching duration (p = 0.020). The knowledge was predicted by department (p = 0.001) while the attitude was predicted by teaching duration (p = 0.036).

CONCLUSION

This study reveals that health education could improve the knowledge, attitude. and first aid management of students with epilepsy among trainee teachers. It is therefore proposed that an intervention programme on baseline knowledge of epilepsy and its first aid management be incorporated into the teacher-training curriculum, particularly those in health-related programmes, to address their deficiencies in knowledge, attitude and first aid management of students with epilepsy.

[The medical social aspects of ambulatory medical care to victims of road traffic accidents]

The article discusses the issues of the organization of medical care to victims of road traffic accidents. The analysis of primary appealability of patients to the first-aid center of Stavropol and Novorossiysk during 2008-2010 is presented. The sampling consisted of 904 cases of this kind of trauma. It is established that among victims of road traffic accident appealed to first-aid centers the pedestrians consist the major part. The traumas of limbs are among the most frequently occurred cases. The victims with cranio-cerebral injuries are among those who appealed most frequently for medical aid. Besides that in most cases (63.4%) the victims with cranio-cerebral injuries were transported not to the neurologic surgery clinic but to the first-aid center This action increased the number of transport stages and duration of time gap before specialized medical care was applied. The conclusion is made concerning the need of further development of out-patient urgent medical care to victims of road traffic accidents.

[Use of modern first-aid kits in the Armed Forces of the Russian Federation]

Taken to supply of the Armed Forces of the Russian Federation, individual and group first aid kits include a range of innovative pharmaceuticals and medical devices, which ensures effective implementation of measures of first aid to servicemen injured and wounded in the performance of combat training missions, the conduct of hostilities with conventional weapons and weapons of mass destruction, as well as the occurrence of natural and man-made disasters (catastrophes).

[About the creation of a unified system of first aid in the Russian Federation]

The current status of first aid in the Russian Federation is covered. The necessity and the basic principles o first aid in the country are formulated, the need for the creation of which is due to the involvement of first aid to victims wide range of people, including and without health education. The necessity of developing and adopting the number of regulations to administrate various aspects of first aid, changes in existing regulations, as well as the establishment and functioning of the interagency coordinating council on first aid. The principles of operation of the system of training of participants in first aid, equipping them with the means to administer first aid are suggested.

Safe Motherhood Program Evaluation: Theory and Practice

Debate on the evaluation of safe motherhood programs has mainly focused on the outcome or process measure to be used. Less attention is paid to the application of different approaches to evaluation. This article reviews current theories of evaluation and provides examples of the extent to which these theories have been applied in the actual practice of evaluation. Most evaluations use multiple methods and approaches, but the rationale and intention behind these choices are often not made explicit. Factors are identified that need to be taken into consideration when planning and conducting safe motherhood program evaluations. Safe motherhood programs are complex interventions, requiring evaluation by different theoretical approaches and multiple methods. Awareness of these approaches will allow health professionals to plan for evaluation and to use evaluation findings more effectively. If cognizant of the different approaches to evaluation, evaluation frameworks can be developed to improve assessment of the effectiveness of these programs.

[Cardiopulmonary resuscitation in pregnancy--European Resuscitation Council guidelines]

Cardio-pulmonary resuscitation is a life-saving technique that should be familiar to all people, even those without medical education. There are two basic life-saving levels: BLS (Basic Life Support) and ALS (Advanced Life Support). ALS a medical procedure that is restricted to medical practitioners. Cessation of circulation may happen to anyone. Cardiac arrest in case of pregnant women is a very specific state. The cause of life-threatening states during pregnancy can be connected with new infections, exacerbation of chronic diseases, as well as changes connected with the pregnancy itself. In those situations, due to physiological and anatomical changes which occur during pregnancy some modifications in the procedure of resuscitation are necessary

Venomous snakebite in mountainous terrain: prevention and management

The prevention and management of venomous snakebite in the world's mountains present unique challenges. This paper presents a series of practical, clinically sound recommendations for management of venomous snakebite in a mountain environment. The authors performed an extensive review of current literature using search engines and manual searches. They then fused the abundant knowledge of snakebite with the realities of remote first aid and mountain rescue to develop recommendations. A summary is provided of the world's most troublesome mountain snakes and the mechanisms of toxicity from their bites. Preventive measures are described. Expected symptoms and signs are reviewed in lay and medical terms. A review of currently recommended first-aid measures and advanced medical management for physicians, paramedics, and other clinicians is included. Venomous snakebites in mountainous environments present unique challenges for management. This paper offers practical recommendations for managing such cases and summarizes the approach to first aid and advanced management in 2 algorithms.

