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Background: Management errors during pre-hospital care, triage process and resuscitation have been widely reported as the major source of preventable and potentially preventable deaths in multiple trauma patients. Common tools for defining whether it is a preventable, potentially preventable or non-preventable death include the Advanced Trauma Life Support (ATLS®) clinical guideline, the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS). Therefore, these surrogated scores were utilized in reviewing the study's trauma services. Methods: Trauma data were prospectively collected and retrospectively reviewed from January 1, 2018, to December 31, 2018. All cases of trauma death were discussed and audited by the Hospital Trauma Committee on a regular basis. Standardized form was used to document the patient's management flow and details in every case during the meeting, and the final verdict (whether death was preventable or not) was agreed and signed by every member of the team. The reasons for the death of the patients were further classified into severe injuries, inappropriate/delayed examination, inappropriate/delayed treatment, wrong decision, insufficient supervision/guidance or lack of appropriate guidance. Results: A total of 1913 trauma patients were admitted during the study period, 82 of whom were identified as major trauma (either ISS > 15 or trauma team was activated). Among the 82 patients with major trauma, eight were trauma-related deaths, one of which was considered a preventable death and the other 7 were considered unpreventable. The decision from the hospital's performance improvement and patient safety program indicates that for every trauma patient, basic life support principles must be followed in the course of primary investigations for bedside trauma series X-ray (chest and pelvis) and FAST scan in the resuscitation room by a person who meets the criteria for trauma team activation recommended by ATLS®. Conclusion: Mechanisms to rectify errors in the management of multiple trauma patients are essential for improving the quality of trauma care. Regular auditing in the trauma service is one of the most important parts of performance improvement and patient safety program, and it should be well established by every major trauma center in Mainland China. It can enhance the trauma management processes, decision-making skills and practical skills, thereby continuously improving quality and reducing mortality of this group of patients. [ABSTRACT FROM AUTHOR]

The sequential extraction method was used to determine the fraction of arsenic (As) in different-sized particulate matters (PMs) (i.e., PM2.5, PM10, and total suspended particles (TSP)). Samples were collected from Baoding, a typical medium-sized city with the serious haze pollution in China. The bioavailabilities of As in the samples were estimated based on the fraction results. A large percentage of fine particles were detected in TSP, with the average PM2.5/PM10 and PM10/TSP ratios all above 0.69. The total concentrations of As in PM2.5, PM10, and TSP samples were in the range of 4.5–296.4, 14.1–708.0, and 32.8–798.0 ng m−3, respectively. The mass percentages of As in PM2.5, PM2.5–10, and PM10–100 were calculated; the results indicated that As tended to concentrate in fine particles. PM-bound As mainly presented in the nonspecifically sorbed fraction (F1) during all of the sampling periods. The percentages of F1-As and bioavailability of As were higher in PM2.5, followed by PM10 and TSP. By contrast, the residual fraction (F5-As) contents declined in the order of TSP > PM10 > PM2.5. Significant differences in the speciation and bioavailability of As in different-sized PMs were found, and the influence of particle size on the speciation and bioavailability of As in PMs was verified. Fine particles adsorbed more As with higher bioavailability, and potentially led to more serious adverse effects on human health than the larger ones. [ABSTRACT FROM AUTHOR]