Snake antivenom product guidelines in India: "the devil is in the details"

Venomous snakebite continues to exact a tremendous toll in human suffering and mortality in India. Contributing to this problem is the fact that all of the current Indian snake antivenom manufacturers include a great deal of misinformation in the package inserts and guidelines that accompany their products. Examples include erroneous recommendations regarding first aid, misleading information regarding the signs and symptoms to be anticipated after Indian snakebite, and misleading and ambiguous recommendations as to initial dosing and repeat dosing of antivenom. In addition, the significant problem of acute adverse reactions to Indian antivenoms is compounded by a lack of appropriate recommendations regarding prevention, diagnosis, and management of such reactions. It is the intent of this article to point out problems with the current Indian antivenom product guidelines and to encourage these manufacturers to produce new literature to accompany their products based on the best available evidence.

Assessment of cooling on an acute scald burn injury in a porcine model

The current Australian and New Zealand Burn Association (ANZBA) recommended Burns First Aid Treatment is place the burn under cool running water for 20 minutes. Wet towels and water spray also have been used frequently. No scientific data exist to compare the effectiveness of these methods of cooling. This study sought to determine experimental evidence for current Burns First Aid Treatment recommendations and the optimal mode of cooling. Four partial-thickness scald burn injuries were induced in 10 piglets each. First aid was then applied for 20 minutes via cool running water, wet towels, or water spray, with no treatment as a control. At day 1 and day 9, biopsies and clinical photographs were assessed in a blinded manner. The control group showed worsening or no change of depth over the course of 9 days. The outcomes with wet towels and water spray were variable. Cool running water consistently demonstrated improvement in wound recovery over the course of 9 days (P < .05). This study demonstrated that cool running water appeared the most effective first aid for an acute scald burn wound in a porcine model compared with wet towels and water spray.

[Again new resuscitation guidelines (2006): justification, costs and potential confusion]

The last revision of the Dutch resuscitation guidelines, a translation of the European Resuscitation Council Guidelines 2005, is based on the recommendations of the International Liaison Committee on Resuscitation (ILCOR). The previous Dutch guidelines were issued in 2002. Most changes are based on laboratory studies and retrospective analyses. The most important changes are: recognizing circulatory arrest on unresponsiveness and abnormal breathing; a new ratio of chest compressions to ventilations i.e. 30:2 instead of 15:2; and following the procedure of checking the airway (A), taking over the circulation (C) and breathing (B). Furthermore in the event of ventricular fibrillation or ventricular tachycardia with no pulsations then one defibrillator shock only is to be given; this is in contrast with the previous application of cycles of 3 shocks. The work and costs of implementation involved in the revision of resuscitation guidelines are tremendous, especially in view of the huge number of laypersons who need to be retrained. Also, frequent changes of guidelines may cause confusion and have a negative effect on the quality of resuscitation. Therefore, it is not evident that the benefits of this revision justify its costs. It would be good to prospectively evaluate the effectiveness and costs of this revision. In the future, these data might help to decide when altered international recommendations should be translated into new Dutch resuscitation guidelines. Alternative strategies should be considered, for example only changing the guidelines for advanced life support.

Significant improvement of the quality of bystander first aid using an expert system with a mobile multimedia device

OBJECTIVE

Better quality bystander first-aid could improve outcome rates for emergency victims significantly. In this case-control study, we hypothesised that expert knowledge presented step-by-step to untrained helpers using a personal digital assistant (PDA), would improve the quality of bystanders basic life support.

METHOD

We confronted 101 lay-helpers with two standard emergency situations. (1) An unconscious trauma victim with severe bleeding. (2) Cardiopulmonary resuscitation (CPR). Performance was assessed using an Objective Structured Clinical Examination (OSCE). One group was supported by a PDA providing visual and audio instructions, whereas the control group acted only with their current knowledge. The expert system was programmed in HTML-code and displayed on the PDA's Internet browser.

RESULTS

The maximum score obtainable was 24 points corresponding to optimal treatment. The control group without the PDA reached 14.8+/-3.5 (mean value+/-standard deviation), whereas the PDA supported group scored significantly higher (21.9+/-2.7, p<0.01). The difference in performance was measurable in all criteria tested and particularly notable in the items: placing in recovery position, airway management and quality of CPR.

CONCLUSION

The PDA based expert system increased the performance of untrained helpers supplying emergency care significantly. Since Internet compatible mobile devices have become widely available, a significant quality improvement in bystander first-aid seems possible.